Measure Title: Failure to Progress (FTP): Proportion of patients failing to achieve a Minimal Clinically Important Difference (MCID) in improvement in pain score, measured via the Numeric Pain Rating Scale (NPRS), in rehabilitation patients with hip, leg or ankle (lower extremity except knee) injury.

Measure ID: IROMS14

High Priority Measure
Measure Type: Patient Reported Outcome
NQS Domain: Effective Clinical Care
Meaningful Measure: Functional Outcomes
Care Setting: Ambulatory Care: Clinician Office/Clinic Includes Telehealth
Risk Adjusted: Yes
Inverse Measure: yes
Proportional Measure: yes
Continuous Variable: No
Ratio Measure: No
Overall Performance Rate: 2nd Performance Rate

Performance Rate Calculated: Six measures will be reported, two overall performance measures and three stratified performance measures are to be included:

All three strata (overall, surgical, and non-surgical) for the NPRS scores are risk adjusted.
The overall performance rate will be based on the difference between the proportion of patients observed to not achieve a MCID minus the predicted RISK ADJUSTED proportion. A positive value would indicate overall good results. A negative value would indicate that the practice performed worse than expected given the adjusted risk score.

Measure Description:
The proportion of patients failing to achieve an MCID of two (2) points or more improvement in the NPRS change score for patients with hip, leg, or ankle injuries treated during the observation period will be reported.

Additionally, a risk-adjusted MCID proportional difference will be determined by calculating the difference between the risk model predicted and observed MCID proportion will reported for each physical therapist or physical therapy group. The risk adjustment will be calculated using a logistic regression model using: LEFS score, baseline pain score, age, sex, payer, and symptom duration (time from surgery or injury to baseline physical therapy visit).

These measures will serve as a physical or occupational therapy performance measure at the eligible physical or occupational therapist or physical or occupational therapy group level.

Denominator Description:
The total number of patients with hip, leg, or ankle injury evaluated and treated by a physical therapist (PT) or Occupational Therapist (OT), or PT or OT Group.

Numerator Description:
The total number of patients with hip, leg, or ankle injuries hip, leg, or ankle (lower extremity except knee), to not achieve an MCID in their NPRS change score (MCID >2) from their initial visits to their final visits in PT/OT practice or PT/OT group during the observation window.

Denominator Exclusions:
Patients who are < 18 years old Patients who did not complete 2 or more surveys Patients that are non-English speaking and translation services are unavailable Patients that are unable to Read Patients that have a mental or cognitive impairment that compromises their ability accurately complete the MIPS PRO Patients meeting Medicare requirements for maintenance therapy, such as the maintenance of functional status or prevention of a slow deterioration in function, as defined by the Medicare Benefits Policy Manual, Chapter 15

Denominator Exceptions:
PT/OT can use their clinical judgement to exclude patients who are extremely medically complex, who in their experience are likely to make poor clinical progress.