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Advocate for the Value of OT with Medicare Self-Care Measures

January 12, 2018

Outcome measures are being implemented across all post-acute care (PAC) settings for Medicare beneficiaries using information from Section GG.

If you work in post-acute care, you already are helping Medicare beneficiaries with self-care and mobility. Now you can use that work to advocate for occupational therapy’s role in meeting outcome measures.

Download the Template 

The Centers for Medicare and Medicaid Services (CMS) is implementing outcome measures in post-acute care (PAC) using items from the Continuity Assessment Record Evaluation (CARE) tool as a result of the Improvement Medicare Post-Acute Care Transformation (IMPACT) Act. Here’s how to do that.

Watch the video for a quick overview of the self-care items and a description of how to advocate for your role in the Medicare outcome measures.

OT practitioners in PAC should begin to advocate for their role and value using the measures. This can be done with 2 steps: (1) make sure that the self-care items are scored at evaluation and discharge at a minimal and (2) meet with administration to advocate for the role of OT with the measures.

Download the AOTA resource to score and track the self-care and mobility items in Section GG. Although AOTA has created a resource to assist in scoring and tracking the items, practitioners should consult the CMS training and instruction materials for their respective site. View the CMS training.

There are four outcome measures that specifically relate to function and are based on the functional items in Section GG of the following Medicare PAC Assessments:

1. Score the self-care items

The evaluation begins with the occupational profile. The AOTA Occupational Profile Template can help to guide the development and documentation of the occupational profile. Download the AOTA Occupational Profile Template.

Based on the profile, select and administer the appropriate assessments to complete the analysis of occupational performance, keeping in mind the items CMS uses to calculate outcome measures.

Use the AOTA evidence-based practice resources to identify standardized assessments and implement best practice interventions to achieve the best possible outcomes. See the links below to access the AOTA evidence-based practice guidance.

Although the self-care measures by CMS focus on basic activities of daily living, this does not diminish the role of OT in instrumental activities of daily living (IADL). OT should continue to focus on IADL performance in context.

The Items

Not all items are currently in each Medicare assessment. But, items are being added over time.

Self-care Items:

Mobility Items:

  • Eating
  • Oral Hygiene
  • Toilet Hygiene
  • Upper Body Dressing
  • Lower Body Dressing
  • Putting on / Taking off Footwear
  • Shower/Bathe Self (In IRF, SNF, and HHA) and Wash Upper Body (in LTCH only)
  • Roll left and right
  • Sit to lying
  • Lying to sitting on side of bed
  • Sit to stand
  • Chair/bed-to-chair transfer
  • Toilet transfer
  • Car transfer
  • Walk 10 feet
  • Walk 50 feet with 2 turns
  • Walk 150 feet
  • Walking 10 feet on uneven surfaces
  • 1 step (curb)
  • 4 steps
  • 12 steps
  • Picking up object
  • Wheel 50 feet with 2 turns (manual or electric)
  • Wheel 150 feet (manual or electric)

These items are scored on a 6 point scale from independent to dependent.

6. Independent—Patient completes the activity by himself/herself with no assistance 

5. Setup or cleanup assistance—Helper SETS UP or CLEANS UP; patient completes activity. 

4. Supervision or touching assistance—Helper provides VERBAL CUES or TOUCHING/STEADYING and/or CONTACT GUARD ASSISTANCE as patient completes activity. 

3. Partial/moderate assistance—Helper does LESS THAN HALF the effort. 

2. Substantial/maximal assistance—Helper does MORE THAN HALF the effort. 

1. Dependent—Helper does ALL of the effort. 

The client’s effort to complete the task is used to score each item. A client may use any adaptive equipment or modified technique at any level. At 5 “Setup or cleanup assistance”, the client is safe to be left completely alone to complete the activity and only requires assistance setting up the activity, cleaning up the activity or both. At 4 “supervision or touching assistance”, someone should be present for the entire activity, but does not need to provide more effort than cues or light touch.

These items do not replace the assessments that OTs use to evaluate clients and create a plan of care. However, the information needed to score these items can easily be collected during the evaluation. OT should continue to assess IADLs, functional cognition, psychosocial participation, and the many other areas included in a comprehensive OT evaluation.

The Measures

Using the items, CMS will calculate several risk-adjusted outcome measures as well as process measures including applications of the following NQF endorsed measures:

(1)    Change in Self-Care Score (NQF #2633) which estimates the risk-adjusted change in self-care function between discharge and admission (www.qualityforum.org/qps/2633);  

(2)    Change in Mobility Score (NQF #2634) which estimates the risk-adjusted change in mobility function between discharge and admission (www.qualityforum.org/qps/2633);  

(3)    Discharge Self-Care Score (NQF #2635) which estimates the percentage of discharged beneficiaries who meet or exceed Medicare’s expected discharge self-care score (www.qualityforum.org/qps/2635); and

(4)    Discharge Mobility Score (NQF #2636) which estimates the percentage of discharged beneficiaries who meet or exceed Medicare’s expected discharge mobility score (www.qualityforum.org/qps/2636). 

CMS is also calculating the percentage of beneficiaries with an admission and discharge functional assessment and a care plan that addresses function.

2. Ask if your evaluation can be used to score the items in your facility

Some of the items may be not required yet in your facility. OT has a unique skillset to greatly impact these measures for facilities and use the items as a way to define value to administration and management.

Ask for a meeting with management and take item scores with you. Tell the story of the clients, their experience with OT, and how your intervention impacted the scores on the items. This is a great opportunity to explain how OT intervention impacted other areas of the client’s life as well (e.g., functional cognition, IADLs).

Once you’ve told the story, ask management if your evaluations can be used to contribute to section GG.

Additional Resources

AOTA provides evidence-based practice resources to support your evaluations & interventions. Browse the resources in Productive Aging, Health & Wellness, and Rehabilitation and Disability.

Kroll, C & Fisher, T. (2017). Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care. American Journal of Occupational Therapy, 72. doi:10.5014/ajot.2018.721002