A practical breakdown of how the THA/TKA PRO-PM feeds into TEAM payment, what the capture rate and case minimum thresholds mean in practice, and which patients actually count toward your score
If your hospital performs total hip or knee replacements and participates in the TEAM model, the THA/TKA PRO-PM isn’t just another quality reporting checkbox. It is one of the quality measures that make up the TEAM Composite Quality Score (CQS) — and that score is directly tied to whether your hospital receives a payment bonus or faces a repayment obligation at reconciliation.
Understanding exactly how this measure flows from PROM survey collection through to your CQS — and where hospitals typically lose ground — is essential for orthopedic program leaders planning their 2025 workflows.
What Is the THA/TKA PRO-PM?
The Hospital-Level Total Hip and/or Total Knee Arthroplasty Patient-Reported Outcome-Based Performance Measure (THA/TKA PRO-PM, CMIT ID #1618) measures the change in a patient’s self-reported pain and function from before surgery to approximately 300–425 days after surgery. It uses matched pre- and post-operative PROM survey pairs and produces a Risk-Standardized Improvement Rate (RSIR) — the proportion of eligible patients at a hospital who achieve substantial clinical improvement, adjusted for patient risk factors.
| Measure ID | CMIT #1618 | THA/TKA PRO-PM |
|---|---|
| Applies to | All TEAM inpatient Lower Extremity Joint Replacement (LEJR) episodes, PY1–PY5 |
| Output metric | Risk-Standardized Improvement Rate (RSIR) |
| Improvement threshold | 20-point improvement on HOOS Jr. (hip) | 22-point improvement on KOOS Jr. (knee) |
| Risk adjustment | Yes — case-mix adjusted for patient risk factors |
| Data source | Hospital IQR Program PROM submissions (required under the Hospital IQR Program beginning with the July 1, 2025 implementation period) |
| Submission burden | No separate TEAM submission beyond Hospital IQR reporting — CMS pulls data directly |
One thing worth noting upfront: TEAM participants do not submit quality data separately to CMS for this measure. CMS pulls the THA/TKA PRO-PM data directly from what hospitals already report to the Hospital IQR Program. The data pipeline is already required — what matters for TEAM is how well your collection workflows perform within it.
How the THA/TKA PRO-PM Is Scored Within the TEAM CQS
The path from your PROM survey data to a payment adjustment runs through six steps. Understanding each step shows you where the leverage points are.
Step 1 — Measure Calculation
CMS calculates your hospital’s RSIR from matched pre-op and post-op PROM survey pairs submitted to the Hospital IQR Program for eligible primary elective THA/TKA patients during the applicable measurement period. The numerator is the count of patients achieving substantial clinical improvement; the denominator is the count of matched eligible patients, risk-adjusted for case mix.
Step 2 — National Distribution Ranking
Your RSIR is plotted against the national distribution of RSIRs from all IPPS-eligible hospitals that reported the measure and met the minimum case count. This national distribution serves as the CQS baseline — and under the proposed sliding historical approach, it refreshes annually, meaning you’re always being measured against an evolving peer group.
Step 3 — Percentile Assignment
Each hospital is assigned a performance percentile based on where its RSIR falls on the national distribution. This is the number that drives everything downstream.
Step 4 — Points Conversion and Weighting
The percentile is converted to quality performance points based on a decile point scale, then weighted within the CQS. The TEAM-specific weights and point scale for the THA/TKA PRO-PM were finalized in the FY25 IPPS/LTCH PPS final rule (89 FR 68986). Confirm exact weight and decile values against § 512.547 and the FY25 final rule before using them in any internal financial modeling.
Step 5 — CQS Contribution
The THA/TKA PRO-PM’s weighted points are summed with the other applicable inpatient measure points to produce your overall CQS for that performance year. The CQS then feeds directly into the reconciliation calculation — adjusting your payment up or down.
Step 6 — No Improvement Points
TEAM does not include year-over-year improvement points in the CQS. Scoring is based solely on achievement relative to the current baseline distribution. There is no credit for improvement from prior years — only for where you stand relative to peers right now. This makes consistent collection and strong response rates more important than incremental gains.
Key Takeaway on Scoring Your RSIR percentile rank against national peers — not your raw improvement rate — is what drives your CQS contribution. A hospital with a strong absolute RSIR but weak relative rank still scores poorly. This makes the national distribution, and your position within it, the number worth watching.
