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Is What You’re Doing Working? How Do You Know?

Shannon Scott, OTR/L
Thursday, April 25th, 2013


As many of you are already aware, those billing to Medicare for therapy coverage now have to report functional outcome data for clients in the form of new non-payable G codes. The G codes are designed to capture the primary issue for which therapy is being provided for. This includes issues such as mobility, changing/maintaining body position, carrying/moving/handling objects, and self-care to name a few. G codes are accompanied by modifiers which indicate the client’s area of limitation and are designed to help track functional changes over time which subsequently results in payment information. These codes are required to not only to be included in the claim to Medicare but also in the client’s medical record with an indication of what tools and outcome measures were used to assess functional outcome. Reporting started in January for a trial 6 month period and beginning July 1/13 claims will not be accepted without the required functional data.

The use of reliable and valid outcome measures to capture functional data therefore becomes even more critical to the therapeutic process. Measuring outcomes has always been a critical part of the therapeutic process to determine if the therapy that is being provided is actually resulting in the desired therapeutic outcomes and goals. This helps guide clinical reasoning and judgment as to whether best practice is being provided. This also reinforces the need for clinicians to be aware of the current evidence based practice in their area of specialty and the importance of utilizing evidence based interventions and tools.

So, is what you are doing working? How do you know? What outcome measures and tools are you using? Are they appropriate for the client’s specific needs? Are they reliable and valid? Do they encompass all aspects of function?  What areas of function should be evaluated?

According to the International Classification of Functioning, Disability and Health (ICF) the important domains of function include body functions and structures, activity, and participation within the appropriate context (environment).

For occupational therapists, the Occupational Therapy Practice Framework: Domain & Process, 2nd Edition (AOTA, 2008) helps define the important areas of evaluation which include evaluating performance skills, which includes not only the use of clinical outcome measures, but also actual observation of the client performing functional tasks within the appropriate environmental context. Evaluation should also address client factors and performance patterns.

Since function encompasses many different components, evaluation and determination of functional progress should also include a variety of outcome measures and tools appropriate to assess all aspects of client functioning.

How many clinicians strictly assess clinical outcomes? Has a client ever demonstrated improved function in the clinic but this functional improvement did not seem to transfer to the home environment or community? It is critical to therefore also assess client participation and satisfaction with therapeutic interventions.

In the January/February 2013 issue of the American Journal of Occupational Therapy, Doucet and Gutman further elaborate on the importance of using reliable outcome measures that quantify functional outcomes and that are also aligned with reimbursable services and practice codes.

Doucet and Gutman (2013) provide an example of the following outcome measures for assessing body impairment, activity limitation, and participation for a client with a stroke;

  • The Fugl-Meyer Motor Assessment (FMA)
  • The Functional Test for the Hemiplegic Upper Extremity
  • The Wolf Motor Function Test
  • The Assessment of Motor and Process Skills (AMPS)
  • The Canadian Occupational Performance Measure (COPM)

A review of current research literature will also provide the clinician with further suggested outcome measures which can include;

  • The Action Research Arm Test (ARAT)
  • The Box & Block Test ( BBT)
  • The Barthel Index
  • The Stroke Impact Scale

Included in the SaeboReJoyce, Saebo’s new task oriented computer gaming system, is the SaeboReJoyce Arm and Hand Function Test (SRAHFT) which research has reported has comparable reliability and validity to the ARAT. (Kowalczewski, Ravid, & Prochazka, 2011). This assessment is administered in a 3-5 minute standardized assessment provided through the use of computer auditory and visual directions and results in graphical data that can be easily exported for analysis or documentation. (www.Saebo.com)

More than ever is the importance of substantiating that the services we provide are producing the desired functional outcomes to not only guide us to use effective and evidence based interventions but also to justify continued reimbursement for our services, and more importantly, for maximizing our client’s quality of life.

shannon-scott

Shannon Scott, OTR/L, is the Clinical Assistant Professor at Stony Brook University Southampton. She is a graduate of the University of British Columbia in Vancouver, Canada and is currently pursuing her doctorate in OT through Quinnipiac University. She has over 23 years of clinical experience, specializing in Neurorehabilitation. She is Level One Brain Injury Certified and is NDT trained. Shannon was one of the first 10 therapists trained in the use of Saebo. Prior to teaching at Stony Brook, Shannon was the Director of Clinical Services at Saebo.

References

American Occupational Therapy Association (2008). Occupational therapy practice framework: Domain and Process (2nd ed.). AJOT, 62, 625-683.

Doucet, B., & Gutman, S. (2013). Quantifying function: The rest of the measurement story. AJOT, 67, 7-9.

International Classification of Functioning, Disability and Health. (2001). www.who.int/classifications/icf/en/

Kowalczewski, J., Ravid, E., & Prochazka, A. (2011). Fully-automated test of upper-extremity function. 33rd Annual International Conference of the IEEE EMBS, Boston, MA.

 

 

 

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