CMS’ PRO-PM in the IPPS | Q&A

On August 1, 2022, CMS announced the final ruling of the Hospital Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2023. Within the IPPS, is the Hospital Inpatient Quality Reporting (IQR) Program that allows CMS to collect data from hospitals that are paid under the system. One of the new measures under the IQR program is the Hospital-Level, Risk Standardized Patient-Reported Outcomes Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Performance Measure (THA/TKA PRO-PM). The goal of the hospital-level THA/TKA PRO-PM is to collect PRO data to capture patients’ pain and function and measure improvement following the two procedures. CODE has received many questions from hospitals on how to best collect and submit reporting for the PRO-PM. We compiled those questions and provided answers in a Q&A format that we hope will be helpful to those who are navigating this measure:

What is the monetary impact during the Mandatory Reporting of the THA/TKA PRO-PM?

During Mandatory Reporting periods, successful submission of PRO data will impact the hospital’s Annual Payment Update (APU) in the IQR Program. Hospitals that fail to meet the reporting requirement will receive a reduction in their APU in Fiscal Year (FY) 2028.

Is there a financial benefit or ‘bonus’ CMS is paying for hospitals that participate in the Voluntary Reporting period?

No. However, we at CODE strongly recommend getting started right away so there is ample time to test the data collection progress, and understand your baseline performance. It will allow hospitals to fine-tune areas where they are not meeting the metric so they are successful. 

If I want to participate in the voluntary period, what do I need to do?

The first voluntary period is for procedures that happen from January 1, 2023 through June 30, 2023. So if you are not collecting PROs now, you are too late. The second voluntary period is for procedures that happen July 1, 2023 through June 30, 2024. You need your PRO program up and running prior to July 1. Something to consider: if you want to use a vendor for PRO collection, the contracting process in hospital settings can take up to 9 months (or more), so time is of the essence. 

If I do not want to participate in the voluntary period, what do I need to do?

The first mandatory period is for procedures that happen from July 1, 2024 through June 30, 2025 with a pre-op collection window of April 2, 2024 through June 30, 2025. This means the infrastructure for collecting and reporting PROs needs to be implemented and refined prior to April 2, 2024 to successfully meet the measure(s).

Do hospitals need to use a PRO Vendor?

No. Hospitals can use FTEs to collect and report PRO data. However, collecting surveys 1 year after the patient’s surgery is not a natural workflow for hospitals, and depending on volume, could require multiple FTEs to administer and score the surveys. You also need FTEs to monitor the data and make changes to ensure you meet the measure(s). Outsourcing the PRO collection to a vendor is more cost-effective than using FTEs. 

How can a PRO vendor help with IPPS – TKA/THA PRO-PM?

In addition to collecting the PRO surveys, a vendor can help with the reporting process, which alleviates a big burden for the staff. Vendors can also be a tremendous resource- any good vendor will be well-versed in the process of collecting and reporting data associated with the CMS IPPS program. 

So What Now?

At CODE, we understand that hospitals are not set up to be able to collect PRO surveys 1 year after a patient’s surgery. That’s where CODE comes in – we have a powerful workforce of trained PRO professionals that are ready to take the collection process off of your hands. We are more than just a software for your staff to use; we are experts on PROs and we will ensure that you are able to successfully meet the requirements of CMS’ performance measure. Save time and money when you outsource PRO collection. CODE can offer you all the benefit of a healthy and consistent outcomes program in just a few quick months. With the CMS’ IPPS reporting period looming ahead, are you ready to submit outcome data?

Resources

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2023 Rates; Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Costs Incurred for Qualified and Non-qualified Deferred Compensation Plans; and Changes to Hospital and Critical Access Hospital Conditions of Participation | Hospital Inpatient Quality Reporting Program | THA/TKA PRO-PM |