Quality Measures in Total Hip and Total Knee Arthroplasty

Abstract

Introduction: Total joint arthroplasty represents the largest expense for a single condition among Medicare beneficiaries. Payment models exist, such as bundled payments, where physicians and hospitals are reimbursed based on providing cost-efficient, high-quality care. There is a need to explicitly define "quality" relevant to hip and knee arthroplasty. Based on prior quality measure research, we hypothesized that less than 20% of developed quality measures are outcome measures. Methods: This study systematically reviewed current and candidate quality measures relevant to total hip and knee arthroplasty using several quality measure databases and an Internet library search. Results: We found a total of 35 quality measures and 81 candidate measures, most of which were process measures (N = 21, 60%), and represented the National Quality Strategy priorities of patient-and caregiver-centered experience and outcomes (31%), effective clinical care (28%), or patient safety (19%). Conclusion: Various stakeholders have developed quality measures in total joint arthroplasty, with increasing focus on developing outcome measures. The results of this review inform orthopaedic surgeons on quality measures that payers could use value-based payment models like the Merit-based Incentive Payment System and Comprehensive Care for Joint Replacement. Level of Evidence: Level I, systematic review of level I evidenceT otal joint arthroplasty is a common orthopaedic procedure performed in the elective setting, making expenditures on arthritis the largest for a single condition among Medicare beneficiaries. 1 In 2014, more than 400,000 total hip arthroplasties (THAs) or total knee arthroplasties (TKAs) were performed, with the average Medicare expenditure for surgery, hospitalization, and recovery ranging from $16,500 to $33,000 across different geographic areas. [2][3][4] Despite decreasing length of hospital stays and improved outcomes, 5,6 the total expense of these procedures will continue to rise with an increase in surgical volume. [7][8][9] Given the notable cost of total joint arthroplasty to the United States health system, these procedures are becoming increasingly regulated through payment models that reimburse based on providing high-quality care. 10 For example, in 2015, the Centers for Medicare & Medicaid Services (CMS) organized a pilot program for the Comprehensive Care for Joint Replacement. This bundled payment program for THA and TKA reimburses hospitals and surgeons based on their ability to provide high-quality, cost-efficient services. 2 In value-based models, payers hold participant hospitals and surgeons financially accountable for an episode

Quality Measures for Pediatric Orthopaedic Surgery: A Systematic Review

“…We found fewer quality measures applicable to pediatric orthopaedic surgery compared with other fields of orthopaedic surgery. 12,13,[16][17][18]21 In similar systematic reviews there were 134 measures identified in the field of hand surgery, 116 measures in arthroplasty, 74 measures in spine surgery, and 116 in orthopaedic sports medicine. Similar to other fields of orthopaedic surgery, quality measures in pediatric orthopaedic surgery are unequally represented, with process measures being the most common.…”

Regional anaesthesia quality indicators for adult patients undergoing non‐cardiac surgery: a systematic review

“…Outcome measures are regarded as the most important Donabedian domain, as they measure directly the effect of the intervention on the patient [42]. The identified distribution is, therefore, encouraging, particularly in comparison with other reviews of quality indicators in other surgical fields, which identified most process indicators [43–47]. That said, 26 (38% of all indicators collected) of the outcome indicators were found in a single paper that defined rates of various regional anaesthesia‐related complications as individual outcome indicators [37].…”

A Comprehensive Primer for Quality Assessment in Orthopaedic Surgery: Quality Measures, Payment Programs, and Registries

“…We identified six recent systematic reviews of quality measures in orthopaedic surgery published in the last five years. [2][3][4][5][6][7] The subspecialties investigated include spine, 2 sports medicine, 3 total hip arthroplasty and total knee arthroplasty (THA/TKA), 4 trauma, 5 upper limb, 6 and foot and ankle. 7 These studies highlight that two-thirds of quality measures apply to care processes rather than validated outcome measures or the result of care delivered.…”

“…This highlights the uneven representation of quality metrics across process and structure domains and the lack of focus on PROs, which are arguably more relevant in orthopaedics. [2][3][4][5][6][7] Although these published reviews provide a comprehensive list of all available orthopaedic quality metrics, many of the metrics highlighted in these papers are no longer actively in use or have been revoked by the originating agency. A more sustainable approach is to highlight open-access, updated resources that include active quality measures and their utility.…”