The Joint Commission Sponsors Webinar to Promote the AJRR

On November 29, 2012, The Joint Commission sponsored a

teleconference that introduced their constituents to AJRR. AJRR Board Chair-man, David G. Lewallen, MD, and AJRR Directors facilitated a lively discussion for over 500 participants. We were overwhelmed with the response to this session and are grateful to The Joint Commission for their assistance in promot-ing AJRR. Special thanks to Joint Commis-sion staff Jean Range, Executive Director, Business Development and David Eickemeyer, Associate Director, Certifica-tion, for their support.

AJRR Holds Their First Information Technology (IT)Webinar

AJRR held its first IT webinar on October 17, 2012. Randy Meinzer, AJRR’s IT Direc-tor, discussed the ways in which hospitals can submit data, the data elements currently collected, and the expansion of Level 2 and 3 data collection in 2013. AJRR reporting capabilities and the registry software were also briefly addressed. The webinar had great attendance and we appreciate the participation by those who were able to join. If you were not able to attend this webinar but would like a copy of the presentation or audio, please contact AJRR staff for further information.

Minnesota Medical School. One of Dr. Gioe’s primary areas of interest is registry-based research. He has published and lectured widely on data originating from a community total joint registry at HealthEast Care System, St. Paul, MN. This registry began in 1991 and Dr. Gioe was a significant contributor to its inception and design.

Steven H. Stern, MD, MBA, Vice President - Cardiac & Orthopaedics/Neuroscience at UnitedHealthcare, continues his term as Secretary/Treasurer. Dr. Stern is a board-certified orthopaedic surgeon who special-ized in adult reconstruction. In his current position at UnitedHealthcare, Dr. Stern is responsible for issues relating to musculo-skeletal care including joint arthroplasty surgery. Dr. Stern has over twenty years of orthopaedic surgical experience and has published numerous articles on total knee and hip arthroplasty.

Continued on page 4 ....

2013 brings changes to the AJRR Board of Directors. Our new Chairman is William J. Maloney, MD. Dr. Maloney is Elsbach-Richards Professor of Surgery and Professor and Chairman, Department of Orthopaedic Surgery at Stanford University. His practice and research program at Stanford focuses on adult reconstructive surgery, specifically hip and knee replacement. Dr. Maloney convened the first meeting on the develop-ment of a national arthroplasty registry in 2001, which was cosponsored by the Ameri-can Academy of Orthopaedic Surgeons (AAOS) and the Agency for Healthcare Research and Quality (AHRQ). Since that time, Dr. Maloney has been continuously involved in AJRR in various leadership positions.

Our new Vice-Chair is Terence J. Gioe, MD, Chief of Orthopaedic Surgery at the Minne-apolis Veterans Affairs Medical Center and Adjunct Professor at the University of

Happy New Year!

Page 1American Joint Replacement Registry • 6300 North River Road, Rosemont, IL 60018 • 847-292-0530 | info@ajrr.net • www.ajrr.net

AJRR’s Newest ParticipantsAdvocate Christ Medical Center

Allen Memorial HospitalConway Medical Center

Doylestown HospitalInova Mount Vernon Hospital

Jordan HospitalMercy Health System

Mt. Carmel New Albany Surgical HospitalNorthwestern Memorial Hospital

Novant HealthOrthoCarolina Research Institute

Reading HospitalSan Antonio Community Hospital

Sibley Memorial HospitalSpencer Hospital

Stanford Hospital and ClinicsSt. John’s Medical CenterSwedish Medical Center

Unity HospitalUniversity of Iowa Hospitals and Clinics

Virginia Hospital CenterVirginia Mason Medical Center

WellStar Health SystemWilliam Beaumont Hospital

William J. Maloney, MD Terence J. Gioe, MD Steven H. Stern, MD, MBA Pamela L. Plouhar, PhD Eric Rugo, MBA

Inside This Issue

Happy New Year!Webinar NewsOperation Walk USALegal CornerInfo Tech 101Meet the Public Advisory BoardChampions of the QuarterUpcoming EventsPublications of Interest

p. 1p. 1p. 1p. 2p. 2p. 3p. 3p. 3p. 4

Operation Walk USA and AJRRThis year marked the second

annual Operation Walk USA event. On December 7, 2012, over 100 surgeons performed total joint replacements on 200 individuals who are under- or uninsured. Prior to Operation Walk USA, these individuals were unable to receive the care they desperately needed, and as such, many experienced substantial pain and disability.

Continued on page 4 ....

