Patient-reported outcome measures (PROMs) have evolved from a nice-to-have capability for research to a quality improvement tool and now to a Medicare mandate with substantial money at stake. What’s interesting is that these mandates are not really about collecting PROMs at all; they are about completing them. The THA/TKA PRO-PM requires matched pre-operative and one-year data for a required share of eligible patients, most of whom are at home when that one-year data point comes due. That is where most organizations win or lose on the CMS THA/TKA PRO-PM, and the newest registry data shows the PROMs completion gap is still wide open.
The Mandate Is A Completion Problem, Not A Collection Problem
The CMS total hip and knee arthroplasty patient-reported outcome-based performance measure (THA/TKA PRO-PM) requires facilities to collect a defined set of PROMs–HOOS Jr. for hip, KOOS Jr. for knee, PROMIS Global or VR-12, plus matching variables–at both the pre-operative and one-year intervals. The measure is scored on "matched" data: a patient counts only when both the pre-op and the one-year survey are captured. Facilities must hit that matched threshold for at least 50% of eligible patients in inpatient and hospital outpatient settings and 45% in ASCs.
From there, CMS applies a substantial clinical benefit (SCB) threshold–a gain of 22 points on HOOS Jr. and 20 points on KOOS Jr.–to produce a facility-level risk-standardized improvement rate. Inpatient settings are already in mandatory reporting, with the post-op data submission deadline coming up on September 30, 2026. For outpatient and ASCs, voluntary reporting is underway now, and mandatory reporting begins in late 2027.
Facilities that fall short face losing up to 25% of their annual payment update if they are inpatient and 2% if they are a HOPD or ASC. In other words, a data completeness problem has now become a reimbursement problem.
The Registry Data Shows The Gap And The Payoff
The scale of the challenge is visible in the American Joint Replacement Registry (AJRR) Annual Report. The registry captures more than 4.4 million hip and knee arthroplasty procedures from 2012 through 2024, making it the largest orthopedic registry in the world by annual procedural count. Yet, according to the report, only 751 institutions submitted PROMs; this figure is up 19% year over year, but still a fraction of the sites performing these procedures.
Where PROMs are captured completely, the payoff is clear. The AJRR data show substantial improvement from the pre-operative baseline to one year after surgery, with nearly 79% of hip patients and two-thirds of knee patients achieving the respective SCB thresholds, using an anchor-based approach. That is the whole point of the measure: complete, matched data does not just satisfy CMS requirements; it tells a data-backed outcomes story that supports the value of the procedure. The barrier is rarely the pre-op survey, captured in the clinic. It is the one-year follow-up, which lands long after the patient has left the hospital’s or clinic’s four walls.
Why Completion Is An Engagement Problem
The matched one-year data point depends on staying connected to a patient through a full year of recovery. Many organizations already collect some patient-reported data, but fragmented systems, manual workflows, and inconsistent processes mean they struggle to complete it, trust it, and use it. Collecting is not completing, and completing is not the same as acting on what the data reveals. That’s why these organizations partner with Force Therapeutics.
The PROMs mandate is fundamentally a patient engagement challenge. Sustained, automated outreach across the episode, not a one-time survey prompt, is what converts an eligible patient into a matched, scorable, compliant record. It is also what makes the data usable in real time rather than a year later.
Force's own real-world data speaks directly to that connection. In an analysis of more than 22,000 THA/TKA patients, our specialized digital care platform exceeded the matched completion and patient-reported outcome requirements CMS uses for quality reporting, demonstrating that a structured, technology-enabled engagement model can reliably clear the thresholds that trip up manual programs. This has been further substantiated in peer-reviewed research focused on the SCB introduced by the THA/TKA PRO-PM.
The same engagement infrastructure does more than satisfy a measure. In a case study of a large U.S. health system, Force's clinical team used PROMs and timely patient surveys to detect early warning patterns among total joint and lumbar fusion patients, then implemented targeted protocol changes that improved recovery and reduced preventable readmission; these are outcomes that matter directly to episode economics, where research indicates a single readmission after total knee arthroplasty can exceed $10,000. Complete data is not only a compliance asset; it is an early-warning system.
What Orthopedic Leaders Should Do
For orthopedic service line and quality leaders, the takeaway is to stop treating PROMs as a survey task and start treating it as an engagement program with a compliance component:
- Design for the matched PROMs pair. Build workflows around completing both the pre-op and the one-year survey, not just sending them; the one-year follow-up is where this mandate is won.
- Automate outreach across the full year. Sustained, condition-specific engagement is what keeps at-home patients responsive twelve months out.
- Make it setting-agnostic. Capture PROMs the same way whether the case is inpatient, hospital outpatient, or ASC, so the 50% / 45% thresholds are exceeded everywhere you operate, and your team doesn’t have to worry about it.
- Use the data, don't just collect it. The signal that supports compliance is the same signal that flags a patient drifting toward a preventable readmission. Have infrastructure in place or secure analytics capabilities that enable early detection and warning systems that help your team stay on top of all patients at once.
The registry data make the trend clear and the rules make the stakes clear: PROMs completion is now a defining capability of high-performing orthopedic programs. The organizations that treat it as an engagement discipline versus a data-entry chore will be the ones clearing the thresholds, telling a credible outcomes story, and catching problems while there is still time to act. With the 2026 AJRR report due for publication in the coming weeks, the data will tell whether more hospitals are managing to accomplish these feats.
To learn more about how leading institutions are closing the PROMs gap and turning complete outcomes data into better care, reach out to the Force team:
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