In a previous article, we covered the Information Transfer PRO-PM survey ahead of its mandating by CMS for Hospital Outpatient Departments (HOPDs). However, that survey is not the only Patient-Reported Outcome Performance Measure (PRO-PM) soon to be required by CMS. Consistent with the industry’s broader push toward outcome-based quality measures, the OQR THA/TKA PRO-PM survey measures patient outcomes from outpatient hip and knee replacements and will also become mandatory for HOPDs and ASCs. Many organizations are already well-versed in the IQR THA/TKA PRO-PM, its counterpart for inpatient procedures. If you’re a Quality or Patient Experience leader at an organization subject to this upcoming requirement to conduct the survey, take a moment to review the following FAQs to make sure you’re up to date and know what to expect.
What does OQR THA/TKA PRO-PM measure?
THA and TKA stand for Total Hip Arthroplasty and Total Knee Arthroplasty, respectively, and the PRO-PM measures the outcomes of these procedures. A notable component of this measure is its two-part data collection process: patients complete both pre-operative and post-operative assessment. The pre-op assessment can be collected up to 90 days prior to the surgery, while the post-op assessment is administered 300–425 days after the procedure (approximately 10–14 months later). Both capture the patient’s self-reported severity of pain during activities and how that affects function and daily living, with the TKA PRO-PM adding a question about knee stiffness.
Is the survey(s) mandatory?
The OQR THA/TKA PRO-PM becomes mandatory for outpatient hip and knee procedures performed in CY2028, with public reporting estimated to begin in 2030–31. Applying the mandate to the two-part survey windows: required pre-op data collection begins October 3, 2027, and required post-op collection starts October 27, 2028. HOPDs and ASCs can get a head start on the mandates with a voluntary administrative window that has been in effect since 2025.
What are the reimbursement requirements?
The OQR THA/TKA PRO-PM ties survey completion to government reimbursement. Minimum completion thresholds are set at 50% of eligible patients for HOPDs and 45% for ASCs. For a survey to count as complete, the patient must finish both the pre-op and post-op components. Failure to reach the minimum completion threshold results in a two-percentage-point reduction to the facility’s annual payment update.
What survey methodologies and eligibility requirements apply?
CMS allows various mode options for these measures, including tablet or smart phone, email, electronic, phone, mail, paper, and with the provider. Proxy respondents may complete the survey when necessary, but responses from the patients themselves are strongly preferred. The measure cohort includes patients enrolled in Medicare fee-for-service (FFS) aged 65 years or older who underwent an elective primary THA and/or TKA billed to Part B (Outpatient).
How can PRC help?
PRC is ready to partner with organizations to collect and prepare OQR THA/TKA PRO-PM data that fulfills the requirements. While this is not a CAHPS® survey, PRC’s extensive experience across CMS’s line of CAHPS studies has well equipped our team to follow government mandates and ensure seamless survey administration for our client partners. Since these are outcome-based measures, they align naturally with PRC’s commitment to healthcare excellence. We look forward to helping organizations improve preparedness and ensure healthy patient outcomes.
Contact us today to explore partnering with PRC for your OQR THA/TKA PRO-PM administration.
Sources & Further Reading:
Comparison of IQR_OQR_ASCQR THA TKA PRO-PM With Timelines
CMS: Patient-Reported Outcome Performance Measures Resources