Newsletter of the American

Joint Replacement Registrythe register

WINTER 2012-2013 Volume 1, No 4

AJRR Board of Directors

William J. Maloney, MD Chair, AAOS Representative

Terence J. Gioe, MD Vice-Chair, Knee Society Representative

Steven H. Stern, MD, MBA Secretary Treasurer, Payer Representative

Thomas C. Barber, MD AAOS Representative

Kevin J. Bozic, MD, MBA AAHKS Representative

Catherine MacLean, MD, PhD Payer Representative

J. Wesley Mesko, MD AAOS Representative

Pamela L. Plouhar, PhD Industry Representative

E. Anthony Rankin, MD AAOS Representative

Eric Rugo, MBA Industry Representative

Patience H. White, MD, MA Patient/Public Representative

In response to comments from many hospi-tals that are participating or considering joining the AJRR, we have made the follow-ing substantive changes to the AJRR standard Participation and Business Associate/Data Use Agreements. A redlined version of these agreements showing these changes as well as some technical revisions will be made available to all existing partici-pants for their review on the AJRR website.

AJRR Participation Agreement:: Section 5 (Confidentiality). All references to the AJRR acting as an Organized Health Care Arrangement under HIPAA have been deleted along with other minor edits. :: Section 8 (Insurance). Participants may satisfy this requirement through the provi-sion of appropriate self-insurance programs.

:: Section 9 (Termination). Either party may now terminate the Participation Agreement without cause on 60 days notice. :: Section 14 (Assignment). The Participa-tion Agreement may be assigned to a party’s affiliate, successor entity, or subsidiary without the written approval of the other

AJRR Contributors

• American Association of Hip and Knee Surgeons (AAHKS)• American Academy of Orthopaedic Surgeons (AAOS)• Aesculap Implant Systems• Biomet• Blue Cross Blue Shield Association• Consensus Orthopedics• DePuy Synthes• DJO Surgical• Exactech• The Hip Society• The Knee Society• Smith & Nephew• Stryker• UnitedHealth Foundation• WellPoint• Wright• Zimmer

party.

AJRR Standard BA/DU Agreement:: Section 5 (a) (Participant’s Notice of Privacy Practices etc.). Instead of the Partici-pant representing and warranting to have a Notice of Privacy Practice in place, we now request that they simply acknowledge that one is in place and available to its patients.

Continued on page 4 ....

Legal Corner By Robert Portman, JD and Amita A. Sanghvi, JD, MHA

Page 2 American Joint Replacement Registry • 6300 North River Road, Rosemont, IL 60018 • 847-292-0530 | info@ajrr.net • www.ajrr.net

Info Tech 101 By Randolph Meinzer

AJRR Level 2 data elements

In 2013, the AJRR will add Level 2 (L2) data reporting capabilities to its data system. The primary goal of collecting L2 data is to risk adjust the data used to create reports and metrics provided to participating hospitals and the orthopaedic community. Currently, the AJRR team, physician committees, and work-groups are developing the list of required versus optional L2 data elements.

At a minimum, AJRR plans to require the submission of patient co-morbidities from all participating sites. Other non-mandatory items that AJRR’s software will accept include pre- and post-operative assessment forms similar to what you may be using for history and physicals; expanded procedural informa-tion; operative complications; and Physician Qualitly and Reporting System (PQRS) information.

:: The pre-operative assessment data entry form includes patient quality of life assess-ments, laboratory values and drop down lists of ICD-9 co-morbidities (e.g., diabetes, hyper-tension, peripheral artery disease, obesity, pulmonary disease, etc.).

:: The extended procedural information will include computer/robotics assistance flags, surgical approach, procedure initiation and completion times, and American Society of Anesthesiologists (ASA) scores.

:: The operative and post operative complica-tions will include those indicators identified by The Hip and Knee Societies. For example, AJRR will have the capability to log infection, fractures, excessive bleeding, and others not mentioned here.

:: The AJRR recognizes the need to collect and store PQRS on behalf of its contributing sites.

AJRR is adding the capabilities to easily enter and store this information for retrieval and analysis to assist in your submission process.

AJRR registry reporting capabilities, available mid-2013, will include L2 data elements and graphical data presentations for those sites that will be subscription members of the AJRR.

AJRR is cognizant that physician practice groups may be involved with pre-operative patient data and post operative care of AJRR L2 data submission. We have included features to enable hospital and physician practice groups to collaborate and share efforts in the submission process.

Prior to launching L2 data collection, the AJRR will conduct a pilot program to assess the various methods hospitals might employ to electronically extract data from adminis-trative claims information as well as the time commitment necessary for manual and electronic data entry participants. The AJRR will provide an update to our partici-pating sites prior to this planned L2 pilot program to gauge interest in participating in the pilot.

Our next IT article will include an overview of AJRR data security and privacy.

Wishing you a successful New Year - Randy

American Joint Replacement Registry • 6300 North River Road, Rosemont, IL 60018 • 847-292-0530 | info@ajrr.net • www.ajrr.net Page 3

degree from Georgetown University School of Medicine and completed training at the Harvard Combined Orthopaedic Surgery Residency Program. He completed additional fellowship training in joint replacement at UCLA. He is a Board Certified Orthopaedic Surgeon and a Fellow of the American Academy of Orthopaedic Surgeons.

