Letter from the Executive Director

AJRR Executive Director
Mr. Jeffrey P. Knezovich, CAE

An ad campaign launched in 1968 which stated, "You've come a long way, Baby" is apropos to what has been happening at the AJRR. As we enter into the second half of 2015, and as you read this issue of The Register, I trust you'll find more information on the progress and activities that we're achieving to help make our Registry more robust, relevant, and substantial. The most significant evolution as of today is getting a large magnitude of hospitals signed up and submitting data - we hit our 500th participating hospital in May!

After year one (2011) of operation, AJRR had 20 institutions participating in the third iteration of a Registry. Our numbers have grown to over 525 participating hospitals with over 260,000 procedures collected. This means we are presently collecting approximately 20% of all the procedures being performed in the U.S. By 2019, our goal of 90% of all the procedures will be met.

Other progress includes:

We're committed to enhancing our communications; therefore, you'll see that we totally revamped our website to make it easier to disseminate information, educate, and create awareness about our progress.
We continue to work in Washington, D.C. to educate the legislators about the importance of the emerging U.S. registry systems and advocate for incentivizing hospitals that support the AJRR.
We continue to work with colleagues in international registries to acquire a harmonized component database. Our efforts in this area include component data from the International Society of Arthroplasty Registries (ISAR), industry records, and other reporting groups who have the knowledge and resources to catalog this data.
Once the individual hospital contract negotiations are complete, the data pipeline begins to develop, including security evaluations, IT infrastructure review, and countless preliminary data extractions. Approximately 5,000 procedures a week are scrubbed for accuracy. AJRR also conducts a data audit of randomly selected institutions to determine if all procedures were properly reported and that our data reflects the hospital's electronic medical records. This provides assurance for the validity of the data being reported upon and denotes the integrity of the Registry.
Just five years ago, leadership considered a Level I (Patient/Procedural data) Registry for Hip and Knee Arthroplasty an important accomplishment to add to the orthopaedic community. In a very short period of time, legislative initiatives and regulatory decisions have moved us to a more robust reporting model to include Patient Reported Outcomes Measures (PROMs). On October 1, 2015, in conjunction with the ICD-10 conversion and release, the AJRR will stand alone as the only national orthopaedic registry able to collect and report PROMs. This is a huge achievement for the AJRR and the countless volunteers who helped get us to this point.

Our success is due in part to the early signees who believed in the importance of our Registry. We applaud all institutions who are now providing the necessary resources and have aspirations to see this Registry evolve into the number one resource for dependable and reliable hip and knee arthroplasty data. As described in our first Annual Report, "We look back at our earlier challenges not as failures, but as successes that we have built upon." Yes, we have come a long way!

Many thanks,

AJRR Launches New, State-of-the-Art Website

Enriches Relationships and Communication with Patients, Surgeons, and Hospitals

Our new homepage launches you directions to provide information on a variety of Registry topics

We officially launched our new website that is more functional and interactive with its users, be it patients, surgeons, or hospitals. The website follows a parallax design that features a section for the California Joint Replacement Registry (CJRR), an interactive map of AJRR participants, a dashboard for the AJRR Board of Directors, and much more. Those who visit the site will benefit from its expanded abilities in accessing information about items such as the User Group as well as registering for events and upcoming webinars. To experience the new features of the site, click here.

AJRR News & Events

AJRR July Board of Directors Reception and Meeting

On July 16, AJRR hosted a Wine & Cheese Reception for the AJRR Board of Directors (BOD) and staff, AAOS staff, and guests at the AJRR headquarters. Those who attended were treated to wine and cheese while touring the new facilities. On July 17, 2015, the AJRR BOD convened their summer meeting at the AAOS headquarters in Rosemont, Ill. Many guests were in attendance to facilitate discussions on specific topics including Ms. Simone Karp from CECity who identified the proposed change to the Physician Quality Reporting System (PQRS) and Ms. Alice Westerfield from Liaison Technologies who identified ways to better collect and secure our data. Two committees also met on July 16 - the Public Advisory Board (PAB) and the Finance and Compensation Committee. We thank all the BOD and committee members for their time and dedication.

