THA/TKA PRO-PM is mandatory for inpatient procedures. TEAM launches January 2026. Outpatient and ASC mandatory reporting hits in 2028. Outcomely ships the exact instruments, cadences, and exports CMS requires — without a managed-service contract.
CMS applies PRO-PM penalties as pay-for-reporting, not pay-for-performance. That means you don't need to hit a specific outcome target — but if you miss the 50% matched completion rate, CMS reduces your hospital's entire Medicare Annual Payment Update. For a mid-size hospital, that's typically a seven-figure annual exposure, not a rounding error on one service line.
What it is: CMS Hospital Inpatient Quality Reporting (IQR) program's mandatory PRO measure for elective primary total hip and knee arthroplasty. Assesses substantial clinical benefit (SCB) at one year post-op.
Ships HOOS JR, KOOS JR, and SILS-2 as pre-built forms with correct scoring. Automates the 0–90 and 300–425 day collection windows. Tracks matched completion rates in real time. Exports data in HQR-compatible CSV and XML formats.
What it is: Same measure, extended to Hospital Outpatient Departments (HOPDs) and Ambulatory Surgical Centers (ASCs). Reflects the shift of THA/TKA procedures to outpatient settings after CMS removed them from the inpatient-only list.
Same instrument library as IQR, plus HOPD/ASC-specific workflows that account for the different completion thresholds and submission portals (HQR for HOPD, ASCQR for ASC).
What it is: Transforming Episode Accountability Model — CMS's mandatory bundled payment model for selected hospitals. Pays hospitals a single, pre-determined amount for the 30-day episode of care around specific surgical procedures (including THA/TKA). Integrates PRO-PM data directly into episode payment.
If your hospital is in the TEAM cohort, you're already on the hook for IQR PRO-PM. Outcomely's PRO-PM workflows satisfy both. TEAM-specific episode reporting fields are flagged in the dashboard so your quality team can track episode-level completion.
What it is: Merit-based Incentive Payment System — the Medicare Part B physician payment program that includes dozens of specialty-specific PRO measures as quality measures.
Ships common MIPS PRO measures as pre-built forms. Tracks completion rates needed for MIPS reporting thresholds. Exports MIPS-compatible data for registry or direct submission.
Built around the exact CMS collection windows, instrument specifications, and submission formats. No custom configuration required.
Your ortho team flags elective primary THA/TKA procedures for Medicare FFS patients 65+. Import from your scheduling system or tag manually.
Outcomely automatically schedules HOOS JR or KOOS JR plus risk-variable questions within the 0–90 day window. Token-based patient links, SMS and email delivery.
Procedure performed. Pre-op data already captured and scored. No gap in the workflow.
Post-op HOOS JR or KOOS JR automatically scheduled in the 300–425 day window. Reminder cadence optimized for the 50% matched completion threshold.
Pre- and post-op responses automatically matched at the patient level. SCB (substantial clinical benefit) calculated per CMS specification.
Export in CMS HQR-compatible CSV or XML format. Submit directly, or hand off to your registry vendor (AJRR, AAOS RegistryInsights).
Managed-service vendors like CODE Technology or Medisolv take on these hospital-owned responsibilities as part of their contracts. Outcomely is designed for teams that want to keep that control and ownership. Many hospitals pair Outcomely for the workflow layer with a light-touch submission partner for the regulatory relationship — which typically costs a fraction of a full managed-service contract.
Research teams and quality departments that want to own the outcomes program internally, share data across studies, and avoid the lock-in of multi-year managed-service contracts. Outcomely fits here.
Mid-size practices and ASCs where a $50K+/year managed-service contract is overkill but compliance still matters. Outcomely fits here.
Hospital innovation groups running pilots, evaluating AI-assisted workflows, or standing up programs faster than enterprise procurement allows. Outcomely fits here.
Where managed services still win: Large health systems running orthopedic programs across dozens of sites with zero internal operational capacity. If your team can't take on any of the "you still own" list above, a managed-service vendor is the right call.
Start a free pilot with synthetic data. See the full PRO-PM workflow in under 10 minutes. We'll walk your team through HOOS JR, KOOS JR, and the CMS export — no sales pressure, no procurement cycle.