Choosing Your Outlook on Functional Limitation Reporting

Unless you’ve gone full-blown ostrich, you’ve heard about Functional Limitation Reporting (FLR)—also known as claims-based outcome reporting (CBOR) and G-code reporting—by now. And if you haven’t, it is absolutely time to get your head out of the sand because FLR is coming quickly. In fact, CMS is making FLR mandatory starting July 1, 2013. And when that happens, Medicare will not reimburse for services if the therapist does not properly report functional limitations via specific G-codes (and corresponding severity modifiers) on the claim form and documentation for each eligible Medicare patient.

Sound intense? Well, luckily, there are several blog posts, a webinar, and an article on Physiospot all readily available to make FLR much more digestible. However, there’s more to FLR than simply digesting, understanding, and come July, doing it. To truly accept it, we must realize its importance—in terms of both positives and challenges.

The Positives
Functional limitation reporting will allow us as therapists to gain a great deal of insight into our patients’ and our peers’ patients’ functional outcomes. Based on treatment type and patient demographics, that data could do wonders for us as individual providers and for us as a profession. We could prove without a doubt that physiotherapy works and discover which techniques work best. FLR and the data that’ll come with it will propel us toward a pay-for-performance reimbursement structure, which is the most ideal way for us to demonstrate patient progress through care. Additionally, FLR will ensure we treat function, not simply objective measures, which will ultimately make us better practitioners.

The Challenges
FLR focuses most heavily on the subjective, or what the patient thinks and feels. This raises the question as to whether this reporting will actually weaken our evidenced-based practice efforts. The rehab therapy profession as a whole has thoroughly researched and thus found many functional outcome measurement tools to be reliable and valid tests. However, they’re still based on the subjective complaints of the patient rather than the objective measures taken by the therapist. This makes it appear as though Medicare cares most about what the patient thinks and feels. In my opinion, this is an accurate stance to take. Unfortunately, though, it doesn’t appear that Medicare truly cares how we achieve patient improvement—just that we get the patient better and fast. Not the most ideal environment for accomplishing true evidence-based practice.

The Future
However apathetic Medicare appears, we can’t let it influence our practice. Yes, we need to comprehend the challenges of FLR, but we can’t let the opportunities hold us back. Let’s focus on the positives. During CSM 2013, I overheard an attendee say: “Functional Limitation Reporting is good. It might be more paperwork [not necessarily true], but it’ll prove our worth.” I’m embracing that outlook as well; we all should. As rehab therapists, we connect with our patients in ways physicians cannot. We positively impact their lives, and in the process, we encourage them to think positive—no matter how difficult things get or how uncertain the future might be. We owe it to our patients and the profession to do the same.

About the Author

Heidi Jannenga, PT, MPT, ATC/L
Heidi was a basketball athlete at the University of California, Davis. Following a knee injury and subsequent successful rehabilitation, Heidi developed a passion for physical therapy. She started her 16-year physical therapy career after graduating with her Masters from the Institute of Physical Therapy in St. Augustine, Florida.

In 2008, Heidi and her husband Brad launched WebPT, the leading web-based Electronic Medical Record (EMR) and comprehensive practice management service for physical therapists. As the company’s COO, Heidi is responsible for product development/management, billing services, and customer support.

She now resides in Phoenix with Brad and their daughter Ava.