2022 QCDR Measure: Functional Status Change for Patients with Vestibular Dysfunction

Measure ID

HM7

Measure Title

Functional Status Change for Patients with Vestibular Dysfunction

Measure Description

Percentage of patients aged 14 years and older diagnosed with vestibular dysfunction who achieve a Minimal Clinically Important Difference (MCID) to indicate functional, emotional, and physical improvement

• Submission Age Criteria 1: Patients aged 14-17 years of age
• Submission Age Criteria 2: Patients aged 18-64 years of age
• Submission Age Criteria 3: Patients aged 65 years and older
• Submission Criteria 4: Overall total rate of patients aged 14 years and older
• Submission Risk Adjusted Criteria 5: Overall total rate of patients aged 14 and older

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, and at the clinic level to assess quality.

Denominator Description

Denominator Criteria (Eligible Cases):

SUBMISSION CRITERIA 1: Patients aged 14-17 years of age on date of encounter

SUBMISSION CRITERIA 2: Patients aged 18-64 years and older on date of encounter

SUBMISSION CRITERIA 3: Patients aged 65 years of age and older on date of encounter

SUBMISSION CRITERIA 4: Patients aged 14 years of age and older on date of encounter

SUBMISSION CRITERIA 5: Patients aged 14 years of age and older on date of encounter  

AND

A diagnosis of vestibular dysfunction diagnosis (ICD-10-CM): BPPV: H81.10, H81.11, H81.12, H81.13

OR

Dizziness: R42, H81.10, H81.11, H81.12, H81.13,

OR

Disorders of vestibular function: H81*

 OR

Vertiginous syndromes: H82*

 OR

Other diseases of inner ear: H83*

 OR

Abnormalities of gait and mobility: R26*

 OR

Other lack of coordination: R27*

 OR

Repeated falls: R29.6

 OR

Concussion: S06.0*, F07.81

 OR

History of falling: Z91.81

 OR

Epidemic vertigo: A88.1

 OR

Benign neoplasm of cranial nerves: D33.3

 OR

Migraine: B43.109, G43.819

 AND

An Index Patient Visit Indicator:

Physical Therapy CPT: 97161, 97162, 97163

OR

Occupational Therapy CPT: 97165, 97166, 97167

AND

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

Definition:

Validated functional assessment tool – A standardized assessment tool that has been scientifically normed statistically validated and/or accepted as an industry standard in functional assessment tool for the symptom and patient population being assessed. An example of a scientifically normed and validated tool for functional outcome assessment includes but is not limited to the Dizziness Handicap Inventory (DHI). A provider or facility developed tool that has not been scientifically normed, statistically validated and/or accepted as an industry standard in functional assessment tool would not meet the intent of this measure.

Encounter – A face to face visit between the patient and the provider for the purpose of assessing and/or improving a functional deficit during a treatment episode.  May include an admission and/or discharge encounter during the performance period.

Treatment Episode – A Treatment Episode is defined as beginning with an Admission for vestibular dysfunction progressing to development of a plan of care, including treatment, without interruption of care (for example a hospitalization or surgical intervention), and ending with Discharge from clinical care by the clinician. A patient currently under clinical care for dizziness remains in a single episode of care until the Discharge is conducted and documented by the eligible clinician. If the patient had multiple treatment episodes during the performance period, then the most recent treatment episode would be utilized to calculate performance.

Admission Encounter – An admission encounter is the first encounter for vestibular dysfunction and includes an evaluation and are typically be represented by CPT codes: 97161, 97162, 97163 for physical therapy or 97165, 97166, 97167 for occupational therapy, CPT 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215 for physician or 98940, 98941, 98942, 98943 for chiropractic care) and development of a plan of care by the eligible clinician. A patient presenting with a vestibular dysfunction, who has had an interruption of a Treatment Episode for the same vestibular dysfunction secondary to an appropriate reason like hospitalization or surgical intervention, is a new Admission.

Discharge Encounter – A discharge encounter is accompanied by a re-evaluation CPT 97164 for physical therapy, or 97168 for occupational therapy, or Functional Limitation Submitting Discharge Status identifying the close of a Treatment Episode for the same vestibular dysfunction identified at admission and documented by a discharge report by the eligible clinician. An interruption in clinical care for an appropriate reason like hospitalization or surgical intervention requires a discharge from the current Treatment Episode.

Denominator Exclusion : A patient refusal or failure to collect a pre and/or post treatment survey collection would not meet the intent of this denominator exclusion.  Illiteracy is defined as the patient’s inability to obtain understanding or process basic information about services, symptoms or patient response in a manner that impairs the patient’s ability to participate in answering/completing the patient reported outcome tool and/or to communicate the baseline and outcome information needed for performance determination.

Numerator Description

Patients who achieved a MCID in vestibular dysfunction, as measured via the validated Dizziness Handicap Inventory or equivalent instrument, to indicate functional improvement greater than zero and a Risk Adjusted Functional Status Change Residual Score for the dizziness handicap successfully calculated with an MCID score that is greater than zero from their initial visits and just prior to or at their discharge visits from the PT/OT practice

Definition:

Patient’s Functional Status Score – A functional status score is produced when the patient or patient proxy completes the functional status measure (either by paper and pencil or electronic versions). The measure is standardized for each validated tool, and the scores are validated for the measurement of function for this population.

Patient’s Functional Status Change Score – A functional status change score is calculated by subtracting the Patient’s Functional Status Score at Admission from the Patient’s Functional Status Score at or near the conclusion of the final rehabilitation treatment encounter or patient discharge.

