AAOS Registry Program Blog

This article first appeared in the December issue of AAOS Now, the monthly news magazine of the American Academy of Orthopaedic Surgeons (AAOS).

A study that sought to determine what factors predict total joint arthroplasty (TJA) outcomes at one year found that among patients in the American Joint Replacement Registry (AJRR) for whom patient-reported outcome measures (PROMs) had been recorded, preoperative PROMs, especially physical function subscores, predicted improvement at one year.

Undergoing the Same Surgery He Performs Informed a Joint Surgeon's Practice

This blog concludes a two-part interview series on the personal experience of Kevin J. Bozic, MD, MBA, who underwent total knee arthroplasty. Both interviews originally appeared in AAOS Now (July and August 2019 issues, respectively) and were conducted by Meredith L. Grogan Moore, BS. The first blog posted on July 24 and the final blog is below.

The first installment in this series charted the story of how renowned joint replacement surgeon Kevin J. Bozic, MD, MBA, discovered his own need for total knee arthroplasty, his reaction to the news, and his input on his treatment course. In part two, Dr. Bozic discusses the recovery process, the impact of the experience on the care of his own patients, the relevance of patient-reported outcomes measures (PROMs), and what other providers can glean from this insider experience.

How Impending Knee Replacement Surgery Took One Arthroplasty Surgeon by Surprise

Fig. 1 Three preoperative radiographic views from Kevin J. Bozic, MD, MBA, of the right knee showing severe medical joint space narrowing and patellofemoral osteoarthritis.

COURTESY OF KEVIN J. BOZIC, MD, MBA

This blog is the first of a two-part series that originally appeared in AAOS Now (July 2019). It shares an interview with Dr. Kevin J. Bozic, MBA, about his own experience with total knee arthroplasty (TKA) and how his decision process and treatment affected him as a patient. In August, our blog will share the second part of the interview which explores, not only his own post-operative patient journey, but how the role reversal from physician-to-patient influenced his interaction with the surgical patients he treats today. The interviews were conducted by Meredith L. Grogan Moore, BS*.

Kevin J. Bozic, MD, MBA, is a renowned joint replacement surgeon in Austin, Texas. After graduating from the Harvard Combined Orthopaedic Residency Program, he trained in adult reconstructive surgery at Rush University Medical Center in Chicago. Widely published across orthopaedic and health services journals, he is a pioneer in value-based health care. He is also chair of the Steering Committee for the American Joint Replacement Registry. A few years ago, Dr. Bozic found himself on a path to reconstructive surgery of his own knee. From the outset, unique considerations emerged. His preoperative physician-turned-patient experience is illuminating.

A successful orthopaedic patient-reported outcomes (PRO) program must have resources that allow it to collect, store, and access its data (i.e., clinical information, device data, and PRO data) so that participants have an ability to compare their data to aggregate, national benchmarks. Understanding your patient outcomes compared to peers can support quality improvement efforts at both the hospital and surgeon level. Having the data from a robust national registry like the American Joint Replacement Registry (AJRR) enables hospitals and clinical practices to make informed decisions based on clinical facts and figures. Click here to review the data elements collected by AJRR and used for national benchmarking efforts.

5 PRO Analytic Resources and Tools to Consider:

Patient-reported outcomes (PROs) provide insights beyond standard clinical quality-of-care measures and further guide physician and patient understanding concerning patient health status, the decision-making process regarding patient care, and the evaluation of effectiveness of quality improvement initiatives. Building your PRO program begins with setting program goals and creating a successful process for PRO data collection and reporting.

One of the biggest challenges within a developing PROs program is compliance with the data gathering process. The diagram at the link below represents the typical workflow supporting a hospital's electronic-based patient-reported outcome measures (PROMs) collection to action effort.

Research has shown that the five workflow features listed below demonstrate valuable efficiencies within this process, and help to ensure that clinicians and patients will find program data collection and reporting requirements manageable and worthwhile.

5 Workflow Features for Implementation:

The increased demand for patient-reported outcome (PRO) data by regulators, payers, accreditors, and professional organizations is widely recognized. However, this blog installment will primarily address government initiatives that focus on PRO quality improvement and reimbursement considerations. Both federal and state governments are actively launching pilots and passing legislation related to the utilization of PROs to underpin value-based reimbursement of care. Maximize your institution's quality improvement and related reimbursement by monitoring PRO quality measures and creating a PROs program design that considers the future direction and requirements of the key government initiatives listed below.

At the federal level, PROs have already been incorporated into a variety of Centers for Medicare & Medicaid Services (CMS) efforts. At the state level, Texas became the first legislature to pass a bill related to PROs for musculoskeletal care through SB55. Governor Greg Abbott signed the bill into law on June 15, 2017, and a pilot program has commenced. Other states are monitoring the results of the initiative. Even if your institution is not in Texas, this pilot program may be considered by other states in the future.

Because government initiatives are subject to change, Rulemaking Alerts (RA) will be incorporated as a supplement to core content throughout this blog.

Top 5 Government Initiatives (Inclusive of PRO Measures):

Three fundamental goals should stand out when starting a patient-reported outcomes (PRO) program. First, you are determined to evaluate care by including outcomes based on the patient’s viewpoint along with other clinical measures. Longitudinally tracking patient assessment of pain and function can provide insights into the effectiveness of hip and knee arthroplasty across a much broader patient population than the relatively small number of patients that suffer implant failures and require surgery.

Second, you are determined to enable your institution’s provision of PRO data to the Centers for Medicare & Medicaid Services (CMS) and other payers as they continue defining quality measures for value-based reimbursement. For example, CMS defines PRO requirements within their Medicare reimbursement programs such as Comprehensive Care for Joint Replacement (CJR) model and the Merit-based Incentive Payment System (MIPS). MIPS recently replaced the Physician Quality Reporting System (PQRS). The demand for PRO data by regulators, payers, accreditors, and professional organizations has accelerated, as patient care associated with PRO programs has demonstrated improvement. Better technology for data capture has also accelerated demand.  

Finally, you are determined to use comparative data and PRO benchmarking to provide evidence for needed quality improvement work at both the hospital and surgeon level. National Registry data is often used to enable this effort.

If these goals are important to your institution, the five steps shared below will help you launch a successful PRO program: