What are Patient Reported Outcomes?

Put simply: patient reported outcome (PRO) surveys are a set of validated, standardized questions that are filled out by the patient.

Each PRO tool has a unique scoring system that quantifies the results as a single number (or several numbers, in some cases). PRO surveys are used to record patients’ functional status before a surgery/intervention, and then again at specific intervals after the surgery/intervention. Rather than using an x-ray or a range-of-motion test to determine the ‘success’ of an intervention, PRO’s ask the patient for his or her own perspective.

In the past, the most common reason for collecting PRO data was academic research. And some forward-thinking healthcare organizations now use PRO data as part of their quality-assurance process. Increasingly, however, PROs are being used for financial reasons, such as meaningful-use quality reporting or pay-for-performance (P4P) programs. Examples of such reporting already in place include the CMS Physician Quality Reporting System (PQRS), as well as the Blue Cross of Massachusetts’ P4P pilot program for total joint replacements.

The most important reason for collecting PRO data is that it quantifies your value. Of all the transformations reshaping American health care, none is more profound than the shift toward value. A key event of this transformation occurred in 2010, when The New England Journal of Medicine published an article written by Harvard Business School professor Michael Porter titled ‘What is Value in Healthcare?’ In this article, Porter states that value in healthcare is defined by a simple equation: ‘Value = outcomes achieved divided by dollar spent’. The impact of this formula has been significant, and has changed reimbursement models from payment based on volume, to payment based on value.

Porter explains the formula like this: “Outcomes, the numerator of the value equation, are inherently condition-specific and multidimensional. For any medical condition, no single outcome captures the results of care. Cost, the equation’s denominator refers to the total costs of the full cycle of care for the patient’s medical condition, not the cost of individual services. To reduce cost, the best approach is often to spend more on some services to reduce the need for others”.

Over the past 10 years, there has been numerous studies published regarding costs in healthcare. However, little has been done with respect to the numerator of the equation — outcomes. Seems strange, right? Well, it’s actually makes a lot of sense… Collecting cost data is easy, and collecting outcome data is not.

Cost data are all the bits of information related to the process of providing care to a patient — things like the number of days a patient spent in the hospital, what type of surgical implants were used, how long the patient went to physical therapy, etc. These data points live in the medical record, and can be extracted easily at any time. Outcome data, however, are a whole different ball game. Collecting it requires patients to participate and follow up at multiple intervals. And it’s time sensitive — there is no going back and collecting it retrospectively if you miss the window.

When you think of this in light of Porter’s value equation, it is actually quite scary: if you reduce the cost of care (denominator) without measuring the impact it has on the quality of patient outcomes (numerator), it can have a negative impact on those patients. So while measuring process or cost data is a useful and important strategy for healthcare institutions, it’s no substitute for measuring outcomes.