2023 # MBHR03 Pain Interference Response utilizing PROMIS

Measure Title: Pain Interference Response utilizing PROMIS

Description: The percentage of adult patients (18 years of age or older) who report chronic pain issues and demonstrated a response to treatment at one month from the index score.

To see additional details, please view the workflow diagram for this measure: View diagram

This measure relies on the PROMIS Pain Interference assessment tool, which can be found here.

Denominator: 

Adult patients (18 years of age or older) who report chronic pain issues (i.e., persistent pain for at least 90 days) as significantly impacting their life

Denominator Criteria (Eligible cases):
Patients ages >= 18
AND
Patients report chronic pain (i.e., persistent pain for at least 90 days)

AND

Patient Encounter CPT codes: 0362T, 0373T, 90785, 90791, 90792, 90832,90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90875, 90876, 96110, 96112, 96113, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171, 96178, 97129, 97130, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 98966, 98967, 98968, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215,99354,  99355, 99406, 99407, 99408, 99409, 99446, 99447, 99448, 99449, 99484, 99492, 99493, 99494, G2011, G2061, G2062, G2063, G0396, G0397, G0402, G0438, G0439 

AND
Patient self-reported pain impacting their life identified by a PROMIS Pain Interference short form of at least 4 items or computer adaptive test score > 60 (using T-score metric)

Numerator: The number of patients in the denominator who demonstrated a response to treatment via a PROMIS Pain Interference score that is reduced by 2 or more points from the index score, one month (+/- 21 days) after the index visit.

Denominator Exclusions: 

• Patients who die OR
  • Are enrolled in hospice in the measurement year OR
  • Are unable to complete the PROMIS Pain Interference measure at follow-up due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, AND a suitable recorder (e.g., advocate) is not available

Denominator Exceptions: 

• Patient refused to complete a PROMIS Pain Interference measure at follow-up OR
• Ongoing care not indicated (e.g., referred to another provider or facility, consultation only) OR
• Patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) OR
• Medical reasons (e.g., scheduled for surgery or hospitalized)

National Quality Forum (NQF) number, if applicable
N/A

Care setting(s) 
Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Home Care; Hospital; Hospital Inpatient; Hospital Outpatient; Long Term Care; Nursing Home; Outpatient Services; Rehabilitation Facility; Rehabilitation Facility: Inpatient

Telehealth, if applicable
Yes

Number of performance rates required for measures
1

Traditional vs. inverse measure
Traditional

Proportional, continuous variable, and/or ratio measure indicator
Proportional

Risk adjustment, if applicable
No

Submission pathway 
Traditional MIPS