Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S63-S68. doi: 10.1016/j.arth.2022.09.026. Epub 2022 Nov 8.
The Centers for Medicare and Medicaid Services (CMS) links patient-reported outcome measures (PROMs) with hospital reimbursement in some value-based models for total joint arthroplasty (TJA). This study evaluates PROM reporting compliance and resource utilization using protocol-driven electronic collection of outcomes for commercial and CMS alternative payment models (APMs).
We analyzed a consecutive series of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2016 and 2019. Compliance rates were obtained for reporting hip disability and osteoarthritis outcome score for joint replacement (HOOS-JR.), knee disability and osteoarthritis outcome score for joint replacement (KOOS-JR.), and 12-item short form survey (SF-12) surveys preoperatively and postoperatively at 6-months, 1 year, and 2- years. Of 43,252 THA and TKA patients, 25,315 (58%) were Medicare-only. Direct supply and staff labor costs for PROM collection were obtained. Chi-square testing compared compliance rates between Medicare-only and all-arthroplasty groups. Time-driven activity-based costing (TDABC) estimated resource utilization for PROM collection.
In the Medicare-only cohort, preoperative HOOS-JR./KOOS-JR. compliance was 66.6%. Postoperative HOOS-JR./KOOS-JR. compliance was 29.9%, 46.1%, and 27.8% at 6 months, 1 year, and 2 years, respectively. Preoperative SF-12 compliance was 70%. Postoperative SF-12 compliance was 35.9%, 49.6%, and 33.4% at 6 months, 1 year, and 2 years, respectively. Medicare patients had lower PROM compliance than the overall cohort (P < .05) at all time points except preoperative KOOS-JR., HOOS-JR., and SF-12 in TKA patients. The estimated annual cost for PROM collection was $273,682 and the total cost for the entire study period was $986,369.
Despite extensive experience with APMs and a total expenditure near $1,000,000, our center demonstrated low preoperative and postoperative PROM compliance rates. In order for practices to achieve satisfactory compliance, Comprehensive Care for Joint Replacement (CJR) compensation should be adjusted to reflect the costs associated with collecting these PROMs and CJR target compliance rates should be adjusted to reflect more attainable levels consistent with currently published literature.
医疗保险和医疗补助服务中心（CMS）在某些基于价值的全关节置换术（TJA）的医保支付模式中，将患者报告的结果测量（PROM）与医院报销挂钩。本研究通过协议驱动的电子采集结果，评估了商业和 CMS 替代支付模式（APM）下的 PROM 报告依从性和资源利用情况。
我们分析了 2016 年至 2019 年连续接受全髋关节置换术（THA）和全膝关节置换术（TKA）的患者系列。报告了髋关节残疾和关节炎关节置换评分（HOOS-JR.）、膝关节残疾和关节炎关节置换评分（KOOS-JR.）和 12 项简明健康调查（SF-12）术前和术后 6 个月、1 年和 2 年的问卷调查的报告依从率。在 43252 例 THA 和 TKA 患者中，25315 例（58%）仅为 Medicare 患者。获得了 PROM 采集的直接供应和员工劳动力成本。卡方检验比较了 Medicare 患者和所有关节置换组的依从率。时间驱动的作业成本法（TDABC）估计了 PROM 采集的资源利用情况。
在仅 Medicare 队列中，术前 HOOS-JR./KOOS-JR. 的依从率为 66.6%。术后 HOOS-JR./KOOS-JR. 的依从率分别为 6 个月、1 年和 2 年的 29.9%、46.1%和 27.8%，SF-12 分别为 70%。术后 SF-12 的依从率分别为 6 个月、1 年和 2 年的 35.9%、49.6%和 33.4%。除 TKA 患者术前 KOOS-JR.、HOOS-JR. 和 SF-12 外，与整体队列相比，医疗保险患者在所有时间点的 PROM 依从性均较低（P<.05）。PROM 采集的估计年成本为 273682 美元，整个研究期间的总费用为 986369 美元。
尽管我们中心在 APM 方面拥有丰富的经验，总支出接近 100 万美元，但我们仍显示出术前和术后 PROM 依从率较低的情况。为了使实践达到令人满意的依从率，综合关节置换补偿应进行调整，以反映与收集这些 PROM 相关的成本，并且 CJR 目标依从率应进行调整，以反映与当前已发表文献一致的更可实现水平。
