2021 QCDR Measure #008: Functional Status Change for Patients With Lower Extremity Functional Status Deficit 

Measure Rationale

Functional deficits are common in the general population and are costly to the individual, their family and society. Improved functional status has been associated with greater quality of life, self-efficacy, improved financial well-being and lower future medical costs. Improving functional status in people seeking rehabilitation has become a goal of the American Physical Therapy Association. Therefore, measuring change in functional status is important for providers treating patients in rehabilitation and can be used to assess the success of treatment and direct modification of treatment.Change in functional status represents the Activities and Participation domain of the International Classification of Functioning, Disability and Health. If treatment is designed to improve the functional deficit, it is logical to assess functional status at the final visit, using a standardized score to determine if treatment improved the functional status of the patient over the treatment episode.Physical therapists are newly eligible for the MIPS program in 2019. The last period for which physical therapists participated in a Medicare quality reporting program was 2016. Per the CMS PQRS 2016 Experience Report (Table A7), for that period there were 46,011 physical therapists who participated in MIPS, 81.6% of eligible physical therapists. MIPS outcome measures for physical therapists do exist in the program. Per the CMS PQRS experience report (Table A16), there were between 765 and 1,319 users of FOTO that were eligible to report measures 217 – 223 in 2016. Therefore, we see a gap of at least 44,692 physical therapists in 2016 that were not eligible for these measures or other significant outcome measures. Today we still see that same gap.2.3% of the current 1,400+ MIPS-eligible users who have purchased the MIPS registry option in the WebPT EMR are manually calculating the risk adjusted change scores and submitting FOTO QDC codes through a custom field on the billing sheet in the EMR. By comparison, MIPS participants are using other PROs (e.g., Low back Disability Index, Oswestry, NDI, LEFS) to complete Measure 182, a process measure. MIPS-eligible clinicians are using surveys and are interested in outcomes but don’t have quality measures to demonstrate that intent other than the FOTO measures.With the new inclusion of physical therapists in the MIPS program, a significant population of physical therapists are utilizing EHRs and patient assessment tools that are directly feeding our Healthmonix registries. We are aiming to assist these clinicians in reporting meaningful patient reported outcome measures that are validated, reliable, and can be risk adjusted. We recognize that the current FOTO measures cited above provide such tools, however only a small percentage of our clinicians utilize those tools. In the spirit of Patients over Paperwork, we are aiming to meet the clinicians where they currently work, especially as they are already faced with the new challenge of participating in MIPS for the first time in 2019. Inclusion of new patient outcome focused measures in the MIPS program will reduce unnecessary burden in terms of time, effort, focus, and cost of potentially switching assessment tools. In addition, many of our clinicians work in organizations where the choice of outcome assessment tools is not their own, but mandated by their organization.The measures we are proposing are meaningful measures. They align with the principles of the Meaningful Measures initiative in that they are patient-centered, meaningful to patients, outcome-based, minimize the level of burden for providers, address a significant opportunity for improvement, and fulfill the requirements of the Macra MIPS program. They have been validated by the industry over time and provide the opportunity to incorporate risk adjustment as well.