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The FLR (Functional Limitation Reporting) is upon us at full force.  For those therapists out there who do not see a high Medicare percentage like I do…well I don’t like you.  Our front desk and therapists don’t work on the sexagesimal system (timekeeping in a base of 60 such as minutes/seconds) but in units of 10 and 30.  (FLR due every 10th visit or 30 days, whichever is first and lucky for us, they never fall on the same time).  If you want to get paid, get used to it.

I am not the first, and certainly not the last, to pout about more paperwork.  My patients frown more, seemingly to be less at their current disability; but at the “re-eval day” when I bring out the standard clipboard, pen and paper (aka an outcome measure such as neck disability index, oswestry, DASH, etc).  Its grunt time to pull out the reading glasses and answer research devoted tools that say they assist in clinical outcomes.

I have always brought out an old school method by asking my patients, “from 0 – 100%, where do you put yourself currently in regards to your prior level of function?”.  I thought I made it up and felt smart, but it is actually an outcome measure used in research.  Therefore, I’m behind the times like usual.  It is called the Single Assessment Numeric Evaluation, or SANE.

The SANE is an outcome measurement tool used to record the patient’s self-reported function.  It is implemented on a scale of 0-100 and correlated with a scale of function from 0-100%.  The 100% representing full function (or function prior to injury) and 0% representing no function.

The SANE takes seconds, doesn’t require me to scan in another document into a patient’s chart, is functional for the patient sitting in front of you, can be adjusted for any region of the body, and overall makes sense.  I would say the SANE is a “painless and timely outcome measure”.

The question remains, does this outcome measure (which has only been correlated to work well with established knee and shoulder outcome measures and doesn’t have an MDC or MCID) work for Medicare’s FLR?  

For those who treat Medicare patients and have to fill out the FLR, don’t you think the SANE most closely correlates with FLR percentages than say, an Oswestry?





  1. Good question.

    I was helping out at a clinic until about a month and dealing with the paperwork requirements of treating clients with Medicare. I absolutely despise all of these new changes and I am glad that am no longer helping at this particular clinic.

    I love treating the Medicare population just as much as the adolescent and adult population but the paperwork requirements of treating Medicare patients takes the joy out of being a PT.

    One of the time-saving methods that was attempted at this clinic was to send the patient home with the questionnaire prior to their “Re-eval” visit and this helped much of the time.

    I checked CMS and they have this answer:
    Q16) Is there a list of Medicare-approved functional assessment tools?

    A16) CMS does not have a list of approved or endorsed functional assessment tools.


    So it seems like your safe in using the SANE tool and I personally love that tool myself and didn’t realize it was a standardized measurement either.

    1. Hey Joel,
      Thanks for responding and providing the link to CMS. It is quite interesting that they require all of this information…yet no approved assessment tools?
      I agree with you in that I love treating this age group too, but much more hoops to go through. Unfortunately I have heard of some clinics opting out of Medicare…which really limits quality care to these individuals.


  2. We are currently using FOTO and have the patients fill out the survey at home via a email link or on a tablet in the clinic which is automatically entered and scored with no extra data entry needed by our staff, We have all clients fill out FOTO every 6 visits thus never missing the 10th visit and with FOTO we can include oswestry or several other functional outcome surveys which are all scored autiomatically.

    1. Hey Mike,
      I’ve definitely heard of FOTO but we haven’t implemented it yet in our clinic…mainly due to costs. Isn’t it a start-up and discharge fee for each patient?

      I know you can compare results all over the country with FOTO, but what other benefits are you seeing with the program?


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