American Association of Hip and Knee Surgeons

Advocacy, Education, Research

CMS THA/TKA Payment Measure Dry Run

Information about the hospital-level, risk-standardized payment associated with a 90-day episode of care for elective primary total hip arthroplasty (THA) and/or total knee arthroplasty (TKA).

Dry Run Overview

The Centers for Medicare & Medicaid Services (CMS) is conducting a confidential hospital reporting period (dry run) for a new claims-based measure from August 24 – September 22, 2015. CMS added the measure to the Hospital Inpatient Quality Reporting (IQR) Program for Fiscal Year (FY) 2018 and subsequent years (see FY 2016 Hospital Inpatient Prospective Payment System (IPPS) Final Rule). CMS plans to publicly report hospitals’ results on Hospital Compare starting July 2016.

How Hospitals Participate

The primary goal of the dry run is to educate hospitals about the measure in advance of its use in the IQR Program. During the dry run, CMS encourages hospitals to download and thoroughly review:

  • Their Hospital-Specific Report (HSR), which contains detailed hospital, state, and national measure results, discharge-level data for the index hospitalization and post-acute care settings, and risk factor information that can assist hospitals in understanding the drivers of costs for their patients.
  • The HSR User Guide, which contains an overview of measure methodology, a guide to interpreting results, instructions for interpreting each table in the HSR, and a glossary of key terms.

CMS is fully committed to supporting hospitals through the dry run process and being responsive to hospital questions and suggestions on measure methodology. CMS encourages hospitals to learn more about their results and the measure by visiting the THA/TKA Payment Dry Run pages on QualityNet to:

  • Register for a national provider call on September 8, 2015 from 3:00-4:00 p.m. ET;
  • Download measure resources including a detailed methodology report, a mock HSR, and the HSR User Guide.

Question & Answer Period

CMS encourages hospitals to email questions about the measure  to during the Q&A period from August 24 – September 22, 2015.

About the Measure

The measure can help hospitals understand if the payments made for their THA/TKA patients over a 90-day episode of care are relatively greater or less than the national average. The measure provides an opportunity for hospitals to explore the drivers of costs for their patients and assess value of care.

Data source: The measure uses Fee-For-Service (FFS) Medicare Parts A and B claims data. CMS calculated the dry run results using eligible discharges from July 1, 2010 through June 30, 2012.

Measure population: The measure includes Medicare FFS patients aged 65 years or over admitted for elective primary THA/TKA. CMS aligned the measure cohort with the publicly reported 90-day THA/TKA complications measure.

Outcome: The measure’s outcome is the hospital‐level, risk‐standardized payment for a 90‐day episode of care following elective primary THA/TKA. The measure captures payments for Medicare patients across multiple care settings, services, and supplies. Payments can be from Medicare, other health insurers, or the patients themselves.

Risk adjustment: The measure standardizes payments by removing geographic differences and policy adjustments that are independent of care decisions and risk‐adjusts based on each hospital’s patient case mix.