If you lead an orthopedic service line, oversee quality, or are a hospital executive, you’ve likely heard of PROs, PROMs, PRO-PMs, PREMs, sometimes used interchangeably. While these terms are related, they are not the same. Today, understanding the distinctions can carry operational consequences or accelerate operational excellence.
With CMS mandates like the THA/TKA PRO-PM in effect and episode-based models such as Transforming Episode Accountability Model (TEAM) introducing expanded episode accountability, patient-reported data is no longer a secondary quality initiative or a nice-to-have. It directly impacts reimbursement, compliance, quality improvement, and how your organization is evaluated.
Here is an explainer on how these terms differ and why it matters.
PROs: The Patient’s Voice
A Patient-Reported Outcome (PRO) is any data point about a patient’s health and condition that comes directly from the patient without clinician interpretation.
Examples of PROs include:
- “My knee pain is a 5 out of 10.”
- “I can climb stairs without assistance.”
- “I’m still having trouble sleeping because of shoulder discomfort.”
- “I’ve returned to work and resumed normal daily activities.”
PROs can capture pain, mobility, physical function, quality of life, and any number of other criteria. They reflect recovery in real-world terms, not clinical indicators.
In elective musculoskeletal care especially, PROs often provide the clearest picture of whether interventions deliver meaningful improvement, specifically because such interventions are typically intended to improve function or quality of life from the patient’s perspective. For instance, a patient can tell you how they are feeling when it comes to their back pain or discomfort when walking, whereas a patient’s objective assessment of how their heart or kidney feels may not have the same level of utility.
In other words, PROs are raw, subjective data from the patient perspective.
PROMs: The Standardized Tools
A Patient-Reported Outcome Measure (PROM) is a validated and standardized instrument used to collect PROs. PROMs are the structured questionnaires that make PROs measurable and comparable across patients.
Common PROMs include:
- HOOS Jr. (Hip disability and Osteoarthritis Outcome Score)
- KOOS Jr. (Knee injury and Osteoarthritis Outcome Score)
- PROMIS (Patient-reported outcomes measurement information system) Global Health or PROMIS 10
- VR-12 (Veterans RAND 12-Item)
- ODI (Oswestry disability index), also known as the Oswestry low back pain disability questionnaire
- NDI (Neck disability index)
- DASH (Disabilities of the arm, shoulder, and hand)
For example, a patient undergoing total knee arthroplasty will complete a KOOS or KOOS Jr. PROM preoperatively and then again after surgery, sometimes at 12W, 6M, and 1Y. For long-term research, patients may complete PROMs up to 5Y later.
PROMs transform subjective patient experiences into standardized data that can be benchmarked across surgeons, facilities, and health systems. Operationally, this is where many organizations encounter friction. Paper packets, manual phone outreach, incomplete forms, and unmatched pre- and post-op submissions create administrative burden and compliance risk.
PRO-PMs: Measuring Performance by Aggregating PROMs
A Patient-Reported Outcome Performance Measure (PRO-PM) uses aggregated PROM data to evaluate hospital or provider performance.
THA/TKA PRO-PM
As of mid 2024, the THA/TKA PRO-PM is a mandatory quality measure under the hospital inpatient quality reporting (IQR) program. Under this measure, hospitals performing total hip and total knee arthroplasty must:
- Collect preoperative and one-year postoperative PROMs
- Ensure responses are matched and other required patient data is collected
- Meet minimum submission thresholds (50% matched PROMs)
- Submit data accurately and on time
If thresholds are not met, hospitals face financial penalties.
Information Transfer PRO-PM
Another example is the Information Transfer PRO-PM, which is required under the hospital outpatient quality reporting (OQR) program and evaluates whether key information is successfully communicated to and understood by patients during care transitions.
While different in focus from the THA/TKA PRO-PM, it similarly evaluates performance at the organizational level rather than the individual patient level.
PRO-PMs Under TEAM: Why This Matters Even More
Under the Transforming Episode Accountability Model (TEAM), which began in January 2026, hospitals are accountable for both cost and quality across a full episode of care.
Importantly, both the THA/TKA PRO-PM and the Information Transfer PRO-PM function as quality measures within the TEAM framework.
That means performance on these measures influences quality scoring and subsequently financial upside or downside. In TEAM, hospitals must not only manage total episode cost, but also demonstrate quality performance through measures that include PRO-PMs.
For hospitals mandated under TEAM, this can create substantial complexity. Stakeholders must ensure at least 50% of eligible patients complete matched pre- and post-op surveys, prevent incomplete submissions that do not count toward thresholds, maintain efficient data collection and centralization processes, and coordinate across various sites and service lines.
Although TEAM is currently mandatory for some 700 hospitals, CMS has made clear indications that it will look to continue using PRO-PMs as a quality measure in future payment models, which may affect all US hospitals in the near future.
Moreover, under the recently announced ACCESS model, CMS will utilize PROMs to measure improvement in chronic conditions, aligning payments directly to outcomes measured by PROMs. This further indicates how CMS will look to deploy PROMs more broadly.
PREMs: The Care Experience
While PROMs measure health outcomes, Patient-Reported Experience Measures (PREMs) assess how patients perceive their care experience. PREMs focus on communication, clarity, and preparedness. While used fairly frequently, they are not typically referred to as PREMs, but rather by each instrument’s name. Well known examples include the Hospital Consumer Assessment of Healthcare Providers & Systems (HCAHPS), Net Promoter Score (NPS), and some other instruments used more commonly outside of the US, such as the NHS Friends and Family Test.
Experience and outcomes are closely connected. Patients who feel informed and supported are more likely to follow care plans and avoid preventable complications.
Why the Distinction Matters
It is easy to group all of this under “patient-reported data.” But strategically, each layer serves a different purpose.
- PROs give you the patient’s voice.
- PROMs standardize that voice.
- PRO-PMs evaluate your organization’s quality performance.
- PREMs reflect the patient’s perception of care.
As these measures are increasingly used in evaluating the quality of care organizations, patient engagement, data completeness, workflow standardization, and interoperability become critical determinants of patient satisfaction and financial performance.
Force Therapeutics’ mission has always been to improve patient experience and outcomes through clinically validated, provider-driven remote care. Today, that mission aligns directly with federal quality mandates. By integrating patient education, remote monitoring, automated PROMs collection, and reporting into a single platform, Force helps organizations deliver better patient care, reduce care variation, protect reimbursement, and demonstrate quality to regulators and insurers with ease.
Hospitals that treat PROs, PROMs, PRO-PMs, and PREMs as isolated initiatives often create unnecessary complexity, whereas those that integrate them into a cohesive digital care strategy are better positioned to succeed today and as value-based care becomes a reality for every hospital in the country.
Understanding these tools is the first step. Operationalizing them consistently and without overstretching care teams is what drives measurable impact, and Force Therapeutics has done it for hundreds of organizations across the US.
Learn how we can help you too:
