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
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 Outpatient Quality Reporting (OQR) program. This performance measure will require that HOPDs 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 CMS annual payment update (APU).
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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’ 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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