Starting July 2024, hospitals and ambulatory surgical centers (ASCs) across the U.S. must comply with the Centers for Medicare & Medicaid Services (CMS) THA/TKA PRO-PM (Total Hip and Knee Arthroplasty Patient-Reported Outcome Performance Measure) requirements. This CMS mandate, aligned with the American Academy of Orthopaedic Surgeons (AAOS), emphasizes patient-reported outcomes (PROMs) to enhance value-based care in orthopedics. Non-compliance risks significant financial penalties, including up to a 2% reduction in Medicare reimbursements. RippleCare’s AI-powered platform simplifies THA/TKA PRO-PM compliance, ensuring seamless PROMs collection, EHR integration, and actionable analytics to avoid penalties and improve patient outcomes.
This comprehensive guide explores the THA/TKA PRO-PM requirements, CMS timelines, financial implications, and how RippleCare’s innovative solutions empower hospitals to excel in orthopedic compliance.
What is THA/TKA PRO-PM?
The THA/TKA PRO-PM is a CMS-mandated performance measure designed to evaluate patient-reported outcomes for elective total hip and knee arthroplasty procedures. It focuses on standardized tools like HOOS Jr. (Hip Disability and Osteoarthritis Outcome Score Junior) and KOOS Jr. (Knee Injury and Osteoarthritis Outcome Score Junior) to assess pain and functional improvements. By prioritizing PROMs, CMS aims to drive value-based care, ensuring hospitals and ASCs deliver measurable improvements in patient health and satisfaction.
Why THA/TKA PRO-PM Matters
- Improves Patient Care: Captures patients’ perspectives on pain and functionality, enabling data-driven clinical decisions.
- Ensures Compliance: Meets CMS requirements to avoid financial penalties.
- Enhances Reputation: Positions hospitals as leaders in orthopedic care and value-based outcomes.
- Boosts Patient Satisfaction: Engages patients in their recovery, fostering trust and loyalty.
With voluntary reporting starting October 2024 and mandatory reporting by 2028, hospitals must act now to align with CMS THA/TKA PRO-PM standards.
CMS THA/TKA PRO-PM Requirements: A Detailed Breakdown
To achieve compliance, hospitals and ASCs must adhere to specific data collection, submission, and reporting protocols outlined by CMS.
Eligibility Criteria
- Patients: Medicare Fee-for-Service (FFS) enrollees aged 65+ undergoing primary elective THA/TKA procedures as inpatients.
- Exclusions: Revisions, partial procedures, fractures, musculoskeletal malignancies, and Medicare Advantage patients.
- Response Rate: CMS requires a minimum 50% response rate for PROMs submissions to avoid penalties.
Data Collection Timelines
- Preoperative Data: Collected 0–90 days before surgery (e.g., April 2, 2024–June 30, 2025, for initial reporting).
- Postoperative Data: Collected 300–425 days after surgery (e.g., April 27, 2025–August 29, 2026).
- Public Reporting: CMS will publish results in 2027, impacting hospital rankings and reimbursement rates.
Key Metrics
- Preoperative Assessments:
- PROMIS-10 Global or VR-12 for general health evaluation.
- Pain level rated on a 0–5 scale (0 = no pain, 5 = worst imaginable).
- Literacy screening to assess patients’ ability to complete medical forms.
- Postoperative Assessments:
- HOOS Jr. for hip procedures.
- KOOS Jr. for knee procedures.
- Performance Metric: CMS evaluates the Risk-Standardized Improvement Rate (RSIR), measuring the percentage of patients achieving substantial clinical benefit (SCB) post-surgery.
Why It Matters
Meeting these requirements ensures compliance with CMS THA/TKA PRO-PM standards, avoids financial penalties, and positions hospitals as leaders in orthopedic compliance and patient-centered care.
How RippleCare Ensures THA/TKA PRO-PM Compliance
RippleCare’s AI-powered platform, RecoveryCOACH, is purpose-built to streamline CMS THA/TKA PRO-PM compliance while enhancing patient outcomes. Here’s how RippleCare delivers:
- Automated PROMs Collection: Simplifies preoperative and postoperative data collection using HOOS Jr. and KOOS Jr., achieving up to 98% patient satisfaction.
- EHR Integration: Seamlessly integrates with existing electronic health record systems for efficient data management.
- Real-Time Analytics Dashboards: Provides actionable insights into patient outcomes, enabling clinicians to optimize care plans.
- Patient Engagement Tools: Sends automated reminders and user-friendly surveys to boost response rates, ensuring the 50% CMS threshold is met.
- Compliance Tracking: Monitors submission timelines and data quality to guarantee adherence to CMS requirements.
Case Study: Achieving 80% PROMs Response Rate
A mid-sized ASC partnered with RippleCare to implement RecoveryCOACH for THA/TKA procedures. Within six months, the ASC achieved an 80% PROMs response rate, surpassing CMS requirements and avoiding a 2% Medicare reimbursement cut. The platform’s automated surveys and analytics dashboards reduced administrative burden by 40%, allowing staff to focus on patient care.
Avoiding CMS Penalties for THA/TKA PRO-PM
Non-compliance with THA/TKA PRO-PM requirements can result in severe financial consequences:
- Penalty Structure: Up to a 2% reduction in Medicare Fee-for-Service Part A reimbursements across all claims, not just orthopedic ones.
- Financial Impact: For a hospital with $100 million in annual Medicare claims, this translates to a potential loss of $2 million.
- Reputation Risk: Non-compliance may lower hospital rankings in CMS public reporting, impacting patient trust and market competitiveness.
RippleCare mitigates these risks by automating PROMs automation, ensuring timely submissions, and providing real-time compliance monitoring. By leveraging RippleCare’s platform, hospitals can safeguard their finances and reputation while prioritizing value-based care.
Frequently Asked Questions
Conclusion: Lead in Orthopedic Compliance with RippleCare
The CMS THA/TKA PRO-PM requirements mark a transformative shift toward value-based care in orthopedics. By prioritizing patient-reported outcomes, hospitals and ASCs can enhance clinical outcomes, boost patient satisfaction, and avoid costly penalties. RippleCare’s RecoveryCOACH platform empowers healthcare providers to achieve seamless compliance, streamline PROMs automation, and deliver exceptional patient care.
Don’t risk financial losses or reputational damage. Schedule a free consultation with RippleCare today or download our “THA/TKA PRO-PM Compliance Checklist” at ripplecare.com to prepare for CMS reporting. Take control and lead in orthopedic compliance now!