Supplemental Information on FORCE-TJR PRO Costs and Value
TJR value cannot be effectively managed without the patient’s outcome captured in standardized, routine patient-reported outcome measures (PROs). The additional six slides (see below) summarize the value of capturing PROs to inform TJR care. We estimate greater than a 5:1 return on the cost of the PRO.
While there is a growing consensus that we need to measure PROs, the actual PROs measures are not new. Validated measures have been around for decades, however, they have not been incorporated into clinical practice for several reasons. First, while orthopedic surgeons can reasonably collect measures of pain and functional status in preoperative evaluations, it is challenging for them to obtain PROs 6 to 12 months after the procedure as patients may not return to the physician, especially if they have a poor outcome. Second, and most importantly, PROs need to be risk adjusted and individual physicians or even large groups do not have a sufficiently large sample size to risk adjust.
FORCE-TJR/Healthcare Value solutions offers a per-PRO fee that provides the PRO assessment, real-time scoring, risk factors for readmission, and centralized, experienced staff to capture over 85% of post-TJR measures– a rates 3 times the experience of other registries. (Franklin et al. JBJS, 2014). The ‘lab test’ model serves health plans as it effectively collects data on any subset of patients insured by the healthplan within the surgeon practice. When compared to the established FORCE-TJR national norms, the pre-operative PRO pain and function profiles reflect patient selection. Post-operative PRO data document the value to the patient. Comparative outcome data are risk adjusted prior to comparisons of post-operative pain, function, and readmission. Quarterly risk-adjusted comparative reports are included in the per-PRO fee.
Additional slides on PRO costs and value are here.