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Functional Status Assessment for Total Hip Replacement

Compare Versions of: "Functional Status Assessment for Total Hip Replacement"

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Functional Status Assessment for Total Hip Replacement Functional Status Assessment for Total Hip Replacement Functional Status Assessment for Total Hip Replacement
CMS eCQM ID CMS56v10 CMS56v11 CMS56v12
CBE ID Not Applicable Not Applicable Not Applicable
MIPS Quality ID 376 376 376
Description

Percentage of patients 18 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270-365 days after the surgery

Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery

Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 300 - 425 days after the surgery

Definition *See CMS56v10.html *See CMS56v11.html

None

Initial Population

Patients 19 years of age and older who had a primary total hip arthroplasty (THA) in the year prior to the measurement period and who had an outpatient encounter during the measurement period

Patients 19 years of age and older who had a primary total hip arthroplasty (THA) in the year prior to the measurement period and who had an outpatient encounter during the measurement period

Patients 19 years of age and older who had a primary THA between November two years prior to the measurement period and October of the year prior to measurement period; and who had an outpatient encounter between November of the year prior to the measurement period and the end of the measurement period

Numerator

Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global Health, Hip Disability and Osteoarthritis Outcome Score [HOOS], HOOS Jr.) in the 90 days prior to or on the day of the primary THA procedure, and in the 270 - 365 days after the THA procedure

Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global Health, Hip Disability and Osteoarthritis Outcome Score [HOOS], HOOS Jr.) in the 90 days prior to or on the day of the primary THA procedure, and in the 270 - 365 days after the THA procedure

Patients with patient-reported functional status assessment results (i.e., Veterans RAND 12-item health survey [VR-12], Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global Health, Hip Disability and Osteoarthritis Outcome Score [HOOS], HOOS Jr.) in the 90 days prior to or on the day of the primary THA procedure, and in the 300 - 425 days after the THA procedure

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

Exclude patients with two or more fractures indicating trauma at the time of the total hip arthroplasty or patients with severe cognitive impairment that starts before or in any part of the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients with two or more fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty or patients with severe cognitive impairment that starts before or in any part of the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Exclude patients with severe cognitive impairment that starts before or in any part of the measurement period.

Exclude patients with one or more specific lower body fractures indicating trauma in the 24 hours before or at the start of the total hip arthroplasty.

Exclude patients with a partial hip arthroplasty procedure on the day of the total hip arthroplasty.

Exclude patients with a revision hip arthroplasty procedure, an implanted device/prosthesis removal procedure or a resurfacing/supplement procedure on the day of the total hip arthroplasty.

Exclude patients with a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm on the day of the total hip arthroplasty.

Exclude patients with a mechanical complication on the day of the total hip arthroplasty.

Exclude patients with a second total hip arthroplasty procedure 1 year before or after the original total hip arthroplasty procedure.

Exclude patients who die on the day of the total hip arthroplasty procedure or in the 300 days after.

Denominator Exceptions

None

None

None

Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

A higher score indicates better quality

A higher score indicates better quality

A higher score indicates better quality

Guidance

The same functional status assessment (FSA) instrument must be used for the initial and follow-up assessment.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

The same functional status assessment (FSA) instrument must be used for the initial and follow-up assessment.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The same FSA instrument must be used for the initial and follow-up assessment.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Telehealth Eligible Yes Yes Yes
Rationale *See CMS56v10.html *See CMS56v11.html

THAs are common surgical procedures that address hip pain and functional impairment, primarily caused by osteoarthritis. Although THA is an effective procedure for addressing osteoarthritis for many patients, some people, particularly those with more severe preoperative pain and impairment, do not experience the improvements in pain, function, and quality of life expected from the procedure (Beswick et al., 2012; Fortin et al., 1999; Tilbury et al., 2016). In 2010, providers performed 326,100 THAs, with 95 percent of them in patients age 45 and older (Wolford, Palso, & Bercovitz, 2015). Although THAs were introduced as a procedure for older adults, the percentage of patients age 55 to 64 (29 percent) who had a THA in 2010 exceeded the percentage of patients age 75 and older (26 percent) who had a THA (Wolford, Palso, & Bercovitz, 2015). Kurtz et al. (2009) projected that patients younger than 65 would account for 52 percent of THAs by 2030. This growth in hip surgeries for patients younger than 65 is significant because these patients often require more expensive joint arthroplasties that will better withstand the wear caused by physical activity (Bozic et al., 2006).

This measure evaluates whether patients complete a patient-reported functional status assessment (FSA) before and after a THA. Measuring functional status for patients undergoing THA permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock, 2010).

