#221: Functional Deficit: Change in Risk-Adjusted Functional Status for Patients with Shoulder Impairments

Quality ID

221

NQF

0426

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

N/A

Measure description

A self-report outcome measure of change in functional status (FS) for patients 14 years+ with shoulder impairments. The change in functional status (FS) assessed using FOTO’s (shoulder) PROM (patient reported outcomes measure) is adjusted to patient characteristics known to be associated with FS 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.

 

Instructions

This outcomes measure is to be submitted once per treatment episode for all patients with a functional deficit related to the shoulder. This is an outcomes measure and its calculation requires submitting of the patient’s functional status score, as a minimum, at admission to and again at discharge from an episode of rehabilitation. The admission score, estimated using patient self-report surveys, is recorded during the first rehabilitation treatment encounter and the discharge score is recorded at or near the conclusion of the final rehabilitation treatment encounter. It is anticipated that physical and occupational therapists providing treatment for functional shoulder deficits will submit this measure.

Definitions:

Functional deficit – Limitation or impairment of physical abilities/function resulting in evaluation and inclusion in a treatment plan of care.

Treatment Episode – A Treatment Episode is defined as beginning with an Admission for a functional shoulder deficit, progressing to development of a plan of care, including treatment, without interruptionof care (for example, a hospitalization or surgical intervention), and ending with Discharge from clinical care by the eligible clinician. A patient currently under clinical care for a shoulder deficit remains in a single episode of care until the Discharge is conducted and documented by the eligible clinician.

Admission – An Admission is the first encounter for a functional deficit involving the shoulder andincludes an evaluation (CPT 97161, 97162, 97163 for physical therapy or 97165, 97166, 97167 for occupational therapy) and development of a plan of care by the eligible clinician. A patient presenting with a shoulder impairment, who has had an interruption of a Treatment Episode forthe same functional shoulder deficit secondary to an appropriate reason like hospitalization or surgical intervention, is a new Admission.

Discharge – Discharge is accompanied by a re-evaluation CPT 97164 for physical therapy, or 97168 for occupational therapy, or Functional Limitation Submitting Discharge Status G-Code (G8980, G8983, G8986, G8989, G8992 or G8995) identifying theclose of a Treatment Episode for the same shoulder deficit identified at admission and documented by a discharge report by the eligible clinician. An interruption in clinical care for an appropriate reasonlike hospitalization or surgical intervention requires a discharge from the current TreatmentEpisode.

Encounter – A face to face visit between the patient and the provider for the purpose of assessing and/or improving a functional deficit.

Patient Reported – The patient directly, or through a proxy, provides answers to functional statussurvey items using standardized, reliable and valid, computerized adaptive testing or paper and pencilsurvey methods.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients 14 years and older with shoulder impairments who have initiated rehabilitation treatment and completed the FOTO shoulder FS outcome instrument at admission and discharge

Option 1 – Physical Therapy Denominator Criteria (Eligible Cases):

All patients aged ≥ 14 years on date of encounter

AND

Patient encounter during the performance period identifying evaluation (CPT): 97161, 97162, 97163

AND

Patient encounter during the performance period identifying discharge (CPT or HCPCS): 97164, G8980, G8983, G8986, G8989, G8992, G8995

AND

Functional deficit affecting the shoulder

AND NOT

DENOMINATOR EXCLUSIONS:

Patient refused to participate: G9734

OR

Patient unable to complete the FOTO shoulder Intake PROM at admission and discharge due to blindness, illiteracy, severe mental incapacityor language incompatibility and an adequate proxy is not available: G9735

OR

Option 2 – Occupational Therapy Denominator Criteria (EligibleCases):

All patients aged ≥ 14 years on date of encounter

AND

Patient encounter during the performance period identifying evaluation (CPT): 97165, 97166, 97167

AND

Patient encounter during the performance period identifying discharge (CPT or HCPCS): 97168, G8980, G8983, G8986, G8989, G8992, G8995

AND

Functional deficit affecting the shoulder

AND NOT

DENOMINATOR EXCLUSIONS:

Patient refused to participate: G9734

OR

Patient unable to complete the FOTO shoulder Intake PROM at admission and discharge due to blindness, illiteracy, severe mental incapacityor language incompatibility and an adequate proxy is not available: G9735

 

Numerator

Patients who were presented with the FOTO Shoulder Functional Status measure at Admission (Intake) and Discharge (Status) for the purpose of calculating the patient’s Risk-adjusted Functional Status ChangeResidual Score

Definitions:

Patient’s Functional Status Score – A functional status score is produced when the patient completes the FOTO functional status survey (either by paper and pencil or computerized adaptive testingadministration). The functional status score is continuous and linear. Scores range from 0 to 100 with higher scores meaning higher functional abilities. The survey is standardized, and the scores are validated for the measurement of function forthis 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 Discharge.

Predicted Functional Status Change Score – Functional Status Change Scores for patients are risk adjusted using multiple linear regression methods that include the following independent variables:Patient’s Functional Status Score at Admission, patient age, symptom acuity, surgical history, gender, number of comorbidities and level of fear-avoidance. The Patient’s Functional Status Change Score is the dependent variable. The statistical regression produces a Risk-Adjusted Predicted Functional Status ChangeScore.

Risk-Adjusted Functional Status Change Residual Score – The difference between the raw non-riskadjusted 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 zero (0) or greater (> 0)should be interpreted as functional status change scores that were predicted or better than predicted given theriskadjustment variables of the patient and risk-adjusted residual change scores less than zero (< 0) shouldbe 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

Not Appropriate (Denominator Exception) – Prior to conclusion of Plan of Care, intervention was interrupted or discontinued for any reason includingby the referring physician, the provider, the payer or the patient, and attempts by the provider to complete a follow-up functional status survey near Discharge were unsuccessful.

Numerator Options:

Performance Met: Risk-Adjusted Functional Status ChangeResidual Score for the shoulder successfully calculated and the score was equal to zero (0) or greater than zero (> 0) (G8663)

OR

Performance Met: Risk-Adjusted Functional Status ChangeResidual Score for the shoulder successfully calculated and the score was less than zero (< 0) (G8664)

OR

Denominator Exception: Risk-Adjusted Functional Status ChangeResidual Scores for the shoulder not measured because the patient did not complete FOTO’s Functional Status Survey near discharge, patient Not Appropriate (G8665)

OR

Performance Not Met: Risk-Adjusted Functional Status ChangeResidual Scores for the shoulder not measured because the patient did not complete FOTO’s Functional Intake on admission and/or follow up Status Survey near discharge, reason not given (G8666)

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