Achieving the Centers for Medicare and Medicaid Services Defined Substantial Clinical Benefit Following Total Knee Arthroplasty and Total Hip Arthroplasty in the Michigan Arthroplasty Registry Collaborative Quality Initiative.

BACKGROUND

The Centers for Medicare & Medicaid Services (CMS) mandates patient-reported outcome measure (PROM) reporting for inpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA) starting July 1, 2024, requiring preoperative (0 to 90 days) and postoperative (300 to 425 days) scores for ≥ 50% of claims. Substantial clinical benefit (SCB) is defined as a 22-point Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement improvement for THA and a 20-point Knee injury and Osteoarthritis Outcome Score for Joint Replacement improvement for TKA, with a CMS-defined goal for hospitals to achieve SCB for ≥ 60% of patients. The purpose of this study was to assess the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) sites' readiness to meet these CMS patient-reported outcome measures collection requirements and their success in achieving SCB thresholds.

METHODS

We analyzed 8,826 THAs and 12,210 TKAs performed between January 1, 2022, and June 30, 2022, in MARCQI. Matched pre and postoperative PROMs and SCB rates were assessed across 81 sites.

RESULTS

Only 22.1% of the patients who underwent THA and 22.7% of the patients who underwent TKA had matched PROMs, and 7.4% of sites met CMS thresholds for collection. However, 90% of sites with matched PROMs met the SCB threshold.

CONCLUSIONS

For a statewide registry in Michigan, few sites met CMS collection requirements, but most achieved SCB targets. These findings reflect the experience of a diverse group of MARCQI sites and may not be generalizable to other states or institutions.