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    Practice Management

    Patient-Reported Outcome Measures (PROMs) for Surgical Practices

    Patient-reported outcome measures (PROMs) capture the patient's own assessment of their health status, function, and quality of life before and after a procedure. CMS and commercial payers increasingly tie reimbursement, quality reporting, and value-based payment adjustments to PROM data. This guide covers the regulatory requirements, validated instruments by specialty, and practical collection workflows for surgical practices.

    What PROMs Are and Why CMS Is Requiring Them

    • PROMs are standardized questionnaires completed by patients (not clinicians) that measure functional status, pain levels, quality of life, and satisfaction. Unlike clinical outcomes (complication rates, readmissions), PROMs capture what matters to the patient: Can I walk up stairs? Can I return to work? Has my pain improved? CMS began integrating PROMs into quality programs in 2017 with the Comprehensive Care for Joint Replacement (CJR) model.
    • The CMS Merit-based Incentive Payment System (MIPS) includes PROMs under the Improvement Activities and Quality categories. For 2025 and 2026, CMS expanded PROM-related measures across the Hospital Outpatient Quality Reporting (OQR) program and the Ambulatory Surgical Center Quality Reporting (ASCQR) program. Specifically, the ASCQR program added patient experience and functional status measures that require pre-operative and post-operative PROM collection.
    • The Bundled Payments for Care Improvement Advanced (BPCI-A) model requires participating hospitals and physician group practices to collect PROMs for hip and knee replacement episodes. CMS uses PROM data to calculate quality scores that affect reconciliation payments. Failure to collect PROMs at the required timepoints results in a penalty applied to the episode payment.
    • Commercial payers (Aetna, UnitedHealthcare, Blue Cross Blue Shield affiliates) are following the CMS trajectory. Several national payer contracts for orthopedic and bariatric surgery now include PROM collection as a condition of participation in bundled payment or center of excellence programs. The American College of Surgeons (ACS) requires PROM collection for participation in its quality verification programs.

    Validated PROM Instruments by Specialty

    • Orthopedics: The Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score Joint Replacement (KOOS JR) are the CMS-endorsed instruments for total joint replacement, each containing 6 items that take under 2 minutes to complete. The PROMIS-10 Global Health measure (10 items) provides a general health baseline and is accepted across all surgical specialties by CMS.
    • Spine surgery: The Oswestry Disability Index (ODI) for lumbar conditions and the Neck Disability Index (NDI) for cervical conditions are the most widely validated and used instruments. The North American Spine Society (NASS) also recognizes the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function computer adaptive test (CAT), which adjusts question difficulty based on responses.
    • General surgery and bariatric: The Gastrointestinal Quality of Life Index (GIQLI) covers digestive symptoms and function. For bariatric surgery specifically, the Moorehead-Ardelt Quality of Life Questionnaire II (MA-II) is the instrument embedded in the Bariatric Analysis and Reporting Outcome System (BAROS) endorsed by the American Society for Metabolic and Bariatric Surgery (ASMBS).
    • Cardiac surgery: The Kansas City Cardiomyopathy Questionnaire (KCCQ-12) is the standard for heart failure and valve procedures. The Seattle Angina Questionnaire (SAQ-7) covers coronary interventions. The Society of Thoracic Surgeons (STS) database integrates both instruments. Ophthalmology uses the Visual Function Questionnaire (VF-25) from the National Eye Institute, and ENT uses the Sino-Nasal Outcome Test (SNOT-22) for sinus procedures.

