What is an IROMS Measure?

The Center for Medicare & Medicaid Services (CMS) has mandated that MIPS data registries must harmonize the measures they report on in 2022. This means that some previously accepted MIPS measures must now be replaced for the 2022 reporting year. What this means for rehab therapists is that four Healthmonix (HM) measures will be replaced by measures developed by Intermountain Rehab Outcomes Management System (IROMS).

The replacement IROMS measures relate to the same diagnosis categories and will use the same ICD-10 triggers as were used for the Healthmonix measures. Additionally, the new IROMS measures will use the same Outcome Measurement Tool (OMT) as the corresponding HM measure they replace.

However, one distinct difference between HM measures and IROMS measures is how success is defined. IROMS measures are known as inverse measures, which means that they are looking for patients who have NOT improved over time. These measures work differently than Healthmonix measures because they were originally designed for use in hospital systems, to help identify which patients were at risk of poor outcomes. For the IROMS measures to be met means that a patient failed to show progress over the given time span. In contrast, for an IROMS measure to be not met means that the patient did, in fact, demonstrate improvement in their outcomes.

Simply put, the scoring for IROMS measures is inverted. If an IROMS measure is met, your MIPS score will decrease, and if an IROMS measure is not met, your MIPS score will increase.

What are the replacement measures?

MIPS score increases * MIPS score decreases **

Example
HM 8 will be replaced by IROMS 13. Previously, when you met the MCID for HM8, it meant that you met the measure as well, which contributed positively to your MIPS score. Now, when you meet the MCID for LEFS, that means that your patient showed progress which does not qualify them to meet IROMS 13. Since IROMS measures are designed to look for failure to progress, you have effectively NOT MET this measure, which is a good thing. Because the IROMS measures are inverted, not meeting IROMS measures has a positive impact on your final MIPS scoring. Remember, you want to see your patients improve over time, which means that meeting the appropriate MCID is still crucial, despite how IROMS interprets the score.

Example

HM 8 will be replaced by IROMS 13. Previously, when you met the MCID for HM8, it meant that you met the measure as well, which contributed positively to your MIPS score. Now, when you meet the MCID for LEFS, that means that your patient showed progress which does not qualify them to meet IROMS 13. Since IROMS measures are designed to look for failure to progress, you have effectively NOT MET this measure, which is a good thing. Because the IROMS measures are inverted, not meeting IROMS measures has a positive impact on your final MIPS scoring. Remember, you want to see your patients improve over time, which means that meeting the appropriate MCID is still crucial, despite how IROMS interprets the score.

Patient Eligibility

If a patient meets any of the following criteria, they are not eligible for IROMS measures:

Patient has a life expectancy of 6 months or less
Patient is non-English speaking and translation services are unavailable
Patient has a mental or cognitive impairment that compromises their ability to complete OMT
Patient meets Medicare requirements for maintenance therapy
Ongoing care not indicated
Patient is extremely medically complex and likely to make poor clinical progress, documentation supports this

IROMS Measure Benchmarks

Currently, IROMS measures do not have a benchmark and are capped at 3 points. CMS has indicated that they intend to use 2021 performance data to establish a performance benchmark for these measures, so we anticipate that these measures will be worth up to 10 points for the 2022 reporting period.

Risk-Adjusted Measures

IROMS measures are risk-adjusted for complicating factors that impact the patient’s recovery. Patient factors, or comorbidities, may include age, gender, weight, past medical history, and other clinical factors. These are applied as a mathematical formula that allows providers to more accurately compare outcomes across patients.

We partner with Healthmonix to provide these measures, and they will automatically apply the risk adjustment formula for you. The risk-adjustment formula will only be applied after the MCID has been determined, which occurs after the Progress Note and/or Discharge Note survey is completed.

To learn more about risk-adjusted measures, click here.

IROMS Measures in WebPT

IROMS measures are configured to display when:

The patient meets the minimum age requirement
The patient has one relevant ICD-10 code on the case
The initial OMT and follow-up OMT are completed and designated as primary

Each IROMS measure can support only one ICD-10 code. If a patient has multiple ICD-10 codes on their case, they may be eligible for more than one instance for the same measure, or for multiple IROMS measures.

For example, the patient has an ICD-10 code for shoulder pain and an ICD-10 code for neck pain. Because Healthmonix QCDR does not have a filter for the primary diagnosis, the patient is eligible for IROMS 19 and IROMS 15.
For example, the patient has an ICD-10 code for shoulder pain and an ICD-10 code for elbow pain. Because IROMS 19 covers both scenarios, the patient is eligible for IROMS 19 twice.

To avoid these scenarios, select a Primary OMT on the case. This confirms the OMT is related to one of the IROMS measures for which the patient is eligible.

IROMS measures are configured not to display when:

The initial OMT was collected in a different clinic location than the follow-up OMT.
There is not a relevant ICD-10 code for the IROMS measure.
The OMT used for the IROMS measure is not selected as the primary OMT on the Initial Evaluation
- For example, you want to report on IROMS 17 (Low Back Pain) but you select the Dizziness Handicap Inventory as the primary OMT instead of the Modified Oswestry Low Back Pain. IROMS 17 reporting will not appear on the MIPS tab; however, the patient will still count towards the Total Instances in the Healthmonix column. This can happen with any of the measures, so you must make a clinical judgment when selecting the appropriate OMT during the Initial Evaluation.
An assistant creates the progress note. The billing therapist must create the note, then the PTA/OTA can re-open to complete it.

Where can I learn more about IROMS measures?

Visit the links below to learn more about each IROMS measure:

SOAP 1.0	SOAP 2.0
Lower Extremity Functional Status Deficit	Lower Extremity Functional Status Deficit
Neck Functional Status Deficit	Neck Functional Status Deficit
Low Back Functional Status Deficit	Low Back Functional Status Deficit
Upper-limb Functional Status Deficit	Upper-limb Functional Status Deficit