The Joint Commission (TJC) and the American Academy of Orthopaedic Surgeons (AAOS) have created a new collaboration for Total Hip and Knee Replacement (THKR) certification.

AAOS brings clinical expertise to the collaboration while TJC contributes standards development and performance measurement requirements.

The two organizations will oversee scientific issues, performance measurement, quality improvement activities, data sharing, research, and education.

Effective Jan. 1, 2019, THKR-certified organizations must participate in a national registry that collects data for hip and knee replacement procedures, says Mark Crafton, executive director of TJC’s state and external relations. One such repository is AAOS’ American Joint Replacement Registry (AJRR), which contains data from more than 1.4 million procedures.

“They can use data from their participation in the registry for quality improvement purposes,” Crafton says. “Generally speaking, organizations that enroll in and submit data to a national registry receive comparative/benchmarking data. Organizations that operate registries may also use de-identified, aggregate data for research, clinical guideline development, and publication purposes.”

The THKR certification is site-specific, and a handful of ASCs had achieved the certification through the fall. The voluntary, advanced certification was established in 2016 for accredited hospitals, ASCs, and critical access hospitals.

ASCs, especially Medicare-deemed ASCs, should know that only one site is included in the scope of the accreditation per CMS requirements, says Pearl S. Darling, MBA, executive director of TJC’s ambulatory care services.

“Organizations eligible for certification can be granted THRK rather than the individual providers/practitioners that perform procedures at an organization,” Crafton says.

Although there are organizations that already have obtained a two-year THKR certification under the old rules, they are expected to meet the new THKR requirements in 2019.

“While we understand it may not be fully implemented, there is an expectation that those who are already THKR-certified will be members of a registry and will have developed selection criteria,” Darling says, adding that she believes ASCs should not experience problems joining a national registry.

The collaboration between AAOS and TJC has not changed the certification review process, Crafton notes. “The reviews will be performed by Joint Commission reviewers.”

The onsite review evaluates compliance with advanced disease-specific care standards, requirements for total knee and hip replacements, preoperative, intraoperative, and postsurgical orthopedic surgical follow-up, and orthopedic consultation. “Organizations will be evaluated against the standards and review process in effect at the time of their onsite visit, regardless of whether it is an initial certification or recertification,” Crafton explains. “[TJC] utilizes a two-year cycle for most disease-specific care certifications, such as THKR, to ensure that the most current scientific evidence is applied to the standards and performance measures evaluated during the review and in the clinical practice guidelines adopted by certified organizations.”

The THKR certification places focus on clinical, evidence-based patient care related to pain management, quality of life issues, functional limitation in mobility, and return to normal daily activities. For ASCs and other certified organizations, this certification provides a pathway for improving patient outcomes through a focus on care consistency, reducing error risk, supporting collaboration and teams across the continuum of care, and committing to high standards for clinical service.