LOW BACK PAIN FUNCTIONAL IMPROVEMENT
Failure to Progress (FTP): Proportion of patients failing to achieve a Minimal Clinically Important Difference (MCID) to indicate functional improvement in rehabilitation of patients with low back pain measured via their validated Modified Low Back Pain Disability Questionnaire (MDQ) score.
The proportion of patients failing to achieve an MCID of six (6) points or more improvement in the MDQ change score for patients with low back pain treated during the observation period will be reported.
Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will reported for each physical therapist or physical therapy group. The risk adjustment will be calculated using a logistic regression model using: baseline MDQ score, baseline pain score, age, sex, payer, and symptom duration (time from surgery or injury to baseline physical therapy visit). These measures will serve as a PT/OT performance measure at the eligible PT/OT or PT/OT group level.
The total number of all patients with knee injury evaluated and treated by a PT or OT, or PT or OT Group, during the observation window.
The total number of patients with low back pain to not achieve an MCID in their MDQ change score (MCID ≥6) from their initial visits to their final visits in PT/OT practice or PT/OT group during the observation window.
Denominator Exclusions (IROMS_Exclude)
Patients who are < 18 years old. Patients that are non-English speaking and translation services are unavailable. Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS patient reported outcome (PRO). Patients that have a life expectancy of 6 months or less. Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15.
Denominator Exceptions (IROMS_Exception)
Ongoing care not indicated, patient seen only 1-2 visits (e.g., home program only, referred to another provider or facility, consultation only, or discharged due to significant decline in medical status as documented in the medical record). PT/OT can use their clinical judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Effective Clinical Care
High Priority Measure
High Priority Type
Patient Reported Outcome
Meaningful Measure Area
Continuous Variable Measure
Number of performance rates to be submitted
Ambulatory Care: Clinician Office / Clinic, Home Care, Outpatient Services, Post-Acute Care, and Telehealth