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CMS also has encouraged use of the ASHA National Outcomes Measurement System (NOMS) Functional Communication Measures (FCMs) to assess functional progress and outcomes; CMS now endorses NOMS as an official registry for the reporting of outcome data to Medicare. However, the determination of a patient’s significant, practical improvement within a specified time period largely has been the purview of the health care professionals responsible for treating that patient. Now, however, professional self-scrutiny is called for by CMs’ recovery audit contractor (RAC) and other Medicare auditing programs, Medicaid, and commercial payers, as well as by provisions in the new PPACA that call for additional auditing, different payment structures (such as bundling), and the conclusions of comparative-effectiveness research. This scrutiny is required in the ongoing effort to answer Douglass’ question: “How do we know, and how do we show, that what we do in therapy makes a difference?”

Enter the ICF Framework

The International Classification of Functioning, Disability, and Health (ICF; World Health Organization, 2001) is a standardized classification of health and health-related domains from individual and societal perspectives, according to health conditions (body functions and structures, activity, and participation) and contextual factors (characteristics of the individual and environment that affect the individual’s ability to function in society). These personal and environmental factors may serve as barriers or enhancements to individual performance and participation (see sidebar on p. 15). Although the ICF classifications are not used for coding or billing health care services in the United States, the ICF provides a valuable framework for structuring clinical care to address increasing demands for efficiently achieving functional outcomes.

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