2021 HM6: Functional Status Change for Patients With Low Back Functional Status Deficit

Measure Description

Percentage of patients aged 18 years or older with a functional deficit related to the low back who achieve a Minimal Clinically Important Difference (MCID) in the Modified Oswestry Low Back Pain Questionnaire (ODI) 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 low back functional status on an index visit:

Instability: M53.2X5, M53.2X6, M53.2X7
OR
Spondylosis/spondylolisthesis: M45*, M43.1*, M47*
OR
Disc protrusion/Prolapse: M51.0*, M51.1*, M51.2*, M51.3*, M51.4*, M51.8*, S33.0*
OR
Stenosis: M48.0*, M99.7*
OR
Sprain: S33.1*, S33.5*, S39.0*
OR
Strain: S39.002, S39.012
OR
Treatment Signs and symptoms associated with back: M54.4*, M54.5*, M54.9*
AND
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 (surgical)
Submission Criteria 2: All patients (non-surgical)
Submission Criteria 3: All patients (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 low back 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 low back impairment successfully calculated with an MCID score that is greater than zero

Numerator Options:

NUMERATOR COMPONENT 1: (SUBMISSION CRITERIA 1 & 2 & 3):

The percentage of patients who achieve a functional status change residual score for the low back impairment successfully calculated with an MCID score that is greater than zero

Performance Met: Functional Status Change Residual Score for the low back impairment successfully calculated and the MCID score that is greater than zero (> 0)
OR
Performance Not Met: Functional Status Change Residual Score for the low back impairment successfully calculated and the MCID score that is less than or equal to zero (≤ 0)
OR
Performance Not Met: Functional Status Change Residual Score for the low back impairment not measured because the patient did not complete the functional status Intake Survey on Initial Evaluative Encounter and/or follow up functional Status Survey near the Final Visit, reason not given
AND

NUMERATOR COMPONENT 2: (SUBMISSION CRITERIA 1 & 2 & 3):

The percentage of patients aged 14 years or older with a functional deficit related to the low back functional status who achieve a Risk Adjusted Functional Status Change Residual Score for the low back impairment successfully calculated with an MCID score that is greater than zero

Performance Met: Risk Adjusted Functional Status Change Residual Score for the low back impairment successfully calculated and the MCID score that is greater than zero (> 0)
OR
Performance Not Met: Risk Adjusted Functional Status Change Residual Score for the low back impairment successfully calculated and the MCID score that is less than or equal to zero (≤ 0)
OR
Performance Not Met: Risk Adjusted Functional Status Change Residual Score for the low back impairment not measured because the patient did not complete the functional status Intake Survey on Initial Evaluative Encounter and/or follow up functional Status Survey near the Final Visit, reason not given

Denominator Exclusions

Hospice services received by patient at any time during the performance period
OR
Patient unable to complete a ODI 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