The Patient-Reported Outcome Performance Measure, Simplified

We’ve Deciphered The OPPS THA/TKA PRO-PM And Prepared A Brochure For HOPDs

Reporting Timeline · Successfully Meeting The Measure · Who
Is Impacted · PROMS in the PRO-PM

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We’ve Deciphered The OPPS THA/TKA PRO-PM And Prepared A Brochure For HOPDs

What We Cover
Reporting Timeline · Successfully Meeting The Measure · Who Is Impacted · PROMS in the PRO-PM

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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 Outpatient Quality Reporting (OQR) program. This performance measure will require that HOPDs collect PROs on primary elective total hip and knee replacements.

timeline of the reporting windows for OPPS PRO-PM

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.

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 Outpatient Quality Reporting (OQR) program. This performance measure will require that HOPDs collect PROs on primary elective total hip and knee replacements.

timeline of the reporting windows for OPPS PRO-PM

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.

 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

  • = HOPD 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 organizations impacted by this Outpatient Quality Reporting (OQR) 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.

Before After

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.

RSIR visualized as a pie chart.

HOPD-Level Outcome | Risk-Standardized Improvement Rate

CMS calculates the facility-level RSIR by aggregating all patient-level results across the facility. For example, a 60% RSIR indicates that 60% of patients at this HOPD 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

  • = Facility-Level Outcome

Risk Standardized Improvement Rate

;

Response Rate Requirement

50% of patients must have both the preoperative and 1-year post-operative PRO data collected.

CODE Technology guarantees a 50% capture rate for organizations impacted by this Outpatient Quality Reporting (OQR) requirement.

Measure Outcomes

What is the Measure Outcome?

The measure will assess patient improvement following THA/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.

Before After

HOPD-Level Outcome| Risk-Standardized Improvement Rate

CMS calculates the facility-level RSIR by aggregating all patient-level results across the facility. For example, a 60% RSIR indicates that 60% of patients at this HOPD had a substantial improvement following their THA/TKA.

RSIR visualized as a pie chart.

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

Time, Resources and Money

· 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 PROM collection.

Higher Overhead, A Lot Of Learning

· 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

So Much More Than An App

· Dedicated Account Manager
· 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

first two screenshots of the brochure

Your Ticket To Understanding the PRO-PM

Unlock CMS’ OPPS 2023 final rule with our HOPD-specific brochure. Learn essential insights about the new patient-reported outcomes performance measure and secure full Medicare reimbursement for your organization.

first page of the brochure

Your Ticket To Understanding
the PRO-PM

Unlock CMS’ OPPS 2023 final rule with our HOPD-specific brochure. Learn essential insights about the new patient-reported outcomes performance measure and secure full Medicare reimbursement for your organization.

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