Measure ID: MIPS 178|Rheumatology|2026 Performance Year

Rheumatoid Arthritis (RA): Functional Status Assessment

Percentage of patients aged 18 years and older with two or more encounters with a diagnosis of rheumatoid arthritis (RA) at least 90 days apart for whom a functional status assessment was performed at least once during the performance period.

ProcessRheumatologyFunctional Assessment

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

Patients aged ≥ 18 years on date of encounter
ANDDiagnosis for rheumatoid arthritis(RA)
ANDPatient encounter during the performance period
ANDAn additional encounter with an RA diagnosis during the performance period or prior performance period that is at least 90 days before or after an encounter with an RA diagnosis during the performance period: M1375
ORPerformance Not Met: Functional status not assessed, reason not otherwise specified (1170F with 8P)

Denominator Exclusions

None

Numerator

Patients for whom a functional status assessment using an ACR-preferred, patient-reported functional status assessment tool was performed at least once during the performance period.

Submission Codes (QDCs)

✓ Performance Met
1170FFunctional status assessed
✗ Performance Not Met
1170F with 8PFunctional status not assessed, reason not otherwise specified

Denominator Exceptions

None — this measure has no denominator exceptions.

🧮MIPS Score Simulator

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VBCA Insights

💡Why This Measure Matters

RA patients care deeply about function—what they can do at home and work—but it often gets overlooked in routine visits. This measure confirms you're assessing functional status at least once using a validated tool like the HAQ or PROMIS. Understanding your patient's actual limitations informs realistic treatment goals and catches functional decline before major disability happens. A single functional assessment during the measurement year is the bar here.

📖Clinical Rationale

Functional limitations are a significant and disruptive complication for patients living with RA. Assessments of functional limitations are used to assess prognosis and guide treatment and therapy decisions. According to the ACR’s RA treatment guidelines, functional status assessment using a standardized, validated measure should be performed routinely for RA patients, at least once per year, but more frequently if disease is active.

📝Clinical Recommendations

The management of RA is an iterative process, and patients should be routinely reassessed for evidence of disease or limitation of function with significant alteration of joint anatomy. Baseline evaluation of disease activity and damage in patients with rheumatoid arthritis through evaluation of functional status or quality of life assessments using standardized questionnaires, a physician’s global assessment of disease activity, or patient’s global assessment of disease activity.

The initial evaluation of the patient with RA should document symptoms of active disease (i.e., presence of joint pain, duration of morning stiffness, degree of fatigue), functional status, objective evidence of disease activity (i.e., synovitis, as assessed by tender and swollen joint counts, and the ESR or CRP level), and mechanical joint problems.

At each follow up visit, the physician must assess whether the disease is active or inactive. Symptoms of inflammatory (as contrasted with mechanical) joint disease, which include prolonged morning stiffness, duration of fatigue, and active synovitis on joint examination, indicate active disease and necessitate consideration of changing the treatment program.

Occasionally, findings of the joint examination alone may not adequately reflect disease activity and structural damage; therefore, periodic measurements of the ESR or CRP level and regular assessments of functional status, as well as periodic radiographic examinations of involved joints should be performed. It is important to determine whether a decline in function is the result of inflammation, mechanical damage, or both; treatment strategies will differ accordingly.

(ACR, 2002) The ACR also conducted an extensive multi-year project, involving systematic literature reviews, expert consensus ratings, and national surveys to reach consensus on which RA patient-reported functional status assessments tools are valid, reliable, and responsive, and feasible to implement in routine clinical practice, resulting in three ACR-preferred functional status assessment tools (cite: https://rheumatology.

org/api/asset/blt65c03d5b72bc6cc2).

📋Implementation Notes

For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient for the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.

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