Letter from the Executive Director

AJRR Executive Director 

 Mr. Jeffrey P. Knezovich, CAE

The year is wrapping up quickly, and I am glad to say that 2015 has been another good one for AJRR. We returned with high spirits from the American Association of Hip and Knee Surgeons (AAHKS) 25th Annual Meeting a couple of weeks ago. Our November Board of Directors Meeting was also held during the AAHKS Annual Meeting, and we reflected on another successful quarter. With nearly 600 participating hospitals, the AJRR is steadily growing to become the most significant orthopaedic Registry in America.
November saw the launch of our Level III patient-reported outcome (PRO) data platform. We can now accept patient-reported outcomes from participating institutions. Over the course of the coming weeks, we will be educating institutions on how to submit their Level III data to us. This is hugely significant to our participants, since in time our Registry will have benchmark PRO data that they can use to compare with their facility.
In addition to the Level III launch, the 2014 Annual Report was released on November 6. With a 164% increase in procedures and a doubling of the number of figures and tables since last year's report, the information provided within is much more substantial. Data collection for next year's report ends on December 31, 2015, so there's still time to be included! Sign and submit your contract to your AJRR Program Coordinator now and your hospital's name will be listed.
In closing, we would like to thank our Board of Directors and all of our staff for their dedication and efforts this year. Board members Drs. Anthony Rankin and Pamela Plouhar will be leaving us in 2016, and we want them to know that we are very grateful for the contributions they have made to this organization. The biggest thanks goes out to all of the hospitals, private practice groups, and surgery centers that submit data to us. It's because of you that we continue to be the National Registry that surgeons can turn to for meaningful data to improve patient outcomes!

Many thanks, and have a wonderful Thanksgiving holiday! 

AJRR News & Events
AJRR at the 25th AAHKS Annual Meeting
The 25th AAHKS Annual Meeting took place from November 5-8 in Dallas. On November 6, Program Coordinator Phil Dwyer gave demonstrations of the new Level III patient-reported outcome platform to meeting attendees. Our booth was stocked with helpful literature that surgeons and other attendees were able to bring home so that they could learn more about what our Registry had to offer. We engaged passersby's at the booth, and filled them in on how they could get involved with the National Registry.
One of the highlights of the meeting was AJRR Board of Directors Chair, Dr. Daniel J. Berry's presentation on the AJRR 2014 Annual Report on Hip and Knee Arthroplasty Data. Since the report was released that day, Dr. Berry's speech touched on key findings from our 2014 data that is now available to the public (View a copy of his presentation here). The California Joint Replacement Registry (CJRR) 2014 Annual Report was released on the same day with data exclusively from participating California hospitals.
Our booth at the 25th AAHKS Annual Meeting
AJRR Director of IT Mr. Randolph Meinzer with AJRR Program Coordinator Mr. Phil Dwyer, demonstrating the new Level III PRO
Dashboard System

AJRR Board of Directors Chair, Daniel J. Berry, MD,
presenting the AJRR 2014 Annual Report to over
1,500 AAHKS Annual Meeting registrants
Upcoming Webinars
Patient-Reported Outcomes Informational Webinar
Our Analytics Department will provide information about the AJRR Level III/patient-reported outcomes (PRO) platform on December 9. Recommended PRO measures will be discussed, as well as the reasons for why starting a PRO data collection program will be beneficial for you and your colleagues. We will demonstrate how to use the new dashboard system and field any questions on how to get started reporting. This is a great webinar to attend if you are thinking of starting a PRO program or are ready to submit your PRO data to our Registry! Click here to register.
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. Yesterday marked the last AJRR Introductory Webinar of the year. The next time this webinar will be offered is on January 13, 2016. Click here to register.
Previous 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 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 Webinar
The AJRR Director of IT, Randolph Meinzer, hosted a webinar on the topic of transitioning from ICD-9 to ICD-10. He detailed how this transition affects the data submission process to the AJRR as well as potential obstacles IT teams may continue to face. Following the presentation, Mr. Meinzer hosted a question and answer session about the transition. To view the slides from this webinar, click here.
Look for Us in the December Issue of Arthroplasty Today  
The December issue of Arthroplasty Today is coming soon! As mentioned in our last newsletter, Arthroplasty Today, published by Elsevier on behalf of AAHKS, is now the official publication of the AJRR. There will be an article about the AJRR 2014 Annual Report in the upcoming issue. Click here to sign up for new content alerts from Arthroplasty Today.
AJRR Leadership Spotlight

AJRR Director of Analytics,

Caryn Etkin, PhD, MPH

Caryn Etkin, PhD, MPH, Director of Analytics at AJRR, has been elected as Chair of the Aging and Public Health (A&PH) section of the American Public Health Association (APHA). Etkin has been a member of the A&PH section since 1999, when she attended her first APHA Annual Meeting. After being encouraged to hold leadership positions in the section, Etkin has served as Secretary, Section Councilor and A&PH Awards Chair. She has been the Chair-Elect for the past two years.
"By staying involved with A&PH for so many years, I continue to enhance my understanding of the varying ways section members are addressing the health needs of older adults throughout the US, and across the world," said Etkin. "I am honored to soon be starting my time as Chair and will do my best to live up to the high standards set by those who have served before me."
Congratulations, Caryn! We're proud of you, and know that you will do a great job.

