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

Abstract

Background: 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 (SCB), defined as a 20-point increase in the Knee Injury and Osteoarthritis Outcome Score (KOOS JR) score. A final "risk-standardized improvement rate" (RSIR) 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.

Methods: We employed a multi-prong approach in a 12-hospital enterprise to collect PROs. We utilized a web-based PRO collection system embedded in our electronic medical record (EMR), a tablet in-person collection system in the clinic, and a patient engagement platform.

Results: 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 three months postoperatively, 76% at six months postoperatively, and 79% at one 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 one year. Utilizing our web-based EMR collection system in addition to the in-person tablet PRO collection achieved minimum collection performance.

Conclusion: Our study found that using a multi-prong approach to comply with the Inpatient Prospective Payment System (IPPS) 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 SCB of 20 points on the KOOS JR and collect this information for reporting.