Challenges in Meeting Centers for Medicare and Medicaid Services Patient-Reported Outcome Measures Collection Requirements and Patient Predictors of Substantial Clinical Benefit Achievement in Total Joint Arthroplasty.

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are highly effective procedures, with the Centers for Medicare and Medicaid Services (CMS) mandating patient-reported outcome measures (PROMs) for Medicare patients starting July 1, 2024. This study evaluated PROM collection rates and identified predictors of substantial clinical benefit (SCB), defined by CMS as a 22-point improvement in Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) for THA and a 20-point improvement in Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) for TKA at four surgical sites across an academic tertiary referral center.

Methods: This retrospective cohort study analyzed PROM data for all patients who underwent THA or TKA from January 2021 to December 2022. Collection rates for PROMs were assessed by meeting the CMS requirement of 'matched pairs' of preoperative and 1-year postoperative PROM and meeting SCB. Logistic regression was used to identify predictors of SCB.

Results: Collection rates of PROMs improved from 2021 to 2022, but matched pair rates remained below 33%. The SCB was achieved by 70.9% of THA patients and 62.1% of TKA patients. Significant predictors of SCB included younger age, lower preoperative PROM scores, and absence of comorbidities such as diabetes or preoperative opioid use. Non-White race patients had significantly lower odds of achieving SCB for TKA (P = 0.003), while preoperative education did not significantly impact SCB rates for either procedure.

Conclusions: The collection of PROMs remains a major challenge, particularly for postoperative intervals, but patients who had greater initial limitations showed substantial improvement. Targeted interventions to optimize preoperative risk factors and enhance long-term follow-up may improve SCB rates and CMS compliance.