I talk a lot about documenting specific metrics that are REQUIRED of chiropractors, not just recommended. The required metrics are pain intensity for each condition, pain frequency for each condition, and functional outcome questionnaire scores for each condition.
The pain intensity and frequency metrics are required to be documented on every visit (for active patients, not wellness patient), and the functional outcome questionnaire scores are required to be documented on the first visit and then every 30 days or sooner.
Because I’ve reviewed countless chiropractic records over many years, I can tell you, with confidence, that a good amount of chiropractors document the pain intensity, very few document the pain frequency, and hardly anyone documents the functional outcome questionnaire scores.
Why are these important?
We are required (CMS sets the rules and standards – Centers for Medicare and Medicaid Services) to track the patients’ progress with our treatment, for each condition that we’re treating. They want this to be measurable progress, though, not just us saying things like “neck better.”
When we document the intensity of pain, we can track the progress to see if it’s changing from visit to visit. It’s very possible, though, that the intensity stays the same for a while. That’s where the frequency of pain comes in. If the intensity stayed the same at a 5/10 for a few weeks, but the frequency improved during that time, we are able to show improvement.
It’s also possible, though, that the intensity AND frequency stay the same. Now what? That’s where the functional outcome questionnaire scores come in.
I saw a patient today – early 30s male – who has had chronic neck, upper and middle back pain for several years. He’s been coming in 1-2 times per week for a few months. All three metrics improved for the first month, but then the intensity and frequency stopped changing.
Today, I had the patient complete the Neck and Back Bournemouth Questionnaires. Compared to the last time the patient completed these, here’s what happened:
When I shared this quantitative and functional improvement with my patient, he was thrilled, even though the intensity and frequency haven’t changed. This is how I can show him the value of our care, and he pays out of pocket for treatment (no insurance). Even better, my EMR does all of the calculations for me.