Measure Title: Failure to Progress (FTP): Proportion of patients failing to achieve a Minimal Clinically Important Difference (MCID) in improvement in pain score, measured via the Numeric Pain Rating Scale (NPRS), in rehabilitation patients with low back pain.
Measure Description: The proportion of patients failing to achieve an MCID of two (2) points or more improvement in the NPRS change score for patients with low back pain 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 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 physical or occupational therapy performance measure at the eligible physical or occupational therapist or physical or occupational therapy group level.
Denominator: The total number of patients with low back pain evaluated and treated by a physical therapist (PT) or Occupational Therapist (OT), or PT or OT Group.
Numerator: The total number of patients with low back pain to not achieve an MCID in their NPRS change score (MCID greater than or equal to 2) 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 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: 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 judgment 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