The outcomes mandate

The outcome is now the measure.
Own it, or be measured by it.

For a decade, orthopaedic quality was scored on complications and utilization — things that happen in your building, on your clock. That is over. CMS now scores you on what the patient reports a year later, from home, where you cannot see. The measure moved to the one place your OR skill cannot reach.

01 · What is actually required

This is a payment-tied rule, not a best practice.

The CMS THA/TKA PRO-PM— the patient-reported outcome performance measure for total hip and knee replacement — is finalized, and it arrives on two clocks. The specifics are the whole story:

Inpatient: the clock is running
In the Hospital Inpatient Quality Reporting program, collection is already mandatory and tied to FY2028 payment. If you do joints in a hospital, you are on this measure now.
Outpatient & ASC: 2031
The outpatient and ASC version phases in through 2028–2030 and becomes mandatory in 2031, affecting FY2032 payment — exactly where joint replacement is migrating. Later, not optional.
A full year, both settings
KOOS JR and HOOS JR, collected before surgery and again roughly a year out. The window that decides your score is the one after discharge, at home.
50% — or 45% in an ASC
Hit a 50% response rate (45% for ASCs) or the data doesn't count. A patient who stops answering is not a lost survey — it is a hole in your quality score.

The 50% response rate is the hard part, and it is not a paperwork problem. The year after a joint replacement happens at home, across months no episode of care observes. Getting a patient to answer a survey at month twelve is the same problem as knowing whether they did their rehab — a monitoring problem, not a clerical one. Whoever solves the follow-up owns the score.

02 · The choice inside the mandate

Compliance is unavoidable. Ownership is a decision.

Every practice will comply somehow. The real fork is who ends up holding the evidence. Because the same data the government requires is the most valuable thing your practice produces: a longitudinal, structured record of what your care actually does to real patients across your real mix of cases.

You as a data source

A registry or vendor collects the minimum CMS requires, keeps it, and hands you a compliance checkmark. The evidence about your own patients lives on someone else’s server, answering someone else’s question, priced by someone else. You did the work and generated the data. You do not own what it becomes.

You as the owner

The same collection, captured as a byproduct of your workflow, in a record you hold. You clear the mandate andkeep a growing evidence base you can use — to counsel patients with your own recovery curves, to compare products and protocols honestly, to show a payer what your care is worth. Compliance becomes an asset instead of a cost.

This is the same distinction a group of surgeons named when they built the OREF/RegenMed MOTIV real-world-evidence network: physicians should not be “treated merely as data sources for institutions, payers, vendors, or registries far removed from the patient’s bedside.”We agree, completely. SurgeonValue is built to sit on the surgeon’s side of that line — the instrument, not the extractor. Physician-led evidence networks and a practice’s own outcome record are the same movement, and they feed each other.

03 · What we claim, and what we don’t

We will not tell you this improves your outcomes.

It would be easy copy and it would be a lie. This year’s RASKAL trial — the first properly powered head-to-head — found robotic knee replacement no better than ordinary navigation on patient-reported outcomes at two years, despite better alignment, shorter operative time, and 82% surgeon preference, at roughly $2,000 more per case. Better technical execution did not move what the patient reported. The field is full of tools that improved the process and promised the outcome.

So we are precise. SurgeonValue does not improve your outcome. It captures it, at the response rate CMS requires, and lets you own the evidence.Whether the number then goes up is your medicine, your protocols, your judgment. Our job is to make sure that when the patient answers at month twelve, the answer reaches you — and stays yours.

04 · How it runs

Collection as a byproduct of the visit.

Pre-op capture at the point of care, then the follow-up that actually closes the loop: the patient tracks recovery from their own phone through the year, which is both the PRO-PM window and a Medicare-reimbursed remote-monitoring stream. The survey that satisfies the mandate and the data that gets you paid for watching the recovery are the same touchpoints. Your live response rate and results sit in your PROM dashboard.

05 · Adjacent
The fee schedule→
What CY2027 does to arthroplasty work RVUs — the cut this evidence helps you argue against.
The optimization gap→
The 60–90 day program that no code pays for, and the outcome data that would justify one.
Practice economics→
Direct-pay, site-of-service, and where a practice's own outcome evidence becomes a negotiating asset.

Track the PRO-PM.

One note when CMS moves a deadline or a response-rate rule, and the analysis when it does. For practices deciding how to own their outcome data — nothing else.

Sourcing. The measure runs as two distinct programs — the inpatient version in Hospital IQR (FY2028) and a separate outpatient/ASC version in Hospital OQR that phases to mandatory in 2031 (FY2032), with a 45% ASC threshold. Timelines, KOOS JR/HOOS JR instruments and response thresholds are from CMS IQR/OQR program materials and the QualityNet THA/TKA measure pages; the two clocks are easy to conflate, so confirm the specifics for your setting against CMS directly before relying on any date. RASKAL: MacDessi et al., Bone & Joint Journal, 2026. MOTIV: Mercuri & Wickline, Journal of Orthopaedic Experience & Innovation, 2026. This page is general information, not legal, billing, or regulatory advice.