Measure Title: Failure to Progress (FTP): Proportion of patients failing to achieve a Minimal Clinically Important Difference (MCID) to indicate functional improvement in knee rehabilitation of patients with knee injury measured via their validated Knee Outcome Survey (KOS) score, or equivalent instrument which has undergone peer reviewed published validation and demonstrates a peer reviewed published MCID.
Measure Description: The proportion of patients failing to achieve an MCID of ten (10) points or more improvement in the KOS change score for patients with knee injury treated during the observation period will be reported.
Additionally, a risk-adjusted MCID proportional difference will be 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 KOS 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.
Denominator: 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.
Numerator: The total number of patients with knee injuries to not achieve an MCID in their KOS change score (MCID greater than or equal to 10) from their initial visits to their final visits in PT/OT practice or PT/OT group during the observation window.
Denominator Exclusions: Patients who are less than 18 years old Patients who did not complete 2 or more surveys 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 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: 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.
NQF ID Number: N/A
NQS Domain: Effective Clinical Care
High Priority Measure: Yes
Measure Type: Outcome
Includes Teleheatlh: Yes
Inverse Measure: Yes
Proportional Measure: Yes
Continuous Variable Measure: No
Ratio Measure: No
Number of performance rates to be calculated and submitted: 6
Risk-Adjusted Status: Yes
Care Setting: Ambulatory Care: Clinician Office/Clinic; Home Care; Outpatient Services; Post-Acute Care; Ambulatory Surgical Center
Submission Pathway: Traditional MIPS