Clinician-Level and Clinician Group-Level Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA and TKA) Patient-Reported Outcome-Based Performance Measure (PRO-PM)

The cohort (target population) includes Medicare fee-for-service (FFS) patients 65 years of age and older undergoing elective primary THA/TKA procedures. 

The cohort does not include patients with hip fractures, pelvic fractures, revision THAs/TKAs, and bone metastases. The rationale for each is outlined below:

• Facture of the pelvis or lower limbs coded in the principal or secondary discharge diagnosis fields on the index admission claim (Note: Periprosthetic fractures must be additionally coded as POA in order to disqualify a THA/TKA from cohort inclusion, unless exempt from POA reporting.) Rationale: Patients with fractures have higher mortality, complication, and readmission rates, and the procedures are typically not elective.
• A concurrent partial hip or knee arthroplasty procedure Rationale: Partial arthroplasty procedures are primarily done for hip and knee fractures and are typically performed on patients who are older, frailer, and have more comorbid conditions.
• A concurrent revision, resurfacing, or implanted device/prosthesis removal procedure Rationale: Revision procedures may be performed at a disproportionately small number of hospitals and are associated with higher mortality, complication, and readmission rates. Resurfacing procedures are a different type of procedure involving only the joint’s articular surface and are typically performed on younger, healthier patients. Elective procedures performed on patients undergoing removal of implanted device/prostheses procedures may be more complicated.
• Malignant neoplasm of the pelvis, sacrum, coccyx, lower limbs, or bone/bone marrow or a disseminated malignant neoplasm coded in the principal discharge diagnosis field on the index admission claim Rationale: Patients with these malignant neoplasms are at increased risk for complication, and the procedure may not be elective.