CMS released earlier this year its fiscal year (FY) 2023 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) final rule. Reimbursement raised by $26 billion for qualified patients and aligns new care provisions with financial incentives (the full text is available here).
Among the most significant updates is the release of 10 new quality measures — including two that apply directly to orthopedic procedures:
Starting October 3rd, providers may begin to collect data for CMS’ first round of voluntary reporting. We, at PatientIQ, strongly recommend getting started right away so there is ample time to test and fine-tune new workflows before reporting is required. Hospitals that fail to meet any of the IPPS reporting requirements will receive a deduction from their annual payment update in FY2028.
The overall goal of the hospital-level THA/TKA PRO-PM is to measure the extent which patients’ self-assessment of their pain and functional status improves before and after their elective THA/TKA procedure. The measure cohort includes patients enrolled in Medicare fee-for-service (FFS), ages 65 years or older who underwent an elective, primary THA and/or TKA.
The PRO-PM measure is significant because it’s the first time the patient’s outcomes — their direct, subjective feedback — will directly impact provider outcomes. Success will hinge on a healthcare provider’s ability to effectively share data and collaborate with patients. Here are some things to consider:
Now is the time to dig into the law and make sure you are clear on what this means for your practice.
It’s also time to begin the voluntary reporting process: The pre-operative data collection period begins on Monday, October 3, 2022, and runs through June 30, 2023, for THA/TKA procedures occurring between January 1, 2023, and June 30, 2023. Participating in the voluntary process which will ensure your hospital has ample time to:
The introduction of the new PRO-PM measure offers an opportunity for healthcare providers to assess patient experience, improve care and demonstrate quality. Contact PatientIQ if you need further guidance from a trusted partner that can oversee the PRO survey process and ensure your PRO-PM measures are ready to submit during the initial voluntary period.