Request for Proposal - premera.com · Deliver high-quality, evidence based TKR/THR Bundled Episodes of Care and Warranty based on recommendation of the Bree Collaborative recommendations,

Request for Proposal Total Joint Replacement Bundle

Issued October 8, 2018

Premera Blue Cross is an Independent Licensee of the Blue Cross Blue Shield Association

047562 (10-08-2018)

© 2018 Premera. Proprietary and Confidential.

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Table of Contents

Introduction and Background ...................................................................................... 3

Statement of Work ......................................................................................................... 4

Administrative Information ........................................................................................... 6

Evaluation and Award Overview ................................................................................ 10

Minimum Qualifications .............................................................................................. 11

Non-Cost Proposal ...................................................................................................... 12

Cost Proposal .............................................................................................................. 14

Exhibit 1: Warranty Definitions .................................................................................. 15

Appendix ...................................................................................................................... 15


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Introduction and Background

Premera Blue Cross

Premera Blue Cross (Premera) is a health benefits company serving over 2 million people from individuals to FORTUNE 100 companies. Premera provides health, life, vision, dental, and other related services. Premera’s headquarters are located in Mountlake Terrace, Washington with operations in Spokane, Washington, and in Anchorage, Alaska. To find out more about Premera, please visit the company’s website at www.PREMERA.com.

Purpose of the Request for Proposal

Premera Blue Cross is soliciting one or more health care provider(s) and/or network of provider(s) to become a contracted Center of Excellence (COE) to provide a Total Joint (Knees and Hips) Replacement (TKR/THR) Bundled Episode of Care for members, based on Dr. Robert Bree Collaborative (Bree Collaborative) recommendations. The TKR/THR Bundled Episode of Care will be offered to Members who receive care in Washington State starting on January 1, 2020. Identifying Centers of Excellence for select specialty services supports Premera’s vision to make healthcare work better for its members. In addition, the market is responding favorably to this vision and asking Premera to engage with high-quality and lower cost providers. Based on this engagement from employers to provide options for benefit design and soft steerage, Premera is issuing this RFP with the intention of identifying TJR specialists to partner with in establishing predictable quality standards and costs to the benefit of patient, providers and employers. Premera will continue to respond to market demands and will advance future RFPs as part of our integrated purchasing strategy on behalf of our customers.

Background

The shift from volume to value-based reimbursement continues to gain traction through the US health care industry. Driven nationally by CMS and locally by Washington State’s largest healthcare purchaser, the Health Care Authority, this movement is challenging health plans to change their traditional, payer-focused role in the ecosystem. Premera is responding to that challenge by re-imagining our provider relationships to address the issues of high cost, inconsistent value, and poor experience that neither Premera nor providers can address independently. The Healthier Washington Initiative was embraced by the Washington State Legislature in 2014 and was focused on increasing the use of value-based contracting and other payment incentives that promote quality, efficiency, cost savings, and health improvement. Premera is aligning how it purchases healthcare to align with the goals of The Healthier Washington Initiative with an initial focus on joint replacement. Joint replacements are one of the most common surgical procedures in the Premera population. Thank you for considering this RFP. Premera hopes you will join in making a positive change in the Washington healthcare system.

http://www.premera.com/


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Statement of Work

The Awarded Provider(s) will provide the services and staff necessary to implement the TKR/THR Bundled Episode of Care, including but not limited to the following:

1. Deliver high-quality, evidence based TKR/THR Bundled Episodes of Care and Warranty based on recommendation of the Bree Collaborative recommendations, including producing and reporting health outcomes. Awarded Provider(s) will provide expected components of preoperative, intraoperative, and postoperative care needed for successful total knee and/or total hip replacement surgery, including both clinical components and quality standards outlined in the Bree Collaborative Recommendations, as follows:

a. Clinical Components: ▪ Documentation of disability due to osteoarthritis despite conservative therapy; ▪ Documentation of fitness for surgery; ▪ Repair of the osteoarthritic joint; and ▪ Post-operative care and return to function

b. Quality Standards: ▪ Appropriateness; ▪ Rapid return to function; ▪ Patient care experience; and ▪ Patient safety

2. Provide a Warranty according to the Bree Collaborative’s recommendations, meaning the Awarded Provider(s) are willing to be financially accountable for complications attributed to total knee and/or total hip replacement surgery. The Bree Collaborative Warranty defines complications and timeframes after surgery during which those complications be attribute to the original surgery; and to track clinical and financial accountability for extra care needed to diagnose, manage, and resolve those complications. The Warranty does not include quality standards other than accountability for complications.

