Merry Medisolving featuring Lake Regional Health System: How to Confidently Navigate the THA/TKA PRO-PM

The patient experience should always be high priority for hospitals, but patient input is now more important than ever with CMS recently introducing THA/TKA PRO-PM (Total Hip Arthroplasty/Total Knee Arthroplasty Patient-Reported Outcome Performance Measure) as its first measure within both the Inpatient Quality Reporting (IQR) and Outpatient Quality Reporting (OQR) programs to rely directly on patient input to calculate performance.

Now that pre-op data collection period for the first year of mandatory IQR reporting has officially begun, many hospitals are quickly discovering that the data collection process can be a beast to tackle. (Quick refresher: IQR pre-op data collection opened on April 1, 2024 for performance year 2027, which tracks procedures that were completed from July 1, 2024 – June 30, 2025. Mandatory OQR reporting of the measure starts with performance year 2028.)

We had the privilege of speaking with members of the quality team at Lake Regional Health System in Osage Beach, Missouri, to show you just how beneficial it is to be as collaborative and prepared as possible when it comes to this complicated measure. Let’s learn more about their experience.

The Interview

Had you been tracking patient-reported outcomes through any sort of survey mechanism prior to THA/TKA PRO-PM?

Mariah: We were including the HOOS (Hip Disability and Osteoarthritis Outcome Score) and KOOS (Knee Injury and Osteoarthritis Outcome Score) surveys in our joint camp prior to the THA/TKA PRO PM evolving.

What were your first thoughts when you learned about the THA/TKA PRO-PM?

Monica: We don’t have a large THA/TKA surgical volume, only about 400 inpatient and outpatient procedures total a year, but we knew it was going to take a lot of research and deep diving into the specifications to get the ball rolling on this measure. After we conducted the key research, our team created a presentation to summarize the high-level points of what the measure would entail, and we gathered our clinical leaders together to share the information with them.

What was the clinical staff’s reaction to this news?

Mariah: We're lucky to have a good team of orthopedic surgeons who are very patient-focused and want people to have good surgical experiences. Their patient satisfaction scores are really important to them, and they're already used to looking for feedback.

Are you participating in the IQR’s voluntary reporting for THA/TKA PRO-PM?

Mariah: Yes, we rolled out the data collection in the inpatient setting and the outpatient setting at the same time. We feel good that we have a head start and feel better prepared for the OQR mandatory reporting in 2028.

Are there any differences between how you’re approaching the inpatient versus outpatient measure?

Mariah: Although most patients are same-day surgery, we’re doing the same pre-operative screening across the board because we can't predict who is going to end up inpatient.

What were some of the practical first steps you took to get the measure built?

Monica: It’s an easy to overlook step, but one of the first things we did was make sure we had permission to use the HOOS and KOOS assessments in our EMR from a copyright perspective.

Mariah: As a side note, another patient-reported outcome tool that CMS recommends does require copyright permission for electronic use. It’s the Oswestry assessment, which focuses on back pain, so we’re still using paper for that one.

So, the rest of your surveys are all administered electronically?

Monica: Most of the forms are available electronically on our patient portal, except for that Oswestry form, and we are encouraging the use of the portal to collect that information. But since the patients who have these surgeries are normally older, many of them don't usually utilize the patient portal. So that's kind of been a little bit of a hurdle for us.

How have you dealt with that issue of patients not using the portal?

Mariah: For pre-op, we’ve temporarily adopted a manual process. Patients complete pre-op forms at joint camp. We’ve added the PRO-PM survey into that packet. We collect the paper surveys before the patients leave camp, and then one of our clinical staff members enters that information electronically.

It’s 100% our intention to go digital, but for now our main focus is just to get this process going. Paper documentation might not be quite as efficient, but it seemed like the most logical way to ensure we captured all of the necessary information for this measure.

Are there any differences between how you handle pre-op surveys versus post-op surveys?

Monica: One issue we have noticed is making sure we have our post-op data collection process scheduled correctly. Our staff was putting it in as an appointment, when we just needed to talk to the patient and gather that data. We're still working through that process with the clinical team.

Mariah: Something that has helped is that we have one designated clinical staff member overseeing both. The person who inputs the data for pre-op, is the one who will do post-op, as well. As we nail down our post-op process, that staff member will make sure emails go out about the survey and send it directly in the mail to patients, too.

What would be your best piece of advice for quality teams that are just getting started with the THA/TKA PRO-PM?

Mariah: I think it’s important to know you’re not going to be successful in this measure if you're trying to drive change from your quality department. This needs to be adopted by the entire orthopedic program, not just your quality and IT teams. You must have buy-in from the physicians and from their support team. We worked with our therapy team to get into joint camp. We had post-acute care involved. We created a multidisciplinary team because of the complexity of this measure. Typically, we might have a small group of two or three people working on a measure. We had probably 10 or 12 people in the room trying to figure this one out.

Monica: My advice is to never anticipate any new measure is going to be easy. I like to manage my expectations, so I will be pleasantly surprised with dates, timelines, or anything like that when the time comes to officially get started, or in our case, get a head start.

For this specific measure, I also think about the 6P rule: Prior Proper Planning Prevents Poor Performance. I think that in this case, with how complex this measure is, I would encourage people to embrace it now. Don't wait. It's not something you're going to be able to throw together in a month—and Medisolv has been great to work with as we navigate through it.

About Lake Regional Health System

Lake Regional Health System is a nonprofit organization that provides comprehensive health care services to residents and visitors throughout the mid-Missouri region. The 121-bed hospital in Osage Beach, Missouri, is a Level II Stroke Center, Level II STEMI (heart attack) Center and Level III Trauma Center. Lake Regional also provides a wide range of specialty care, including cancer care, heart care and orthopedics. Plus, Lake Regional operates primary care clinics, Express Care walk-in clinics, rehab therapy clinics, programs for home health and hospice, and retail pharmacies. To learn more, visit lakeregional.com.