Survey of US practitioners on the validity of the Medicare Functional Classification Level system and utility of clinical outcome measures for aiding K-level assignment

Publication date: Available online 22 March 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Dylan Borrenpohl, Brian Kaluf, Matthew J. Major
ObjectiveThis study characterized the opinion of the prosthetic clinical care community on the Medicare Functional Classification Level (K-level) assignment process to classify mobility and rehabilitation potential of persons with lower-limb loss, including limitations and practicalities involved with the integration of outcome measures (OMs) into the clinical practice framework for K-level assignment.DesignSurvey.SettingEnglish online questionnaire with built-in logic.ParticipantsVolunteer sample of prosthetics practitioners (n=236). Data were analyzed only for United States practitioners (n=213).InterventionsNot applicable.Main Outcome MeasuresSubjective responses to 19 multiple choice, Likert scale, and open-ended questions.ResultsForty-seven percent of respondents indicated that they were the sole determinant in the K-level assignment process, while 43% indicated that it was a collaborative process with another healthcare professionals. Sixty-nine percent of respondents reported using standardized outcome measures to assist in K-level assignment, and the majority did not agree that commonly-reported barriers to implementation (e.g., lack of time and training) were relevant. Sixty-seven percent of respondents did not believe the K-level system can accurately assign a level of rehabilitation potential, with 75% agreeing that incorporating OMs into clinical practice would enhance objectivity of the K-level assignment process.ConclusionThe results suggest that the majority of prosthetics practitioners are involved in the K-level assignment at some level, and most agreed that there are considerable limitations with this system. To address these issues, many practitioners are utilizing OMs to assess various aspects of patient mobility and rehabilitation potential, and minimize the subjectivity of the assignment process.



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