Letter from the Executive Director
AJRR Executive Director 
 Mr. Jeffrey P. Knezovich, CAE
On behalf of the AJRR, I hope that all of you had a great holiday season! We may still be digesting the home-cooked meals that we enjoyed with our family and friends, but the New Year has begun and it's time we think about work. December ended with exciting news; the AJRR is now the official registry of the American Association of Hip and Knee Surgeons (AAHKS). As the year came to an end, so did the terms of two very important Board of Directors members. We wholeheartedly thank both Tony Rankin, MD, and Pam Plouhar, PhD, for their individual support and contributions through the years. In addition to welcoming in two new Board members in their place, Alyssa Burns has joined our staff as a Program Coordinator to help with the hospital recruiting efforts, and Christina De La Rosa has come aboard as an additional IT Data Technician.
The first quarter of 2016 holds many great developments for you. We will be collecting Level II and Level III data elements as well as assembling a more comprehensive User Group Network. The User Group consists of users from participating hospitals. It is a community for AJRR participants to ask questions and receive answers, and will improve the overall knowledge of our Registry at participating institutions. Also, this publication has now been changed to a monthly circulation. You can expect to see a more concise newsletter that better addresses our readership's interests.
With each month that goes by, AJRR moves closer to our recruiting goal of collecting 90% of hip and knee replacements performed throughout the US. We currently have nearly 615 participating institutions, 4,460 surgeons, and over 400,000 procedures. 2016 will bring in hundreds of more hospitals, private practices, and ambulatory surgery centers, which will make the data in our Registry that much stronger. The National Registry is operating at full force, and we are excited for the new opportunities to come.
Many thanks,

AJRR News & Events
Congratulations to Our 2016 AJRR Board of Directors!
Executive Committee
Chair - Daniel J. Berry, MD, Hip Society Representative
Vice Chair - Kevin J. Bozic, MD, MBA, AJRR Representative
Secretary Treasurer - David E. Mino, MD, MBA, Payer Representative
Blair Fraser, AdvaMed Representative
Yvonne Bokelman, MBA, FACHE, AdvaMed Representative
Michael R. Dayton, MD, AAOS Representative
Craig J. Della Valle, MD, Knee Society Representative 
Robert L. Krebbs, Payer Representative
Gregory B. Krivchenia, II, MD, AAOS Representative
Kristen Murtos, AHA Representative
Colin Nelson, Patient/Public Representative
Douglas E. Padgett, MD, AAOS Representative
Brian S. Parsely, MD, AAHKS Representative
Scott M. Sporer, MD, AAOS Representative
Bryan D. Springer, MD, AAHKS Representative
Jeffrey Knezovich, CAE, Ex-Officio
David G. Lewallen, MD, Ex-Officio
A special thanks to the Board Members whose terms have come to a close: E. Anthony Rankin, MD, AAOS Representative, and Pamela L. Plouhar, PhD, AdvaMed Representative. In recognition of their service, a contribution was made in their name to Operation Walk USA. We appreciate their efforts in advancing the AJRR mission!

E. Anthony Rankin, MD

Pamela L. Plouhar, PhD


Upcoming Webinars
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. This webinar is offered on January 13, 2016. Click here to register.
Previous Webinars
Patient-Reported Outcomes Informational Webinar
Our Analytics team hosted an informational webinar about the AJRR Level III/patient-reported outcomes (PRO) platform on December 9, 2015. Recommended PRO measures were discussed, as well as the reasons for why starting a PRO data collection program is beneficial. Our Director of IT demonstrated how to use the new dashboard system, and along with the Analytics team, fielded questions on how to get started reporting. To listen to a recording of the webinar, click here. To view the slides, click here.
Recordings and slides from all other previously held webinars can be found on our website. Slides with all of the tables and figures from the 2014 Annual Report can be found on our website too.


Board of Directors Member

Yvonne Bokelman

Welcome, Yvonne Bokelman

AJRR would like to welcome Yvonne Bokelman to the Board of Directors of our Registry! She will be serving as an AdvaMed Representative, assuming the position left vacant by Dr. Plouhar.
Ms. Bokelman majored in Business Administration at the University of Phoenix - Tucson, Arizona, and received her master's degree there as well. Her career led her throughout the country in various health care administrative roles, eventually bringing her to the Midwest. After holding the position of Executive Vice President at Health Directions, LLC, in Chicago for a year, Ms. Bokelman took her talents to Medtronic, Spinal & Biologics, in Memphis, Tennessee. She worked for Medtronic for six years.
Ms. Bokelman is currently Vice President, Global Market Access, Health Economics & Reimbursement at Zimmer Biomet, Inc. The company is based in Warsaw, Indiana and is an orthopaedic medical device leader. Ms. Bokelman has accomplished many great things during her time at Zimmer Biomet, such as creating the company's first US field reimbursement team, initiating a comprehensive payer strategies program, and speaking nationally on health care reform impacts and coverage and reimbursement-related issues. Some of her professional affiliations include the American College of Healthcare Executives, the Healthcare Financial Management Association, the Colorado Association of Healthcare Executives, and the Medical Group Management Association.
We are excited to work with Ms. Bokelman, and look forward to her contributions.

