Published 9/1/2012

Know What CMS Is Saying About Your Performance

From September 4, 2012 to October 3, 2012, the Centers for Medicare and Medicaid Services (CMS) will conduct a “dry run” of the following new hospital-level performance measures for elective total hip (THA) and total knee arthroplasty (TKA): 

  • Risk-Standardized Complication Rates Following THA and/or TKA
  • 30-Day All-Cause Risk-Standardized Readmission Rates Following Elective Primary THA and/or TKA

Because  these measures are hospital-based, data will be shared with hospitals, not orthopaedic surgeons. AAOS members interested in these performance measurement data will need to seek them out from their hospitals.

Why should you care?
Beginning in 2013, these measures will be publicly reported on the hospital compare.gov website as part of the CMS Hospital Quality Reporting Program. All hospitals in which total joint arthroplasty is performed will be affected by these measures. The results of this test, or “dry run,” will be shared confidentially with hospitals, but not made available to the public. The formal roll out of the program will take place in January 2013.

“Orthopaedic surgeons should learn about the measures and review their results” suggested Dr. Bozic. “These patient-centered outcome measures provide us with an opportunity to learn about the quality of care we provide to our patients. I encourage AAOS Fellows to request the results from their hospital quality team and to evaluate and measure the results of their hospital-specific patient-level data.”

About the measures
Under the measure for Risk-Standardized Complication Rate Following THA and/or TKA, complications that can be reported will be identified during the index admission or associated with a readmission that occurs up to 90 days after the index admission date, depending on the complication. The follow-up period for complications from date of index admission is as follows:

  • Mechanical complications—90 days
  • Periprosthetic joint infection—90 days
  • Wound infection—90 days
  • Surgical site bleeding—30 days
  • Pulmonary embolism—30 days
  • Death—30 days
  • Acute myocardial infarction—7 days
  • Pneumonia—7 days
  • Sepsis/septicemia—7days

The measures were developed by a team of clinical and statistical experts from Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation under contract to CMS.  They were developed with extensive input from leading hip and knee surgeons, including Daniel J. Berry, MD, and Robert H. Bucholz, MD, both past presidents of the AAOS, and Kevin J. Bozic, MD, MBA, current chair of the AAOS Council on Research and Quality. A technical expert panel, which included Jay Lieberman, MD, third vice president of the American Association of Hip and Knee Surgeons, also contributed to the development of the final measures. The National Quality Forum (NQF) has endorsed both measures.

CMS will actively support hospitals in understanding their results via:

  • A national provider call on September 14, 2012
  • Responses to questions via email during the test period (September 4-October 3, 2012)
  • A Hospital-Specific Report containing detailed hospital results, state and national benchmarks, information about how to interpret the results, and an overview of the measures’ methodology
  • An Excel® file containing the hospital’s patient-level data and risk factor information
  • Information about the measures posted on www.qualitynet.org

The AAOS encourages fellows to seek out performance measurement data from their hospitals as an educational tool, since it will soon be made available to the public through the hospital compare.gov website. Any questions can be directed to Dr. Bozic, chair of the AAOS Council on Research and Quality Chair, at Kevin.Bozic@ucsf.edu or William Martin III, MD, AAOS medical director, at martin@aaos.org