Generally speaking, when we say 'objective measures,' what does that mean?

Assessments generally have some degree of both subjective and objective information. Objective measures consist of standardized patient assessment instruments, outcome measurement tools or measurable assessments of functional outcome. This limits the degree of individual interpretation of the parameter being measured.

The Medicare Manual requirement for chiropractic services is to establish a treatment plan to include the following:

  1. Recommended level of care (duration and frequency of visits)
  2. Specific treatment goals and
  3. Objective measures to evaluate treatment effectiveness. Since each subsequent visit requires assessment of treatment effectiveness, the objective measures should be documented each subsequent visit

Examples of objective measures to evaluate goals include:

  • Pain (Pain Scales are a subjective response by the patient. Since this is a recognized assessment parameter by the medical community, pain measures are allowable as objective measures. The examples are using the Visual Analog Scale (VAS) since this is accepted as measures.

    • Baseline: 9 on a scale of 1-10 (VAS)
    • Goal: Decrease pain to 1
    • Today’s score: 5
  • Standing:  

    • Baseline: Only able to stand for 20 minutes 
    • Goal: Able to stand for more than 1 hour  
    • Today’s measure: Able to stand 30 minutes
  • Range of Motion (ROM):

    • Baseline: Lumbar spine flexion of 53 degrees and extension 11 degrees
    • Goal: Increase lumbar flexion to 80 and extension to 25
    • Today’s measure: Lumbar flexion of 65 degrees and extension 20

The important thing to remember is that regardless of the objective measure a provider chooses to use in evaluating effectiveness, the measure must be addressed and documented for each date of service. For instance if measuring progress by pain reduction, the pain scale measure for the date of service should be documented. When using an ADL goal such as standing for a length of time, the parameter of measure should be how long the patient can stand on the date of service. For this reason having your only measurable goal based on the Oswestry Score may not be practical. If your goal is to decrease the Oswestry by 50 percent, to address it every date of service would require performing the Oswestry each date you see the patient. This in no way negates the value of the Oswestry as an assessment tool. It is a very thorough tool for re-evaluation of a patient’s progress after a series of treatments over time.

CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, chapter 15 (PDF, 1.28 MB), section 240  

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