Is Your PROM Program Going To Meet The Measure?

Can Your Hospital Afford a 25% Medicare Payment Reduction? 

Even a minor misstep in collecting the CMS Total Hip Arthroplasty and Total Knee Arthroplasty Patient-Reported Outcome Performance Measure (THA/TKA PRO-PM) data can lead to catastrophic outcomes:

• 25% APU Reduction: Applies to inpatient Medicare Fee-for-Service claims. This APU reduction not only applies to THA and TKA procedures, but across all Medicare Fee-for-Service claims for services provided by the facility.
• Future CMS Measures: Non-compliance now signals risk for not  meeting requirements under emerging value-based payment models.
• Reputation Risks: Public reporting of Risk-Standardized Improvement Rates (RSIR) affects how patients and payers view your facility.

For some organizations, APU reductions result in millions of dollars in reduced Medicare payments making successful compliance with this measure both a strategic and financial imperative.

What is the CMS THA/TKA PRO-PM Measure?

Starting July 1, 2024, CMS made the THA/TKA PRO-PM mandatory for hospital inpatient procedures. This measure requires hospitals to report inpatient procedures and corresponding patient-reported outcome measures (PROMs) under the Hospital Inpatient Quality Reporting (IQR) program. The measure requires the collection of patient-reported outcomes both pre-operatively (within the 90 days prior to surgery) and one year post-operatively (between 300-425 days after surgery). The IQR program requires that 50% of patients must have complete data sets. Not meeting the data completion requirement results in reporting failure.

Is Your Hospital Meeting CMS Reporting Requirements?

With both the financial and reputational impact at stake, organizations cannot afford to fail this reporting requirement. The question must be asked, “How is your PROMs program performing?” If you cannot answer that question IMMEDIATELY, you have a problem! Here are some things to consider in evaluating whether or not you are set up for success or failure for THA/TKA PRO-PM compliance:

• If finding your organization’s THA/TKA capture rate by facility takes over 15 minutes, it’s a red flag that your CMS submission will not be compliant.
• If your pre-operative capture rate is below 80% this is a signal that you have a high risk of failing the data completeness requirements.
• If you cannot track your functional improvement by facility to ensure your average score meets benchmark requirements, your reputation is at risk.

Why You Need A Strategy For PROM Collection 

The healthcare policy landscape has changed, and adoption of patient-reported outcome data as a performance measure requirement is on the rise by federal and commercial insurers. As reimbursement becomes increasingly tied to outcomes under value-based healthcare, having a sustainable and reliable system for collecting patient-reported outcomes is critical

 Managing PROM collection is a resource-intensive process. It requires thoughtful implementation, substantial administrative support and solid integration with technology. Organizations that plan to manage their PROM program internally should consider the following challenges related to THA/TKA PRO-PM:

•  1-year PROMs are difficult to collect: A 50% capture rate at 1-year is not easy to attain. If you are counting on seeing the patient in order to collect the 1-year survey you will need to ensure the timing of patient encounters aligns with the 300-425 day postoperative data collection window.
• Disruption to workflow: Whether collecting a survey while the patient is checking in for surgery or during a 1-year post-operative clinic visit, workflows need to be adjusted and extra time allocated for PROM collection.
•  FTE resources are required: Both clinical and IT resources are necessary during implementation and on an ongoing basis for PROM collection and reporting. Expect to assign a full-time employee for every 100 procedures performed monthly.
• Capture rate and facility-level outcome score reporting: Whether collecting on paper or electronically, leaders need ongoing visibility of the capture rate and improvement scores. EHRs do not have this reporting capacity natively

Partner For Success

Outsourcing PROM collection and reporting to a vendor, like CODE Technology, offers a cost-effective and efficient solution. Our specialized team of clinical professionals is equipped to take on the management of your PROM program, freeing your staff so they can work at the top of their license. CODE takes the burden of collecting PROMs off your staff and out of the care setting.

We ensure that your PROM program is designed and implemented to meet your goals. CODE offers more than a software platform; we offer software-and-service that provides end-to-end support. CODE enrolls patients, deals with cancellation and rescheduling of procedures, handles patient survey questions, assigns patients to receive phone calls from CODE’s dedicated phone call team, makes recommendations on patient education to ensure that your capture rate remains high, and works with your data daily to ensure data quality and integrity. Your dedicated, clinically trained account manager will meet with you regularly to ensure your program is on track to meet your specific needs. With CODE, facilities can focus on delivering quality patient care while we handle the intricacies of PROM management.