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Functional Status Assessment for Total Knee Replacement

Last updated: May 9, 2019

CMS Measure ID: CMS66v8
Version: 8
NQF Number: Not Applicable
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 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 Populationinfo-icon

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, Knee Injury and Osteoarthritis Outcome Score [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:
Measure Scoring: Proportion
Measure Type: Process
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: Functional Outcomes

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated clinical recommendation statement.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated guidance statement to correct grammatical errors for clarity and to improve alignmentinfo-icon across measures.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated denominatorinfo-icon statement by capitalizing 'initial populationinfo-icon' to align with other measures.

    Measure Section: Denominator

    Source of Change: Measure Lead

  • Updated numerator exclusionsinfo-icon statement by capitalizing the word 'Applicable' to align with other measures.

    Measure Section: Numerator Exclusions

    Source of Change: Measure Lead

  • Updated multiple sections in header by defining acronyms and correcting grammatical errors for clarity.

    Measure Section: Multiple Sections

    Source of Change: ONC Project Tracking System (JIRA)info-icon: CQMinfo-icon-3114

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Added logic to capture functional status assessments using the same tool before and after the procedure to improve alignment with measure intent.

    Measure Section: Numeratorinfo-icon

    Source of Change: ONC Project Tracking System (JIRA): CQM-3114

  • Replaced numerator definitions 'Total Knee Arthroplasty with Initial Assessment' and 'Knee Assessment 270 to 365 Days after Total Knee Arthroplasty Procedure' with 'Assessed Initial and Follow up KOOS with TKA', 'Assessed Initial and Follow up KOOSJr with TKA', 'Assessed Initial and Follow up PROMIS10 with TKA', 'Assessed Initial and Follow up VR12 Oblique with TKA', and 'Assessed Initial and Follow up VR12 Orthogonal with TKA' to capture functional status assessments using the same tool before and after the procedure to improve alignment with measure intent.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (JIRA): CQM-3114

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Hospice Library (Hospice-2.0.000).

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Replaced value set VR12 Mental Component T Score (2.16.840.1.113883.3.464.1003.118.12.1177) with direct reference codes (LOINC codes (72026-8, 72028-4)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set VR12 Physical Component T Score (2.16.840.1.113883.3.464.1003.118.12.1176) with direct reference codes (LOINC codes (72025-0, 72027-6).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set PROMIS 10 Global Mental Health Score (2.16.840.1.113883.3.464.1003.118.12.1138) with direct reference code (LOINC code (71969-0)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set PROMIS 10 Global Physical Health Score (2.16.840.1.113883.3.464.1003.118.12.1139) with direct reference code (LOINC code (71971-6)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced 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) with direct reference code (LOINC code (72100-1)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Pain Score (2.16.840.1.113883.3.464.1003.118.12.1180) with direct reference code (LOINC code (72102-7)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Sport Recreation Score (2.16.840.1.113883.3.464.1003.118.12.1152) with direct reference code (LOINC code (72099-5)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Replaced value set Knee Dysfunction and Osteoarthritis Outcome Score [KOOS] Symptoms Score (2.16.840.1.113883.3.464.1003.118.12.1182) with direct reference code (LOINC code (72101-9)).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

External Resources