Treatment goals should be included as part of each patient’s care plan. It was once acceptable to use general treatment goals like, “to decrease pain” and “to improve function”, but more and more, many third-party payers are looking to see specific, measurable, functional goals.
According to the Medicare Benefits Policy Manual, for care to be considered “medically necessary”, the care given must have “a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function”.
In a previous post, we discussed how utilizing Outcome Assessment Questionnaires can be helpful in setting functional treatment goals, showing functional improvement, and in turn, helping to prove medical necessity.
Here, we want to focus on goals.
Setting Treatment Goals
Are you currently setting short term and long-term goals?
Are they specific to the particular patient and their unique circumstances or could they apply to ANY chiropractic patient?
Are the goals measurable? How will you be able to tell if the patient is progressing or not?
Are you using Outcome Assessments to identify functional deficiencies? Are you setting goals based on those deficiencies?
Wouldn’t the process of goal setting be much easier if you used the same formula across the board? All goals...all patients?
I think this will help!
S.M.A.R.T.
Recently, I discovered an article discussing the SMART criteria.
The SMART criteria are specifically used for setting goals and objectives. This method has been used for several years by corporations, in project management, performance management, and personal development.
Objectives and goals may differ, but the general idea and the SMART acronym tend to remain the same.
What does S.M.A.R.T. stand for?
There are several variations of some of the elements of the SMART acronym. The most appropriate variation is most often determined by the source and usually based on the context in which the criteria will be used.
For the purpose of setting and documenting goals in a chiropractic treatment plan S.M.A.R.T. means;
Specific. Measurable. Attainable. Relevant. Trackable.
S.M.A.R.T. - Defining Goals for a Plan of Care
When you think about setting treatment goals for each individual patient, there are a few things that should be considered. Having a PROCESS for consideration of these things can help you in setting specific and measurable goals for each patient. In turn, that will make it easy for you to show functional improvement and medical necessity for a patient's treatment.
For each goal, use the S.M.A.R.T. criteria as outlined below.
SPECIFIC - Is your goal specific to this particular patient and their unique circumstances at this time? What do you want to accomplish? Why is this a goal?
MEASURABLE - Can this goal be measured? How will you measure current status and progress toward your goal?
ATTAINABLE - Is your goal attainable? Realistic for this patient?
RELEVANT - Why am I setting this goal now? Is the goal relevant to the patient's specific complaints/functional deficiencies? Relevant to achieving overall objectives?
TRACKABLE - What is a realistic deadline for accomplishing your goal? Are you able to track and easily show (document) results and progress toward this goal? How will you know when this goal has been met?
A Closer Look
Your patient filled out a Revised Oswestry Questionnaire and for #5 (sitting) they marked “Pain prevents me from sitting more than ten minutes.”
Based on the patient's response on the Revised Oswestry Questionnaire your goal is to enable the patient to sit for longer than 10 minutes without pain. In order to do this you must work to reduce the pain in the low back that is preventing it.
Examples:
A. Original Goal - "to decrease pain" (NOT specific, measurable, trackable)
B. S.M.A.R.T. goal - “to decrease pain in the low back to enable the patient to sit for longer than 10 mins without pain”
S.M.A.R.T. for Better Treatment Goals
SPECIFIC - You know the S.M.A.R.T. goal is specific to the patient and the issues he/she is experiencing at this time (because you had them complete a Revised Oswestry Questionnaire to determine how their current low back issue is affecting the performance of daily living activities). You have also specified the location of the pain you are aiming to decrease.
MEASURABLE - Pain reduction can be measured using the VAS (visual analog scale). Functional progress can be measured by the length of time the patient is able to sit without pain as treatment progresses.
ATTAINABLE - In this case there are no complicating factors and no reason to believe this goal cannot be achieved with this patient. (For this patient, you may not ever be able to completely eliminate low back pain while sitting but chances are you can definitely reduce the pain to a point where they are able to sit for longer than 10 minutes.)
RELEVANT - Let's say this patient has a desk job and sits for long periods of time throughout the day. It is imperative that the patient be able to sit for longer than 10 minutes without pain in order to perform his job and is likely one of the first things that need to happen. (relevant) The goal is based on the patient's specific complaints and functional issues. (relevant)
TRACKABLE - Note your time frame for achieving this goal in your Initial Treatment Plan on your first exam. Pain levels are trackable and easily documented using a VAS (visual analog scale), Pain Diagram (on the Document Plus Daily Note form). Length of time patient is able to sit without pain can be tracked and documented by noting a patient's verbal response on a daily visit and by revisiting the Revised Oswestry Questionnaire.
Once you use the process a few times, you will automatically begin asking yourself these questions as you set goals for your patients and it will become easier and faster.
Remember that your care plan should be thoroughly outlined at the patient's INITIAL VISIT.
Documentation of changes examination, status, progression, and care plan should be maintained in the records at EACH VISIT. This should include documentation of goals that have been met over the course of care and any CURRENT or NEW treatment goals.
Do you have any tips or tricks for setting goals in your treatment plan? Please share in the comments.