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According to AAOE Survey, Only 35% of Orthopaedic Practices are Collecting PROMs

Thursday, July 13, 2017   (0 Comments)
Posted by: Alyssa DelPrete, AAOE Communications
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Only 35% of orthopaedic practices who participated in a survey conducted by the American Alliance of Orthopaedic Executives (AAOE) indicated that they are collecting patient reported outcomes measures (PROMs). However, the majority said they are collecting patient satisfaction surveys (61%) and identified quality measures (71%).

Practice executives looking at these numbers might not be shocked, particularly those from small practices. Given the number and scope of recent regulations imposed on practices, executives are saying it often isn’t feasible to take on additional data collection activities outside of the required measures. Time and resources can only stretch so far, and small practice executives share that it can already be a challenge to collect and report required data.

While only 35% of orthopaedic practices may be collecting this data, that number might not be representative of the percentage of practice administrators who recognize the data’s importance. Rather, it could signify a need for simpler, more affordable technology in the market to make PROMs a realistic goal for practices.

Winchester Orthopaedic Associates, Ltd. has just started collecting PROMs for total hip and total knee replacements due to their MIPS requirements, according to Tom Witt, Chief Operations Officer. Their focus is on fulfilling MIPS and MACRA requirements which consume a significant amount of time and resources. He says PROMs “never showed up on the radar.”

“To just pick something else that we maybe should be doing but haven’t had the time to do,” he says, “you just don’t go there.”

Terrance Rosenthal, Practice Administrator at The Orthopaedic Clinic PC, also points to MIPS and MACRA requirements as roadblocks to his practice’s participation in PROMs. “It’s hard enough for us to have the staff and capabilities to collect what we have to collect to avoid penalties and get incentives," he explains.


Why Practices Should Be Collecting PROMs

Witt and Rosenthal both recognize the value in collecting PROMs, even if their practices don’t currently have the bandwidth available to tackle the project.

Witt admits it would be sensible to collect PROMs to ensure that the procedures his practice performs are resulting in positive patient outcomes. While they talk to patients individually to follow up on their outcomes, he says having a measured result for patients would be ideal.

Rosenthal sees a marketing opportunity with PROMs. He explains that patients play a major role in marketing your practice, and outcomes have a big impact on patient satisfaction.

So how are the 35% of practices collecting PROMs making it happen?

Robert Wunar, Chief Executive Officer of Orthopaedic + Fracture Specialists, shares that his practice started collecting PROMs a couple of years ago after his physicians came back from national meetings equipped with ideas and knowledge related to future industry trends. Patient reported outcomes were part of the discussion.

“To use a very bad metaphor, skating to where the puck is going to be, not where the puck is,” Wunar says when describing the physicians’ insight.

He does, however, recognize the cost and time barriers preventing many practices from diving into PROMs. Still, he predicts that PROMs will start having a bigger impact on practices and will become more of a priority.

He doesn’t think this data will become a requirement in the future. Still, he anticipates that many practices that have the resources to collect PROMs will begin doing it soon.


The Process of Collecting PROMs

Wunar shares that his practice is just in the beginning stages of utilizing their data. For two years, they have collected patient reported outcomes information at the pre-surgical stage, and then post-surgical at six weeks, three months, six months, one year, and then annually to gauge long term improvements.

He explains that they use this data at a macro level and micro level. At the micro level, if a patient reports unsatisfactory results, they return to the patient’s chart and determine what could have been detected to more accurately predict how a better outcome could be achieved. From a macro perspective, they use outcomes to benchmark their practice against national figures or for comparisons within their own group or region.

Despite these efforts, Wunar says they are just beginning to create a full program to dig into the data.

“We are now just having what we call matched data sets, where we have full continuums of care beyond just the initial 6 months or 6 week visit,” he explains. “So we can look longitudinally at our outcomes.”

He says they plan to use the data for internal process improvements in addition to external purposes. One such external use is comparing outpatient and inpatient results.

“For those of us that are doing total joint procedures, at an inpatient hospital facility, as well as an ambulatory surgery, look at the lower cost of care setting in an ambulatory care center and comparing that with outcomes results,” he says. “So if we’re saving $20,000 on a case that’s moving from the hospital to an ambulatory surgery, are we achieving better, or perhaps even similar, results on patient outcome?”

Additionally, Wunar see a correlation between outcomes improvements and performance under bundled payment initiatives. Overall, he sees the data having operational, patient care, and even strategic applications.


How to Get Started

Wunar classifies his practice as medium sized, and shares that he was previously in a larger orthopaedic practice that also collected PROMs. He recognizes that small practices can face challenges when tackling PROMs, but he insists that it is possible and anticipates more opportunity in the future for smaller practices to get involved.

The first step? Getting physician buy-in.

“When surgeons ‘drink the Kool-Aid’ and understand that these are important strategic initiatives and then communicate that to their partners, I think that’s the driving force that will really get a lot of the groups involved in recording and reporting patient outcomes,” he explains.

He also predicts advances in technology will make PROMs a more realistic goal for practices going forward. As more vendors start coming into the marketplace, competition will cause programs to get easier and more affordable. His main advice for practices is to keep an eye on PROMs technology as these changes occur.

“Right now, I think because it’s so early in the industry for physician practices to collect or report this data, there are pretty significant barriers to entry in terms of cost,” he says. “As those come down, I would ask smaller practices to continue to look at this, maybe annually, and see if the cost is at a level at which they can tackle the patient outcome challenge.”

Overall, Wunar is optimistic about the future of PROMs. “There’s going to be more turnkey systems that you can ‘plug and play’ rather than some of the early entrants that have forged the path in what outcomes means and how we should look at them.”

Despite the challenges involved with collecting patient reported outcomes measures, Wunar, Witt, and Rosenthal all agree on its growing importance in the industry. If Wunar is correct, it may only be a matter of time before the majority of practices are collecting this data.

Witt admits it should already be a priority. “We should be doing this,” he says, “we should’ve always been doing this.”


Ready to get started collecting PROMs? Members of the American Alliance of Orthopaedic Executives (AAOE) can sign up now for the AAOE Data Warehouse opening January 2018, which will collect quality measures, patient reported outcomes, and patient satisfaction surveys. Plans are also underway for the data warehouse to include a qualified clinical data registry approved by CMS for MIPS reporting (pending CMS approval in early 2018).

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