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Public Access Survey for 2023 MIPS Quality ID #478 (NQF 3461): Functional Status Change for Patients with Neck Impairments

Before you get started:

  1. It is required that you read and ensure your understanding of the measure specification for this quality measure.To download the measure specification, visit the CMS Quality Payment Program website. Search under MIPS/Explore Measures and Activities and select the Clinical Quality Measure Specifications. CMS requires MIPS measure specifications to be housed on the CMS Quality Payment Program website.
  2. Hint: make sure you understand how to calculate the Residual Score by reading the Definitions in the Numerator section of the measure specifications.
  3. Once you understand all details of the measure specifications, access the Public Access Survey below for your patients to take the survey at the time of Initial Evaluation, Progress Evaluations, and Discharge during the relevant episode of care.

 

Success Tips:

  • Before administering the survey to your patients, take a “test” survey for yourself (the clinician) to gain familiarity with what your patients will experience and the location of the scoring results that will appear for your MIPS usage on the last page after each patient completes the patient-facing questions.
  • Each time your patient completes the survey, be sure to record the date of survey completion, the Functional Status Score, and the Predicted FS Change This will allow you to calculate the Residual Score as described in the Numerator of the measure specification.

 

About the Public Access Survey

This Public Access Survey provides computer adaptive test (CAT) administration of the primary (FOTO) patient-reported outcome measure (PROM) and standardized patient questions toward risk adjustment as described in the measure specification. Scoring results and details you need for calculating the corresponding MIPS measure are provided on the last screen of the assessment.

Also provided is an option to administer an alternative (“legacy”) PROM to your patient instead of the primary FOTO PROM. Crosswalk functionality, as described in the measure specification, is included. Further details about crosswalk functionality in Clinical Quality Measures 217-222 and 478 are provided here.

The Public Access Survey is available free of charge for non-commercial uses in the context of individual clinical practice, i.e., patient-level measurement, for purposes of participation in the Centers for Medicare and Medicaid Services’ Merit-based Incentive Payment System (MIPS). For any commercial or other type uses, such as incorporation of the measure components into a product or service, Contact FOTO.

To access the Public Access Survey, you will need to read, understand, and agree to the FOTO Standards of Administration and the Terms and Conditions.

 

Public Access Survey to Support Quality ID 478 (recommended)

For best user experience, select Public Access Survey to Support Quality ID 478 (recommended) here. This recommended option  provides patients with a shorter survey experience, using the FOTO Neck CAT (computer adaptive test), and reduced clinician/staff burden with automated score and risk adjusted predicted change score provided on the last page of the survey. 

This recommended approach aligns with CMS initiatives toward innovation and leveraging modern science and technology to improve meaningfulness and reduce burden for providers and patients while strengthening data integrity for CMS.

 

Alternative PROM option 

This option allows you to administer the Neck Disability Index (NDI) to your patient instead of the FOTO Neck CAT.  Using this survey option, the NDI may be used to fulfill the PROM component of this quality measure. Even though the NDI and FOTO Neck are different PROMs with different scoring metrics, cross-walked scoring functionality allows clinicians the option to administer the NDI to their patients for use in routine clinical care while reporting this quality measure (ID 478) for MIPS. 

Analytic testing results confirmed the accuracy (reliability) and validity of the cross-walking methods and no statistically significant differences in “measure achievement points” as defined by CMS and used in CMS benchmarking deciles for MIPS Quality Benchmarks.  

Access the Public Access Survey to Support Quality ID 478 with the NDI as the alternative PROM and with all crosswalk functionality automated here.

 

Manual Administration, Scoring, and Calculating Option (not recommended)

This option is not recommended because of increased provider and patient burden and risk for error in hand-scoring and calculation steps. To gain access to the manual components (PROM short form and scoring table, crosswalk functionality as applicable, risk adjustment coefficients), email your request to FOTO.  We will contact you directly to provide the manual components. 

Complete the following steps to gain access to the Public Access Survey:
Name(Required)
Read the Standards of Administration of FOTO Measures

ADMINISTRATION GUIDELINES: 

Standardization helps insure that patients at different clinics and different settings are all responding to questions based on their own perspectives and experiences. 

Standardization seeks to minimize coaching and other external influences on patient responses. 

  1. I. Background – definition of administration, why important 
  2. II. Patient Instructions Prior to Answering Survey Questions 
  3. III. General Guidelines for Helping Patients Who Request Assistance 
  4. IV. Supplemental Instructions 
  5. V. How to Handle Common Scenarios 
  6. VI. Non-verbal Communication 
  7. VII. Paraphrasing Instructions 
  8. VIII. When to Administer FOTO Surveys 
  9. IX. How Much Assistance is Too Much? 

