"You" Put the "U" in "Unet"
The 2016 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting from March 1-5 was a busy time for the AJRR. We held our quarterly Board of Directors Meeting at a nearby Orlando, Florida hotel and engaged with surgeons at our exhibit booth. However, the highlight of the Annual Meeting came with the March 2 User Group Network (Unet) meeting, which brought together authorized Registry users from all over the country to discuss their participation. In addition to the 29 users that attended in Orlando, 13 called in via webinar. The meeting kicked off with excitement as AJRR Director of Marketing and Communications Lori Boukas welcomed everyone and remarked that this meeting would continue interactions among all users.
AJRR User Joe Greene from the University of Wisconsin Hospital Department of Orthopedics & Rehabilitation gave a presentation on his institution's patient-reported outcome measures (PROMs) process, and answered questions afterwards. Then, Randy Meinzer, AJRR Director of Information Technology, gave a Registry demonstration and showed off the PROMs dashboards and patient portal. AJRR Director of Analytics Caryn Etkin followed the demonstration with a discussion on Level II patient risk factor/comorbidity data elements and quality initiatives. She provided an update on the on-going collaborations that AJRR is participating in with organizations such as the National Quality Registry Network (NQRN).
To further encourage the exchange of user ideas, users broke out into groups at their tables and discussed issues pertaining to the Registry and how they could benefit through future calls and meetings. Great ideas included additional survey measures in the system, hosting a webinar on institutional review boards (IRBs), and dashboards with Level II implant selections. We realize that topics like these are very important to our institutions, so we will work towards making them a reality.
Unet conference calls are held quarterly on the third Thursday of the month. Upcoming calls will take place on June 16 at 12 pm, September 15 at 12 pm, and December 15 at 12 pm.
To enroll in Unet, click here.


AJRR Update on Level II Data Collection

Many new and exciting initiatives are upon us. The recent launch of our Level III patient-reported outcomes (PRO) platform will assist you in your efforts to adhere to the requirements outlined in the Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) Final Rule. The next step in the evolution of AJRR involves consideration of risk variables, also known in our system as Level II. Risk-adjustment controls for diseases and conditions and other patient characteristics that vary from hospital to hospital and may cause surgical outcomes to vary. There may be circumstances beyond the provider's and hospital's control that may impact the patient's surgical results and how hospitals are viewed when taking care of complex cases. In other words, risk adjustment allows for a "leveling" of the playing field across all patients regardless of comorbidities. 

AJRR committees and workgroups have diligently assessed a variety of sources in the consideration of which variables to include in our Level II system, and how to advise you to capture the relevant data. We have provided you with a Level II Data Collection document which includes the variables we would like to capture for Level II. These variables represent patient comorbidities, CJR risk variables, and surgical complications. While submission of this data is not required, you will receive more accurate risk-adjusted reports and dashboards from us with your Level II data included. In the coming weeks, we will develop additional documentation, finalize our data specifications for Level II, and host webinars about this new platform.  

To access the Level II Data Collection document, click hereIf you have any questions, please contact AJRR Director of Analytics Dr. Caryn Etkin, at etkin@ajrr.net.
Thank You for Your Contributions, Colin Nelson
Mr. Colin Nelson

was held on February 29 in Orlando, a day before the AAOS Annual Meeting began. Many topics such as recruitment and the Annual Report were discussed. Additionally, this was Colin Nelson's last meeting as a Board member and Chair of the Public Advisory Board. Mr. Nelson had been on the Public Advisory Board since its inception in 2010 and had been the chair since 2014.

We thank Mr. Nelson for his contributions to the AJRR over the years and wish him the best in his new endeavors!
Welcome, Margaret VanAmringe, MHS

Ms. Margaret VanAmringe, MHS
We're happy to report that Margaret VanAmringe, MHS has been voted by the Board to replace Mr. Nelson as both Chair of the Public Advisory Board and Patient/Public Representative on the AJRR Board of Directors.

