Patient-reported outcomes in vascular surgery are here to stay

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In 2022, the Centers for Medicare and Medicaid Services (CMS) is again emphasizing the importance of patient-reported outcomes (PROs) through legislation regarding the Quality Payment Program. In the Merit-based Incentive Payment System (MIPS), the use of PRO tools was designated as a highly weighted Improvement activity.1 The objective of this activity is to incorporate PRO data into routine clinical care, thus increasing patient engagement and health outcomes for all populations. PRO improvement activities require both documentation of promotion of PRO tools and PRO data collection for 2022. 

In addition, this year eight of the MIPS Quality Measures involve the use of PROs.2 The measures focus on functional status changes for patients with a range of orthopedic pathologies; one asthma- and one psoriasis-focused quality measure assessing patient-reported disease control; and one primary care measure that captures 11 patient-reported items to assess the broad scope of primary care. Overall, CMS is increasing its focus on PRO measures in both the quality and improvement spaces, and vascular surgeons need to be aware of and prepared for this shift. 

There are a number of PRO measures (PROMs) relevant to vascular disease. Last year, the Society for Vascular Surgery (SVS) Performance Measures Committee (PMC) identified all available PROMs relevant to vascular surgeons. The PMC also evaluated PROMs perceptions, barriers to implementation and concerns.3 

The PMC identified 31 PROMs related to vascular surgery diseases, and three sub-themes in knowledge gaps among vascular surgery physicians: lack of awareness of existing PROMs; knowledge of how they are developed and validated; and clarity around how they should be used. 

Participating physicians were concerned about the usefulness of PROMs in vascular surgery, barriers to the use and implementation of PROMs, and possible unintended consequences of reporting PROMs. Based on these findings, the PMC recommended four actions to facilitate the widespread implementation of vascular surgery-related PROMs: develop more vascular surgery-specific PROMs that expand our ability to assess response to treatments for vascular disease; develop recommended best practices for their collection and use; provide education about them; and partner with stakeholders to improve PROM development and implementation. 

One of MIPS’ major limitations to date has been the relevance of quality measures to vascular surgery. There are less than a handful of vascular-specific measures recognized by CMS, and two are currently up for potential removal due to a lack of reporting in performance year 2020. Given the CMS focus on PROs, it may be valuable for the SVS to advocate for PROM development for use in MIPS and, ultimately, MIPS Value Pathways (MVPs). The SVS PMC is currently tackling this issue, along with the action items around PROMs noted above.3 In order for PROMs to be effectively applied, SVS members need to better understand and implement these measures moving forward. 

References 

  1. Quality Payment Program. 2022 Improvement Activities: Traditional MIPS. Available at https://qpp.cms.gov/mips/explore-measures?tab=improvementActivities&py=2022 Accessed 7/15/2022. 
  2. Quality Payment Program. 2022 Quality Measures: Traditional MIPS. Available at https://qpp.cms.gov/mips/explore-measures?tab=qualityMeasures&py=2022. Accessed 7/15/2022. 
  3. Hicks CW, Vavra AK, Goldsborough E 3rd, et al. Current status of patient-reported outcome measures in vascular surgery. J Vasc Surg. 2021 Nov;74(5):1693-1706.e1. 

Evan Lipsitz, MD, is PMC chair, Caitlin Hicks, MD, the vice chair, and Ashley K. Vavra, MD, a member of the committee. Karen Woo, MD, is past chair. 

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