deliver high-quality care. In response to demand from facilities and payers seeking a way to distinguish specific ASCs as high-performing centers for TJR procedures, both The Joint Com- mission and the Accreditation Asso- ciation for Ambulatory Health Care (AAAHC) have launched orthopedic- specific certifications.

The Joint Commission established

its Advanced Certification for Total Hip and Total Knee Replacement (THKR) in 2016 and awards the cer- tification to ASCs that undergo a rig- orous onsite evaluation and uphold a number of high standards leading to improved patient outcomes (see pages 14–15 of June-July 2016 ASC Focus). In November 2018, AAAHC announced the launch of its own Advanced Orthopaedic Certification program designed specifically for ASCs. The program, developed with the input of a multi-disciplinary tech- nical panel, designates those ASCs that demonstrate an ability to translate effective leadership and integrated care throughout an entire episode of care, including post-discharge,


excellent clinical outcomes. These certifications allow ASCs to confi- dently show both patients and payers that their facility is committed, via a consistent, clinically proven, inte- grated care approach to performing orthopedic procedures at the highest possible level.

The introduction of distinct TJR certifications also signifies macro- level shifts in the outpatient surgery market, specifically, that the number of ASCs performing TJR procedures has reached the critical mass neces- sary to demand a special signifier for centers providing the highest, most consistent quality of care. Commercial payers also have sought to recognize and reward high-perform- ing ASCs. In 2006, the Blue Cross and Blue Shield (BCBS) Association launched its Blue Distinction Cen- ters for Specialty Care program. This

mark of excellence is awarded to facil- ities demonstrating expertise in sev- eral specific specialties, with a distinct designation for knee and hip replace- ments. In 2019, the program expanded to include ASCs and notably requires applying ASCs to hold one of the pre- viously described TJR credentials from The Joint Commission or AAAHC. The BCBS Blue Distinction Center designation also qualifies facilities for Anthem’s Centers of Medical Excel- lence (CME) designation. Aetna has its own Institutes of Quality (IOQ) desig- nation. This is awarded to facilities that meet requirements related to quality, value and network access.

Capturing Data

The final piece of the puzzle is data. That data needs to allow the ASC industry to examine and reflect on vol- ume and quality of total joint proce- dures. The American Joint Replace- ment Registry (AJRR), part of AAOS and an ASCA Affinity Partner, is the primary national registry accumulat- ing data on TJR procedures. Regis- tries are programs that collect volun- tary data from health care entities, generally focused on a specific condi- tion or diagnosis. They provide valu-


Visit ASCA’s website every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs. GovtAffairsUpdate

able insights into high-level trends— such as procedure incidence rate over time—and document outcomes that can showcase a facility’s high perfor- mance to patients and payers. AJRR has been designated a Qualified Clin- ical Data Registry by CMS since 2014 and is the largest orthopedic registry in the world, according to AJRR’s 2018 annual report, capturing 1.4 million procedures in 2018 alone. Only seven ASCs submitted data to AJRR in 2017—down from a peak of eight centers in 2016—but those facili- ties did report more than 800 total cases of total hip and total knee arthroplasty. Growing procedure volume sub-

mitted to AJRR will be crucial in future years for the ASC industry, par- ticularly as CMS considers adding TJR procedures to Medicare’s ASC- payable list. The Joint Commission recently announced that participation in AJRR will be a mandatory require- ment for their THKR certification. The data accumulated in AJRR will allow stakeholders to compare ASC perfor- mance in TJR procedures across sites of service and, hopefully, show the growing role that ASCs play in meet- ing the increasing need for TJR proce- dures overall.

ASCA maintains strong relation-

ships with all the organizations men- tioned and has and will continue to advocate at CMS for the safety and efficacy of moving total joint proce- dures to the ASC setting. Research shows that with the right processes, total joint procedures can be done safely and cost-effectively in outpa- tient settings. For more information on total joint procedures and ASCA’s advocacy on this topic, write Alex Taira at

Alex Taira is ASCA’s policy analyst. Write him at


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