Orthopedic Practice Analytics: Joint Replacement Outcomes, Bundle Performance, and Functional Scores

The Comprehensive Joint Replacement (CJR) program is mandatory for hospitals in selected Metropolitan Statistical Areas (MSAs) and covers THA and TKA episodes. CJR measures 90-day episode cost against a CMS target price — with gainsharing opportunities for hospitals and orthopedic practices that manage post-acute care utilization efficiently. An orthopedic practice participating in CJR needs to know, for every THA/TKA patient, whether the patient went to SNF (high-cost), IRF, or home with home health (lower cost), how long they stayed, and what the total 90-day episode cost was. Most orthopedic practices don't have access to this post-acute claims data in a timely format.

Functional outcome scores — KOOS (Knee injury and Osteoarthritis Outcome Score) for TKA and HOOS (Hip disability and Osteoarthritis Outcome Score) for THA — are increasingly required for registry reporting, payer quality contracts, and CJR quality composite scoring. Collecting pre-operative baseline scores and 6-month and 12-month post-operative scores requires a systematic patient contact and data entry workflow that most orthopedic practices have not implemented operationally. The practices that collect PRO data consistently are the ones that can demonstrate outcomes in value-based contracting conversations.

Pre-operative optimization is increasingly recognized as the highest-impact intervention for reducing THA/TKA complications and length of stay. Pre-op BMI above 40, HbA1c above 8.0 in diabetic patients, and active smoking status are the three modifiable risk factors most strongly associated with surgical site infection, readmission, and functional outcome. An orthopedic practice that tracks pre-operative optimization completion — HbA1c testing, smoking cessation documentation, and pre-habilitation completion — can demonstrate clinical excellence and reduce payer complication risk scores simultaneously.

CJR (Comprehensive Joint Replacement) is mandatory for hospitals in approximately 100 selected MSAs, covering THA and TKA MS-DRGs (469, 470). CJR measures performance over 90-day episodes — the anchor hospital stay plus all post-acute care spending. Hospitals in CJR can create gainsharing arrangements with orthopedic surgeons, creating aligned financial incentives to manage post-acute care utilization. BPCI-A (Bundled Payments for Care Improvement-Advanced) is voluntary and available for additional MS-DRGs beyond THA/TKA including fracture and spine surgery bundles.

MIPS orthopedic quality measures include appropriate use criteria for advanced imaging (spine MRI, knee MRI), perioperative care measures, surgical site infection prevention measures, and functional outcome collection for total joint replacement — the CMS-required PRO-PM (Patient-Reported Outcome-based Performance Measure) for THA/TKA that became mandatory for large orthopedic practices beginning in 2023.