The Patient-Reported Outcome Performance Measure, Simplified
We’ve Deciphered The OPPS THA/TKA PRO-PM And Prepared A Brochure For ASCs
Reporting Timeline · Successfully Meeting The Measure · Who
Is Impacted · PROMS in the PRO-PM
Access The Brochure
We’ve Deciphered The OPPS THA/TKA PRO-PM And Prepared A Brochure For ASCs
What We Cover
Reporting Timeline · Successfully Meeting The Measure · Who Is Impacted · PROMS in the PRO-PM
Access The Brochure
Mandatory PROM Collection Is Right Around The Corner
In November 2023, CMS adopted the total hip arthroplasty/total knee arthroplasty (THA/TKA) patient-reported outcome-based performance measure (PRO-PM) for use in the Ambulatory Surgical Center Quality Reporting (ASCQR) program. This performance measure will require that ASCs collect PROs on primary elective total hip and knee replacements.
Failure to successfully collect and report PROMs for the THA/TKA PRO-PM will result in a 2% 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
In November 2023, CMS adopted the total hip arthroplasty/total knee arthroplasty (THA/TKA) patient-reported outcome-based performance measure (PRO-PM) for use in the Ambulatory Surgical Center Quality Reporting (ASCQR) program. This performance measure will require that ASCs collect PROs on primary elective total hip and knee replacements.
Failure to successfully collect and report PROMs for the THA/TKA PRO-PM will result in a 2% 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
- ASC Level Outcome
Risk-Standardized Improvement Rate
Response Rate Requirement
Response Rate Requirement
45% 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 45% capture rate for organizations impacted by this Ambulatory Surgery Center Quality Reporting (ASCQR) 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 ASC 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.
ASC-Level Outcome| Risk-Standardized Improvement Rate
CMS calculates the ASC facility-level RSIR by aggregating all patient-level results across the facility. For example, a 60% RSIR indicates that 60% of patients at this ASC had a substantial improvement following their THA/TKA.
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
- ASC Level Outcome
Risk Standardized Improvement Rate
Response Rate Requirement
45% of patients must have both the preoperative and 1-year post-operative PRO data collected.
CODE Technology guarantees a 45% capture rate for organizations impacted by this Ambulatory Surgery Center Quality Reporting (ASCQR) 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 ASC 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.
ASC-Level Outcome| Risk-Standardized Improvement Rate
CMS calculates the ASC facility-level RSIR by aggregating all patient-level results across the facility. For example, a 60% RSIR indicates that 60% of patients at this ASC had a substantial improvement following their THA/TKA.
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’ OPPS 2023 final rule with our ASC-specific brochure. Learn essential insights about the new patient-reported outcomes performance measure and secure full Medicare reimbursement for your organization.
Your Ticket To Understanding
the PRO-PM
Unlock CMS’ OPPS 2023 final rule with our ASC-specific brochure. Learn essential insights about the new patient-reported outcomes performance measure and secure full Medicare reimbursement for your organization.
Dig Into Our Thought-Leadership Blogs
Breaking Down the CMS Final Rule: The PRO-PM For Outpatient THA/TKA
On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) finalized the Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2024. CMS moved forward with adopting the...
Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Overview
Overview of Medicare OPPS and ASC Proposed Rulings The Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Proposed Rule, unveiled annually by the Centers for Medicare & Medicaid Services (CMS), outlines the...
Introduction to CMS’s CY 2024 OPPS/ASC Proposed Rule & THA/TKA PRO-PM
July 13, 2023, CMS released the Calendar Year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule. As part of the OPPS/ASC proposed rule, CMS is proposing several changes to the Hospital...