3. Awarded Provider(s) will provide timely regular data and reports at quarterly meetings with Premera.

4. Awarded Provider(s) will provide appropriate, timely and convenient access to care for Members.

5. Awarded Provider(s) will submit claims for each TKR/THR Bundled Episode of Care, which will be paid post-discharge within an agreed upon time frame.

6. Awarded Provider(s) will be responsible for gathering all of the necessary documentation to demonstrate that the Bree Collaborative’s recommendations for clinical and quality standards have been met.

7. Awarded Provider(s,) with Premera’s approval, will establish an exception process for the cases in which a provider recommends proceeding with TKR/THR surgery for a patient who does not meet appropriateness standards under the Bree Collaborative’s recommendations.

Below are links to the relevant Bree Collaborative information:


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1 http://www.breecollaborative.org/wp-content/uploads/tkrthr_bundle.pdf 2 http://www.breecollaborative.org/wp-content/uploads/bree_warranty_tkr_thr.pdf 3 http://www.qualityhealth.org/

The responsibilities of Premera include, but are not limited to, the following:

1. Premera will make payments to the Awarded Provider(s).

2. Premera will work with employers to provide financial incentives to the defined member population to utilize the contracted Center(s) of Excellence for total knee and/or total hip replacements.

3. Premera to advertise to and educate Members.

4. Premera will provide agreed upon reporting regarding financial and quality performance.

5. Premera will provide concierge level care coordination to members who receive procedures at a chosen center of excellence.

http://www.qualityhealth.org/


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Administrative Information

Premera Contact Information

All questions and correspondence related to this RFP and the final RFP submission must be directed to the following single point of contact at Premera: Premera Contact:

Stacey Gerhardt

[email protected] SUBJECT: TJR Bundle RFP Question(s) and Response

Submit all questions to [email protected] by October 19, 2018 Premera responses to all questions will be distributed to all RESPONDERS by October 26, 2018

Send RFP responses to [email protected] by November 12, 2018.

RESPONDER Contact Information

Please provide the following information for a single point of contact for RESPONDER’s response.

Contact’s Name:

Title:

Company Name:

Telephone:

Email Address:

Communication between Premera and RESPONDER

RESPONDER'S designated representative shall submit all questions and comments to the Premera contact via email. The representatives identified in the Contact Sections above shall perform all communications between RESPONDER and Premera. No other employees or representatives of either party shall have any authority to request or make any clarifications, additions, or changes to the information in the RFP. Verbal comments, explanations, or instructions given by Premera during this process shall not be binding.

mailto:[email protected]




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Schedule of Events

The schedule for the RFP process is outlined below. Premera will notify RESPONDER if there are changes to this schedule.

Milestone Date

Request for Proposal issued October 8, 2018

All Responder questions submitted via email to Premera via

[email protected]

October 19, 2018

Premera responses to questions received are distributed to all Responders via email

October 26, 2018

Closing date and time for RFP responses to be submitted to

Premera Blue Cross via [email protected] November 12, 2018

RFP evaluation/analysis period November 13, 2018 – December 31, 2018

Anticipated Apparent Successful Proposer Announcement January 3, 2019

Contract Negotiations January 7 – February 28, 2019

Anticipated Award Date March 1, 2019

Contract Begins January 1, 2020

Rules for Submitting Response

Response Submission

Submit an electronic copy via email to the Premera contact. Microsoft Word format is preferred for the response document; however, a comment enabled PDF is acceptable.

Disposition of Documents

Responses to this RFP become the property of Premera. No items submitted by RESPONDER will be returned.

