The document defines Quality Performance Outcomes Payments (QPOP) as a program that uses validated psychological screens and functional tools to have meaningful conversations with patients about their progress and goals. QPOP benefits providers by supporting decision making and identifying barriers to treatment, and benefits patients through shared decision making and a sense of control over their recovery. Providers must be certified in QPOP by attending training, passing an exam, and meeting documentation standards that involve demonstrating shared decision making, interpreting screen results, establishing functional goals and plan of care, and discussing outcomes at follow ups and final assessment.

1. Quality Performance
Outcomes Payments
(QPOP)
Provider Education Unit
Division of Workers’ Compensation
1

2. 2
IMAGINE……

3. 3

4. “It is more important to
know what sort of
person has a disease
than to know what sort
of disease a person
has.”
Hippocrates 4

5. Objectives
 Define the QPOP program
 Explain how QPOP benefits providers
and patients.
 Identify the DOWC provider
certification requirements for QPOP.
 Understand the DOWC documentation
standards for QPOP and analyze case
examples for documentation
standards.
5

6. What is QPOP?
 Data provides information about the patient:
◦ Is the patient making functional gains?
◦ Is the patient at MMI?
6
Psychological
Screen
Functional
Tool

7. What is QPOP?
• Would they benefit from a visit with a
mental health provider?
 Gives data for provider to discuss with the
patient their progress and plan of care
7

8. QPOP is about having a “real”
conversation with the patient…..
Typical vs. patient’s recovery with
review of data
• Patient information/provider
information
• Review of data from the screens
• Discussion of normal progression for
specific injury
8

9. QPOP is about having a “real”
conversation with the patient…..
Shared decision making
• Setting patient specific goals
• Discussing plan of care
9

10. QPOP is about having a “real”
conversation with the patient…..
Patient specific goals and treatment
plan
• What goals does the patient want to
achieve?
• Are the goals important to them?
• Do not have to be specific to work,
can include specific ADLs
10

11. Why use QPOP?
 “Half of injured workers feel symptoms of
depression at some point during the year
after their injury” – even if there were no
signs of depression before injury.
 Study by the Institute for Work and Health, Journal of Occupational
Rehabilitation (2015)
11

12. Why use QPOP?
 “The course of depressive symptoms
in the first six months is an important
indicator of how well injured workers
will likely feel by the year’s end.”
 Six month period is window of
opportunity to screen for symptoms of
depression.
 Study by the Institute for Work and Health, Journal of Occupational
Rehabilitation (2015)
12

13. Why use QPOP?
 Already utilizing a psychological
screen and functional tool?
◦ Mirrors Medicare’s standards for
depression screening and functional
outcome assessment standards.
13

14. How to Apply QPOP
 Utilize as standard practice
 Administer until MMI determination
 Administrative staff to provide screens
to patients
 Data is available at initial evaluation
and follow up appointments
14

15. How Does QPOP Benefit
Providers?
 Supports decision making
◦ Objective findings from screening tools
and goals to help determine MMI
 Identifies barriers to treatment
◦ Psychosocial factors can influence
outcomes
 Decrease incidence of delayed
recovery
 Increased revenue
 QPOP certification open to all
15

16. How does QPOP benefit
patients?
 Shared decision making with providers
◦ Functional goals
◦ Plan of care
 Control over outcomes
◦ Providers sharing outcome data
16

17. QPOP Certification
Requirements
 Attend Level I or Level II Accreditation
seminar
 Attend QPOP presentation
 Pass the QPOP examination
 Submit report to the Division for auditing
◦ If sufficient, provider is certified and added to
list on DOWC website
◦ If insufficient, feedback is provided and must
submit another report
◦ Tutoring is available, recommended after 3
insufficient reports
17

18. QPOP Requirements
1. Utilize DOWC validated
psychological screen
2. Utilize DOWC validated functional
tool
3. Abide by the DOWC documentation
standards.
18

19. DOWC Approved Musculoskeletal
Functional Tools
 Upper Extremity
◦ Quick DASH (Disabilities of the Arm, Shoulder
and Hand
◦ Simple Shoulder Test
◦ Hand/ Wrist Symptom Severity Scale
◦ PREE – Patient Rated Elbow Evaluation
◦ Oxford Elbow, Shoulder and Shoulder
Instability Scores
 Lower Extremity
◦ LEFS (Lower extremity functional scale)
◦ Lower Limb Questionnaire
◦ Foot and Ankle Outcomes Questionnaire
◦ Oxford Hip and Knee Scores
19

20. DOWC Approved Musculoskeletal
Functional Tools
 Spine
◦ Oswestry Low Back Disability
Questionnaire
◦ Quebec Back Pain Disability Scale
◦ Neck Disability Index
◦ Dallas Pain Questionnaire (DPQ)
 General
◦ SF-36 and SF-12
◦ FOTO – Focus on Therapeutic
Outcomes
20

