Abstract
This study explored perspectives of OTs at a skilled-nursing facility regarding the use of standardized assessments during patient evaluation. Study results revealed that clinical observations are the chosen method of evaluation to support billing procedures using new CPT codes. Participants indicated that despite the value of objective measurements, they cannot ignore the pressures of time and productivity.
Primary Author and Speaker: Callie Victor
Additional Authors and Speakers: Susan Krutis
Contributing Authors: Erica Chandler, Beth Chang, Whitney Cherry, Paige Doughty, Danielle Hubka, Kaitlin Murphy, Zach Zepf
Increased productivity demands and lack of practical, standardized instruments result in inconsistent use of occupational therapist chosen standardized assessments during initial patient evaluations. Accordingly, in skilled nursing facilities (SNF) occupational therapists use non-standardized and setting specific standardized assessments during their initial evaluations to determine Current Procedural Terminology (CPT) complexity codes (Kroll & Fisher, 2017). Use of non-standardized assessments contributes to inconsistency and overly subjective application of criteria to accurately capture billing complexity codes. In addition, the use of setting specific standardized assessments may not accurately represent functional performances or improvements (Kroll & Fisher, 2017) and although not intended, may replace the use of occupational therapist chosen standardized assessments completed during evaluations (Sandhu, Furniss, & Metzler, 2018).
The purpose of this research was to describe perspectives of occupational therapists regarding the use of standardized assessments to distinguish CPT complexity codes in a SNF. There is little published research on occupational therapists’ strategies when determining a client’s complexity level for billing since the 2017 CMS codes. The proposed research questions were as follows: What factors do occupational therapists consider when choosing assessment methods to determine CPT complexity codes? What are the perceptions of occupational therapists about the use of standardized assessments to assist in determining CPT complexity codes? How does the method of evaluation support occupational therapists' selection of patient levels of complexity for billing procedures?
The study was a mixed methods case study, integrating quantitative and qualitative data from a survey and interview. Seven occupational therapists in a private, 100-bed not-for-profit SNF made up the sample. Descriptive statistics and polling of the participants were obtained from an online survey following informed consent. Participants then completed interviews via video conferencing. The recorded interviews were analyzed, transcribed, labeled, and coded until themes emerged.
The survey responses showed a range of experience both as an occupational therapist (4.5-22 years) and working at that facility (1-17 years). All participants chose to use non-standardized assessment methods, rather than standardized, to help distinguish the most appropriate CPT complexity code for initial evaluation. There were two main themes that emerged from the interviews. One theme, ‘The Pressure Cooker of Productivity’, encompasses participant statements about their experience working with the time constraints, productivity standards, and requirements of Medicare as a main insurance payer in the SNF. Another theme, ‘Clinical Observations are a Practical, Multi-purpose Tool’, characterizes the participants' views on the feasibility of using standardized assessments as evaluation tools for clients in the SNF.
Clinical observations, rather than standardized assessments, were described as the most flexible and comprehensive approach to capture necessary information about a patient’s performance and context. Using new CPT codes did not seem to change participant views about methods of assessment, but added another layer to an already complex set of processes. Although participants valued the idea of standardized assessments to capture empirical data regarding their patients, the barriers to initiate and see this through were overwhelming. This study invites us to consider whether use of standardized assessments during initial evaluations is too lofty a goal in light of productivity pressures for occupational therapists.
Kroll. C., & Fisher, T. (2017). Justifying rehabilitation intensity through functional performance measures in postacute care. American Journal of Occupational Therapy, 72 (1), 1-6. doi:10.5014/ajot.2018.721002
Sandhu, S., Furniss, J., & Metzler, C. (2018). Using the new postacute care quality measures to demonstrate the value of occupational therapy. American Journal of Occupational Therapy, 72 (2), 1-6. doi.org/10.5014/ajot.2018.722002