Functional Status Change for Patients with Neck Impairments

Measure Specification

Neck impairments provide a common reason for patients seeking care in healthcare settings. During 2017, the FOTO database recorded 414,436 episodes of care across multiple healthcare systems and clinics throughout the United States. Prevalence estimates from epidemiologic studies on neck pain (defined as pain in the neck, with or without pain referred into one or both upper limbs, that lasts for at least 1 day) have a mean 1-year prevalence range of 23%1 to 37% and a mean lifetime prevalence of 49%.

2 Consequently, neck pain is recognized as a global health care burden.3,4 Assessment of functional status using PROMs in patients with neck pain is an essential step in addressing this burden, provided the scores can be interpreted in clinically useful ways to inform patient-centered clinical decision making. 5, 6 The Neck FS PROM offers the advantages of modern scientific measurement methods like item response theory (IRT).

IRT and related methods provide a number of measurement advantages including valid assumptions of interval scaling, superior scale coverage, uni-dimensionality for valid score change interpretations, and precise methods for evaluating components of the measures such as the functional questions and scales. IRT additionally forms the basis for computer adaptive testing (CAT) administration which reduces patient burden by minimizing the number of functional questions the patient must respond to in order to obtain a precise estimate of the patient’s functional ability level.

When combined with robust risk adjustment to provide for fair comparisons between providers, the Neck FS PROM forms the basis for a valuable patient reported outcome performance measure (PRO-PM).

PROMs are increasingly advocated as necessary components of an overall strategy to improve healthcare7, 8 and are advocated for use in clinical decision making in clinical practice guidelines pertaining to neck impairments.9, 10 Placing risk-adjusted Neck FS PROM data directly into the hands of the provider embodies the definition of patient-centered healthcare and is consistent with National Quality Forum’s vision to achieve performance improvement and accountability through patient-reported outcomes.

11 This approach improves quality of care by promoting improved communication between provider and patient, and it enhances the provider’s understanding of the patient’s perception of functional status. The Neck FS PROM and PRO-PM results can be shared with the patient to further promote patient engagement.

This measure contains one stratum defined by a single submission criteria. This measure produces a single performance rate. For purposes of MIPS implementation, this episode measure is submitted once for each treatment episode during the performance period. It requires submitting the patient’s FS PROM score, at a minimum, at the start (Initial Evaluation or Intake) and again at the conclusion (Discharge) of a Treatment Episode.

The Initial Evaluation score is recorded during the first treatment encounter, and the Discharge score is recorded at or near the conclusion of the final treatment encounter. 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 Initial Evaluation for a functional neck deficit, progressing through treatment without interruption (for example, a hospitalization or surgical intervention), and ending with Discharge signifying that the treatment has been completed.

A patient currently under clinical care for a neck deficit remains in a single “Treatment Episode” until the Discharge is conducted and documented by the MIPS eligible clinician. Initial Evaluation – An “Initial Evaluation” is the first encounter for a functional deficit involving the neck and includes an evaluation (CPT 97161, 97162, 97163, 97165, 97166, 97167, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 98940, 98941, 98942, 98943*, 99304, 99305, or 99306), or an “Initial Evaluation” Status M-code (M1143).

A patient presenting with a neck impairment, who has had an interruption of a Treatment Episode for the same functional neck deficit secondary to an appropriate reason like hospitalization or surgical intervention, is an “Initial Evaluation.” Discharge – “Discharge” is accompanied by a treatment finalization and evaluation completion M-Code (M1009) identifying the close of a Treatment Episode for the same neck deficit identified at the Initial Evaluation and documented by a “Discharge” report by the MIPS eligible clinician.

An interruption in clinical care for an appropriate reason like hospitalization or surgical intervention requires a discharge from the current Treatment Episode. Encounter – A visit between the patient and the provider for the purpose of assessing and/or improving a functional deficit. Patient Reported – The patient directly provides answers to the FS PROM items.

If the patient cannot reliably respond independently (e.g., in the presence of cognitive deficits), a suitable proxy may provide answers. Risk Adjustment Factors – A set of factors used to calculate a patient’s risk score which predict the outcome score. In addition to the risk adjustment factors collected in the patient demographic portion of the assessment, a full list of considered specific comorbidity details can be found in Table 1 of this publication https://www.

ncbi.nlm.nih.gov/pubmed/29787696 7. Neck FS PROM score – The “Neck FS PROM score” may be achieved using one of three forms: the FOTO Neck FS PROM computer adaptive test, the FOTO Neck FS PROM short form, or an alternative PROM score that is cross- walked to the Neck FS PROM using a cross-walk form developed by the measure steward. Computer adaptive test (CAT) is recommended to achieve best balance between reduced patient burden and score precision.

At least one cross-walk form has been developed by the measure steward and meets scientific standards to successfully link a construct-equivalent PROM using advanced psychometric equating methods. For more information about the Neck FS PROM score forms and to access the components that are available free of charge for use with this MIPS quality measure [e.

g., patient-reported outcome measure(s), cross-walking, risk adjustment], visit Public Access to FOTO Measures.