When PROM Software Fails: How a Midwest Health System is Now Protecting Millions in CMS Reimbursement with CODE

When their Patient-Reported Outcome Measure (PROM) software returned zero results for the CMS THA/TKA PRO-PM reporting period, the team needed a dependable solution. Enter CODE Technology’s fully-managed PROs service.

Case Study

When a Midwestern health system discovered its PROM software couldn’t generate accurate CMS THA/TKA PRO-PM reports for the next measurement period, the team faced immediate compliance risk and potential loss of millions in reimbursement. With surveys required pre-operatively and again one year post-op and a minimum 50% capture rate needed to pass IQR reporting, incomplete data, unclear eligibility logic and inconsistent vendor support left the organization unable to confirm whether it was meeting the measure at all. As operational burden grew and reporting confidence eroded, the health system turned to CODE Technology for a reliable, CMS-ready PROM program that restores accountability, drives high capture rates and delivers the quality of data clinical and executive leaders can trust.

Background

The health system implemented a PRO software tool for the CMS THA/TKA PRO-PM reporting but quickly lost confidence due to data accuracy issues, incomplete reports and weak vendor support. Because CMS payment updates depend on reliable PRO-PM submissions, these failures put millions in annual reimbursement at risk.

Challenges

Red flags showed up across several critical areas of their PRO program:

Implementation Was Messy and Staff-Burdening

  • The health system described implementation as disorganized and high-lift.
  • Staff had to spend time cleaning data, validating eligibility and chasing down errors.

Reporting Failures Impacting CMS Compliance

  • The health system was able to generate 2024–2025 pre/post reports — but 2025–2026 reports returned zero results; their chosen PRO method struggled to extract all required data fields.
  • These were the same reports required for CMS submission.
  • This raised immediate concerns about data completeness, eligibility logic, and compliance risk.

Lack of PROMs + CMS Expertise from Vendor

  • The quality team often felt they had to train their PRO vendor’s support team.
  • Support could not reliably explain PROMs, eligibility logic or CMS measure rules.
  • The vendor’s frequent turnover meant the health system needed to start over with each new rep.

Contract Limitations Added Risk

  • Their original PRO vendor has a ‘No Termination Without Cause’ clause, creating operational and financial exposure.

Solution: CODE Technology

Here’s what prompted the team to transfer their PRO program CODE:

  • Reliable CMS-ready reporting
  • Dedicated clinical account manager (no turnover, no retraining)
  • Minimal IT lift, zero operational burden
  • High patient response rates with multi-channel outreach
  • Fast go-live and transparent data dashboards

Outcome

The team gained confidence in their data, reduced staff burden and finally had a predictable path to CMS THA/TKA PRO-PM reporting compliance.

Changing PROMs vendors is a big decision. CODE makes it an easy one.

Let’s discuss CODE’s 4 easy transition options.

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