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MIPS 2023: How to Document Patient Reported Outcomes (SOAP 2.0)

MIPS IROMS Measures require the completion of a Patient Reported Outcome (PRO) at least twice during the Episode of Care. The change in score between the patients completing these surveys is applied to a risk adjustment formula, which in turn gives MIPS participants their score for the measure. In this guide, we’ll cover how to document the required PRO’s for successful completion of IROMS Measures for the MIPS 2023 Performance Period. 

Before the Initial Evaluation

The first PRO must be completed prior to or during the Initial Evaluation. There are two options for administering PRO’s to patients: manually add the desired PRO to the patient’s Episode of Care—or let Keet’s automation handle the survey distribution for you. 

Auto-Invite & MIPS Global Workflows

The Keet Auto-Invite Workflow invites your patients to create a Keet account, so that they can complete the PROs ahead of their visits. You do not need to turn the Auto-Invite workflow on if you prefer to complete the PROs with patients during the visit. 

With Keet’s MIPS workflow turned on, patients will be sent a Qualification survey once their Initial Evaluation is scheduled. The patient’s responses are then analyzed, and the MIPS Global Workflow automatically assigns the appropriate PRO. Once the PRO is completed by the patient, it will appear in their Episode of Care in Keet. 

While the Auto-Invite & MIPS Global workflows are not required to be turned on, we strongly encourage it, as it removes the burden of manually selecting which PRO to assign to a patient, and sending it to the patient when appropriate. 

Manually Administer PROs

You can also manually add the PRO to the patient’s Episode of Care if you choose. In Keet, visit the patient’s Episode of Care, click Add Activity, and click to add the desired PRO. 

This needs to be done for each MIPS eligible patient prior to—or at the time of—their Initial Evaluation, and at least one more time during their course of care. 

Treatment Classification

In order for Keet to properly apply the risk adjustment formula for IROMS measures, the treatment classification must be documented on the Episode of Care.

Initial Evaluation

After the patient completes the PRO, you’ll need to document it in the WebPT EMR. Remember, the data in Keet is what is collated and submitted to CMS. The information in the WebPT EMR is to make your documentation defensible in the case of an audit.

  1. In the WebPT EMR, open the Initial Evaluation note type on the patient’s chart.
  2. Click the MIPS badge that appears. This will open a new tab that directs you to the patient's Episode of Care in Keet.
    1. If you’ve logged in to Keet within the last 3 hours, you will not be asked to log in again. 

    Tip: We’ve found that most members prefer to have a tab of the WebPT EMR and a tab of Keet open on the same screen.

  3. In the Care Plan section of the Episode of Care, you’ll find the PRO that has been assigned to the patient.
  4. If the patient has not yet completed the PRO, they can complete the survey on their own device via QR code, or they can complete it with the provider during the visit.

  5. If you are not documenting Measure 134: Preventive Care and Screening: Screening for Depression and Follow-Up Plan, delete it from the Objective section.
  6. In the Objective section of the WebPT EMR, click Add Standardized Test.
  7. Choose the Patient Reported Outcome or Other.
    1. Add the Patient Reported Outcome directly to document the entire entire questionnaire, including the patient responses, or;
    2. Add Other to the Objective section to document simply the name of the test and the score.
    3. Remember, the information in Keet is what is collected and sent to CMS. The information in the WebPT EMR makes your documentation defensible in the event of an audit. 
  8. Document the rest of the note as you normally would, and finalize the note. 

Follow-up Visits

Remember, PROs must be completed and documented twice for successful measure completion. The MIPS Global Workflow will automatically send patient’s their follow-up surveys 21 and 42 days after their Initial Evaluation. When the follow-up survey is completed by the patient, simply follow the steps above on a Progress Note or Discharge in the WebPT EMR. 

What is an IROMS Measure?

Intermountain Rehab Outcomes Management System (IROMS) Measures are MIPS measures with a component that requires completion of a survey by the patient. These measures satisfy the MIPS Outcome Measure reporting requirement. 

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

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. 

Kee 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. 

IROMS Measures in WebPT and Keet

The following IROMS Measures can be reported using WebPT + Keet. 

Measure Name Associated PRO MCID
IROMS 11: Functional Status Change for Patients with Knee Functional Status Deficit Knee Outcome Survey (KOS) 10
IROMS 13: Functional Status Change for Patients With Lower Extremity Functional Status Deficit Lower Extremity Functional Scale (LEFS) 9
IROMS 15: Functional Status Change for Patients With Neck Functional Status Deficit Neck Disability Index (NDI) 7.5
IROMS 17: Functional Status Change for Patients With Low Back Functional Status Deficit Modified Low Back Pain Disability Questionnaire (MDQ) 6
IROMS 19: Functional Status Change for Patients With Upper-limb Functional Status Deficit Quick Disability or Arm, Shoulder and Hand Score (QDASH) 8
HM7: Functional Status Change for Patients With Lower Extremity Functional Status Deficit Dizziness Handicap Inventory (DHI) 18
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