New AJRR Board of Directors Member Douglas Padgett, MD
Welcome, Douglas Padgett, MD

We would also like to welcome Douglas Padgett, MD to the AJRR Board of Directors! Dr. Padgett will be serving as an AAOS Representative, replacing Dr. Rankin.
Dr. Padgett grew up in Seaford, New York and received his B.A. at St. Michael's College in Vermont in 1978. He graduated from New York Medical College with his MD in 1982, and completed his residency in orthopaedic surgery at Hospital for Special Surgery (HSS) in New York, NY. In the early 90s, Dr. Padgett was the Director of the Adult Reconstructive Service at the Naval Hospital in San Diego, and was later deployed to the Persian Gulf. He performed surgery during Operations Desert Shield and Desert Storm.
Dr. Padgett then joined the Hospital for Special Surgery, where he has been practicing ever since. He has been on the board of both The Hip Society and the American Association of Hip and Knee Surgeons, and served on the AAOS program committee, so he is experienced in leading orthopaedic organizations. In addition to holding several leadership positions at orthopaedic associations and HSS, Dr. Padgett is also an Associate Professor of Orthopedic Surgery at Weill Cornell Medical College. Currently, his fields of interest include deep vein thrombosis prevention and robotic assisted surgery.
AJRR: The Official Registry of the
American Association of Hip and Knee Surgeons 
On December 28, 2015, it was announced that the American Association of Hip and Knee Surgeons (AAHKS) had designated AJRR as its official registry. The decision was approved by the AAHKS Board of Directors at their December meeting.
AAHKS has been a long-standing supporter of the AJRR over the years and has established a close collaborative relationship in many areas. They nominate members to two seats on our Board of Directors. Also, an executive summary of our 2014 Annual Report was featured in the December issue of the AAHKS sponsored publication Arthroplasty Today. AAHKS has provided us with substantial financial support, and the two organizations have worked together to ensure that the Registry collects appropriate data that includes AAHKS approved measures and risk adjustment factors.
AAHKS has over 2,700 members that come from the United States and 38 other countries. Their members are board certified and perform at least 50 hip and knee arthroplasties per year, so the data contained in our dashboards and annual reports are important to their practices.
To read the Arthroplasty Today article about the annual report, click here. To sign up for new content alerts from Arthroplasty Today, click here.
From the Hill
By Marisol Goss
Visit the Advocacy & Public Affairs section on our website to learn more
As the year came to a close on Capitol Hill, we continued to advocate for clinical data registries (CDR) and qualified clinical data registries (QCDR). During the month of November in 2015, the Comprehensive Care for Joint Replacement (CJR) mandatory demonstration program was introduced. Since this is a demonstration program that will be implemented on April 1, 2016, we will be following legislation and regulatory activities and how participants and providers will be affected. There will be CJR participant hospitals in 67 metropolitan statistical areas (MSAs). We currently collect hip and knee replacement data from hospitals in 50% of the MSAs designated in the CJR rule.
For FY 2016, we will continue to promote advocacy on Capitol Hill that will include directing Office of Human Research Protection (OHRP) to issue a guidance in respect to the Common Rule and securing an exclusion for registries. We will also be working with the Centers for Medicare & Medicaid Services (CMS) to provide access to Medicare claims data promptly on July 1, 2016, and ensuring that the process for obtaining this data is convenient, timely and affordable. The AJRR is also supportive of Unique Device Identifier (UDI) implementation in registries, exploring congressional funding for registry development and implementation, and enacting legislation providing Medicare bonus payments for provider participation in QCDR registries. FY 2016 will definitely be a productive and busy year for us. 

For ongoing information and copies of our comment letters, click here.
AJRR Leadership Spotlight
Jeffrey P. Knezovich, CAE, AJRR Executive Director, has been appointed to serve on the National Prosthetics Registry (NPR) Executive Committee. The NPR is a new registry that was founded to reduce disability and improve patient care for those who have lost limbs. Modern medicine has led to higher chances of survival for soldiers on the battlefield. Unfortunately, this also means that the number of soldiers living with amputations has risen. It's a very pertinent time to form a registry in the field of prosthetics.
Several different organizations are collaborating to create the registry, including AJRR, Mayo Clinic, the DoD Extremity Trauma and Amputation Center of Excellence (EACE), the Department of Veterans Affairs, the American Orthotic and Prosthetic Association, Cogenz International, and the Thought Leadership and Innovation Foundation. NPR will have access to our data collection system, and will be able to collect four levels of data from all of our participating institutions.
The NPR Executive Committee is in charge of creating guiding rules and providing legal, financial, administrative, and scientific direction. They will review progress and approve future phases, while also overseeing registry output. Jeff will be bringing administrative and operational experience to the Executive Committee; his current position consists of making sure that every aspect of our Registry goes smoothly.
"I hope that my participation in the NPR leads to a prosperous new registry that improves patient outcomes for conditions that the AJRR does not address," said Mr. Knezovich. "I will do everything within my power to guide this new registry and lead it to success. The AJRR is thrilled to collaborate with all of these distinguished organizations for this great cause."