I. Background 

What does Administration mean? 

The term “administration” in this context refers to manner in which each FOTO Intake and Status assessment is presented to the patient. 

Why is this important? 

Adhering to standards for administering FOTO measures promotes validity, reliability and responsiveness. These properties are critical to clinicians and others who expect consistency and accuracy in measurement of outcomes. Using standard procedures for survey administration allows for more accurate benchmarking of performance across clinics. 

At least as importantly, patients deserve evidence-based care informed by the highest caliber of research, and accurate outcomes measurement is a critical component of evidence-based practice. Researchers, scholars, and policymakers similarly desire measurement that produces the most meaningful & precise results. 

Insuring that all patients receive the same instructions prior to answering survey questions preserves the integrity of the assessment. It is also important that guidelines are consistently followed when patients have questions or need help in responding. Standardization seeks to minimize coaching and other external influences on patient responses. When interacting with a patient who is completing FOTO measures, clinicians and others who have the best of intentions can inadvertently bias reporting just by what they say or how they act. 

Standardization helps insure that patients at different clinics and in different settings are all responding to questions based on their own perspectives and experiences. Scores that are obtained under standardized conditions are more trustworthy and the subsequent interpretations sound. © 2015 Focus on Therapeutic Outcomes Inc. All Rights Reserved Standards of Administration Page 2 

II. Patient Instructions Prior to Answering Survey Questions 

INTAKE- These instructions will be displayed for the patient at the start of the survey. The survey administrator is advised to state or paraphrase these instructions verbally. Keep in mind the importance of tone of voice and body language. Deliver the verbal patient instructions in a manner that communicates that the assessments are valuable. 

The following assessment will ask you about difficulties you may have with certain activities. 

It’s an important part of your evaluation. It will help us: 

· understand how your condition is affecting your activities, and 

· develop treatment goals with you. 

Please answer the questions with respect to the problem for which we are seeing you. Respond based on how you have been over the past few days. 

STATUS – The guidelines are the same as for Intake. 

Please answer these questions to help us assess your progress since starting therapy. 

Remember: 

– Answer the questions with respect to the problem for which we are seeing you. 

– Respond based on how you have been over the past few days. 

III. General Guidelines for Helping Patients Who Request Assistance

Keep mind that patient self-report measures are intended to assess the patient’s perception. 

DO  DO NOT 
• Follow the standardized instructions 
• Re-read 
• Re-emphasize 
• Objectively re-state 
• Interpret the question for the patient 
• Tell the patient how to answer

Illustration of General Guidelines using the Fear Avoidance Beliefs question(s).
• Re-read the instructions on the computer screen (okay to paraphrase): “It’s asking you to rate how strongly you agree or disagree with this statement, ‘I should not do physical activities which might make my pain worse.’”
• Re-emphasize: “….’I should not do physical activities which (might) make my pain worse.’”
• Objectively re-state: “Mr. Smith, how strongly do you agree or disagree with this statement: “I should not do physical activities which (might) make my pain worse?’”

IV. Supplemental Instructions 

In response to patient questions or other special circumstances, the following are supplemental instructions that may be delivered verbally to the patient, in addition to the Intake and Status instructions. Remember to remind the patient of key points from the Intake and Status instructions when applicable.

  • “There are no wrong answers. We want to know what YOU think.”
  • “If you are asked about something you haven’t done recently, estimate how hard it would be if you tried to do it now.”
  • “Keep in mind that the assessment does not know who you are. These are standardized questions. If a question does not seem to apply to you, choose the response closest to the right answer for you…or…select the ‘best fit’ answer.”
  • “The computer is assessing your abilities. In order to find out what you can do, it has to find out what you cannot do.”
  • “Your clinician is interested in learning more about how your condition may or may not be affecting you either physically and/or emotionally.”
  • “You also will have the opportunity to respond regarding your satisfaction with your experience at this facility.” (for Status if Satisfaction not turned off.)
  • “The information you give is a part of your medical record, and subject to regulations that protect health care information.”
  • “This assessment usually takes about 5-10 minutes.” (Okay to say longer if you feel that will be the case. The point here is that you give the patient a time estimate.)

V. Common Scenarios 

This section applies the general guidelines and other standardized wording for common scenarios. 

A patient’s function may be limited due to medical contraindications, such as post-operative rotator cuff repair: 

  • Do not tell the patient which response to choose. Re-state the instructions and/or the question and/or the patient’s perception. For example, 

Patient: “I’m not supposed to raise my arm because my doctor told me not to yet. How should I answer this question about reaching a shelf at shoulder height?” 

Response: “Remember that the instructions for this questionnaire said that you are supposed to answer based on how you are presently. You said that you are not supposed to raise your arm; how do you think that applies to this question about reaching up to a shelf at shoulder height? There are no wrong answers; choose what you feel is the best-fit response.” 