If the RESPONDER intends to submit confidential or proprietary information as part of the proposal, any limits on the use or distribution of that material should be clearly delineated in writing in or attached to their response. Premera will use reasonable precautions to avoid disclosure of RESPONDER replies to competitor RESPONDERS. Premera reserves the unrestricted right to copy and disseminate submitted responses for internal review and for review by external advisors, at Premera’s sole discretion.

Obligations and Disclaimers

Premera will have no obligation to a RESPONDER unless and until both parties sign an agreement. Premera expects that all responses to this RFP may result in inclusion in a final contract. Premera reserves the right to:

• Decline to make a subsequent award at its sole discretion; • Reissue this RFP and, at its discretion, to waive minor irregularities and discrepancies; and • Reject any or all RESPONDERS from further consideration based on their response to this RFP.




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Representation of Fact

By responding to this RFP, the RESPONDER is affirming that the information subsequently provided is factual and true.


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Request for Proposal Response Preparation Instructions

Responder(s) shall complete and provide the following information (1-4) and submit together, as a complete Proposal. Incomplete or vague responses may be considered non-responsive and may be rejected. Failure to complete and submit the required items listed in this section may disqualify the Proposer from further participation in this RFP.

1. Minimum Qualifications

Responder is instructed to complete and submit the Minimum Qualifications Section. The responder

may attach additional sheets if necessary.

2. Subcontractor Information

Responder is instructed to include additional information if the Responder intends on utilizing Subcontractors. If no information is provided Premera will assume that Subcontracts will not be used. Premera will accept responses that include third party involvement only if the Responders submitting the response agrees to take complete responsibility for all actions of such Subcontractors.

If applicable, Responder shall identify all subcontractors who will perform services in fulfillment of contract requirements, including their name, the nature of services to be performed, address, telephone, email, federal tax identification number (TIN), and anticipated dollar value of each subcontract. Premera reserves the right to approve or reject any and all Subcontractors that Proposer proposes. Any Subcontractors not listed in the Responders response, who are engaged after award of the Contract, must be pre-approved, in writing, by Premera, before providing services under the contract.

3. Non-Cost Proposal

Responder is instructed to complete and submit the Non-Cost Section. The Responder may attach additional sheets if necessary.

4. Cost Proposal

Responder is instructed to complete and submit the Cost Section. The Responder may attach additional sheets if necessary.

Prices proposed must be in U.S dollars. All costs associated with the services provided must be incorporated into the Responder’s Cost Submittal.


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Evaluation and Award Overview

Premera will select a limited number of Responders in order to meet the needs of its members. The selection will be based on relative scores.

The scores for each Proposal will be assigned a relative importance for each scored section. The relative importance for each section is as follows:

Requirements Available Points

Non-Cost Proposal: Cost Proposal:

325 points 250 points

Total Possible Points: 575 points

EVALUATION PROCESS

1. Minimum Qualifications (pass/fail)

Premera will review each element of the Minimum Qualifications Submittal to determine on a pass/fail basis compliance with the requirements specified in of this RFP. Only responses that meet these requirements will move to the next evaluation step.

2. Evaluation – Non-Cost and Cost Elements (scored)

▪ Non-Cost Proposal Evaluation:

Evaluators will score each element of the Non-Cost Submittal. The Procurement Coordinator will tabulate the evaluators’ scoring. A calculation will be performed to establish a single score for the Non-Cost section of each Proposal. There are a maximum of 325 points available in the Non-Cost Submittal.

▪ Cost Proposal Evaluation:

The Procurement Coordinator will calculate the Cost score for the Cost Proposal section of the Response using Proposer’s Cost submittal. The total available points for the Cost Proposal section are 250 points. Cost scoring will be calculated by combining elements of the Cost Proposal to determine the overall cost to the HCA.

▪ Proposer Total Score: Proposers’ Total Scores will be calculated by summing Cost and Non-Cost factor points (maximum of 100 points) to determine the Proposer’s total evaluated score.


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Minimum Qualifications

Please keep responses clear and concise, and refrain from using company name or other information that will identify your company while preparing your response for the Minimum Qualifications Submittal.

Responses to each question should be two (2) pages or less.

Please answer the questions listed below to verify that your firm meets the minimum qualifications specified in below. Please attach additional pages as necessary.

