The CMS THA/TKA PRO-PM Guide
Overview
The new THA/TKA PRO-PM is a significant change for hospitals, being the first measure in CMS's Inpatient Quality Reporting program that uses patient feedback to evaluate performance. If hospitals don't submit the necessary data, they will face lower reimbursement rates.


 


This measure focuses on tracking improvements in patient-reported pain and function after elective primary THA/TKA surgeries, aiming to foster better cooperation and decision-making between patients and healthcare providers.


 


However, implementing THA/TKA PRO-PM is complex. Hospitals will need to establish new pre- and post-operative procedures and submit extensive data. CMS will then use this data, along with their own, to determine hospital performance.


 


CMS is offering two voluntary reporting periods before mandatory reporting begins in 2027. Data collection for these periods has already started, so hospitals need to act quickly. Thankfully, Ortech has the resources to help hospitals prepare and begin data collection now.
Cases Included
To be included in your THA/TKA PRO-PM measure data, patients must meet three criteria.
  • Enrolled in Medicare fee-for-service
  • Aged 65 or older
  • Undergoing an In-Patient elective primary THA and/or TKA (including bilateral procedures)
CMS will require you to submit complete data sets for, at minimum, 50% of your eligible patients in order to meet your IQR requirements.
Cases Excluded
The key word in determining if a patient is eligible for the measure is “elective.” If a patient exhibits any of the following criteria, he or she is not considered an “elective” surgical patient, and is therefore ineligible for the measure:
  • The procedure is a revision or to address a mechanical complication from a prior THA/TKA procedure
  • The procedure involves a concurrent partial hip/knee arthroplasty procedure or resurfacing procedure
  • The patient has a femur, hip, or pelvic fracture which has triggered the procedure
  • That patient has a disseminated malignant neoplasm or a malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow
  • The patient is undergoing simultaneous removal of an implanted device or prosthesis
What data do I need to collect?
As you can see in the chart to the left, THA/TKA PRO-PM relies on a combination of patient-reported outcome (PRO) data and risk variable data; administrative claims data; and Medicare enrollment and beneficiary data, collected at different points in the patient’s care.


Some key PROMs:
When Should the Data Be Collected?
THA/TKA PRO-PM requires you to collect your PRO data within two very specific windows of time:
    

  • Pre-op: Between 90 and 0 Days before the Surgery
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  • Post-op: Between 300 and 425 days after the Surgery
    • 

Because the post-op data collection window is so large, there is a long lead time between the year an eligible procedure occurs and the year it actually gets included with your submitted data. As such, the data collection periods for the 2025 and 2026 voluntary reporting periods are already underway. Fortunately, you still have plenty of time to start collecting data to meet your 2026 voluntary submission requirements (remember: you only have to submit matched data for 50% of your eligible patients).
We got you covered and ready to get you going today!
Why Ortech?
Ortech is the longest standing, most trusted registry provider assisting hospitals, clinics, manufacturers and care providers with capturing and managing patient data. Ortech has built its software-as-a-service (SaaS) application with workflow efficiency tools to reduce burdensome administrative and data management tasks. Ortech has taken the complexities of every aspect of care and transformed them into a simplified tool, phiSuite.
"Simplicity is the key to brilliance" - Bruce Lee