October 17-23, 2021, is Healthcare Quality Week! So, of course, this week has us all thinking all about healthcare quality measures, value-based care, and how we can improve patient experience in healthcare.
Wait… you weren’t thinking about that? Just me? Well… I can’t say I’m surprised but let’s dive into why I think we all need to pay closer attention to value-based care and quality outcomes in occupational therapy.
As you read this article, I encourage you to consider these questions and return to them at the end.
- How is occupational therapy (OT) utilized in reporting outcome measures?
- How can OT play a larger role in improving the outcomes listed and others?
- Is OTutilized early enough in the plan of care to impact quality reporting (usually the first 3-5 days of care episode)
- Are OT electronic medical records (EMR) optimized for quality outcome reporting?
- Is therapy using the same EMR as physicians and nursing?
- Do EMR questions need to be changed to better align with quality measures?
- Is Section GG scoring and/or OASIS M1800s included in OT evaluation, reassess, and discharge documentation?
- How can the knowledge of occupational therapy practitioners be utilized to train other clinicians on accurate assessment of function and self-care?
Some Background: What Are Healthcare Quality Measures?
The Centers for Medicare & Medicaid Services (CMS) has been using quality measures for several years to track patient outcomes. It has come in different forms, such as value-based purchasing, the Quality Reporting Program, star ratings, and measures endorsed by the National Quality Forum (NQF). CMS describes quality measures as
“…tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for healthcare.
These goals include: effective, safe, efficient, patient-centered, equitable, and timely care.”
(CMS, 2020)
Healthcare quality measures collect outcomes in hospitals and all post-acute care settings. These outcomes are publically reported through provider-submitted data as well as Medicare claims.
Common Quality Measures In Post-Acute Care
The most common quality measure occupational therapy practitioners are aware of is most likely Section GG. The IMPACT Act directed CMS to develop a standardized measure in post-acute care, which ultimately led to Section GG. Long-term care hospitals (LTCH), inpatient rehabilitation facilities (IRF), skilled nursing facilities (SNF), and home health (HH) all utilize this measure.
Accurate scoring of Section GG is crucial for quality outcomes and accurate reimbursement in most post-acute settings. Occupational therapy practitioners are experts in self-care. So, wouldn’t OTs be the most natural fit for scoring Section GG?
The OASIS M1800s are used to assess function under PDGM in home health. M1800 data is also used for outcome measure reporting. So, again, it makes sense to use the clinicians who are experts in function to assist with scoring these measures. For more info on OT’s role in the OASIS, check out this article.
NQF Endorsed Measures
The National Quality Forum (NQF) is a not-for-profit organization that aims to improve healthcare quality outcomes by producing evidence-based measures. CMS frequently implements these measures as well as their own to track outcomes across the care continuum. I have listed some of the NQF measures below that I found in my research that I felt mainly applied to OT:
- Change in Self-Care Score NQF #2633
- Change in Mobility Score NQF #2634
- Discharge Self-Care Score NQF #2635
- Discharge Mobility Score NQF #2636
- 30 Day Readmission Measure NQF #2510
- One or more Falls with Major Injury NQF #0674
- Patients with an admission and discharge functional assessment and a care plan that address function NQF #2631
AOTA Resources
AOTA has a variety of resources available to practitioners to assist them in tracking their outcomes. www.aota.org/value is the best place to look to find these resources. If occupational therapy practitioners can demonstrate how they provide high-value care through outcome measures, it is easier to convince management to expand their occupational therapy department. Thus, creating more jobs and opportunities for the OT profession. If you have any questions, AOTA’s quality team can also be reached at quality@aota.org.
Outpatient Quality Metics
In outpatient settings, the primary way we see quality measured is through MIPS. MIPS is the Merit-Based Incentive Payment System that provides adjusted reimbursement based on quality outcomes. However, not all practitioners and clinics are required to report to MIPS. However, if your clinic doesn’t yet have to report to MIPS, it is still a good idea to review the measures as it seems to expand each year. MIPS is another area where occupational therapy practitioner can demonstrate their impact through scores such as functional outcome assessments, medication management, cognition, depression screens, fall safety, etc.
It is never too early to start implementing strategies to track outcome measures in your setting. Additionally, having objective data to demonstrate why your clinic is the best is always a good PR move.
How Quality Metrics Should Impact Practice
Overall, Section GG and quality metrics do not replace a comprehensive occupational therapy evaluation. Occupational therapists should continue to utilize their clinical judgment when evaluating each patient, plan of care development, goal setting, and assessment selection. However, I would encourage occupational therapy practitioners to keep these outcome measures in mind as they complete and document their evaluation.
Having an open conversation with management about these outcomes shows that practitioners are paying attention. It also opens a conversation about how occupational therapy practitioners impact patients and how appropriate utilization of OT can impact reimbursement from Medicare.
Remember those questions I listed above? Here they are again.
- How is occupational therapy (OT) utilized in reporting outcome measures?
- How can OT play a larger role in improving the outcomes listed and others?
- Is OTutilized early enough in the plan of care to impact quality reporting (usually the first 3-5 days of care episode)
- Are OT electronic medical records (EMR) optimized for quality outcome reporting?
- Are they using the same EMR as physicians and nursing?
- Does the wording of EMR questions need to be changed to better align with quality measures?
- Is Section GG scoring and/or OASIS M1800s included in OT evaluation, reassess, and discharge documentation?
- How can the knowledge of occupational therapy practitioners be utilized to train other clinicians on accurate assessment of function and self-care?
There are many opportunities to include occupational therapy in improving patient outcomes and quality reporting in each setting. Although we know occupational therapy is a crucial part of the care team, does the way your setting collects and reports data reflect that?
