New CMS Policy on the Mandatory Collection of Patient-Reported Outcome Measures for Total Hip and Knee Arthroplasty by 2027

Abstract

The Centers for Medicare & Medicaid Services (CMS) has finalized a landmark national policy to standardize and expand the collection and reporting of patient-reported outcome measures (PROMs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA). This policy will be rolled out through phased implementation, beginning with voluntary reporting starting in 2023 and transitioning to mandatory reporting starting in 2025, which will be tied to hospital payment determinations in fiscal year 2028. The overarching goal of this policy is to gather meaningful pre- and postoperative PROM data directly from patients to enhance clinical care, shared decision-making, and quality measurement for these common elective procedures. This national initiative underscores the value of incorporating patient perspectives and priorities into assessments of surgical care quality. For orthopaedic surgeons and hospitals, participating in the initial voluntary reporting period provides an opportunity to integrate PROM collection into clinical workflows and to leverage these data to improve patient care. The achievement of robust PROM response rates and a strong performance on the underlying THA/TKA Patient-Reported Outcome-Based Performance Measure may have increasing relevance as payment models shift toward value-based care. The aim of the present forum was to provide an in-depth review of this new CMS policy and key details regarding required PROM instruments, data-collection time frames, and other specifications that surgical teams should understand as they prepare for implementation. The goal was to equip orthopaedic surgeons with actionable information as they embark on this new era of national PROM collection and reporting.

Variation in processes of care for total hip arthroplasty across high-income countries

“… 48 The Centers for Medicare and Medicaid Services will also begin requiring mandatory collection of PROMs in the United States in 2027. 49 In New Zealand, the New Zealand Orthopaedic Association runs a Joint Registry, which collects PROM data for hip replacement. 50 In their 2023 report, the New Zealand Orthopaedic Association found that having an Oxford Hip Score below 27 was significantly associated with undergoing a hip revision within 2 years.…”

“…US surgeons and hospitals can report these outcomes voluntarily, and they will be required in Medicare starting in 2027. 49 The United States is also testing payment methodologies to reduce costs and potentially improve quality, but these approaches have had only small effects on reducing costs per THA case. 43…”