Complication Measures Overview

Publicly reporting the risk-standardized complication measure for THA/TKA

For 2013 public reporting, the Centers for Medicare & Medicaid Services (CMS) introduced the total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) complication measure during the September 2012 dry run. The THA/TKA complication measure assesses a broad set of healthcare activities that affect patients' well-being. Furthermore, measuring and reporting risk-standardized complication rates will inform health care providers about opportunities to improve care, strengthen incentives for quality improvement, and promote improvements in the quality of care received by patients and in the outcomes they experience.

The public reporting of the risk-standardized complication measure is consistent with the priorities of the Department of Health and Human Services' National Quality Strategy, which aims to: a) improve health care quality; b) improve the health of the U.S. population; and c) reduce the costs of health care.

For more information about the THA/TKA complication measure, please see Measure Methodology and Resources.

Please note that hospitals will receive their 2013 Hospital-Specific Reports (HSRs) beginning April 18, 2013.


The THA/TKA complication measure captures a more focused domain of care by encouraging hospitals to minimize medical and surgical complications during surgery and the postoperative period. This measure was endorsed by the National Quality Forum in 2012.

The risk-standardized THA/TKA complication measure includes Medicare fee-for-service (FFS) beneficiaries aged 65 years and older who were electively admitted for primary THA and/or TKA. The measure is based on administrative Medicare claims data and adjusts for each hospital's case mix (patient age, sex, and comorbidities), so that hospitals that care for older, sicker patients are on a “level playing field” with hospitals serving healthier patients.

For each hospital, the complication measure estimates a risk-standardized complication rate (RSCR). The measure outcome is one or more of the following eight complications within specified time periods:

  • acute myocardial infarction (AMI), pneumonia, or sepsis/septicemia during the index admission or within seven (7) days of admission
  • surgical site bleeding, pulmonary embolism, or death during the index admission or within 30 days of admission
  • mechanical complication or periprosthetic joint infection/wound infection during the index admission or within 90 days of admission

Questions and Comments

CMS has contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) to support the implementation of these measures. Send questions about the THA/TKA complication measure to Yale at: To ensure proper handling of inquiries, please reference the specific measure(s) and the specific program(s) to which your questions relate. Do NOT submit patient-identifiable information (e.g., Date of Birth, Social Security Number, Health Insurance Claim Number) to this address.

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