1. Business License. Please confirm below that your organization is currently licensed to conduct

business in the state of Washington. If your firm is not currently licensed, please provide a commitment that your firm will become licensed within thirty (30) calendar days of being selected as the Apparent Successful Proposer.

2. Registered Provider. Please confirm below that your organization is a Washington In-State Provider.

3. Network. Please confirm that all total knee and/or total hip replacement procedures performed within the scope of the Contract by the Awarded Contractor(s) will occur in the state of Washington.

4. Experience. Please confirm that your organization is a health care provider(s) and/or network of provider(s) that can offer a TKR/THR Bundled Episode of Care for total knee and/or total hip replacement, effective January 1, 2020.

5. Capacity. Please confirm that your organization is capable and has capacity to meet the volume of total knee and/or total hip replacement procedures outlined in the cost proposal.

6. Volume. Please provide for each of the orthopedic surgeons who will be performing TKR/THR Bundled Episodes of Care, their total annual volume of each procedure.


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Non-Cost Proposal

In this section, you are expected to propose how and why you are the most qualified to perform these services. You will also propose your plans, approach and methodology as to how you intend to perform these services.

Proposal Questions:

Please answer the questions listed below attaching additional pages as necessary:

A) Provider Qualifications and Experience (Please limit your response to 3 pages for this section) (25 Points)

1. Provide a brief history of your organization including the structure of ownership.

2. From January 2016- December 2018, how many TKR/THR procedures were performed? How many were performed on Medicare patients?

3. Does the patient have a choice of surgeons from your facility or group? If not, please describe how the patient is assigned a surgeon, anesthesiologist, or rehabilitation team?

B) Bundle Experience (Please limit your response to 1 page per question for this section) (100 Points)

1. How long has your organization, including facilities and provider groups, been providing services within a care bundle for total knee and/or hip replacement?

2. Please provide a list of names of the orthopedic surgeons who perform TKR/THR Bundled Episodes of Care, the number of TKR/THR Bundled Episodes of Care, he/she has performed, facilities where surgeries were performed and any adverse events or outcomes they have had in the last two (2) calendar years.

3. Is your organization able to aggregate all claims from all providers participating in the program into a single claim file and invoice for payment?

4. Is your organization able to aggregate claims and send all claims at once for payment?

C) Total Joint Replacement Process (Please limit response to 2 pages per question for this section). The Bree Collaborative has defined four distinct stages of a TKR/THR Bundled Episode of Care, as described below. Please answer the questions for each stage and describe your organization’s ability to meet these requirements. (100 Points)

Stage 1: Disability due to Osteoarthritis despite Conservative Therapy

Prior to surgery, candidates for joint replacement therapy should have clearly documented disability and evidence of osteoarthritis according to standardized radiographic criteria. Unless highly disabling osteoarthritis is evident at the time the patient first seeks medical attention, a trial of conservative therapy is appropriate.

Beginning with initial assessment, please describe the following steps and activities in detail:

1. The type of providers involved and their role; communication mechanisms used between

patient and providers and the approximate length of time between each step.

2. The approximate length of time between initial patient referral to acceptance in the

program; and


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3. How your organization manages a patient who is referred for a total hip and/or knee

replacement but does not meet the appropriateness criteria.

Stage 2: Fitness for Surgery

Prior to surgery, candidates for joint replacement therapy should meet minimal standards to ensure their safety and commitment to participate actively in return to function. If a provider chooses to proceed with TKR/THR surgery on a patient who does not meet these standards, then informed consent, patient engagement, individual review, and preauthorization are required.

Please describe your process to determine fitness for surgery and include what types of providers involved, their role, communication mechanisms used (between patient and providers), and length of time of between each step.

Stage 3: Surgery and Repair of Osteoarthritic Joint

An experienced surgical team should use evidence-based practices to avoid complications related to implanted hardware; prevent infection, venous thrombosis, and blood loss; manage pain while avoiding side effects; and manage pre-existing medical problems carefully.

For each step or activity, please describe in detail:

1. The type of providers involved and their role; communication mechanisms used between

patient and providers, and the approximate length of time between each step.

2. Your organization’s implant procurement process; specifically, what controls does the

provider have in place to use high-quality, cost-effective implants.

