The New Centers for Medicare and Medicaid Services Patient-Reported Outcome-Based Performance Measure: What It Means and How Can I Align.

The recognition of the benefits of the measurement and utilization of patient-reported outcome measures (PROMs) in clinical care continues to increase. Furthermore, the Centers for Medicare and Medicaid Services recently mandated a patient-reported outcome-based performance measure (PRO-PM) supporting the measurement of PROMs pre- and postoperatively for patients undergoing primary hip and knee arthroplasty. Under this new policy, hospitals not measuring and reporting complete data on 50% or more of included patients are at risk for substantial loss of Medicare Part A reimbursement. As with any new policy, there are nuances, barriers, possible undesirable consequences, and opportunities for improvement that should be considered and mitigated for said policy to have the greatest potential benefit on the population. In this article, we review the implications of the new policy, barriers to successful implementation, and possible undesirable consequences, and aim to provide guidance and strategies to assist surgeons, health systems, and other stakeholders in understanding, aligning with, and improving care based on the new Centers for Medicare and Medicaid Services PROM-PM.

Duke Scholars

Author Mark B McClellan Fuqua School of Business