What’s Next for Hospital-Level PRO-PMs?

In 2025, CMS will require hospitals to submit the Inpatient Quality Reporting (IQR) program’s first-ever Patient-Reported Outcomes Performance Measure (PRO-PM): the Hospital-Level Total Hip Arthroplasty/Total Knee Arthroplasty PRO-PM (THA/TKA PRO-PM). For quality leaders everywhere, this inaugural PRO-PM is more than just another item to add to the IQR to-do-list. It’s also a signal of big things to come.

This month, we sat down with Medisolv CEO, Zahid Butt, M.D., for a frank conversation about the pros and cons of the new THA/TKA PRO-PM, what hospitals need to consider as they wade into the PRO-PM waters, and, ultimately, what the future of PRO-PMs might look like for us all.

Let’s start with the obvious question: why this particular PRO-PM and why now?

Dr. Butt: Actually, let’s start with acknowledging the fact that the concept of patient-reported outcomes and patient satisfaction data is not new! There are countless patient-reported outcome measure (PROM) tools that are in use by practices and healthcare systems today. Payers, like CMS, have a long-standing desire to get direct patient feedback as well. We’re all familiar with the HCAHPS survey, which is essentially a customer satisfaction survey and has been required of hospitals to report for a long time. So, the basic concept is not new.

However, in terms of where to start with mandatory PRO-PMs, it makes sense to me that CMS started with orthopedics. More than a third of all Americans live with some form of musculoskeletal disease, and it’s a top driver of U.S. healthcare spending. It’s clearly a major burden on Americans in terms of quality of life and healthcare costs, and we as an industry need to be addressing this head-on.

What do you think will be the biggest obstacle with getting PRO-PMs off the ground for CMS?

Dr. Butt: Ultimately, standardization is the key to success in quality data and analytics. Standardization of the tools, and standardization in the coding. On the tools front, it’s good that CMS is locking it down for the THA/TKA PRO-PM by requiring the HOOS and KOOS surveys, rather than letting hospitals use whatever instrument they want. [Editor’s note: You can download the HOOS and KOOS surveys here.]

If the tools are not standardized then you can assume that the coding probably isn’t either. Let’s say we want to measure a patient’s pain improvement. In one PROM tool, the field maybe called pain control. In another tool, it’s coded as pain management, and in a third tool it’s labeled as pain score. To a human, it all reads as the same thing, but a computer doesn’t see that. And that’s the issue: a lot of the PROMs commonly used today have always existed in the paper world, so they haven’t had to define things in a standardized way that could be computed automatically. As we move forward with PRO-PMs in national payment or public reporting programs, we’ll need to develop standard tools and terminology that can be easily mapped in anyone’s system and used in digital quality measures.

Let’s talk about the digitization of it all. It’s interesting that CMS did not set this measure up as an eCQM considering their aggressive goals of converting everything to dQMs by 2025.  

Dr. Butt: That’s right—it’s clear from the measure’s language that CMS is not locking hospitals down to any sort of digital or electronic specifications. For CMS, the bigger priority was just getting a PRO-PM into the IQR program; they’re less concerned about telling you how it should be done.

Do you think hospitals should take the initiative and set this measure up with a digital-first mindset anyway? One example would be administering the survey: it could be delivered to patients digitally via waiting room kiosks or iPads. 

Dr. Butt: I'm always for more digital and more automation. Things only become more expensive and time-consuming if you don't automate them. But I think an equally important issue is deciding where and when should you administer the patient survey. In our industry, there are some concerns that, when a provider helps with the survey intake, or even if the patient is sitting in the provider’s office while taking the survey, bias will creep in. In other words, patients will tend to inflate the scores because they are worried about offending their providers. When you're sitting in the exam room or in the waiting room, you are in a different mode and mindset then when you’re at home or out in the real world. So, there is a school of thought that these PRO-PM surveys should only be administered outside of the provider’s office, and only the patient or their caregiver should be able to input the data.

So, in an ideal world, where all the technology is figured out and available to us, how would you like to see PRO-PM patient surveys administered?

Dr. Butt: It should be very easy if this is to be a healthcare consumer facing activity. For example, you get a text message with a simple rating system, like one to five stars. You select the number of stars and you’re done. There shouldn't be a lot of text for patients to read and interpret. Many customer-facing industries, like hospitality, have already moved in this direction. They ask fewer questions, but they want a large number of people answering those questions to give them a sense of how well something was done. If 90% of the people who stayed in your hotel answer that question, you will have a sense of how well you are doing. My analogy is a bit of an oversimplification but in general the easier you make it the more responses you’ll get.

In the THA/TKA PRO-PM, there is a long lead time between the year an eligible procedure occurs and the year it actually gets included with a hospital’s submitted data. Any concerns about how useful the data will be in terms of helping to create meaningful improvement in real-time?

Dr. Butt: We have to remember that step one with any new measure is just bringing attention to the need for change. Creating the THA/TKA PRO-PM motivates hospitals to pay more attention to outcomes through the patient’s vantage point. By monitoring their data more regularly, they also start looking at solutions that drive positive change. It’s a domino effect that ultimately benefits the patients.

More Tools to Help You Understand the THA/TKA PRO-PM

Make sure you’re using the THA/TKA PRO-PM 2024 voluntary reporting period to its fullest advantage before the measure is required in 2025. And remember: mandatory data collection for 2025 actually begins in April of 2024. Contact Medisolv for 1:1 guidance or check out some of our latest tools and solutions to get started:

• eBook: A Quick Guide to the THA/TKA PRO-PM
• Article: 2024 IQR Program Requirements
• Brochure: The Medisolv PRO-PM Module
• On-Demand Product Demo: Medisolv PRO-PM Module Product Demo

Source: (National  Institutes of Health, 2023 https://pubmed.ncbi.nlm.nih.gov/36574617/)