Insufficient Mandatory Patient-Reported Outcome Rates at an Academic Hospital Despite Increased Resource Allocation

Beginning July 1, 2024, the Centers for Medicare and Medicaid Services (CMS) began mandating at least 50% institutional compliance of patient-reported outcome-based performance measures (PRO-PMs) for Medicare fee-for-service patients undergoing inpatient, elective arthroplasty. The purpose of this study was to quantify a single institution's PRO-PM capture rates before the deadline and determine risk factors for noncompliance.

There were 2,692 patients who underwent primary elective hip and knee arthroplasty at a single institution from 2021 to 2022. Demographic and compliance data (PRO-PM collected in the preoperative window within 90 days before surgery and the postoperative window at 365 ± 60 days) was recorded. Compliance was further analyzed after the introduction of a text-based service designed to collect PRO-PMs. Multivariable analysis was performed to determine independent risk factors for noncompliance with completing PRO-PMs.

Overall, less than half of patients (N = 1,329, 49.1%) completed preoperative PRO-PMs within 90 days of surgery, and only 25.8% of patients (N = 695) completed postoperative PRO-PMs at 305 to 425 days. Compliance with both pre- and postoperative PRO-PMs was 14.1% (N = 380). Compliance with both pre- and postoperative reporting increased from 7.9 to 19.6% following the introduction of a text-based platform reminding patients to complete the surveys. Risk factors for noncompliance include non-English primary language (odds ratio (OR) 4.96, 95% confidence interval [1.43 to 17.21], P = 0.012), higher comorbidity burden (OR 1.1 [1.03 to 1.18], P = 0.005), and not receiving a text reminder to complete the survey (OR 2.84 [2.15 to 3.76], P < 0.001).

The low rate of compliance with the new Centers for Medicare and Medicaid Services mandate for PRO-PM collection, even at an academic center with a high desire to collect and study patient outcomes with PRO-PMs, suggests the mandate may be overly burdensome, though initiatives designed to increase patient engagement may help improve compliance.