Key Takeaways
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The pre-collection window for the mandatory CMS THA/TKA PRO-PM begins in less than 30 days
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There are financial implications for failing to report all of the necessary data
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There are financial implications for failing to meet the minimum improvement metrics
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There is still time to collect the data you need
By now, if you’re part of a hospital that performs inpatient total hip or total knee arthroplasties, you’ve heard of the CMS THA/TKA Patient-Reported Outcomes (PRO) Performance Measure. Intended to measure improvement in patients’ self-reported pain and functional status before and after elective THAs or TKAs, the PRO-PM requires the collection and reporting of PROs – and the pre-collection window for mandatory reporting begins in less than 30 days.
Reporting requirements in review
To avoid financial penalties, hospitals must report the following to the CMS:
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A minimum of 50% of all eligible patients with complete pre-operative and post-operative data
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A minimum 22 pt. improvement in HOOS, Jr. scores
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A minimum 20 pt. improvement in KOOS, Jr. scores
Understanding the financial implications
But what if hospitals fail to report? Or, what if the organization fails to report all of the necessary data?
Failure to either report or reach the minimum improvement metrics will result in a one-quarter reduction in the annual payment rate update – on average a 2% impact on the annual IPPS payment.
However, the exact impact on your organization may vary.
You can get a greater sense of the implications for your hospital by scheduling one of our free CMS consultations. In 30 minutes or less, our experts will conduct a cost-impact analysis and review your current outcomes program to help you get the information you need for successful CMS reporting.
Compliance is still possible
If you don’t have a program in place to collect all the necessary PROs, there’s still time. Our CMS consultations can also brief you on how to get started and avoid the cost of non-compliance.
