Raising the Bar

Updated Certification Requirements Seek Elevated Quality & Consistent Care 

The Joint Commission & The American Academy of Orthopaedic Surgeons (AAOS) recently collaborated to revise total hip & knee replacement certification standards.

Given the many uncertainties of the continuously changing industry, healthcare leaders recognize the value of distinguishing themselves from the competition—especially in a crowded, consumer-first marketplace. For C-suite leaders looking to not only differentiate themselves, but also publicize their ability to meet higher standards of quality, safety and efficacy, seeking accreditation as a center of excellence (COE) is a strategic move that can help kick-start progress in meeting these wide-ranging goals.

Kelsey Duggan
Kelsey Duggan Ph.D., MBA

That’s where prized certifications (such as those from The Joint Commission) come into play—especially as the criteria for COEs can be something of a gray area, notes Kelsey Duggan, Ph.D., MBA, senior director, medical device management for HealthTrust.

Though COEs are broadly defined as specialized programs that provide high concentrations of expertise and focused resources within healthcare organizations, “in general, there is no governing body and there are no standardized requirements for becoming a COE,” Duggan explains. “So, specific organizations, including private insurers and employers, have developed criteria for their own COE designations.”

Duggan is echoed by the Advisory Board, which writes: “Hospitals self-designate services as ‘centers of excellence’ with varying rigor of standards.”

Since creating unbiased guidelines for your own hospital’s COE can be overwhelming and considered less legitimate, hospitals and healthcare organizations are beginning to rely on regulated COE programs and standards such as those developed by The Joint Commission.

Established in 2016, The Joint Commission’s Total Hip and Knee Replacement (THKR) Certification is a voluntary advanced certification program aimed at critical access hospitals, accredited hospitals and ambulatory surgery centers (ASC) that wish to enhance the consistency, safety and quality of their services and patient care.

Awarded for a two-year period, the THKR certification increases focus on clinical, evidence-based patient care related to quality of life issues, pain management, functional limitation in mobility and return to normal daily activities. Simultaneously, the certification also addresses the growing number of patients who undergo THKR surgeries and, perhaps most important, provides hospitals and ASCs with a framework in which to improve patient outcomes.

Designated pathways for providers within this framework are threefold: establishing a consistent approach to care and removing variation or risk of error; supporting team collaboration across the continuum of care; and a commitment to higher standards of clinical service.

Higher Standards of Care

In the past, The Joint Commission has narrowed its focus for orthopedic certification by refining specific areas like fall rates, enhanced patient education, length of stay, surgical site infections, pain management and early ambulation.

The American Academy of Orthopaedic Surgeons (AAOS) and The Joint Commission collaborated in the fall of 2018 to update the existing THKR certification standards with the intention of incorporating greater clinical oversight and performance measures.

Now in effect since Jan. 1, 2019, Duggan says The Joint Commission’s THKR certification is important for a variety of reasons, including the added competitive edge.

“As payers look to narrow their networks, it will be important for facilities to demonstrate quality, outcomes and efficiency related to joint replacement if they want to be included,” Duggan explains.

Investing in COE certifications can also help hospitals and healthcare systems boost patient volume and physician satisfaction by holding themselves accountable to higher degrees of care.

“Both patients and providers will be attracted to the facility that is committed to the continuous improvement of their orthopedic service line,” Duggan says.

The standout difference in the updated THKR requirements, Duggan notes, is the mandatory participation in the American Joint Replacement Registry (AJRR)—the world’s largest national registry of hip and knee replacement data. The recent registry requirement will become effective July 1, 2019.

AAOS recently integrated with the AJRR to create a “family” of registries for the purpose of collecting, analyzing and reporting data to be shared and used to improve quality and outcomes. Though there are some similar, well-established registries in England, Australia and Sweden, Duggan says the United States’ efforts to bolster a registry is relatively new.

“Participation in the AJRR will provide near real-time feedback reports and summary statistics,” Duggan explains. “And the scale allows for meaningful national benchmarking and peer-to-peer comparisons.”

Preparing for Accreditation

Looking to undertake accreditation from The Joint Commission? It’s critical that facilities work closely with the payers of the patients who have, for instance, total hip and knee (THKR) procedures. Doing so means that providers can be certain of compliance. HealthTrust has created checklists detailing eligibility and certification requirements as well as strategies for success to assist members seeking joint and spine accreditation from The Joint Commission.
To explore HealthTrust’s tools, contact Kim Wright, RN, AVP Clinical Data Solutions, at kimberly.wright@healthtrustpg.com. 

A Seamless Continuum of Care

Earning a THKR certification is no small task. Organizations must undergo rigorous onsite reviews by experts from The Joint Commission in order to evaluate compliance in a number of focus points, including advanced, disease-specific care standards and orthopedic consultations, among others.

The hospitals and organizations that receive the THKR accreditation are required to collect and report monthly data on a variety of measures, including home discharge, day of surgery postoperative ambulation, health status assessment and more. Each of these measures span the continuum of each patient’s care so they are dependent on hospitalwide collaboration and teamwork. Duggan notes that certifications like THKR hold hospitals accountable to meeting and maintaining those higher standards.

“For example, early mobilization has been shown to reduce complications and improve outcomes,” Duggan says. “Efforts to get a patient up and moving successfully on the day of surgery often begin prior to surgery through patient education and prehab. On the day of surgery, the surgeon must meet with both the anesthesiologists and the physical therapists on the floor to ensure the patient is awake and is able to be seen by the appropriate staff at the proper time for same-day ambulation.”

For more information on The Joint Commission’s orthopedic certifications, visit their site.

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