{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:57:53Z","timestamp":1790510273301,"version":"4.1.0"},"reference-count":31,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Centers for Medicare and Medicaid Services Patient-Reported Outcomes Performance Measure defines substantial clinical benefit (SCB) on the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) as a 22-point improvement for all Medicare patients undergoing total hip arthroplasty (THA). Because inpatient and outpatient THA patients differ at baseline, a single threshold may not fully reflect substantial improvement across care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>We sought to determine separate HOOS-JR SCB thresholds for inpatient and outpatient Medicare THA patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed prospectively gathered data from 5480 Medicare patients ages 65\u2009years and older who underwent primary, elective THA between 2016 and 2022 at a single institution. Patients were stratified by inpatient and outpatient status. An anchor-based approach was used with the Veterans RAND 12-Item Health Survey transition item, \u201cCompared to 1\u2009year ago, how would you rate your physical health now?\u201d Patients were categorized as substantially improved, improved, or unimproved. SCB for HOOS-JR absolute change was derived separately for inpatient and outpatient cohorts using receiver operating characteristic analysis, with the optimal cutoff selected by maximizing Youden\u2019s\n                      <jats:italic toggle=\"yes\">J<\/jats:italic>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Baseline HOOS subdomain scores were worse in the inpatient cohort. The HOOS-JR SCB was 31.9\u2009points for inpatients and 32.3\u2009points for outpatients. Using these thresholds, 61% of inpatients and 66% of outpatients achieved SCB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This retrospective analysis of prospectively collected data from a single, high-volume institution found that Medicare THA inpatients and outpatients demonstrated similar HOOS-JR SCB of approximately 32\u2009points. These findings suggest that a unified SCB across care settings may be reasonable, although the current 22-point benchmark may overestimate SCB achievement. Further studies are needed to clarify how baseline status and patient expectations influence SCB attainment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level III: prognostic study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15563316261487185","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T10:20:34Z","timestamp":1790331634000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Defining Clinically Meaningful Improvement Thresholds for Inpatient Vs Outpatient Medicare Total Hip Arthroplasty Patients: A Reassessment of Centers for Medicare and Medicaid Services Patient-Reported Outcome Performance Measure Policy Benchmarks"],"prefix":"10.1177","author":[{"given":"Ignacio","family":"Pasqualini","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0604-4218","authenticated-orcid":false,"given":"Shlok V.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shujaa T.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled A.","family":"Elmenawi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Cleveland Clinic Adult Reconstruction Research (CCARR) Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-7538","authenticated-orcid":false,"given":"Nicolas S.","family":"Piuzzi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Spindler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor G.","family":"Murray","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Molloy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim L.","family":"Stearns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor E.","family":"Krebs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas