Surveyor Notes: Goals and Outcomes

By David W. Edwards, CPO, FAAOP, Senior Surveyor

The ABC Standards PC.4 and PC.5 come directly from the DMEPOS Quality Standards to establish goals and expected outcomes related to the beneficiary’s use of a provided item or service. Such goals and outcomes could include reducing pain, increasing comfort, enhancing function and independence, providing joint stability, preventing deformity, increasing range of motion, addressing cosmetic issues and/or promoting healing. Feedback from the beneficiary and/or prescribing physician will help you determine the appropriateness of an orthoses/prostheses.

As good clinicians we are gathering as much information as possible during our clinical assessment and allowing the patient to be part of the treatment plan. While this information is important in helping us determine which item and componentry to use in treating the patient, what becomes more important is understanding how to meet the patient’s specific goals. A patient’s goals may include walking the dog, gardening, playing golf and playing with the grandchildren. But, if a patient states that they’d like to run a marathon and they’ve never run a race before, they may be disappointed with the outcome of their treatment if their goals aren’t realistic. Make sure you discuss and document all realistic attainable goals not just the clinical goal of the device or item.

There are many different ways to collect data that helps you document patient goals and outcomes. Perhaps that data could come from your clinical notes during a fitting or follow-up visit, notes from a follow-up phone call or the results of a 60 or 90 day patient satisfaction survey. You could also request a physician’s note after the patient has been treated.

What does this collection of data do for us? By collecting the data and identifying where there may be gaps in meeting goals, we can justify changes in the componentry and treatment plan. Over time, we can see how successful we are individually and as a practice in establishing and meeting goals and outcomes. This proves to payers the validity of our reimbursement claims and is a reminder to the patient of the benefits in meeting the goals they expressed in the initial evaluation. These successes are also a great marketing tool. Meeting goals and having consistently positive outcomes can set you apart from your competition in the eyes of your patients and referral sources.

These standards are the foundation for establishing good outcomes for the patient. By documenting the patient’s specific goals and outcomes and whether we are meeting those goals, we come full circle in supporting the need and justification of the items provided. Keep in mind that the patient may not be able to meet their goal or expected outcome 100% of the time due illness or other issues that arise, but it’s important to document the improvement they have been able to make. We all strive to achieve the best outcomes and establishing, documenting and communicating both a patient’s personal and clinical goals will keep us on track for success.