Letter from the Executive Director
AJRR Executive Director
Jeffrey P. Knezovich, CAE

The AJRR has accomplished much in 2016 so far. Every day we are getting closer to our goal of collecting 90% of all total hip and knee arthroplasty procedures in the U.S. With such overwhelming growth comes the need for a Registry that can technologically support the procedural volume. The AJRR Board of Directors met on July 15, at our Rosemont offices, and the direction of our technology moving forward was discussed front and center.
Our Board of Directors decided that the best course of action would be to find a new technology partner to help our system move to the next level. As a result of the merger agreement between AJRR and the California Joint Replacement Registry (CJRR) in the spring of 2015, CJRR will be fully integrated into AJRR on January 1, 2017. The CJRR will exist as a standing committee, and along with gaining 10 CJRR hospitals, AJRR will be moving all of its current participants onto the CJRR platform sponsored by technology vendor Ortech Systems, Inc. The transition will be made as seamless as possible for all AJRR and CJRR participants.
This new partnership with Ortech will allow for several Registry updates. We will be able to enhance the dashboards with improved analysis and mobile support and have the capability to accept the submission of Level II complications, comorbidities, and risk factor data. We'll be able to expand our electronic health record (EHR), patient-reported outcome (PRO), and device manufacturer vendor partnerships, and build a services layer for vendor data integration.
A more robust Registry platform also provides us with opportunities to better assist our participants with quality initiatives. The platform will give us enhanced capabilities to collect and report on Level III PRO data with full Comprehensive Care for Joint Replacement (CJR) model support. Additionally, our Registry will satisfy programs like the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS). Accreditation organizations like The Joint Commission and insurer's distinction programs like Blue Cross and Cigna have standards that the AJRR will be able to help meet. The new technology will also let us satisfy objectives from certifying boards like Maintenance of Certification (MOC).
The field of orthopaedics is constantly changing, and so are the needs of health care providers and their patients. As the National Registry, we want to be able to offer a relevant solution at all times. Our planned Registry upgrades will give institutions the tools to make better health care decisions. If you have any questions or concerns about these upcoming developments, please do not hesitate to let us know. We are always interested in hearing feedback from our stakeholders.
Many thanks,

Check Out Our New Unet Forum
The AJRR User Group Forum has an index of categories that allows users to engage with each other by category topic.

In late July we launched an online discussion forum for our User Group Network (Unet). This f orum is open to all users in a private group that allows them to ask questions, share lessons lea rned, and connect directly with each other. The standard frequency of communication for the group has consisted of quarterly conference calls and an in-person session at the AAOS Annual Meeting. The User Group Forum now provides a communication channel for users to interact with each other, without having to wait until the next quarterly call.
If your institution is participating in the AJRR, you can create an account for the Forum by visiting this link.
AAHKS Annual Meeting Registration is Now Open
The American Association of Hip and Knee Surgeons (AAHKS)  26th Annual Meeting will be held from November 10 - 13 in Dallas, Texas. The meeting will address a broad array of topics such as implant design, outcomes, surgical techniques, the latest socioeconomic issues in he alth care, and complications of primary and revision total joint arthroplasty (TJA) for hip and knee surgeons. Special courses such as "The Business of Total Joint Replacement: Surviving and Thriving" are also offered for residents, non-physician team members, and hospital administrators. We will have a booth at the meeting where we will be offering dashboard demonstrations and more information about the National Registry. The results of our 2016 Annual Report will also first be released at the meeting.
If you would like to register and plan your trip to the AAHKS Annual Meeting, click here.
AAHKS Publishes Online MACRA Resource Center

On May 9, 2016, the Centers for Medicare & Medicaid Services (CMS) published a  proposed rule addressing implementation of physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This proposed rule defines how CMS intends to shift traditional fee-for-service payments that reward physicians for the volume of services delivered to Medicare payments that reward value and patient outcomes.
AAHKS has developed an online MACRA Resource Center for health care providers to use for more information on the new payment reform. In addition to links to several CMS, American Academy of Orthopaedic Surgeons (AAOS), and American Medical Association (AMA) informational pages, this new resource center has sections on the MACRA physician payment framework, Advanced Alternative Payment Models (Advanced APMs), Merit-Based Incentive Payment System (MIPS), the composite scoring system, and more.
To access this valuable resource, click here.
What Does it Take to be a QualityPath Hospital?
The Alliance is a not-for-profit cooperative that exists to help their members manage their health care dollars while positively impacting their employees' health. They contract with several hospitals, professional service providers, and insurance trusts in Illinois, Wisconsin, and Iowa. The Alliance has a program called QualityPath which covers 100% of medical costs for patients for certain procedures, including knee and total hip replacements. These patients are directed specifically to QualityPath-designated hospitals and surgeons who are known for quality care. To receive this esteemed designation for knee and total hip replacement, hospitals are required to be AJRR participants.
If your institution would like to qualify for QualityPath designation, please contact AJRR Program Coordinator Alyssa Burns at burns@ajrr.net. She will be able to provide assistance with the Registry enrollment process.
AJRR and the Bree Collaborative TKR/TJR Bundle
The Bree Collaborative is a partnership established to provide a mechanism through which  public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State. Workgroups made up of Bree members and community experts send quality improvement recommendations to health care purchasers. Our mission aligns with the goals of the Bree Collaborative, and the "Repair of the Osteoarthritic Joint" section of the Bree Collaborative TKR/THR Bundle requires all implants to be registered using the AJRR.
Nearly 50% of Bree Collaborative members are currently participating in the AJRR. If you are a Washington institution that is not yet participating in the National Registry but would like to qualify for the TKR/THR Bundle, contact AJRR Program Coordinator Phil Dwyer at dwyer@ajrr.net for information on how to enroll.
Upcoming CJR Data Submission Deadline
The Centers for Medicare & Medicaid Services (CMS) requires the submission of data from July 1 to August 31, 2016 for hospitals in the Comprehensive Care for Joint Replacement (CJR) model's Metropolitan Statistical Areas (MSAs). If you are a hospital in one of these 67 regions, make sure that you submit your data before the October 31, 2016 deadline! Our patient-reported outcome (PRO) platform can help add to your composite score, as PROs give hospitals two bonus points. CMS is being more lenient with PRO submission in 2016 since this is the first year of CJR, so submitting PRO data now is a great way to boost your composite score before it becomes a mandatory aspect of the model.
For a list of the PRO data elements to be collected for CJR, click here.
Authorized Vendor Profile 

