Blue Cross Blue Shield Association (BCBSA) recently announced a formal collaboration with the American Joint Replacement Registry (AJRR) and the American Spine Registry (ASR). The partnership will allow BCBSA to use quality outcomes data from consenting registry participants to evaluate current and prospective provider applicants for designation under BCBSA’s Blue Distinction^® Center (BDC) for Knee and Hip Replacement and BDC for Spine Surgery programs.

As two of the largest orthopaedic registries, AJRR and ASR (a collaborative effort between the American Association of Neurological Surgeons and AAOS) collect data from millions of spine, total hip arthroplasty (THA), and total knee arthroplasty (TKA) procedures for their respective registries. Registry participants include hospitals, ambulatory surgery centers (ASCs), and private practice groups, which can leverage the power of their submitted data to improve the quality of care and assess outcomes to benefit their patients.

“The data from both registries are ripe with information that can be used for quality measurement and reporting to improve patient care,” said James I. Huddleston III, MD, FAAOS, chair of the AJRR Steering Committee. “We want to advance the utility and transparency of registry outcomes data for accreditation organizations, as well as quality designation programs, such as BCBSA’s Blue Distinction Centers, so it can be used as a performance measure to help designate qualifying providers as having met rigorous standards for providing safer and more effective care for spine, hip, and knee procedures.”

Both registries provide a pathway for reporting patient-aggregated, de-identified, site-level data from consenting registry participants. For the current 2025 evaluation cycle, providers can submit quality-measurement data for evaluation under BCBSA’s BDC for Knee and Hip Replacement and/or BDC for Spine Surgery designations, via either authorized AJRR/ASR reports or manually, via each BDC program’s Provider Survey. AJRR and ASR participation and performance-data submission will be required, however, for future application cycles.

AJRR and ASR will aggregate and stratify the required BCBSA quality measures on behalf of participating registry participants. This process reduces the burden for hospitals and ASCs to submit these measures by race and ethnicity across five measures for each specialty distinction, streamlining the initial designation or redesignation application process.

“The Blue Distinction Centers for Knee and Hip Replacement and Blue Distinction Centers for Spine Surgery designations are BCBSA’s national recognitions for expertise in delivering specialty care, given to hospitals and ambulatory surgery centers that meet a series of objective quality measures,” said Erin Barney, vice president of healthcare solutions at BCBSA. “Our partnership with AAOS enables seamless access to objective performance measure reports from consenting AJRR and ASR registry participants. This data is crucial for identifying top-tier institutions for spine surgery and for total knee and total hip replacement procedures, and guiding patients to higher-quality healthcare facilities that best fit their specialty care needs.”

Steven Glassman, MD, FAAOS, ASR Executive Committee co-chair, emphasized the importance of data-driven patient care and quality improvement. “By committing to submit their data to AJRR and ASR registries, these participating AJRR and ASR hospitals and ASCs have already demonstrated their dedication to quality improvement as well as their recognition of the value of data-driven patient care,” he said.

Reported measures
The following AJRR/ASR performance metrics are shared on a recurring quarterly basis when a hospital or ASC applies and opts in to authorize AJRR/ASR to send registry data to BCBSA.

Combined AJRR and ASR measures:

• 90-day unplanned all-cause inpatient readmission (hospitals)/admissions (ASCs/outpatient hospitals) rate
• 90-day major complication composite rate
• 90-day postoperative mortality rate AJRR-specific measures:
• preoperative and postoperative functional/health assessment status inpatient measures for hospitals
  • THKR-IP-4a: preoperative functional/health assessment status—hip and knee overall
  • THKR-IP-5a: three-month postoperative functional/health assessment status—hip and knee overall
• preoperative and postoperative functional/health assessment status measures for ASCs:
  • THKR-OP-4a: preoperative functional/health assessment status—hip and knee overall
  • THKR-OP-5a: three-month postoperative functional/health assessments status—hip and knee overall

ASR-specific measures:

• preoperative and postoperative functional/health assessment status
  • ACSS-4 (cervical): preoperative and postoperative patient-reported outcomes (PROs)
  • ACSS-8 (lumbar): preoperative and postoperative PROs

“As some of the more costly orthopaedic procedures, joint and spine surgeries are a focal point for payers aiming to identify higher-quality care for their accounts and members,” said Dr. Huddleston. “AAOS’ goals include promoting value-based care, and sharing these AJRR and ASR benchmarks will provide others with data to guide objective decision making that optimizes improved quality outcomes, which is a full half of any quality-plus-cost value-
based analysis.”

Encouraging participation
Dr. Glassman explained that the partnership offers significant value to registry participants on several levels. “The most obvious benefit is access to a well-recognized national designation program,” he said. “Additionally, this collaboration is another important step toward the more effective use of registry data for real-time quality improvement, which is an essential goal for AJRR and ASR surgeons. Increasingly, accreditation and designation organizations are looking beyond data collection alone and toward the integration of that data into patient care.”

Dr. Glassman also highlighted the importance of active physician involvement to champion their hospital or ASC to become an AJRR or ASR participant and to apply for BDC designation. “For many registries, participation is primarily an administrative function,” he said. “AJRR and ASR are different in that active physician participation is critical to optimizing the quality of data provided to the registry. For ASR specifically, we found that over the first several years of data collection, having a physician champion is crucial to optimizing data quality and the value it brings back to the institution.”

To learn more about AJRR and ASR or how to submit a completed data consent form, email RegistryEngagement@aaos.org or call 847-292-0530.

About Blue Distinction Centers
BDCs meet overall quality measures, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in their own service areas; for details, providers should contact their Local Blue Plan. A Blue Distinction Center+ (BDC+) also meets cost measures that address consumers’ need for affordable healthcare. Each provider’s cost of care is evaluated with data from its Local Blue Plan. Providers in California, Idaho, New York, Pennsylvania, and Washington may lie in two Local Blue Plan areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost-of-care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or a member’s own policy’s coverage, each member should contact their Local Blue Plan and ask their provider before making an appointment. Neither BCBSA nor any Blue Plans are responsible for noncovered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.

BCBSA is an association of independent, locally operated Blue Cross Blue Shield companies and owns the registered trademarks Blue Cross^®, Blue Shield^®, and Blue Distinction^®.

Jennifer Lefkowitz is a freelance writer for AAOS Now.