Minimal Clinically Important Difference (MCID)-  Minimal Clinically Important Difference is defined as the smallest change in a treatment outcome obtained via a validated patient derived tool that reflect changes in clinical intervention that a patient identifies as important and meaningful for functional, emotional, and physical improvement via a validated and standardized validation tool such as the Dizziness Handicap Inventory (DHI) or equivalent instrument which has undergone peer reviewed published validation. MCID is calculated using patients who were presented with a DHI or equivalent assessment tool at Admission (Intake) AND just prior to or at Discharge (Status) for the purpose of calculating the patient’s Functional Status Change Residual Score for the treatment episode.

NUMERATOR NOTE:  https://www.archives-pmr.org/article/S0003-9993(13)00538-8/pdf  The DHI is reliable and valid for adults with peripheral and central vestibular pathology, multiple sclerosis, posttraumatic brain injury, whiplash-associated disorders, and benign paroxysmal positional vertigo.

Numerator Options (SUBMISSION CRITERIA 1 & 2 & 3 & 4):

Performance Met: Functional Status Change Residual Score for the vestibular dysfunction successfully calculated and the score was greater than zero (> 0)

OR

Performance Not Met: Functional Status Change Residual Score for the vestibular dysfunction successfully calculated and the score was less than or equal to zero (≤ 0)

OR

Performance Not Met: Functional Status Change Residual Score for the vestibular dysfunction not measured because the patient did not complete the functional status Intake Survey on admission and/or follow up DHI or equivalent instrument near discharge, reason not given

NUMERATOR (SUBMISSION CRITERIA 5):

Patients who achieved a MCID in vestibular dysfunction from their initial visits and just prior to or at their discharge visits from the PT/OT practice

Definition:

Patient’s Functional Status Score – A functional status score is produced when the patient or patient proxy completes the functional status measure (either by paper and pencil or electronic versions). The measure is standardized for each validated tool, and the scores are validated for the measurement of function for this population.

Patient’s Functional Status Change Score – A functional status change score is calculated by subtracting the Patient’s Functional Status Score at Admission from the Patient’s Functional Status Score at or near the conclusion of the final rehabilitation treatment encounter or patient discharge.

Minimal Clinically Important Difference (MCID)-  Minimal Clinically Important Difference is defined as the smallest change in a treatment outcome obtained via a validated patient derived tool that reflect changes in clinical intervention that a patient identifies as important and meaningful for functional, emotional, and physical improvement via a validated and standardized validation tool such as the Dizziness Handicap Inventory (DHI) or equivalent instrument which has undergone peer reviewed published validation. MCID is calculated using patients who were presented with a DHI or equivalent assessment tool at Admission (Intake) AND just prior to or at Discharge (Status) for the purpose of calculating the patient’s Functional Status Change Residual Score for the treatment episode.

Predicted Functional Status Change Score – Functional Status Change Scores for patients are risk adjusted using multiple factors, including the following independent variables: Patient’s Functional Status Score at Admission, patient age, symptom acuity, surgical history, gender, specific co-morbidities, use of medication for the condition at Intake, exercise history, history of previous treatment for the condition and type of post-surgical status. The Patient’s Functional Status Change Score is the dependent variable. For each patient completing a functional status assessment at admission (intake), the model provides a risk-adjusted prediction of functional status change at discharge.

Risk-Adjusted Functional Status Change Residual Score – The difference between the raw non-risk- adjusted Patient’s Functional Status Change Score and the Risk-Adjusted Predicted Functional Status Change Score (raw minus predicted) is the Risk-Adjusted Functional Status Change Residual Score, which is in the same units as the Patient’s Functional Status Scores, and should be interpreted as the unit of functional status change different than predicted given the risk-adjustment variables of the patient being treated. As such, the Risk-Adjusted Residual Change Score represents Risk-Adjusted Change corrected for the level of severity of the patient. Risk-Adjusted Residual Change Scores of greater than zero (>0) should be interpreted as functional status change scores that were predicted or better than predicted given the risk- adjustment variables of the patient, and risk-adjusted residual change scores less than or equal to zero (≤ 0) should be interpreted as functional status change scores that were less than predicted given the risk-adjustment variables of the patient. Aggregated Risk-Adjusted Residual Scores allow meaningful comparisons amongst clinicians or clinics.

Numerator Option (SUBMISSION CRITERIA 5):

Performance Met: Risk-Adjusted Functional Status Change Residual Score for the vestibular dysfunction successfully calculated and the score was greater than zero (> 0)

OR

Performance Not Met: Risk-Adjusted Functional Status Change Residual Score for the vestibular dysfunction successfully calculated and the score was equal to or less than zero (≤ 0)

OR

Performance Not Met: Risk-Adjusted Functional Status Change Residual Score for the vestibular dysfunction not measured because the patient did not complete the functional status Intake Survey on admission and/or follow up DHI or equivalent instrument near discharge, reason not given

Denominator Exclusions

Hospice services received by patient at any time during the performance period

OR

Patient unable to complete a DHI or equivalent instrument at admission and discharge due to blindness, illiteracy, severe mental incapacity or language incompatibility without the availability of an adequate proxy available: PRO7.3Y

NQF Number

N/A

NQS Domain

Effective Clinical Care

High Priority Measure

Yes

High Priority Type

Outcome

Measure Type

Patient Reported Outcome

Meaningful Measure Area

Functional Outcomes

Inverse Measure

No

Proportional Measure

Yes

Continuous Variable Measure

No

Ratio Measure

No

Number of performance rates to be submitted

4

Measure Risk-Adjusted?

Yes

Care Setting(s)

Ambulatory Care: Clinician Office / Clinic