    Building a PROM Collection Workflow

    • Collection timing follows a pre/post design: a baseline PROM before surgery (typically at the pre-operative visit or within 30 days of surgery) and one or more follow-up PROMs (commonly at 90 days, 6 months, or 1 year). CMS CJR and BPCI-A require the 90-day and 1-year timepoints for joint replacement. Missing the baseline collection makes the post-operative data uninterpretable, so embed the baseline into your pre-op checklist as a mandatory step.
    • Electronic collection via patient portal, email link, or tablet in the waiting room yields higher completion rates than paper forms. A 2023 analysis in the Journal of Bone and Joint Surgery reported 78% completion rates for electronic PROMs versus 45% for mailed paper forms. Send automated reminders at 1 day, 3 days, and 7 days after the target collection date. Phone call follow-up for non-responders after 10 days captures an additional 10% to 15%.
    • Staff training is essential. Front-desk and medical assistant staff need to understand why PROMs are collected (reimbursement, quality reporting, patient care) so they can explain the purpose to patients. Patients who understand the reason for the questionnaire complete it at significantly higher rates. Script example: "This 2-minute survey helps us measure how well you are doing after surgery. It directly influences our quality scores and helps us improve care for future patients."
    • Store PROM data in a structured format linked to the patient's surgical episode, CPT code, and date of service. This structure is required for CMS quality reporting submissions and enables practice-level outcome analysis (e.g., average improvement in KOOS JR score for total knee replacements, stratified by surgeon, age, and BMI). Practices participating in the ACS NSQIP or STS databases can upload PROM data through those existing registries.

    Using PROM Data for Practice Improvement and Marketing

    • Aggregate PROM data reveals patterns invisible in complication-rate tracking alone. If your average KOOS JR improvement after TKA is 25 points but patients over BMI 40 average only 15 points, that data can inform pre-operative counseling, patient selection, or targeted pre-habilitation programs. The National Quality Forum (NQF) endorsed PROM-based quality measures specifically because they capture functional outcomes that complication rates miss.
    • Surgeons can use their own PROM data in credentialing applications, hospital privilege renewals, and payer contract negotiations. Demonstrating above-average functional improvement scores relative to national benchmarks (published annually by CMS for CJR and BPCI-A participants) strengthens your negotiating position for bundled payment rates and center of excellence designations.
    • Publicly reported PROM scores are coming. CMS began publicly reporting hospital-level THA/TKA PROM data on the Care Compare website in 2024 and is expanding to additional procedures. Practices that begin collecting PROMs now will have established baselines and improvement trends before public reporting becomes mandatory for their specialty.
    • Sharing de-identified, aggregate PROM results with prospective patients ("Our patients report an average pain reduction of 6 points on a 10-point scale at 90 days after total knee replacement") provides evidence-based outcome expectations. This approach is supported by the American Medical Association's guidelines on ethical marketing, which encourage the use of validated outcome data over testimonials.
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    Frequently asked

    Questions patients ask.

    Are PROMs required by CMS for all surgical specialties?

    Not yet universally, but the scope is expanding each year. As of 2026, PROMs are required for joint replacement episodes under CJR and BPCI-A, strongly incentivized in MIPS Improvement Activities, and included in the ASCQR and Hospital OQR programs for specific measures. The ACS and specialty societies (AAOS, STS, ASMBS) require PROMs for quality program participation. Even where not yet mandated, collecting PROMs positions your practice for inevitable expansion of these requirements.

    What is the minimum PROM completion rate needed for CMS reporting?

    For the CJR model, CMS requires a minimum 60% response rate for PROM data to be included in quality score calculations. Below 60%, the practice receives a quality penalty on its reconciliation payment. BPCI-A uses a similar threshold. The practical target should be 70% to 80% to provide a buffer. Electronic collection with automated reminders is the most reliable method for achieving these rates consistently.

    How do I choose which PROM instrument to use?

    Start with the instrument required or endorsed by CMS for your specific procedure (HOOS JR or KOOS JR for joints, KCCQ-12 for cardiac, PROMIS-10 for general). If no CMS-specific instrument applies, use the one endorsed by your specialty society. Key selection criteria: validation for your patient population, length (under 2 minutes maximizes completion rates), availability in multiple languages, and compatibility with your EHR for structured data capture. Licensing costs vary: PROMIS instruments are free (developed with NIH funding), while some proprietary instruments (KCCQ, SF-36) require paid licenses.

    Can PROM data be used in malpractice defense?

    Yes. Pre-operative PROM scores document the patient's baseline functional status in the patient's own words. Post-operative PROMs showing functional improvement provide objective evidence of surgical benefit. The American Academy of Orthopaedic Surgeons (AAOS) has noted that PROM data strengthens malpractice defense by demonstrating that the standard of care was met and the patient achieved measurable improvement. Conversely, declining PROM scores can also serve as an early warning system to address complications before they escalate to litigation.

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    This blog provides general information about healthcare compliance and aftercare best practices. It does not constitute legal, medical, or regulatory advice. Consult qualified professionals for guidance specific to your practice.