R.","family":"Scarcella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Zielinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Roth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Bloomfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P.","family":"McLaughlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Deren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Surace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","unstructured":"Pasqualini I Elmenawi KA Khan ST et al. Inpatient Medicare total hip arthroplasties have distinct characteristics and are less likely to achieve substantial clinical benefit for Hip Disability and Osteoarthritis Outcome Score for Joint Replacement: implications for Centers for Medicare and Medicaid Services patient-reported outcome measures policy. J Arthroplasty. 2025;41(3):689-694. https:\/\/doi.org\/10.1016\/j.arth.2025.07.045","DOI":"10.1016\/j.arth.2025.07.045"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","unstructured":"Pasqualini I Emara AK Rullan PJ et al. Return to sports and return to work after total hip arthroplasty: a systematic review and meta-analysis. JBJS Rev. 2023;11(8):1-8. https:\/\/doi.org\/10.2106\/JBJS.RVW.22.00249","DOI":"10.2106\/JBJS.RVW.22.00249"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","unstructured":"Sinclair ST Klika AK Jin Y Piuzzi NS; Cleveland Clinic O.M.E. Arthroplasty Group; Higuera CA. The impact of surgeon variability on patient-reported outcomes in total hip arthroplasty. J Arthroplasty. 2022;37(7S):S479-S487.e1. https:\/\/doi.org\/10.1016\/j.arth.2022.02.100","DOI":"10.1016\/j.arth.2022.02.100"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","unstructured":"Elmenawi KA Pasqualini I Khan ST et al. Comparing Medicare and non-Medicare inpatient total knee arthroplasty: is the new Centers for Medicare and Medicaid Services patient-reported outcomes performance measure mandate applicable to all?. J Arthroplasty. 2025;40(11):2799-2804. https:\/\/doi.org\/10.1016\/j.arth.2025.05.082","DOI":"10.1016\/j.arth.2025.05.082"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","unstructured":"Rull\u00e1n PJ Deren ME Zhou G et al. The arthroplasty surgeon growth indicator: a tool for monitoring supply and demand trends in the orthopaedic surgeon workforce from 2020 to 2050. J Bone Joint Surg Am. 2023;105(13):1038-1045. https:\/\/doi.org\/10.2106\/JBJS.22.00874","DOI":"10.2106\/JBJS.22.00874"},{"key":"e_1_3_2_7_2","doi-asserted-by":"crossref","unstructured":"Sloan M Premkumar A Sheth NP. Projected volume of primary total joint arthroplasty in the U.S. 2014 to 2030. J Bone Joint Surg Am. 2018;100(17):1455-1460. https:\/\/doi.org\/10.2106\/JBJS.17.01617","DOI":"10.2106\/JBJS.17.01617"},{"key":"e_1_3_2_8_2","doi-asserted-by":"crossref","unstructured":"Campbell A Emara AK Klika A Piuzzi NS; Cleveland Clinic O.M.E. Arthroplasty Group. Does implant selection affect patient-reported outcome measures after primary total hip arthroplasty?. J Bone Joint Surg Am. 2021;103(24):2306-2317. https:\/\/doi.org\/10.2106\/JBJS.20.01931","DOI":"10.2106\/JBJS.20.01931"},{"key":"e_1_3_2_9_2","unstructured":"CMS. Comprehensive care for joint replacement model. 2025. Accessed August 10 2025. https:\/\/www.cms.gov\/priorities\/innovation\/innovation-models\/cjr"},{"key":"e_1_3_2_10_2","doi-asserted-by":"crossref","unstructured":"Call CM Olaniyan AA Walsh ZA Babikian G Rana AJ McGrory BJ. Patient hospital and outcome factors associated with attaining substantial clinical benefit following primary total hip arthroplasty. J Arthroplasty. 2025;41(3):680-688.e2. https:\/\/doi.org\/10.1016\/j.arth.2025.07.036","DOI":"10.1016\/j.arth.2025.07.036"},{"key":"e_1_3_2_11_2","unstructured":"Boyles M. Breaking down the CMS final rule: the PRO-PM for outpatient THA\/TKA. CODE Technology | We Collect Patient Reported Outcomes. 2023. Accessed July 8 2025. https:\/\/www.codetechnology.com\/blog\/breaking-down-the-cms-final-rule-the-pro-pm-for-outpatient-tha-tka\/"},{"key":"e_1_3_2_12_2","doi-asserted-by":"crossref","unstructured":"Pasqualini I Piuzzi NS. New CMS policy on the mandatory collection of patient-reported outcome measures for total hip and knee arthroplasty by 2027: what orthopaedic surgeons should know. J Bone Joint Surg Am. 2024;106(13):1233-1241. https:\/\/doi.org\/10.2106\/JBJS.23.01013","DOI":"10.2106\/JBJS.23.01013"},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Pasqualini I Benyamini B Khan ST et al. Measures of clinical meaningfulness for the Hip Disability and Osteoarthritis Outcome Score vary by aseptic revision total hip arthroplasty diagnosis. J Arthroplasty. 