Platform Name: The Surgical Outcomes Systemâ„¢ (SOS)
Platform Website: www.surgicaloutcomesystem.com
AJRR Vendor Since: November 2014
General Description: SOS is an orthopaedic and sports medicine global registry that is cloud-based and tablet-friendly. The intuitive platform enables physicians to easily collect and analyze patient outcomes and procedures to address the demands of evidence-based medicine. The SOS global registry allows physicians to remotely monitor their patients' outcomes over two years through patient-reported outcome (PRO) questionnaires and clinician reported objective measures. SOS integrates analysis and reporting tools that are used in conjunction with the systematic collection of data for foot and ankle, hand, orthopaedic sports medicine, spine, and adult reconstructive orthopaedics to improve quality at the population and individual patient levels. The primary purpose of the SOS is for monitoring and evaluating the outcomes of various orthopaedic and sports medicine medical procedures, leading to the development of evidence-based protocols for treating patients. Secondary purposes of SOS include analysis and publication of results, patient education, and cost-effectiveness of treatment procedures and products. SOS is an Arthroscopy Association of North America (AANA) member benefit. 
Quality Initiative Assistance: SOS is listed on the National Quality Registry Network (NQRN) website and is a specialized registry that is ready to accept data generated from the certified electronic health record (EHR) technology of surgeons and other eligible professionals seeking to achieve Objective 10 (Public Health Reporting) of Meaningful Use Stage 2. SOS patient-reported outcome measures (PROMs) and risk variables are aligned with the Comprehensive Care for Joint Replacement (CJR) Bundled Payment Plan.
Features Offered:
  • SOS is the first global registry in orthopaedics that encompasses all sub-specialties (sports, arthroplasty, distal extremities, and spine), therefore all users are able to access and analyze a global de-identified (de-identified by facility, surgeon, and patient) aggregate dataset
  • SOS is a cloud-based platform and HIPAA audited to ensure compliance with relevant standards and protect sensitive data
  • The physician/facility owns the data
  • SOS will automatically email surveys to patients at predefined time points
  • Both the patient portal and surgeon portal are accessible on PCs, tablets, and smart mobile devices
  • Users are able to create, share, and edit "favorite" operative templates
  • Users of SOS are able to analyze, plot trends, and export raw data within their own portal on any collected data fields
Integration with AJRR: SOS is an authorized vendor of the AJRR, and collaborates with AJRR participating sites to submit the SOS PROMs data to the National Registry. 
Fun Fact: SOS is approved through the Data Protection Authorities for privacy and security in more than 15 countries globally. To view all of the approved countries, visit the SOS website.

A full list of AJRR's Technology Partners can be found  here .
Data Corner


Our 2014 Annual Report has a wealth of information on procedural and component data. Table 2 (pictured above) contains some interesting findings. Femoral head diameter choice at the time of hip arthroplasty has shown some increase for 36 mm sizes in this sample over the past three years. There is also a corresponding decrease in those less than 28 mm, with overall nearly 85% of heads measuring 32 mm or larger for all three years.
Slides with all the tables and figures from the 2014 Annual Report can be found on our website .
Upcoming Webinars

Due to the coming upgrades of the Registry platform, our webinar program is being retooled. We are in the process of creating new and relevant content to present to all of our current and potential participants.

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
Our Newest Hospitals

We've welcomed these participants into the Registry since the last volume of
The Register:

#725 - Sonoma Valley Hospital in Sonoma, CA
#726 - Community Hospital South Campus in Oklahoma City, OK
#727 - Community Hospital North Campus in Oklahoma City, OK
#728 - Palomar Medical Center in Escondido, CA
#729 - Pomerado Hospital in Poway, CA
#730 - Wuesthoff Medical Center - Rockledge in Rockledge, FL
#731 - St. Vincent Charity Medical Center in Cleveland, OH
#732 - Mease Countryside Hospital in Safety Harbor, FL
#733 - Mease Dunedin Hospital in Dunedin, FL
#734 - Morton Plant Hospital in Clearwater, FL
#735 - Morton Plant North Bay Hospital in New Port Richey, FL
#736 - South Florida Baptist Hospital in Plant City, FL
#737 - St. Joseph's Hospital in Tampa, FL
#738 - Winter Haven Hospital in Winter Haven, FL
#739 - Bartow Regional Medical Center in Bartow, FL
#740 - St. Anthony's Hospital in Saint Petersburg, FL

AJRR currently has   740   participating hospitals in all 50 states! Click here for a full list of all participating sites.

AJRR in the News

AAOS Now published an article about the benefits of using AJRR for CJR bonus points in their July issue: 

Huntington Hospital's Registry participation received coverage in Pasadena Now:

To view our p ress releases, 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

©2016. All rights reserved.