21. DOWC Approved Psychological
Outcome Measures
 BBHI 2
◦ Brief Battery for Health Improvement – 2nd
Edition
 DRAM
◦ Distress and Risk Assessment Method
 CES-D
◦ Center for Epidemiological Studies
Depression Scale
 PRIME – MD
◦ Primary Care Evaluation for Mental Disorders
 BDI –II
◦ Beck Depression Inventory -2nd edition
 Zung Depression Inventory
 PHQ, PHQ-9 – Patient Health
Questionnaire 21

22. QPOP Documentation Standards
ALL QPOP reports are separate
from Evaluation & Management
(E&M), follow up and final
assessment reports
22

23. Why Two Separate Reports?
E&M Report QPOP Initial Report
 History of Injury
 Review of Systems
 Past Medical, Family
and Social/Work
History
 Physical Examination
 Psychological Screen
and Functional Tool
Documented
 Interpretation of Data
Results
 Discussion of Results
with the Patient
 Creation of Patient
Specific Goals
 Plan of Care
Discussion with
Patient
23

24. Documentation Standards:
Initial Evaluation
• Documentation must:
 Demonstrate shared decision
making
 Include Division approved
psychological screen and functional
tool
24

25. Example of Sufficient Initial
Evaluation
 “Patient was given the Oswestry Pain
Questionnaire and Zung Depression
Inventory. ………..
25

26. Documentation Standards:
Initial Evaluation
 Documentation must:
 Demonstrate shared decision making
 Interpretation of testing results
26

27. Continuation: Example of
Sufficient Initial Evaluation
 “……. Ms. Back scored 30% (21-
40%: moderate disability) on the
Oswestry and scored mildly
depressed (50-59%) category on the
Zung Depression Inventory…..”
27

28. Documentation Standards:
Initial Evaluation
 Documentation must:
 Discussion of results with the patient
28

29. Continuation: Example of
Sufficient Initial Evaluation
 ….“The patient and I discussed the
results of the Oswestry and Zung
screens, which indicate that she has
difficulty walking more than ½ mile
and lifting heavy objects off of the
floor. She is mildly depressed so we
will watch this closely.”
29

30. Documentation Standards:
Initial Evaluation
 Documentation must:
 Demonstrate shared decision making
 Establish a plan of care
30

31. Example of Sufficient Initial
Evaluation
 “…….“We discussed if future
psychological screens indicate an
increase with depression, then a
psychological referral may be
indicated. We also discussed a
typical progression for this type of
injury.”
31

32. Documentation Standards:
Initial Evaluation
 Documentation must include:
Functional goals :
• Use shared decision making to
create functional goals
32

33. Functional Goals
 Goals need to be:
Specific
• What is important to the patient?
Functional
• Pick up grandkids, comb hair, walking,
sitting
Measurable
 Walk for 1 hour
◦ Time frame
 How long it will take to achieve the
goal? – 3 weeks
33

34. Goal Writing Examples
 Patient will return to work in 3 weeks.
 Patient will use proper body
mechanics for work.
 Patient will be able to lift the left upper
extremity in order to comb her hair in
6 weeks.
 Patient will be able to sleep 6 hours
per night in 6 weeks.

35. Documentation Standards:
Follow Up Visit
Demonstrate shared decision making
Documentation of functional data, why
this alters/modifies plan of care.
Use your clinical judgement to
determine if a psychological screen
needs to be repeated.
Is treatment given working? Continue
and bill.
35

36. Sufficient Follow Up
Documentation Example
 “Patient is six weeks status post ankle
ORIF and he has improved to a 25 (from
a 10) on the Foot/Ankle Questionnaire.
We discussed the functional data which
shows improvement and patient agrees
to continue with physical therapy as he
feels it is beneficial. The patient reported
no signs of depression and was not at
risk according to the screen performed at
the initial evaluation; therefore, a
psychological screen was not repeated.”
36

37. Documentation Standards: Final
Assessment
Demonstrate shared decision
making
Discussion of functional outcomes
and progress toward goals
Discussion of MMI
37

38. Final Assessment Example
Report
 “Mr. Smith is status post rotator cuff
repair with the following data: 9/21/15,
he scored 50 on the Quick DASH,
1/26/16, he scored 25 and 3/15/16 he
scored 15. He has been compliant
with participation in extensive
rehabilitation. We discussed the data
points which demonstrate functional
improvement. He denies any feelings
of depression.
38

39. Continuation: Final Assessment
Example Report
 Although he is not back to baseline
with function, his condition is stable
and no further treatment is reasonably
expected to improve his condition.
Therefore, Mr. Smith and I agree he
has reached MMI.”
39

40. Rehabilitation Communication
Form/QPOP Report
 New form for 2017 (WC196)
 SOAP note with Objective portion as a
summary of findings from initial
evaluation to present
 Incorporates the functional tool and
scores
 Succinct patient information for
provider
 Bill no more than every 2 weeks for 6
weeks, once every 4 weeks thereafter40

41. QPOP Documentation
Summary
 All reports are separate from other
reports (two pieces of paper)
 Random auditing will occur with
documentation – continue with
documentation sufficiency!
41