Data Chat

ICD-10 Transition
All procedures performed after October 1, 2015 should follow the new AJRR ICD-10 Level I layout. The new data specifications can be found on our website. Another link on the "ICD-10 Conversion" page leads to the ICD-10 triggering list. We suggest that you periodically review this list to ensure that you are submitting all of the appropriate codes to us. Please note, you may now have to query your report for not only the primary procedure code, but the secondary, to make sure that we are receiving all removal-replacement dual-coded procedures.
For all participating hospitals that are currently submitting data, we highly recommend that you submit an ICD-10 test file. This file can be uploaded to our secure site like all other submissions. Please allow a week for review; you will be notified of any changes that should be made to your report. Once a successful test is run, you can continue with regular data submissions.
Our IT staff is currently working on converting all of the ICD-9 procedures in the Registry to their corresponding ICD-10 procedures. Once the conversion is completed, authorized users will be able to view the updated ICD-10 dashboards and reports. ICD-9 codes will be preserved and still viewable as well.
In addition to the ICD-10 conversion, the Registry will contain several new features. These include a network dashboard view that summarizes and reports on all hospitals within the network, and expanded patient-reported outcome capabilities including national, network, and hospital based comparative results. We can still accept retrospective ICD-9 coded procedures for all new hospitals joining our Registry. The mapping to the corresponding ICD-10 will occur within our database.

AJRR currently has 596 participating hospitals in all 50 states! Click here for a full list of all participating sites.

Standard Yearly Reports Coming Soon

Our non-subscribing hospitals from 2014 and earlier receive a free Standard Yearly Report with their data compared to national benchmarks! If you are employed by one of these hospitals, you can expect to get your Standard Yearly Report in the mail in mid-December, before the holidays hit.
From the Hill
By Marisol Goss
Visit the Advocacy & Public Affairs section on our website to learn more
The last few months have been centered primarily on regulatory activities, starting with the Comprehensive Care for Joint Replacement Proposed Rule. On July 6, 2015 the Centers for Medicare & Medicaid Services (CMS) announced the Comprehensive Care for Joint Replacement mandatory demonstration program, a new Medicare payment model for hip and knee replacement procedures performed in hospital inpatient settings. The final rule was released on November 16, 2015. On July 15, 2015, CMS issued another proposed rule, the FY 2016 Physician Fee Schedule that updates payment policies and payment rates for services provided under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2016. We submitted comment letters to CMS on both proposed rules on September 8, 2015.
We joined the Physician Clinical Registry Coalition on July 14, 2015, in submitting a letter to The Secretary's Advisory Committee on Human Research Protections (SACHRP) regarding issues of ongoing concern relating to the application of the Common Rule to registries. In addition, we attended the National Medical Device Registries Task Force meeting hosted by Food and Drug Administration (FDA) and the American College of Cardiology on August 24, 2015 to listen to discussions regarding the new National Medical Device Registry Task Force report entitled, "Recommendations for a National Medical Device Evaluation System: Strategically Coordinated Registry Networks to Bridge the Clinical Care and Research." A request for Public Comment was posted in the Federal Register on August 25, 2015. We submitted a comment letter October 26, 2015.
On August 31, 2015, we attended a Patient-Reported Outcomes Summit for Total Joint Arthroplasty at CMS along with AAOS, The Hip Society, The Knee Society, and Yale-New Haven Health Services Corporation Center for Outcomes Research and Evaluation (Yale/CORE). AAHKS sent a letter to CMS on September 3, 2015 reflecting the consensus recommendations of the represented orthopaedic organizations. The Physician Clinical Registry Coalition (PCRC) and us have worked together since August 2015 to develop a definition of a physician-led clinical data registry. The HELP Committee agreed to consider putting a definition of a registry in its upcoming "Innovations" bill, and may require interoperability among Electronic Health Records (EHRs) and registries, as well as incentives for hospitals to participate in registries.
On September 28, 2015, CMS announced a Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This RFI seeks public comment on Section 101 of MACRA. We submitted a comment letter on November 16, 2015. We presented at the 2015 Medical Device Epidemiology Network (MDEpiNet) Annual Meeting, on October 1 - 2, 2015 at the FDA. Jeff Knezovich, AJRR Executive Director, presented on our potential contribution to the Coordinated Registry Network (CRN) and urged FDA to consider us as they implement the planned orthopaedic Pilot Demonstration Projects.

