Brief description of measure CMS56: Functional Status Assessment for Total Hip Replacement: Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery. CMS66: Functional Status Assessment for Total Knee Replacement:  Percentage of patients 19 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. Description of issue In an effort to align with a related measure in development, stakeholders recommended extending the functional status assessment follow-up time frame from 9–12 months to 10–14 months to allow for more flexibility in collecting the postoperative assessment and to better align with clinical workflows and typical one-year follow-up scheduling. In order to implement this change, the measure developer is seeking feedback on the following two options which update when the procedure and follow-up functional status assessment timing occur. Option 1: Keep the procedure timing of the year prior to the measurement period and extend the follow-up functional status assessment timing. This option aligns the post-procedure functional status assessment timing with the related measure in development and allows the measure to maintain the current procedure timing (i.e., THA/TKA procedures in the year prior to the measurement period). However, the procedure timing and follow-up functional status assessment timing will overlap in November and December of the year prior to the measurement period. Therefore, patients who have a procedure in November or December of the year prior to the measurement period will only have up to 12 months to complete the follow-up functional status assessment rather than 14 months which may increase push-back from clinicians.     Option 2: Push back the procedure timing and extend the follow-up functional status assessment timing. This option aligns the post-procedure functional status assessment timing with the related measure in development, ensures that patients will have the full 14 months to complete the functional status assessment within the measurement period, and captures procedures that occur in a full 12-month period.   However, the procedure timing would be pushed back to November two years prior to measurement period and late October of the year prior to measurement period. The follow-up functional status assessment timing will begin in November one year prior to the measurement period and extend through the calendar year measurement period. Therefore, there may be some instances where patients have a procedure and follow-up functional status assessment before the measurement period. Goal of review Obtain clinical and technical feedback

Proposed solution ​Please see below proposed changes in CMS56. The same changes will also be made to CMS66.   ***OPTION 1***  Initial Population Header language before: Patients 19 years of age and older who had a primary total hip arthroplasty (THA) in the year prior to the measurement period and who had an outpatient encounter during the measurement period Initial Population Header language after Option 1: Patients 19 years of age and older who had a primary total hip arthroplasty (THA) in the year prior to the measurement period and who had an outpatient encounter between November of the year prior to the measurement period and the measurement period   Logic before Option 1: define "Has Qualifying Encounter":     exists ( ( ["Encounter, Performed": "Outpatient Consultation"]        union […] ) ValidEncounters      where ValidEncounters.relevantPeriod during day of "Measurement Period") Logic after Option 1: define "Has Qualifying Encounter":     exists ( ( ["Encounter, Performed": "Outpatient Consultation"]        union […] ) ValidEncounters      where ValidEncounters.relevantPeriod during day of Interval["November 1 Year Prior to the Measurement Period", end of "Measurement Period"])                define "November 1 Year Prior to the Measurement Period":      DateTime((year from start of "Measurement Period" - 1), 11, 1, 0, 0, 0, 0, 0) ***OPTION 2*** Initial Population Header language before: Patients 19 years of age and older who had a primary total hip arthroplasty (THA) in the year prior to the measurement period and who had an outpatient encounter during the measurement period   Initial Population Header language after Option 2: Patients 19 years of age and older who had a primary total hip arthroplasty (THA) between November two years prior to the measurement period and October of the year prior to measurement period; and who had an outpatient encounter between November of the year prior to the measurement period and the measurement period Logic before Option 2: define "Total Hip Arthroplasty Procedure":     ["Procedure, Performed": "Primary THA Procedure"] THAProcedure        where Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) starts 12 months or less on or before start of "Measurement Period" define "Has Qualifying Encounter":     exists ( ( ["Encounter, Performed": "Outpatient Consultation"]        union[…] ) ValidEncounters      where ValidEncounters.relevantPeriod during day of "Measurement Period") Logic after Option 2: define "Total Hip Arthroplasty Procedure":    ["Procedure, Performed": "Primary THA Procedure"] THAProcedure       where Global."NormalizeInterval" ( THAProcedure.relevantDatetime, THAProcedure.relevantPeriod ) starts during day of Interval["November 1 Two Years Prior to the Measurement Period", “October 31 Year Prior to the Measurement Period"] define "Has Qualifying Encounter":     exists ( ( ["Encounter, Performed": "Outpatient Consultation"]        union […] ) ValidEncounters            where ValidEncounters.relevantPeriod during day of Interval["November 1 Year Prior to the Measurement Period", end of "Measurement Period"]) define "November 1 Two Years Prior to the Measurement Period":     DateTime((year from start of "Measurement Period" - 2), 11, 1, 0, 0, 0, 0, 0) define "October 31 Year Prior to the Measurement Period":     DateTime((year from start of "Measurement Period" - 1), 10, 31, 23, 59, 59, 0, 0) define "November 1 Year Prior to the Measurement Period":     DateTime((year from start of "Measurement Period" - 1), 11, 1, 0, 0, 0, 0, 0)  ***Follow up time frame updates for BOTH Option 1 and Option 2*** Description before: Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 270 - 365 days after the surgery Description after: Percentage of patients 19 years of age and older who received an elective primary total hip arthroplasty (THA) and completed a functional status assessment within 90 days prior to the surgery and in the 300 - 425 days after the surgery Numerator before: Patients with patient-reported functional status assessment results […] in the 90 days prior to or on the day of the primary THA procedure, and in the 270 - 365 days after the THA procedure Numerator after: Patients with patient-reported functional status assessment results […] in the 90 days prior to or on the day of the primary THA procedure, and in the 300 - 425 days after the THA procedure   Current logic for the follow up: define "Has THA with Initial and Follow Up HOOS Assessments":  exists ( […]       such that FollowUpHipAssessmentHOOS during day of Interval[        end of TotalHip + 270 days,        end of TotalHip + 365 days] ) Updated logic for the follow up: define "Has THA with Initial and Follow Up HOOS Assessments":  exists ( […]        such that FollowUpHipAssessmentHOOS during day of Interval[        end of TotalHip + 300 days,        end of TotalHip + 425 days] ) The same logic update will be applied across these definitions: • "Has THA with Initial and Follow Up HOOS Assessments" • "Has THA with Initial and Follow Up HOOSJr Assessments" • "Has THA with Initial and Follow Up PROMIS10 Assessments" • "Has THA with Initial and Follow Up VR12 Oblique Assessments" • "Has THA with Initial and Follow Up VR12 Orthogonal Assessments" Rationale for change This change aligns with the follow-up timeframe of the related measure in development and current evidence supporting flexible follow-up timeframes. Additionally, this allows more flexibility in collecting the postoperative functional status assessments and better aligns with the clinical workflow and typical one-year follow-up scheduling.