Quality Measures in Physical Medicine and Rehabilitation: What’s Really Getting Measured by Qualified Clinical Data Registries (QCDRs)?

Research Objectives: To investigate the characteristics of quality measures mandated by the Centers for Medicare and Medicaid Services (CMS) for rehabilitation providers eligible for the Merit-based Incentive Payment System (MIPS) and who report through Qualified Clinical Data Registries (QCDRs).

Design: Observational study using publicly available data.

Setting: Practice settings of MIPS-eligible healthcare professionals

Participants: Measures in QCDRs for the 2021 to 2024 MIPS performance years.

Interventions: Not Applicable

Main Outcome Measures: The number and characteristics of QCDR quality measures classified under a rehabilitation specialty.

Results: In the four years of data CMS has released, the number of quality measures for rehabilitation available through QCDRs ranged from 82 in 2022 to just 48 in 2024, with a total of 86 unique measure IDs across all 4 performance years. Notable trends were observed in measure characteristics, with measures that could be used from telehealth increasing from 80% in 2021/2022 to 100% in 2023/2024 and risk adjustment of measures ranging from 54% in 2024 to 75% in 2023. Among all rehabilitation QCDR measures, 76% of 2021 measures, 68% of 2022 measures, 83% of 2023 measures, and 71% of 2024 measures were classified as patient-reported outcome-based performance measures (PRO-PMs). Among these PRO-PMs, the primary area of assessment across all four years was pain and function.

Conclusions: The increase in quality measures that include telehealth suggests that measure stewards are responding to shifts in care delivery contexts. Surprisingly, there were fewer risk-adjusted measures as a percentage of the total number of rehabilitation QCDR measures in 2024 versus earlier years; a possible explanation is the introduction of measures that assess condition-agnostic outcomes. Trends in the use of PRO-PMs were also unexpected, given the emphasis CMS has placed on including the patient’s voice in assessing care quality. Data from the 2022 reporting year indicated that 56 QCDR quality measures were classified as PRO-PMs, which shrank to just 34 in the 2024 reporting year. Additionally, while pain and function are critical to patient health and well-being, these domains may not sufficiently capture the complexity of patient needs or the quality of rehabilitation care. Finally, the number of unique measure IDs has decreased significantly in the most recent 3 reporting years, reducing from 46 in 2022 to just 27 in 2024. Together, these results suggest that CMS and QCDR measure stewards may be focusing on deploying fewer measures with a more flexible approach for assessing care quality.

Author(s) Disclosures: The Authors have no conflicts of interest to disclose