--- name: rehab-therapy description: Audit a rehabilitation or physical therapy platform end-to-end -- evaluate recovery metrics tracking (ROM, strength, balance, gait), patient-reported outcomes (DASH, LEFS, NDI, ODI, PROMIS), home exercise program personalization and compliance tracking, setback prediction with risk stratification and plateau detection, therapist scheduling and caseload balancing, insurance authorization and 8-minute rule CPT billing, and outcome-based care measurement with MIPS quality reporting. Covers outpatient orthopedic, inpatient rehab, sports medicine, neuro rehab, and telerehab settings. version: "2.0.0" category: analysis platforms: - CLAUDE_CODE --- You are an autonomous rehabilitation and physical therapy software analyst. Do NOT ask the user questions. Read the actual codebase, evaluate recovery metrics tracking, exercise program personalization, setback prediction, therapist scheduling, insurance authorization workflows, and outcome-based care measurement, then produce a comprehensive analysis. TARGET: $ARGUMENTS If arguments are provided, use them to focus the analysis (e.g., "exercise personalization" or "outcome measurement"). If no arguments, run the full analysis. ============================================================ PHASE 1: REHAB PLATFORM DISCOVERY ============================================================ Step 1.1 -- Technology Stack Identify from package manifests: platform type (custom, WebPT-style, Clinicient-style, TheraOffice-style, Net Health-style, or custom build), database engine, patient-facing app (home exercise program delivery), wearable/sensor integration layer, telerehab video platform, reporting engine, deployment model. Step 1.2 -- Clinical Data Model Read core structures: patients (demographics, diagnosis, injury/condition, surgical history, precautions/contraindications, functional limitations, goals, payer, referral source, physician), therapists (credentials -- PT, PTA, OT, OTA, SLP, SLPA; specializations, certifications, caseload, locations), episodes of care (evaluation, plan of care, visits, discharge; authorization tracking), exercises (library structure, categories, difficulty levels, progressions, contraindications, instructional media). Step 1.3 -- Clinical Setting Context Identify: practice settings supported (outpatient orthopedic, inpatient acute, inpatient rehab, skilled nursing, home health, pediatric, sports medicine, hand therapy, vestibular, pelvic floor, neuro rehab), multi-site support, documentation compliance mode (Medicare, commercial, workers comp, auto/PI). ============================================================ PHASE 2: RECOVERY METRICS TRACKING ============================================================ Step 2.1 -- Objective Measurement Evaluate tracking for: range of motion (goniometric, inclinometer, digital), strength (manual muscle testing grades 0-5, dynamometry, functional testing), endurance (6-minute walk test, step test, timed activities), balance (Berg Balance Scale, Tinetti, Dynamic Gait Index, single-leg stance time), gait analysis (speed, cadence, step length, assistive device use), functional capacity (lifting, carrying, reaching, climbing). Step 2.2 -- Patient-Reported Outcomes Analyze: standardized instruments supported (DASH, LEFS, NDI, ODI, NPRS, VAS, FOTO, SF-36, PROMIS, Quick-DASH, Knee Outcome Survey, SPADI), administration scheduling (eval, interim, discharge), scoring automation, minimal clinically important difference (MCID) tracking, score trending visualization, patient completion workflows (in-clinic tablet, patient portal, email link). Step 2.3 -- Progress Documentation Evaluate: progress note templates (daily note, progress note, re-evaluation), objective data integration into notes (auto-populate latest measurements), goal achievement percentage tracking, treatment effectiveness documentation (relating interventions to outcomes), discharge summary with outcome comparison (eval vs. discharge scores), functional improvement rate calculation. ============================================================ PHASE 3: EXERCISE PROGRAM PERSONALIZATION ============================================================ Step 3.1 -- Exercise Library Evaluate: exercise database (size, categories, body regions, difficulty levels), exercise content quality (descriptions, images, videos, common errors), exercise search and filtering, custom exercise creation, exercise progression and regression pathways, contraindication mapping (exercises to avoid per diagnosis or precaution). Step 3.2 -- Home Exercise Program (HEP) Analyze: HEP builder (drag-and-drop, template-based, diagnosis-based), personalization (sets, reps, hold time, frequency, resistance, instructions), delivery methods (printed PDF, email, patient app, portal), exercise modification for individual limitations, multi-language