Quality Initiatives and Tools

AJRR has been designated as a Qualified Clinical Data Registry (QCDR) by the Centers for Medicare & Medicaid Services (CMS) every year since 2014. We are dedicated to helping you participate in quality improvement initiatives and adopt tools that may enhance clinical practice.

Participation in the AJRR has many benefits including assistance with several federal quality initiatives, insurer’s distinction programs, and state collaboratives. These programs provide reimbursements and other incentives for displaying improvement in the quality of patient care, prompting medical institutions to use clinical data registries like AJRR to compare outcomes success. Learn more about these programs below.

Quality Initiatives

Aetna Institutes of Quality

Registry Participation Helps with Insurer's Designation

Aetna, one of the nation’s leading diversified health care benefits companies, offers Institutes of Quality (IOQ) designation to facilities that provide orthopaedic services and meet certain standards for clinical quality, cost efficiency, and network access for specific orthopaedic surgery programs in the IOQ network.

One of several mandatory requirements for IOQ institutions is to report orthopaedic case information to external Registries such as the American Joint Replacement Registry. If you would like to use AJRR to satisfy the external registry requirement, you must have a signed and executed contract by the date listed in Aetna's materials. Please refer to Aetna for the exact deadline and criteria.

For more information on the Aetna IOQ program, click here.

Blue Shield of California

Registry Participation Makes it Easier for Reimbursement Authorization

Effective the first quarter of 2017, it is expected that Blue Shield of California’s providers that are AJRR participants will automatically receive authorization for their patients’ hip or knee replacement procedures. Blue Shield of California is the first insurer to offer this benefit.

This is great news for the state of California’s patients who are having hip or knee replacement surgery. Automatically receiving authorization for their insurance reimbursement gives patients and providers one less thing to worry about so they can focus on their health and recovery.

California has its own statewide Registry contained within the AJRR, and as of the end of 2016 includes just over 60,000 patients from the state of California, which makes up about 11% of the Registry.

Blue Shield of California has always been a big proponent of utilizing quality initiatives to provide better care to patients. The AJRR applauds its’ leadership for recognizing the importance that Registry participation means to its surgeons and hospitals; saving time and money by making it easier for surgeons to not duplicate quality initiative efforts; and for giving peace of mind to patients.

The Blue Shield of California is one example of an enhanced value proposition of Registry participation. AJRR offers assistance with several federal quality initiatives, insurer’s distinction programs, and state collaboratives. These programs provide reimbursements and other incentives for displaying improvement in the quality of patient care, prompting medical institutions to use clinical data registries like AJRR to compare outcomes success.

For more information about Blue Shield of California, visit www.blueshieldca.com.


Comprehensive Care for Joint Replacement (CJR)

Top 12 List for CJR

The Centers for Medicare & Medicaid’s (CMS) Comprehensive Care for Joint Replacement (CJR) model final ruling was released in November 2015 and the orthopaedic community is addressing the issues and figuring out how the ruling impacts them – especially when it comes to Clinical Data Registry participation. Utilizing the data from your participation with AJRR can be considered a quality initiative that can earn hospitals credit towards this CMS program.

We've put together this Top 12 list of things to know about CJR and Clinical Data Registries.

Download the PRO and Risk Variable Data Elements list here.

More info about CJR can be found here
CMS supplied Frequently Asked Questions can be found here

Maintenance of Certification (MOC)

Beginning in 2015, the American Board of Orthopaedic Surgery (ABOS) recognized registry involvement by surgeons counting as credit towards their Maintenance of Certification (MOC) process. We have submitted an application to be considered, and will keep you informed if our Registry counts toward a surgeon’s MOC credit.

ABOS is the certifying board that sets the standards for ensuring that orthopaedic surgeons stay current in their profession. The ABOS MOC Program is focused on assessing the surgical knowledge, skill set, and professionalism of ABOS physicians on behalf of patients, families, and communities. In order to meet the goal of improving the relevance of MOC while minimizing burden, a wide menu of existing educational and improvement activities have been recognized by the ABOS and will remain an important part of this process.

What is MOC?

Maintenance of Certification (MOC) is the process through which surgeons of the American Board of Orthopaedic Surgery (ABOS) can maintain their primary certificate in orthopaedic surgery. The American Board of Medical Specialties (ABMS), of which the ABOS is one of 24 medical specialty certifying boards, has developed the MOC process as a robust continuous professional development program. The ABOS has created a MOC program that is specific for orthopaedic surgeons who are initially ABOS certified. More information about ABOS’ MOC Program can be found here.

Meaningful Use

The Centers for Medicare & Medicaid Services (CMS) has an Electronic Health Record (EHR) Incentive Program that offers providers' payment in return for showing that they are using their EHR in a way that can positively affect patients.

Click below to see how participation in our Registry can help.

An Overview of Meaningful Use for Eligible Professionals for AJRR's Hip and Knee Replacement Registry

For a list of FAQs about Meaningful Use and participation in our Registry, visit our FAQ Page and scroll to the bottom.


Physician Quality Reporting System (PQRS)

pqrs Screenshot

We have been approved as a Qualified Clinical Data Registry (QCDR) for the Centers for Medicare & Medicaid Services’ (CMS) Physician Quality Reporting System (PQRS) for 2016. This year we collaborated with the American Orthopaedic Association's Own the Bone program and the American Association of Hip and Knee Surgeons (AAHKS) to provide 38 PQRS and custom measures.

Our Orthopaedic Quality Resource Center provides a new standard to complete PQRS requirements based on satisfactory participation. A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. The data submitted to CMS via a QCDR covers quality measures across multiple payers. Our Orthopaedic Quality Resource Center includes 38 approved 2016 PQRS measures (click here to view).

Register here to get started.

Learn more about PQRS here.

Learn more about QCDRs here.

Download the 2016 PQRS Brochure here.

Read the article "Up to 6 Percent of Your Medicare Payments Are at Risk—Are You Ready?" here.

Meaningful Use

One of the easiest and most cost-efficient ways AJRR can help satisfy the public health reporting objective is to submit data to a specialized registry. AJRR’s hip and knee replacement registry is perfect for orthopaedic surgeons to meet Meaningful Use Requirements. Check out our Meaningful Use section to get more information.

A second way that AJRR can help for Meaningful Use’s specialized registry reporting is through its partnership with CECity and our Orthopaedic Quality Resource Center. Bringing together CECity’s cloud-based platform and data integration, we can help you to instantly participate in Meaningful Use registry reporting. The network includes solutions for eligible hospital, critical access hospitals, and eligible professionals – in all of orthopaedics, not just hip and knees. Automated submission is available for users of EHRs including: Allscripts, Aprima, Athenahealth, Chartmaker, Greenway, NextGen, and STI... (more will be coming in 2016).

Don’t see your EHR listed? CECity can still help you. Contact Emily Dockter at CECity for more information about specialty registry reporting! She can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. or (412) 338-0366.

The Alliance Cooperative (Midwest States)

Registry Participation Helps with Quality Designation for the Midwest

AJRR promotes quality through The Alliance cooperative, a Midwest Quality Designation program. AJRR is part of a list of criteria its QualityPath designation. To receive this esteemed designation for knee and total hip replacement from The Alliance, hospitals and surgeons are required to be AJRR participants.

The Alliance is a not-for-profit cooperative that exists to help their members manage their health care dollars while positively impacting their employees' health. They contract with several hospitals, professional service providers, and insurance trusts in Illinois, Wisconsin, and Iowa. The Alliance has a program called QualityPath which covers 100% of medical costs for patients for certain procedures, including knee and total hip replacements. These patients are directed specifically to QualityPath-designated hospitals and surgeons who are known for quality care.

“AJRR appreciates The Alliance recognizing our dedication towards improving patient care,” said AJRR Chair Daniel J. Berry, MD. “Programs like QualityPath are essential to driving the field of orthopaedics forward. As more hospitals and surgeons are drawn to Registry participation, our dataset will become more comprehensive and actionable, therefore providing a more accurate representation of joint arthroplasty in America.”

