In March, MNCM’s Measurement and Reporting Committee (MARC) approved several recommendations for the redesign of the spine surgery measures. Consideration of redesign was sparked by a request from the Centers for Medicare & Medicaid Services (CMS) who have adopted six MNCM spine measures into the Quality Payment Program. The evolution of these measures offered an opportunity for benchmarking capability and stability.
The spine measure redesign workgroup, led by Paul Huddleston from Mayo Clinic, reached consensus on several redesign recommendations that will enhance measure use and reporting.
The scope of work included three tasks:
- Consider a target-based measure construct for measures of functional status and pain
- Expand the denominator for the discectomy/laminotomy population
- Discuss the usability/value of the quality of life measures with PROMIS Global-10
After several meetings with thorough discussion, review of extensive data analysis and numerous constructs, the workgroup reached consensus on the following recommendations:
Modify the current measure constructs for functional status, back pain, and leg pain
Recalculation of existing data (no change in elements submitted).
- Functional status is less than or equal to 22 OR a change of 30 points or greater on the Oswestry Disability Index (ODI).
- Back pain is less than or equal to 3.0 OR a change of 5.0 points or greater on the VAS Pain scale.
- Leg pain is less than or equal to 3.0 OR a change of 5.0 points or greater on the VAS Pain scale.
- Patients who are not assessed remain in the denominator and are counted as not meeting the target.
- MARC requests additional monitoring of average pre-op scores as a proxy for appropriateness.
Expand the discectomy/laminotomy denominator population
It is very likely that medical groups are not using CPT codes to determine which patients to administer pre-operative assessments to; proceed forward with expanded denominator definition and delay public reporting.
- Expansion of denominator from single CPT code 63030 to include all the following discectomy/laminectomy CPT procedure codes: 63005, 63012, 63017, 63030, 63042, and 63047. No narrowing by diagnosis. Name changed to discectomy/ laminectomy to reflect expanded population.
- Add the same exclusions currently used for the lumbar fusion population; spine related cancer, fracture or infection and scoliosis (neuromuscular, idiopathic, or congenital).
- No submission for discectomy/laminectomy 2018 dates of procedure. Submit 2019 dates of procedure in 2020 for private reporting.
- Change in submission timeframe more appropriate for this measure with a shorter assessment period.
MARC, a subcommittee of the MNCM Board of Directors, approved these amended recommendations March 13, 2019. Measure changes pending final Board approval in May 2019.