- This measure is intended to assess hospital performance for patients undergoing elective primary THA/TKA procedure.
- To measure patients’ improvement after a THA/TKA, based on their self-assessment of their pain and function.
- Promote collaboration and shared-decision making between patients and providers across the full spectrum of care.
- 1st ever PRO-PM of its kind that incorporates the patients’ self-assessment of their pain and function directly in the measure outcome.
- The Measure: Hospital IQR Reporting Primary THA/TKA Patients.
- Collect & Submit complete Pre-Op & Post-Op data on 50% minimum eligible THA/TKA Patients annually (Capture Rate %).
- Patients that don’t achieve the Significant Clinical Benefit threshold are not eligible towards the Capture Rate Measure.
Ai Cloud PRO-PM THA/TKA App
Automating CMS PRO-PM
Data-Collection & Reporting
Ai Cloud PRO-PM THA/TKA App
Automating CMS PRO-PM
Data-Collection & Reporting
PRO-PM Express™ is your solution for CMS PRO-PM data collection & reporting
Exciting News: Commercial Launch of Eagle-I 3D and Debut of PRO-PM Express™
Eagle-I 3D is at the forefront of innovation, specializing in AI-powered solutions that streamline and automate Patient Reported Outcomes Performance Measurement (PRO-PM) management. Our cutting-edge AI Cloud App is a scalable, stand-alone platform that delivers a turnkey SaaS solution, purpose-built to meet the new CMS THA/TKA PRO-PM requirements.
The PRO-PM Express™ advanced application simplifies the collection and reporting of mandatory CMS PRO-PM data, ensuring compliance and mitigating the risk of Medicare FFS Part A Claim penalties. By automating these critical processes, Eagle-I 3D reduces incremental costs per episode and enhances the potential for improved RSIR quality ratings, as reflected in the CMS annual public records.
Maximize the potential of your idol DICOM images by integrating them with your transformational PRO-PM data in My PRO-PM Vault™. Our novel PRO-PM Express™ “Image Upload” feature allows you to seamlessly combine imaging data with PRO-PM patient information. My PRO-PM Vault™ creates a powerful Personalized Patient Registry, enabling you to establish a comprehensive internal transformational database. With My PRO-PM Vault™ unique library and our Ai capabilities, you'll unlock numerous advantages, including improved clinical analysis, increased patient engagement, enhanced research opportunities, actionable analytics, better payor negotiations, and effective peer-to-peer sharing.
Simplify your new PRO-PM tasks and ensure compliance with Ai automation…
Avoid Penalty
Reduce Workflow
Increase Savings
Inside PRO-PM Express
New Mandate: CMS THA/TKA
PRO-PM Data Collection & Reporting
Overview ▼
The Stakes ▼
- Financial Penalty on total Medicare FFS Part A claims
- 25% reduction Annual Payment Update (APU)
- Disqualified from Medicare’s value-based purchasing program
- YOY Compounded $ Losses
- Any yearly $ loss carries forward annually
- Incremental labor costs
- Data collection & reporting processes
- Published Patient Outcomes Performance Reports
- RSIR Quality Ratings released into Public Domain
- Increased staffing demands
- Patient data collection, data analysis & reporting
Calculate Your APU (%) Penalty Risk & Incremental Labor Costs
Guesstimate your facility’s financial exposure to the new CMS THA/TKA PRO-PM mandate
(assumption model*: Deploying CMS Templates manual data collection, entry, & reporting)
CMS THA/TKA PRO-PM Calculator
Medicare Annual Payment Update (APU 3.1%) Penalty (25% MBU)*
Incremental THA/TKA Labor Costs*
Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure
Johannes F. Plate, MD, PhD a, b, *, Justin T. Deen, MD, MBA c, b, Christopher F. Deans, MD d, b, Aidin E. Pour, MD, MS e, Adolph J. Yates, MD, FAOA a, Robert S. Sterling, MD, FAOA
Abstract
A new mandatory hospital-level, risk-standardized performance measure for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by the Centers for Medicare &Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinical benefit threshold between preoperative and postoperative outcomes measures (Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Knee injury and Osteoarthritis Outcome Score for Joint Replacement). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching substantial clinical benefit. The percentile score among hospitals will be reported. Following 2 voluntary reporting periods, mandatory reporting will begin in 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates
Key Takeaways ▼
- “Performance measure participation will be mandatory and reported publicly, making early alignment between the surgeon and institution necessary to promote accurate, timely, and consistent data collection.”
- “Failure to meet the program requirements will result in a 0.25% reduction in the annual payment update in the inpatient prospective payment system from CMS, and therefore, awareness and proactive implementation of the THA/TKA PRO-PM are required for hospitals and institutions impacted by this new outcome measure.”
- “The THA/TKA PRO-PM implementation may require novel processes and workflows for hospitals that have not participated in previous alternative payment models. Nurse navigators, care coordinators, and data specialists may be needed to identify eligible patients for preoperative and postoperative survey completion. Data capture solutions within the electronic medical record may alleviate reporting burden. Hospitals are encouraged to use the voluntary reporting periods to refine their workflows. It is expected that the surgeon-specific/group-specific equivalent of this measure, which has gone through National Quality Framework endorsement, will eventually be added as a quality measure in the Merit-based Incentive Payment System Value Pathway, creating incentivization for surgeons to work with their hospitals.”
¹ Plate Johannes F., et.al.; Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure; The Journal of Arthroplasty 39 (2024) 1136e1139
¹ https://www.arthroplastyjournal.org/article/S0883-5403(24)00062-7/abstract
¹ https://www.arthroplastyjournal.org/article/S0883-5403(24)00062-7/abstract
Increased Workflow
CAREGIVER
TRADITIONAL PATIENT CARE ROLE
DATA COLLECTOR
NEW WORKFLOW #1
PRO-PM SURVEYS/ENTRY
ACCOUNTING
NEW WORKFLOW #2 DATA ANALYSIS/REPORTS
Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure
Johannes F. Plate, MD, PhD a, b, *, Justin T. Deen, MD, MBA c, b, Christopher F. Deans, MD d, b, Aidin E. Pour, MD, MS e, Adolph J. Yates, MD, FAOA a, Robert S. Sterling, MD, FAOA
A new mandatory hospital-level, risk-standardized performance measure for elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on patient-reported outcomes (THA/TKA PRO-PM) has been implemented by the Centers for Medicare &Medicaid Services (CMS). All THA and TKA in Medicare fee-for-service beneficiaries at inpatient facilities are included. The THA/TKA PRO-PM is the proportion of risk-standardized THA or TKA patients meeting or exceeding the substantial clinical benefit threshold between preoperative and postoperative outcomes measures (Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement, Knee injury and Osteoarthritis Outcome Score for Joint Replacement). This binary outcome (yes/no) is then divided by all eligible patients creating a percentage of patients reaching substantial clinical benefit. The percentile score among hospitals will be reported. Following 2 voluntary reporting periods, mandatory reporting will begin in 2025. The CMS requires 50% reporting rates; failure leads to annual payment reduction in fiscal year 2028. The CMS intends the THA/TKA PRO-PM to be a patient-centered, meaningful, and relatable measure of hospital performance reported to the public. For surgeons, this is an opportunity to collaborate with hospitals for developing and implementing a THA/TKA data collection system to avoid penalties for the hospital. Further implementation for outpatient surgery and in ambulatory surgery centers has been announced by CMS. Major resources will be needed to succeed in the expected capture rates.
The Abstract ▼
- “Performance measure participation will be mandatory and reported publicly, making early alignment between the surgeon and institution necessary to promote accurate, timely, and consistent data collection.”
- “Failure to meet the program requirements will result in a 0.25% reduction in the annual payment update in the inpatient prospective payment system from CMS, and therefore, awareness and proactive implementation of the THA/TKA PRO-PM are required for hospitals and institutions impacted by this new outcome measure.”
- “The THA/TKA PRO-PM implementation may require novel processes and workflows for hospitals that have not participated in previous alternative payment models. Nurse navigators, care coordinators, and data specialists may be needed to identify eligible patients for preoperative and postoperative survey completion. Data capture solutions within the electronic medical record may alleviate reporting burden. Hospitals are encouraged to use the voluntary reporting periods to refine their workflows. It is expected that the surgeon-specific/group-specific equivalent of this measure, which has gone through National Quality Framework endorsement, will eventually be added as a quality measure in the Merit-based Incentive Payment System Value Pathway, creating incentivization for surgeons to work with their hospitals.”
