2021 HM5: Functional Status Change for Patients With Neck Functional Status Deficit

Measure Description

Percentage of patients aged 18 years or older with a functional deficit related to the neck who achieve a Minimal Clinically Important Difference (MCID) in the Neck Disability Index (NDI) or equivalent score that indicates a functional improvement greater than zero. One rate will be reported:

• The Risk-Adjusted MCID proportional difference where the difference between the risk adjusted predicted MCID and the observed MCID (measured via NDI or equivalent tool) 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

Denominator Criteria (Eligible cases):

All patients aged 18 years or older with a functional deficit related to the neck functional status, ICD-10-CM on an index visit:

Cervicogenic headache: G44*, M99.00, M99.01, R51*
OR
Cervical instability: M53.2*
OR
Whiplash: S13.4
OR
Cervical radiculopathy: M47.81*, M50*, M54.1*
OR
Degenerative disc disease and disorders: M50*, S13.0*
OR
Stenosis: M47.2*, M48.0*, M99.7*
OR
Sprain: S13.1*, S13.2*, S13.4*, S13.5*
OR
Strain: S16*

An Index Patient Visit Indicator:
Physical Therapy CPT: 97161, 97162, 97163
OR
Occupational Therapy CPT: 97165, 97166, 97167

Denominator Criteria (Eligible Cases):
Submission Criteria 1: All patients Neck (surgical)
Submission Criteria 2: All patients Neck (non-surgical)
Submission Criteria 3: All patients Neck (surgical and non-surgical)

AND

Two face to face patient encounters for a treatment episode that began or ended during the performance period

Numerator

Percentage of patients aged 18 years or older with a functional deficit related to the neck 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 neck 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
OR
Patient unable to complete a NDI or equivalent assessment tool due to blindness, illiteracy, severe mental incapacity or language incompatibility without the availability of an adequate proxy available

Denominator Exceptions

N/A

Numerator Exclusions

N/A

NQF ID Number

N/A

NQS Domain

Effective Clinical Care

High Priority Measure

Yes

Includes Telehealth?

Yes

Inverse Measure

No

Proportional Measure

Yes

Continuous Variable Measure

No

Ratio Measure

No

Number of performance rates to be calculated and submitted

3

Risk-Adjusted Status?

No