The Patient-Reported Outcome Performance Measure, Simplified
We’ve Deciphered The IPPS THA/TKA PRO-PM And Prepared A Comprehensive Whitepaper
Who is Impacted · PROMs in the PRO-PM · Reporting Timeline · Data Submission Process · Successfully Meeting the Performance Measure
Access The Whitepaper
We’ve Deciphered The IPPS THA/TKA PRO-PM And Prepared A Comprehensive Whitepaper
What We Cover
Who is Impacted · PROMs in the PRO-PM · Reporting Timeline · Data Submission Process · Successfully Meeting the Performance Measure
Access The Whitepaper
Mandatory PROM Collection Is Right Around The Corner
CMS’ final rule for the fiscal year 2023 Hospital IPPS increased hospital payments by $26 billion and introduced a new performance measure to the Inpatient Quality Reporting (IQR) program for primary total hip and knee replacement patients: the patient-reported outcome performance measure (PRO-PM). Here’s the time timeline hospitals should follow to successfully participate in the mandatory THA/TKA PRO-PM reporting period and lock-in their full annual payment potential.
Vendor Selection
Start Of Mandatory Pre-Op PROM Collection
Procedures Window Starts
Start Of Mandatory Post-Op PROM Collection
%
Failure to successfully collect and report PROMs to the THA/TKA PRO-PM will result in a ¼ reduction in your annual Medicare payment update.
Ready to talk logistics? Get a free consult from a PRO-PM expert.
Mandatory PROM Collection Is Right Around The Corner
CMS’ final rule for the fiscal year 2023 Hospital IPPS increased hospital payments by $26 billion and introduced a new performance measure to the Inpatient Quality Reporting (IQR) program for primary total hip and knee replacement patients: the patient-reported outcome performance measure (PRO-PM). Here’s the time timeline hospitals should follow to successfully participate in the mandatory THA/TKA PRO-PM reporting period and lock-in their full annual payment potential.
Vendor Selection
Start Of Mandatory Pre-Op PROM Collection
Procedures Window Starts
Start Of Mandatory Post-Op PROM Collection
%
Failure to successfully collect and report PROMs to the THA/TKA PRO-PM will result in a ¼ reduction in your annual Medicare payment update.
Ready to talk logistics?
Get a free consult from a PRO-PM expert.
Meeting the Performance Measure
When monitoring the patient-reported outcome performance measure, it’s important to keep track of a few key elements. Ensuring a comprehensive understanding of these factors will contribute to an effective implementation and successful reporting.
- PRO Response Rate
- Patient-Level Outcome
Functional Improvement
- Hospital-Level Outcome
Risk-Standardized Improvement Rate
Response Rate Requirement
Response Rate Requirement
50% of patients must have both the preoperative and 1-year post-operative PRO data collected. APU is impacted by successfully meeting this capture rate.
CODE Technology guarantees a 50% capture rate for hosptials impacted by this Inpatient Quality Reporting (IQR) requirement.
Measure Outcomes
What is the Measure Outcome?
The measure will assess patient improvement following TKA/TKA using improvement thresholds between pre-op and post-op. The thresholds are set at 22 points for HOOS, JR and 20 points for KOOS, JR. CMS will publicly report the facility-level risk standardized improvement rate (RSIR) or the percentage of patients who met or exceeded the threshold.
Patient-Level Outcome | Functional Improvement
A proportion of patients should meet or exceed an improvement threshold between their preoperative and post-operative PRO scores: 22 points for the HOOS JR and 20 points for the KOOS JR.
Hospital-Level Outcome | Risk-Standardized Improvement Rate
CMS calculates the hospital-level RSIR by aggregating all patient-level results across the facility. For example, a 60% RSIR indicates that 60% of patients at this hospital had a substantial improvement following their THA/TKA.
Success Checklist
There are two key metrics of the patient-reported outcome performance measure. To ensure hospitals get their full annual payment update, they must meet the PRO Response Rate.
- PRO Response Rate
- Functional Improvement
PRO Response Rate
50% of patients must have both the preoperative and 1-year post-operative PRO data collected.
CODE Technology guarantees a 50% capture rate for hosptials impacted by this Inpatient Quality Reporting (IQR) requirement.
Functional Improvement | A Positive Change In PROM Score
A proportion of patients should meet or exceed an improvement threshold between their preoperative and post-operative PRO scores: 22 points for the HOOS JR and 20 points for the KOOS JR.
Your Options For Starting a PRO Program
The PRO industry can easily be broken up into three categories: a build-your-own system, a do-it-yourself collection software, or a full-service experience that maintains and upholds program integrity
Build Your Own Solution
Time, Resources and Money
· Expensive To Build And Maintain
· Huge Toll On IT Resources
· No Promise Of Program Success
An External Software
Higher Overhead, A Lot Of Learning
· Weighty Employee Workload
· Recruiting Reporting Experts
· Hours Of Report Building
· Notoriously Low Capture Rates
CODE Technology
So Much More Than An App
· Guaranteed Capture Rate
· Configurable App Dashboards
· Automated Reporting Options
Your Options For Starting a PRO Program
The PRO industry can easily be broken up into three categories: a build-your-own system, a do-it-yourself collection software, or a full-service experience that maintains and upholds program integrity
Build Your Own Solution
Adding a customized functionality to a preexisting software.
· Upwards Of 12-18 Month Implementation
· Expensive To Build And Maintain
· Huge Toll On IT Resources
· No Promise Of Program Success
An External Software
A software that requires full-time employees to manage PRO collection.
· Countless Of Programs To Master
· Weighty Employee Workload
· Recruiting Reporting Experts
· Hours Of Report Building
· Notoriously Low Capture Rates
CODE Technology
A combination of software and service with proven success over the past decade.
· Dedicated Account Manager
· Guaranteed Capture Rate
· Configurable App Dashboards
· Automated Reporting Options
Your Ticket To Understanding the PRO-PM
Unlock CMS’ Hospital IPPS 2023 final rule with our comprehensive whitepaper. Learn essential insights about the new patient-reported outcomes performance measure and secure full Medicare reimbursement for your hospital.
Your Ticket To Understanding
the PRO-PM
Unlock CMS’ Hospital IPPS 2023 final rule with our comprehensive whitepaper. Learn essential insights about the new patient-reported outcomes performance measure and secure full Medicare reimbursement for your hospital.
Dig Into Our Thought-Leadership Blogs
CMS THA/TKA PRO-PM | 3 Reports You Must Have
It is imperative for organizations impacted by CMS’ THA/TKA PRO-PM to track PROM capture rate and functional improvement scores. There are three reports CODE is using that have proven to be ‘mission critical’ to monitor performance: 1) Capture Rate, 2) Data...
Understanding the Inpatient Prospective Payment System
Explore CMS’ IPPS, its impact on hospitals and patient care, quality programs, challenges, staffing, and more.
CMS’ PRO-PM in the IPPS | Q&A
A compilation of questions from hospital administration on CMS’ PRO performance measure in the 2023 Hospital IPPS Ruling in a Q&A format.