42. QPOP Documentation
Summary
 Initial Evaluation:
Division approved psychological
screen and Division approved
functional tool must be used.
Interpretation and discussion of
testing results with the patient
Shared decision making with the
patient to establish plan of care and
functional goals
42

43. QPOP Documentation
Summary
 Follow up:
Documentation of functional data
Discuss why this alters/modifies plan
of care.
Use your clinical judgement to
determine if a psychological screen
needs to be repeated.
 Only bill every 2-4 weeks when change
in treatment plan occurs
43

44. QPOP Documentation
Summary
 Final Assessment:
Discussion of functional outcomes and
progress toward goals with the patient
Discussion of MMI
Use your clinical judgement to
determine if a psychological screen
needs to be repeated.
44

45. How will I be paid for QPOP?
 DOWC – QPOP Billable Fees
 Initial Evaluation: (Z0815) $80.00
 Follow up: (Z0816) $40.00
 Final Visit: (Z0815) $80.00
 Rehabilitation Visits:
(Z0817)$15.00
45

46. Case 1
 30 year old male electrician who
presented with 6 weeks of low back
pain with intermittent radiculopathy. He
was diagnosed with a lumbar strain.
Later, an MRI was performed which
showed L4-5 herniated disc with nerve
root impingement. The radicular pain is
now decreased to 2/10. However, he
continues to complain of limiting low
back pain.

47. Case 1 - Continued
 The Oswestry reports that radicular pain
symptoms prevents him from lifting more than
10#.
 He is unable to sleep more than 2 hours at a
time due to pain, even when taking pain
medication.
 Patient reports he is frustrated and is worried
that he cannot return to his profession and is
not getting his full salary to pay the bills for
his family.
 The Oswestry score is 40 (moderate
disability).
 The DRAM score is in the

48. 0
5
10
15
20
25
30
35
40
45
50
Initial 2 wks 4 wks 6 wks
Oswestry
DRAM

49. Case 1 – Using your Clinical
Judgement, What’s Next?
 Refer for a psychological evaluation?
 Continue with current plan of care?
 Refer to a spine surgeon?

50. Case 1 – Follow up
 Patient was referred to a psychologist for an
evaluation. The psychologist reported the
patient was suffering from depression and
began treatment.
 The ATP prescribed physical therapy as
well.
 At 16 weeks the patient showed great
improvement from the psychiatric treatment
and physical therapy. He returned to work
with temporary restrictions and was
discharged from psychological treatment.

51. 0
5
10
15
20
25
30
35
40
45
50
Initial 4 wks 6 wks 8 wks 12 wks 16 wks
Oswestry
DRAM

52. Case 2 – Knee Pain
 40 year old male plumber who presented
with 4 weeks of knee pain on 6/20/15.
Failed conservative treatment. Diagnosed
with meniscus tear, he had a right partial
meniscectomy. He presents to the ATP 4
weeks following surgery for a check up. He
reports that he is improving with PT. His
ROM is 5-110 and ambulates with antalgic
gait. He is given the Division approved
LEFS in addition to the DRAM.

53. Case 2 – continued
 The LEFS reports that he has moderate
difficulty squatting and going up and
down 10 steps.
 He has slight difficulty walking two
blocks.
 The LEFS score has not improved since
2 weeks status post surgery.
 The DRAM score is in the Normal
category.
 He is currently using OTC medications
for pain and icing the knee which helps.

54. 0
5
10
15
20
25
30
35
40
Initial 2 wks 4 wks
LEFS
DRAM

55. Case 2 – Using Your Clinical
Judgement, What’s Next?
 Discuss the results with the patient?
 Re-examine for other diagnoses?
 Repeat the psychological screen?
 Place the patient at MMI?

56. Case 2 - Continued
 After counseling the patient regarding
his efforts in physical therapy and the
potential of being at MMI. He admitted
that he was not doing his home
exercise program as instructed. He
was only doing a couple of the
exercises a couple of times per week.
You send him back to physical therapy
for 6 more weeks.

57. Case 2 – Continued – 10 weeks
s/p
 On his follow up at 10 weeks status
post, you notice that his functional
scores improved over the first two
weeks and then plateaued. ROM is
improved from 0-120. He has some
swelling and pain with activities.
Although his knee is sore at the end of
the day he is able to perform normal
job duties. He complains that he is
unable to run like he wants to and he
does not feel like he is back to normal.

58. 0
10
20
30
40
50
60
Initial 2 wks 3 wks 4 wks 5 wks 6 wks 8wks 10 wks
LEFS

59. Case 2 – Using Your Clinical
Judgement, What’s Next?
 Counsel the patient?
 Re-examine for other diagnoses?
 Place the patient at MMI?

60. Summary
 Implement psychological screen
and functional tool
 Shared decision making
 Discussion
 Patient centered goals
 Clearer picture?
60

61. Imagine that patient now……
61

62. Contact Information:
Courtney Holmes
303-318-8756
Courtney.Holmes@State.CO.U
S