If Functional Reporting were true outcomes reporting physical therapists would need to use risk-adjusted outcomes measures, not paper questionnaires.
Instead of true outcomes reporting, physical therapists are only being assessed on our ability to report patient functional status via the claims system.
The Centers for Medicare and Medicaid (CMS) states in Transmittal 165 that this new system is designed to assess the ability of physical therapists to report patient functional status via claims forms, like the CMS 1500.
A trusted source at the APTA states that Medicare just wants physical therapists to show that we are using functional status measures and that we can predict change.
However, the change scores are not valid indicators of change. And, the functional status scores can't be used as valid indicators of patient function. They can't even be used to compare my outcomes to your outcomes.
According to Jewell (p.154), "These (ordinal scores) are not measured with numbers, but are indicated with modifying words. The absence of a known distance between each level of these scales means that mathematical functions cannot be performed directly with the measure."
Ordinal data, such as reported on the OPTIMAL scale, Oswestry, LEFS, SPADI, ABC, DHI, Berg etc. can't be used to do addition and subtraction, multiplication or division.
However, the new Medicare Severity Scale require physical therapists to convert the raw scale scores to percentage categories corresponding to modifiers that can be appended to the CMS 1500 paper or electronic claim form.
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| Medicare Severity Scale for G-code Modifiers |
Not the case, says my trusted source. "Don't get caught up in the math," he said, "The numbers aren't important", he implied.
"Functional Reporting is here to stay but you're not measuring true outcomes and you shouldn't expect this data to be used to improve the reimbursement situation for physical therapists."
Like I said, this is only a test.
Logging you in...
@SnippetPhysTher · 635 weeks ago
One of the few I am aware of that holds promise in being reasonable in determining functional limitation, having science assisting in determining projected goal and crosswalking is FOTO.
We are in a crap load of a mess because CMS has no clue what the heck they are requesting AND our colleagues are focusing on compliance vs knowing and understanding the tools and using them appropriately.
Tim_Richardson 60p · 635 weeks ago
Can you explain "crosswalking"? You've mentioned it a couple of times and I think you mean how the G-code categories (such as Mobility: Walking and Moving
Around) link up to individual item scores (such as a TUG score).
Is that correct?
Thanks,
Tim
@SnippetPhysTher · 635 weeks ago
A TUG score has a cut off for when a patient is at risk of falls. Being a risk of falls does not correlate into some level of functional limitation.
The Berg has a score... there is a cut off score for falls. The Berg score has nothing to do with functional limitation.
The LEFS is just a score... it doesn't have a definition for percent functional limitation.
Do you see a pattern here? Quite a few of the tools we have to assess a patient whether via functional performance OR self-report were not created to define a specific level of functional limitation.
We are being asked to use some of the tools inappropriately to meet some "compliance" standard.
IF we decide to use "professional judgment" in determining the functional limitation, we are still screwed. How exactly do I know if a person has a 26% functional limitation or a 32% functional limitation via my professional opinion? And, how exactly do I document how I arrived at that functional limitation so I am consistently evaluating the patient and the hopefully changing amount of functional limitation?
No scientific study would ever allow what is being proposed. There is no validity or reliability in determining functional limitation for most of those tools. And... in my opinion, our documentation is also a legal document. If we are knowingly interpreting tools inappropriately, exactly where do we stand from a legal perspective?
I believe we need to make sure we truly ARE using the right tool to provide the required information. In my mind, this is so much bigger than some compliance issue.
We also need to be careful. That data IS going to be used to determine some alternative payment system. The data shouldn't be grouped. AND... we're providing garbage information as a whole due to lack of consistency in reporting. That lack of consistency is going to screw us over... just my opinion.