CMS Finalizes PRO-PM for THA and TKA: What ASCs Need to Know

The Centers for Medicare & Medicaid Services (CMS) has finalized a new Patient-Reported Outcome-Based Performance Measure (PRO-PM) for Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). This measure uses patient surveys to capture important outcomes related to pain and function after surgery. For ambulatory surgery centers (ASCs), understanding these requirements is critical as CMS moves from voluntary to mandatory reporting over the next few years.

This post explains what medical professionals at ASCs need to know about the PRO-PM, the reporting timelines, data collection windows, and how to manage these new requirements efficiently.

What is the PRO-PM for THA and TKA?

CMS’s PRO-PM focuses on patient-reported outcomes using two validated surveys:

• HOOS Jr (Hip disability and Osteoarthritis Outcome Score, short form) for hip replacements

• KOOS Jr (Knee injury and Osteoarthritis Outcome Score, short form) for knee replacements

  
  

These surveys ask patients about their pain levels and functional abilities before and after surgery. The goal is to measure surgical success from the patient’s perspective, which is a crucial indicator of quality care.

Hospitals and hospital outpatient departments (HOPDs) started mandatory reporting in July 2024. For ASCs, CMS has set a phased approach:

• Voluntary reporting from calendar years 2025 through 2027

• Mandatory reporting beginning January 2028

Reporting Requirements and Data Collection Windows

CMS requires data collection during two specific time frames:

• Pre-operative window: 0 to 90 days before surgery

• Post-operative window: 300 to 425 days after surgery

Collecting data within these windows ensures that patient outcomes reflect both baseline status and long-term recovery.

Why these windows matter

Collecting pre-op data helps establish a baseline for pain and function. Post-op data collected nearly a year after surgery captures the patient’s recovery and the lasting impact of the procedure. This timing aligns with clinical expectations for healing and rehabilitation.

Medical professional administering PRO-PM survey to patient

Medical professional administering PRO-PM survey to patient in clinical setting

Challenges for ASCs in Meeting PRO-PM Requirements

ASCs face several challenges in managing PRO-PM reporting:

• Survey administration: Ensuring patients complete HOOS Jr and KOOS Jr surveys within the required time frames

• Data abstraction: Collecting, organizing, and verifying patient responses accurately

• CMS submission: Meeting CMS deadlines and formatting requirements for data reporting

Many ASCs lack dedicated staff or systems to handle these tasks efficiently. This can lead to incomplete data, reporting errors, or missed deadlines, which may affect reimbursement and quality ratings.

How Nurse Follow Up Supports PRO-PM Success

Nurse follow up plays a key role in improving patient response rates and data quality. Nurses can:

• Contact patients before surgery to explain the importance of completing surveys

• Remind patients during follow-up visits or calls to complete post-op surveys

• Address patient questions or concerns about the surveys

  
  

This personalized approach increases patient engagement and helps ensure data completeness.

Using CAHPS Experience to Enhance Patient-Reported Outcomes

CMS also uses CAHPS (Consumer Assessment of Healthcare Providers and Systems) surveys to measure patient experience. While CAHPS focuses on satisfaction and communication, PRO-PM surveys focus on clinical outcomes like pain and function.

Combining insights from CAHPS and PRO-PM can give medical professionals a fuller picture of patient care quality. For example, an ASC might find that patients report good communication but still experience pain after surgery. This insight can guide targeted improvements.

How J.L. Morgan & Associates Can Help ASCs Manage PRO-PM Reporting

Managing PRO-PM reporting can be complex and time-consuming. J.L. Morgan & Associates offers a full-service solution that includes:

• Survey administration: Handling patient outreach and survey distribution

• Data abstraction: Collecting and verifying survey responses

• CMS submission: Preparing and submitting data in compliance with CMS rules

  
  

By outsourcing these tasks, ASCs can reduce administrative burden, improve data accuracy, and focus on patient care. This support helps medical professionals meet CMS requirements without overloading their staff.

Preparing Your ASC for Mandatory Reporting in 2028

ASCs should start preparing now to meet the mandatory reporting deadline in 2028. Steps to consider include:

• Implementing workflows to collect pre-op and post-op PRO-PM data

• Training staff on survey administration and patient communication

• Establishing nurse follow up protocols to boost patient participation

• Evaluating technology solutions for data management and CMS submission

• Considering partnerships with experienced firms like J.L. Morgan & Associates

  
  

Early preparation will help your ASC avoid last-minute challenges and ensure smooth compliance.

Summary

CMS’s finalized PRO-PM for THA and TKA introduces new patient-reported outcome requirements that ASCs must meet. These measures focus on pain and function using HOOS Jr and KOOS Jr surveys, with mandatory reporting starting in 2028 after a voluntary phase.

Medical professionals at ASCs should understand the data collection windows, reporting timelines, and the importance of nurse follow up to improve patient engagement. Combining PRO-PM with CAHPS data can provide a comprehensive view of patient care quality.

Partnering with experts like J.L. Morgan & Associates can simplify survey administration, data abstraction, and CMS submission, saving staff time and ensuring compliance.

Start preparing today to meet CMS requirements and improve patient outcomes in your ASC.

Questions? Contact us today!