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5 Best Practices for CMS THA/TKA PRO-PM Compliance

Before mandatory reporting began, some organizations had already mastered PROMs collection. We interviewed two leading orthopedic quality experts who participated in voluntary reporting and are on track to seamlessly meet mandatory reporting requirements, and they are sharing their best practices.

  1. Maximize your pre-op collection as much as possible:
    • Patients are usually more attentive in the period prior to surgery, and using any and all in-person and virtual touch points to encourage patients in the pre-op phase to submit those required PROMs will position you for compliance. If you don’t collect at pre-op, the post-op data for that patient isn’t going to count toward your overall compliance.
  2. Set patient expectations and tee up education:
    • Patient education, both in-person and remote, is critical for compliance: remember to communicate to patients the importance of submitting those PROMs at the right time, including their own ability to see their post-operative recovery success–patients love seeing how far they’ve come. And if they have not submitted PROMs by the expected time, ensure you or your vendor partner have a process to follow up with those patients as needed.
  3. Collect PROMs from all patients at all sites, regardless of payer:
    • Collecting on only the required patients will make the process confusing for your care team as they would have to determine what is needed for each patient, not to mention it prevents you from gaining valuable clinical insight into the rest of your patient population.
    • Equally important, all payers are gradually mandating the collection of PROMs and other data elements as a condition for full reimbursement and preferred designations; collecting the data on all patients now will make adhering with future regulatory requirements a much smoother process.
  4. Use a EHR-integrated vendor:
    • The current mandate revolves around data collection and reporting compliance; focusing on ensuring the highest level of patient engagement maximizes the likelihood of regulatory compliance.
    • The right vendor can help avoid needing additional resources by providing a sophisticated tool to support patient care/education and a time-based delivery of surveys, care protocols, and other patient education, which supports patient care, communication and more. It can also enable data collection from affiliated offices as well as independent hospital reporting. Keeping track of each patient and when to send out forms/reminders to complete and capture information is too onerous for an individual to manage and can lead to additional risk for errors.
  5. Stay current on regulations:
    • CMS and other insurers are continuously making updates and adjustments to payment models; staying well-informed and ensuring your workflows are as efficient and adaptable will help you be prepared for regulatory and legislative updates.

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