Two Thresholds, Two Separate Systems: Capture Rate vs. the 25-Case Minimum
This is where hospitals frequently get confused — and where the confusion has real consequences. Two different thresholds apply to the THA/TKA PRO-PM, and they operate independently.
| Threshold | IQR Capture Rate | TEAM Case Minimum |
|---|---|---|
| What it is | 50% of eligible inpatient THA/TKA patients must have matched surveys submitted (45% for outpatient under OP-42 once mandatory) | 25 matched pre-op and post-op survey pairs required for CMS to calculate a statistically reliable RSIR |
| Consequence of failure | IQR non-compliance penalty — reduction to IPPS annual payment update, affecting all Medicare FFS Part A claims including non-orthopedic. May affect participation or scoring in certain CMS quality programs. | Hospital has no reportable measure value — treated as receiving a score effectively equivalent to the 50th percentile for CQS purposes |
| Linked to TEAM? | No — separate from TEAM. Failing IQR capture rate does not remove hospital from TEAM participation. | Yes — this is the threshold that determines whether your TEAM CQS gets a real score or a default |
| Can you fail one but pass the other? | Yes — these are parallel systems, not sequential gates | Yes — a hospital can clear 25 cases but still fail the 50% IQR capture rate, and vice versa |
The practical implication: if your hospital fails the 50% IQR capture rate but still has 25 or more matched survey pairs, CMS will compute your RSIR from the surveys that were submitted and assign a real percentile. You receive an actual score on the THA/TKA PRO-PM within the TEAM CQS, even while facing the separate IQR payment penalty.
The reverse scenario is more painful: a small-volume hospital that submits surveys for 100% of its eligible patients but doesn’t reach 25 matched pairs gets assigned the a default score effectively equivalent to the 50th percentile for CQS purposes — regardless of how good those surveys look.
Non-Response Bias Caveat Even when a hospital clears the 25-case minimum with a low capture rate, CMS uses statistical weighting to attempt adjustment for non-response bias — but this adjustment cannot fully compensate. A hospital barely clearing 25 cases with poor overall capture may see a less representative RSIR than one achieving higher response rates. High capture rate is not just an IQR compliance issue; it protects the accuracy of your TEAM score.
Who Counts: THA/TKA PRO-PM Denominator Inclusion and Exclusion
Not every THA/TKA patient at your hospital contributes to your RSIR. The CMIT #1618 measure specification defines the denominator precisely. The authoritative source is the THA/TKA PRO-PM Measure Methodology Report available on QualityNet.
Patients Included in the Denominator
- Medicare FFS beneficiaries, age 65 or older at time of surgery
- Enrolled in Medicare FFS Parts A and B for the 12 months prior to the index admission, and Part A during the admission
- Undergoing elective primary THA or TKA (inpatient, identified by ICD-10 codes aligned with the THA/TKA Complications measure cohort)
- Pre-operative PROM survey completed within 90 days before surgery
- Post-operative PROM survey completed 300–425 days after surgery
- Both instruments completed: generic health survey (VR-12 or PROMIS Global-10) AND joint-specific survey (HOOS Jr. for hip, KOOS Jr. for knee)
Patients Excluded from the Denominator
- Non-Medicare FFS patients — commercial, Medicare Advantage, Medicaid-only, or dual-eligible billed through MA
- Patients under age 65
- Revision procedures or procedures to address mechanical complications from a prior THA/TKA
- Partial arthroplasty (not a primary total)
- Hip fracture cases
- Patients with active malignancies in the surgical site
- Simultaneous device removal procedures
- Outpatient THA/TKA procedures (covered separately by OP-42)
- Patients who die within 300 days post-procedure (cannot complete the post-op PROM within the required window)
- Patients without matched pre-op and post-op survey pairs within the required timeframes
A Common Point of Confusion: Comorbidities Do Not Exclude
Patients with stroke or other conditions affecting mobility or quality of life are NOT excluded from the denominator. The measure does not exclude based on comorbidities of this type. Instead, it risk-adjusts for a range of clinical factors using patient-reported, provider-reported, and claims-based variables. The complete risk variable list is in Section 2.6 of the Measure Methodology Report.
What This Means for Workflow Prioritization Collecting PROM surveys from non-Medicare, revision, or non-elective patients is good clinical practice — but those surveys do not improve your TEAM CQS score. For scoring purposes, prioritize consistent identification of eligible Medicare FFS primary elective THA/TKA patients at scheduling, and concentrate your follow-up resources on the 300–425 day post-op window. That is where most programs lose matches.
Practical Workflow Priorities for Improving Your THA/TKA PRO-PM Score
1. Identify Eligible Patients at Scheduling, Not at Admission
The 90-day pre-op survey window means patients should be flagged for PROM completion well before their surgery date. Programs that identify eligible Medicare FFS primary elective THA/TKA patients at the time of scheduling — not at admission or on the day of surgery — have a far wider window to secure pre-op completion and reduce last-minute scrambling.
