February 27, 2019

Who We Are The American Academy of Physical Medicine and Rehabilitation (AAPM&R): The primary medical society for the specialty of physical medicine and rehabilitation Kavitha Neerukonda, Associate Executive Director, Quality and Research Initiatives Offers education, advocacy, networking, and practice resources to more than 9,000 rehabilitation physicians In 2016, we began making a significant investment in developing a qualified clinical data registry Beth Radtke, Senior Manager, Quality and Registry Initiatives Richard Zorowitz, MD Attending Physician, Outpatient Physician Services Professor of Clinical Rehabilitation Medicine Georgetown University School of Medicine MedStar National Rehabilitation Network

AAPM&R’s Vision Physiatrists are the essential medical experts in value-based evaluation, diagnosis, and management of neuromusculoskeletal and disabling conditions. Physiatrists are indispensable leaders in directing rehabilitation and recovery, and in preventing injury and disease. Physiatrists are vital in optimizing outcomes and function early and throughout the continuum of patient care. Data is an enabler of each of the components of the new vision (Essential, Indispensable and Vital)

Overview of the PM&R Specialty ~50% work in acute and post-acute care settings ~50% work in outpatient settings Many clinical conditions Many EHRs Variable practice sizes; some multi-specialty practices

Physiatry’s National Quality Position:Our Challenge The value (quality ÷ cost) of physiatric care is being challenged Specialty-specific challenges related to quality No national strategy to address quality No acceptable tools to effect widespread quality change Little high level evidence to guide care No specialty specific measures

Since 2015, the Academy embarked on a quality journey and pursued the development of a registry. 2016 2017 2018 2019 Prioritize Quality as a focus of the Academy Traditional options not enough for Academy to see benefits Registry as an effective way to build a quality arm Registry development began Initial focus on spine patient population Spine measures adapted from NeuroPoint Alliance (an arm of AANS) Began planning for other areas of focus Registry soft launch Receive QCDR status Identification of neurorehabilitation next area of focus for measure development Partnership with PCPI for measure development Receive QCDR status Integrate PCPI developed measures into registry Receive QCDR status DATA CAPTURE *QCDR - Qualified Clinical Data Registry

Evolution of Measure Development PCPI Contract QCDR 3rd year as a CMS- approved QCDR Deep Dive in Spine 8 measures currently in the Registry Deep Dive in Neuro-Rehabilitation 5 measures currently in the Registry Deep Dive in Pediatric Rehabilitation Coming in Fall 2019 Adapted existing measures

Process for AAPM&R’s Measure Development Journey AAPM&R’s Evidence, Quality and Performance Committee identifies need for PM&R specific quality measures AAPM&R Board of Directors approves and work with the PCPI to develop PM&R specific measures Technical Expert Panel Chairs identified Technical Expert Panel call for nominations Technical Expert Panel member selection

Process with PCPI TEP Convened Technical Expert Panel In-Person Meeting TEP prioritized developing measures for patients undergoing management for the following conditions: stroke, acquired brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis Measure Specifications & Public Comment Period Gain consensus around measure concepts for measure development and address key issues E-Specifications of Measures Measure specifications drafted and reviewed by Technical Expert Panel Comments received from outside stakeholders on drafted measures TEP finalized prioritized measure specifications PCPI staff implemented e-specifications into AAPM&R’s registry

Final Measures Assessment and Management of Muscle Spasticity - Inpatient Setting Management of Muscle Spasticity - Outpatient Post-Acute Brain Injury: Depression Screening and Follow-Up Plan of Care Family Training—Inpatient Rehabilitation/Skilled Nursing Facility - Discharged to Home  Functional Assessment to Determine Rehabilitation Needs Full measure specifications are available at: https://www.aapmr.org/quality-practice/registry/measures/2019-measures

Technical Expert Panel Co-Chairs Richard Zorowitz, MD Amy Houtrow, MD TEP Members Samir Belagaje, MD Allen Heineman, PhD Yohannes Endeshaw, MD, MPH, FAASM, AGSF Valerie A. Jones, MD Steve M. Gnatz, MD, MHA Jennifer L. Moore, PT, DHS, NCS Diedre Hannah, RN, CNS Jilly Rye, DNP, RN, CCRN, CNL Kimberly P. Hreha, EdD, Ms, OTR/L

Challenges CMS approval of measures “as-is” Adoption of measures E-specifications automatic data capture

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