Today's post comes from Tom Ambury, PT and compliance officer at PT Compliance Group, based off this month’s “Compliance Chat” blog post.

By now, I hope most of you are using functional outcome measures. If you haven’t started yet, you might want to consider taking the next few weeks to get prepared and begin the process in January of 2013. Why? Let’s start with the fact that physical therapy documentation is coming under greater scrutiny especially regarding demonstrating the medical necessity of the treatments provided. You may have heard me say this before, but physical therapists are paid to treat the impairments identified in the initial evaluation and restore the patient’s ability to function. So, to get paid for the services rendered, medical necessity will depend directly on how much we are able to improve the patient’s ability to function. In 2013, the scrutiny of our documentation will be even greater than this year.

How do we do objectively document improvement in function?

We need to objectively measure function by using specific objective functional outcome measures consistently throughout the episode of care. This means that we will need to administer functional outcome measures at the initial evaluation, re-evaluation/progress report, and discharge.

Early this month, Charlotte talked about the importance of evidence-based practice and listed some tools, like Dartfish, that could help you with consistency, autonomy, and correctness. Here, I tackle another tool: FOTO.

Focus On Therapeutic Outcomes, Inc. (FOTO) is a medical rehabilitation company that has been providing patient evaluation tools and aggregate data management services since 1992. Almost 2,000 clinics across the US and Israel use the FOTO Outcomes Data Collection System today.  

This national benchmark database and reporting service provides outpatient rehabilitation professionals with risk-adjusted national comparisons of treatment effectiveness and efficiency as well as patient satisfaction. It’s the largest and most valid external directory for rehabilitation that measures functional outcomes for orthopedic, neurological, work hardening/work conditioning, pain management, cardiovascular, and pelvic floor dysfunction patients. 

FOTO’s data collection process for measuring outcomes is comprised of three main components:

1. Patient Intake

2. Patient Status

3. Staff Discharge

After the completion of each component, FOTO produces a patient-specific report allowing you to access individual as well as single and multi-practice performance. The system then rolls up this outcome data by care type, impairment, clinician, practice, and organization, and compares it, quarterly and annually, to similar risk-adjusted data from almost 2,000 clinics.

“By measuring our performance against providers all over the country, we can identify our strengths and improve on any areas requiring focus as it relates to functional outcomes and providing an exceptional experience to the patient,” says AthletiCo, a physical and occupational/hand therapy provider in Illinois, Milwaukee, and Northwest Indiana. 

Today's post comes from Ann Wendel, PT, ATC, CMTPT, of Prana Physical Therapy. Thanks, Ann!

Recently, the APTA posted information proposing an Alternative Payment System (APS). The proposed system would have three evaluation codes and nine treatment codes for physical therapists to use. According to the APTA, their goal with APS is to “reform payment for outpatient physical therapy services to improve quality of care, recognize and promote the clinical judgment of the physical therapist, and provide policymakers and payers with an accurate payment system that ensures the integrity of medically necessary services.”

The APTA is proposing to “reform payment for outpatient physical therapy services by transitioning from the current fee-for-service, procedural-based payment system to a per session payment system. APTA believes that a system that categorizes patients based on the severity of their condition and intensity of the interventions required better reflects the professional clinical reasoning/judgment and decision making by the physical therapist, improves provider compliance, reduces administrative burdens surrounding current payment models, and is consistent with and enhances payer recognition of the value of physical therapist-directed care.”

While I believe that all physical therapists would agree that a simpler coding system is desirable (especially if it improves quality of care, promotes the clinical judgment of physical therapists, and enhances payer recognition of the value of physical therapist-directed care), not all physical therapists believe that the APS as proposed is the best system to adopt.