Hospitals nationwide are currently experiencing significant challenges meeting the new Centers for Medicare & Medicaid Services (CMS) regulations surrounding patient-reported outcome measures (PROMs), which require PROMs from more than half of all patients. Hip and knee replacements are the most common surgeries to track. For high-volume hospitals like Hospital for Special Surgery (HSS) there are often additional steps that need to be taken to ensure accuracy.

A recent study conducted by researchers at HSS and presented at the American Association of Hip and Knee Surgeons (AAHKS) annual meeting demonstrated that there is a way for outcomes following hip and knee replacement surgeries to be measured more efficiently without compromising accuracy. Alexander S. McLawhorn, MD, MBA, hip and knee surgeon at HSS and one of the authors of the study, shared his perspective.

At HSS, we are dedicated to ensuring patient experience and safety remain our top priorities, while also reducing the unnecessary regulatory burden for the hospital. This study indicated that outcome measurement after hip and knee replacement can be accurate and reliable even if hospitals don’t collect PROMs for a majority of patients. More than 740,000 Medicare beneficiaries undergo primary total hip or knee replacement each year, that number is expected to increase to 1.2 million by the year 2030, making this a critical time to address this topic.

 Capturing feedback from as many patients as possible can become an administrative burden for everyone involved. There are many different stakeholders when it comes to PROMs, including regulatory, research and clinical teams. Each of these areas requests PROMs from patients at different points in their journey, uses PROMs differently, and requires different levels of reporting for their needs.

-Alexander S. McLawhorn, MD, MBA

Our proposed solution is collecting carefully chosen samples, which can still lead to accurate results. For very high-volume institutions like HSS, you are not losing any accuracy in terms of your measurement by measuring fewer patients. Our research also suggests that this more efficient approach could result in a significant overall reduction in administrative burden, particularly since most total hip and knee replacements are performed at high-volume centers. The net effect would be a large reduction in unnecessary data collection, an increase in operational efficiency and cost savings.

This approach is not applicable to all institutions. In fact, our findings revealed that lower-volume institutions may not experience the same benefit of a streamlined process. If a low-volume hospital only submits 50% of their cases, you may have very inaccurate assessment of quality. In some cases, you may need 100% reporting for some very low volume institutions.

HSS undertook this research because of our dedication to advancing patient safety and care quality. It is important that patients know the measures of quality for different institutions. What we are proposing is a strategy that will allow patients to receive information in a more efficient way. This research is intended to move a very important policy conversation forward. Changes involving CMS can take a significant amount to implement.  If we are able to adapt this common-sense approach patients and healthcare institutions everywhere will benefit.

HSS has been and will continue to be a leader in this space and instrumental in defining these tools now and well into the future.