2023 Limber Health Outcomes Quality Measure Specifications

LMBR1: Patients Suffering from a Knee Injury who Improve Physical Function

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from a Knee injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Physical Function Computer Adaptive Testing, mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score.

In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics.

This measure will include three rates:
1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Physical Function or like mapped measure.
2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Physical Function or like mapped measure.
3) The overall performance rate of Rate 1 and Rate 2 combined. 

Denominator: All patients 18 years or older with a knee injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with a knee injury who achieve an overall score change of 2.1 points in PROMIS Physical Function or like mapped measure.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window. 
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe comorbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.

High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes

LMBR2: Patients Suffering From a Lumbar Spine (Low Back) Injury who Improve Physical Function

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from a Lumbar Spine (Low Back) injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Physical Function Computer Adaptive Testing, mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics. This measure will include three rates:1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Physical Function  or like mapped measure.2) The number of surgical patients achieving a score change greater than or equal to the MCID in PROMIS Physical Function or like mapped measure 3) The overall performance rate of Rate 1 and Rate 2 combined. 

Denominator: All patients 18 years or older with a lumbar spine (low back) injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period. 
Numerator: Number of patients aged 18 years or older with a lumbar spine (low back) injury who achieve an overall score change of 2.1 points in PROMIS Physical Function or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window. 
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe comorbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits. 

High Priority Measure? Yes  
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR3: Patients Suffering From a Cervical Spine (Neck) Injury who Improve Physical Function

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from a Cervical Spine (neck) injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Physical Function Computer Adaptive Testing, mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics. This measure will include three rates:1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Physical Function or like mapped measure.2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Physical Function  or like mapped measure3) The overall performance rate of Rate 1 and Rate 2 combined.

Denominator: All patients 18 years or older with a cervical spine (neck) injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with a cervical spine (neck) injury who achieve an overall score change of 2.1 points in PROMIS Physical Function or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window.
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe comorbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.

High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR4: Patients Suffering From a Lower Extremity Injury who Improve Physical Function

Measure Title: Patients Suffering From a Lower Extremity Injury who Improve Physical Function
Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from a hip, foot, or ankle injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Physical Function Computer Adaptive Testing, mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics. This measure will include three rates:1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Physical Function or like mapped measure.2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Physical Function or like mapped measure.3) The overall performance rate of Rate 1 and Rate 2 combined. 

Denominator: All patients 18 years or older with a hip, foot, or ankle injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with a hip injury who achieve an overall score change of 2.1 points in PROMIS Physical Function or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window. 
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe co-morbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.
High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR5: Patients Suffering From a Upper Extremity Injury who Improve Physical Function

Measure Owner: Patient360 in Colaboration with ETSU & Limber Health

Measure Description: Percentage of patients 18 years or older suffering from a shoulder, elbow, wrist/hand injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Upper Extremity Computer Adaptive Testing in the PROMIS Pain Interference Computer Adaptive Testing (CAT), mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics. This measure will include three rates:1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Upper Extremity Function or like mapped measure.2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS PROMIS Upper Extremity Function or like mapped measure.3) The overall performance rate of Rate 1 and Rate 2 combined.  

Denominator:All eligible patients 18 years or older with shoulder, elbow, wrist/hand injury evaluated and treated by a physical therapist (PT) or physical therapy group with a hip, ankle, or foot injury at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with shoulder, elbow, wrist/hand injury who achieve an overall score change of 2.0 points in PROMIS Pain Interference or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window. 
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe comorbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits. 

High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR6: Patients Suffering From a Knee Injury who Demonstrate Improved Pain

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health

Measure Description: Percentage of patients 18 years or older suffering from knee pain who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Pain Interference Computer Adaptive Testing (CAT), mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics. 
This measure will include three rates:
1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Pain Interference  or like mapped measure.
2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure. 
3) The overall performance rate of Rate 1 and Rate 2 combined  

Denominator: All patients 18 years or older with knee injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with knee injury who achieve an overall score change of 2.0 points in PROMIS Pain Interference or or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window.
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe co-morbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.
High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR7: Patients Suffering From a Lumbar Spine (Low Back) Injury who Demonstrate Improved Pain

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from lumbar spine (low back) pain who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Pain Interference Computer Adaptive Testing (CAT), mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics.
This measure will include three rates:
1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
3) The overall performance rate of Rate 1 and Rate 2 combined.

Denominator: All patients 18 years or older with lumbar spine (low back) injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with lumbar spine (low back) pain who achieve an overall score change of 2.0 points in PROMIS Pain Interference or or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window. 
Denominator Exceptions:
Physical Therapists can exclude patients based on an evaluation who may have severe co-morbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits. 
High Priority Measure?
Yes  
High Priority Type:
OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)NQS
Domain:
Effective
Clinical CareCare Setting:
Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure?
Functional Outcomes

LMBR8: Patients Suffering From a Cervical Spine (Neck) Injury who Demonstrate Improved Pain

Measure Owner: Patient360 in Colaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from cervical spine (neck) injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Pain Interference Computer Adaptive Testing (CAT), mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics.

