Patient-reported outcome measures (PROMs)

PROMs capture what matters most to patients: how pain, stiffness, or functional limitation affects daily life. Because the data come straight from the patient rather than a proxy observer, PROMs reflect lived experience in a way that physical examination findings alone cannot. Common orthopedic instruments include the HOOS JR and KOOS JR for hip and knee arthroplasty, the Oxford Hip and Knee Scores, the PROMIS Global-10, and the Veterans RAND 12-Item Health Survey (VR-12). Each tool is psychometrically validated for reliability, responsiveness, and minimal clinically important difference (MCID), which sets the threshold for a meaningful change in a patient's score.

In the U.S. policy environment, PROMs have evolved from optional quality-improvement tools into formal performance measure requirements. CMS defines a patient-reported outcome (PRO) as any status report on a patient's health condition coming directly from the patient without clinician interpretation, covering health-related quality of life, symptoms and symptom burden, and health behaviors. A PROM is the specific instrument used to capture that PRO. Orthopedic practices submitting data to the American Joint Replacement Registry (AJRR) can route PROM data to CMS programs, satisfying both voluntary and mandatory reporting obligations.

Data collection follows a defined perioperative timeline: a pre-operative baseline window and a post-operative follow-up window (typically 270–365 days after surgery). Scores are compared to calculate the patient-reported improvement. Practices that miss the baseline collection window cannot retroactively satisfy the measure, because CMS requires a matched pre- and post-operative pair to calculate a performance score.

Starting with the 2027 payment year (performance period beginning July 1, 2024), CMS made inpatient PROM collection mandatory for total hip arthroplasty (THA) and total knee arthroplasty (TKA) under the Inpatient Quality Reporting Total Hip and Knee Replacement PRO Performance Measure (IQR THA/TKA PRO-PM). Practices that fail to collect matched pre- and post-operative PROM data will face a performance gap on the measure, which feeds into value-based payment calculations and public reporting. On the reimbursement side, commercial payers increasingly require documented functional assessment scores as part of prior authorization packages for joint replacement; an authorization request that omits objective functional scores is more likely to be denied under automated payer-review systems. Proactively embedding PROM collection into the workflow also supports prior-authorization documentation by quantifying functional limitation with validated, payer-recognizable language.