An innovative effort to improve the quality of hip and knee replacement surgeries received a significant boost today with the announcement that three major health plans will contribute $550,000 to support expansion of the California Joint Replacement Registry (CJRR).
The CJRR collects, reports, and shares scientifically valid data on the results of hip and knee replacements performed in California to guide physician and patient treatment decisions and support programs for provider recognition and reward.
Founded in 2009, the CJRR is a collaboration of the California HealthCare Foundation, the primary funder; the Pacific Business Group on Health; and the California Orthopaedic Association. Blue Shield of California has committed to donate $300,000 over three years, health plan Cigna has pledged to donate $150,000 over three years, and Anthem Blue Cross has contributed $100,000 in 2014.
Progress Report Provides Key Findings
A new report presents findings from the registry's first two years of data collection (2011-2013), including information about 5,100 hip and knee replacement surgeries from nine participating hospitals and 61 surgeons.
By the end of 2014, approximately 30 hospitals and affiliated surgeons — comprising academic medical centers, community hospitals, and surgeon practices — will contribute data to the CJRR. With a new agreement with Kaiser Permanente, by early 2015 the CJRR expects to report on surgeries from hospitals that perform half of the hip and knee replacements in the state.
Among the observations in California Joint Replacement Registry: Progress Update:
- Data suggest that California is following national trends, with more and more patients having joint replacements and (on average) having them at a younger age.
- Patients undergoing surgery at hospitals participating in the CJRR report improvements in pain and function (the CJRR is one of the few multi-institutional registries in the US to measure these outcomes).
- Consistent with national trends, patients with knee or hip arthritis who undergo surgery at hospitals participating in the CJRR often have other medical conditions that make their operations more challenging. For example, 35% of CJRR patients fit the Centers for Disease Control and Prevention's definition of obesity.
- A majority of patients who have hip or knee replacements at hospitals participating in the CJRR have a hospital stay of fewer than three days.
Health Plans See Value
In California, more than 90,000 hip and knee replacements are performed every year, a number expected to rise as more Americans remain active as they age. Yet, despite the rapid growth in these surgeries, information about quality remains limited.
"A number of stakeholders are seeking objective information about the outcomes of joint replacement surgeries to guide their decisionmaking," says Kevin J. Bozic, MD, MBA, William R. Murray professor and vice chair of the department of orthopaedic surgery at the University of California, San Francisco and chair of the CJRR Steering Committee. "The CJRR helps demonstrate how surgeon, hospital, and device factors influence joint replacement patient outcomes," he said.
In addition to financial support, the three health plans have assisted in urging high-volume hospitals in their respective networks to participate in the CJRR, helping to improve the power of the data to support the best outcomes.
"Joint replacements are demanding procedures on patients — physically, mentally, emotionally, and financially," said Mark Morgan, president of Anthem Blue Cross. "We want to provide our members with as much information as possible so they can make informed choices on achieving the best results from joint replacement surgery. Anthem has already pioneered a reference-based pricing program to reduce the cost of knee and hip replacements. We see this as the logical next step."
"The California Joint Replacement Registry demonstrates how collecting and harnessing data can improve patient outcomes," said Paul Markovich, president and CEO of Blue Shield of California. "By encouraging best practices and engaging members in their own health care choices, we further our goal of increasing access to high-quality, affordable health care for all Californians."
"Cigna has been a leading advocate of cost and quality transparency and our contribution to the California Joint Replacement Registry is evidence of our commitment to giving consumers tools that help them make informed decisions about their health," said Jennifer Gutzmore, MD, senior medical director for Cigna in California. "Through the registry, we are also helping facilitate communication among doctors, hospitals, and individuals, which will lead to better care coordination, improved health outcomes, and importantly, greater value for patients."
About the CJRR
The California Joint Replacement Registry (CJRR) was created to meet the need for objective, scientific information about the results of hip and knee replacement surgeries in the state. One of only three multi-institutional Level 3 registries in the country, CJRR collects and incorporates clinical information and direct feedback from patients about the outcomes of hip and knee replacements.