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CMS-Mandated Patient-Reported Outcomes (PRO) Reporting is Here: How to Be Prepared for Effective Collection and Submission

For our breakdown of the recent Centers for Medicare and Medicaid Services (CMS) ruling to incorporate PROs for Total Hip and Knee Arthroplasty (THA/TKA) into inpatient quality measures for FY2023, including timelines, data specifications, inclusion/exclusion criteria, and implications for orthopedic providers, see here.

We know this recent ruling will have a substantial impact on your organization’s workflows and are aware of the various challenges and questions it presents. Determining whether you can fulfill the CMS requirements without a vendor or partner is the first step. If you do plan to implement collection and submission processes internally, it is strongly recommended that you participate in the voluntary reporting periods to ensure all workflows and protocols are tested and established in time for mandatory reporting.

Going it alone without a comprehensive infrastructure and established processes in place can be difficult and presents challenges itself, not the least of which are additional burdens on your resources and FTEs beyond preexisting staffing difficulties. With that in mind, CMS has enabled organizations to collect and submit data through a vendor or registry.

However, standard PRO collection solutions, vendors, or registries may not satisfy the unique needs or long-term goals of your organization, given significant variation in the quality and capabilities of currently available offerings. Below are 7 considerations you should make when deciding how to best collect and submit PROs for THA/TKA through a partner:

  1. Partner strategically for long-term goals: While the new THA/TKA PRO performance measures (PMs) introduced by CMS are in the fee-for-reporting Hospital inpatient quality reporting (IQR) program--meaning payment is not dependent on quality of outcomes--there is a penalty, specifically a one quarter reduction in the applicable annual percentage increase, for hospitals that fail to meet sufficient reporting requirements in the mandatory reporting period. Therefore, your short-term goal should be to collect as much eligible patient data as possible in all three periods.However, when it comes to PROs, data collection is not the whole story. Targeted, personalized patient education, goal-setting, and consistently high engagement are paramount to effective and complete data collection, and are also associated with improved patient-reported outcomes.It is safe to assume that CMS intends to ultimately utilize these PRO-PMs as part of value-based payments, meaning payments will be dependent on quality of outcomes. Selecting a comprehensive partner that can boast consistently high engagement and strong outcomes and can act as a virtual member of your care team will position your organization for effective adherence with CMS data reporting requirements for years to come. Furthermore, it will ensure optimal reimbursement, enable efficient workflows, and alleviate FTE scaling challenges.
  2. Emphasize thorough integration: Your data partner must offer Electronic Medical/Health Record (EMR/EHR) interoperability and must have experience integrating into existing workflows and systems. Having a partner that is already familiar with the challenges of integration and provides strong integration support can ensure minimal disruption to your clinical and administrative workflows.
  3. Seek out provider-prescribed solutions: Find a partner that can customize each patient’s experience in accordance with your prescribed care plan; this increases patient adherence and also ensures standardized care across various patient cohorts. In addition, patients who know that their provider is actively using the platform to communicate with them and view their adherence, engagement, and outcomes typically exhibit stronger engagement with their virtual care plan, further supporting outcomes and patient satisfaction.
  4. Maximize ROI on patient data collection: Engage with a partner that empowers you through data analytics for clinical and business insights that help you optimize resource allocation and enables you to use the platform to conduct trials, patient studies, or in-house research using your own patient data. Strong clinical insights can help your team ensure high quality patient care by enabling rapid and accurate clinical decision-making at scale, while business insights allow your organization to support growth and maintain a positive economic outlook.
  5. Stay flexible: CMS regulations can change, and it is likely that collection and submission requirements may vary going forward, or that specific data requirements may become more stringent. Being able to easily configure the patient experience, including forms collected, education provided, and exercises prescribed, in a short period of time will enable you to remain agile in the face of future changes.
  6. Ensure safety of patient data: Your partner should be familiar with legal data agreements and should have rigorous processes in place to ensure patient health information (PHI) is protected and that HIPAA, HITECH, and AICPA SOC 2 compliance are maintained through protocols, training, and audits.
  7. Mitigate impact of health literacy, digital access, and language barrier challenges: Strong multilingual patient education that is proven to alleviate health literacy challenges, coupled with smart, accessible product design, can reduce barriers to care and improve patient accessibility among disadvantaged populations.

Implementing PRO collection systems requires careful consideration of the impact it will have on your clinical and administrative workflows and the added burdens on your FTEs.

Force Therapeutics is more than just a PRO collection tool: our provider-prescribed platform, driven by our AI-powered Intelligent Care Plan, enables comprehensive data collection through a personalized patient experience, leading to strong and sustainable patient engagement, improved outcomes, and optimized clinical workflows.

To see what Force Therapeutics can do beyond data collection, schedule a demo today.

Join thousands of healthcare executives, orthopedic surgeons, and care team members who trust Force as their digital care partner.

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