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

After months of preparation, I am pleased to report that we have completed the California Joint Replacement Registry (CJRR) 2016 Annual Report. In the time since our initial progress report was released in 2014, the volume of cases and surgeons in the CJRR has continued to grow steadily. The new data for this year include completion rates for patient-reported outcome (PRO) surveys as well as incidence of device utilization and surgical approaches in total hip arthroplasty.
Our collaborations with both the Center for Outcomes Research and Evaluation (CORE) at the Yale School of Medicine and  Blue Shield of California continue to progress as well. The Yale group has completed their analysis of our PRO data; their report should be released shortly. Blue Shield has engaged CJRR and the California Orthopaedic Association (COA) to assist with their pre-authorization program for hip and knee replacement. Their program, which began on April 1, is off to a strong start. We anticipate our formal agreement to be finalized in the near future. As part of this collaboration, patients being cared for by CJRR surgeons at CJRR hospitals will be exempt from the pre-authorization program. In addition, we expect CJRR to play a significant role in collecting and disseminating the data collected from members of Blue Shield.
On the research front, CJRR presented multiple papers at the past annual meetings of the American Association of Hip and Knee Surgeons (AAHKS), the American Academy of Orthopaedic Surgeons (AAOS), and the International Society for Arthroplasty Registries (ISAR). In these studies, we examined variations in risk-adjusted hospital-expected complication rates after hip and knee arthroplasty. Current research projects include the evaluation of 1) PROs with different surgical approaches, 2) the relationship between complications at community versus academic hospitals and surgeons, and 3) the exploration of socioeconomic risk adjustment. We have a critical mass of data in CJRR at this point, so please send us your research proposals at info@ajrr.net if you are interested.  
Lastly, please mark your calendars for the next annual meeting of the CJRR. This will be held in San Francisco at the PARC 55 San Francisco Hotel on the afternoon of May 19, 2017. We hope our members will also stay in town to attend the 6th International Congress of Arthroplasty Registries. For registration information, please see the article about the Annual Meetings below. As always, thank you to all of our stakeholders for your continued dedication and support of the CJRR.


James I. Huddleston, III, MD
The Release of the 2016 Annual Report

The CJRR 2016 Annual Report will be released on November 11, 2016, in conjunction with the release of the AJRR 2016 Annual Report and the American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting. A link to a downloadable copy will be available on the AJRR website that day. The data presented in the report was collected between April 1, 2011, and June 17, 2016.
CJRR was the first orthopaedic registry in the U.S. to publicly publish patient-reported outcome  measures (PROMs) data collected from participating hospitals. In the PROMs section of the 2016  report, you will notice that more hospitals than last year have contributed enough data to be included. This will be the first time we have included data on completion rates of surveys. The collection of patient-reported outcome (PRO) data remains challenging in the United States. Fortunately, there are  multiple entities tackling this problem through a variety of innovative solutions. Interestingly, all hospitals achieved an average rating for the percentage of patients able to achieve improvement in their scores at one year after the operation.
To view past CJRR Annual Reports and Progress Reports, click here. The CJRR 2016 Annual Report will be posted on that same page next month.
Registry Platform Technology Update
CJRR hospitals will have on-demand access to the AJRR dashboards starting January 1, 2017
The process of migrating both CJRR and AJRR participants over to the new Registry platform continues.  We expect to release the ability to collect new patient-reported outcome (PRO) surveys for all CJRR hospitals in the next several weeks. These surveys include the HOOS, JR., KOOS, JR., and PROMIS-10 Global Health. Collection of the new surveys is optional. However, along with the VR-12, they will be your default surveys in the Registry, and the Centers for Medicare & Medicaid Services' (CMS) Comprehensive Care for Joint Replacement (CJR) model offers bonus points to hospitals that collect them. We understand the importance of the CJR to many of our participants, so in the coming weeks we will also be releasing the ability to submit all of the measures that the quality initiative's bonus point requests.

There are several platform enhancements that will be available to hospitals on January 1, 2017. Updated data specs for both Level I patient-related data and Level II comorbidities and complications data will be released. Data specs for every CJR-required field will also be offered; the quality initiative mandates elements from all three data levels. The biggest addition will be that CJRR hospitals will have access to the AJRR Demand Reporting & Electronic Dashboard System. The dashboards will allow participants  to drill down data and run reports as often as they would like, a capability that they did not have in the past. Each CJRR hospital was provided a grant on an annual basis from the California Health Care Foundation (CHCF), but that will end once the merger is complete. We ask that each hospital pay an annual $2,850 subscription fee for dashboard access.  The additional configuration fee for CJRR participants has been waived.

A few CJRR processes are being retired and replaced with more efficient methods. Quarterly reports will no longer be provided after Q4 2016, with the last one being delievered around February 2017. The AJRR dashboards will take the place of the reports, as all CJRR hospitals with subscriptions will be able to compare their hospital to national benchmarks. Participants will also no longer be able to use fax as a method of submitting surveys, but the AJRR offers multiple options for simple electronic data submission.

It is possible that your hospital may have experienced minimal service interruptions; please note that this is only a temporary side-effect of the technology update. We are currently working to resolve this issue and full service will resume for all CJRR hospitals shortly. If you are experiencing any problems with your system, please let us know at  info@ajrr.net .

If you have any questions about what to expect in the coming months as the merger is completed, please reach out to AJRR Program Coordinator Phil Dwyer at dwyer@ajrr.net or AJRR Program Assistant Monica Moore at moore@ajrr.net.
CJRR and ISAR Annual Meetings to Be Held in Conjunction

The 6th International Congress of
Arthroplasty Registries, the   International Society of Arthroplasty Registries (ISAR)  Annual Meeting, will be held in San Francisco from May 20-22, 2017. CJRR hospital staff is encouraged to attend, as the CJRR Annual Meeting will be held in San Francisco on May 19. Both events will take place at the  PARC 55 San Francisco Hotel.
The ISAR Annual Meeting will inform attendees on recent registry trends and provide the chance to network with other registry users. Also, representatives from the CJRR, AJRR, and the American Association of Hip and Knee Surgeons (AAHKS) deliver presentations and have posters featured at the meeting each year.
Some of the topics to be covered at this year's ISAR meeting include:
  • Innovations in Registry statistics and methodologies
  • Translating research into clinical practice
  • Electronic health records (EHR) and big data analytics transforming the future
Visit the ISAR website for more information. You can register for the ISAR Annual Meeting here. Visit the AJRR website for links to posters from past ISAR meetings. Registration for the CJRR Annual Meeting will be forthcoming.
Our Solution for PQRS, VBM, and MU Reportin g

The AJRR Orthopaedic Quality Resource Center can be accessed from the AJRR website
Through collaboration with CECity, the AJRR Orthopaedic Quality Resource Center is a  Qualified  Clinical Data Registry (QCDR) that has been approved by the Centers for Medicare & Medicaid Services (CMS) . AJRR's QCDR is comprised of 38 quality measures that can assist eligible providers (EPs) and Group Practice Reporting Option (GPRO) practices with the Physician Quality Reporting System (PQRS) and Meaningful Use quality initiatives.

Reporting PQRS through this resource center can help avoid the maximum penalty and achieve the maximum incentive under the 2016 PQRS and Value Based Modifier (VBM) programs. These programs collectively place approximately 6% of 2018 allowed Medicare Part B FFS charges at risk.  The annual cost for AJRR's QCDR per provider is $439.

For an article with more information about the AJRR Orthopaedic Quality Resource Center, click here. To get started using the QCDR, click here
California Joint Replacement Registry is Affiliated with the American Joint Replacement Registry
www.ajrr.net/cjrr | 847-292-0530