2025;40(9 suppl 1):S382-S388. https:\/\/doi.org\/10.1016\/j.arth.2025.04.065","DOI":"10.1016\/j.arth.2025.04.065"},{"key":"e_1_3_2_14_2","doi-asserted-by":"crossref","unstructured":"Lyman S Lee YY McLawhorn AS Islam W MacLean CH. What are the minimal and substantial improvements in the HOOS and KOOS and JR versions after total joint replacement?. Clin Orthop Relat Res. 2018;476(12):2432. https:\/\/doi.org\/10.1097\/CORR.0000000000000456","DOI":"10.1097\/CORR.0000000000000456"},{"key":"e_1_3_2_15_2","doi-asserted-by":"crossref","unstructured":"Pasqualini I Turan O Emara AK et al. Outpatient total hip arthroplasty volume up nearly 8-fold after regulatory changes with expanding demographics and unchanging outcomes: a 10-year analysis. J Arthroplasty. 2024;39(8):2074-2081. https:\/\/doi.org\/10.1016\/j.arth.2024.02.048","DOI":"10.1016\/j.arth.2024.02.048"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","unstructured":"O.M.E. Cleveland Clinic Orthopaedics. Implementing a scientifically valid cost-effective and scalable data collection system at point of care: the Cleveland Clinic OME cohort. J Bone Joint Surg Am. 2019;101(5):458-464. https:\/\/doi.org\/10.2106\/JBJS.18.00767","DOI":"10.2106\/JBJS.18.00767"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","unstructured":"O.M.E. Cleveland Clinic Orthopaedics. Value in research: achieving validated outcome measurements while mitigating follow-up cost. J Bone Joint Surg Am. 2020;102(5):419-427. https:\/\/doi.org\/10.2106\/JBJS.19.00531","DOI":"10.2106\/JBJS.19.00531"},{"key":"e_1_3_2_18_2","doi-asserted-by":"crossref","unstructured":"Roth A Anis HK Emara AK et al. The potential effects of imposing a body mass index threshold on patient-reported outcomes after total knee arthroplasty. J Arthroplasty. 2021;36(7S):S198-S208. https:\/\/doi.org\/10.1016\/j.arth.2020.08.060","DOI":"10.1016\/j.arth.2020.08.060"},{"key":"e_1_3_2_19_2","doi-asserted-by":"crossref","unstructured":"Curtis GL Tariq MB Brigati DP Faour M Higuera CA; Cleveland Clinic Orthopaedic Arthroplasty Group. Validation of a novel surgical data capturing system following total hip arthroplasty. J Arthroplasty. 2018;33(11):3479-3483. https:\/\/doi.org\/10.1016\/j.arth.2018.07.011","DOI":"10.1016\/j.arth.2018.07.011"},{"key":"e_1_3_2_20_2","doi-asserted-by":"crossref","unstructured":"Erossy MP Emara AK Rothfusz CA et al. Similar healthcare utilization and 1-year patient-reported outcomes between cemented and cementless primary total knee arthroplasty: a propensity score-matched analysis. J Knee Surg. 2023;36(5):530-539. https:\/\/doi.org\/10.1055\/s-0041-1739201","DOI":"10.1055\/s-0041-1739201"},{"key":"e_1_3_2_21_2","doi-asserted-by":"crossref","unstructured":"Rull\u00e1n PJ Pasqualini I Zhang C Klika AK Piuzzi NS; The Cleveland Clinic O.M.E. Arthroplasty Group. How to raise the bar in the capture of patient-reported outcome measures in total joint arthroplasty: results from active and passive follow-up measures. J Bone Joint Surg Am. 2024;106(10):879-890. https:\/\/doi.org\/10.2106\/JBJS.23.00558","DOI":"10.2106\/JBJS.23.00558"},{"key":"e_1_3_2_22_2","doi-asserted-by":"crossref","unstructured":"Iorio R. CORR Insights\u00ae: validation of the HOOS JR: a short-form hip replacement survey. Clin Orthop Relat Res. 2016;474(6):1483-1485. https:\/\/doi.org\/10.1007\/s11999-016-4797-0","DOI":"10.1007\/s11999-016-4797-0"},{"key":"e_1_3_2_23_2","doi-asserted-by":"crossref","unstructured":"Nilsdotter AK Lohmander LS Kl\u00e4ssbo M Roos EM. Hip Disability and Osteoarthritis Outcome Score (HOOS)\u2014validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10. https:\/\/doi.org\/10.1186\/1471-2474-4-10","DOI":"10.1186\/1471-2474-4-10"},{"key":"e_1_3_2_24_2","doi-asserted-by":"crossref","unstructured":"Wellington IJ Davey AP