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Resources for the Mandatory Centers for Medicare & Medicaid Services Inpatient Quality Reporting Total Hip Arthroplasty/Total Knee Arthroplasty Patient-reported Outcomes Performance Measure

The Hospital-Level, Risk-Standardized Patient-Reported Outcomes Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Performance Measure was finalized in the 2023 Inpatient Prospective Payment System (IPPS) Final Rule.

Also known as the Centers for Medicare & Medicaid Services (CMS) Inpatient Quality Reporting (IQR) THA/TKA Patient-reported Outcomes Performance Measure (PRO-PM), this performance measure specifically focuses on PROs to assess pain and functional status improvements following these procedures.

The goal of this measure is to quantify pain and functional improvements with validated patient-reported outcome measures (PROMs) to improve patient lives.

When do I need to start collecting baseline data and PROMs?

Preoperative data needs to be captured for procedures performed beginning July 1, 2024. Outcomes will be publicly reported by CMS in 2027.

Who is included?

  • Age 65 and older
  • Enrolled in Medicare fee-for-service
  • Primary elective THA/TKA reimbursed as INPATIENT

Exclusions

  • Medicare Advantage Patients
  • Revisions/Removals/Mechanical Complications
  • Partial/Hemi/Uni-compartmental
  • Musculoskeletal Malignancy
  • Fractures


What data are required?

Every question in the below list needs to be completed for a minimum of 50% of eligible patients.

 

Pre-op Patient- or Provider-Reported Risk Variable

  • PROMIS-10 GlobalORVR-12
  • At the moment, what is your back pain?
    • 0 = None, 1 = Very Mild, 2 = Moderate, 3 = Fairly Severe, 4 = Very Severe, 5 = Worst Imaginable
  • How comfortable are you filling out medical forms by yourself? (Single Item Literary Screening [SILS]-2)
    • 0 = Not at all, 1 = A little bit, 2 = Somewhat, 3 = Quite a bit, 4 = Extremely
  • What amount of pain have you experienced in the last week in your other knee/hip?
    • 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Extreme

Pre- and Postoperative Functional Status Assessments


How can the American Joint Replacement Registry support participating hospitals with this measure?

The AAOS American Joint Replacement Registry (AJRR) released an update on February 1, 2024, in support of the IQR PRO-PM. The release included the addition of 3 PRO-PM-specific data elements to the AJRR specifications and the availability of an IQR PRO-PM report in RegistryInsights®.

  • With the addition of theses elements to the Procedure and PROMs data specifications,* AJRR can fully capture all required data elements for the PRO-PM:
    • Medicare_HIC_Number – 11-digit Alphanumeric ID – procedure file submission
    • Chronic_Narcotics_Use_>90 – 0 = No, 1 = Yes (use of narcotics for ≥90 days prior to surgery) – procedure file submission OR preregistration form for sites using the RegistryInsights PRO Tool
    • Person_Survey_Status – 0 = Self, 1 = Surrogate – PROMs file submission or part of assessments questions if utilizing the registry PRO Tool**

*To update your file layout, please download the the 2024v1 AJRR specification from the Tools section of the RegistryInsights platform. IQR-required elements are denoted in the specification and data dictionary files under the required status columns.

**A "Person Completing Survey" question will be added to PRO Tool assessment questions in a later February release

  • The IQR PROMs Performance Report allows sites to track their PROMs completion and scores for the 65+ primary total hip and knee cases. The report is formatted for direct submission to the Hospital Quality Reporting (HQR) portal, or sites can sign this data sharing agreement and AJRR will submit the data to CMS on their behalf.

 

 

How does AJRR capture the risk variables?

These can be submitted via the AJRR Procedure and PROMs file layouts submitted by a hospital or an authorized third-party vendor, or via the RegistryInsights PRO Tool.

  • Low Back Pain, Health Literacy, and Total Painful Joint Count
    • For sites submitting PROMs via file, they need to complete the PROMs_CJR fields listed in our data dictionary (rows 120-122) and in the PROMs tab of the data spec (rows 84-86):

  • For sites utilizing the PRO Tool, they need to make sure the “CJR Risk Assessment” is listed as a pre-op assessment in their PRO profile. To update a PRO Profile, please reach out to RegistrySupport@aaos.org.
  • BMI is calculated from Height and Weight data elements submitted with the procedure file
  • Chronic Narcotics Use is a new element in the 2024v1 procedure file


When should data be collected?

 

What is the financial penalty for not reporting a complete data set for 50% of all eligible patients?

CMS will reduce 25% of the Annual Payment Update (usually 2-4%) for ALL the hospital’s Medicare Fee-for-Service Part A claims, including non-orthopaedic claims. Additionally, the hospital will be disqualified from participation in all Medicare value-based purchasing programs.


How will hospitals be scored?

CMS will publicly report the percentage of patients who achieve a substantial clinical benefit (SCB).

CMS will factor in all the risk variable data you submitted, as well as your claims data, to create your final “risk-standardized improvement rate” (RSIR). For example, if you achieve a 60% RSIR, in general, 60% of your patients reported a substantial improvement after their THA/TKA procedure.

Additional Resources: