MIPS Reporting for Orthopaedics and Physical Therapy

Measure Title: Failure to Progress (FTP): Proportion of patients failing to achieve a Minimal Clinically Important Difference (MCID) in improvement in pain score, measured via the Numeric Pain Rating Scale (NPRS), in rehabilitation patients with low back pain.

Measure ID: IROMS18

High Priority Measure
Measure Type: Patient Reported Outcome
NQS Domain: Effective Clinical Care
Meaningful Measure: Functional Outcomes
Includes Telehealth
Risk Adjusted: Yes
Care Setting: Ambulatory Care: Clinician Office/Clinic Includes Telehealth
Inverse Measure: yes
Proportional Measure: yes
Continuous Variable: No
Ratio Measure: No
Overall Performance Rate: 2nd Performance Rate

All three strata (overall, surgical, and non-surgical) for the NPRS scores are risk adjusted.
The overall performance rate will be based on the difference between the proportion of patients observed to not achieve a MCID minus the predicted RISK ADJUSTED proportion. A positive value would indicate overall good results. A negative value would indicate that the practice performed worse than expected given the adjusted risk score.

Measure Description
The proportion of patients failing to achieve an MCID of two (2) points or more improvement in the NPRS change score for patients with low back pain treated during the observation period will be reported.
Additionally, a risk-adjusted MCID proportional difference determined by calculating the difference between the risk model predicted and observed MCID proportion will reported for each physical therapist or physical therapy group. The risk adjustment will be calculated using a logistic regression model using: baseline MDQ score, baseline pain score, age, sex, payer, and symptom duration (time from surgery or injury to baseline physical therapy visit).
These measures will serve as a PT/OT performance measure at the eligible PT/OT or PT/OT group level.
Denominator Description
The total number of all patients with low back pain evaluated and treated by a PT or OT, or PT or OT Group, during the observation window.
Numerator Description
The total number of patients with low back pain to not achieve an MCID in their NPRS change score (MCID ≥ 2) from their initial visits to their final visits in PT/OT practice or PT/OT group during the observation window.
Denominator Exclusions
Patients who are < 18 years old. 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. The provider must clearly document in the medical record the specific medical complexity / complexities present to qualify for this exception.