The Center for Medicare and Medicaid Services’ (CMS) new PRO-PM payment policy requires hospitals to submit validated pre- and post-operative measures of pain and function among hip and knee joint replacement patients to receive their full Annual Payment Update (APU).
Importantly, non-compliance penalizes reimbursement of all inpatient services, not just the joint replacements.
Features
STATIX’s PRO Subscription Service
A high PRO response can be difficult to achieve, but critical for compliance. STATIX offers a subscription PRO collection service for Medicare’s performance measure that includes:
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Response rates greater than 90%
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Multi-model data collection platform
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Appropriately timed follow-up PROs
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Integrated postage-paid reply mail survey
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Phone Interviewers, web and mobile app surveys
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PROMs collected for THA & TKA patients
(Hip dysfunction and Osteoarthritis Outcome Score (HOOS Jr.)) (Knee injury and Osteoarthritis Outcome Score (KOOS Jr.))
How To Join
3 Simple Steps to Compliance
Enrolling your hip and knee joint replacement patients into STATIX’s PRO subscription service is an easy and affordable way to help stay compliant with Medicare’s new mandatory performance measure.
1
Subscribe at STATIX.COM
- Register an account through STATIX’s self-subscribe platform (link)
- E-sign our service agreement and a HIPAA business associate agreement
- Add/manage users: those you designate to add patients to our PRO collection service
2
Enter your Patients
- Your users will login anytime to the dashboard to add contact information for your Medicare patients undergoing hip and knee joint replacement surgery.
- Designate a date of surgery, which identifies the date that pre- and post-operative PROs need to be collected.
- STATIX will send mailed and emailed instructions and reminders to complete the PROs at the appropriate time via postage-paid mail, web, and the mobile app. We will also add them to our telephone interviewer queue to complete over the phone.
3
Download Your PRO Compliance Data
- Through the dashboard, you can download the PRO data that we collect on your behalf in real time.
- Data is formatted and specified by variable names in a manner that is ready to submit to Medicare for the PRO performance measure.
Penalties
What is your Hospital's APU adjustment & penalty?
The PROM's must be captured and submitted to CMS on at least 50% of eligible patients for the hospital to qualify for the full APU. Typically, a hospital's APU is 2-4%. The penalty for non-compliance is a 25% reduction in the APU. The amount can never be recovered, so this loss would essentially compound over time. Hospitals will also be disqualified from Medicare’s value-based purchasing program.
Pricing
Introductory PRO-PM Pricing
STATIX’s subscription service for the PRO-PM is offered at an introductory price of just $249 per month plus a $30 one-time charge for each patient enrolled for PRO follow-up. You may cancel the service at any time and STATIX will still conduct the follow-up PRO survey collection to the patients who you have already enrolled.
Medicare's Hip/knee Patient-Reported Outcome-Based Performance Measure (PRO-PM)
- Single Center
- Unlimited TKA/THA participants
- Surveys based on PRO-PM model
- Mobile ePROn app
- STATIX follow-up
$249 / month
+ $30.00 per joint replacement patient
Get
Started
F.A.Q
Frequently Asked Questions
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What is Medicare’s Patient Reported Outcome Performance Measure (PRO-PM) for Hip and Knee Joint Replacement?
The Center for Medicare and Medicaid Services’ (CMS) new PRO-PM payment policy requires hospitals to submit validated pre- and post-operative measures of pain and function among hip and knee joint replacement patients to receive their full Annual Payment Update (APU). Importantly, non-compliance penalizes reimbursement of all inpatient services, not just the joint replacements.
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What is a Patient Reported Outcome Measure?
A Patient Reported Outcome (PRO) is any report about a patient’s health condition, status or behavior that is directly elicited from the patient without interpretation of the patient’s response by a clinician or anyone else.
Patient Reported Outcome Measures (PROMS) are tools, such as surveys, that are used to collect patient-reported outcomes. For example, the National Institutes of Health (NIH) developed the Patient Reported Outcomes Information System (PROMIS) to validate and measure multiple domains of a patient’s self-reported health status, such as physical function, pain interference, and social function.
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Which primary PROMs are collected for the PRO-PM?
- THA patients: Hip dysfunction and Osteoarthritis Outcome Score (HOOS Jr.)
- TKA patients: Knee injury and Osteoarthritis Outcome Score (KOOS Jr.)
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What other data elements need to be collected?
- Mental Health Subscale items from either PROMIS-Global or VR-12 (Pre-op)
- Health Literacy (SILS2) (Pre-op)
- BMI or Height/Weight (Pre-op)
- Use of Chronic Narcotics (Pre-op)
- Total Painful Joint Count: Patient-Reported Pain in non-operative Lower Extremity Joint (Pre-op)
- Quantified Spinal Pain: Patient-reported Back Pain, Oswestry Index Question (Pre-op)
- Medicare provider number (Pre & Post op)
- Medicare Beneficiary Identifier (Pre & Post op)
- Date of birth (Pre & Post op)
- Date of procedure (Pre & Post op)
- Procedure Type (Pre & Post op)
- Date of admission (Pre & Post op)
- Date of PRO date collection (Pre & Post op)
- Mode of Collection
- Person Completing the Survey
- Generic PROM version (Pre-op)
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Who is included?
- Medicare beneficiaries aged 65 and older.
- Enrolled in Medicare Fee-for-service coverage plan.
- Undergoing primary elective THA/TKA reimbursed as an inpatient.
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Who is excluded?
- Those having revision, removal, or mechanical complications.
- Those having partial/Hemi/Uni-compartmental joint replacement.
- Those with musculoskeletal malignancy.
- Medicare Advantage patients.
- Those with fractures.
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When does the policy start? What are the reporting dates?
The first reporting year covers the period from July 1, 2024 – June 20, 2025.
Patients undergoing joint replacement starting July 1st, 2024, should have pre-operative data collected within 90 days prior to surgery.
Pre-operative data needs to be submitted to Medicare by September 30, 2025.
Post-operative data needs to be collected between 300-425 days after the procedure (covering the period from April 27, 2025 – August 29, 2026).
Post-op submission deadline is September 20, 2026.
Contact
Contact Us
To begin using STATIX please contact us at the numbers shown or submit the webform below. We try to respond to requests within 24 hours.
Our Address
PO BOX 581380, Salt Lake City, UT 84158
Email Us
Call Us
+1 (866) 845-7828