CJRR is pleased to provide you with information and news you can use
pertaining to your participation in the Registry.
 James I. Huddleston, III, MD
CJRR Medical Director
Letter from CJRR's Medical Director

I would like to thank all of you who participated in our annual meeting webinar in February. It was well-attended and hopefully informative for those who logged on. Please send us your comments on whether you prefer a webinar or an in-person meeting for this type of event in the future.
In an effort to reduce the burden of data collection and to support our participating institutions involved in the Comprehensive Care for Joint Replacement (CJR) model, we are in the process of adding two additional patient-reported outcome (PRO) instruments to our current offerings. In the near future, we will support the Hip disability and Osteoarthritis Outcome Score as well as the Knee injury and Osteoarthritis Outcome Score (HOOS, JR. and KOOS, JR., respectively). This will allow our members to optimize the collection of the PROs required in the CJR bundled payment model (VR-12, HOOS, JR., and KOOS, JR.).
Please let us know if you are interested in participating in our collaboration with the Center for Outcomes Research and Evaluation (CORE) at Yale New Haven Health Services Corporation (YNHHSC). YNHHSC CORE has contracted with the Centers for Medicare & Medicaid Services (CMS) to gain a better understanding of how PROs may be used in determining who the most appropriate candidates are for hip and knee replacement surgery.
As most of you probably know by now, Blue Shield of California has recently implemented a pre-authorization program for hip and knee replacement. Along with our partners at the California Orthopaedic Association (COA), we have engaged with Blue Shield in an effort to see how they can assist members of the CJRR with this process. I will report more on this exciting development in our next newsletter.
Lastly, please see Jeff Knezovich's article in this newsletter for plans on the future of the CJRR.  We are making good progress on finalizing plans for the funding of the CJRR beyond the end of 2016. We appreciate your patience as we work through this transition. These plans will be communicated directly to our participating institutions in the near future. 

James I. Huddleston, III, MD
Join the CORE Research Effort

As you all know, collection of patient-reported outcomes (PROs) are of utmost importance to CJRR's efforts. As part of our work, CJRR entered into a collaborative arrangement with Yale New Haven Health Services Corporation (YNHHSC) to advance the science of PROs at a national level. 

The Centers for Medicare & Medicaid Services (CMS) has contracted with YNHHSC Center for Outcomes Research and Evaluation (CORE) to develop a Hospital Level Performance Measure(s) of Patient Reported Outcomes Following Elective Primary Total Hip and/or Total Knee Arthroplasty (THA/TKA PRO-PM). The remaining measure development work involves finalizing the measure specifications. To accomplish this, CORE is partnering with CJRR to obtain relevant PRO data. These data will enable CORE's team, supported by a nationally convened Technical Expert Panel (TEP), to explore the most meaningful and understandable ways to use PRO data to assess hospital-level performance. 

Currently, three CJRR hospitals have agreed to participate in this collaboration. CORE is hoping to have more hospitals join the effort, as it is imperative to have your assistance in order to complete the work that CORE is undertaking. 

For more information, please contact Dr. Caryn Etkin, AJRR Director of Analytics at etkin@ajrr.net or 847-430-5032.
Enrollment Update and More at Successful Annual Meeting 

In mid-February, the CJRR held its 2016 Annual Meeting via a webinar. To start things off, AJRR Program Coordinator Phil Dwyer reviewed the general hospital enrollment numbers, and Walter Sujansky, MD, PhD, President, Sujansky & Associates, LLC, reviewed the numbers as they pertained to patients and cases. Kevin J. Bozic, MD, MBA, followed with an informative presentation titled, "Utilizing PROs to Assess Appropriateness of Surgery," during which he spelled out the importance of effectively using patient-reported outcomes (PROs) for the hospital, surgeon, and patient. CJRR Medical Director James I. Huddleston, III, MD, then presented a review of CJRR's Annual Report to the meeting attendees, and lead a group discussion on PRO collection at hospitals and how best to improve overall collection rates.
AJRR Director of Analytics, Caryn Etkin, PhD, MPH, and Dr. Huddleston subsequently updated the group on the various research initiatives being undertaken, such as the Yale collaboration and projects that studied the impact of socio-economic factors and surgeon-level practice settings. Finally, AJRR Executive Director Jeffrey P. Knezovich, CAE, and Dr. Huddleston spoke to the future and the "next steps" of the CJRR (please refer to Jeff's letter below for a detailed look into this).
If you would like to view the slides that were presented during the CJRR 2016 Annual Meeting, please contact Phil Dwyer at dwyer@ajrr.net.
What's Going to Happen to CJRR?
Jeffrey P. Knezovich, CAE
AJRR Executive Director

On April 1, we celebrated the one year anniversary of the merger of CJRR into AJRR. Our plan was a seamless transition for the CJRR participating hospitals; it was our goal to keep things as they were and to promote an expanded role for the CJRR. This was accomplished with the publishing of the first CJRR Annual Report, the inclusion of additional collection capabilities, and the building of relationships with nationally known institutions that wished to report on their findings when examining the aggregate data. 
The CJRR management team (California Data Use Group) is spearheaded by James I. Huddleston, III, MD, Associate Professor and Medical Director, Total Joint Replacement Center, Stanford Hospital and Clinics. In his capacity as CJRR Medical Director, he organizes and leads the group's activities and programming. He is instrumental in representing the CJRR at the AJRR Board of Directors Meetings and works with staff to coordinate action plans to promote the role of the CJRR on a statewide basis.
It was announced during the 2016 CJRR Annual Meeting webinar on February 12 that by year's end the AJRR and CJRR would combine their separate, but very similar data collection platforms into one enterprise. The most obvious reason for this merge is to control escalating data costs. Secondly, it reduces duplicative processes. With the consolidation of the Registries into one platform, the process of downloading data twice (into both the CJRR system and AJRR system) and sorting through the duplicate records will be gone.
The AJRR Board of Directors has approved a plan where the CJRR will remain in control of its destiny while having a reporting mechanism to the AJRR Board in place. AJRR will fully fund CJRR activities. Monies will no longer be made available from the California Healthcare Foundation (CHCF), as it was for the last year. At the onset of the initial CHCF grant there was never the likelihood that grant monies would be made available forever. Currently, each participating and data submitting CJRR hospital has been supported with over $20,000 in annual funding.
Again, AJRR will be able to absorb most of the CJRR infrastructure costs. By year's-end, all CJRR hospitals will be required to be licensed to use the final platform selected for data collection and reporting. It's estimated that each institution will not see any significant increase to their budgets. The annual licensing fee is not expected to exceed $3,000.
After the July 15, 2016 AJRR Board of Directors meeting, all CJRR hospitals will be notified of the final transition plan and costs. Again, we see this transition as having minimal impact on the institutions supporting the CJRR. If you have any questions or comments leading up to the release of the final plan, please feel free to contact me at knezovich@ajrr.net. I would like to hear from you on this or any other matters that might concern you as we become a more powerful data collection enterprise.
With kind regards,
Jeff Knezovich, CAE
Executive Director
CJR is Here, and Both CJRR and AJRR Can Help

As you probably know, the Centers for Medicare & Medicaid Services' (CMS) Comprehensive Care for Joint Replacement (CJR) model started requiring bundled payments and quality measurement for episodes of care associated with hip and knee joint replacements on April 1. The model is mandatory for 794 hospitals in 67 Metropolitan Statistical Areas (MSAs) in America, with many of these hospitals being located in California. If your institution is among the hospitals participating in the CJR, you may still be unsure of how you will meet the requirements. Luckily, participation in a Clinical Data Registry like CJRR or AJRR can be considered a quality initiative that can earn hospitals credit towards the CMS program.

Both CJRR and AJRR have the ability to meet CJR's quality and outcome needs; their PRO platform's Level III data elements include quality of life and joint-specific patient-reported outcome measures. AJRR accepts Level II data elements now as wellwith CJR risk variables that include measures for risk adjustment, comorbidities, and complications. The National Registry can provide its participants with dashboard and benchmark reports that can be used to submit to CMS.
We've put together a Top 12 list of things to know about CJR and Clinical Data Registries. Questions like who is affected, the composite quality score methodology, and more are answered in the list.
We've also created a list of the data elements to be submitted for CJR.
A CMS supplied Frequently Asked Questions page can be found here.
More information on the American Joint Replacement Registry can be found here.
California Joint Replacement Registry is Affiliated with the American Joint Replacement Registry
www.ajrr.net/cjrr | 847-292-0530

CJRR - Affiliated with the American Joint Replacement Registry | 9400 West Higgins Road | Suite 210 | Rosemont | IL | 60018