AJRR User Group Network Will Host its First Conference Call
With over 600 participating institutions (hospitals, health systems, surgery centers, and private practice groups), the AJRR created the AJRR User Group Network (Unet). This network was created to provide all of AJRR's users and participants the opportunity to share ideas and interact with each other about the collection of hip and knee arthroplasty procedures data in the United States through a National Registry.
We (the AJRR) strive to create an environment within the orthopaedic community that fosters conversation about best practices and learning ways to improve hip and knee replacement Registry implementation and processes within their own institution.

Launched at the 2015 American Association of Orthopaedic Surgeons (AAOS) Annual Meeting, members of this network will have the opportunity to participate in regular conference calls and webinars, contact other Registry users for information, and help shape the orthopaedic Registry community through their insights and contributions.
Please join us for our inaugural Unet conference call on Thursday, January 21, 2016 at 12:00 p.m. CST. To sign up for Unet and register for the conference call, click here. The group is open to all participants of the AJRR.
AJRR Collecting Level II and Level III Data Elements
As announced in the previous issue, we are now able to collect Level III patient-reported outcome (PRO) data elements. Participating institutions can view the dashboards of AJRR-recommended patient-reported outcome measures (PROMs) on a new platform within AJRR's Demand Reporting & Electronic Dashboard system. Once more Level III data is collected, hospitals will be able to compare how they rank nationally with benchmarks. In the coming months, we will be able to collect Level II patient risk factor and comorbidity data. Participating hospitals and private practice groups can prepare for this development by viewing the Comorbidity/Risk Adjustment Analysis and Data Collection Requirements document on our website. The CMS Comprehensive Care for Joint Replacement (CJR) Model Final Rule and the AJRR both require certain pre-operative data elements, and this document makes clear what will be expected of institutions. Risk adjustment will help to account for the differences between our participating institutions, and will provide Registry users with more accurate comparison data.

CJRR Case Study Published in December

In mid-December, a case study called Collecting Patient Reported Outcomes: Lessons from the California Joint Replacement Registry was published in Generating Evidence & Methods to improve patient outcomes (eGEMs). The case study detailed five years' worth of experiences that the California Joint Replacement Registry (CJRR) had when implementing their PRO program, and touched on ways that hospitals can improve the process. The PRO program collected information from patients that were in the process of hip and knee replacement surgery, and brought a few common problems to light.
Some of the issues that CJRR hospitals ran into were the costs of surveys, difficulties encouraging patients to fill out PRO surveys, and the real and perceived burden to clinic and hospital staff. CJRR proposed that if policy changes were combined with ramped up incentives, many of these problems would be resolved. We have begun collecting Level III patient-reported outcome measures (PROMs), so these findings are very useful to any of our participating institutions looking to start a PRO program of their own.
To read the case study, click here.
Data Chat

When users now log in to the AJRR Demand Reporting & Dashboard system, they will see updated dashboards that reflect our system upgrade to ICD-10. All of the ICD-9 procedures in the Registry prior to this upgrade have been converted to an equivalent ICD-10 procedure. This will provide one unified reporting system.
In addition, there is now the option of a "system" tab which will allow a hospital system to benchmark their metrics against the national average. In order to get a system view like this, please contact your AJRR Program Coordinator to define which hospitals should be included. Once this is configured, we will contact your institution's user letting them know that their system view is now available.
Our patient-reported outcome measures (PROMs) dashboards are also now available. The dashboards will show our recommended PROMs. These include: HOOS JR., KOOS JR., VR-12, and PROMIS-10 Global Health. Please note, if your hospital has not submitted any of the recommended PROMs data, these charts will appear blank.

AJRR currently has 612 participating hospitals in all 50 states! Click here for a full list of all participating sites.

Due to recent hirings, the AJRR Program Coordinator regions have changed. Make sure you know which staff member is assigned to your state! Click here for Program Coordinator contact information.

AJRR in the News

The media continues to cover the 2014 Annual Report on Hip and Knee Arthroplasty Data and the Level III PRO platform launch:

Also, a health care magazine wrote about how the PRO platform could help hospitals with the new Centers for Medicare & Medicaid Services (CMS) Final Rule:
The recent designation of AJRR as the official AAHKS registry received some coverage too:  
For press releases on these topics and more, 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, Lori Boukas, Marisol Goss, and Randy Meinzer.

2016. All rights reserved.