3. How your organization ensures the implant device is appropriate for each patient; and

4. Your organization’s protocols for replacement if an implant device is recalled.

Stage 4: Post-Operative Care and Return to Function

A standard process should be in place to support the goals of avoiding post-surgical complications, ensuring rapid return to function, optimizing hospital length of stay, and avoiding unnecessary readmissions.

For each step or activity, please describe in detail through 90-days post discharge the type of providers involved and their role; communication mechanisms used between patient and providers, and the approximate length of time between each step.

D) Quality Measures (Please limit your response to 1 page per question) (100 Points)

1. Please CONFIRM your ability to provide reporting for the quality measures outlined in Table 1 in the Appendix. In Table 1, TKR/THR patients are defined as non-Medicare, first-time, single-joint total knee or total hip replacement surgery for osteoarthritis, excluding patients with joint replacement for fracture, cancer, or inflammatory arthritis. Also, please note that three of the quality measures refer to specific results or scores and therefore have no numerator or denominator.

2. Please CONFIRM your ability to provide reporting for the measures outlined in Table 2 in the Appendix, with the current annual rates, using the most recent twelve (12) months of data available. In Table 2, TKR/THR patients are defined as non- Medicare, first-time, single-joint total knee or total hip replacement surgery for osteoarthritis, excluding patients with joint replacement for fracture, cancer, or inflammatory arthritis.

3. Has your organization and/or program been recognized for its’ achievements, (i.e. NCQA designations, Joint Commission programs, health plan designations, etc.)? If so, please


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provide the organization that provided the recognition and the year of the award.

E) Please describe and confirm: 1. All staff orthopaedic physicians will be available to participate in the Premera bundles 2. How you accommodate for pharmacy at the time of discharge 3. Your ability to perform pre-operative appointments via video 4. Your organization will actively engage in monthly collaborative operations meetings with

Premera to support continuous process improvement 5. Your organization will participate in quarterly State of the Program meetings as needed 6. Your organization will name a single point of contact who is empowered to make timely legal

and financial decisions to support this program 7. Your organization will agree to name a single point of be responsible for care coordination

and navigation at your facility 8. Established preferred hotel relationships


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Cost Proposal

Instructions to Proposer: Responder shall complete Table 1 below by entering their pricing information as specified in the table.

Table 1: Deliverable Pricing (250 Points)

For the purposes of this table only, “Bundled Payment” includes all of the following:

a) Pre-Operative workup by the surgeon and any associated codes

b) The surgery including Diagnosis-Related Groups (DRG) 469, 470 or CPT codes 27130 and 27447and all related services from admission to discharge; and

c) Basic post-operative care including basic labs, x-ray if appropriate, clearance to travel, if appropriate

Based on historical data Premera estimates that the volume of TKR/THR procedures that fall under this RFP for awardees to be approximately 275 - 450 procedures per year based on market demand and purchasing strategies. What is theminimum price your organization can propose for the Bundled Payment?

Description Total Price

Bundled Payment $ total

If, within your proposed price, there are any deviations or additions to the Bundle Payment, such as anything your organization feels would add value to the Bundled Payment, please list those in the section provided below:


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Exhibit 1: Warranty Definitions

The warranty associated with total joint bundles specifies that the purchaser will not provide reimbursement for readmission for avoidable complications within the risk window specified below. For the purposes of this RFP, the TKR/THR Warranty entails the following:

a) Represent significant complications attributable to the TKR/THR procedure

b) Are identifiable in administrative claims data

c) Are fair to hospitals and physicians

1. Surgical Complications

a. Mechanical Complications

b. Peri-prosthetic joint complications

i. Incision

ii. Revision

iii. Removal

c. Wound Infection

i. Incision and drainage

ii. Revision

iii. Removal

d. Surgical site bleeding requiring readmission for incision and drainage

e. Pulmonary embolism

2. Medical complications

a. Acute myocardial infarction

b. Pneumonia

c. Sepsis/septicemia

Definitions related to a warranty for TKR and THR 1. Diagnostic code for osteoarthritis - excludes trauma, cancer, inflammatory arthritis (e.g.

rheumatoid arthritis) and congenital malformation 2. Procedural codes for TKR and THR 3. Age limits

4. Definition of complications excluded from additional reimbursement 5. Definition of warranty period

Diagnostic codes

• The ICD-10 diagnostic code for osteoarthritis of the knee = M17.X

• The ICD-10 diagnostic code for osteoarthritis of the hip = M16.X

Procedure codes

▪ Total hip replacement ICD-10 codes: 0SR90J9, 0SR90JA, 0SR90JZ, 0SRB0J9, 0SRB0JA, 0SRB0JZ.

