Total Knee and Total Hip Replacements (TKA, THA) are among the most common procedures performed in the United States with around 700,000 performed each year. While most procedures are considered highly successful, CMS identified a “significant variance in the quality and cost of care for these surgeries.”
Therefore, The Joint Commission teamed up with a Technical Advisory Panel, comprised of experts in orthopedic surgery, anesthesia, rehabilitative medicine, internal medicine, physical therapy, perioperative nursing, social work, and joint program administration, to select four new performance measures for advanced certification in THA and TKA procedures. Each measure underwent rigorous testing and was open for public comment.
These measures (for both inpatient and outpatient) and their descriptions are as follows:
- THKR-1 Regional Anesthesia: Process measure for patients undergoing a total hip or total knee replacement with regional anesthesia attempted or performed. Regional anesthesia includes neuraxial anesthesia (spinal and epidural blocks) as well as peripheral nerve blocks.
- THKR-2 Postoperative Ambulation on the Day of Surgery: Process measure for patients undergoing total hip or total knee replacement who ambulated postoperatively the day of surgery or ambulated in the PACU or within 4 hours of discharge from the PACU.
- THKR-3 Discharged to Home: Process measure for patients discharged to home following a total hip or total knee replacement.
- THKR-4 Preoperative Functional/Health Status Assessment: Process measure for the percentage of patients who completed the general health (PROMIS Global-10) and joint-specific functional status assessments within 90 days prior to surgery, which includes HOOS JR. or HOOS Pain, Function Daily Living Subscales for THAs, and KOOS JR. or KOOS Stiffness, Pain, Function Daily Living Subscales.
Collection for these new measures will be mandatory as of January 1, 2018, for all existing and new incoming THKR-certified programs. Measures will need to be reported, quarterly, to The Joint Commission’s Certification Measure Information Process (CMIP), which can be found on the Joint Commission Connect secure extranet site.
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