The AJRR PAB is looking for volunteers to be part of its committee. If you are interested in improving the value of AJRR by ensuring a public voice, serving as an ambassador, and providing input into AJRR, please contact Lori Boukas, Director of Marketing and Communications and staff liaison for the PAB at boukas@ajrr.net.

AJRR Executive Director Mr. Jeffrey P. Knezovich, CAE; AAOS COO/CFO Mr. Richard J. Stewart; AAOS CEO Karen L. Hackett, FACHE, CAE; and AJRR Legal Counsel Mr. Rob Portman

AJRR Program Coordinator Mr. Phil Dwyer; AJRR Data Submission Analyst Ms. Kristine Baldwin; and Public Advisory Board Member Mr. David Mekemson

CECity Chief Business Officer Ms. Simone Karp presenting to the Board of Directors

Webinars

The Joint Commission Webinar

On Wednesday, July 8, AJRR partnered with The Joint Commission to host an Introductory webinar for their members. Click here to access a replay of the webinar and here to view the slides used during the presentation.

PQRS Webinar

AJRR co-hosted a webinar with CECity on July 28. During this presentation, CECity representatives discussed the new Qualified Clinical Data Registry (QCDR) reporting method of the Physician Quality Reporting System (PQRS). To listen to a replay of this webinar, click here. To view the slides from this webinar, click here.

ICD-10/UDI Transition Webinars

The AJRR Director of IT, Randy Meinzer, will be hosting a series of webinars on topics of transitioning from ICD-9 to ICD-10 for all hospitals that are interested. He will detail how this transition will affect the data submission process to the AJRR as well as potential obstacles IT teams will face. These webinars are free to attend! Following the presentation, Mr. Meinzer will host a question and answer session about the transition. For a list of date and times and to register for a webinar event, click here.

Introductory Webinars

AJRR staff continues to host Introductory webinars for those who are interested in joining the Registry and would like a first-hand look at the Demand Reporting & Electronic Dashboard System. Listed below are the dates for the upcoming Introductory webinars.

Wednesday, August 19 @ 12 p.m. CST
Wednesday, September 16 @ 12 p.m. CST
Wednesday, October 21 @ 12 p.m. CST
Wednesday, November 18 @ 12 p.m. CST
Wednesday, December 16 @ 12 p.m. CST

To register for one of these webinars, click here.

Data Chat

ICD-10 Transition: Are you ready?

In the next few months, AJRR IT staff will be offering webinars to provide information about the ICD-10 transition and how it will affect data submission to the Registry. These webinars are free to attend. To register, click here.

AJRR Partners with Mathematica Policy Research: Seeking Test Sites

Mathematica Policy Research and its partners are working under contract with the Centers for Medicare & Medicaid Services (CMS) to test new measures for potential use by eligible professionals (EPs) in the Electronic Health Record (EHR) Incentive Program. Mathematica is seeking hospitals and surgical centers to serve as test sites for two clinical quality measures under development: Functional status assessment and improvement for patients who received a primary, elective total hip arthroplasty or total knee arthroplasty (FSA-TKA/THA). The measures assess care for a total hip replacement or a total knee replacement based on standardized, patient reported outcome measures (PROMs) tools and are calculated at the EP level.

Broadly, they seek test sites that currently capture the following data elements in an EHR:

Pre- and post-surgical FSA scores for primary, elective TKA/THA patients (using VR-12, Promis 10, or HOOS/KOOS). The pre-surgical score must be collected in the 90 days prior to or including the day of surgery and the post-surgical score must be collected 9-12 months after surgery
Diagnosis of severe dementia or other cognitive disorders (to exclude patients with a severe dementia)
Diagnosis of acute injury/fracture (to exclude patients whose TKR/THR is not elective)

They are looking for sites with existing data for at least 50 patients-that is, at least 50 patients with both a pre- and post-surgical PRO score.

Sites that join the project may receive an incentive payment of $4,000. If you are interested in participating in the project, please contact Kristie Liao at Mathematica Policy Research at kliao@mathematica-mpr.com.