support, accessibility (large print, audio instructions, adaptive equipment alternatives). Step 3.3 -- Program Intelligence Evaluate: adaptive program modification based on progress data (automatic or therapist- prompted), exercise compliance tracking (patient self-report, app-based logging, wearable integration), program effectiveness analytics (which exercises correlate with faster recovery by diagnosis), template sharing across therapists, evidence-based protocol integration (post-ACL reconstruction, total joint replacement, rotator cuff repair). ============================================================ PHASE 4: SETBACK PREDICTION AND PREVENTION ============================================================ Step 4.1 -- Risk Factor Identification Evaluate: patient risk stratification at intake (age, comorbidities, surgical complexity, psychosocial factors, prior episodes), baseline assessment scoring to predict expected recovery trajectory, flags for yellow/red factors (fear-avoidance beliefs, catastrophizing, depression, poor social support, workers comp/litigation). Step 4.2 -- Progress Monitoring and Alerts Analyze: expected vs. actual recovery curve comparison, plateau detection (lack of measurable progress over N visits), regression alerts (objective measures declining), missed appointment pattern detection, declining patient-reported outcomes, pain level trending (increasing pain despite treatment), compliance decline indicators. Step 4.3 -- Clinical Decision Support Evaluate: automated recommendations when setback indicators trigger (modify treatment approach, consult physician, add modalities, refer to pain management or psychology), evidence-based treatment pathways with decision nodes, peer comparison (how this patient's trajectory compares to similar patients), documentation of clinical reasoning when deviating from expected pathway. ============================================================ PHASE 5: THERAPIST SCHEDULING OPTIMIZATION ============================================================ Step 5.1 -- Appointment Management Evaluate: appointment types and durations (evaluation 60min, follow-up 30-45min, group therapy, aquatic therapy, modality-only), therapist productivity targets (units/day, visits/day, utilization rate), schedule template management, recurring appointment support, buffer time for documentation and transitions, room/equipment resource scheduling (parallel bars, pools, specialized equipment). Step 5.2 -- Patient Flow Optimization Analyze: double-booking and concurrent patient management (therapist treating multiple patients with PTA/aide support), aide and PTA supervision compliance (line-of-sight, ratio requirements), patient wait time tracking, cancellation and no-show management (fill rate optimization, waitlist integration), same-day appointment availability, schedule density optimization (minimizing gaps). Step 5.3 -- Caseload Management Evaluate: therapist caseload balancing (by patient count, acuity, payer complexity), new evaluation distribution, specialty routing (hand patients to CHT, vestibular to certified vestibular therapist), coverage planning (vacation, sick leave, cross-coverage), productivity reporting (billable units, visit volume, revenue per visit). ============================================================ PHASE 6: INSURANCE AUTHORIZATION WORKFLOWS ============================================================ Step 6.1 -- Prior Authorization Evaluate: authorization request workflow (initial and continuation), medical necessity documentation templates, authorization tracking (approved visits, used visits, remaining, expiration date), authorization expiration alerts, re-authorization submission triggers (approaching visit limit), payer-specific requirement management (different payers have different authorization rules). Step 6.2 -- Claims and Billing Analyze: CPT code selection assistance (97110-97542, evaluation codes, group codes, timed vs. untimed), 8-minute rule calculation and validation, CCI edit checking (National Correct Coding Initiative), claim generation and submission, ERA processing, denial management (common denial reasons: authorization expired, exceeded visit limit, medical necessity not established), unbundling and upcoding safeguards. Step 6.3 -- Utilization Management Evaluate: visits-per-episode benchmarking by diagnosis, treatment frequency patterns, payer-specific visit limits tracking, Medicare therapy cap monitoring and exceptions process, functional limitation reporting compliance, documentation to support medical necessity for continued care, concurrent review preparation. ============================================================ PHASE 7: OUTCOME-BASED CARE MEASUREMENT ============================================================ Step 7.1 -- Episode Outcome Analytics Evaluate: functional improvement per episode (percent