#470: Average Change In Functional Status Following Total Knee Replacement Surgery

Quality ID

470

NQF

2653

High Priority Measure

Yes

Specifications

Registry

Measure Type

Outcome

Specialty

Orthopedic Surgery

Measure Description

The average change (preoperative to postoperative) in functional status using the Oxford Knee Score (OKS) for patients age 18 and older who had a primary total knee replacement

 

Instructions

This measure is to be submitted each time a patient undergoes a total knee replacement during the denominator identification period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. Unique to this measure is the Minimum Process of Care Performance Threshold Requirement. This measure based threshold requires that at least 50% of the denominator eligible patients must have both a preoperative and postoperative functional status assessment completed. Therefore, if the performance rate for Submission Criteria One is below 50%, the MIPS eligible clinician would not be able to meet the denominator of the Submission Criteria Two and this measure CANNOT BE SUBMITTED. CMS anticipates that the sum of change for the Submission Criteria Two will be calculated using 100% of procedures that met performance in Submission Criteria One.

NOTE: The standard program requirement of Data Completeness for all denominator eligible procedures (those receiving total knee replacement procedure) must be submitted.

This measure contains elements of a proportion or rate and a simple average of the change in functional status preoperatively to postoperatively among patients having received a total knee replacement procedure. The measure intent is that MIPS eligible clinicians will submit all denominator eligible procedures for performance calculation.

A preoperative and postoperative functional status assessment using the Oxford Knee Score (OKS) a patient reported outcome tool within three months preoperatively AND at one year (9 to 15 months) postoperatively for at least 50% of denominator eligible patients receiving a total knee replacement procedure is a denominator inclusion criterion to be eligible to submit this performance measure - the average change in preoperative to postoperative functional status (Submission Criteria Two). A MIPS eligible clinician must submit 100% of the population identified with a preoperative and postoperative functional status assessment (Performance Met Criteria for Submission Criteria One) of this measure for Submission Criteria Two.

Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

THERE ARE TWO SUBMISSION CRITERIA FOR THIS MEASURE:

1) Patients 18 years of age or older as of October 1 of the denominator identification period who had a primary total knee replacement procedure performed during the denominator identification period

AND

2) Average change (preoperative to one year postoperative) in functional status for all eligible patients 18 years of age or older as of October 1 of the denominator identification period who had a primary total knee replacement procedure performed during the denominator identification period and whose functional status was measured by the Oxford Knee Score (OKS) patient reported outcome tool within three months preoperatively and at one year (9 to 15 months) postoperatively

 

SUBMISSION CRITERIA 1: PATIENTS 18 YEARS OF AGE OR OLDER AS OF OCTOBER 1 OF THE DENOMINATOR IDENTIFICATION PERIOD WHO HAD A PRIMARY TOTAL KNEE REPLACEMENT PROCEDURE PERFORMED DURING THE DENOMINATOR IDENTIFICATION PERIOD

Denominator (Submission Criteria 1)

Patients 18 years of age or older as of October 1 of the denominator identification period who had a total knee replacement procedure performed during the denominator identification period

Definition:

Denominator Identification Period - The twelve month period in which eligible patients have a denominator eligible procedure. This allows for enough time for a follow-up assessment to occur during the twelve month performance period. The denominator identification period includes dates of procedure 10/1/2017 to 9/30/2018.

Denominator Criteria (Eligible Cases) 1:

Patients aged ≥ 18 years by October 1 of the Denominator Identification Period

AND

Patient procedure during performance period (CPT): 27445, 27446, 27447

 

Numerator (Submission Criteria 1)

All eligible patients whose functional status was measured by the Oxford Knee Score (OKS) patient reported outcome tool within three months preoperatively AND at one year (9 to 15 months) postoperatively

Definition:

Denominator Identification Period - The twelve month period in which eligible patients have a denominator eligible procedure. This allows for enough time for a follow-up assessment to occur during the twelve month performance period. The denominator identification period includes dates of procedure 10/1/2017 to 9/30/2018.

Measure Assessment Period (Performance Period) - The period of time following the procedure date that is in which a postoperative Oxford Knee Score (OKS) functional status score can be obtained.

Preoperative Assessment Oxford Knee Score (OKS) - A preoperative Oxford Knee Score (OKS) functional assessment score can be obtained from the patient any time up to three months preoperatively, inclusive of the date of the procedure. Assessment scores obtained via a telephone screening or more than three months before the procedure will not be used for measure calculation.

Postoperative Assessment Oxford Knee Score (OKS) - A postoperative Oxford Knee Score (OKS) functional assessment score can be obtained from the patient one year (9 to 15 months) after the date of procedure. Assessment scores obtained via a telephone screening or prior to nine months and after fifteen months postoperatively will not be used for measure calculation.