▪ Total knee replacement ICD-10 codes: 0SRC07Z, 0SRC0JZ, 0SRC0KZ, 0SRD07Z, 0SRD0JZ, 0SRD0KZ, 0SRT07Z, 0SRT0JZ, 0SRT0KZ, 0SRU07Z, 0SRU0JZ, 0SRU0KZ, 0SRV07Z,

0SRV0JZ, 0SRV0KZ, 0SRW07Z, 0SRW0JZ, 0SRW0KZ.


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Avoidable Complications

Definition of avoidable complications included in warranty:

▪ As specified by CMS TEP report (included in the 2012 Total Knee and Total Hip Replacement Warranty here: www.breecollaborative.org/wp-content/uploads/bree_warranty_tkr_thr.pdf )

▪ Aligned with ICD-10 codes adopted by HVHC and NQF-1550

▪ See www.breecollaborative.org/wp-content/uploads/TJR-Codes-17-1031.xlsx for ICD-9/ICD-10 crosswalk of avoidable complications

Warranty Period and other terms

1. Warranty period is complication-specific

7 Days* 30 Days* 90 Days* Acute myocardial infarction Pneumonia Sepsis/septicemia

Death

Surgical site bleeding Wound infection

Pulmonary embolism

Mechanical complications Periprosthetic joint infection

*from the date of surgery

2. The warranty is valid only at the hospital or facility performing the surgery. If a patient is admitted for a

complication covered under the warranty, the hospital or facility performing the surgery will reimburse Premera for those costs. Therefore patients experiencing complications are strongly encouraged to seek treatment at that hospital.


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APPENDIX Table 1

Total Knees Total Hips

Standards Numerator Denominator Percentage Numerator Denominator Percentage

1. Standards for Appropriateness

a. Number of TKR/THR

patients receiving

formal shared decision-

making decision aids

pre-operatively

Number of TKR patients

receiving formal shared

decision-making

decision aids pre-

operatively

Total

number of

TKR

patients.

Number of THR patients

receiving formal shared

decision-making decision aids

pre- operatively

Total number of

THR patients.

b. Number of TKR/THR

patients with

documented

musculoskeletal

function prior to

surgery (Knee

Osteoarthritis Outcome

Score (KOOS) Jr., or

Hip Osteoarthritis

Outcome Score (HOOS)

Jr.


with documented

patient-reported

measures of quality of

life and musculoskeletal

function prior to surgery,

Knee Osteoarthritis

Outcome Score (KOOS)

Jr. or PROMIS-10

Global Health

Total

number of

TKR

patients.

Number of THR patients with

documented patient-reported

measures of quality of life and

musculoskeletal function prior to

surgery, Hip Osteoarthritis

Outcome Score (HOOS) Jr.

Total number of

THR patients.


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Standards Numerator Denominator Percentage Numerator Denominator Percentage

c. Proportion of

TKR/THR patients with

documented patient-

reported measures of

quality of life-the

PROMIS 10 Global

Health. 1. d. Results of

scores for KOOS Jr.

and HOOS Jr and

questions regarding

everyday physical

activities (Question 7)

and pain (Question 10)

on the PROMIS-10

survey.


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2. Standards for Evidence –Based Surgery

a. Number of

TKR/THR patients

receiving measures

to manage pain

using multimodal

anesthesia


receiving manage pain

using multimodal

anesthesia

Total

number

of TKR

Patients.


receiving measures to manage

pain using multimodal anesthesia

Total number of

THR

Patients.

b. Number of

TKR/THR patients

receiving measures

to reduce risk of

venous

thromboembolism

and pulmonary

embolism in the

peri-operative

period.


receiving measures to

reduce risk of venous

thromboembolism and

pulmonary embolism in

the peri-operative period.

