Starting July 2024, hospitals across the U.S. will face a game-changing shift in how outcomes for Total Hip and Knee Arthroplasty (THA/TKA) procedures are measured and reported. The American Academy of Orthopaedic Surgeons (AAOS) has introduced new Patient-Reported Outcome Measures (PROMs) requirements. Non-compliance could cost hospitals millions in Medicare reimbursements.
Is your hospital ready? Here’s a detailed guide to help you understand the financial implications, compliance strategies, and the role of PROMs in enhancing patient outcomes. Let’s dive in.
What are Patient-Reported Outcome Measures (PROMs)?
Patient-Reported Outcome Measures (PROMs) are standardized tools that capture patients' perceptions of their health status, particularly regarding pain and functional improvements following medical procedures. By focusing on PROMs, the AAOS aims to improve patient care, enhance recovery tracking, and ensure value-based care in orthopaedics.
Why It Matters: Hospitals that adopt PROMs effectively can boost patient satisfaction, improve clinical outcomes, and strengthen their reputation for delivering quality care.
Financial Implications for Hospitals
Failing to meet the AAOS’s new PRO-PM requirements can result in significant financial losses. The Centers for Medicare & Medicaid Services (CMS) will impose penalties for non-compliance, including:
- Penalty Details: A 25% reduction in the Annual Payment Update (APU) across all Medicare Fee-for-Service Part A claims, including non-orthopaedic ones.
- Real-World Impact: For a hospital with $100 million in Medicare claims, non-compliance could result in losses of up to $1 million.
Why It Matters: Beyond financial penalties, non-compliance may tarnish a hospital’s reputation and reduce its competitiveness in the healthcare market.
Data Collection Requirements
To meet compliance, hospitals must adhere to strict data collection and reporting timelines.
Timeline for Data Submission
- Preoperative Data: Collected between April 2, 2024, and June 30, 2025.
- Postoperative Data: Collected from April 27, 2025, to August 29, 2026.
- Public Reporting: CMS will publicly share results in 2027.
Eligibility Criteria
- Included Patients: Medicare Fee-for-Service enrollees aged 65 and older undergoing primary elective THA/TKA procedures as inpatients.
- Exclusions: Revisions, partial procedures, fractures, musculoskeletal malignancies, and Medicare Advantage patients.
Why It Matters: Adhering to these timelines ensures compliance and avoids penalties, positioning hospitals as leaders in value-based care.
How Hospitals Will Be Evaluated
CMS will assess hospitals based on the percentage of patients achieving a substantial clinical benefit (SCB). For example, if a hospital’s risk-standardized improvement rate (RSIR) is 60%, this means 60% of patients reported significant improvements post-surgery.
Key Metrics for Assessment
Preoperative Assessments:
- PROMIS-10 Global or VR-12: General health evaluations.
- Pain Level: Rated on a scale from 0 (no pain) to 5 (worst imaginable).
- Literacy Screening: Assesses comfort with filling out medical forms.
Postoperative Functional Status Assessments:
- Knee Injury and Osteoarthritis Outcome Score Junior (KOOS Jr.)
- Hip Outcome Score Junior (HOOS Jr.)
Why It Matters: These metrics not only determine compliance but also help hospitals improve clinical decision-making and enhance patient care.
The Ripple Effect of PRO-PM Compliance
The implementation of PRO-PM is more than just a regulatory requirement—it’s a catalyst for change in orthopaedic care. Hospitals that embrace these measures can:
- Enhance patient satisfaction and trust.
- Improve clinical outcomes through data-driven care.
- Secure financial stability by avoiding penalties.
- Build a reputation as leaders in value-based care.
How RippleCare Can Help
Navigating the new AAOS PRO-PM requirements can be challenging, but RippleCare is here to simplify the process. Our innovative solutions are specifically designed for THA/TKA procedures and include:
- Comprehensive PROMs Management: Streamline pre- and postoperative data collection.
- Compliance Assurance: Ensure your hospital meets CMS’s strict reporting requirements.
- Advanced Analytics: Gain actionable insights to improve patient outcomes.
- User-Friendly Platform: Simplify data tracking and reporting for your team.
Why It Matters: With our expertise in value-based care, we help hospitals achieve compliance while enhancing patient care and minimizing financial risks.
Take Control Today!
As the PRO-PM deadline approaches, proactive management is essential. RippleCare is ready to assist your hospital in navigating these changes with confidence. Don’t wait—schedule a free consultation or download our "THA/TKA PRO-PM Compliance Checklist" to get started.
Conclustion
The AAOS’s new PRO-PM requirements mark a pivotal shift towards value-based care in orthopaedics. By prioritizing patient-reported outcomes, hospitals can enhance the quality of care, avoid financial penalties, and build a reputation for excellence.
RippleCare is here to support your hospital every step of the way. Don’t wait—take control today and ensure compliance while improving patient outcomes in THA/TKA procedures.