Lower 1-Year PROM Completion Rates and Need for Intensive Follow-Up in Inpatient Medicare THA Patients: Implications for the CMS PROM Policy

Introduction: The Centers for Medicare and Medicaid Services (CMS) has mandated the collection and reporting of patient-reported outcome measures (PROMs) in total joint arthroplasty (TJA). However, evidence is lacking in identifying patients who fail to respond to PROM collection efforts. This study aimed to (1) evaluate rates of successful PROM collection between inpatient and outpatient Medicare total hip arthroplasty (THA) patients and (2) identify patient-specific factors associated with active follow-up to obtain 1-year PROMs. Methods: A prospective analysis of 5,480 primary THA patients aged ≥65 years from 2016 to 2022 was performed. Patients were stratified into inpatients (length of stay [LOS] >1) and outpatients (LOS ≤1). Methods of 1-year postoperative PROM collection included passive electronic methods (e-mail, text, patient portal) and active methods (phone calls, personalized e-mails/texts/letters). Response rates and factors associated with active follow-up were compared between groups. Results: Overall, a lower proportion of inpatient Medicare THA patients completed 1-year PROMs compared with outpatients (75% [2,108/2,809] vs. 85% [3,372/3,983]). Passive follow-up was more successful among outpatients than inpatients (52% vs. 45%, p < 0.001). Active follow-up was more successful among inpatients than outpatients (55% vs. 48%, p < 0.001). On adjusted analysis, older age (odds ratio [OR] 1.2 per interquartile range [IQR] increase, p < 0.001), non-White race (OR 1.89, p < 0.001), and worse baseline PROMs (p < 0.05) independently predicted the need for an active 1-year follow-up. However, outpatient status (odds ratio [OR] 0.84, p = 0.003) and a higher education level (OR 0.66 per IQR increase, p < 0.001) were associated with lower utilization of active follow-up. Conclusion: Inpatient Medicare THA patients have substantially lower 1-year PROM completion rates and require more resource-intensive active methods compared with their outpatient counterparts. Optimizing collection in this population is essential for accurate quality measurement under the new CMS PROM policy. The results suggest that tailored protocols addressing barriers around sociodemographics, health literacy, and patient engagement may be needed.