Administering Functional Outcome Measures: Considerations for Maintaining Validity and Efficiency

By: Jennifer Heiligman, PT, MPT

Outcome measures are validated functional scales or surveys used to assess a patient’s functional deficits and impairments with the resulting findings used to establish a treatment plan and goals for therapy leading to better outcomes.  Progress of the patient toward those goals is also measured when the outcome surveys are readministered at intervals throughout the episode of care.  

Use of Functional Outcome Measures has become more prevalent in the rehab therapy industry over the past 10 years.  This is partially due to the advent of value based care which relies heavily on evidence based treatment.  Medicare began this transition back in 2006 when it initiated the Physician Quality Reporting System (PQRS).  This program has since evolved into the Merit-Based Incentive Payment Program (MIPS) and will soon be transformed once again into MIPS Value Pathways (MVPs).  

Regardless of the name change, these programs have one thing in common.  Practitioners receive increased reimbursement when they provide evidence of patient progress and improvement throughout their episode of care.  Functional outcome measures, when administered appropriately, can provide the support needed to prove therapies rendered were medically necessary, appropriate and beneficial.  In addition, if using a registry, like FOTO or PTOR to report outcome measures, this allows the registry to compile and aggregate all the data collected from all of their users.  After risk adjusting the data, the registry is left with valuable information that can be used to benchmark patient outcomes which support evidence based practice for rehab therapy interventions.  This information leads to better care, improved outcomes and can lower costs.

The validity of a functional outcome measure is defined as the extent an outcome measure captures what it is intended to measure.  As the treating therapist when administering outcome measures, you will want to make sure you are selecting the most appropriate and valid test or survey for the specific body region, impairment, or activity level that is being assessed.  Per the APTA Guide to Physical Therapy Practice: “outcome measurements at the level of activity and participation demonstrate the value of physical therapy in helping individuals achieve their identified goals and, therefore, are most meaningful.”   Based on the evidence and research, the correct functional outcome measure will assist you, as the therapist, in creating an appropriate treatment plan to help attain the goals set by you and the patient leading to better outcomes.

Once the standardized outcome measure is selected, it is important to establish a baseline status of the patient. This is accomplished by completing the outcome measure during, or in some cases prior to, the Initial Evaluation.  The results of the tool are then used by the therapist to generate a prognosis that will help predict outcomes.

The outcome tool should be administered at regular intervals during the patient’s episode of care.  This will allow the therapist to see progress being made toward the established goals.  If there is little or no progress, the therapist may then choose to alter the treatment plan in order to promote improvement.  Administering the tool about every 5-6 visits will allow the therapist to see if those predicted outcomes are going to be met.  By completing the measure this often it should allow you to have an updated score on the survey in the event the patient self discharges prior to the expected end of the episode. 

The outcome measure should also be completed as close to the time of discharge as possible. If it is a short episode of care, strive to administer the outcome measure at the time of the initial evaluation, at least once during the episode and at the time of discharge.  These tools are expected to be able to illustrate functional progress that the patient made as a result of the treatments that were rendered.  Showing improvement from the baseline established at the Initial evaluation to the time of discharge helps support medical necessity of your care which could lead to better reimbursement as value based care replaces fee for service.

It is beneficial to make administering the tools as efficient as possible.  The most efficient means of administering the surveys is electronically.  Check with your EMR or registry, if using one, to see if they offer the functionality to electronically send outcome surveys to your patients.  If using OptimisPT, when sent electronically the surveys will automatically be scored and imported into the patient’s electronic medical record.  This eliminates the need for paper copies of the tools and the need to upload it into your EMR.  

Incorporating the process of administering functional outcome measures into your regular workflow improves efficiency and will assist in making sure the tests are administered consistently.  As the therapist, keep track of the visits used and when they reach 5-6 visit increments, have the patient complete an updated survey.  If available, add an alert or pop up within your EMR to remind yourself when that updated outcome measure is due.   By consistently incorporating this process into your daily workflow, administering the surveys will not seem like such a burden, it will become part of your everyday workflow.  

Reviewing the results of the surveys with the patient should also be something that is done consistently.  If the patient is showing progress, this works to motivate them even more when they are able to see how their scores have improved.  On the other hand, if only minimal to no progress is noted, it may help to make the patient realize they need to be more invested in their therapy in order to meet the goals they had established for themselves with the therapist.  If using the OptimumME app, the patient will be able to see a graph of their outcome measure scores over time.  This will visually illustrate even more clearly their success, or lack thereof, with therapy.

Managing functional outcomes are a key component of rehab therapy and are becoming even more important as we move into the realm of value based care.  Using standardized functional outcome measurement tools allows for the valid comparison of therapy interventions and their success.  This data then leads to better clinical practices and helps motivate the patient to continue with their rehab therapy plan of care in order to meet their goals.