UDI - Unique Device Identifier Research

Natalia Wilson, MD, MPH, Research Assistant Professor at Arizona State University is looking to identify hospitals that are utilizing UDI/UDI Proxy to document hip and knee implant components used in total hip and knee arthroplasty. If you or your hospital are currently utilizing a UDI/UDI Proxy and would like to participate in this study, please contact Natalia Wilson, MD, MPH at natalia.wilson@asu.edu.

AJRR currently has 528 participating hospitals in all 50 states! Click here for a full list of all participating sites.

PQRS/QCDR Update

EPs can easily register for 2015 reporting on the Orthopaedic Quality Resource Center website

The new AJRR Orthopaedic Quality Resource Center website for 2015 Physician Quality Reporting System (PQRS) data will launch on August 5, 2015. This will allow physicians to register for 2015 reporting. Eligible professionals (EPs) can report their Medicare patient data to the Center for Medicare & Medicaid Services (CMS) while being provided with timely, continuous performance monitors, performance gap analysis and patient outlier identification, access to patient care management tools, targeted education, and various resources used to close performance gaps, and registry benchmarks.

From now on, the program will apply a negative payment adjustment to EPs and PQRS group practices who did not satisfactorily report data on quality measures for covered professional services in 2013. Those who report satisfactorily for the 2015 program year will avoid the 2017 PQRS negative payment adjustment.

For more information on PQRS or the payment adjustment, visit the PQRS webpage here.

From the Hill

By Judi Buckalew, BSN, MPH

Visit our new Advocacy & Public Affairs section on the website to learn more

On July 6, 2015, the Centers for Medicare &

Medicaid Services (CMS) released a Medicare payment model for hip and knee replacement procedures, the Comprehensive Care for Joint Replacement (CCJR). This model will test bundled payment and quality measures for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute providers to work together to improve quality and coordination of care and to secure savings for the Medicare program.

The CCJR model is a retrospective bundled payment model. It would hold hospitals financially accountable for the cost and quality of a CCJR episode of care defined by the admission of an eligible Medicare fee-for-service beneficiary to a hospital paid under the Inpatient Prospective Payment System that results in a discharge paid under MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or MS-DRG 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities).

On July 15, 2015, CMS issued a proposed rule, the FY 2016 Physician Fee Schedule (PFS) that updates payment policies and payment rates for services provided under the Medicare PFS on or after January 1, 2016. The rule contains proposed changes to several quality reporting initiatives that are associated with PFS payments, the PQRS, Medicare Shared Savings Program, Medicare Electronic Health Record Incentive Program, the Merit-Based Incentive Payment System (MIPS), Alternative Payment Models, Value Based Modifier as well as changes to the Physician Compare tool housed here.

The Secretary's Advisory Committee on Human Research Protections (SACHRP) hosted a meeting on July 21 - 22, 2015 that was focused on providing expert advice and recommendations to the Secretary on issues and topics pertaining to the protection of human subjects. The presentation gave an overview of QCDRs, the CMS quality reporting programs, the Medicare Access and CHIP Reauthorization Act (MACRA), the Common Rule, and suggestions from CMS to the Office of Human Research Protection (OHRP).

For ongoing information about our advocacy & public affairs initiatives, visit our new section on our website here.

ISAR Update

The International Society for Arthroplasty Registers (ISAR) is a global consortium of joint replacement registries. The consortium facilitates the sharing of information to enhance the ability of participating countries to meet their own objectives. ISAR also assists in the development of collaborative activities and provides support to both established and developing registries, such as the AJRR.

ISAR began as a collaborative effort primarily including Scandinavian countries Australia, Canada, and New Zealand. Recently, membership has grown to include over 40 registries from across Europe, Asia, and Africa, along with national and local registries in the U.S.

Sponsored by ISAR, the Fourth International Congress of Arthroplasty Registers was held May 23-25 in Gothenburg, Sweden. Home of the Swedish Hip Arthroplasty Register (SHAR), the oldest arthroplasty register, the University of Gothenburg was the ideal site

for this conference.

