2021 HM8: 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 one goal: 1) 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 lower extremity functional status,

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

FOOT:
Plantar fasciitis: M72.2
OR
Hallus valgus: M20.1*
OR
Bunion: M21.61*
OR
In-toeing: Q66.6
OR
Club foot: M21.54*, Q66.0, Q66.89
OR
Pes Planus: Q66.5*, M21.4
OR
Fractures of foot and toes: S92*

HIP:
Femoral acetabular impingement: M25.85*
OR
Hamstring tendinopathies: M67.85*, M70.85*, M76.89*, S76*
OR
Greater trochanteric pain syndrome: M70.6*, M70.7*, M76.1*, M76.2*, M25.55*
OR
Hip osteoarthritis: M16.*
OR
Hip Arthroplasty: Z47.1*, Z96.64*
OR
Fracture of femur: S72*
OR
Hip Arthroscopy Aftercare: Z47.1 AND appropriate code to indicate HIP
OR
Hip Arthroscopy: Z96.64
OR
Osteoarthritis of hip: M16.*
OR
Repetitive 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*
OR
Meniscal: S83.2*, M23.3*
Or
Patellofemoral dysfunction: M22.2X1, M22.2X2
OR
Tendon disorders: M76.3*, M76.5*
OR
Knee Arthroplasty: Z47.1*, Z96.65*
OR
Fractures of knee: S82.1*, S82.2*, S82.3*
OR
Knee Arthroscopy Aftercare: Z47.1 AND appropriate code to indicate KNEE
OR
Knee Arthroscopy: Z96.65
OR
Osteoarthritis of knee: M17.*
OR
Repetitive 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, M53.88
OR
Piriformis syndrome: G57.0*
OR
Fracture of pelvis: S32.3*, S32.4*, S32.5*, S32.6*,

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: Foot and Ankle operative (surgical) patients
SUBMISSION CRITERIA 2: Foot and Ankle (non-surgical) patient
SUBMISSION CRITERIA 3: Knee operative (surgical) patients
SUBMISSION CRITERIA 4: Knee (non-surgical) patients
SUBMISSION CRITERIA 5: Hip and Pelvis operative (surgical) patients
SUBMISSION CRITERIA 6: Hip and Pelvis (non-surgical) patients
SUBMISSION CRITERIA 7: Foot, Ankle, Knee, Hip and Pelvis (surgical) patients
SUBMISSION CRITERIA 8: Ankle, Knee, Hip and Pelvis (non-surgical) patients
SUBMISSION CRITERIA 9: Foot, Ankle, Knee, Hip and Pelvis (surgical and non-surgical patients)

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 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
OR
Patient 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

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

9

Risk-Adjusted Status?

No