Hospitals in CJR markets will want to consider collecting patient-reported outcomes to get bonus quality points from CMS—and using a technology platform that excels at long-term patient engagement so they’re more apt to respond.

Hospitals have been moving toward a more patient-centered approach to care delivery for several years now and under the first government-mandated bundled payment program they’ll definitely want to step up their game. The Comprehensive Care for Joint Replacement (CJR) program of the Centers for Medicare & Medicaid Services (CMS) is incentivizing providers to collect patient-reported outcomes (PROs). Pre- and post-operative data collection comprises 10 percent of providers’ quality composite score that is ultimately tied to the payment they receive from CMS.

Engaged patients are a prerequisite to PRO collection—and technology will be the key enabler to meeting CMS’ goals that will grow more challenging to meet. If you aren’t regularly communicating with patients in the monthsbefore and after their surgery, they’re less likely to fill out a survey asking about their functional recovery, return to work and other outcomes that matter to them.

A growing number of providers have been utilizing InVivoLink technology to both build the physician/patient relationship and collect patient-reported outcomes using the survey tools recommended under CJR. These include the popular 10-question PROMIS (Patient Reported Outcomes Measurement Information System) Global Health Score, KOOS, JR (Knee Disability and Osteoarthritis Outcome Score for Joint Replacement) and HOOS, JR (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement), as well as others listed in Table 1. In addition to the standard CMS-required PRO surveys, InVivoLink allows other patient-reported and clinician-reported outcomes to be added to the mix, as needed, for research purposes. The Web-based platform lets care teams study patients’ health status pre- and post-surgery, and can link to a provider’s clinical data warehouse, electronic health record system or materials management platform as needed.

InVivoLink is highly configurable, with patient interactions and data collection tied to relevant educational content and customized to specific surgeons, implants, hospitals and patient groups. Patients are encouraged to begin interacting with the tool the moment their procedure is scheduled. Their email address is used to deliver surveys at regularly scheduled intervals or, alternatively, patients fill out the questionnaire on a tablet during joint class, pre-admission testing or a clinic visit. Dashboards let care teams know which patients have begun, completed or not yet started an outcomes survey so they can help drive compliance to the CMS target.

Response rates matter under CJR. To qualify for bonus points on their quality composite score in the first performance period (April 1—Dec. 31, 2016), hospitals need to voluntarily collect PROs on 50 percent of eligible cases or at least 50 patients. They’re only required to gather answers twice, once preoperatively and again between nine and 12 months after surgery. Hospitals using InVivoLink to support participation in CMS’ Bundled Payments for Care Improvement Initiative may choose to have many more collection points—preoperatively and often three, six, nine and 12 months after surgery.

The Connecticut Joint Replacement Institute in Hartford, Connecticut, has used the tool to bump up the response rate to its surveys upwards of 90 percent across 25 surgeons performing around 3,200 cases annually. In addition, InVivoLink has enhanced its ability to care for patients because scores are available in real time and can be utilized during patient visits to educate, communicate expectations and empower individuals to take a more active role in their recovery. Data accuracy has also improved; no faxing, handwriting or data entry is required once patients have completed the survey online.

InVivoLink’s video library makes the patient education process more personalized and meaningful for patients. While an on-site joint class remains a best practice, participants in these classes often include a combination of patients receiving new hips, knees and shoulders, and within those patient groups the planned surgical approach also varies. Many of those patients are older and find it uncomfortable to sit through a one- or two-hour class—in some cases, on top of driving long distances just to get there. Under the best of circumstances, patients may have trouble recalling what was taught a few weeks prior to their operation. The “anytime” availability of the personalized videos make InVivoLink a valuable, time-sensitive memory aid for patients and their caregivers.

For hospitals that opt to utilize InVivoLink as an implant registry, PROs can be tied to implants and physician-specific cost data, an important consideration for facilities that will be gainsharing with CJR collaborators. The registry provides visibility to who is using which implants, and can easily tease out clinical and financial outcome differences between “premium” and lower-priced implants. It can even compare the outcomes of surgeon practice patterns, approach and various patient populations. The real-time implant granularity in the registry combined with InVivoLink’s patient data enable more meaningful interactions between surgeons regarding value and efficacy.

With CJR, CMS has made clear its plans to scale bundled payment programs to achieve the Triple Aim of improving outcomes and the patient experience of care as well as reducing costs. The agency believes that patient-reported outcomes are a key measure, so all providers will eventually be challenged to collect this new, valuable data set.

Hospitals that want to better understand the importance of collecting patient-reported outcomes, the impact on their composite quality score under CJR and how they can leverage technology to improve their performance are invited to watch the videos on these topics. To learn more about HealthTrust’s CJR solution, contact Doug Jones.


Table 1: PRO Reporting Requirements for CJR (surveys, risk variables and patient identifiers)


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John Bass

John Bass

John Bass is chief executive officer of InVivoLink, Inc., a HealthTrust affiliate providing bundled payment optimization software and services, where he has worked since its founding in 2009. He has over 20 years of experience in healthcare technology as well as expertise in orthopedics, patient engagement, patient-reported outcomes, value-based medicine and supply chain. Prior to InVivoLink, Bass was COO of Titan Management Group and a senior product manager at Global Healthcare Exchange. He has a chemistry degree from the University of North Carolina at Chapel Hill. More Articles by This Author »