Cote MP et al. Substantial clinical benefit values demonstrate a high degree of variability when stratified by time and geographic region. JSES Int. 2023;7(1):153-157. https:\/\/doi.org\/10.1016\/j.jseint.2022.10.003","DOI":"10.1016\/j.jseint.2022.10.003"},{"key":"e_1_3_2_25_2","doi-asserted-by":"crossref","unstructured":"Spece H Kurtz MA Piuzzi NS Kurtz SM. Patient-reported outcome measures offer little additional value two years after arthroplasty: a systematic review and meta-analysis. Bone Joint J. 2025;107-B(3):296-307. https:\/\/doi.org\/10.1302\/0301-620X.107B3.BJJ-2024-0910.R1","DOI":"10.1302\/0301-620X.107B3.BJJ-2024-0910.R1"},{"key":"e_1_3_2_26_2","doi-asserted-by":"crossref","unstructured":"Piuzzi NS; Cleveland Clinic O.M.E. Arthroplasty Group. Patient-reported outcomes at 1 and 2 years after total hip and knee arthroplasty: what is the minimum required follow-up?. Arch Orthop Trauma Surg. 2022;142(9):2121-2129. https:\/\/doi.org\/10.1007\/s00402-021-03819-x","DOI":"10.1007\/s00402-021-03819-x"},{"key":"e_1_3_2_27_2","doi-asserted-by":"crossref","unstructured":"Tanghe KK Beiene ZA McLawhorn AS MacLean CH Gausden EB. Metrics of clinically important changes in total hip arthroplasty: a systematic review. J Arthroplasty. 2023;38(2):383-388. https:\/\/doi.org\/10.1016\/j.arth.2022.09.007","DOI":"10.1016\/j.arth.2022.09.007"},{"key":"e_1_3_2_28_2","doi-asserted-by":"crossref","unstructured":"Kunze KN Fontana MA MacLean CH Lyman S McLawhorn AS. Defining the patient acceptable symptom state for the HOOS JR and KOOS JR after primary total joint arthroplasty. J Bone Joint Surg Am. 2022;104(4):345-352. https:\/\/doi.org\/10.2106\/JBJS.21.00550","DOI":"10.2106\/JBJS.21.00550"},{"key":"e_1_3_2_29_2","doi-asserted-by":"crossref","unstructured":"Ng MK Golub IJ Piuzzi NS Razi A Wong CHJ Mont MA. Outpatient primary total hip arthroplasty is a safe alternative to inpatient primary total hip arthroplasty: a matched-cohort analysis study. Surg Technol Int. 2021;39:sti39\/1490. https:\/\/doi.org\/10.52198\/21.STI.39.OS1490","DOI":"10.52198\/21.STI.39.OS1490"},{"key":"e_1_3_2_30_2","doi-asserted-by":"crossref","unstructured":"Cleveland Clinic O.M.E. Arthroplasty Group. Understanding the main predictors of length of stay after total hip arthroplasty: patient-related or procedure-related risk factors?. J Arthroplasty. 2021;36(5):1663-1670.e4. https:\/\/doi.org\/10.1016\/j.arth.2020.11.029","DOI":"10.1016\/j.arth.2020.11.029"},{"issue":"1","key":"e_1_3_2_31_2","first-page":"45","article-title":"Outcomes vary significantly using a tiered approach to define success after total hip arthroplasty","volume":"43","author":"Carender CN","year":"2023","unstructured":"Carender CN, Gulley ML, De A, Bozic KJ, Callaghan JJ, Bedard NA. Outcomes vary significantly using a tiered approach to define success after total hip arthroplasty. Iowa Orthop J. 2023;43(1):45-54.","journal-title":"Iowa Orthop J"},{"key":"e_1_3_2_32_2","doi-asserted-by":"crossref","unstructured":"Rosinsky PJ Chen SL Yelton MJ et al. Outpatient vs. inpatient hip arthroplasty: a matched case-control study on a 90-day complication rate and 2-year patient-reported outcomes. J Orthop Surg. 2020;15(1):367. https:\/\/doi.org\/10.1186\/s13018-020-01871-8","DOI":"10.1186\/s13018-020-01871-8"}],"container-title":["HSS Journal\u00ae: The Musculoskeletal Journal of Hospital for Special Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15563316261487185","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15563316261487185","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15563316261487185","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T11:33:17Z","timestamp":1790508797000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15563316261487185"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":31,"alternative-id":["10.1177\/15563316261487185"],"URL":"https:\/\/doi.org\/10.1177\/15563316261487185","relation":{},"ISSN":["1556-3316","1556-3324"],"issn-type":[{"value":"1556-3316","type":"print"},{"value":"1556-3324","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"15563316261487185"}}