2021 QCDR Measure #008: Functional Status Change for Patients With Lower Extremity Functional Status Deficit

Measure Title Functional Status Change for Patients With Lower Extremity Functional Status Deficit
Measure Description Percentage of patients aged 18 years or older with a functional deficit related to the lower extremity who achieve a Minimal Clinically Important Difference (MCID) in Lower Extremity Functional Scale (LEFS) score that indicates a functional improvement greater than zero. Two rates will be reported:• The overall proportion of patients achieving an MCID in LEFS change score.• The Risk-Adjusted MCID proportional difference where the difference between the risk adjusted predicted MCID and the observed MCID (measured via LEFS) proportion is greater than zero.The measure contains two goals: 1) for patients to achieve an unadjusted MCID greater than zero and, 2) for patients to achieve a risk adjusted MCID where the difference between the risk adjusted predicted MCID and the observed MCID proportion will be greater than zero. The measure is adjusted to patient characteristics known to be associated with functional status and quality of life outcomes (risk adjusted) and used as a performance measure at the patient level, at the individual clinician level, and at the clinic level to assess quality.
Denominator All patients aged 18 years or older with a functional deficit related to the lower extremity functional status,

ANKLE:Achilles tendinopathy: M76.6*, M76.89*ORPosterior tibialis dysfunction: M76.82*, M76.89*ORLigament sprain: S86.0*, S93.4*ORFractures of ankle: S82.5*, S82.6*, S82.84*, S82.85*, S82.9*ORFractures of fibula: S82.4*ORRepetitive stress injury to musculoskeletal system (ankle-related): M70.87*, M25.37*, M25.47*, M25.57*, M25.67*, M79.67*

FOOT:Plantar fasciitis: M72.2ORHallus valgus: M20.1*ORBunion: M21.61*ORIn-toeing: Q66.6ORClub foot: M21.54*, Q66.0, Q66.89ORPes Planus: Q66.5*, M21.4ORFractures of foot and toes: S92*

HIP:Femoroacetabular impingement: M25.85*ORHamstring tendinopathies: M67.85*, M70.85*, M76.89*, S76*ORGreater trochanteric pain syndrome: M70.6*, M70.7*, M76.1*, M76.2*, M25.55*ORHip osteoarthritis: M16.*ORHip Arthroplasty: Z47.1*, Z96.64*ORFracture of femur: S72*ORHip Arthroscopy AfterCare: Z47.1 AND appropriate code to indicate HIPORHip Arthroscopy: Z96.64OROsteoarthritis of hip: M16.*ORRepetitive stress injury to musculoskeletal system (hip-related): M70.6*, M70.7*, M70.85*, M25.35*, M25.45, M25.55*, M25.65*, M79.65*

KNEE:Ligamentous injury: S83*, M23*ORMeniscal: S83.2*, M23.3*OrPatellofemoral dysfunction: M22.2X1, M22.2X2ORTendon disorders: M76.3*, M76.5*ORKnee Arthroplasty: Z47.1*, Z96.65*ORFractures of knee: S82.1*, S82.2*, S82.3*ORKnee Arthroscopy AfterCare: Z47.1 AND appropriate code to indicate KNEEORKnee Arthroscopy: Z96.65OROsteoarthritis of knee: M17.*ORRepetitive stress injury to musculoskeletal system (knee-related): M70.4*, M70.5*, M70.86*, M25.36*, M25.46*, M25.56*, M25.66*, M79.66*PELVIS:Sacroiliac dysfunction: M53.2X8, M53.88ORPiriformis syndrome: G57.0*ORFracture of pelvis: S32.3*, S32.4*, S32.5*, S32.6*,

ANDAn Index Patient Visit Indicator:Physical Therapy CPT: 97161, 97162, 97163OROccupational Therapy CPT: 97165, 97166, 97167ORChriopractor Therapy CPT: 99203, 99202-99204, 99212-99214Denominator Criteria (Eligible Cases):SUBMISSION CRITERIA 1: Foot and Ankle operative (surgical) patientsSUBMISSION CRITERIA 2: Foot and Ankle (non-surgical) patientsSUBMISSION CRITERIA 3: Knee operative (surgical) patientsSUBMISSION CRITERIA 4: Knee (non-surgical) patientsSUBMISSION CRITERIA 5: Hip and Pelvis operative (surgical) patientsSUBMISSION CRITERIA 6: Hip and Pelvis (non-surgical) patientsSUBMISSION CRITERIA 7: Foot, Ankle, Knee, Hip and Pelvis (surgical) patientsSUBMISSION CRITERIA 8: Foot, Ankle, Knee, Hip and Pelvis (non-surgical) patientsSUBMISSION CRITERIA 9: Foot, Ankle, Knee, Hip and Pelvis (surgical and non-surgical patients)ANDTwo face to face patient encounters for a treatment episode that began or ended during the performance period: GXXXX

