The national hip and knee joint replacement registry, FORCE-TJR, has received certification from the Centers for Medicare & Medicaid Services as a Qualified Clinical Data Registry (QCDR). The announcement came as Hospital Peer Review was going to press. A fuller exploration of this will appear in the next issue.

In a brief interview at deadline, Patricia Franklin, MD, MPH, MBA, the registry director, told Hospital Peer Review that hospital quality improvement professionals need to have effective ways to monitor the quality and safety for the total joint replacement patients. “In addition, they need to meet the Patient Quality Reporting System [PQRS] standards to earn financial incentives and meet quality benchmarks,” she says.

Membership in FORCE-TJR now meets all the quality, regulatory, and financial goals for organizations. “The routinely collected FORCE-TJR outcomes — patient-reported pain and function, 30-day readmissions, and 90-day complications — are collected, risk-adjusted, and compared to national norms. Each quarter the hospital quality leadership receives updated reports to monitor quality of care,” says Franklin.

In addition, as a Qualified Clinical Data Registry (QCDR), she says, FORCE-TJR can submit a subset of these same measures to CMS to meet the PQRS financial incentives with no additional work. If the hospital participates in a local ACO or bundled payment program, the FORCE-TJR outcome measures allow the hospital to document outcomes and to quantify the total cost of care, including readmissions.

So far, Franklin says, FORCE-TJR has successfully collected and tracked more than 30,000 total knee and hip replacement patients across the U.S. in more than 150 provider institutions, and the registry is expanding. Along with patient and disease tracking, it provides information on implant performance, patient reported outcomes, and quality monitoring for total joint replacement.

The press release on the new certification notes that members who participate in the collection and submission of PQRS quality measures by FORCE-TJR can avoid the 2016 payment adjustment (2.0%).

The certification also includes some new non-PQRS measures: pain and functional status assessment for hip and knee replacements; improvement in pain and function after hip and knee replacements; and mental health assessment for patients who undergo hip and knee replacements.

Going forward, Franklin says the certification will allow for further creation of new measures, especially those related to patient-reported outcomes.

FORCE-TJR, originally a four-year, $12 million national research project funded by the Agency for Healthcare Research and Quality (AHRQ), is the first registry for total joint replacements to identify risk-adjusted national benchmarks, including patient risk factors and other clinical measures, to guide surgeon and patient decisions regarding timing of surgery and optimal patient selection.

For more information on this topic, contact Patricia Franklin, MD, MPH, MBA, Registrar, FORCE-TJR, Worcester, MA. Email: