Joseph P. DeAngelis, MD, and William Timothy Brox, MD
One of the cornerstones of current healthcare reform efforts is the attempt to measure the impact of implementing evidence-based guidelines in clinical practice. As the nation moves toward value-based healthcare delivery, these “performance measures” may provide the link that makes compensation proportional to performance.
As physicians, we realize that neither regulators nor legislators should define these measures. Orthopaedic surgeons are the most qualified professionals to develop and evaluate quality of care measures for patients with musculoskeletal conditions, and taking steps to own this process is imperative for our profession.
Earlier this year, the members of the AAOS Performance Measure Committee (PMC) gathered to discuss the next steps in their charge to develop, validate, and implement orthopaedic-specific performance measures. Acting under the purview of the Council on Research and Quality, the PMC has been tasked with providing Academy members with practical tools to improve the quality of care for orthopaedic patients.
This endeavor, which will be conducted in conjunction with orthopaedic specialty societies, aims to establish a framework for evaluating and endorsing measurement tools that help patients and physicians quantify their clinical outcomes. The committee’s current efforts are focused on two areas: assessing function and pain in patients with osteoarthritis and the management of hip fractures in the elderly. Future endeavors will likely include measures for other musculoskeletal conditions that have sufficient evidence to guide the process, for example those with clinical practice guidelines (CPGs).
As part of the AAOS strategic plan, the PMC facilitates the transition from CPGs and appropriate use criteria (AUC) into tangible clinical performance measures (CPM) focused on relevant and important clinical outcomes. Particular emphasis will be placed on the transition from these evidence-based recommendations to the practical implementation of the suggested behaviors.
Starting with CPGs
CPGs are developed by AAOS physician volunteer work groups to advance physician-patient communications and improve the diagnosis and treatment of musculoskeletal conditions. CPGs are developed using sound, evidence-based methodology, beginning with a comprehensive systematic review of the relevant orthopaedic literature. (See “AAOS to Add Systematic Reviews to Evidence-based Products”.)
Subject-matter expert workgroup panels then fashion concrete recommendations that can serve as educational tools. All recommendations are based on assessments of current scientific and clinical information and accepted approaches to treatment. Current CPGs can be found on the AAOS website (www.aaos.org/guidelines).
Over the past 3 years, the AAOS and orthopaedic specialty societies have made considerable headway in writing and publishing these quality measures and have increased the number of instruments significantly. Many of these resources enable physicians to satisfy the requirements stipulated by the Centers for Medicare & Medicaid Services as part of existing legislature. Because the situation is rapidly changing, continued and increased efforts will be needed to document the significant value of orthopaedic patient care efforts. This documentation will help preserve reimbursements and remuneration as competition to shrink healthcare budgets increases.
Ending with CPMs
Performance measures as developed will be based on CPGs, which provide the evidence to support high value healthcare delivery. They will be selective, focused, measurable, and actionable. Over the next 4 years, the PMC plans to complete a minimum of six performance measure sets, along with implementation and validation tools.
The PMC is a critical component of the plan for orthopaedic surgeons to retain and exert a leadership position in defining quality metrics as they relate to the practice of orthopaedic surgery. AAOS members who wish to increase their understanding of performance measures are encouraged to review the free “Performance Measures Development Webinar” and the Frequently Asked Questions on the Performance Measures Page of the AAOS website (www.aaos.org/research)
In addition, the AAOS has a position statement on “Public Reporting of Provider Performance” that outlines the development of public reporting programs and sets forth the Academy’s position on their use.
Joseph P. DeAngelis, MD, and William Timothy Brox, MD, are members of the AAOS Performance Measures Committee.
AAOS Position Statement
Public Reporting of Provider Performance
National Quality Measures Clearinghouse