Are you writing functional therapy goals? I guess I better take that a step back and ask if you are accurately writing functional therapy goals for a Medicare Plan of Care. Required elements of the Medicare Plan of care include 1) Diagnoses; 2) Long term treatment goals, and 3) Type, amount, duration and frequency of therapy services.
According to the Medicare documentation requirements detailed in the Medicare Benefits Policy Manual, Chapter 15, Section 220.1.2 (B)
Goals should be measurable and pertain to identified functional impairments. When episodes in the setting are short, measurable goals may not be achievable; documentation should state the clinical reasons progress cannot be shown. The functional impairments identified and expressed in the long term treatment goals must be consistent with those used in the claims-based functional reporting, using non-payable G-codes and severity modifiers, for services furnished on or after January 1, 2013.
Medicare also describes other elements as optional, but considered good practice: short term goals, goals and duration for the current episode of care, specific treatment interventions, procedures, modalities or techniques and the amount of each. Short term goals are good bridges to long term outcome goals, and help guide progress, particularly as impairment goals wherein objective tests and measurements related to strength, range of motion and endurance are concerned. However, increased strength is not a functional outcome goals, nor is increased range of motion. However to get to a functional outcome, it is necessary to progress through the impairments preventing function.
Tips for writing functional therapy goals
Let’s take a look at writing functional therapy goals. You are working with a patient that has had a total knee replacement, and you are following a protocol for progressing the patient through a post-knee therapy program, but have you defined what the functional outcome is (remember this has to tie in to functional limitation reporting)? A good place to start is the patient’s prior level of function. For example, “patient could previously go from stand to sit and sit to stand when using a normal commode in their home”. The current level of function as this patient presents for post-knee replacement therapy at your clinic might look like this: “Currently able to go from stand to sit with max assistance, and unable to go from sit to stand without use of seat raiser and max assist”. Are you beginning to get the picture? Short term goals are likely to address range of motion and weight bearing, in other words, these are incremental impairment goals that when achieved will assist in the patient achieving the long term functional outcome goal of “Ability to go from stand to sit and sit to stand in order to use the commode”. The function is sit to stand and stand to sit, and the outcome is the ability to simply “use the commode”.
There are plenty of other activities to select that represent a functional outcome – very often I see “ability to stand at the kitchen counter to prepare a light meal”, or “ability to ascend and descend 5 steps at the entrance of the home”. These outcomes are functional. There are plenty of functional activities that a patient will want to achieve following therapy – better golf swing, bend down to do gardening, get up from Lazy-Boy recliner, and so forth. But let’s face it, there is nothing like the ability to use the commode to help describe the medical necessity of therapy. Amen.