Response to the Medicare sacroiliac joint injection local coverage determination patient-reported outcome requirement: A quality improvement project

The Centers for Medicare and Medicaid Services recently implemented a Local Coverage Determination (LCD) for sacroiliac joint (SIJ) injections and procedures that requires the collection of a pain score and function assessment following each procedure for approval and reimbursement of subsequent SIJ injections. This data was initially collected via manual telephone call; however, a more viable long-term solution was necessary to efficiently collect and record mandatory data. The purpose of this quality improvement project was to reduce manual collection of SIJ pain scores from 100 % to 50 % or fewer without adversely impacting patient satisfaction. To address the quality gap, the team built an automated solution within our EHR to collect the required patient reported pain and function data electronically. The improvement measure chosen to measure the gap in quality was total percentage of manual nursing phone calls. The balancing measure was the patient experience metric “likelihood of recommending practice.” For the improvement measure, baseline manual collection rate was 100 %. During the first post-intervention improvement re-measure period, manual call rate was 34.50 % (p-value = 0.01). For the second post-intervention re-measure period, manual call rate was 25.95 % (p-value = 0.02). During the re-measure periods, reduction in manual effort translated to a time savings of approximately 38 h and $3400 in salary expense. At baseline, the balancing measure was 86.56 %, compared to 87.75 % during the post-intervention re-measure period (p-value = 0.06). In this quality improvement project, we significantly reduced manual effort required to collect mandatory SIJ LCD PRO data without adversely affecting patient likelihood of recommending the practice. This quality improvement project will allow us to save valuable time and resources and can serve as proof of concept for larger populations or other indications.