Functional Status Assessment for Knee Replacement

Last updated: March 22, 2017

CMS Measure ID: CMS66v4
Version: 4
NQF Number: None
Measure Description:

Percentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments.

Initial Patient Population:

Adults aged 18 and older who had a primary total knee arthroplasty (TKA) within the 12 month period that begins 180 days before the start of the measurement period and ends 185 days after the start of the measurement period and who had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after TKA procedure.

Denominator Statement:

Equals initial population

Denominator Exclusions:

Patients with multiple traumas at the time of the total knee arthroplasty or patients with severe cognitive impairment

Numerator Statement:

Patients with patient reported functional status assessment results (eg, VR-12, VR-36, PROMIS-10 Global Health, PROMIS-29, KOOS) not more than 180 days prior to the primary TKA procedure, and at least 60 days and not more than 180 days after TKA procedure

Numerator Exclusions:

Not applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Person and Caregiver-Centered Experience and Outcomes
Next Version: Functional Status Assessment for Total Knee Replacement
Previous Version: Functional Status Assessment for Knee Replacement
Measure Score: Proportion
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 use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.

Specifications

Release Notes

Header

  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced 'Intersection' clause to build clause logic.
  • Introduced occurrencing on variables to enforce that the same instance of a clinical event is used throughout the measure when the logic within the variable does not limit the event to a single instance, e.g., FIRST or MOST RECENT.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Introduced variables $PrimaryTKAprocedure and $OptConsultorOVorF2FEncounter to allow re-use of logical expressions and reduce redundancy/complexity.
  • Removed the end time and added the 'overlaps' operator to the exclusion for lower body fractures to try to more accurately exclude someone with a traumatic hip replacement.
  • Replaced 'Measurement Start Date' and 'Measurement End Date' with 'Measurement Period' and as necessary replaced existing timing operator (e.g., replacing 'starts before start of' with 'starts before end of').
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.

Value Sets

  • Added postoperative visit codes to the initial population to allow more providers to report the measure.
  • Value set Postoperative Visit (OID 2.16.840.1.113883.3.464.1003.101.12.1070): Created a new value set with 1 CPT code (99024).

External Resources