Updated data submission guidance for Total Hip and Total Knee Replacement performance measure

The Joint Commission updated the advanced Total Hip and Total Knee Replacement (THKR) certification program’s performance measure THKR-5: Postoperative Functional/Health Status Assessment to align with a similar measure adopted by the U.S. Centers for Medicare & Medicaid Services (CMS). The updated measure that was effective Jan. 1, 2024, requires providers to submit postoperative functional/health status assessments (FSAs) for the patient-reported out-come measures (PROMs) and/or FSAs at one year (within 300-425 days).

The Joint Commission is providing the following guidance to ensure that organizations understand what data need to be submitted to the Certification Measure Information Process (CMIP) tool and when that data are due.

Organizations are required to submit data for THKR-5 to CMIP in the month that corresponds to the procedure discharge date. Organizations can leave the THKR-5 CMIP fields blank until the 300-425 days postprocedure date range. CMIP will issue alerts when the data should be available and entered. Organizations have until the end of the next quarter to submit THKR-5 into CMIP. The data fields within CMIP remain open for the previous eight quarters.

The following are examples of data submission time frames:

• For a procedure date of Jan. 1, 2024, the assessment completion date range (300-425 days postprocedure) is Oct. 27, 2024-Mar. 1, 2025, with a deadline for CMIP data submission of June 30, 2025, and the month the date is entered into the CMIP field is January 2024.
• For a procedure date of Feb. 1, 2024, the assessment completion date range (300-425 days postprocedure) is Nov. 27, 2024-Apr. 1, 2025, with a deadline for CMIP data submission of Sept. 30, 2025, and the month the date is entered into the CMIP field is February 2024.
• For a procedure date of Mar. 1, 2024, the assessment completion date range (300-425 days postprocedure) is Dec. 26, 2024-Apr. 30, 2025, with a deadline for CMIP data submission of Sept. 30, 2025, and the month the date is entered into the CMIP field is March 2024.

Organizations are not required to submit four months of THKR-5 data into CMIP prior to initial certification. However, submitting four months of data is still required for all other THKR measures. The collection of THKR-5 data should begin for procedures conducted four months prior to the initial certification decision.

Questions regarding performance measurement may be directed to the Question Forum on The Joint Commission’s website.