Signed participation agreements are not the only documentation needed for the designation. Hospitals and surgeons must provide a high-level plan to submit data to the Registry. Institutions also need to give Registry implementation updates to the Alliance in order to maintain their QualityPath designation.

“We welcome the participation of all Midwestern hospitals that can meet our basic data submission requirements,” continued Dr. Berry. “The data contained inside our Registry helps surgeons determine appropriate methods of care. Our mutual goal of providing improved surgical outcomes makes us an excellent fit for the QualityPath program. The AJRR looks forward to continuing to work with health care professionals and institutions to help them acquire quality designations and deliver superior care.”

For more information on QualityPath, please visit www.the-alliance.org.

The Bree Collaborative (Washington State)

AJRR and the Bree Collaborative TKR/TJR Bundle for Hospitals in WA

The Bree Collaborative is a partnership established to provide a mechanism through which public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State. Workgroups made up of Bree members and community experts send quality improvement recommendations to health care purchasers. Our mission aligns with the goals of the Bree Collaborative, and the "Repair of the Osteoarthritic Joint" section of the Bree Collaborative TKR/THR Bundle requires all implants to be registered using the AJRR.

Nearly 50% of Bree Collaborative members are currently participating in the AJRR. If you are a Washington institution that is not yet participating in the National Registry but would like to qualify for the TKR/THR Bundle, contact AJRR Program Coordinator Phil Dwyer at This email address is being protected from spambots. You need JavaScript enabled to view it. for information on how to enroll.


AJRR Total Joint Risk Calculator

Our Risk Calculator was developed for orthopaedic surgeons to use to counsel their Medicare-eligible patients (65 years or older) on their individual risk of poor outcomes for total hip and knee replacement surgery.

When surgeons enter the patient's demographics and comorbidities into the Risk Calculator, the tool calculates a patient's risk of periprosthetic joint infection (PJI) within two years and mortality within 90 days.

We do not recommend that patients use the Risk Calculator on their own. This tool was developed for surgeons to provide guidance to patients regarding their prospective total joint replacement surgery.

Access the Risk Calculator Now

How to Use the Risk Calculator

The Risk Calculator should be used only by orthopaedic surgeons

  1. Agree to the Terms and Conditions by clicking the “Agree” box to access the risk calculator.
  2. Enter the patient information by clicking on all appropriate fields.
    Please note:
    • Height and weight fields do not need to be entered if obesity is checked in the comorbidity section
    • Definition for the "Buy-In Status" field:
      • "No Buy-In" response means patient does not have Medicaid secondary insurance
      • "State Buy-In" response means patient has Medicaid secondary insurance
  3. Once all appropriate fields have been entered, click the "Calculate Risk" box at the bottom of page and the result page will appear. 
  4. At the top of the result page will be a list of the patient's information (i.e., demographics and comorbidities) selected for the patient.
  5. Further instructions to update the patient information are located at the bottom of the results page.

About the AJRR Risk Calculator

  • AJRR owns all rights to the Risk Calculator.
  • The Risk Calculator was developed by Ortho Apps, a collaborative of Massachusetts General Hospital, Mayo Clinic, University of California, San Francisco, and Exponent, Inc.
  • Ortho Apps used the Medicare 5% sample claims database to calculate PJI within two years and mortality within 90 days after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA) as a function of demographic and clinical characteristics in 65,499 Medicare patients who underwent primary THAs and 137,546 Medicare patients who underwent primary TKAs between 1998 and 2011.


Collaborations, Affiliations, and Other Registries

Collaborating with and supporting other registries and related organizations is an important strategic goal of ours. The descriptions below discuss our involvement with some of these organizations.

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Physician Clinical Registry Coalition
Operation Walk USA
National Quality Registry Network (NQRN)
Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI)
International Society of Arthroplasty Registers (ISAR)
International Consortium of Orthopaedic Registers (ICOR)

The Register

June 2017

June Register 2017

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The Register

June 2017

June Register 2017

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