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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.
Show
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.