Why Should I Include a PRO Program at My Institution

Patient-reported outcomes (PROs) can be valuable tools in guiding physicians and patients on understanding a patient’s health status, in the decision-making process regarding patient care – for example, severity of joint disease based on patient-reported outcome measures (PROMs) may be a good indicator for surgery, and for evaluating the effectiveness of quality improvement initiatives. In short, there are three major reasons why providers may be interested in collecting PROs:

1. Expanding the criteria for how to evaluate care by including outcomes based on patient’s viewpoint with other clinical measures

As the California Joint Replacement Registry (CJRR), an organization that recently merged with AJRR, was developing their PRO platform in 2010, they discussed the rationale for capturing PROs in this manner:

“Longitudinally tracking patient assessment of pain and function can provide insights into the effectiveness of hip and knee arthroplasty across a much broader patient population than the relatively small number of patients that suffer implant failures and require surgery. Perhaps most importantly, PRO data reflect the patient’s perspective on the outcome of the surgery – described as ‘the truest end result of our care as physicians,’ by one orthopedic surgeon.” 

PRO data provide meaningful information in conjunction with other clinical measures, and therefore, provide the opportunity to have a fuller picture of the impact of care and may be used by the clinician during patient encounters. These surveys can be considered an important step toward engaging patients in their own health care and informing medical decision making.

2. Federal initiatives

PRO data will be critical as the Centers for Medicare & Medicaid Services (CMS) and other payers move toward defining quality measures to evaluate health care providers’ performance for value-based reimbursement of care. For example, CMS emphasizes the use of PROs by defining PRO requirements within their Medicare reimbursement programs such as the Comprehensive Care for Joint Replacement (CJR) model and the Physician Quality Reporting System (PQRS). Eligible professionals will need to include PRO measures in their course of clinical care and submit their results to meet these new standards for reimbursement without incurring penalties. Specifically, CMS intends to have 90% of payments tied to quality outcomes by 2018.

For the CJR initiative, hospitals are not required to submit PRO data, however PRO data will be linked to the hospital’s reconciliation payment. CMS is using a composite score methodology to link quality outcomes to payment. Specifically, a hospital’s score will be determined in part by performance and improvement on two quality measures: a) the THA/TKA Complications measure (NQF #1550) and b) the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey (NQF #0166) as well as voluntary submission of THA/TKA of PRO and limited risk variable data. Those institutions voluntarily submitting PRO data will have to submit data on ≥50% or ≥50 eligible procedures. Successful submission of PRO and risk variable data will add two additional points to a participant hospital’s composite quality score. For more information, please view any of the documents posted under the “Additional Information” section of the CJR website at https://innovation.cms.gov/initiatives/cjr.

3. Comparative benchmarks

 AJRR provides hospitals and practice groups with PRO benchmarks to compare their results to the national experience. Knowing how surgeons compare with their peers, as well as against the nation can be very beneficial for practice improvement efforts. Comparative data may facilitate and provide evidence for the need for quality improvement work at both the hospital and surgeon level. Additionally, hospital and practice groups can use that data to publicly report their own results, should they wish. Having the data from a robust National Registry will enable institutions to make informed decisions based on clinical facts and figures.  A national database will be able to analyze and report national total hip and knee arthroplasty measures and offer opportunities for further investigation at both local and national levels. AJRR understands that researchers, institutions, and organizations may want to have opportunities to access the data in the Registry to conduct further analyses to address specific hypotheses, such as replacement outcomes and implant performance, beyond the national benchmarks.

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