A number of AJRR Board and Committee members were in attendance with many presenting scientific findings or moderating sessions. These included Medical Director Dr. David Lewallen, Board members Blair Fraser and Dr. Gregory Krivchenia, and Committee members Michael Dohm, Stephen Graves, Brian Hallstrom, Richard Hughes, Hilal Maradit-Kremers, and Jing Xie. AJRR Director of Analytics Dr. Caryn Etkin presented an overview of the status and growth of AJRR along with a summary report of our Level II pilot study.

AJRR is paying special attention to exciting developments which arose from the meeting, including the concept of an "average" patient as developed by the SHAR; and two new Patient Reported Outcome Measures, the HOOS, JR and KOOS, JR. The Congress also included presentations on hip fracture and shoulder arthroplasty, which were new content areas for the meeting.

Champions of the Quarter

Each quarter, AJRR highlights individuals from participating hospitals who have championed AJRR enrollment and have demonstrated outstanding cooperation and professionalism while helping to implement the registry into their institutions. Selections for Champions of the Quarter are made based on nominations and are voted on by AJRR staff. To view our past Champions, visit our Champion of the Quarter section on our website. To nominate someone from your hospital, please contact miller@ajrr.net.

This quarter, AJRR would like to recognize Ms. Natalie Reed from Willamette Valley Medical Center in McMinnville, Ore., Mr. Joseph Greene from University of Wisconsin Hospitals in Madison, Wis., and Dr. Gary Wyard from Twin Cities Orthopedics in Waconia, Minn.

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Ms. Natalie Reed

Ms. Natalie Reed has been working for Willamette Valley Medical

Center for the past 15 years. She was a physical therapist at the hospital for most of her time there but has been the Joint Replacement Institute of Oregon Program Manager for the last five years. In this position, she has many responsibilities including daily program operations, data collection, and working closely with other hospitals and staff; however, she really loves educating and working with patients and their families by serving as their "go-to" person.

Q: What made you decide to enroll your hospital in AJRR?

A: It is important to be part of the national registry to benchmark metrics to improve the quality of care and outcomes for patients undergoing joint replacement surgery. We need to be part of this movement to provide the best care to our patients.

Q: Would you recommend enrollment with AJRR to others?

A: Absolutely, for anyone performing these procedures, they need to be part of the registry moving forward.

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Mr. Joe Greene

Mr. Joseph Greene has been working for the University of Wisconsin Hospital Department of Orthopedics and Rehabilitation since 1991 as the Program Manager in Outreach and Development. In this position, Mr. Greene oversees regional relationships with providers, independent practices, and health systems. He also assists in raising philanthropic funding and manages many projects that improve the healthcare service delivery like managing their relationship with Epic and developing UW Hospital's orthopedic population health initiatives within the UW Health System.

Q: What made you decide to enroll your hospital in AJRR?

A: Although our interest likely began with the need for us to have an effective mechanism to identify patients with specific types of implants, we recognized the need to report to an external registry for many other purposes like improving quality and safety, along with increasing interest of payers and the government in requiring reporting now and in the future. It is very important for us to be able to evaluate our overall total joint service against other relevant benchmark institutions. In our opinion, the AJRR will be the best resource and the best mechanism for our program and other programs to accomplish this goal.

Q: How was your experience working with the AJRR staff?

A: The AJRR realizes how important it is to leverage new healthcare information functionality and EMR technology to improve outcomes and quality across not only an individual institution, but also across the entire country from a population health perspective. They are tackling some very challenging questions and projects right now that often have no defined road map. So, you have to create one and learn quickly. They enjoy the opportunity to create a registry that is very usable, and that will mean a lot to quality patient care in orthopedics.

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Dr. Gary Wyard

Dr. Gary Wyard has been with Twin Cities Orthopedics since 1978 and currently serves as the Chief Medical Officer. In this position, Dr. Wyard's main job is to peer review within the organization as well as supervise initiatives on quality of care issues, outcome measures, patient satisfaction and PROMs.

Q: Would you recommend enrollment with AJRR to others?

A: I definitely would recommend enrollment with AJRR. I know the AJRR's mission is to have at least 90% of procedures, and I believe that would be a benefit of the orthopedic community and the community that the orthopedic surgeons service.

Q: What do you like most about the AJRR?

