The CCJR® Gerard A. Engh Excellence in Knee Research Award: Patient-Reported Outcomes Collection and Mandatory Medicare Inpatient Total Knee Arthroplasty Patient-Reported Outcome Performance Measures: How to Optimize the Process.

Abstract

The Centers for Medicare and Medicaid Services (CMS) has mandated that patient-reported outcomes (PROs) reporting for total knee arthroplasty (TKA) start on July 1, 2024, which will impact reimbursement in 2028. The financial penalty for not reporting 50% of eligible patients is 25% of the Annual Payment Update (usually 2 to 4%). The CMS will evaluate for a substantial clinical benefit, defined as a 20-point increase in the Knee Injury and Osteoarthritis Outcome Score (KOOS JR) score. A final "risk-standardized improvement rate" will be calculated based on all risk variables and claims data submitted. The purpose of this study was to present our process for complying with these mandates. We employed a multiprong approach in a 12-hospital enterprise to collect PROs. We utilized a web-based PRO collection system embedded in our electronic medical record, a tablet in-person collection system in the clinic, and a patient engagement platform. Since 2019, we enrolled 7,354 TKA patients in a patient engagement platform and 6,942 (94%) have opted in and used the platform. Percentages of PRO completion were 90% preoperatively, 80% at 3 months postoperatively, 76% at 6 months postoperatively, and 79% at 1 year postoperatively. Patient satisfaction scores averaged 4.51 out of five at 90 days. The KOOS JR. scores improved on average from 52.0 preoperatively to 74.9 in 1 year. Utilizing our web-based electronic medical record collection system in addition to the in-person tablet PRO collection achieved minimum collection performance. Our study found that using a multiprong approach to comply with the Inpatient Prospective Payment System CMS Inpatient TKA-PRO Performance Measures will meet the minimum standards of 50% paired PROs reporting. Furthermore, our hospital system was able to meet the required substantial clinical benefit of 20 points on the KOOS JR and collect this information for reporting.