The 80% PROMs Mandate: The Hidden $1.2M Risk Most Joint Programs Overlook - How AJRR Gaps and Rising Readmissions Are Putting 4-Star Hospitals on the Edge
- SolvEdge
- Nov 13, 2025
- 4 mins read
The Centers for Medicare & Medicaid Services (CMS) is raising the stakes for orthopedic programs with its new 80% Patient-Reported Outcome Measures (PROMs) mandate. Hospitals that fail to meet this threshold face not only financial penalties but also reputational damage and increased readmission rates. For joint programs, the risk is not hypothetical: non-compliance can cost over $1.2 million annually in lost reimbursements and avoidable penalties.
The $1.2M Compliance Risk: What’s at Stake
CMS mandates 80% completion of matched pre- and post-op PROMs for elective total hip and knee arthroplasty (THA/TKA) by 2026.
Hospitals failing to meet the threshold face up to a 2% reduction in Medicare reimbursements, which can exceed $1.2 million for high-volume centers.
Non-compliance also exposes hospitals to public reporting of lower percentile scores, impacting patient trust and referral rates.
AJRR Gaps: Where Data Falls Short
The American Joint Replacement Registry (AJRR) is the primary data source for CMS compliance, but gaps in data collection and reporting remain common.
Many hospitals lack the infrastructure to capture, track, and submit PROMs efficiently, leading to missed cases and incomplete submissions.
AJRR’s 2025 report highlights that only 60% of participating sites meet the 80% threshold, leaving 40% exposed to penalties.
Rising Readmissions: The Hidden Cost of Poor PROMs
Hospitals with incomplete PROMs data are more likely to experience higher readmission rates, as gaps in patient-reported outcomes mask early warning signs.
Readmissions not only increase costs but also trigger CMS penalties under value-based care models.
Case Study: A Midwest hospital system reduced readmissions by 18% after implementing automated PROMs collection and analytics, saving $850,000 annually.
How to Mitigate Risk: Actionable Steps
Invest in automated PROMs platforms that integrate with EHRs and AJRR for seamless data capture and submission.
Conduct regular audits of PROMs completion rates and identify gaps in data collection.
Train staff on the importance of PROMs compliance and patient engagement.
The 80% PROMs mandate is not just a compliance issue-it’s a financial and operational imperative. Hospitals that fail to act risk millions in lost revenue and reputational damage. By closing AJRR gaps and leveraging automated solutions, joint programs can protect margins and improve patient outcomes.
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