Oxford Knee Score (OKS) patient Reported Outcome Tool - The Oxford Knee Score (OKS) is a 12-item patient-reported outcome tool PRO specifically designed and developed to assess function and pain after total knee replacement (TKR) surgery (arthroplasty). It is short, reproducible, valid and sensitive to clinically important changes. The OKS was designed to be completed by the patient thus minimizing potential bias unwittingly introduced by surgeons when assessing the results themselves. The PRO was designed and developed by researchers at Oxford University Innovation and the University of Oxford. A copy of the tool can be obtained below or at the following link: https://innovation.ox.ac.uk/outcome-measures/oxford-knee-score-oks/. Indicate that this tool is for use in a CMS program and licensing fees should be waived. https://innovation.ox.ac.uk/clinical-outcomes/information-for-cms-members/

NUMERATOR NOTE: In the event that a patient’s functional status is measured by the Oxford Knee Score (OKS) within three months preoperatively OR at one year (9 to 15 months) postoperatively, but not for both the preoperative and postoperative functional status measurements, then submit Performance Not Met M1046. In the event that a patient’s functional measurement status is unknown OR was obtained via a telephone screening OR was measured by the Oxford Knee Score (OKS) greater than three months preoperatively OR more than one year (9 to 15 months) postoperatively, then submit Performance Not Met M1046. In the event that a patient’s functional status is measured using a different patient reported functional status assessment tool for either the preoperative or postoperative functional status assessment measurement, then submit Performance Not Met M1046.

Numerator Options:

Performance Met: Functional status measurement with score was obtained utilizing the Oxford Knee Score (OKS) patient reported outcome tool within three months preoperatively AND at one year (9 to 15 months) postoperatively (M1045)

OR

Performance Not Met: Functional status measurement with score was not obtained utilizing the Oxford Knee Score (OKS) patient reported outcome tool within three months preoperatively AND at one year (9 to 15 months) postoperatively (M1046)

 

SUBMISSION CRITERIA 2: AVERAGE CHANGE (PREOPERATIVE TO ONE YEAR POSTOPERATIVE) IN FUNCTIONAL STATUS FOR ALL ELIGIBLE PATIENTS 18 YEARS OF AGE OR OLDER AS OF OCTOBER 1 OF THE DENOMINATOR IDENTIFICATION PERIOD WHO HAD A PRIMARY TOTAL KNEE REPLACEMENT PROCEDURE PERFORMED DURING THE DENOMINATOR IDENTIFICATION PERIOD AND WHOSE FUNCTIONAL STATUS WAS MEASURED BY THE OXFORD KNEE SCORE (OKS) PATIENT REPORTED OUTCOME TOOL WITHIN THREE MONTHS PREOPERATIVELY AND AT ONE YEAR (9 TO 15 MONTHS) POSTOPERATIVELY

Denominator (Submission Criteria 2)

Patients 18 years of age or older as of October 1 of the denominator identification period who had a total knee replacement procedure performed during the denominator identification period and whose functional status was measured by the Oxford Knee Score (OKS) patient reported outcome tool within three months preoperatively AND at one year (9 to 15 months) postoperatively

Definition:

Denominator Identification Period - The twelve month period in which eligible patients have a denominator eligible procedure. This allows for enough time for a follow-up assessment to occur during the twelve month performance period. The denominator identification period includes dates of procedure 10/1/2017 to 9/30/2018.

Measure Assessment Period (Performance Period) - The period of time following the procedure date that is in which a postoperative Oxford Knee Score (OKS) functional status score can be obtained.

Preoperative Assessment Oxford Knee Score (OKS) - A preoperative Oxford Knee Score (OKS) functional assessment score can be obtained from the patient any time up to three months preoperatively, inclusive of the date of the procedure. Assessment scores obtained via a telephone screening or more than three months before the procedure will not be used for measure calculation.

Postoperative Assessment Oxford Knee Score (OKS) - A postoperative Oxford Knee Score (OKS) functional assessment score can be obtained from the patient one year (9 to 15 months) after the date of procedure. Assessment scores obtained via a telephone screening or prior to nine months and after fifteen months postoperatively will not be used for measure calculation.

Oxford Knee Score (OKS) patient Reported Outcome Tool - The Oxford Knee Score (OKS) is a 12-item patient-reported outcome tool PRO specifically designed and developed to assess function and pain after total knee replacement (TKR) surgery (arthroplasty). It is short, reproducible, valid and sensitive to clinically important changes. The OKS was designed to be completed by the patient thus minimizing potential bias unwittingly introduced by surgeons when assessing the results themselves. The PRO was designed and developed by researchers at Oxford University Innovation and the University of Oxford. A copy of the tool can be obtained below or at the following link: https://innovation.ox.ac.uk/outcome-measures/oxford-knee-score-oks/. Indicate that this tool is for use in a CMS program and licensing fees should be waived. https://innovation.ox.ac.uk/clinical-outcomes/information-for-cms-members/

Denominator Criteria (Eligible Cases) 2:

Minimum Process of Care Threshold Requirement: MIPS eligible clinician has at least 50% of all eligible patients receiving primary total knee replacement procedure that have a functional status measured with the Oxford Knee Score (OKS) patient reported outcome tool within 3 months preoperatively AND at 1 year (9 to 15 months) postoperatively

AND

Functional status was measured by the Oxford Knee Score (OKS) patient reported outcome tool within three months preoperatively AND at one year (9 to 15 months) postoperatively: M1047

 

Numerator (Submission Criteria 2)

The average change (preoperative to one year postoperative) in functional status for all eligible patients

NUMERATOR NOTE: For the purposes of submitting this measure Data Completeness has been determined in Submission Criteria One. The rate calculated for Submission Criteria Two of this measure is calculated using the subset of patients identified in the Performance Met Numerator Option of Submission Criteria One.

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