Implementation of the New Medicare-Mandated Patient Reported Outcomes After Joint Arthroplasty Performance Measure

Authors

Johannes F. Plate, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA; American Association of Hip and Knee Surgeons Health Policy Fellowship Program. Electronic address: Platefj2@upmc.edu.
Justin T. Deen, Department of Orthopaedic Surgery and Sports Medicine, University of Florida, Gainesville, FL; American Association of Hip and Knee Surgeons Health Policy Fellowship Program.
Christopher F. Deans, Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE; American Association of Hip and Knee Surgeons Health Policy Fellowship Program.
Aidin E. Pour, Department of Orthopaedics & Rehabilitation, Yale University, New Haven, CT.
Adolph J. Yates, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA.
Robert S. Sterling, Department of Orthopaedic, George Washington University, Washington, DC.

Document Type

Journal Article

Publication Date

1-24-2024

Journal

The Journal of arthroplasty

DOI

10.1016/j.arth.2024.01.038

Keywords

Medicare; patient reported outcome measure; payment; performance; total hip arthroplasty; total knee arthroplasty

Abstract

INTRODUCTION: A new mandatory hospital-level, risk-standardized performance measure for elective total hip (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by Medicare & Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinic benefit (SCB) threshold between preoperative and postoperative outcomes measures (HOOS JR, KOOS JR). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching SCB. The percentile score among hospitals will be reported. Following two voluntary reporting periods, mandatory reporting will begin 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. CONCLUSIONS: The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates.

APA Citation

Plate, Johannes F.; Deen, Justin T.; Deans, Christopher F.; Pour, Aidin E.; Yates, Adolph J.; and Sterling, Robert S., "Implementation of the New Medicare-Mandated Patient Reported Outcomes After Joint Arthroplasty Performance Measure" (2024). GW Authored Works. Paper 4125.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4125

Department

Orthopaedic Surgery