Hip/Knee Readmission and Complication Measures

The total hip arthroplasty (THA) and/or total knee arthroplasty (TKA) readmission and complication measures are complementary measures. The readmission measure encourages quality improvement efforts targeted toward improving inpatient care and the transition to outpatient settings to minimize readmissions for all causes. The complication measure captures a more focused domain of care by encouraging hospitals to minimize medical and surgical complications during surgery and the postoperative period. The National Quality Forum endorsed both measures in 2012.

  • THA/TKA Readmission – The risk-standardized readmission measure includes Medicare Fee-for-Service (FFS) beneficiaries aged 65 years and older who were electively admitted for primary THA and/or TKA between January 1, 2008 and December 31, 2010. The measure is based on administrative claims data. For each hospital, the readmission measure estimates a risk-standardized readmission rate (RSRR) based on unplanned readmissions to any acute care hospital within 30 days of discharge. The measure 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.
  • THA/TKA Complication – The risk-standardized complication measure includes Medicare FFS beneficiaries aged 65 years and older who were electively admitted for primary THA and/or TKA between January 1, 2008 and December 31, 2010. The measure is based on administrative claims data. 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; or mechanical complication or periprosthetic joint infection/wound infection during the index admission or within 90 days of admission. The complication outcome is a yes/no outcome. If a patient experiences one or more complications in the applicable time period, the complication outcome for that patient is counted in the measure as a “yes.” The measure 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.

Hospitals Included in the Measures

The THA/TKA readmission and complication measures are calculated for all non-federal short-stay, acute-care hospitals and critical access hospitals.

Measure Development

The THA/TKA measures were developed by a team of clinical and statistical experts from Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE). YNHHSC/CORE developed the measures through a transparent process that included input from a national Technical Expert Panel and public comment.

The measures methodologies are described in the THA/TKA Readmission Technical Report, (PDF-1.1 MB) and the THA/TKA Complication Technical Report, (PDF-1.3 MB).

Resources

For a complete list of dry run resources—including measure fact sheets, frequently asked questions (FAQs), dry run timeline, and information about the national provider calls—see Resources.

Questions and Comments

The Centers for Medicare & Medicaid Services (CMS) will receive and respond to hospital and stakeholder questions and comments via e-mail during the September 2012 dry run. Send questions about the THA/TKA measures to: cmshipkneeoutcomes@yale.edu. 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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