A: It's mission. I am also impressed with the structure of its board; it is one of the reasons we joined AJRR. There are other high profile doctors in our community that have been very active with the American Academy of Orthopaedic Surgeons (AAOS), also various people from the Mayo Clinic, including some of AJRR's governance leaders, who directed me in the direction of selecting AJRR.

AJRR in the News

AJRR and MAI Enter into Collaborative Agreement

AJRR has entered into a collaborative relationship with Mendenhall Associates, Inc. (MAI), publisher of Orthopedic Network News, to provide data services to augment the master file of orthopaedic implants and components maintained by the AJRR. Click

here to read more.

AJRR Releases Orthopaedic Quality Resource Center Web Portal

AJRR has launched a web portal whereby its participating surgeons can report to the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) program. AJRR is one of 49 organizations in the US designated as a Qualified Clinical Data Registry (QCDR) by CMS to provide expanded, comprehensive medical procedure outcome information, including patient safety data. PQRS requirements can be completed based on satisfactory participation with AJRR. Click here to read more.

AAHKS Update

The 25th Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) takes place November 5-8, 2015 at the Sheraton Dallas Hotel in Dallas. "The Business of Total Joint Replacement: Surviving and Thriving" is the newest course added to the educational schedule that takes

place prior to the scientific program. This course was created especially for hospital administrators, practice administrators, out-patient surgery center administrators, payors, and surgeons who deal with improving quality, cost reduction, standardization of care, and risk. Contracting for bundles and total cost of care will also be discussed. Lunch will be served, and there will be open discussion at the end of the course. The course takes place on Friday, November 5 from 7:00 a.m. - 2:00 p.m. This is a great session for staff who want information on how registries improve quality!

AJRR will have a booth in their Exhibit Hall at this year's meeting. Be sure to stop by if you are in town to pick up our 2014 Annual Report that will be making its debut at this event!

To find out more about the AAHKS Annual Meeting, visit their homepage here. If you have questions about the event, please contact Ms. Eileen Lusk, Director of Education and Meetings at meeting@aahks.org.

Publications of Interest

Ayers DC, Fehring TK, Odum SM, Franklin PD. Using Joint Registry Data from FORCE-TJR to Improve the Accuracy of Risk-Adjustment Prediction Models for Thirty-Day Readmission After Total Hip Replacement and Total Knee Replacement. J Bone Joint Surg Am. April 2015; 97 (8): 668 -671. doi: 10.2106/JBJS.N.00889

Kesterke N, Egeter J, Erhardt JB, Jost B, Giesinger K. Patient-reported outcome assessment after total joint replacement: comparison of questionnaire completion times on paper and tablet computer. :Arch Orthop Trauma Surg. July 2015; 135(7): 935-941.

Liddle AD, Pandit H, Judge A, Murray DW. Patient-reported outcomes after total and unicompartmental knee arthroplasty: A study of 14,076 matched patients from the National Joint Registry for England and Wales. Bone Joint J. June 2015; 97-B(6): 793-801. doi: 10.1302/0301-620X.97B6.35155

Niinim�ki TT. The reasons for knee arthroplasty revisions are incomparable in the different arthroplasty registries. Knee. March 2015; 22(2): 142-144.

Schrama JC, Fenstad AM, Dale H, Havelin L, Hallan G, Overgaard S, et al. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements: A study of 390,671 primary arthroplasties from the Nordic Arthroplasty Register Association. Acta Orthop. March 17, 2015 [epub ahead of print] doi:10.3109/17453674.2015.1017793

Stryker LS, Odum SM, Fehring TK, Springer BD. Revisions of Monoblock Metal-on-metal THAs Have High Early Complication Rates. Clin Orthop Relat Res. February 2015; 473(2): 469-474

For a full list of publications of interest, click here.

Special Thanks to All of Our Contributors!

The Register is the official newsletter of the American Joint Replacement Registry serving to connect the orthopaedic community. For questions, comments, or concerns, please contact Terra Miller, Marketing and Communications Specialist at miller@ajrr.net.

The Register editor: Terra Miller, MS

Contributing authors: Natasha Prosek, Lori Boukas, Caryn Etkin, PhD, MPH, Judi Buckalew, BSN, MPH, Marisol Goss.

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