Consistent, current and complete health care documentation is an essential component of quality patient care. Practitioners are required to maintain uniform, organized records containing patient demographics, history and treatment information. To facilitate communication and promote efficient and effective treatment, Medicare has implemented the Physician Quality Reporting System (PQRS). This program will be mandatory beginning in 2015. For the 2013 PQRS reporting period, two measures are required for chiropractors: Pain Assessment and Functional Outcome Assessment.
Pain Assessment
Although there are numerous pain measures practitioners can use to assess pain, the Numeric Rating Scale (0-10) is a good choice. It provides a reliable and valid method of measuring the patient's perception and report of pain.2,6,8-9 Patients find the scale intuitive and easy to use, and practitioners find it easy to score compared to the Analog Scale, which patients do not like and practitioners need a ruler to measure. Medicare requires a pain scale report on every Medicare patient for most visits.
Functional Outcome Assessment
The need to measure the function of the spine and to demonstrate clinical effectiveness has resulted in many reliable and valid patient report instruments in the past 20 years. Yet most self-reporting instruments measuring spinal function are underutilized in daily practice, because they require too much time for patients to answer (5-10 minutes per instrument) and health care workers to score (1-5 minutes per instrument).4 Patients become overwhelmed when they have too many time-consuming forms to fill out. The fact that many patients have symptoms in multiple anatomical regions compounds the problem by necessitating the completion of multiple forms. Consider the following scenarios:
Scenario #1: Your new patient has neck and low back pain from two distinct events. To document the patient's condition appropriately, you should use two outcome measures: one for the cervical spine and one for the lumbar spine. Overall, no instruments are shown better than Oswestry for the low back or Neck Disability Index for the neck, both which have been widely researched and validated.3,10 Each of these instruments requires 3-5 minutes for a patient to complete.1,8,10
Scenario #2: An established patient has a new episode of upper back pain with no neck or low back issues. What outcome measure should you use? Neck Disability Index is primarily for cervical pain and related complaints, and Oswestry is primarily for lumbar pain and related complaints. Neither of these measures is for the thoracic spine, per se.
One validated measure for the thoracic spine is the Patient Specific Functional Scale. This scale can be used to measure activity limitations and to compare progress from the baseline measurement in patients with thoracic spine pain.11 It has demonstrated reasonable reliability, validity, and responsiveness, but the estimated time for a patient to complete this instrument is 5 to 10 minutes.7,11
The Burden of Multiple Forms and a More Effective Choice
Medicare requires a functional scale score to be utilized at least every 30 days. To comply with Medicare's PQRS requirement, you can use three separate measures (i.e., Neck Disability Index for cervical conditions, Patient-Specific Functional Scale for thoracic conditions and Oswestry for lumbar conditions); but the administrative burden of using three measures is substantial.
A practical alternative to using multiple forms is to use one instrument, the Functional Rating Index (FRI). This instrument can be used with cervical, thoracic or lumbar conditions – eliminating the need for multiple instruments for spine-related conditions.
The FRI has been tested, and the initial results published in Spine.4 Multiple independent research teams have verified that the FRI demonstrates excellent reliability, validity and responsiveness, and significantly reduces administrative burden.5 Moreover, the FRI requires only about one minute for a patient to complete, and about 20 seconds for a health care worker to score – a fraction of the time required for any of the above three measures.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
