Inpatient CMS THA/TKA PRO-PM: What You Need to Know

Key Takeaways
  • New Reporting Requirements for THA/TKA Procedures Begin Soon The pre-procedure data collection window for voluntary reporting of the inpatient THA/TKA PRO-PM kicks off in October 2024. Mandatory reporting starts in 2025.
  • Financial Penalties for Non-Compliance Non-compliance with THA/TKA PRO-PM reporting can risk in a 2% cut across your entire organization's annual Medicare reimbursements, not just THA/TKA procedures.
  • Free Consultation to Assess Your Risk Let us analyze your situation and estimate potential financial penalties for non-compliance.
  • Streamline THA/TKA PRO-PM Reporting with Best Outcomes Our ePRO tool automates data collection, simplifies data export, and provides actionable insights to ensure you meet CMS requirements and avoid penalties.
Reporting requirements at a glance
To avoid financial penalties, providers must report the following to CMS
  • Data Collection: 30 days prior to surgery & one year post OP
  • SCB: -HOOS, JR: 22 points-KOOS, JR: 20 points
THA/TKA PRO - PM measure
  • CMS pays acute care hospitals for inpatient stays under a payment program called the inpatient Prospective Payment System (IPPS).
  • Hospital inpatient Quality Reporting (IQR) collects data from Hospitals.
  • PRO data; claims data; Medicare enrollment and beneficiary data.
  • CMS for measure calculation directly or utilize an external entity, such as a vendor or registry,
  • Hospitals that fail to meet any of the IPPS reporting requirements will receive a deduction from their annual payment update FY 2028.
The Challenge: New CMS Reporting Mandates for THA/TKA
Similar to the inpatient program in 2022, the Centers for Medicare & Medicaid Services (CMS) is now mandating reporting of the THA/TKA PRO-PM for inpatient procedures in both Hospital inpatient and ASC Quality Reporting Programs.
The Deadline is Approaching
The 2025 reporting pre-procedure collection window begins on October 3rd, 2024. Don't wait until the last minute!
Best Outcomes: Your Partner in THA/TKA PRO-PM Compliance
Avoid financial penalties and ensure smooth reporting with Best Outcomes! Our user-friendly ePRO tool offers:
  • Automated Data Collection Reduce administrative burden and ensure complete datasets.
  • Actionable Insights Turn patient-reported data into meaningful information to guide care and improve patient outcomes.
  • Simplified Data Export Easily export data in the format required by CMS.
  • Improved Patient Engagement Enhance patient communication and satisfaction through ePRO surveys.
Get Started Today!
Don't risk financial penalties. Contact Best Outcomes today for a free consultation and learn how our ePRO tool can help you achieve seamless THA/TKA PRO-PM compliance.
Data Element TypePreoperative Data ElementsPostoperative Data Elements
Patient-Reported Outcome Measures (PROMs) THA patients:HOOS, JR
TKA patients:HOOS, JR
THA patients:HOOS, JR
TKA patients:HOOS, JR
Patient-Or-Provider-Reported Risk VariablesMental Health Subscale items from either PROMIS-Global or VR-12N/A
Health Literacy (SILS2)
BMI or Height/Weight
Use of Chronic Narcotics
Total Painful Joint Count: Patient-Reported Pain in Non-Operative Lower Extremity Joint
Quantified Spinal Pain: Patient-Reported Back Pain, Oswestry Index Question
Matching VariablesMedicare Provider NumberMedicare Provider Number
Date of BirthDate of Birth
Date of ProcedureDate of Procedure
Procedure TypeProcedure Type
Date of AdmissionDate of Admission
PROM-related VariablesDate of PRO Data CollectionDate of PRO Data Collection
Mode of CollectionMode of Collection
Person Completing the SurveyPerson Completing the Survey
Generic PROM VersionN/A
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