Nowadays you need to use more and more objective findings to document a patient’s improvement and response to treatment. A major tool to substantiate a patient’s need for care are objective measurement tools such as Oswestry disability indexes, pain questionnaires, etc. The inherent problem with these assessments is that patient’s do not recall what they previously said and consequently report (verbally) feeling so much better but SCORING much worse on subsequent assessments. Then there are those who think reporting that they are worse will result in MORE authorized treatment when, in fact, the opposite is actually true.
If a patient fails to show improvement, it is determined that the treatment they are receiving is failing and future authorization isn’t warranted. I’ve decided that the best way to handle this is to explain to patient’s how outcome assessments are utilized and let them know that if they fail to show “objective” improvement, more care may not be authorized. Lastly, it becomes almost imperative to give the patient a copy of their LAST assessment so that they can draw their own comparisons between what they last reported and how they currently feel. I wish I could say to the patient, “hey, do you realize you just said you were significantly better but scored much worse than last time?!” but I can’t, then the tool would lose all objectivity. I will tell you, this process is cumbersome. It is difficult on yourself and/or your staff to remember to do all of these steps while greeting patients, entering patient and/or visit information, answering the phones, handling other insurance issues or authorizations such as ASH….but this is all part of the game that we must play. Unfortunately, I don’t see it getting much easier, but worse. We must all find a way of incorporating sound procedures in our office to make sure these details are handled in order to continue justifying and administering our valuable form of healthcare and having it covered by insurance.