Setting |
CMS Program |
Developed by |
Measure ID |
Title |
Description/ benchmark (when available) |
Outpatient |
Quality Payment Program - Merit-based incentive payment system (MIPS) (*) |
US Wound Registry |
CDR3 |
Process measure: Plan of Care Creation for Diabetic Foot Ulcer (DFU) and Venous Leg Ulcer (VLU) not Achieving 30% Closure at 4 Weeks
|
2019 measure. A plan of care needs to be created for patients that fail to achieve 30% of wound closure within 4 weeks of the application of the first CTP, and will include review of whether appropriate usual care has been implemented as well as whether further CTP applications are indicated
|
Outpatient |
Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
|
US Wound Registry
|
CDR5 |
Process measure: Adequate Compression of Venous Leg Ulcers (VLU) at each treatment visit, appropriate to arterial supply.
|
Percentage of venous leg ulcer visits among patients aged 18 years and older in which adequate compression is provided within the 12-month reporting period. Compression method should be appropriate to documented arterial supply. As a benchmark, among providers reporting this measure, performance is more than 70% of visits. However, among providers who do NOT report the measure, compression is provided in only 25% of VLU visits
|
Outpatient
|
Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
|
US Wound Registry |
CDR6 |
Venous Leg Ulcer outcome measure: Healing or Closure
|
Percentage of venous leg ulcers among patients age 18 or older that have achieved healing or closure within 12 months, stratified by the Wound Healing Index (WHI). As a benchmark, performance rate in 2016 was 19% for WHI 1, 35% for WHI 2, and 54% for WHI 3
|
Outpatient | Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
| US Wound Registry
| CDR9 | Appropriate use of Cellular and/or Tissue Based Product (CTP) in diabetic foot ulcers (DFUs) or venous leg ulcer (VLUs) among patients 18 years or older
| 2019 measure. Percent of patients 18 or older with venous or diabetic foot ulcer who receive cellular and/or tissue based products (CTPs) appropriately. Appropriate Use of CTPs for a DFU or VLU is defined as use that adheres to Medicare coverage policy regarding the total number of applications over a specific timeframe. Regional Medicare Administrative Carrier (MAC) policies differ but using the most restrictive Local Coverage Determination (LCD), appropriate use is defined as: No more than 10 applications per wound, CTP applications do not continue if the wound is unchanged in size or larger in size after 4 weeks have elapsed from the first application, CTP applications do not continue once the wound is 0.5 cm2 or smaller. Prior to application of a CTP, patient should undergo vascular assessment to exclude ischemia, control bioburden, and debride necrotic material, as well as provide other appropriate basic interventions such as compression of a venous ulcer or offloading of a diabetic foot ulcer. Currently the benchmark rate is only 23%.
|
Outpatient
| Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
| US Wound Registry
| USWR22
| Patient Reported Measure: Patient Reported Nutritional Assessment in Patients with Wounds and Ulcers
| The percentage of patients aged 18 years and older with a diagnosis of a wound or ulcer of any type who self-report nutritional screening with a validated tool (such as the Self-MNA® by Nestlé) as well as food insecurity assessment, AND for whom the clinician provides and documents a follow up/ intervention plan within the 12-month reporting period.
|
Outpatient
| Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
| US Wound Registry
| USWR23
| Non Invasive Arterial Assessment of patients with lower extremity wounds or ulcers for determination of healing potential
| Percentage of patients aged 18 years or older with a non healing lower extremity wounds or ulcers that underwent a non-invasive arterial assessment once in a 12 month period, stratified by ABI, perfusion pressure, or oximetry. Data from the USWR indicates that fewer than 10% of patients with chronic non-healing leg ulcers undergo any type of vascular assessment (ABI, transcutaneous oximetry or skin perfusion pressure) even at hospital based outpatient wound centers.
|
Outpatient
| Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
| US Wound Registry
| USWR24
| Patient Reported Experience of Care: Wound Outcome
| All eligible patients with wounds or ulcers who completed of Wound Outcome Questionnaire who showed 10% improvement at discharge or transfer to another site of care during the 12 month reporting period.
|
Outpatient
| Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
| Medicare
| MIPS 128
| Preventative Care and Screening: Body Mass Index (BMI) Screening and Follow-Up
| Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter
|
Outpatient
| Quality Payment Program - Merit-based incentive payment system (MIPS) (*)
| Medicare | MIPS 131
| Pain Assessment and Follow-Up
| 2019 measure. Percentage of visits for patients aged 18 years and older with documentation of a pain assessment using a standardized tool(s) on each visit AND documentation of a follow-up plan when pain is present
|