Is It Fair That Patient-Reported Outcome Measures Completion Is Tied to Reimbursement? Patient Demographics Are Associated With Rates of PROM Completion and Potential Health Disparities.

Abstract

Patient-reported outcome measures (PROM) allow clinicians to measure functional outcomes following surgery. The Centers for Medicare & Medicaid Services (CMS) has made reporting of PROMs mandatory for inpatient total joint arthroplasty (TJA) reimbursement. Despite these mandates, there is lack of research identifying patient factors associated with PROM noncompliance. The goal of this study was to identify significant predictors of which patients are less likely to complete PROMs. This retrospective study included patients who underwent primary TJA between January 1, 2022, and March 31, 2023, at a large community orthopaedic institute. Patient demographics, health characteristics, and postoperative data obtained from patient charts were compared between patients who completed and did not complete 1-year postoperative PROMs. Continuous variables were compared using independent samples t-tests or Mann-Whitney U-tests. Categorical variables were compared using Chi-square analyses or Fisher's exact tests. Among the 3,913 patients included, 70.6% completed 1-year PROMs and 29.4% did not. Patients were more likely to fill out 1-year PROM surveys if they did so preoperatively and at three months postoperatively. Non-White, non-English speaking, Medicare insurance, psychiatric history, higher Charlson Comorbidity Index (CCI), discharge to skilled nursing facilities (SNF), and revision surgery within one year were significant predictors of PROM completion non-compliance. Patients are less likely to complete PROMs were non-White, non-English speaking, discharged to SNF, did not have commercial insurance, had higher CCI scores, had documented psychiatric diagnoses, or had revision surgery within one year. These characteristics are associated with patients who have historically faced health inequities. Mandating PROMs for reimbursement may disincentivize surgeons and widen the inequity gap. Development of early postoperative care plans may increase long-term follow-up adherence for patients who are at risk of PROM completion noncompliance. The CMS and other insurers should consider risk stratification for high-risk noncompliance groups to adequately assess response rates.