Greater Resource Utilization for Patient-Reported Outcome Measures Collection in Medicare Inpatient Versus Outpatient Total Knee Arthroplasty: Implications for the New Centers for Medicare and Medicaid Services PRO-PM Policy.

Abstract

The Centers for Medicare and Medicaid Services (CMS) now mandates the collection and reporting of patient-reported outcome measures (PROMs) for total joint arthroplasty. However, ensuring adequate follow-up remains a challenge. Furthermore, differences in PROMs capture rates and collection strategies between inpatient and outpatient Medicare total knee arthroplasty (TKA) populations are not well understood. We aimed to (1) evaluate differences in PROMs collection processes and success rates between inpatient and outpatient Medicare TKA patients and (2) identify factors associated with requiring active follow-up to obtain 1-year PROMs. A prospective analysis was conducted on 7,926 Medicare patients aged ≥ 65 years who underwent elective TKA from 2016 to 2021 at a single institution. Patients were stratified as inpatient (length of stay [LOS] > one day) or outpatient (LOS ≤ one day). The PROMs at one year were collected using passive methods (email, text message, patient portal) and active methods (phone calls, personalized communication). Rates and predictors of active follow-up were compared. Inpatients had lower overall 1-year PROMs completion rates than outpatients (77 versus 84%, P < 0.001). Passive follow-up was more successful for outpatients (52.1 versus 43.8%, P < 0.001), while inpatients more often required active follow-up (56.2 versus 47.9%, P < 0.001). Active follow-up was associated with older age, men, non-White race, and greater socioeconomic disadvantage. Outpatient status, higher education, higher body mass index, and smoking cessation were protective. The one-year PROMs completion rates were significantly lower in inpatient than outpatient Medicare TKA patients. Moreover, inpatients required more intensive follow-up efforts. Targeted, resource-efficient strategies may be needed to optimize PROMs collection among inpatients, especially those facing sociodemographic barriers. Effective PROMs collection is essential for quality assessment under CMS's Patient-Reported Outcomes-Based Performance Measure (PRO-PM). Inpatient Medicare TKA patients may benefit from tailored outreach protocols to improve engagement and compliance.