Dr. Bengs’ research interests include femoral bone loss modeling for revision surgery, hip and knee range of motion, and fragility fractures. His awards and honors include an Orthopedic Research Education Foundation grant, Los Angeles Orthopaedic Hospital Doctor’s Grant, Marmour Award, and Alpha Omega Alpha.

Orville Johnson, “OJ”, is a Registered Nurse and the current Director of Surgical Services at Central Peninsula Hospital (CPH) in Soldotna, Alaska. OJ manages a surgical staff of 48 and an average of

5,400 surgical cases annually. Under his leadership, the department has twice been recognized by The Joint Commission for top quality in surgical care.

AJRR is excited to have two champions this quarter. Our champions represent the wide range of organizations participating in the AJRR. It is our goal to represent hospitals across the country from large academic medical centers to community hospitals. As such, our Champions this quarter are Benjamin C. Bengs, MD, Assistant Profes-sor, Department of Orthopaedic Surgery at the David Geffen School of Medicine at University of California, Los Angeles (UCLA) and Orville “OJ” Johnson, RN, BSOE, Director of Surgical Services at Central Peninsula Hospital in Soldotna, Alaska.

Dr. Bengs is a full-time faculty surgeon at Santa Monica - UCLA Medical Center and Orthopaedic Hospital with an assistant professor appointment at the UCLA David Geffen School

of Medicine. He specializes in joint replace-ment, joint revision, and fracture care.

Dr. Bengs completed his undergraduate degree in Physiology with High Honors and Cum Laude at the University of California at Santa Barbara. He received his medical

Prior to joining CPH, Johnson was employed as the Director of Perioperative Services at Alaska Regional Hospital for eight years and as an Operating Room Supervisor in facilities in New Mexico, Oklahoma, Missouri, and Palmer, Alaska. Johnson has 32 years of experience in nursing.

Mr. Johnson attended the Midwestern Baptist Theological Seminary in Kansas City, Missouri, and graduated from Wayland Baptist University, Hawaii Campus in Hono-lulu, Hawaii, with a BS in Occupational Education. He double majored in Nursing and Christian Studies and minored in Classi-cal Voice.

Meet the AJRR Public Advisory Board

Integral to the success of the AJRR is the participation of our Public Advisory Board (PAB). The PAB seeks to improve the value of AJRR by ensuring a public voice in the registry’s data collection, reporting, and utilization activities. The PAB members represent a variety of stakeholders, all with the interest of the patient at the forefront. We would like to acknowledge the contributions of these individuals.

Patience H. White, MD, MA, is the Chair of the Public Advisory Board, and as such, sits on the AJRR Board of Directors as the PAB representative. Dr. White is Vice President, Public Health at the Arthritis Foundation and Professor of Medicine and Pediatrics at George Washington University School of Medicine and Health Sciences in Washing-ton, DC.

John A. Canning, Jr., serves as one of the patient representatives to the PAB. He is Chairman of Madison Dearborn Partners, LLC, a private equity firm in Chicago, IL.

Sally B. Hurme, JD, is Project Advisor - Education & Outreach for AARP in Wash-ington, DC.

Colin Nelson, BA, is Senior Research Associate with the Informed Medical Decisions Foundation in Boston, MA.

Martha Nolan, JD, is Vice President, Public Policy for the Society for Women's Health Research in Washington, DC.

Margaret VanAmringe, MHS, is Vice President for Public Policy and Government Relations at The Joint Commission. Her office is located in Washington, DC.

Robert P. Watkins, Esq., also serves as a patient representative to the PAB. Mr. Watkins is an attorney with Williams & Connolly, LLP, in Washington, DC.

Did you know?Many hospitals are excited to promote their affiliation with the AJRR. As a result, we have developed a few items which hospitals may use to promote this collaboration. After we receive signed contracts from a hospital, we will send along an “AJRR Participant” logo for use on brochures, newsletters, or websites. For our first 200 participants, we will also send along a “Charter Member” logo. For those hospitals that would like to issue a press release, a template document will be included to tailor for their Surgeon Champion and local community. You will also see “AJRR Partner” logos appearing on materials belonging to our contributors and software partners. If you did not receive these materials, but would like to use them at your participating hospi-tal, please contact Caryn Etkin at etkin@ajrr.net or 847-430-5032.