  • Let’s say the patient decides that even though they aren’t supposed to reach to shoulder height, that they could do it if they tried and thus they select “moderate difficulty” rather than “Unable;” that would be the correct response because it is the patient’s perception! 
  • Notice that the response above only takes into account what the patient said or knows, that their doctor said they are not to raise their arm. Thus, either a clinical or non-clinical staff member can do this. 

A patient feels that certain questions are inappropriate, such as an older adult being asked about running or hopping: 

  • For example, 

Patient: “I’m 80 years old, so why am I being asked if I can run?” 

Response: “The computer is assessing your abilities. In order to find out what you can do, it has to find out what you cannot do.” 

Administering optional questionnaires about psychosocial topics contain questions some patients may consider sensitive. 

  • For example, 

Patient: “Why is this asking about things that are not my problem??” 

Response: “Keep in mind that the assessment does not know who you are. These are standardized questions. If a question does not seem to apply to you, choose the response closest to the right answer for you…or…select the ‘best fit’ answer.” 

Patient: “Why is it asking me about worry and distress? My problem is physical. Do you guys think I am faking it?!” 

Response: “Your clinician is interested in learning more about how your condition may or may not be 

affecting you either physically and/or emotionally.” 

A patient asks if they should respond based on their function with or without their assistive device: 

  • Instruct the patient to respond based on what the patient feels would be normal function for them. For example, o Someone who has used a walker for several years might consider that their normal function means how they can walk using a walker,…or they might not! 
    • Someone who is using an assistive device short-term due to the injury/condition might consider that their normal function means how they could perform without the device. 
  • Always default to affirming to the patient that their perception is correct. 

A patient is uncertain whether to respond based on their function using the affected extremity relative to the unaffected extremity 

  • Re-state for the patient any relevant Intake or Status instructions with emphasis on the key words within the questionnaire being taken. For example, 

Response: “I can see that on the question you are being asked it says, ‘Using your affected arm how much difficulty do you have…?’ How much difficulty do you feel you have because of your affected arm? Remember, there are no wrong answers; however you interpret it is correct.” 

  • Instruct the patient to respond based on what the patient feels would be normal function for them. 

VI. Non-verbal Communication 

Keep in mind the importance of tone of voice and body language. Deliver the verbal patient instructions in a manner that communicates that the assessments are valuable. The patient’s responses may be more thoughtful and accurate if the patient understands the assessment process is an important component of their care episode. 

VII. Paraphrasing Standardized Patient Instructions 

It is generally acceptable to paraphrase or restate the sentences. Remain true to the message and be objective. 

Often it is best to start by using the scripted sentences verbatim, and as you become more comfortable with remembering the responses, you might evolve into putting things in your own words. 

VIII. When to Administer FOTO Assessments

It is recommended that patients complete their FOTO assessments prior to the evaluation with the clinician. 

Completing the assessment post-evaluation is the preferred option only if the alternative would be not getting the assessment at all. 

IX. How Much Assistance Is Too Much? 

After delivering the Intake or Status instructions verbally, the survey administrator may wish to remain with the patient until the first functional question in order to make sure the patient is comfortable navigating the survey. Once survey setup is complete and the patient has started answering the functional survey, DO step away and let the patient know that you are available if the patient needs help. 

If the patient asks for help, follow the guidelines provided above under Supplemental Instructions and Common Scenarios. For patients who seem to need the close presence or guidance of another, see FOTO guidelines for Proxy and Recorder survey administration options. 

Read the Terms of Service

These Terms & Conditions of Use (these “Terms”) constitute a binding agreement between you and Net Health Systems, Inc. (“Net Health”), owner of the FOTO Patient Outcomes, governing your use of and access to the FOTO patient-reported outcome measures, scoring tables, cross-walk tables, and risk-adjustment components (collectively, the “FOTO Content”). The FOTO Content is provided free of charge, subject to these Terms, to eligible healthcare providers as a support tool in connection with treatment of patients in a clinical context. Any intended use of the FOTO Content outside of this specified context is prohibited absent the express written consent of Net Health. Your use of and access to the FOTO Content is subject to your agreement with these Terms, and these Terms constitute the entire agreement between you and Net Health regarding your use of and access to the FOTO Content. The FOTO Content is not intended for use by minors under the age of 18, and by using the FOTO Content, you attest that you are of majority age. 

PLEASE READ THESE TERMS CAREFULLY BEFORE ACCESSING OR USING THE FOTO CONTENT. BY ACCESSING OR USING THE FOTO CONTENT, YOU AGREE TO BE BOUND BY ALL OF THE TERMS AND CONDITIONS OF THESE TERMS. 

