The Patient-Reported Outcome Performance Measure, Simplified
We’ve Deciphered The IPPS THA/TKA PRO-PM And Prepared A Comprehensive Whitepaper
Who is Impacted · Reporting Timeline · Data Submission Process · Successfully Meeting the Performance Measure
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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.
Failure to successfully collect and report PROMs to the THA/TKA PRO-PM will result in a ¼ reduction in your CMS annual payment update (APU).
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.
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.
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.
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
- Upwards Of 12-18 Month Implementation
- Expensive To Build And Maintain
- Huge Toll On IT Resources
- No Promise Of Program Success
- Countless Of Programs To Master
- Weighty Employee Workload
- Recruiting Reporting Experts
- Hours Of Report Building
- Notoriously Low Capture Rates
- 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.
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