Orthopaedic practice executives highlight the benefits, offer advice for getting started
In a recent American Alliance of Orthopaedic Executives (AAOE) survey, only 35 percent of the participating practices are collecting patient-reported outcomes measures (PROMs). However, most practices indicated they are collecting patient satisfaction surveys (61 percent) and identified quality measures (71 percent) (Fig. 1).

Orthopaedic practice executives, particularly those from small practices, may not be shocked by these figures. Given the number and scope of recent regulations imposed on practices, executives state it often isn’t feasible to take on additional data collection activities, as time and resources can only stretch so far. The low collection rate could also signify the need for simpler, more affordable technology in the market to make PROMs a realistic goal for practices.

Due to Merit-based Incentive Payment System (MIPS) requirements, Winchester Orthopaedic Associates, Ltd., Winchester, Va., has just started collecting PROMs for total hip and total knee replacements. According to Tom Witt, Winchester’s chief operations officer, the practice’s focus is on fulfilling MIPS and Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirements, which consume a significant amount of time and resources. He says PROMs “never showed up on the radar.”

Terrance Rosenthal, practice administrator at The Orthopaedic Clinic PC, Opelika, Ala., also points to MIPS and MACRA requirements as roadblocks to his practice’s participation in PROMs. “It’s difficult enough to have the staff and capabilities to collect what we have to collect to avoid penalties and get incentives,” he said.

Mr. Witt and Mr. Rosenthal both recognize the value in collecting PROMs, even if their practices don’t currently have the bandwidth available to tackle the project.

Mr. Witt admits it makes sense to collect PROMs to ensure that the procedures surgeons in his practice perform are resulting in positive patient outcomes. Although they talk to patients individually to follow-up on their outcomes, he says having a measured result for patients would be ideal.

Mr. Rosenthal sees a marketing opportunity with PROMs. He explains that patients play a major role in marketing a practice, and outcomes have a big impact on patient satisfaction.

The collection process
So how are the 35 percent of practices collecting PROMs making it happen? Orthopaedic + Fracture Specialists, Portland, Ore., began its efforts a couple of years ago after the practice’s physicians returned from national meetings that inspired them to begin patient-reported outcome reporting. For 2 years now, the practice has been collecting PROMs preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and annually thereafter.

“To use a very bad metaphor, [we are] skating to where the puck is going to be, not where the puck is,” explained Robert Wunar, chief executive officer, of the physicians’ insight.

He explains that the practice uses the data at both the micro and macro levels. At the micro level, if a patient reports unsatisfactory results, they return to the patient’s chart and determine what could have been detected to more accurately predict how a better outcome could be achieved. From a macro perspective, they use outcomes to benchmark their practice against national figures or for comparisons within their own group or region.

Despite these efforts, Mr. Wunar says they are just beginning to create a full program to dig into the data.

He says they plan to use the data for internal process improvements as well as for external purposes. One such external use is comparing outpatient and inpatient results. Practices whose surgeons perform total joint procedures in both inpatient and ambulatory settings should compare the lower cost of ambulatory care with clinical outcomes, Mr. Wunar advises. “If we’re saving $20,000 on a case that’s moving from the hospital to an ambulatory surgery, are we achieving…similar results on patient outcome?”

Additionally, Mr. Wunar sees a correlation between outcomes improvements and performance under bundled payment initiatives. Overall, he sees the data having operational, patient care, and even strategic applications.

Getting started
Small practices can face challenges when tackling PROMs, but Mr. Wunar insists that it is possible, and he anticipates that there will be more opportunities in the future for smaller practices to get involved. The first step, he said, is getting physician buy-in.

Mr. Wunar also predicts advances in technology will make PROMs a more realistic goal for practices going forward. As more vendors enter the marketplace, competition will lead to more affordable and easier to use programs. He advises practices to keep an eye on PROMs technology as these changes occur.

Need help?
Members of the AAOE can sign up for the AAOE Data Warehouse, which will collect quality measures, patient-reported outcomes, and patient satisfaction surveys. Plans are also underway for the data warehouse to include a qualified clinical data registry approved by the U.S. Centers for Medicare & Medicaid Services (CMS) for Merit-based Incentive Payment System reporting (pending CMS approval in early 2018).

Alyssa DelPrete is the communications specialist for the AAOE. She can be reached at adelprete@aaoe.net.