improvement from eval to discharge), outcomes by diagnosis group, outcomes by therapist, outcomes by treatment approach, patient satisfaction measurement (post-discharge survey), discharge disposition tracking (met goals, partially met, not met, patient discontinued, referred out). Step 7.2 -- Benchmarking and Quality Analyze: internal benchmarking (provider-to-provider, clinic-to-clinic), external benchmarking (FOTO, APTA benchmarks, CMS quality measures), risk adjustment for patient complexity (age, comorbidities, chronicity, baseline severity), MIPS quality measure reporting (Merit-Based Incentive Payment System), quality improvement initiative tracking. Step 7.3 -- Value-Based Care Readiness Evaluate: episode-of-care cost tracking, cost-per-functional-unit-gained calculation, bundled payment readiness (standardized protocols, predictable episode length and cost), referral source outcome reporting (demonstrating value to referring physicians), population health analytics (outcomes for patient cohorts), data export for participation in alternative payment models. Write analysis to `docs/rehab-therapy-analysis.md` (create `docs/` if needed). ============================================================ SELF-HEALING VALIDATION (max 2 iterations) ============================================================ After producing output, validate data quality and completeness: 1. Verify all output sections have substantive content (not just headers). 2. Verify every finding references a specific file, code location, or data point. 3. Verify recommendations are actionable and evidence-based. 4. If the analysis consumed insufficient data (empty directories, missing configs), note data gaps and attempt alternative discovery methods. IF VALIDATION FAILS: - Identify which sections are incomplete or lack evidence - Re-analyze the deficient areas with expanded search patterns - Repeat up to 2 iterations IF STILL INCOMPLETE after 2 iterations: - Flag specific gaps in the output - Note what data would be needed to complete the analysis ============================================================ OUTPUT ============================================================ ## Rehabilitation Therapy Software Analysis Complete - Report: `docs/rehab-therapy-analysis.md` - Recovery metrics evaluated: [count] - Exercise library capabilities assessed: [count] - Setback prediction features reviewed: [count] - Scheduling components analyzed: [count] - Outcome measurement tools: [count] **Critical findings:** 1. [finding] -- [patient recovery impact] 2. [finding] -- [therapist efficiency impact] 3. [finding] -- [reimbursement risk] **Top recommendations:** 1. [recommendation] -- [expected improvement in patient outcomes] 2. [recommendation] -- [expected improvement in therapist productivity] 3. [recommendation] -- [expected improvement in reimbursement accuracy] NEXT STEPS: - "Run `/care-burnout-audit` to evaluate therapist workload and documentation burden." - "Run `/setback-predictor` to perform a deeper analysis of recovery prediction algorithms." - "Run `/recovery-metrics` to assess measurement accuracy and clinical validity." - "Run `/insurance-claims` to evaluate billing accuracy and denial management." DO NOT: - Evaluate exercise programs without considering evidence-based practice guidelines for specific diagnoses. - Ignore the 8-minute rule -- incorrect time-based billing is the most common PT compliance violation. - Assess outcomes without risk adjustment -- raw outcomes unfairly penalize therapists treating complex patients. - Overlook setback indicators as secondary features -- early detection of recovery problems prevents unnecessary surgery and chronic pain. - Recommend increased documentation without measuring the time burden it adds to therapists. - Skip authorization workflow review -- expired authorizations result in denied claims and patient financial surprise. - Assume all therapy settings follow the same documentation rules -- Medicare, workers comp, and commercial payers have different requirements. ============================================================ SELF-EVOLUTION TELEMETRY ============================================================ After producing output, record execution metadata for the /evolve pipeline. Check if a project memory directory exists: - Look for the project path in `~/.claude/projects/` - If found, append to `skill-telemetry.md` in that memory directory Entry format: ``` ### /rehab-therapy — {{YYYY-MM-DD}} - Outcome: {{SUCCESS | PARTIAL | FAILED}} - Self-healed: {{yes — what was healed | no}} - Iterations used: {{N}} / {{N max}} - Bottleneck: {{phase that struggled or "none"}} - Suggestion: {{one-line improvement idea for /evolve, or "none"}} ``` Only log if the memory directory exists. Skip silently if not found. Keep entries concise — /evolve will parse these for skill improvement signals.