Conference Coverage

Hip and Knee Arthroplasty Study Finds Higher Baseline PROM Capture After CMS Mandate

Edited by:
Brian McCurdy

Key Highlights

  • The analysis included more than 1.8 million surveys from 115,204 patients undergoing hip or knee arthroplasty.
  • Before the mandate, real-world PROM capture declined from 79% at baseline to 62% at one year.
  • Investigators identified 10 implementation strategies, including training, feedback loops, and PROM champion development.

Baseline patient-reported outcome measure (PROM) capture increased after the 2024 Centers for Medicare and Medicaid Services (CMS) mandate, as shown in a mixed-methods evaluation of US total hip arthroplasty (THA) and total knee arthroplasty (TKA) practices. The study, presented at the 2026 American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting in Dallas, also identified organizational and behavioral factors shared by facilities with strong capture performance.

The investigators examined PROM collection in the context of CMS outcome-aligned payment initiatives, including the THA/TKA mandate, CJR-X, and TEAM. They noted that national real-world capture data remain limited despite the growing regulatory importance of patient-reported outcome performance measures (PRO-PMs). The study assessed collection through 1 year after arthroplasty and factors supporting successful implementation.

Researchers evaluated 676 US facilities from 2021 through 2024. Quantitative analyses assessed real-world and third-party “vendor-able” PROM capture at baseline, 3 months, and 1 year among adults undergoing THA or TKA.

The qualitative component involved semi-structured interviews with 18 health system stakeholders. Investigators analyzed interviews using the COM-B and Theoretical Domains Framework to identify barriers, facilitators, and strategies for behavioral change.

Study Findings

Across more than 1.8 million surveys involving 115,204 patients, pre-mandate real-world capture rates during 2021–2023 were 79% at baseline, 76% at 3 months, and 62% at one year. Following the 2024 mandate, baseline capture reached 88% for real-world collection and 89% for vendor-able collection. Private practices led in early capture, while academic centers demonstrated stronger long-term consistency.

High-performing organizations shared 3 attributes: a clearly defined measurement purpose and readiness for outcome-aligned payment; integration of clinical, technical, and operational workflows; and a culture emphasizing education, transparency, and patient-centered value. Investigators identified 10 theory-informed strategies, including structured training, workflow integration, feedback loops, and developing PROM champions.

Clinical Implications

According to the authors, sustainable PRO-PM performance requires technical integration alongside deliberate organizational change. They concluded that a service-based approach to health outcome measurement can support optimal capture and characterized early outcome-aligned payment models as having a positive impact on PROM collection in THA and TKA. They also described the COM-B/TDF framework as offering actionable implementation guidance.

Expert Commentary

“Sustainable PRO-PM performance for OAP models requires both technical integration and deliberate organizational change,” the researchers concluded.

Reference

Bozic KJ, Shapiro LM, Brinkman N, Jayakumar P, Kleinsmith RM. Optimizing PROM capture and performance in total hip and knee arthroplasty under CMS payment models. Paper #22. Abstract presented at the American Association of Hip and Knee Surgeons Annual Meeting, November 5–8, 2026, Dallas, TX.