When Patient-Reported Outcomes Become Payment: The THA/TKA PRO-PM Timeline Every Orthopedic Surgeon Should Have on the Calendar

For elective primary hip and knee replacement, patient-reported outcomes are moving from a nice-to-have to a reporting requirement tied to payment. CMS is phasing in the THA/TKA Patient-Reported Outcome-Based Performance Measure on two separate tracks, one inpatient and one outpatient, and the outpatient clock starts collecting data in October 2027. 

What the measure actually is

The THA/TKA PRO-PM captures risk-standardized improvement in a patient’s own report of pain and function from before surgery to after recovery. It relies on validated instruments orthopedic surgeons already know: HOOS JR for hip replacement and KOOS JR for knee replacement.¹ 

For the first time, a CMS quality program is scoring joint replacement on what the patient reports, not only on claims and complications.

Track 1 — Inpatient (Hospital IQR)

The inpatient measure was finalized in the FY 2023 inpatient rule and, after two voluntary reporting periods, is now in mandatory reporting in the Hospital Inpatient Quality Reporting program beginning with the FY 2028 payment determination.² 

One point surgeons should understand clearly: only the paired response rate affects a hospital’s annual payment update. Whether a given patient hits the outcome threshold is publicly reported but does not, by itself, drive the payment penalty.¹ Preoperative data is collected around the time of surgery, while postoperative data is collected roughly 300 to 425 days later.

Track 2 — Outpatient (Hospital OQR and ASCQR)

CMS adopted the same measure for the outpatient setting in the CY 2024 OPPS/ASC final rule, applying it to both hospital outpatient departments and ambulatory surgical centers. After a voluntary window running through CY 2027, mandatory reporting begins with the CY 2028 reporting period, feeding the CY 2031 payment determination. 

Required preoperative collection begins October 3, 2027, and required postoperative collection begins October 27, 2028. The completion thresholds are 50 percent of eligible patients for hospital outpatient departments and 45 percent for ASCs, and a survey counts only when both the pre- and post-operative components are captured.

The two timelines are easy to confuse, so here they are, side by side.

The timeline at a glance

Why this matters beyond quality reporting

The PRO-PM is also embedded in the proposed CJR-X bundled payment model, where it is one of five quality measures in the Composite Quality Score that determines a hospital’s eligibility for a reconciliation payment and its effective discount factor. It sits alongside complication and patient-experience measures rather than driving the score on its own, but the same PRO data a hospital collects for quality reporting feeds that score under CJR-X. 

Practices that already capture paired pre- and post-operative PROs will be positioned to help their hospital partners on both fronts at once.

Getting the data is the hard part

The measure is not conceptually difficult; the operational challenge is capturing a matched preoperative and postoperative survey on enough patients, more than a year apart, without losing them to follow-up. 

AAOS supports members through the American Joint Replacement Registry, which added PRO-PM-specific data elements and makes an IQR PRO-PM report available through RegistryInsights. Practices contributing to AJRR have a built-in path to the required data.

What to do now

1. Build your PRO workflow by adopting a digital outcomes collection tool that supports the measures you need, both for required reporting and outcomes improvement

2. Decide who owns identification, survey, and follow-up across your clinic, scheduling, and perioperative teams, so patients are not lost between handoffs.

3. If you replace joints in more than one setting, track both timelines; the inpatient and outpatient requirements run on different clocks.

Patient-reported outcomes put the patient’s own experience of pain and function at the center of how joint replacement is measured. That is the right thing to measure. We recommend getting in touch today to learn about how we can support outcomes collection in your organization.

References

1. https://www.aaos.org/registries/quality-collaborations/iqr-resources/

2. https://qualitynet.cms.gov/inpatient/measures/THA_TKA