The article “Risk Stratification, Outcome Assessment, and Online Transparency” makes important points about the increased interest by consumers, payors, policymakers, and healthcare providers in assessing provider performance. Provider performance can be measured using a variety of metrics, including structural measures (adoption of electronic health records), process measures (implementation of evidence-based clinical practice guidelines), efficiency measures (utilization of resources and cost of care), and patient experience measures. However, the most direct assessment of the effectiveness of an intervention is patient outcomes.

The most important outcomes to orthopaedic patients is reduction in pain and improvement in quality of life and function. These outcomes are best measured through Patient-Reported Outcome Measures (PROMs), which, as the authors note, are currently logistically difficult to assess. However, the orthopaedic profession, with help from the AAOS and others, is making great strides in helping orthopaedic surgeons measure patient-reported outcomes.

An important dimension of measuring provider performance is risk adjustment. By adjusting outcomes based on the risk factors that are inherent to the patient population treated by the provider (such as age, sex, comorbid conditions, severity of arthritis), the outcomes that are most directly under the control of the provider can be isolated. This is an important concept, especially when attributing differences in outcomes to differences in provider performance.

As emphasized by the authors, it is important that the orthopaedic profession define which outcomes are most important to measure and which risk factors should be taken into account in risk models to facilitate fair and objective comparisons across providers. The AAOS is actively engaged in informing these discussions and trends through its recently launched Performance Measures Committee. Your input and guidance into how our performance as orthopaedic surgeons will be assessed is critical to our ability to improve the value of care we provide to patients.

Kevin J. Bozic, MD, MBA, chairs the AAOS Council on Research and Quality.

Information on his potential conflicts of interest can be found at www.aaos.org/disclosure