Total

number

of TKR

Patients.


receiving measures to reduce

risk of venous

thromboembolism and

pulmonary embolism in the

peri-operative period.

Total number of

THR

Patients.

c. Number of

TKR/THR patients

receiving measures

to reduce blood loss

such as

administration of

tranexamic acid in

the peri-operative

period.



reduce blood loss such as

administration of

tranexamic acid in the

peri-operative period

Total

number

of TKR

Patients.



blood loss such as

administration of tranexamic

acid in the peri-operative

period.

Total number of

THR

Patients.

d. Number of

TKR/THR patients

receiving measures

to reduce infection

such as

administration of

prophylactic

antibiotics in the

peri- operative

period.



reduce blood loss such as

administration of

tranexamic acid in the

peri-operative period

Total

number

of TKR

Patients.



blood loss such as

administration of tranexamic

acid in the peri-operative

period.

Total number of

THR

Patients.


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e. Number of

TKR/THR patients

receiving measures

to maintain optimal

blood sugar control

in the peri-

operative period.



maintain optimal blood

sugar control in the peri-

operative period.

Total

number

of TKR

Patients.


receiving measures to maintain

optimal blood sugar control in

the peri-operative period.

Total number

of THR

Patients.

3. Standards for Ensuring Rapid Return to Function

a. Number of

TKR/THR patients

with documented

physical therapy

within 24 hours of

surgery.


with documented

physical therapy within

24 hours of surgery.

Total

number

of TKR

Patients.


documented physical therapy

within 24 hours of surgery.

Total number of

THR

Patients.

b. Number of TKR/THR

patients with

documented patient‐reported measures of

quality of life and

musculoskeletal

function nine to

twelve months

following surgery

(same as used as in

standard 1b).


with documented patient-

reported measures of

quality of life and

musculoskeletal

Function nine to twelve

months following surgery

(same as used as in

standard 1b).

Total

number

of TKR

Patients.


documented patient- reported

measures of quality of life and

musculoskeletal function nine to

twelve months following surgery

(same as used as in standard 1b).

Total number of

THR

Patients.

c. Results of measures

from 2b, specifically

including responses to

the questions

identified in standard

1c. Please list the

average scores in the

percent column.

4. Standards for the Patient Care Experience


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a. Proportion of

total hospital or

practice

TKR/THR

patients

surveyed using

HCAHPS.


surveyed using

HCAHPS.

Total

number

of TKR

Patients.


surveyed using HCAHPS.

Total number of

THR

Patients.

b. Results of

measures from 4a,

specifically

responses to Q6

and Q22 if

HCAHPS is used.

5. Standards for Patient Safety and Affordability

a. Number of

TKR/THR patients

readmitted to the

hospital within 30

days of discharge,

all causes.


readmitted to the hospital

within 30 days of

discharge, all causes.

Total

number

of TKR

Patients.



within 30 days of discharge, all

causes.

Total

number

of THR

Patients.

b. Number of

TKR/THR patients

readmitted to the

hospital within 30

days of discharge for

any of the nine

complications

included under the

terms of the

warranty.



within 30 days of

discharge for any of the

nine complications

included under the terms

of the warranty.

Total

number

of TKR

Patients.


readmitted to the hospital within

30 days of discharge for any of

the nine complications included

under the terms of the warranty.

Total

number

of THR

Patients.


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Table 2 Column A –Knees

(Total Number of Total Knee

Replacement Patients)

Column B – Hips

(Total Number of Total Hip Replacement

Patients)

Average length of stay for a

hip/knee replacement procedure.

Post discharge re-admission rate to hospital (includes transfers from Rehab/SNF).

30 day

60 day

90 day

The infection rate of all noted

surgically-related infections within

30 days

The dislocation rate within 90 days

of original procedure date.

The rate of incision and drainage,

revision and removal procedures

within 90 days of original

procedure.

The rate of medical complications

(acute myocardial infarction,

pneumonia, sepsis/septicemia, DVT

or Pulmonary embolisms) within 90

days of original procedure.