The Weekly Quality Brief: THA/TKA Pro-PM Eligibility, Hybrid Measure Data Thresholds, and TEAM Model Pricing
The Weekly Quality Brief
In this episode of The Weekly Quality Brief, Kristen Beatson and Kristen Pergola answer questions from healthcare quality professionals related to PRO-PM requirements, hybrid measure data completeness, and CMS payment models. They review eligibility criteria for THA/TKA PRO-PM measures, including the limitation to Medicare fee-for-service patients, and explain how CMS distinguishes between hospital outpatient departments and physician offices based on ownership and provider-based status.
The discussion also covers hybrid measure requirements, including thresholds for missing lab results and vital signs and how CMS may evaluate completeness across cases. Additional topics include how CMS calculates target prices under the TEAM model using historical Medicare payments and multiple adjustment factors, as well as how organizations can interpret and manage cases that no longer qualify for measure populations in ENCOR.
The hosts also address the voluntary status of the ExRad eCQM across programs, considerations for preparing for eCQM validation audits, and how a single patient encounter may qualify for multiple measures such as COMP, PSI-11, and PSI-13 based on differing measure criteria.
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