Quality Measure Public Reporting Is Associated with Improved Outcomes Following Hip and Knee Replacement

Area of Science:

• Orthopaedic Surgery
• Health Services Research
• Quality Improvement

Background:

• Orthopaedic quality measures are integrated into national hospital payment programs.
• Public reporting of risk-standardized readmission rates (RSRRs) and complication rates (RSCRs) for total hip arthroplasty (THA) and total knee arthroplasty (TKA) was implemented.
• The study investigates the temporal association between public reporting and changes in THA/TKA outcomes.

Purpose of the Study:

• To assess if public reporting of THA and TKA RSRRs and RSCRs correlated with decreased outcome rates.
• To evaluate trends in complication and readmission rates among Medicare beneficiaries undergoing hip and knee replacements.

Main Methods:

• Analysis of annual trends in national observed and hospital-level RSRRs and RSCRs from FY 2010 to FY 2016.
• Calculation of hospital-level rates using public reporting methodology.
• Examination of outcome distribution trends using density plots.

Main Results:

• A steady decline in complication and readmission rates and their variation was observed from FY 2010 to FY 2016.
• Hospital-level RSCRs decreased by 33% and RSRRs by 25%.
• Relative reductions in interquartile range were 18% for RSCRs and 34% for RSRRs, with no evidence of widespread bias.

Conclusions:

• Hospital-level complication and readmission rates for THA and TKA, along with performance variation, decreased during the period of public reporting and financial incentives.
• These findings suggest steady improvements and increased consistency in clinical outcomes for THA/TKA patients.
• The complex interplay between public reporting, payment, and hospital coding warrants further investigation.