Upcoming EventsAJRR will have a booth at this upcomingmeeting:• AAOS Annual Meeting Chicago, Illinois March 19 - 23, 2013

Champions of the Quarter

American Joint Replacement Registry • 6300 North River Road, Rosemont, IL 60018 • 847-292-0530 | info@ajrr.net • www.ajrr.net Page 4

6300 North River RoadRosemont, Illinois 60018

www.ajrr.net | info@ajrr.net

AJRR Staff

Rylee Christensen Research InternSeptember Cahue, MPH Research AssociateCaryn Etkin, PhD, MPH Director of ResearchSteve Hamada Senior Software EngineerSusan Hobson, MPH Research AssociateJeffrey Knezovich, CAE Executive DirectorPamella Leiter, MSA, OTR/L Director of Policy and Strategic AlliancesRandolph Meinzer Director of Information TechnologyHannelore Venable Administrative Assistant

Publications of Interest

Arterburn D, Wellman R, Westbrook E, Rutter C, Ross T, McCulloch D, Handley M, Jung C. Introducing decision aids at Group Health was linked to sharply lower hip and knee surgery rates and costs. Health Affairs. September, 2012; 31(9): 2094-2104.

Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among medicare beneficiaries. 1991-2010. JAMA. September 26, 2012; 308 (12): 1227-1236.

Ellison P, Hallan G, Høl PJ, Gjerdet NR, Havelin LI. Coordinating retrieval and register studies improves postmarket surveillance. Clin Orthop Relat Res. November, 2012 470 (11): 2995-3002.

Franklin PD, Allison JJ, Ayres DC. Beyond joint implant registries: a patient-centered research consortium for comparative effectiveness in total joint replacement. JAMA. September 26, 2012; 308 (12): 1217-1218.

Robinson JC, Pozen A, Tseng S, Bozic, KJ. Variability in costs associated with total hip and knee replacement implants. Jour-nal of Bone and Joint Surgery. September 2012, 94A (18): 1693-1698.

Slover J, Zuckerman JD. Increasing use of total knee replacement and revision surgery. JAMA. September 26, 2012; 308 (12): 1266-1268.

Smith AJ, Dieppe P, Howard PW, Blom AW. Failure rates of metal-on-metal hip resur-facings: analysis of data from the National Joint Registry for England and Wales. Lancet. November 17-23, 2012; 380 (9855): 1759-1766.

Tomek IM, Sabel AL, Froimson MI, Muschler G, Jevsevar DS, Koenig KM, Lewallen DG, Naessens JM, Savitz LA, Westrich JL, Weeks WB, Weinstein JN. A collaborative of leading health systems fins wide variations in total knee replace-ment delivery and takes steps to improve value. Health Affairs. June, 2012; 31 (6): 1329-1338.

Legal CornerContinued from page 2

:: Section 5(c) (Breach Notification). We have changed the breach notification language to allow the Participant to issue breach notices without AJRR prior review and approval as long as such notices do not identify AJRR

:: Section 6(b) (Termination). The BA/DU Agreement will now terminate upon termi-nation of the underlying Participation Agree-ment except as otherwise specified in the BA/DU Agreement.

:: Section 8(c) (Interpretation). Any ambiguity in the interpretation of the provi-sions of the BA/DU Agreement will be resolved in favor of the meaning that permits Participants to comply with the HIPAA regulations or applicable state patient privacy laws.

Robert Portman, JD and Amita A. Sanghvi, JD, MHA are with the law firm of Powers Pyles Sutter & Verville PC in Washington, DC

Happy New Year! Continued from page 1

Also new to our Board of Directors is Pamela L. Plouhar, PhD, who is the World-wide Vice President of Clinical Research at DePuy Synthes, Inc. As such, she provides leadership to all Clinical Research functions for the DePuy Synthes, Inc. companies. She has a proven track record of results as an innovator and a leader. As an innovator, she has received the Johnson Medal for her contributions to the development of the Restore Orthobiologic Implant. She has been awarded a number of patents and has also served as a reviewer for National Institutes of Health and National Science Foundation proposals.

Eric Rugo, MBA, Vice President Govern-ment Affairs & Health Policy of Stryker, Inc. rounds out our Executive Committee. In 2004, Mr. Rugo created and launched Stryker Orthopaedics’ health policy and government relations activity. He has also developed the reimbursement capability for the orthopaedics division of Stryker to address the growing need to understand this aspect of the business. Mr. Rugo is the lead representative for Stryker Orthopaedics to AdvaMed, an industry advocacy associa-tion.

AJRR & Operation Walk USAContinued from page 1

AJRR is proud to be a partner with this worthwhile organization. Our data collec-tion software will be housing the basic demographic and procedural data collected on these patients, so that the staff and surgeons of Operation Walk USA can learn more about the patients that were treated in December. We look forward to seeing Operation Walk USA grow in the coming years and anticipate continued collaboration.

Please support the AJRR through donations to the Orthopaedic

Research and Education Foundation. Scanning this QR

code will take you directly to the AJRR donation page.

http://www.oref.org/site/PageServer?pagename=ajrr