This article was originally published in the October 2018 issue of AAOS Now, the American Academy of Orthopaedic Surgeons' (AAOS) monthly news magazine.
First Module Will Cover Shoulder Replacement
October is a milestone month for the Academy’s Registry Program, as it launches the Shoulder & Elbow Registry (SER). Building on the success of the American Joint Replacement Registry (AJRR)—the trailblazer data depository and resource for U.S. knee and hip arthroplasty that last year was reintegrated under the AAOS umbrella—SER will be previewed at the American Shoulder and Elbow Surgeons (ASES) meeting Oct. 11–14 and make its formal debut at the Academy’s Fall Meeting Oct. 25–27.
The first module to become operational in the new SER will cover shoulder arthroplasty procedures, to be followed by modules for rotator cuff repair and elbow replacement in 2019.
Registries and the Value Equation
“SER, the first of a number of planned offerings emerging from the experience of the highly successful AJRR, demonstrates the Academy’s commitment to providing the infrastructure for our members to study outcomes of their procedures,” said Gerald R. Williams Jr., MD, chair of the SER Steering Committee and the 2016–2017 Academy president. “As a member-driven organization, we offer this as value to our members, to help the frontline orthopaedic surgeon doing these procedures to collect quality data without having to create the entire infrastructure him- or herself.”
He noted that the registry has been developed with the support of organizational allies—namely, ASES, the American Orthopaedic Society for Sports Medicine, and the Arthroscopy Association of North America—as will be future additions to the registry roster covering other areas of focus. “We appreciate the help and support of our specialty societies for each anatomic registry,” Dr. Williams said.
Shoulder and elbow were identified and prioritized by the AAOS Registry Oversight Committee as the next clinical area for a new registry, explained Daniel J. Berry, MD, chair of the AAOS Registries Oversight Committee. “These are high-volume procedures that are performed across the specialty,” Dr. Berry said. “It became clear that shoulder and elbow needed a high-quality registry. Many AJRR clients already perform shoulder arthroplasty. They will be able to enroll in this module and easily add to their contracts, as well as recruit additional participants.”
The registry apparatus has been undergoing testing at a dozen pilot exemplary sites, representing an array of practice sizes and types based on AJRR participation, to test the process before it is launched live.
Contributing to Quality
As the organizational face of orthopaedics, the Academy, wielding a comprehensive infrastructure in technology and research, is uniquely suited to develop and maintain the core portfolio of registries serving the profession and stakeholders across the healthcare universe. “From a single source with the acquisition of AJRR to multiple anatomic areas, the Academy has created a foundation and precedent for all orthopaedic registries,” Dr. Berry said. “With our technical expertise and physician leaders like Dr. Williams, we’ve been able to roll this out at a quick pace and at a high caliber compared to starting from scratch.”
The Academy’s burgeoning family of registries will help orthopaedic surgeons provide high-quality care in many ways. “Data collection can be used in advocating the high quality of care that orthopaedic surgeons provide and can serve to demonstrate the quality-of-life specialty that is orthopaedics,” Dr. Williams said. “Registries can be used to inform the science and research that form the foundation of the standard of care. Close collaboration with Academy research staff enables the organization to use the data to inform guidelines and appropriate use criteria and performance measures and to inform the whole quality-of-life cycle.”
Registries will serve a vital role in empowering surgeons to demonstrate quality based on their data. “The government and payment agencies are encouraging us to move in the direction of providing quality measures,” Dr. Williams said. “They signal that they are going to pay on quality. By creating a home for registries for all specialties of orthopaedics, the Academy is acting to provide a product and resource that will ultimately assist our members in synchronizing their practice with these trends.”
The pressures on hospitals to provide quality data will continue to increase, he said. “The payers are ahead of the government in terms of listing tier levels of hospitals based on quality measures that they think are important, including infection rate, death rate, and readmission rate. Hospitals will need to provide data showing that they are performing at a certain level. If they make changes that demonstrate they have improved and are performing well, that favors them. It is also a market opportunity. They can create centers of excellence and similar initiatives. The same opportunity applies to individual surgeons.”
Shoulder: ‘A Good Bridge’
Dr. Williams explained that a registry for shoulder and elbow procedures follows logically from the inaugural AJRR enterprise covering hip and knee replacement. “One of the reasons shoulder and elbow was chosen was that people thought it was a good bridge from the mostly inpatient setting of hip and knee,” he said. “Shoulder replacements are moving to a stronger outpatient emphasis in comparison to hip and knee. Most rotator cuff repairs are done in the outpatient setting. The SER builds on the AJRR registry structure to include outpatient collection of data, so the next registries that come along that are almost all outpatient will be a smooth transition.”
Although much of the data reporting and contractual arrangements for registries are done at a hospital or institutional level and the benefits of registries may seem removed from daily practice, individual surgeons have ample reason to encourage participation by their institutions or clinical organizations. The data aggregated by registries will yield numerous advancements in medical knowledge and, subsequently, patient care. The data will serve to quantify the value provided by orthopaedic surgeons, in the eyes of the government and payment parties as well as the public, which increasingly judges physicians by online ratings.
“If you are a surgeon working in a certain hospital and that hospital doesn’t participate in a registry, you may be at a disadvantage,” Dr. Williams said. “There is also an important social benefit to doing this. Registries serve patients by providing them with information on quality results for what they about to undergo.”
David G. Lewallen, MD, medical director for AJRR, echoed this sentiment at the AAOS 2018 Annual Meeting. “Physicians need to understand that there is a potential reimbursement benefit in the future and an advocacy benefit,” Dr. Lewallen said. “We may be able to use the data, with both federal and state as well as private payers, to defend payments for the things we do that work well. Because there are so many things we do that are of benefit to patients, having the data to prove that will be invaluable to hospitals and doctors as they move forward in a sometimes-Darwinian environment.”
He also noted that success of AJRR and of the Academy’s nascent portfolio of new registries hinges on the efforts of individual “surgeon champions.” Almost all the hospitals that have joined AJRR “did so because of the efforts of these individual surgeons who voiced their opinion that participation is important,” he said.
Academy members interested in becoming physician champions for their practice sites are encouraged to contact the Academy Registry Program at RegistryInfo@aaos.org
“We have a dedicated team to help them through the contracting and support the onboarding,” Dr. Berry said. “For surgeons who want to get involved, our staff is available to help their teams make it happen.”
View SER Frequently Asked Questions here.
Terry Stanton is the senior science writer for AAOS Now. He can be reached at firstname.lastname@example.org.
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