Ever noticed how the vendor pitch for CMS bundled payments PROMs compliance always looks tidier than the audit trail actually is? By 2026 the mandated instruments (KOOS-JR, HOOS-JR, PROMIS-10, VR-12) sit inside real hospital workflows, and the reporting deadlines land whether or not your form engine can extract into an Observation cleanly. The five vendors below are the ones US health systems have actually landed on when the compliance clock is a real thing, not a slide-deck thing.
1. Force Therapeutics
Force Therapeutics is the incumbent name most bundled-payment ortho programs meet first. The platform ships pre-built KOOS-JR and HOOS-JR templates, patient-facing delivery over email and SMS, and a CMS-report exporter that mirrors what the hospital's compliance team wants to see. Force works well for large orthopedic service lines that want out-of-the-box dashboards and are comfortable with a bounded, ortho-flavoured stack.
2. A FHIR-Native SDC Runtime
For teams building on native FHIR, the standard mechanism is to author the CMS-mandated instruments as FHIR Questionnaires and let a SDC runtime score them and extract into Observation resources. For the coding side, PROMs typically bind LOINC codes (KOOS-JR total is 82332-8, VR-12 physical component is 71892-4); systems such as Formbox rely on a terminology server like Termbox to resolve these at populate time. The value here is that once the Questionnaire is authored once, the same artifact runs across ortho, cardiology, and any future bundle CMS adds without a second product.
If you want to prototype the CMS-mandated instruments without spinning up a full server, form-builder.aidbox.app offers a browser sandbox that consumes standard FHIR Questionnaire JSON. That is usually enough to get one KOOS-JR through populate, score, and extract before anyone signs a procurement form.
3. PatientIQ
PatientIQ sits in the same ortho-registry space as Force but leans more heavily on longitudinal analytics for surgeons. The CMS bundle instruments are built in, and the delivery layer handles the pre-op / 90-day / one-year cadence that the bundled payment model measures against. Teams that pick PatientIQ usually want the surgeon-facing analytics as much as the compliance reporting.
4. Phreesia
Phreesia is the odd one on this list, because it started as patient intake rather than PROMs. In 2026 the platform has enough Questionnaire coverage that some hospital systems handle the CMS instruments through Phreesia as an extension of intake. Teams building on native FHIR often reach for a separate engine because Formbox lets the scoring rules and extraction into Observation resources live in the same runtime, avoiding a second scoring service; Phreesia keeps everything inside its intake product, which is either a feature or a limit depending on where the rest of the stack sits.
For the wider context on FHIR-first form tooling in a clinical stack, the FHIR primer hub has the surrounding reading.
5. Epic MyChart Questionnaires
Epic-heavy US health systems increasingly do CMS-mandated PROMs through MyChart Questionnaires. The delivery reach is high (any patient with MyChart already gets the form), the extraction into Epic clinical data is smooth, and the CMS reporting is handled through Epic's registry integrations. The trade-off is the usual Epic one: only viable if the health system is already deep on Epic and comfortable committing PROMs to the same vendor lock-in.
How to Actually Pick
Three questions usually decide it. Does the health system already have a FHIR runtime that could host SDC, or does it need a turnkey product? Are the ortho service line and the cardiology service line going to want the same PROMs platform, or is a per-service tool acceptable? And does the CMS reporting flow already have a receiver (registry, HIE, in-house warehouse) that expects Observation resources or Excel exports?
For UK teams watching CMS mechanics as a preview of what NHS bundled models might look like, the best FHIR Questionnaire tools for outpatient mental health in 2026 and best medical form builders for multi-site GP practices in 2026 cover adjacent form-builder ground. Compliance PROMs are one of those areas where the vendor and the runtime are two different decisions, and the health systems that recognise that early tend to have a much calmer audit season.