Ms. VanAmringe
is the Executive Vice President for Public Policy and Government Relations at The Joint Commission, and heads The Joint Commission's Washington, D.C. office. Some of her responsibilities include working with Congress, government agencies, national professional groups, consumer organizations, and purchasers of health care. She has been a member of the AJRR Public Advisory Board since 2010.                                                            
Ms. VanAmringe earned her Master of Health Sciences degree from the Johns Hopkins School of Hygiene and Public Health. In the past, she has worked at what is now the Agency for Health Research Quality, and has held various positions in the Immediate Office of the Secretary, Department of Health and Human Services, including Senior Advisor, and Acting Deputy Chief of Staff. She was a legislative fellow in the office of the Majority Leader, Senator George Mitchell, between 1989 and 1990 and worked for 10 years for what today is CMS.
We are excited that Ms. VanAmringe has taken on more responsibilities within the AJRR leadership, and look forward to her continued input.
Welcome, Richard Seiden
Mr. Richard Seiden

We would like to welcome Richard Seiden, our newest Public Advisory Board Member. He was nominated by former AJRR Board of Directors Member Dr. E. Anthony Rankin.
Mr. Seiden is a partner and health care business lawyer with Foley & Lardner LLP in Los Angeles, CA. He handles health care business counseling at his practice, and works on projects such as mergers and acquisitions, general business and financing matters, and the formation of business entities. Mr. Seiden advises major non-profit hospital systems as outside general counsel, and has helped create medical office buildings, doctor-owned hospitals, and several joint ventures.
Mr. Seiden received his B.A. magna cum laude in 1971 at the University of Pennsylvania. He then graduated from Boalt Hall School of Law, University of California, Berkeley. Throughout his career, Mr. Seiden has been admitted into several professional memberships, including the American Health Lawyers Association, American Bar Association, California Bar, and the Los Angeles County Bar Association. He has had two knee replacements, a hip replacement, and a shoulder replacement. 
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. Eileen Poletick from Morristown Medical Center, part of Atlantic Health System, in Morristown, NJ, and Ms. Lisa Wied and Ms. Judy Weibel from Gundersen Health System in La Crosse, WI.
Ms. Eileen Poletick
Morristown Medical Center
Ms. Eileen Poletick has been working at Morristown Medical Center on and off for 25 years. She started out as a per diem staff nurse, but her current title is Research Coordinator for the Department of Orthopaedics. The title is somewhat of a misnomer, because Morristown Medical Center doesn't conduct a lot of funded Orthopaedic research; it's mostly investigator initiated studies. Ms. Poletick handles the orthopaedic surgery department's quality-reporting, using what she calls a kind of "alchemy" to combine clinical and administrative data. She enjoys having a thoughtful manager who encourages his employees to search for the answers to difficult but important questions. Her role in the AJRR data submission process is checking over the data and identifying where each data point lives. She also educates and creates awareness to the surgeons and gets them interested in working with AJRR.
Q: Do you enjoy working with AJRR staff? If yes, why?
A: Yes, I can't say enough about AJRR staff responsiveness. I ask tons of questions, and staff members always get back to me the same day. Whether I call or send an email, an AJRR staff member is always there with an answer. Level III (patient-reported outcomes) is still a work in progress, but I have a very long wish list for the project and look forward to using the platform to the fullest. I also enjoy working with the other User Group members. AJRR has a winning group of people on the Unet Advisory Board, and Joe Greene's presentation on patient-reported outcome measures (PROMs) at the meeting in March was incredibly helpful to Atlantic Health System as we begin our move towards Level III data submission.
Q: What are three words to describe Morristown Medical Center?
A: Not counting prepositions, I would describe Morristown Medical Center as having the "Soul of a Community Hospital." We're a 700-bed teaching hospital, yet we still have maintained a connection to our roots and community. Our system goal is to be a trusted network of caring. Morristown Medical Center has a picture of the original hospital from over 100 years ago; it looks like a house. We've grown to consist of multiple locations, and have received a lot of recognition, such as being listed as a US News & World Report "Best Hospital" in four specialties including orthopaedics. Morristown Medical Center is accomplishing great things while staying integrated with the community.
Q: What is the best vacation you've been on?
A: Israel is by far the best vacation I've been on. Twenty years ago, my sister and I took our families to Israel and rented a van to drive around the country. The part I enjoyed most was seeing artifacts and structures that were sometimes as old as 5,000 years. In America, we usually consider 200-year-old objects in museums to be old, so this was a whole new level.
Q: Tell us something about yourself that would surprise us.
A: I didn't get my bachelor's degree until my late 30s. Shortly after that I received my masters, and then got my doctorate in nursing practice in my 50s.
Q: If you could interview one person (dead or alive) who would it be?
A: It's hard for me to choose just one. There are a lot of courageous women I would like to interview, like Florence Nightingale and Amelia Earhart. I would love to ask them about what motivated them and made them brave enough to take a different path in life.
Q: If you could pass on one piece of information to a new AJRR participant, what would it be?
A: Make a good friend in your Information Services (IS) department. They're the pivot point of data flow from us to the AJRR. While it's one thing to collect data, it's another thing to find out where it is. It can be located on a plethora of systems; there are data everywhere. That's why it's so important to make these connections.