Stratification *See CMS56v10.html *See CMS56v11.html

None

Risk Adjustment *See CMS56v10.html *See CMS56v11.html

None

Clinical Recommendation Statement *See CMS56v10.html *See CMS56v11.html

While there is no clinical guideline recommending that clinicians assess patients who are undergoing total hip replacements using patient-reported outcomes of function and pain, several clinical specialty societies support the use of a general health questionnaire and a disease-specific questionnaire for these patients. In particular, they recommend the Veterans RAND 12-item health survey (VR-12) or the Patient-Reported Outcomes Measurement Information System [PROMIS]-10-Global as the general health questionnaire and the Hip Disability and Osteoarthritis Outcome Score [HOOS], Jr. as the disease-specific questionnaire (American Association of Orthopaedic Surgeons, the American Joint Replacement Registry, The Hip Society, The Knee Society, & the American Association of Hip and Knee Surgeons, 2015).

Peer-reviewed and grey literature support additional exclusions for patients undergoing total hip replacements. Staged procedures, concurrent procedures, partial procedures, resurfacing procedures, revision procedures, and removal of implant devices or prosthesis were linked to significant morbidity; complications (such as dislocation, infection, and reinfection); and high failure rates (Ludwick, 2021). In addition, mechanical complications, such as instability and dislocation, are also linked to complications and are associated with primary and revision THA/TKA (Gkiatas, 2021). Malignant neoplasms (such as osteonecrosis of the femoral head) are associated with substantial pain and functional disabilities before THA/TKA (Bernhard, 2021).

Additionally, peer-reviewed and grey literature support various postoperative time frames, including follow-up within 10 to 14 months (Franklin, 2021) (Holte, 2021).

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Specifications
Attachment Size
CMS56v12.html 107.97 KB
CMS56v12.zip 126.79 KB
CMS56v12-TRN.xlsx 22.88 KB
CMS56v12-eCQMFlow.pdf 2.49 MB
eCQM Jira Issue Tracker
*Note there may be more tickets in the eCQM Tracker - ONC Project Tracking System (Jira) for this measure. Only tickets tagged with their associated CMS measure ID appear.

Header

  • Updated the description, initial population and numerator by extending the follow-up assessment and total hip arthroplasty (THA) procedure timeframes to harmonize timings with a related measure in development.

    Measure Section: Description

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the clinical recommendation statement based upon more recent literature and evidence to support the measure.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated the description, initial population and numerator by extending the follow-up assessment and total hip arthroplasty (THA) procedure timeframes to harmonize timings with a related measure in development.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised the fracture exclusion from two lower body fractures at the time of the procedure to one specific lower body fracture at the time of the procedure to more accurately indicate a non-elective THA.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Added denominator exclusions to remove patients who do not receive elective total hip arthroplasty (THA) to harmonize with a related measure in development.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the description, initial population and numerator by extending the follow-up assessment and total hip arthroplasty (THA) procedure timeframes to harmonize timings with a related measure in development.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Multiple Sections

    Source of Change: Annual Update

Logic

  • Added denominator exclusions to remove patients who do not receive elective total hip arthroplasty (THA) to harmonize with a related measure in development.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Replaced direct reference code used to identify patients with severe cognitive impairment to align with measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Revised the fracture exclusion from two lower body fractures at the time of the procedure to one specific lower body fracture at the time of the procedure to more accurately indicate a non-elective THA.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Definitions

    Source of Change: Standards/Technical Update

  • Updated the measure logic by extending the follow-up assessment and total hip arthroplasty (THA) procedure timeframes to harmonize timings with a related measure in development.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Revised the fracture exclusion from two lower body fractures at the time of the procedure to one specific lower body fracture at the time of the procedure to more accurately indicate a non-elective THA.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added QDM datatype 'Diagnosis' to the Hospice.'Has Hospice Services' definition referencing a new value set containing SNOMED finding codes to provide an additional approach for identifying patients receiving hospice care.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added denominator exclusions to remove patients who do not receive elective total hip arthroplasty (THA) to harmonize with a related measure in development.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added 'day of' specificity to hospice expressions for consistency.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the timing comparison precision in the definitions from datetime to date by adding 'day of' or 'date from' to align with the measure intent and harmonize timings across similar eCQMs.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Replaced direct reference code used to identify patients with severe cognitive impairment to align with measure intent.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Functions

    Source of Change: Annual Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Added direct reference code SNOMED CT code (419099009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced direct reference code SNOMED CT code (428351000124105) with direct reference code SNOMED CT code (702956004) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Deleted 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003): Added 2 SNOMED CT codes (305911006, 385765002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Replaced value set Lower Body Fracture (2.16.840.1.113883.3.464.1003.113.12.1037) with value set Lower Body Fractures Excluding Ankle and Foot (2.16.840.1.113883.3.464.1003.1178) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Malignant Neoplasms of Lower and Unspecified Limbs (2.16.840.1.113883.3.464.1003.1180) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Mechanical Complications Excluding Upper Body (2.16.840.1.113883.3.464.1003.1182) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089): Added 4 CPT codes (98980, 98981, 99444, 99457) based on review by technical experts, SMEs, and/or public feedback. Added 3 HCPCS codes (G2250, G2251, G2252) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Partial Arthroplasty of Hip (2.16.840.1.113883.3.464.1003.1184) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Removal, Revision and Supplement Procedures of the Lower Body and Spine (2.16.840.1.113883.3.464.1003.1189) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Mar 04, 2024