Expanding the Scope of Centers for Medicare and Medicaid Services Patient-Reported Outcome Measures Mandatory Reporting: Evaluating Total Hip Arthroplasty Outcomes Beyond Substantial Clinical Benefit for Hip Disability and Osteoarthritis Outcome Score-Joint Replacement

Abstract

Background: The Centers for Medicare and Medicaid Services (CMS) has established the reporting of patient-reported outcome measures after inpatient total knee and total hip arthroplasty (THA) as a performance measure. However, its focus on substantial clinical benefit (SCB) for Hip Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS-JR) may not capture the full dimensions of patient-reported outcome measures. This study aimed to examine the proportions of the inpatient and outpatient THA patients, covered by Medicare or commercial insurance, who achieved different clinically meaningful improvements [SCB; minimal clinically important difference (MCID); and patient acceptable symptom state (PASS)] across HOOS-JR, HOOS-Pain, and HOOS-Physical Function Shortform (PS) scores.

Methods: A retrospective study of 18,855 primary THA cases between 2016 and 2023 was analyzed. Demographics and HOOS-JR, HOOS-Pain, and HOOS-PS scores were recorded. The SCB for HOOS-JR was set at 22 points per CMS threshold. Achievement of the thresholds for MCID (7.76, 8.35, 9.47) and PASS (76.8, 80.6, 83.6) for HOOS-JR, HOOS Pain, and HOOS-PS, respectively, was analyzed.

Results: The proportions of Medicare inpatients who achieved HOOS-JR clinically meaningful thresholds were 80% for SCB, 94% for MCID, and 59% for PASS. For HOOS-Pain, MCID, and PASS were achieved by 96 and 69%, respectively, and for HOOS-PS, by 88 and 67%. Medicare outpatients demonstrated higher rates of SCB (85%), MCID (96%), and PASS (71%) for HOOS-JR, with similar patterns for HOOS-Pain and PS. In the commercial cohort, inpatients achieved SCB, MCID, and PASS rates of 82, 95, and 61% for HOOS-JR, respectively, while outpatients reached 86, 97, and 73%.

Conclusions: The proportions of patients who achieved clinically meaningful thresholds varied depending on the measurement used, with the greatest variation seen between SCB-JR and PASS-JR. This raises concerns about the sole reliance on SCB-JR under the new CMS policy, as it may not fully reflect the patient's perspective of improvement.

Level of evidence: II.