Home Health & Hospice

Insider’s Scoop | Make Therapy Goals Measurable

Homecare Insider, October 5, 2015

Editor’s note: This week’s The Inside Story was adapted from one of HCPro’s most popular home health titles, The How-to Guide to Home Health Therapy Documentation, written by  Cindy Krafft, PT, MS. The complete volume provides all of the information, forms, and tools that a home health agency needs to ensure it has an effective therapy documentation for proper reimbursement. For more information or to order, call customer service at 800-650-6787 or visit www.hcmarketplace.com.

Well-written goals correlate to assessment findings. The “measurement” component begins with consistent data collection and the incorporation of relevant standardized tests as indicated. The presence of a deficit in strength, range of motion, or cognition does not necessitate skilled therapy interventions or always translate into the potential to improve. Factors such as the length of time the patient has had the deficit and his or her willingness to work on improving the deficit are but two components of what is referred to as “rehabilitation potential” and must be taken into consideration when developing therapy goals. Goals must contain a measurement to reflect the impact of treatment on specific aspects of the skills and abilities of each unique patient.

Periodic rumors arise surrounding the use of measurements, such as gait distances in physical therapy goals, of which the most common is that setting a target of greater than 150 feet will lead to a denial of payment. There is nothing currently in the regulations resembling a list of specific distances that put a record at risk. Envision a conference room at the Medicare office building in Maryland. The person leading the meeting is addressing an agenda item regarding concerns about overutilization of physical therapy in home health. After some debate, the group decides that 149 feet of ambulation is acceptable and so is 150 feet, but if the distance goes to 151 feet or more, an automatic denial will be given. Logically, this scenario does not make sense. Issues regarding gait distance being perceived as too high have never been about the measurement in isolation, but rather the fact that for too many, gait-related goals rely on a higher distance than was possible at the assessment visit without a relevant functional context.