Ms. Lisa Wied is the Administrative Director, Orthopaedic Center and Ms. Judy Weibel is the Director, Information Systems at Gundersen Health System. Lisa has been working at Gundersen for 15 years, while Judy will be approaching 27 years this May. They both love being able to serve their patients and staff and making a positive impact on the lives of others. Gundersen Health System is in the process of data submission, and both Lisa and Judy, along with others within the Orthopaedic Center will be responsible for various levels of the AJRR data submission (by Information Systems) and analysis (by their Orthopaedic Team).
Ms. Lisa Wied
Gundersen Health System
Ms. Judy Weibel
Gundersen Health System

Q: What do you like most about AJRR?
A: Our experience to date has been great. It's really important for us to be a part of a National Registry and have benchmarks for our Orthopaedic Department. The aspect we like most about the AJRR is that it gives us opportunities for expanded quality improvement so we can continue to provide our patients with exceptional care.
Q: If Hollywood made a movie about your life, who would you like to see cast as you?
A: Lisa: I would definitely want Melissa McCarthy to be cast as me. 
    Judy: I can see myself being portrayed by Julia Roberts in a movie about my life.
Q: If you could interview one person (dead or alive) who would it be?
A: Lisa: Without a doubt, I would have to choose Marilyn Monroe.   
    Judy: I would be most interested in interviewing Pope Francis.
Q: Tell us something about yourself that would surprise us.
A: Lisa: My background is not in healthcare - I "grew up" in the competitive culture of office machine dealers. Serving patients has been wonderful. It's a nice change of pace! 
    Judy: I've gotten a hole in one before!
Q: If you could pass on one piece of information to a new AJRR participant, what would it be?
A: The process of implementation is extremely smooth and easy with the staff at AJRR leading you through each step. They have been very helpful and responsive during our data submission process; don't be afraid to ask any questions that you might have!
From the Hill
By Marisol Goss

