Home Health & Hospice Week

CMS wants providers to use the outcomes tools and may require them soon.

It doesn't have to be expensive to get up to speed with Medicare's new outcome recommendations for Part B therapy.
 Last week's Eli's Home Care Week looked at two of the four therapy outcomes tools the Centers for Medicare & Medicaid Services recommended for Part B therapy providers in its Dec. 29, 2006 Transmittal No. 63 (see Eli's HCW, Vol. XVI, No. 14). This week, check out two more tools, which are available for free.

SLPs Can't Go Wrong with NOMs

Who it's for: The American Speech-Language Hearing Association's National Outcomes Measuring System is a tool designed specifically for speech-language pathologists across the continuum of care.

How it works: Unlike Focus on Therapeutic Outcomes Inc.'s FOTO Patient Inquiry reviewed last week, which takes the patient's perspective, NOMS is for a clinician to complete. "This is largely due to the cognitive nature of speech-language disorders," explains Tobi Frymark, associate director of ASHA's National Center of Evidence-Based Practice. "NOMS uses a series of seven-point rating scales known as 'functional communication measures' in the most common areas that SLPs treat adults," Frymark continues.

NOMS also lets you compare your cases to its national database. The clinician completes the tool at admission and again at discharge, including demographics and information such as frequency and intensity of services, and then submits the data to ASHA's national registry, Frymark explains.

The database is well established too, dating back to 1998. "Currently, 1,400 facilities participate, and that includes 2,500 registered NOMS users," Frymark says.

Extra: NOMS has the bigwigs' endorsement. "A June 2006 [Medicare Payment Advisory Commission] report and a July 2006 report contracted by CMS both noted that NOMS was the only outcomes tool capable of assessing patients with severe speech, swallowing, cognitive and communication disorders," Fry-mark says. "Some SLPs still use FOTO, but MedPAC recognizes that a patient self-assessment tool is not an appropriate way to go for patients who have decreased comprehension or impaired ability to communicate."

Cost: If you're an ASHA member, the tool is included under your member benefits. You can find out more about NOMS online at www.asha.org/members/ research/NOMS/default.htm.

Factor In A Confidence Scale With OPTIMAL

Who it's for: Promoted by the American Physical Therapy Association, APTA's Outpatient Physical Therapy Improvement in Movement Assessment Log is designed specifically for physical therapists.

How it works: OPTIMAL is a patient questionnaire that measures performance of 21 different physical movements, such as squatting or reaching. One differentiator of OPTIMAL is that it measures these 21 activities on two scales: difficulty and self-confidence, says Marc Goldstein, APTA's director of research services. "Knowing someone's confidence is important because even if the patient is able to do a certain movement, if he doesn't have the confidence, he's not going to make the attempt," he explains.

Extra: OPTIMAL asks an additional question at the end for the patient to choose three items that they would most like to do without any difficulty. "That makes OPTIMAL a clinically relevant outcomes measurement tool--the therapist can then get more information from the patient on difficulties with those particular activities," Goldstein says.

Cost: "Clinicians, educators and researchers can receive permission to use OPTIMAL for free," according to the APTA Web site. You can also obtain OPTIMAL for commercial use under certain licensing requirements. Go to www.apta.org for more information. If you're interested in database and benchmarking capabilities, you will find those through a separate product called APTA Connect, a paid product that includes OPTIMAL; however, OPTIMAL as a standalone product is free, Goldstein clarifies. 

Note: For information on outpatient therapy, see Eli's Rehab Report at www.elihealthcare.com/spec_rehab_report.htm or by calling 1-800-874-9180.