What should SOAP charts say?
| "The codependent
(massage) therapist gets caught up in needing approval from the client
or needs to be the expert, or needs to be right."
Jacquelyn
Small |
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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:
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What do we really want to be telling insurance companies about
what goes on in a session?
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What do we want to show them about what
techniques do what?
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What do we want to tell them about what happens as a
result of the therapeutic relationship?
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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
