Abstract
As the population ages and the prevalence of knee osteoarthritis increases, total
knee arthroplasty (TKA) is expected to grow in demand. Traditionally, the success
of TKA has been measured through clinical assessments, imaging, and the incidence
of postoperative complications. Over the past decade, patient-reported outcome measures
(PROMs) have become crucial in evaluating clinical outcomes. PROMs are soon to be
tied to financial incentives in value-based payment programs as a measure of the quality
of care provided. Centers for Medicare and Medicaid Services (CMS) has implemented
a nationwide policy to enhance and standardize the collection of PROMs for those undergoing
total joint arthroplasty. The policy is titled Patient Reported Outcome based Performance
Measure or “PRO-PM.” This requires mandatory reporting in 2025, and by 2028, hospital
payment evaluations will incorporate this data. CMS will require hospitals to achieve
at least 50% postoperative PROM collection rates to qualify for full annual payment
in 2028. Providers are incentivized to improve scores on PROMs, such as pain levels
and physical function after procedures, as higher PROM scores often correlate with
better reimbursement rates under these programs. Recent advancements in interactive
technology, including mobile apps and telemedicine platforms, have enabled the collection
of PROMs from patients without requiring or prior to a clinic visit. Looking ahead,
the mandatory PROM reporting requirements set by the CMS highlight the urgency of
adopting scalable, technology-driven solutions. Literature suggests women, individuals
with lower socioeconomic status, lower educational attainment, and non-English speakers
have significantly lower PROM response rates. While these mandates aim to standardize
care quality, they also risk exacerbating disparities if underserved populations face
barriers to participation. Equity-focused strategies, alongside continued investment
in technology, will be critical to achieving widespread adoption and maximizing the
benefits of PROMs in TKA care. Ultimately, the integration of electronic and adaptive
PROM systems has the potential to transform the TKA landscape, offering a model for
leveraging technology to enhance patient engagement, optimize care delivery, and improve
outcomes across diverse populations.
Keywords
total knee arthroplasty - patient-reported outcome measures - total joint - arthroplasty
