Paul Tornetta III, MD, PhD, FAAOS


Published 6/20/2024
Paul Tornetta III, MD, PhD, FAAOS

Advancing Quality and Innovation in Orthopaedics: A Look into AAOS Initiatives

With AAOS’ ongoing commitment to enhancing the health of patients with musculoskeletal conditions and promoting innovation in orthopaedics, we continue to evolve the tools and resources available to members.

In this message, I will highlight some recent accomplishments and ongoing initiatives of the Research and Quality Council, chaired by David S. Jevsevar, MD, MBA, FAAOS, which underscore AAOS’ dedication to excellence in patient care and professional support.

Guiding excellence in care
AAOS is currently working on the development of multiple Clinical Practice Guidelines and Appropriate Use Criteria, including carpal tunnel syndrome, acute isolated meniscal pathology, and implant infections in patients undergoing dental procedures. These guidelines are not mandates but serve as valuable tools emphasizing the best evidence to support our members and the broader healthcare community in delivering optimal care.

Pioneering progress
We continue to focus on key areas including emerging research and strategic partnerships. The Committee on Devices, Biologics, and Technology is leading the development of orthobiologics education and tools. The recently developed AAOS Biologics Dashboard offers members, patients, and payers an online, user-friendly tool to help navigate the approval status of biologic interventions. Consistent with the new AAOS Strategic Plan, the committee, chaired by Jason L. Dragoo, MD, FAAOS, has also prioritized patient education, releasing several summaries of biologic and technology-related content on OrthoInfo, AAOS’ award-winning patient-facing educational resource.

Important relationships like that with the FDA have been enhanced by AAOS-member-supported subject-matter expertise. We have held several successful joint symposia, including the AAOS/FDA Townhall at the AAOS 2024 Annual Meeting, which fostered dialogue about innovation within the orthopaedic community. Additionally, OrthoPitch debuted this year at the Annual Meeting and served as an incubator for orthopaedic innovation startups, reinforcing AAOS’ commitment to nurturing cutting-edge advancements and investing in the future of musculoskeletal health.

Empowering orthopaedic excellence
The AAOS Committee on Healthcare Safety, chaired by Mary Foley Carnduff, MD, MBA, FAAOS, is dedicated to equipping AAOS members with valuable tools to augment practice. Among the resources provided by this committee are:

  • The AAOS Device Recall Dashboard, offering timely recall information that is not easily accessible elsewhere and essential information for surgeons, including direct links to the FDA website
  • Patient safety resources aimed at promoting team-based practices and enhancing patient outcomes
  • AAOS toolkits that consolidate resources from across AAOS, covering topics such as workplace violence, healthcare professional wellness, pain management, and more

Improving patient outcomes utilizing data-driven decision making
The healthcare policy landscape has undergone a substantial shift, with federal payers like the Centers for Medicare & Medicaid Services (CMS) and commercial insurers now requiring the utilization of patient-reported outcome (PRO) data as a performance metric in orthopaedic care. In response, the AAOS Patient-Reported Outcomes Measures (PROMs) Workgroup, co-chaired by Kurt Spindler, MD, FAAOS, and Lauren M. Shapiro, MD, MS, FAAOS, has developed PROMs in Practice resources. These tools are designed to provide members with tools to help them integrate PROs into their practices.

Furthermore, the AAOS Registries offer support to participating sites by assisting with quality reporting for payer incentive programs, meeting accreditation requirements for various advanced certification programs, and facilitating other valuable data-reuse opportunities.

In addition to the activities and accomplishments achieved through the Research and Quality Council, the AAOS Registry Program continues to advance under the leadership of the Registry Oversight Committee, chaired by William J. Maloney, MD, FAAOS. With a focus on advancing the registries to support quality improvement across orthopaedics, there are several key initiatives across the program to continue the momentum in developing the registries.

Registry resources supporting surgeon reporting for CMS performance measures
The Hospital-Level, Risk-Standardized Patient-Reported Outcomes Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Performance Measure was finalized in the 2023 Inpatient Prospective Payment System Final Rule. Also known as the CMS Inpatient Quality Reporting (IQR) THA/TKA Patient-Reported Outcomes Performance Measure (PRO-PM), this performance measure specifically focuses on PROs to assess improvements in pain and functional status following these procedures.

The goal of this measure is to quantify pain and functional improvements with validated PROMs to improve patients’ lives. Preoperative data need to be captured for procedures performed beginning July 1, 2024. Outcomes will be publicly reported by CMS in 2027.

The American Joint Replacement Registry (AJRR) released an update in February 2024 in support of the IQR PRO-PM. The release included the addition of three PRO-PM-specific data elements to the AJRR specifications and the availability of an IQR PRO-PM report in RegistryInsights®. If your hospital or practice requires additional support in fulfilling this requirement, click here for more information on how AJRR can help. 

Continued focus on registry dashboard enhancements
AAOS Registries represent approximately 14,000 surgeons and contain more than 4 million patients. Our goal now is to enhance the registry dashboards to increase the value of participation for surgeons. Access to registry dashboards for AAOS members launched in August 2023, and approximately 300 members visit their dashboards each month. A guide for accessing registry dashboards can be accessed here. New dashboard features have launched for AJRR, the Shoulder & Elbow Registry, and the American Spine Registry (ASR). The new features include new quality measures and enhanced benchmarking. In late summer 2024, a new quality scorecard will be launched for AJRR to introduce a risk-adjusted 1-year revision rate for THA/TKA procedures to be added to the scorecard. This is an important major advancement. The additional benchmarked measures will include unplanned 90-day readmission rates, composite complication rates, and pre- and postoperative PROM completion rates at 1 year. Visit here for more information on continued dashboard updates.

New quality collaboration
In June, AAOS announced a formal collaboration with Blue Cross Blue Shield Association (BCBSA) to allow consenting participants’ quality outcomes data from AJRR and ASR to be used by BCBSA for evaluating current and prospective Blue Distinction Centers for Knee and Hip Replacement. As part of the collaboration, AAOS will provide a pathway for reporting patient-aggregated, deidentified, site- and surgeon-level data from consenting AJRR participants to BCBSA on a quarterly basis. The metrics will be used by BCBSA as part of a process that evaluates and designates qualifying sites as higher-quality institutions for knee and hip replacement. To find more information about how your hospital or ASC can participate in and benefit from the program, click here

Our goal is for AAOS to be the trusted source of musculoskeletal knowledge for its members, patients, and partners across the healthcare spectrum. Through strategic partnerships, steadfast commitment to quality enhancement, and a forward-looking approach to emerging areas, we will continue to propel orthopaedics into a future defined by excellence and innovation.

By aligning our initiatives with the evolving landscape of orthopaedics, AAOS is ensuring that its members are equipped with the resources and support necessary to deliver unparalleled care and drive meaningful progress in the field.

Paul Tornetta III, MD, PhD, FAAOS, is the 2024–2025 AAOS president and the director of orthopaedic trauma at Boston Medical Center. He is also professor and chair of the Department of Orthopaedic Surgery at the Chobanian & Avedisian School of Medicine of Boston University.