What should SOAP charts say?
While researching information for my
insurance billing manual, my attention came to the dilemma we have in massage
therapy about charting what we do in order to get paid by insurance companies.
I often hear comments from massage
therapists such as "No one reads our notes anyway" and "I don't write
what I do in a session on a chart because the insurance company won't
pay for it. I keep separate notes for myself".
Charting what we do is one of the only ways
we have to provide insurance companies, physicians and the medical community
with information about what we do in a session with a client. It is a
necessary part of developing our profession.
Insurance companies want us to tell them how
has a client improved. Have they gotten better as a result of the session
with us? This is the only thing they can use to determine if a treatment
is "medically necessary". This really does not tell what exactly happens
as a result of a massage session. There is so much more to what actually
goes on in a session beyond the technique we do and is the client getting
better. What does better mean? What do we want to be telling insurance companies
about what we do and see in a session?
Here in Washington State, we are being
required (as a contracted provider of one health insurance
company) to take a SOAP charting class offered by Diana Thompson, author
of "Hands Heal: Communication, Documentation, and insurance billing for Manual
Therapists". I have read the book and have taken the class. The book
talks about how we need to communicate what we do in a session and that a
session is more than just trying to "fix" a client -which is the heart of my
writing and websites. She talks about "mirroring" and active listening and
how that is such a part of the therapeutic relationship. Then the charting
system she proposes goes on to focus on functional outcomes- what the insurance
companies want to hear about.
I also recently read an article on "CARE"
charting in Massage and Bodywork magazine. CARE charting tells the
condition of the client (C), before and after the session, the action taken (A),
the response of the client (R), and an evaluation (E) or plan for the next
session. I think there is a great potential for "CARE" charting but I am not
sure it will be accepted by insurance companies as they seem to be stuck on SOAP
charting. If insurance companies want us to set functional goals, we can
add that to the evaluation section as a recommendation.
My challenge to the profession is this:
-
What do we really want to be telling
insurance companies about what goes on in a session?
-
What do we want to show them about what
techniques do what?
-
What do we want to tell them about what
happens as a result of the therapeutic relationship?
-
While I believe we do need to comply with
the insurance companies need to see improvement, what else can we be telling
them about our work?
The reason I am doing this is that it seems
that, Diana Thompson's method of charting
functional outcomes will soon be the standard. The insurance companies
seem to love this method. One insurance company in WA state has already bought
into it and made it a requirement to learn (but I don't have to actually change
what I do, just take the class to fill the requirement). If we don't take a
stand and look at this issue, it will soon be too late or will take longer to
change. While this method of charting has been instrumental in getting our
work accepted by the insurance companies, it comes at a high cost to the
profession. Insurance companies and medical professions are missing out on the
core of healing. They are still in the dark about what we really do.
To enhance our profession we need a way of
charting that fulfills the insurance companies needs and ours too!
See also:
Problems with Functional Outcome charting
