I’m going to tell you about a little-known secret in the rehab therapy industry.
No one cares about those treatment goals you just documented.
At least, no one else cares about your patient goals. You obviously care about them, because treatment goals are how you gauge your patients’ progress and fortify your documentation against audits and compliance mishaps. But patients and payers don’t give a hoot about your goals the way you write them today—even though they absolutely need to.
Functional goals tell patients how we will help them—and payers how they should pay us.
Properly written functional goals serve multiple purposes. For one, they engage patients, putting their progress and care in terms that they can understand and relate to. This encourages them to be more involved—and put more effort into—their care plan. Beyond that, functional goals tell payers what PTs do—demonstrating our value by showing how and why our treatments help our patients live better lives. Ultimately, this is what payers look at when they decide how to pay for our services: which deficits the patient arrived with and what sort of progress they should achieve under your supervision. If our goals display high levels of skill and value, then we’re more likely to get higher pay—simple as that. And of course, it goes without saying that properly written functional goals round out our documentation and make it more defensible.
Most therapists are writing functional goals for themselves—and themselves only.
Unfortunately, a large percentage of PTs aren’t writing goals like the ones I described above—and I have proof. We recently pulled some functional goals data from the WebPT EMR. (These pieces of documentation state how therapists want or expect their patients to improve as a result of a plan of care.) I was floored by the lack of connection between functional problem lists and their corresponding goals—specifically with respect to articulating functional gains.
Here’s an example of one of the goals I saw: “Increase shoulder strength from 4 to 4+.”
This goal means basically nothing to a patient—let alone a payer—and it could mean different things to different PTs. Very few therapy outcome measurement tools (OMTs) are widely known in the greater medical industry, and a goal like this one—with next to no contextual information—does not clearly demonstrate our value or the practicality of seeking our treatment. And remember, these are the very same goals that payers and auditors see, so if we’re not explaining how we can improve patient function in a way they understand, then how can we expect them to adequately compensate us for that value?
And when it comes to patients, it’s mission critical that we secure buy-in and trust. If we aren’t listening to them and sharing expectations and outcomes, then we should not be surprised at our industry’s dropout rates and lack of plan of care completion. By writing these detached functional goals, we lose opportunities to connect with patients and demonstrate the value of PT and how it can improve their lives.
We can’t half-ass our goals—or our documentation.
Now, I must give credit where credit is due: I saw a notable number of goals in the data sheet that were passable. For instance, some clinicians talked about pain scales—which was great! But we offer even more value than simply reducing pain, and we must communicate exactly how we can improve our patients’ lives. Others were more specific in connecting ROM or strength improvements with specific functional activities. For instance, someone wrote: “Patient will demonstrate sufficient AROM
in (R) shoulder in order to reach to (and above) shoulder level for independent hair care, without pain < 3/10.”
This is a great example of what we, as therapists, must do to showcase our value in a way that is meaningful to everyone—not just ourselves.
And yes, I’m sure the therapists with the scantest written goals were still talking to patients about improving their activities of daily living (ADLs)—but that didn’t show up in their documentation. Thorough, easily understood documentation is vital to our ability to be respected and rewarded by those who control patient access to (and reimbursement of) our care. Auditors, insurance companies, and chart reviewers all must be able to understand this information. Remember: If they aren’t seeing it
in your SOAP notes, they may not comprehend its value at all.
We must create goals that elicit buy-in from patients and payers.
At the risk of sounding like a broken record, I will say this again: patients and payers need to understand and appreciate our functional goals. Leveraging OMTs is important, and it’s an easy way to communicate functional goals, especially when those outcome measures are meaningful within the greater medical community (e.g., DASH, LEFS, NDI, or Oswestry). For example, part of your documentation could say, “LEFS score will improve from 53/80 to 70/80 or greater.” We must document with a combination of qualitative and quantitative language.
Use accessible language in addition to OMTs.
If nothing else, the goals data sheet I reviewed proved that therapists are using OMTs as objective measures for goals. However, numerical goals should be framed by objectives that mean something to the patient—like reaching the upper shelf, carrying groceries from the car to the kitchen, or holding their grandchild. Framing goals through ADLs that are important to patients can be incredibly motivating; your word choice alone can push a patient to comply with their therapy plan.
Each problem typically has a one-to-one correlation with a goal, and you should create a problems list in combination with your objective findings and your subjective interview with the patient. Patient-reported or performance-based outcome measures are also very important when creating a goal list—especially because patients can participate in their care and understand why and how their answers will be used to assess their baseline status and future progress. All of this information is critical to ensuring your documentation is translatable beyond PT—and that it tells a complete story.
Get patients involved.
Additionally, you can elevate the impact of OMTs by incorporating patients’ questionnaires and/or assessments into your interactions with them. Engage them to help them understand what you are measuring and why. Use that data to show patients their progress. It can be an excellent patient engagement tool when leveraged correctly and consistently. We know from our EMR data that too many PTs collect OMT scores only at the initial eval and (if they are lucky) at discharge. By doing that, you’re missing a huge opportunity to connect with patients, get them involved with their care, and reinforce the value and impact of the treatment they are receiving.
To get better reimbursements and tackle the 90% problem, we need widespread buy-in.
If we continue to document goals in a way that’s meaningless to patients and payers, we’re basically shooting ourselves in the foot. This is what insurance companies see when they audit charts—and obfuscated goals don’t prove our value. I firmly believe this is contributing to our inability to fully engage patients in their care, share our value through documentation, and ultimately, secure better payment rates.
The bottom line is this: if we don’t commit to elevating the quality of our problems and goals lists by providing functional detail, we will be missing out on an opportunity to expand our market and tap into the 90% of patients who need therapy but never get it. We can do better. I know we can.
As they’re currently written, your functional goals will not make an impact beyond your own mind. But that need not be the case for long. You can write functional goals that everyone—patients and payers alike—cares about, and by doing so, contribute to a better future for the rehab therapy profession as a whole.