The first mandatory Centers for Medicare & Medicaid Services (CMS) THA/TKA patient-reported outcomes – performance measure (PRO-PM) collection period starts in April 2024, and many orthopedic leaders, executives, administrators, quality professionals, and navigators are working to ensure their organizations and orthopedic care teams are well prepared to meet the requirements and avoid any penalties.
Some organizations are facing the daunting responsibilities of communicating the new requirements to relevant care teams, reviewing existing patient data to measure current performance, adjusting (and creating new) clinical protocols, reworking internal workflows, and possibly finding a new virtual care partner, all while worrying about the substantial financial impact that may occur if they fail to adhere with the new requirements.
Other organizations, however, already meet the mandatory PRO collection rates and have existing infrastructure to seamlessly collect and report the necessary data.
Upcoming Virtual Panel
On March 6th 2024, Force Therapeutics is hosting a virtual panel discussion with two of the country’s leading orthopedic program administrators and quality experts–Berkshire Health Systems’ Mary Ariosto-Coe, Orthopedic Service Line Administrator, and Hartford HealthCare’s Dianne Vye, Regional Director of Quality and Safety–to discuss the upcoming mandatory patient-reported outcomes (PROs) collection requirements for total hip and knee arthroplasty (THA/TKA) in CMS quality reporting programs.
Register here to learn what the most specialized orthopedic care teams are doing to be ready for the first inpatient mandatory collection period beginning April 2024.
What is the CMS THA/TKA PRO-PM?
With the stated goal of measuring patient improvement and promoting shared decision making, CMS introduced the THA/TKA PRO-PM into the hospital inpatient quality reporting program in late 2022 and into the hospital outpatient and ASC quality reporting programs in late 2023. For the inpatient setting, this measure has been rolled out in phases, with two voluntary reporting cycles (which are ongoing), followed by the first mandatory reporting cycle, which begins in April of this year.
This mandate applies to elective primary THA/TKA patients aged 65 or over and enrolled in Medicare fee for service (with some exclusions), and uses standardized questionnaires known as patient-reported outcome measures (PROMs), to measure patient improvement following TJA procedures. These PROMs, collected up to 90 days prior to surgery and 300-425 days after surgery, are compared and measured against what is termed a “Substantial Clinical Benefit” threshold; with some statistical accounting for data matching, risk variables, and non-response, this produces a facility-level score showing the percentage of patients meeting this SCB threshold.
The requirement for mandatory reporting is to collect and submit a specific set of PROMs and additional data elements at the intervals we mentioned for at least 50% of eligible patients in accordance with the pre-defined deadlines and timelines. One important distinction here is that this data has to be matched from pre-op to post-op intervals for each patient–meaning the required data has to be submitted for each individual patient for both intervals, covering at least 50% of all eligible patients. Under the inpatient quality reporting program, hospitals that don’t meet this reporting requirement will be subject to a 25% reduction in their CMS annual payment update for fiscal year 2028.
Get the answers to all your most pressing questions today: register for our upcoming CMS THA/TKA PROs Mandate virtual panel and receive our complimentary Complete CMS THA/TKA PRO-PM Guide for Orthopedic Care Teams.
Common Questions from Ortho Team
- When was the CMS THA/TKA PRO-PM introduced?
- Which patients does this apply to? What is the patient cohort?
- How is the THA/TKA PRO-PM outcome measure calculated?
- What data do I need to collect? When do I need to collect them?
- What are the data collection and reporting timelines and deadlines? Are they different for inpatient, outpatient, and ASCs?
- How do I submit the data to CMS? Do I have to do it myself?
- What are the exact requirements that will affect payment?
- What are the penalties for failing to meet the requirements?
- What are the benefits of voluntary participation?
- What are some important considerations that I should make ahead of voluntary or mandatory participation?
Interested in learning how Force Therapeutics can help you meet mandatory requirements? Contact us for more information or a demo.