This measure will include three rates:
1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
3) The overall performance rate of Rate 1 and Rate 2 combined.

Denominator: All patients 18 years or older with cervical spine (neck) pain evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period. 
Numerator: Number of patients aged 18 years or older with cervical spine (neck) pain who achieve an overall score change of 2.0 points in PROMIS Pain Interference or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window.
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe co-morbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.
High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR9: Patients Suffering From a Lower Extremity Injury who Demonstrate Improved Pain

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from hip, ankle, or foot injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Pain Interference Computer Adaptive Testing (CAT), mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics. 

This measure will include three rates:
1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
3) The overall performance rate of Rate 1 and Rate 2 combined.

Denominator: All eligible patients 18 years or older with hip, ankle, or foot injury evaluated and treated by a physical therapist (PT) or physical therapy group with a hip, ankle, or foot injury at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with hip, ankle, or foot injury who achieve an overall score change of 2.0 points in PROMIS Pain Interference or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window. 
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe comorbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.
High Priority Measure? Yes
High Priority Type: OUTCOMES
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

LMBR10: Patients Suffering From a Upper Extremity Injury who Demonstrate Improved Pain

Measure Owner: Patient360 in Collaboration with ETSU & Limber Health
Measure Description: Percentage of patients 18 years or older suffering from shoulder, elbow, wrist/hand injury who achieve the Minimal Clinically Important Difference (MCID) in the PROMIS Pain Interference Computer Adaptive Testing (CAT), mapped legacy measure, or like tool of measurement. This measure will be reported as the overall number of patients of rate 1 and rate 2 combined. To qualify, the patient must complete a baseline score and then one follow-up or discharge score. In order to fairly measure performance between providers, the measure is risk-adjusted based on age, sex, symptom characteristics, PROMIS baseline scores, social determinants of health, and psychosocial metrics.

This measure will include three rates:
1) The number of non-surgical patients achieving a score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
2) The number of surgical patients achieving a  score change greater than or equal to the MCID in PROMIS Pain Interference or like mapped measure.
3) The overall performance rate of Rate 1 and Rate 2 combined

Denominator: All patients 18 years or older with shoulder, elbow, wrist/hand injury evaluated and treated by a physical therapist (PT) or physical therapy group at the beginning of the measurement period with at least one eligible follow up encounter during the measurement period.
Numerator: Number of patients aged 18 years or older with shoulder, elbow, wrist/hand pain who achieve an overall score change of 2.0 points in PROMIS Pain Interference or like mapped measurement tool.
Denominator Exclusions: Patients who are under the age of 18. Patients who are non-English speaking or/and can not read. Patients who have severe mental or cognitive deficits limiting the accuracy of their questionnaire. This will be determined by the physical therapist at the time of the evaluation. Patients where score change cannot be measured due to lack of 2+ completed surveys within the measurement window.
Denominator Exceptions: Physical Therapists can exclude patients based on an evaluation who may have severe comorbidities or demonstrate medical complexity that does not follow a standard care pathway. Patients may also be excluded if they are seen for less than 3 visits.
High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient Reported Outcome based Performance Measure (PRO-PM)
NQS Domain: Effective Clinical Care
Care Setting: Ambulatory Care: Clinician Office/Clinic
Includes Telehealth? Yes
Which Meaningful Measure Area applies to this measure? Functional Outcomes

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2024 Limber Health Outcomes Quality Measure Specifications

Limber Health's 2024 quality measures are approved by CMS for outcomes reporting in the Merit-Based Quality Incentive Payment System (MIPS).

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MSK1: Patients Suffering From a Neck Injury who Improve Physical Function

Measure Description: Percentage of patients 18 years or older suffering from a neck injury who achieve the Minimal Clinically Important Difference (MCID) in the NDI or PROMIS Pain Interference, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in NDI/PROMIS Pain Interference/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a neck injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with neck injuries to achieve an MCID in their NDI change score (> or = to -7.5) or ( > or = -2) in PROMIS Pain Interference change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a neck injury who achieve an overall score change of > or = the MCID in the NDI, PROMIS Pain Interference or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK2: Patients Suffering From an Upper Extremity Injury who Improve Physical Function

Measure Description: Percentage of patients 18 years or older suffering from an upper extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the QDASH or PROMIS Upper Extremity, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in QDASH/PROMIS Upper Extremity/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with an upper extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with upper extremity injuries to achieve an MCID in their QDASH change score (> or = to -8) or (> or = 2.1) in PROMIS Upper Extremity change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a knee injury who achieve an overall score change of > or = the MCID in the NPRS, or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK3: Patients Suffering From a Back Injury who Improve Physical Function

