Implementing the Total Hip and Knee Arthroplasty Patient-Reported Outcome-Based Performance Measure in Outpatient and Ambulatory Surgical Center Settings: A Practical Review of New Centers for Medicare & Medicaid Services Policies.

Abstract

The Centers for Medicare & Medicaid Services (CMS) recently finalized policies to expand the collection and reporting of patient-reported outcome measures (PROMs) for total hip and knee arthroplasty (THA/TKA) to outpatient and ambulatory surgical center (ASC) settings. The THA/TKA Patient-Reported Outcome-Based Performance Measure (PRO-PM) will be implemented through the Hospital Outpatient Quality Reporting (OQR) and ASC Quality Reporting (ASCQR) programs, with voluntary reporting starting in 2025 and mandatory reporting in 2027. This measure aims to assess improvement in patient-reported pain and function following elective primary THA/TKA procedures. The PRO-PM uses the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) instruments to capture pre- and postoperative outcomes. Facilities will submit PRO data and additional risk variables through the CMS Hospital Quality Reporting portal. The measure cohort includes Medicare fee-for-service beneficiaries undergoing outpatient procedures, with some exclusions. The measure outcome is a risk-standardized improvement rate, defined as the proportion of patients achieving a substantial clinical benefit threshold. Key differences exist between the outpatient/ASC and inpatient PRO-PM specifications, including data completeness thresholds and performance period lengths. Implementation challenges include integrating PRO data collection into workflows, achieving sufficient response rates, and addressing potential non-response bias. As value-based payment models expand, the THA/TKA PRO-PM will play an increasingly important role in assessing quality and outcomes for these procedures across the care continuum. Future research should evaluate variations in performance and associations with other quality indicators.