Numerator Percentage of patients aged 18 years or older with a functional deficit related to the lower extremity functional status who achieve a Functional Status Change Residual Score with a Minimal Clinically Important Difference (MCID) to indicate functional improvement greater than zero and a Risk Adjusted Functional Status Change Residual Score for the lower extremity impairment successfully calculated with an MCID score that is greater than zero
Denominator Exclusions Hospice services received by patient at any time during the performance period: GXXXXORPatient unable to complete a LEFS or equivalent assessment tool due to blindness, illiteracy, severe mental incapacity or language incompatibility without the availability of an adequate proxy available: GXXXX
Denominator Exceptions None
Numerator Exclusions None
National Quality Strategy (NQS) Domain Effective Clinical Care
Measure Type Outcome
High Priority Yes
Measure Risk-Adjusted? Yes
Meaningful Measure Area Functional Outcomes
Meaningful Measure Area Rationale This measure utilizes patient-reported clinically recommended functional outcomes tracked by the clinician to indicate outcomes of care
Inverse Measure No
Proportional Measure Yes
Continuous Variable Measure No
Ratio Measure No


Measure Rationale

Functional deficits are common in the general population and are costly to the individual, their family and society. Improved functional status has been associated with greater quality of life, self-efficacy, improved financial well-being and lower future medical costs. Improving functional status in people seeking rehabilitation has become a goal of the American Physical Therapy Association. Therefore, measuring change in functional status is important for providers treating patients in rehabilitation and can be used to assess the success of treatment and direct modification of treatment.Change in functional status represents the Activities and Participation domain of the International Classification of Functioning, Disability and Health. If treatment is designed to improve the functional deficit, it is logical to assess functional status at the final visit, using a standardized score to determine if treatment improved the functional status of the patient over the treatment episode.Physical therapists are newly eligible for the MIPS program in 2019. The last period for which physical therapists participated in a Medicare quality reporting program was 2016. Per the CMS PQRS 2016 Experience Report (Table A7), for that period there were 46,011 physical therapists who participated in MIPS, 81.6% of eligible physical therapists. MIPS outcome measures for physical therapists do exist in the program. Per the CMS PQRS experience report (Table A16), there were between 765 and 1,319 users of FOTO that were eligible to report measures 217 – 223 in 2016. Therefore, we see a gap of at least 44,692 physical therapists in 2016 that were not eligible for these measures or other significant outcome measures. Today we still see that same gap.2.3% of the current 1,400+ MIPS-eligible users who have purchased the MIPS registry option in the WebPT EMR are manually calculating the risk adjusted change scores and submitting FOTO QDC codes through a custom field on the billing sheet in the EMR. By comparison, MIPS participants are using other PROs (e.g., Low back Disability Index, Oswestry, NDI, LEFS) to complete Measure 182, a process measure. MIPS-eligible clinicians are using surveys and are interested in outcomes but don’t have quality measures to demonstrate that intent other than the FOTO measures.With the new inclusion of physical therapists in the MIPS program, a significant population of physical therapists are utilizing EHRs and patient assessment tools that are directly feeding our Healthmonix registries. We are aiming to assist these clinicians in reporting meaningful patient reported outcome measures that are validated, reliable, and can be risk adjusted. We recognize that the current FOTO measures cited above provide such tools, however only a small percentage of our clinicians utilize those tools. In the spirit of Patients over Paperwork, we are aiming to meet the clinicians where they currently work, especially as they are already faced with the new challenge of participating in MIPS for the first time in 2019. Inclusion of new patient outcome focused measures in the MIPS program will reduce unnecessary burden in terms of time, effort, focus, and cost of potentially switching assessment tools. In addition, many of our clinicians work in organizations where the choice of outcome assessment tools is not their own, but mandated by their organization.The measures we are proposing are meaningful measures. They align with the principles of the Meaningful Measures initiative in that they are patient-centered, meaningful to patients, outcome-based, minimize the level of burden for providers, address a significant opportunity for improvement, and fulfill the requirements of the Macra MIPS program. They have been validated by the industry over time and provide the opportunity to incorporate risk adjustment as well.


Occupational Therapy QCDR Quality Measures-2021, Orthopedics QCDR Quality Measures-2021, Physical Therapy QCDR Quality Measures-2021, QCDR-2021