Hospital volume is not associated with clinically meaningful PROM achievement following primary total hip arthroplasty.

BACKGROUND

As the United States healthcare system transitions toward value-based care, patient-reported outcomes (PROMs) have become central to defining surgical quality and guiding reimbursement. Under the Centers for Medicare & Medicaid Services (CMS) Patient-Reported Outcomes Performance Measure (PRO-PM) initiative, hospitals are required to collect and report PROMs following total hip arthroplasty (THA). However, it remains unclear whether patients treated at high- and low-volume hospitals achieve comparable rates of clinically meaningful improvement.

METHODS

We retrospectively analyzed 4962 Medicare beneficiaries who underwent primary THA within a large integrated health system between 2016 and 2023. Hospitals were stratified by procedural volume (≥500 vs < 500 THAs annually). Patient-reported outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score for Pain, Physical Function (PS), and Joint Replacement (JR). Clinically meaningful thresholds included the minimal clinically important difference (MCID), patient acceptable symptom state (PASS) threshold, substantial clinical benefit (SCB), and satisfaction. Multivariable logistic regression evaluated associations between hospital volume and failure to achieve each PROM threshold, adjusting for demographic and clinical covariates.

RESULTS

Hospital procedural volume was not associated with differences in PROM achievement. The odds of failing to reach MCID, PASS, or SCB thresholds, or to report satisfaction, were comparable between high- and low-volume hospitals across all HOOS domains (all P > 0.05).

CONCLUSIONS

Patients achieved similar rates of meaningful improvement following THA regardless of hospital volume. As CMS increasingly ties reimbursement to PROM-based benchmarks, these findings support the equitable implementation of PRO-PM initiatives across diverse care settings and reinforce that standardized, evidence-based care, rather than procedural volume, drives high-value arthroplasty outcomes.

LEVEL OF EVIDENCE: II (prospective).