AAOS Now

Published 7/1/2016

The "PROs" of Using AJRR to Meet CJR Requirements

The Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model, which first went into effect on April 1, 2016, requires hospitals within 67 geographic regions (known as metropolitan statistical areas, or MSAs) to bundle payments for lower extremity joint replacement (LEJR) procedures. Because data must be submitted from July 1 to Aug. 31, 2016, the 794 hospitals in areas designated as MSAs should be conscious of the steps they will take to qualify.

With the CJR, hospitals are given a composite quality score based on the performance and improvement of two required quality measures. These quality measures are incredibly significant to hospitals, as their composite score determines if CMS offers extra money or asks for repayment at the end of the year. A lesser-known method for adding points to your CJR composite score is to submit voluntary patient-reported outcomes (PROs), which is an area where the American Joint Replacement Registry (AJRR) can provide assistance.

Obtaining "bonus points"
The CJR is a 5-year model aimed at improving quality of care and cost efficiency in hip and knee procedures. It will be changing its data submission periods and requirements annually. AJRR—which collects hip and knee replacement data from hospitals, private practice groups, and ambulatory surgery centers, and presents the information in reports—collects all of CMS' voluntary PRO measures. Hospitals have the choice of submitting either the Veterans Rand 12 (VR-12) or Patient Reported Outcomes Measurement Information System (PROMIS) 10-Global, or either the Hip Disability and Osteoarthritis Outcomes Survey (HOOS) and Knee Injury and Osteoarthritis Outcome Score (KOOS), JR., or the HOOS and KOOS subscales.

Currently, CMS is testing out this preliminary PRO Performance Measures (PRO-PM) submission, and is offering two bonus points to hospitals that meet the requirements. Since it is the first year of the model, CJR is showing more leniency. To qualify in 2016, hospitals have to submit data on at least 50 percent or 50 hip and knee procedures, whichever comes first. This procedure volume is much lower than in the second year of CJR, which will require data to be submitted on at least 60 percent or 75 procedures. In the third year, 70 percent or 100 eligible procedures must be reported, while in years 4 and 5, CJR will require data on at least 80 percent or 200 eligible procedures.

Note that only preoperative and risk variable data between July 1 and Aug. 31 are required in the first year, with a submission deadline of October 31, 2016. Hospitals that submit PRO data now can boost their composite scores, as the rules only ask for a portion of what will later be expected. CMS plans to make PRO data submission mandatory before or during the CJR's third year.

"The AJRR strongly urges hospitals to begin the collection of PROs," said Daniel J. Berry, MD, chair of the AJRR board of directors. "Our platform provides options when it comes to the measures hospitals can submit, so registry participants are not limited by the PROs they collect.

"Whether a hospital has a long-standing PRO process or started collecting last week, we have an excellent solution that will assist in meeting the number of procedures required by the CJR," continued Dr. Berry. "If a hospital hasn't begun collecting yet, it may not be able to qualify for extra money this year. However, it will be ready for next year, which will still provide a sizable reward and is easier than if a hospital were to wait any longer."

Other benefits of collecting PROs
Another perk of starting to collect and submit PROs is the edge that PROs give physicians in a clinical setting. PROs can be valuable tools for helping physicians and patients understand a patient's health status, navigate the decision-making process for patient care, and evaluate the effectiveness of quality improvement initiatives. Furthermore, PRO data may help hospitals quantify their value. AJRR provides participants with PRO benchmarks to compare their results at the national level. Knowing how surgeons compare to other surgeons within their hospital—as well as with surgeons nationwide—is helpful. Additionally, hospitals can use that data to publicly report their own results. Having access to data from a robust national registry can enable hospitals to make informed decisions based on clinical facts and figures.

CMS is working toward making PRO-PM data submission mandatory in a couple of years. Although AJRR's Level II patient risk, comorbidity, and complications data capability will be released at a later date, the AJRR Level III PRO platform already satisfies the CJR PRO submission category. Hospitals may find that PRO-PM data will be useful this year if their other quality measure scores are not high enough to receive reconciliation payment.

"We go out of our way to offer helpful resources like our PRO platform because we recognize the importance of quality initiatives, such as the CJR," asserted Dr. Berry. "CMS, AJRR, and [hospitals that participate in AJRR] all have the same goal: to improve patient care. The AJRR will continue to be relevant in the world of federal quality initiatives and adapt to the ever-changing needs of our participants."

For more information on how the AJRR can help with CJR, please visit www.AJRR.net or call 847-292-0530.