For ongoing information and copies of our comment letters, click here.
Countdown to Meaningful Use Deadline 
Time is running out! CMS requires Eligible Professionals (EP) to show proof of onboarding for a specialized registry by November 30. For information on how AJRR can help, please view our Overview of Meaningful Use for Eligible Professionals for AJRR's Hip and Knee Replacement Registry.
AJRR in the News

Here are some articles about the release of the 2014 Annual Report on Hip and Knee Arthroplasty Data:
2014 Annual Report
The Level III PRO platform launch was covered by a news outlet as well:

For press releases on these topics and more, click here. For a PowerPoint presentation of our 2014 Annual Report that you can use in presentations and talks, click here.
Champion of the Quarter

Each quarter, we highlight 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 our staff. To view our past Champions, visit our Champion of the Quarter section on our website. To nominate someone from your hospital, please contact Erik Michalesko at michalesko@ajrr.net.
This quarter, we would like to recognize Ms. Michelle Davis from Ochsner Health System in New Orleans, La.
Ms. Michelle Davis

Ms. Michelle Davis has been working with Ochsner Health System for 18 months. She is the Clinical Operations Manager
of Orthopaedics and Neurosurgery, and some of her responsibilities include guiding day-to-day physician practice operations and overseeing the budget. She also manages a support staff of nearly 50 employees. Ms. Davis enjoys learning about the clinic side of health care administration, since her experience comes from the inpatient side.

Q: What made you decide to renew your site's subscription with AJRR?
A: We were already enrolled when I came on board; four hospitals in Ochsner Health System were pilot hospitals for AJRR. However, I saw the benefit in a National Registry, so for the past few months I worked to make sure that the appropriate staff saw the amendments to our contract. That way, Ochsner Health System could renew their subscription.
Q: Would you recommend enrollment with AJRR to others?
A: Yes, I would. The AJRR staff is very professional, and I never heard a single complaint from other Ochsner Health System staff that worked with them. Our research coordinator worked closely with the AJRR team and had nothing but positive things to say about the experience.
Q: What do you like most about AJRR?
A: AJRR is a great organization to assist with our data coordinating and gathering. There are many perks from participating in a Registry; the benchmark numbers are helpful for not only orthopaedists, but for hospitals in general. I'm happy that we served as pilot hospitals and are now are able to continue being involved.
Q: What do you enjoy doing during your free time?
A: My two favorite pastimes are playing sports and shopping.

Blair Fraser Participates in Operation Walk
AJRR Board of Directors member Blair Fraser

We are proud of Blair Fraser, member of the AJRR Board of Directors and Vice President of Scientific and Medical Affairs at Smith & Nephew. In the first week of November, Fraser participated in his third year of Operation Walk at Hermano Pedro Hospital in Antigua, Guatemala. Operation Walk is a humanitarian effort in which orthopaedic surgeons, nurses, physical therapists, and other health care professionals work with device manufacturers from Smith & Nephew to provide care for underprivileged Guatemalan citizens. Fraser was on a team of surgeons from Canada, Ohio, California, and Arizona, and his role was to maintain inventory control and process instrument sets.
"These patients get their lives back. They become productive members of society and are able to provide for their families," said Fraser. "It's a very humbling experience. Patients recover so quickly, and are so grateful for this."
Smith & Nephew donated all of the implants for the 65+ hip and knee arthroplasties performed. Patients walked for miles to the hospital so that they could receive the surgeries that they needed; normally, they wouldn't ever have access to the procedures. Operation Walk has been providing total joint replacement surgeries for 10 years, and will continue its efforts for years to come.

Publications of Interest

Blömer W, Steinbrück A , Schröder C, Grothaus F-J, Melsheimer O, Mannel H, Forkel G, Eilers T, Liebs TR, Hassenpflug J, Jansson V. A new universal, standardized implant database for product identification: a unique tool for arthroplasty registries. Arch Orthop Trauma Surg.  July 2015; 135(7): 919-926. doi: 10.1007/s00402-015-2238-2.
Markel DC, Allen MW, Zappa NM. Can an arthroplasty registry help decrease transfusions in primary total joint replacement? A quality initiative. Clin Orthop Relat Res. July 28, 2015 [epub ahead of print]. doi: 10.1007/s11999-015-4470-z.
Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J. August 2015; 97-B(8): 1076-1081. doi: 10.1302/0301-620X.97B8.35170.
Pitto RP, Garland M, Sedel L. Are ceramic-on-ceramic bearings in total hip arthroplasty associated with reduced revision risk for late dislocation? Clin Orthop Relat Res. Dec 2015; 473(12):3790-5. doi: 10.1007/s11999-015-4395-6.
Tucker K, Pickford M, Newell C, Howard P, Hunt LP, Blom AW. Mixing of components from different manufacturers in total hip arthroplasty: prevalence and comparative outcomes. A study of over 90,000 cases of mixed components in the National Joint Registry for England and Wales. Acta Orthop. September 1, 2015 [epub ahead of print]. doi: 10.3109/17453674.2015.1074483. 

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 Erik Michalesko, Marketing and Communications Specialist at michalesko@ajrr.net

The Register editor: Erik Michalesko
Contributing authors: Kristine Baldwin, Caryn Etkin, PhD, MPH, Marisol Goss, and Randy Meinzer.

©2015. All rights reserved.