2. Treat the 300–425 Day Post-Op Window as a Managed Process
This window is where the most matches are lost. It’s long enough to feel manageable and short enough to miss if outreach is passive. High-performing programs build:
- Automated outreach triggers at day +300 with escalating reminders through the window
- A dedicated due/overdue patient list reviewed by care coordinators at regular intervals
- Re-engagement workflows for non-responders before day +425
- Accurate documentation of patients who die within 300 days, so they are properly excluded rather than counted as non-respondents
3. Require Both Instruments — Every Time
Both the generic health survey (VR-12 or PROMIS Global-10) AND the joint-specific survey (HOOS Jr. or KOOS Jr.) are required for a patient to count as a matched pair. A patient who completes only the HOOS Jr. does not count toward your RSIR numerator. Build your collection workflow so both instruments are always administered together — at both the pre-op and post-op time points.
4. Aim Well Above the 50% Capture Rate Minimum
The 50% IQR threshold is a compliance floor, not a performance target. As noted above, low capture rates introduce non-response bias that statistical weighting cannot fully correct — meaning a hospital barely meeting the minimum may see a less accurate RSIR than its true performance warrants. Programs should target capture rates well above 50% to protect both their IQR standing and the integrity of their TEAM score.
How CODE Technology Supports THA/TKA PRO-PM Compliance for TEAM
CODE Technology’s PROM platform is built to manage the full longitudinal workflow the THA/TKA PRO-PM requires — from pre-op survey administration within the 90-day window through post-op follow-up management in the 300–425 day window, with automated outreach, matched pair tracking, and IQR submission support.
If you’re building or optimizing your THA/TKA PRO-PM workflow for TEAM, contact CODE Technology to learn how our platform helps hospitals improve capture rates, protect their RSIR accuracy, and perform within the TEAM Composite Quality Score.
Frequently Asked Questions: THA/TKA PRO-PM and the TEAM Composite Quality Score
The THA/TKA PRO-PM (CMIT #1618) is a hospital-level quality measure that tracks risk-standardized improvement in patient-reported pain and function following total hip or knee arthroplasty. Within the TEAM model, it is one of the quality measures that make up the Composite Quality Score (CQS), which directly influences reconciliation payments. A higher RSIR percentile rank translates to a higher CQS contribution and a more favorable payment outcome.
No. CMS pulls THA/TKA PRO-PM data directly from what hospitals report to the Hospital IQR Program, where PROM submission has been required under Hospital IQR reporting requirements beginning in 2025. There is no separate TEAM quality data submission requirement for this measure.
Eligible patients must complete both a generic health survey (VR-12 or PROMIS Global-10) and a joint-specific survey (HOOS Jr. for hip replacements, KOOS Jr. for knee replacements) at two time points: within 90 days before surgery, and between 300 and 425 days after surgery. Both instruments are required at both time points for a patient to count as a matched pair.
A patient counts toward the numerator (achieves substantial clinical improvement) with a 20-point improvement on the HOOS Jr. (hip) or a 22-point improvement on the KOOS Jr. (knee), measured from pre-op to post-op survey. These thresholds are defined in the CMIT #1618 measure specification.
If a hospital does not meet the 25-case minimum required for CMS to calculate a statistically reliable RSIR, it is treated as receiving a score effectively equivalent to the 50th percentile for CQS purposes. This applies regardless of how high the capture rate is for the cases that were submitted.
No — these are parallel systems. The 50% IQR capture rate is a Hospital IQR Program compliance requirement; failing it triggers an IPPS payment update penalty. The 25-case minimum is the TEAM scoring threshold; a hospital can fail one and still satisfy the other. For TEAM CQS scoring, the 25-case minimum is the operative threshold.
No. The measure denominator is limited to Medicare Fee-for-Service (FFS) beneficiaries. Medicare Advantage, commercial, Medicaid-only, and dual-eligible patients billed through MA are excluded. Collecting PROM data from these patients is good clinical practice but does not affect your RSIR or TEAM CQS score.
No. TEAM does not include improvement points in the CQS. Scoring is based solely on achievement relative to the current baseline national distribution. Your RSIR percentile rank against peers each performance year is what counts.
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Sources: CMS CMIT #1618 THA/TKA PRO-PM Measure Specification | qualitynet.cms.gov/inpatient/measures/THA_TKA | FY25 IPPS/LTCH PPS Final Rule, 89 FR 68986 | § 512.547 | § 512.635(d) | CMS Quality Payment Program — qpp.cms.gov
