Measure 503
Gains in Patient Activation Measure (PAM®) Scores at 12 Months
DESCRIPTION:
The Patient Activation Measure (PAM) is a 10- or 13-item questionnaire that assesses an individual’s knowledge, skills, and confidence for managing their health and health care. The measure assesses individuals on a 0-100 scale that converts to one of four levels of activation, from low (1) to high (4). The PAM performance measure (PAM-PM) is the change in score on the PAM from baseline to follow-up measurement.
| MEASURE ID: | 503 |
|---|---|
| Type: | Patient-Reported Outcome |
CMS Derm Specialty Set: | Yes |
| High priority: | Yes |
| Topped out: | No |
| Telehealth Eligible: | Yes |
| Reporting methods: | Registry/QCDR |
| Maximum points: | 10 |
MEASURE PURPOSE:
To use the PAM in order to have the trajectory of a chronic disease over time and the likelihood of a new chronic disease diagnosis in the coming year.
Measure 503 FAQs
Q. Is this measure reportable via claims?
A. No.
Q. Are patient encounters conducted via telehealth allowable?
A. Yes. Encounters coded with GQ, GT, POS 02, or POS 10 modifiers are allowable.
Q, The measure says the second PAM score must occur during the performance period. Is the performance period a year?
A. Yes, the 12-month performance period would be from 1/1/2025-12/31/2025.
Q. Are there any exceptions for this measure?
A. Yes. Patients who are at PAM Level 4 at baseline or patients who are flagged with extreme line response sets on the PAM.
Q. What is the Minimum Threshold Requirement for this measure?
A. Clinicians must collect a follow-up survey on at least 25% of all eligible patients during the performance period AND must administer a follow-up PAM survey to a minimum of 50 unique patients. If the performance rate for Submission Criteria 1 is below 25% and does not include 50 unique patients, this measure can NOT be submitted.
Q. What is the Patient Activation Measure-Performance Measure?
A. The PAM-PM requires that PAM be measured at two points in time with the second measure occurring 4 to 12 months from the baseline measure. The difference in PAM score from time 1 to time 2 is the change in score.
Q. What is the minimum PAM net score increase needed to meet the performance requirements for this measure?
A. A 3 point PAM score increase OR a 6 point PAM score increase each within a 4 to 12 month period both meet performance requirements for this measure.
Q. Which PAM score should be used if there are multiple PAM scores available?
A. The most recent PAM score should be utilized for the follow-up PAM score, while the Baseline PAM score should be the earliest PAM score that falls within the 4 to 12 months prior to the date of the follow-up.
Link to PAM Survey:
Calculation
Criteria 1
The numerator: Patients with a Baseline PAM score and then a second score taken within 12 months of the baseline (but not less than 4 months)
The denominator: Patients aged 14 years and older with at least two qualifying visits during the performance period
Criteria 2
The numerator: Percentage of eligible patients who achieved a net increase in PAM score of at least 3 points in a 4 to 12 month period (passing)
The denominator: Patients aged 14 years and older with Performance Met for Submission Criteria 1 who had a baseline PAM score and a second score within 4 to 12 months of baseline PAM score and who were seen for a qualifying visit at least twice during the performance period
Criteria 3
The numerator: Percentage of eligible patients who achieved a net increase in PAM score of at least 6 points in a 4 to 12 month period (excellent)
The denominator: Patients aged 14 years and older with Performance Met for Submission Criteria 1 who had a baseline PAM score and a second score within 4 to 12 months of baseline PAM score and who were seen for a qualifying visit at least twice during the performance period
Criteria 4
The numerator: The average change (net difference) for all eligible patients between the baseline PAM score and the second score taken within 12 months of the baseline (but not less than 4 months)
The denominator: Patients aged 14 years and older with Performance Met for Submission Criteria 1 who had a baseline PAM score and a second score within 4 to 12 months of the baseline PAM score and who were seen for a qualifying visit at least twice during the performance period
Measure calculation example
Dr. Smith saw 200 patients aged 14 years and older with at least two qualifying visits during the performance period. None of these patient encounters can be excluded, so the denominator for Criteria 1 is 200.
Dr. Smith collected baseline PAM scores for 180 of these patients and a second PAM score within 4 to 12 months. This is the numerator for Criteria 1. Quality of patient care = 180/200 = 90.0%. Dr. Smith has a performance score of 90.0% for Criteria 1.
Of the 180 patients with baseline and follow-up PAM scores, 90 achieved a net increase of at least 3 points. This is the numerator for Criteria 2. Quality of patient care = 90/180 = 50.0%. Dr. Smith has a performance score of 50.0% for Criteria 2.
Of the 180 patients with baseline and follow-up PAM scores, 50 achieved a net increase of at least 6 points. This is the numerator for Criteria 3. Quality of patient care = 50/180 = 27.8%. Dr. Smith has a performance score of 27.8% for Criteria 3.
For Criteria 4, the denominator is 180. The numerator is the average net change in PAM scores across all eligible patients. Dr. Smith has a performance score based on the average net change.
Each patient's net change is calculated as:
Net Change = Follow-up PAM Score − Baseline PAM Score
Let’s assume the net PAM score changes for 10 sample patients are:
| Patient | Baseline PAM Score | Follow-up PAM Score | Net Change |
|---|---|---|---|
1 |
50 |
55 |
+5 |
2 |
45 |
48 |
+3 |
3 |
60 |
57 |
-3 |
4 |
52 |
58 |
+6 |
5 |
48 |
50 |
+2 |
6 |
55 |
55 |
0 |
7 |
43 |
49 |
+6 |
8 |
51 |
53 |
+2 |
9 |
59 |
60 |
+1 |
10 |
47 |
51 |
+4 |
Now, sum up all the net changes:
5 + 3 + (−3) + 6 + 2 + 0 + 6 + 2 + 1 + 4 = 26
Divide by the total number of patients (10 in this sample, but 180 in real calculation):
26 / 10 = 2.6
Thus, Dr. Smith’s average net PAM score change is +2.6 points.
Overall performance rate is determined using a specific performance rate. For #503, it is the second performance rate. Dr. Smith has a score of 50% for this measure. This translates to 5-10 points when reporting by registry.
Important note
CMS has not set benchmarks for this measure. As a newer MIPS measure, it is subject to a 5-point scoring floor if data completeness is met.
