Measuring Quality, The New priority in THA/TKA patient care
THA/TKA PRO-PM are now at the heart of CMS quality initiatives. Patient-reported outcomes have become a critical priority across multiple healthcare settings:
Hospital Inpatient Quality Reporting (IQR)
Mandatory for inpatient procedures
50% response rate required
Include 25% reduction in APU
Hospital Outpatient Quality Reporting (OQR)
Applies to outpatient procedures
45% response rate required
Impacts APU by 2% (for outpatient and ASC’s) from CY 2030
Ambulatory Surgery Center Quality Reporting (ASCQR)
Required for ASCs starting 2025
45% response rate required
Affects APU from CY 2030
Transforming Episode Accountability Model (TEAM)
TEAM coming to hospitals in 2025/2026 will require the THA/TKA PRO-PM as a component
Alternative payment model for episodes of care
Merit-based Incentive Payment System (MIPS)
Applicable for outpatient clinics and individual providers
The PRO-PM Challenge, A New Era of Quality Measurement
The Patient-Reported Outcome Performance Measure (PRO-PM) represents a paradigm shift in healthcare quality reporting.
This approach brings with it a level of complexity previously unseen in the industry, with intricate rules and timelines that span multiple years.
Unlike traditional quality measures, PRO-PM requires a long-term commitment to patient engagement and data collection, as the life span of the measure extends over 12 months for each patient.
PRO-PM raises the stakes significantly; non-compliance can result in substantial financial penalties, directly impacting your bottom line.
As healthcare providers, you're not just adapting to a new reporting system – you're navigating a fundamental transformation in how quality of care is measured and rewarded.
Critical THA/TKA PRO-PM Timelines
The transition from voluntary to mandatory reporting is currently underway for both inpatient and outpatient procedures:
Remember: Failure to meet reporting requirements will result in reductions to your Annual Payment Update (APU) starting as early as Fiscal Year 2028 for inpatient procedures and Calendar Year 2030 for outpatient and ASC procedures. The reduction will amount to 25% of your APU for impatient providers and 2% for outpatients to ASC providers. In addition, Non compliant providers will be disqualified from participation in all medicare purchasing programmes (across all specialties).
What This Means for You
Quality is paramount: Delivery of excellent clinical care that will now be measured using the patient's voice via the survey instruments
Financial impact: penalties on your APU from CMS, public reporting and transparency will cost you business as patient will gravitate toward high quality centers
Public Scrutiny: Your performance will be publicly reported, affecting your reputation
Patient Engagement: New strategies needed to ensure high response rates
Resource Reallocation: Staff must be trained and reassigned to manage PRO-PM
Data Management: Accurate collection, analysis, and reporting are time consuming, complicated to figure out, different deadlines, and will require careful analysis of the data to ensure accuracy and that you are meeting the requirements as set forth by CMS.
Explore our latest blog post, co-written with our partner, Amazon Web Services (AWS), to gain valuable insights into CMS requirements for collecting PRO-PMs and how The Clinician’s THA/TKA solution can help your organization achieve compliance quickly and efficiently.
AWS Blog Post: Optimise CMS compliance with an AWS powered SaaS THA and TKA PRO-PM digital care pathway
The Clinician Advantage: Best of Both Worlds
We uniquely combine enterprise-grade quality with SaaS efficiency:
Enterprise-Level Expertise: Leveraging years of experience in PRO-PM
SaaS Agility: Quick implementation, lower costs, regular updates
Focused Specialization: Dedicated to perfecting THA/TKA PRO-PM solutions
Security/compliance: We adhere to the most stringent data privacy.
