By Matt Phillion
Under the Hospital Inpatient Quality Reporting Program, hospitals will be required to collect and report patient-reported outcomes (PRO), risk variables, matching variables, and PRO-related variables for at least half of eligible total hip and total knee replacement patients beginning in 2025.
What does this mean for hospitals? To start, the data will impact the level of reimbursement as part of the CMS shift to value-based care, so practices will struggle and could see financial penalties if they don’t have a mechanism to collect this patient data. To do so efficiently, organizations will need to look to patient engagement solutions to collect that data—and higher patient engagement can lead to better outcomes across the board.
“What’s really important is the way CMS [Centers for Medicare & Medicaid Services] rolled this out,” says Bronwyn Spira, founder and CEO of Force Therapeutics. “The penalties for noncompliance start in 2026, but the data collection window actually starts sooner. Organizations are going to need to start collecting preoperative outcomes and quality metrics as soon as April 2024. If I’m standing in the shoes of a healthcare leader assessing potential financial penalties, I’m thinking about how I can prepare by getting systems, behaviors, and workflows in place so that once the penalty window hits, [I’ve] got all [my] systems and processes down.”
Organizations will want to know what they’re collecting, where, and how—and how they’re driving that data collection not only for the preoperative perspective but also for postoperative to be ready for the first mandatory data submission deadline in September 2025.
“They need to be capturing outcomes, not just from a single point in time but across the entire episode,” says Spira.
It will be challenging for organizations: they can collect data with a form or questionnaire, virtually or by phone, but when you’ll need to re-engage that patient in six months to a year afterward, how do you create the kind of engagement tether that will keep patients involved and make sure organizations can be in compliance?
Begin with patient engagement
There are a few key tenets to establishing a digital engagement strategy, and the key word is strategic, Spira explains.
There are a couple of key things that drive meaningful engagement: the patient has to know that the education they’re engaging with comes from their own provider, that “it’s not coming from an amorphous ‘Dr. Google,’” says Spira. “It’s not one-size-fits-all. It has to be specific to that patient, and it has to be personalized. That’s the difficult part.”
The industry struggles to standardize care for patients, but patients know how they differ from other patients, and personalizing engagement acknowledges this.
“Being able to create a framework that’s dynamic enough to personalize care for patients but also makes sure they’re receiving standardized care instructions across their continuum of care—that’s difficult to do,” says Spira. “I always think about having a sophisticated infrastructure as opposed to just emailing the patient when you need a form or to ask how much pain they’re in. It has to be a longitudinal engagement system.”
When considering a patient-centric system, every interaction has to be meaningful, personal, and valuable. This is particularly important for digital interactions.
“Every time they log in, there should be something there for them; otherwise, they don’t keep coming back,” says Spira. “There should always be an answer to what’s important today, what should the patient know, are you paying attention to this aspect of your care. Maybe it’s about their wound, or about how much activity they’re engaging in, how much they’re sitting or sleeping. All of these things may seem insignificant, but it’s highly relevant to be able to continually feed information to the patient. It’s true engagement and provides real value.”
Organizations can’t afford to engage in half measures here.
“To truly engage with a patient takes a hundred different interactions on the platform, but it only takes one thing to disengage the patient,” says Spira. “Then inertia sets in, and it gets harder to reengage.”
The goal should be to ensure that the digital involvement platform becomes synonymous with their care, she says.
“When I have a question, this is the place I go for my answer, as opposed to wondering what I’m supposed to do today,” says Spira. “You want the platform to be synonymous with where they go for their information.”
It’s easy when looking at penalties and reimbursement to not see the forest for the trees—but at the end of the day, better engagement leads to better outcomes.
“With the patient at the center of everything, it drives the right outcomes,” says Spira. “We’re collecting data, but it’s really about the quality of those outcomes.”
CMS is introducing these changes in a series of steps to ease the way in: they’ll start with demonstrating organizations can collect the outcomes to start, and then other measures weigh in.
“First: prove you can collect these outcomes. Then show you’re doing something to improve them over time,” says Spira. “How do we know that these surgeries are necessary and helpful?”
Incentives as drivers
Rare is the provider who enters healthcare not driven by wanting to offer the best care they can for the patient. But that doesn’t automatically mean they know the right thing for every patient.
“Providers are in it for the patient,” says Spira. “I think CMS does have to incentivize organizations as a whole to encourage the right behaviors, but I think providers are definitely along for the ride.”
How hands-on physicians want to be with the data will vary from provider to provider.
“Some surgeons will absolutely want to hear when their patients, for example, have a wound infection—not just to avoid readmission but because they want to care for the patient,” says Spira. “Others are more hands off, wanting postoperative care to be handled by the care team. The answer is to address both viewpoints, and we’re really thinking about how you operationalize responsiveness to patient questions.”
Improving data collection through patient involvement
The first step to collecting the right data and reaching the appropriate level of patient engagement, Spira notes, is acknowledging that the electronic health record (EHR) doesn’t do this.
“The EHR is the system of record, the repository of data, and the very important backbone of any health organization, but it’s not purpose-built to engage with patients longitudinally across an organization,” she says. “We’re going to need patient-facing tech or a last-mile patient engagement infrastructure that allows you to have meaningful interactions, communication, and engagement that’s outside the EHR.”
The next step is understanding that an investment in an enterprise-type technology that addresses many pain points is a good investment for the long term: a comprehensive system that answers the question of workforce engagement and managing burnout.
“Support staff and physician extenders have taken such a beating. All organizations are struggling to staff up those positions, so how can you deal with that not only today with this set of issues but also in the long term?” says Spira. “How can you use technology to improve efficiency?”
The next step is dealing with the amount of data at hand and ensuring it’s relevant and accessible to the people who need it when they need it.
“I always think of data in two ways. One is actionable data at the point of care—real-time data you can act upon now,” says Spira. “That’s the data set for the care team on the ground. They can intervene in real time to prevent complications, readmissions and answer important questions that impact recovery. The second bucket of data looks across aggregated data sets to understand trends, what they mean for the organization, and how you use that data to optimize results. So, on one hand, real-time patient-reported pain data can inform immediate adjustments to care plans, avoiding unnecessary ED visits, while on the other hand, long-term aggregated longitudinal data can provide insight into why some ORs or surgeons produce better patient outcomes than others.”
There’s an opportunity to leverage development in AI to analyze and surface data to help maximize how staff can make the most of the time and personnel they have available to them.
“It’s helpful to know where to spend time where in-person interaction will be most valuable to the patient population. Speaking to the data we see at Force Therapeutics, total joint replacement is so well understood that roughly 80% of patients actually don’t need that many non-automated touch points, but those other 20% are at risk, and that’s where healthcare professionals’ use of time is most valuable,” says Spira. “Knowing the rest of the patient population following a prescribed plan of care that will lead to a successful outcome, and building in triggers or escalations when the patient veers off course is an incredibly important step in the right direction.”
The industry can no longer effectively manage the number of patients that it needs to manage, so knowing who needs the most help can drive up the health of the patient population at large.
“If you can leverage meaningful digital connections with patients and the data derived from an engaged patient, I think we can see a very clear path to better outcomes, lower costs, and less variability in care in the future. I think those things done right are very powerful.”
Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at firstname.lastname@example.org.