¹ Plate Johannes F., et.al.; Implementation of the New Medicare-Mandated Patient-Reported Outcomes After Joint Arthroplasty Performance Measure; The Journal of Arthroplasty 39 (2024) 1136e1139
¹ https://www.arthroplastyjournal.org/article/S0883-5403(24)00062-7/abstract
¹ https://www.arthroplastyjournal.org/article/S0883-5403(24)00062-7/abstract
CAREGIVER
TRADITIONAL PATIENT CARE ROLE
DATA COLLECTOR
NEW WORKFLOW #1 PRO-PM SURVEYS/ENTRY
ACCOUNTING
NEW WORKFLOW #2 DATA ANALYSIS/REPORTS
The Landscape
Networks
Independents
Community
ASC
OPSC
Clinician/Group
The Story
The
Task
New CMS PRO-PM SHARED RISK MANDATE
➢Patient Risk Variables Survey
➢HOOS JR/KOOS JR Pre-op & Post-Op Surveys
➢Extensive PRO-PM Data Collection & Reporting
➢CMS Episode Measurement Guidelines
➢CMS Audited Fiscal Reports
➢Medicare Annual FFS Part A Claims Penalty
The
Penalty
Hospital (IPPS) Annual Payment Update (APU) $ Risk
MBU Penalty (25%) Guidelines
(Annual Medicare FFS Part A Claim)
➢Survey Capture Rate % (50% Min)
➢Substantial Clinical Benefit (inclusion eligibility)
Lets Do the MBU Math Example…
➢Year 1 Medicare FFS Part A Claim: $25,000,000
➢No Penalty APU (3.1%): $25,775,000
➢w/Penalty (25% MBU): $25,568,750
➢Year 1 Loss: ($206,250)
➢3 Year Compounded Loss: ($638,129)
The
Challenge
FTE Labor & Costs
➢Incremental FTE Workflow Costs
➢Unknown Caregiver Scope of Skills
➢Patient Compliance Risk
➢Data Reporting Accuracy & Deadlines
Lets Do the FTE Math Example….
➢THA/TKA Patients/Year: 1500
➢THA/TKA Surgeons: 16
➢Total Cost/Episode (patient): $81
➢Total Costs/Facility: $123,000
➢Total Costs/MD: $5,719
The
Task
New CMS PRO-PM SHARED RISK MANDATE
-Patient Risk Variables Survey
-HOOS JR/KOOS JR Pre-op & Post-Op Surveys
-Extensive PRO-PM Data Collection & Reporting
-CMS Episode Measurement Guidelines
-CMS Audited Fiscal Reports
-Medicare Annual FFS Part A Claims Penalty
The
Penalty
Hospital (IPPS) Annual Payment Update (APU) $ Risk
MBU Penalty (25%) Guidelines
(Annual Medicare FFS Part A Claim)
-Survey Capture Rate % (50% Min)
-Substantial Clinical Benefit (inclusion eligibility)
Lets Do the MBU Math Example…
-Year 1: 25,000,000 Medicare FFS Part A Claim
-No Penalty MBU (3.1%): $25,775,000
-w/Penalty (25%) MBU (2.35%): $25,587,500 Year 1 $ Loss: ($187,500)
Compounded $ Loss (3 yrs): ($1,185,785)
The
Challenge
FTE Labor & Costs
-Incremental FTE Workflow Costs
-Unknown Caregiver Scope of Skills
-Patient Compliance Risk
-Data Reporting Accuracy & Deadlines
Lets Do the FTE Math Example….
-THA/TKA Patients/Year: 500 FTE
-Time/Episode: 45 mins
-Raw FTE Cost/Episode: $70 -Annual Raw FTE Costs: $35,156
The
Risk
Profit/Loss Risk
Let’s Do the CMS PRO-PM Penalty Math…
THA/TKA Episodes (patients)/Yr: 1500
THA/TKA Surgeons: 16
MBU Penalty + FTE Costs Year 1
➢Medicare FFS Part A Claim: $25,000,000
➢MBU (25%) Penalty ($206,250)
➢FTE Costs: ($123,000)
➢Total Year 1 Costs: ($329,250)
Assuming No Penalty in Years 2 & 3
➢Compounded 3 Year Costs: ($1,007,129)
Our
Solution
PRO-PM Express App
➢Data Collection/Reporting Automation
➢CMS Submission-Ready Annual Reports
➢Cordial Patient Engagement & Education
➢Scalable User Ecosystem
➢Seamless FTE Workflow Efficiencies
➢Real-time Dashboard Analytics
➢Service as a Subscription (SaaS)
Your
Success
Scalable Cycle Automation
➢Optimized CMS Guideline Achievement
➢Scalable Ecosystem
➢Automated Data Collection
➢Automated CMS Submission-ready Annual Reports
➢Reduced FTE Labor & Costs
➢Reduced APU Penalty Risk
The Measurements
Note: Performance measure participation will be mandatory and reported publicly making early alignment between the surgeon and institution necessary to promote accurate, timely, and consistent data collection. ¹
Measurements
Substantial Clinical Benefit Threshold (SCB) (must meet or exceed SCB to be eligible)
➢HOOS JR: 22 pts.
