Pain Assessment and Follow-Up
Description: The percentage of visits by adult patients who report pain in which the physician uses a standardized tool to assess pain and create a follow-up plan.
Measure ID: 131
CMS Derm Specialty Set: No
High priority: Yes
Topped out: No by Registry, Yes by Claims,
Reporting methods: Registry/QCDR, or Claims
Maximum points: 10
Measure purpose: This measure encourages physicians to identify patients who suffer from pain and use a standardized tool to assess that pain and produce a follow-up plan. The use of a standardized tool is thought to reduce inconsistencies in pain assessment caused by racial and gender bias.
The numerator: The number of patient visits where the patient reports pain and the physician uses a standardized tool to asses pain and provides a follow-up plan.
The denominator: All visits for patients aged 18 years and older.
Measure calculation example
Dr. Cohen saw 192 adult patients during the reporting period. This is the denominator.
Dr. Cohen used a standardized tool to assess pain and make a follow-up plan for 83 patients. This is the numerator.
Quality of patient care = 83/192. Dr. Cohen has a score of 43.2% for this measure. This translates to 4.0 to 4.9 points when reporting by registry.
Because of how this measure is structured, physicians score 3 points even if they report on only one patient. Physicians receive no additional score for reporting scores that fall below 15.8% if submitting via registry. For example, if Dr Cohen reported on one patient encounter, he would earn 3 points. Note that this measure is topped-out when reporting by claims. As a result, physicians must achieve a performance score higher than 80.4% to earn more 3 points.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. The maximum points you can achieve for the quality score is 45 points.
Benchmarks for registry submissions
The table below shows CMS benchmarks for registry submissions.
|Below 3 ||Decile 3||Decile 4||Decile 5||Decile 6||Decile 7||Decile 8||Decile 9||Decile 10|
|Performance rate||1 patient||15.80 -
|Points||3 points||3 - 3.9||4 - 4.9||5 - 5.9||6 - 6.9||7 - 7.9||8 - 8.9||9 - 9.9||10|
Benchmarks for claims submissions
The table below shows CMS benchmarks for claims submissions.
|Below 3 ||Decile 3||Decile 4||Decile 5||Decile 6||Decile 7|
|Performance rate||1 patient||80.57 -
| 96.92 -
|Points||3 points||3 - 3.9||4 - 4.9||5 - 5.9||6 - 6.9||7|