Functional Status Assessment for Total Knee Replacement

Last updated: May 15, 2018

CMS Measure ID: CMS66v7
Version: 7
NQF Number: None
Measure Description:

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

Initial Patient Population:

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

Denominator Statement:

Equals initial population

Denominator Exclusions:

Patients with two or more fractures indicating trauma at the time of the total knee arthroplasty or patients with severe cognitive impairment that overlaps the measurement period.

Exclude patients whose hospice care overlaps the measurement period.

Numerator Statement:

Patients with patient-reported functional status assessment results (i.e., VR-12, PROMIS-10 Global Health, KOOS, KOOS Jr.) in the 90 days prior to or on the day of the primary TKA procedure, and in the 270 - 365 days after the TKA procedure

Numerator Exclusions:

Not applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services (CMS)
Domain: Person and Caregiver-Centered Experience and Outcomes
Previous Version:
Improvement Notation:

A higher score indicates better quality

Guidance:

A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity.

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

Quality ID: 375
Meaningful Measure: Patient Reported Functional Outcomes

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated measure header rationale to align with most recent literature.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Added new reference to clinical recommendation statement to align with current recommendations.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated the Initial Population age to 19 to better align with measure intent.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised the denominator exclusions statement to better align with the logic.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the Denominator Exclusion statement for patients in hospice care to better align with the logic.

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-2815)

  • Revised the numerator description to better align with the logic.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Updated the Initial Population age to 19 to better align with measure intent.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Replaced 'Discharge status' attribute with 'Admission Source' and 'Discharge Disposition' attributes for 'Encounter, Performed' and 'Encounter, Active' datatypes to align with QDM 5.3 changes.

    Measure Section: Denominator Exclusions

    Source of Change: Standards Update

  • Revised the numerator logic to ensure the entire functional status assessment is completed to better align with the measure intent.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Added supplemental timing attributes to most datatypes in QDM 5.3 to facilitate accurate retrieval of time related information within CQL logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specification and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Removed the 'Face-To-Face Interaction' data element and added relevant SNOMED codes to the Encounter Grouping value sets to better align between the SNOMED and CPT encounter codes.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource center (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards 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.

  • Value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Activities of Daily Living Score (2.16.840.1.113883.3.464.1003.118.12.1153): Added Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Activities of Daily Living Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Pain Score (2.16.840.1.113883.3.464.1003.118.12.1180): Added Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Pain Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Sport Recreation Score (2.16.840.1.113883.3.464.1003.118.12.1152): Added Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Sport Recreation Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Symptoms Score (2.16.840.1.113883.3.464.1003.118.12.1182): Added Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Symptoms Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Knee Injury and Osteoarthritis Outcome Score for Joint Replacement [KOOSJR] (2.16.840.1.113883.3.464.1003.118.12.1218): Added Knee Injury and Osteoarthritis Outcome Score for Joint Replacement [KOOSJR].

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1264) including 7 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008): Added SNOMEDCT extensional value set (2.16.840.1.113883.3.464.1003.101.11.1266) including 3 codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Fracture - Lower Body (2.16.840.1.113883.3.464.1003.113.12.1037): Added 41 ICD10CM codes and deleted 1835 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS-10 Global Mental Health Score (2.16.840.1.113883.3.464.1003.118.12.1138): Added PROMIS-10 Global Mental Health Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set PROMIS-10 Global Physical Health Score (2.16.840.1.113883.3.464.1003.118.12.1139): Added PROMIS-10 Global Physical Health Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set VR-12 Mental Component T-Score (2.16.840.1.113883.3.464.1003.118.12.1177): Added VR-12 Mental Component T-Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set VR-12 Physical Component T-Score (2.16.840.1.113883.3.464.1003.118.12.1176): Added VR-12 Physical Component T-Score.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Face-to-Face Interaction (2.16.840.1.113883.3.464.1003.101.12.1048): Removed Face-to-Face Interaction.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Functional Status Assessment for Knee Replacement (2.16.840.1.113883.3.464.1003.118.12.1030): Removed Functional Status Assessment for Knee Replacement.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced LOINC single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Replaced SNOMEDCT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Replaced CPT single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

External Resources