➢KOOS JR: 20 pts.
Data Capture Rate (%)
➢50% threshold (eligible pool only)
Numerator
Risk-adjusted proportion of patients undergoing an elective THA/TKA that meet or exceed the SCB on the HOOS JR or KOOS JR from Pre-Op to Post-Op assessment
Denominator (inclusion criteria)
➢Enrolled in Medicare FFS Part A & Part B for the 12 months prior to the date of the Index Admission and enrolled in Part A during the Index Admission
➢Aged 65 or older
➢Discharged alive from non-federal short-
term acute care hospital
➢Elective primary THA/TKA procedures only (patients with fractures and revisions, malignant neoplasms, or medical complications are not included)
CMS PRO-PM Timeline
What PRO-PM Express Offers
How PR0-PM Express™ may meet or exceed CMS SCB Thresholds & Capture Rates (50%)
| High CMS PRO-PM Compliance Rate Solution: Automated Data Collection & Reporting |
Ai Cloud Base | |
|---|---|---|
| ✔ | Rapid Patient Enrollment | Quick/Simple Form |
| ✔ | Auto-Invites Patient PRO-PM Surveys | Email/Text Link |
| ✔ | Auto-Alerts Patient/Admin PRO-PM Survey Submission | Email/Text Reminder (link) |
| ✔ | Auto-Data Analytics Database & Statistics Dashboards | Data Processing & Archiving |
| ✔ | Auto-Calculated CMS Compliant-Ready Reports | Auto-Populated Data Report Files |
Friendly & Elegant User Interface
Minimized Workflow
The Best Features in the Industry at your Fingertips
Ai Powered Software
Auto-Patient Invites & Patient/Admin Notifications
Real Time Dashboard Performance & Activity
Scalable Ecosystem
Process Automation
Cloud Storage & Cyber Security
Our security
EXPERIENCE IT YOURSELF
Secure Your Introductory Offer Now!
Pricing
individual Hospital (IQR)
Mandatory Reporting
Unlimited Users
Automated CMS Data Collection/Reporting
Instant Installation (no EHR/EMR integration)
Includes support/upgrades
No contracts - cancel anytime
Hospital network (IQR)
Mandatory Reporting
Unlimited Users
Automated CMS Data Collection/Reporting
Instant Installation (no EHR/EMR integration)
Includes support/upgrades
No contracts - cancel anytime
ASC (ASCQR)/OPSC (OQR)
Voluntary Reporting
Unlimited Users
Automated CMS Data Collection/Reporting
Instant Installation (no EHR/EMR integration)
Includes support/upgrades
No contracts - cancel anytime
Clinician/Groups (MIPS)
Voluntary Reporting
UnlimitedImage Users
Automated CMS Data Collection/Reporting
Instant Installation (no EHR/EMR integration)
Includes support/upgrades
No contracts - cancel anytime
CMS PRO-PM THA/TKA FAQ’s
Why does my facility or clinician practice need PRO-PM Express™?
-To meet or exceed your mandatory CMS THA/TKA PRO-PM guidelines
-To optimize your workflow efficiencies/costs and reporting accuracies
-To enhance your Patient Engagement and PRO-PM survey tracking capabilities
Does PRO-PM Express™ allow multiple users?
Yes. It provides a scalable ecosystem that the System Administrator can easily assign/ activate a hierarchy of users (Staff; MD’s) and that’s password protected
Do I need to integrate PRO-Pm Express™ into our facility’s EHR/EMR system?
-No. The beauty is that PRO-PM Express is an Ai Cloud App in a stand-alone platform
-It allows for virtually immediate installation and usage (simply just sign up & start…)
Can I import existing THA/TKA patient data into PRO-PM Express™?
Yes. Simply, CSV or HTML files can be easily uploaded and imported
How does PRO-PM Express™ address CMS annual reporting?
Automatically and accurately formats the reporting period’s data into authorized CMS guideline files (e.g. CSV, HTML) in a “submission-ready” state
How does the pricing of PRO-PM Express™ compare to the CMS THA/TKA manual templates?
-Very cost-effective. For example, please access our CALCULATOR above for a quick look
-Click the button (Request a customized assumption model & demo)