Limited License to Access and Use the FOTO Content 

Net Health grants you a non-exclusive, non-assignable, non-sublicensable, terminable, limited license to access and use the FOTO Content as a support tool in connection with the treatment of patients and for monitoring patient progress solely in connection with your participation in the Center for Medicare & Medicaid Services’ (“CMS”) Merit-based Incentive Payment System (“MIPS”). You may view, copy, print and use content contained within the FOTO Content solely for the foregoing use. Nothing in these Terms is intended to, or may be construed as, conferring any license or other grant of right to use any patent, copyright, trademark, service mark or other intellectual property of Net Health or any third party. 

Except as set forth above, you may not use, copy, modify, distribute, translate, reproduce, republish, disassemble, reverse engineer, decompile, mirror, frame, hyperlink or transmit any of the content or materials of the FOTO Content or rent or sell use of or access to the FOTO Content, or any of the content or materials on the FOTO Content. Other than allowing your patients to complete the FOTO Content forms in your practice, you may not permit third parties to access the FOTO Content or use any FOTO Content and may not make any other use of the FOTO Content or any FOTO Content except as set forth in these Terms. 

You agree to use the FOTO Content for lawful purposes only. You may not post or transmit through the FOTO Content any material (i) that violates or infringes in any way upon the rights of others, (ii) that is unlawful, threatening, abusive, defamatory, invasive of privacy or publicity rights, vulgar, obscene, profane or otherwise objectionable, or (iii) that encourages conduct that would constitute a criminal offense, give rise to civil liability or otherwise violate any law. 

You understand and agree that Net Health may terminate or otherwise deny your access to the FOTO Content and without notice in the event Net Health believes in its sole discretion that you have violated these Terms. 

You acknowledge and agree that your use of the FOTO Content, including any material or information contained therein, is at your own discretion and risk. 

Net Health reserves the right without prior notice to discontinue any features or content available on the FOTO Content, or otherwise change specifications at any time without incurring any obligations to you or any other party. Nothing herein shall be deemed as a guarantee that the FOTO Content will be available at any given time. 

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The FOTO Content and all content included therein, including but not limited to the text, graphics, button icons, images, artwork, names, logos, trademarks, are and shall remain the property of Net Health and are protected by applicable intellectual property laws. The compilation of all content on the FOTO Content, as well as the original arrangement, organization, design, formatting, trade dress, look and feel of the FOTO Content is the exclusive property of Net Health and is also protected by applicable intellectual property laws. The FOTO Content may also contain various third-party names and marks that are the property of their respective owners. 

Any unauthorized use of our marks or of our copyrighted material or trade dress or any other intellectual property is strictly prohibited and may be prosecuted to the fullest extent of the law. 

To the extent that you send Net Health any feedback, ideas, comments, or suggestions relative to the FOTO Content (collectively, “Feedback”), such Feedback shall not be treated as confidential, Net Health shall have no obligation or responsibility to take any action whatsoever in regard to such Feedback, and such submission of Feedback shall be considered a royalty-free perpetual assignment of such Feedback to Net Health for Net Health to use (or not use) in its sole discretion, including but not limited to copying, reproducing, or incorporating such Feedback into the FOTO Content without any obligation to you. 

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Modal Title

Cross-walked scoring (linking methods) (1-3) originated, primarily, in the field of Educational Psychology and in recent years crossed over into the field of healthcare PROMs. For example, a large list of cross-walks has been established using PROMIS and other PROMs. (4)

Statistically equivalent score-linking between an IRT-based PROM and a suitable legacy PROM is produced using advanced psychometric methods. The approach results in a cross-walk table that facilitates the conversion of a legacy PROM score to the metric of the IRT-based PROM. Once a legacy score is cross-walked to its equivalent IRT-based PROM score, the corresponding risk adjustment model for the CQM can be applied and the risk-adjusted predicted change score calculated, followed by the calculation of patient-level residual scores (i.e., observed change minus predicted change) from which the “performance met” criterion is applied (residual >=0). Depending on the measurement characteristics of the legacy PROM, an adjustment factor may be applied to the crosswalk-based residuals to balance the rates of performance met to those of the IRT-based PROM.

References
1. Albano AD, Rodriguez MC. Statistical equating with measures of oral reading fluency. J of Sch Psych 50 (2012) 43–59.
2. Albano AD. R Package ‘equate’ (Version 2.0-3): Observed-Score Linking and Equating. October 21, 2014.
3. Albano AD. equate: An R Package for Observed-Score Linking and Equating. October 21, 2014.
4. PROsetta Stone Linking Patient-Reported Outcome Measures. https://www.prosettastone.org/. Accessed January 15, 2022.

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