Using Outcome Measures to Justify Medical Necessity, Reimbursement, and Clinical Accountability in Real-life Settings (AM2025-OS04)

Credit Hours

1.75 Scientific Credits

Learning Objectives

• Upon completion participants will be able to better understand which outcome measures focus on medical necessity by relating to the physician's perspective and their obligation to provide clinical documentation support for orthotic and prosthetic users.
• Upon completion participants will be able to apply outcome measures which are most effective in the real life clinical setting, including empowering the clinician to apply outcome measures to meet their clinical obligations in the private sector and the VHA.
• Upon completion participants will be better enabled to understand a referring physician's obligations to merit based reporting and how outcome measures can help them meet those obligations, by presenting and best representing the patient's perspective to the referring physician.

Course Description

Using Outcome Measures to Justify Medical Necessity, Reimbursement, and Clinical Accountability in Real-life Settings (AM2025-OS04)

The O&P profession has been emphasizing the need for outcome measures for over a decade. Reliability and validity has been the emphasis when developing and using an outcome measure. Ultimately, applying outcome measures to our everyday clinical practice and to the benefit of our patients is the goal. Ecological validity examines whether an outcome measure is generalizable to real-life settings, which includes medical justification. The purpose of this presentation is to discuss outcome measures which have the best ecological validity in the real-life clinic setting when considering return on time investment. This presentation will primarily target the clinicians whose priority for using outcome measures is justifying medical necessity and reimbursement to assist them with the real-life everyday setting of being accountable for their patients’ needs. Ecological outcome measures which are viewed from the perspective of the physicians and payers expectations to justify medical necessity will be emphasized. Outcome measures and clinical practice guidelines for communication with the Veterans Health Administration physicians and prosthetic clinics will also be discussed. This symposium will challenge the current paradigm and focus on utilizing outcomes practically for clinical accountability to our patients.

Presenter Name(s)

• Jason T. Kahle, MSMS, L/CPO, FAAOP
• M. Jason Highsmith, PhD, PT, DPT, CP, FAAOP(D)
• Andreas H. Kannenberg, MD (GER), PhD
• Tyler D. Klenow, MSPO, MBA, CPO, FAAOP(D)