Measure Description: Percentage of patients 18 years or older suffering from a back injury who achieve the Minimal Clinically Important Difference (MCID) in the MDQ or PROMIS Pain Interference, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in MDQ/PROMIS Pain Interference/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a back injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with back injuries to achieve an MCID in their MDQ change score (> or = to -6) or (> or = -2) in PROMIS Pain Interference change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a low back injury who achieve an overall score change of > or = the MCID in the MDQ, PROMIS Pain Interference or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK4: Patients Suffering From a Lower Extremity Injury who Improve Physical Function

Measure Description: Percentage of patients 18 years or older suffering from a lower extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the LEFS or PROMIS Physical Function, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in LEFS/PROMIS Physical Function/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a lower extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with lower extremity injuries to achieve an MCID in their LEFS change score (> or = to 9) or (> or = 2.1) in PROMIS Physical Function change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a low back injury who achieve an overall score change of > or = the MCID in the MDQ, PROMIS Pain Interference or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK5: Patients Suffering From a Knee Injury who Improve Physical Function

Measure Description: Percentage of patients 18 years or older suffering from a knee injury who achieve the Minimal Clinically Important Difference (MCID) in the KOS or PROMIS Physical Function, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in KOS/PROMIS Physical Function/or like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a knee injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with knee injuries to achieve an MCID in their KOS change score (> or = to 10) or (> or = 2.1) in PROMIS Physical Function change score or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a knee injury who achieve an overall score change of > or = the MCID in the KOS, PROMIS Physical Function or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK6: Patients Suffering From a Neck Injury who Improve Pain

Measure Description: Percentage of patients 18 years or older suffering from a neck injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a neck injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with neck injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a neck injury who achieve an overall score change of > or = the MCID in the NPRS, or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK7: Patients Suffering From an Upper Extremity Injury who Improve Pain

Measure Description: Percentage of patients 18 years or older suffering from an upper extremity injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with an upper extremity injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with upper extremity injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with an upper extremity injury who achieve an overall score change of > or = the MCID in the NPRS, or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK8: Patients Suffering From a Back Injury who Improve Pain

Measure Description: Percentage of patients 18 years or older suffering from a back injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a back injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with back injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a low back injury who achieve an overall score change of > or = the MCID in the NPRS, or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK9: Patients Suffering From a Lower Extremity Injury who Improve Pain

Measure Description: Percentage of patients 18 years or older suffering from a back injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.
This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a back injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with back injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a low back injury who achieve an overall score change of > or = the MCID in the NPRS, or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

MSK10: Patients Suffering From a Knee Injury who Improve Pain

Measure Description: Percentage of patients 18 years or older suffering from a knee injury who achieve the Minimal Clinically Important Difference (MCID) in the Numeric Pain Rating Scale, or like mapped measure during the performance year. Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will be reported for each PT/OT/MSK Provider/Group. The risk adjustment will be calculated using a logistic regression model using: baseline function score, baseline pain score, age, sex, payer, surgical status, and symptom duration (time from surgery or symptom onset to baseline physical therapy visit) as well as instrument tool used. These measures will serve as a PT/OT/MSK Provider performance measure at the eligible PT/OT/MSK Provider or group level.

This measure will include one rate:
1) The overall performance rate of non-surgical and surgical patients who achieve the MCID in the Numeric Pain Rating Scale like mapped measure.

Denominator: The total number of all patients 18 years or older at the time of the initial evaluation or start of care with a knee injury evaluated and treated by a Physical Therapist (PT), Occupational Therapist (OT), or Musculoskeletal(MSK) Provider or group.
Numerator: The total number of patients with knee injuries to achieve an MCID in their Numeric Pain Rating Scale change score (MCID > or = to 2) or like mapped measure, from their initial visits to their final visits in PT/OT practice or PT/OT group during the performance year.
Denominator Exclusions: 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 judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress or follow a standard care pathway. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.
Numerator Exclusions: None

High Priority Measure? Yes
High Priority Type: Outcome
Measure Type: Patient-Reported Outcome-based Performance Measure (PRO-PM)
Inverse Measure: No
Proportional Measure:
Yes
Continuous Variable Measure:
No
Ratio Measure:
No
Number of Performance Rates to be submitted:
1
Performance Rate Description(s):
This measure will include the combined rate of;Rate 1) Total number of patients aged 18 years or older with a knee injury who achieve an overall score change of > or = the MCID in the NPRS, or like mapped measure.
Overall Performance Rate:
1st Performance Rate
Measure Risk-Adjusted?:
Yes
If Risk-Adjusted, indicate which Score is Risk-Adjusted:
1st performance rate
MIPS Reporting Options:
Traditional MIPS
Care Setting:
Ambulatory Care: Clinician Office/Clinic; Ambulatory Surgical Center; Home Care; Outpatient Services; Post-Acute Care
Includes Telehealth?
Yes

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