Quality measurement and public reporting in total joint arthroplasty.

Concerns over rising health care costs and variations in practice patterns have stimulated the development of value-based purchasing programs that seek to incentivize higher quality and lower cost health care. The purpose of this study was to evaluate differences in practice patterns in total joint arthroplasty (TJA) and to determine whether adherence to payer-defined guidelines are associated with improved patient outcomes and lower costs of care. Claims data were reviewed for all total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures completed for a 2-year period in a national commercially insured population. Differences in practice patterns among providers were compared using summary measures normalized for patient severity of illness. Correlations between adherence to guidelines and patient outcomes and costs were evaluated. Adherence to guidelines, patient outcomes, and costs of care varied significantly for both THA and TKA. Adherence to payer-defined guidelines had little or no correlation with either patient outcomes or costs of care. These findings underscore the need to define evidence-based performance measures for use in TJA public reporting programs.