eCQM Title

Functional Status Assessment for Total Knee Replacement

eCQM Identifier (Measure Authoring Tool) 66 eCQM Version number 8.3.000
NQF Number Not Applicable GUID be8d9655-1194-46ef-b43e-4b1d0c36ab71
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer National Committee for Quality Assurance
Endorsed By None
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
This Physician Performance Measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract HHSP23320095627WC; HHSP23337008T) with the National Committee for Quality Assurance (NCQA) to develop this electronic measure. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications.

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Measure Scoring Proportion
Measure Type Process
Risk Adjustment
Rate Aggregation
Total knee arthroplasties (TKAs) are common surgical procedures for addressing knee pain and functional impairment caused primarily caused by osteoarthritis. From 2008 to 2010, TKAs were the most common procedure for adults age 45 and older. From 2000 to 2010, physicians performed 5.2 million TKAs, with 693,400 procedures performed in 2010 alone (Williams, Wolford, & Bercovitz, 2015). Although TKA s were introduced as a procedure for the elderly, the mean age of patients undergoing TKA is decreasing. In 2010, the mean age for those undergoing TKA was 66.2, a 3.9 percent decrease from 68.9 in 2000. Kurtz et al. (2009) projected that patients younger than 65 would account for 55 percent of TKAs by 2030. This growth in knee surgeries for younger patients is significant because they often require more expensive joint arthroplasties that will better withstand 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 TKA. Measuring functional status for patients undergoing total knee replacement 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 et al., 2010).
Clinical Recommendation Statement
The American Association of Hip and Knee Surgeons (AAHKS) states that it is important to ensure that the general/mental health survey be completed prior to surgery during the preoperative visit, as well as the post-operative visit. AAHKS (2015) recommends using a general health instrument, such as the Veterans RAND 12-item health survey (VR-12) or PROMIS Global 10  in addition to condition-specific tools.
Improvement Notation
A higher score indicates better quality
The American Association of Hip and Knee Surgeons. (2015). Patient-reported outcomes summit for total joint arthroplasty report. Retrieved from
Bozic, K. J., Morsehed, S., Silverstein, M. D., et al. (2006). Use of cost-effectiveness analysis to evaluate new technologies in orthopaedics: The case of alternative bearing surfaces in total hip arthroplasty. Journal of Bone and Joint Surgery, American Volume, 88(4), 706-714.
Kurtz, S. M., Lau, E., Ong, K., et al. (2009). Future young patient demand for primary and revision joint arthroplasty: National projections from 2010 to 2030. Clinical Orthopaedics and Related Research, 467(10), 2606-2612. 
Rothrock, N. E., Hays, R. D., Spritzer, K., et al. (2010). Relative to the general U.S. population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). Journal of Clinical Epidemiology, 63(11), 1195-1204.
Williams, S. N., Wolford, M. L., & Bercovitz, A. (2015). Hospitalization for total knee replacement among inpatients aged 45 and over: United States, 2000-2010. NCHS Data Brief No. 210. Hyattsville, MD: National Center for Health Statistics.
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.
Transmission Format
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
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.
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
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity, and sex

Table of Contents

Population Criteria




Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set