Visit the Advocacy & Public Affairs section on our website to learn more
The beginning of 2016 has already been a busy time for AJRR on Capitol Hill. With the Comprehensive Care for Joint Replacement (CJR) program set to start on April 1, 2016, there has been lots of activity. As you may already know, the CJR program is mandatory and hospitals alone are the initiators. While there is no downside risk for the first year, there are stop-loss limits of five percent in performance year two, 10 percent in year three, and 20 percent in years four and five. Furthermore, payments are tied to quality, including patient-reported outcomes, and gainsharing is available in situations where the participant hospital arranges to engage in care re-design strategies and services with physicians and other CJR collaborators. On March 4, 2016, CMS published a notice correcting errors in its November 24, 2015 final rule to implement the CJR model. CMS clarified their methodology for incorporating the effective discount percentage determined by quality performance into prospective target prices. Target prices will be determined prospectively using a 3 percent discount percentage, and hospitals may experience a different effective discount percentage at reconciliation due to quality. 
AJRR has also been responding to requests for comments from CMS. On January 6, 2016, AJRR submitted comments to the Office of Human Research Protection (OHRP) on the Federal Policy for the Protection of Human Subjects: Notice of Proposed Rule Making on the Common Rule. AJRR was supportive of the proposal to create an exclusion for quality assurance/improvement activities and harmonization of the Common Rule. In addition, AJRR provided comments on January 28, 2016, to the U.S. Senate Committee on Health, Education, Labor, & Pensions on their HELP Health IT Bipartisan Staff Discussion Draft. AJRR supports the establishment of the definition for the term "clinician-led clinical data registry" along with the proposal that there be considerations for the reporting criteria that includes submitting, editing, and retrieving data from registries such as clinician-led clinical data registries. CMS then released a proposed rule on the Medicare Program: Expanding Uses of Medicare Data by Qualified Entities on February 2, 2016. Comments were due March 29, 2016 and AJRR submitted comments. AJRR is continuing to monitor issues and viewpoints in the orthopaedic community.

For ongoing information and copies of our comment letters, click here.
Publications of Interest

Dave A, Jang B, Bruce W. A short-term follow-up study of a surgeon-customised fully-coated hydroxyapatite femoral stem using a nation-wide joint registry. J Orthopaedics. 2016 June; 13(2): 90-94. doi:10.1016/j.jor.2015.12.001
Gordon M, Rysinska A, Garland A, Rolfson O, Aspberg S, Eisler T, Garellick G, Stark A, Hailer NP, Sköldenberg O. Increased Long-Term Cardiovascular Risk After Total Hip Arthroplasty A Nationwide Cohort Study. Medicine. February 2016 [epub ahead of print]. doi: 10.1097/MD.0000000000002662
Sabah SA, Henckel J, Koutsouris S, Rajani R, Hothi H, Skinner JA, Hart AJ. Are all metal-on-metal hip revision operations contributing to the National Joint Registry implant survival curves? A study comparing the London Implant Retrieval Centre and National Joint Registry datasets. Bone Joint J. January 2016; 98-B(1):33-39. doi: 10.1302/0301-620X.98B1.36431 

For a full list of publications of interest, click here.
Upcoming Webinars
Introductory Webinars
AJRR staff continues to host introductory webinars for those who are interested in joining the Registry and would like a basic overview of what we offer. If your institution resides in one of the CJR metropolitan statistical areas, this webinar should be of special interest to you! Introductory webinars will be held at the following times this year:
To register for one of these sessions, click here.
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 both December 9, 2015 and January 6, 2016. 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

Data Corner

Our 2014 Annual Report has a wealth of information on procedural and component data. Figure 28 (pictured above) contains some interesting findings. The mean age of patients having knee arthroplasty was 66.1 years, which is similar to the mean age for hip arthroplasty. This is a slight decrease compared to last year when the mean age for knee arthroplasty was 66.7 years. It will be fascinating in the years ahead to see if this small change continues to be consistent with the gradual decrease in mean age for hip arthroplasty reported by others over the past several decades.
Slides with all of the tables and figures from the 2014 Annual Report can be found on our 

AJRR currently has 674 participating hospitals in all 50 states! Click here for a full list of all participating sites.

AJRR in the News

A few articles about AJRR were featured in the AAOS Now dailies during this year's AAOS Annual Meeting: 

Additionally, OrthoServiceLine published an article about AJRR's patient-reported outcome measures guide. The publication also spotlighted orthopaedic leaders like AJRR Board Member Dr. Kevin Bozic and surgeon champion Dr. Richard Iorio:

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: Caryn Etkin, PhD, MPH, and Marisol Goss.

©2016. All rights reserved.


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