​FORCE-TJR Team Receives $6.3 Million Funding Award by the Patient-Centered Outcomes Research Institute (PCORI)

May 2016

Dr. Patricia Franklin, Director of Outcomes Research in the Department of Orthopedics and Physical Rehabilitation at UMass Medical School, and her team received a $6.3million funding award from the Patient-Centered Outcomes Research Institute (PCORI) to develop a ‘Patient Osteoarthritis Careplan to Inform Optimal Treatment’.
This project will transform the core dataset of the AHRQ-funded FORCE-TJR to active TJR decision tools to serve patients, surgeons, and referring clinicians.
Surgeons rely on hip and knee osteoarthritis (OA) patients to report their symptoms of pain and disability to measure disease progression. When arthritis symptoms persist despite treatment, patients consider total joint replacement surgery (TJR). Electing TJR surgery is a collaborative decision between the patient and the surgeon that requires access to real-time data to inform optimal individualized treatment. Anticipating this need, the FORCE-TJR team designed a prototype system of real-time scored patient-reported pain and function assessments and tested it in pilot surgeon offices. Scored, trended data, as well as benchmark data, were available at the visit to support the treatment discussion between the patient and the surgeon. Drawing on positive feedback from patients and surgeons, Dr. Franklin’s team will expand the tool to a web-based system intervention that will provide individualized patient OA Careplans to patients and clinicians. The OA Careplans will incorporate several components, including the likely outcomes of surgery tailored to individual patient risk factors, as well as evidence-based information for non-operative care. The goal is to improve the process and quality of OA treatment decisions and the overall quality of OA care. Patients, surgeons, and family members will participate actively in study design and implementation.
“We appreciate PCORI’s support to extend lessons learned from the 25,000 patients in the FORCE-TJR cohort to serve future knee and hip arthritis patients. Using innovative statistical models and informatics, we will develop real-time individualized information to support treatment decisions and evaluate the impact of this information, together with peer support, on patient treatment and outcomes,” said Dr. Franklin.
“This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other stakeholders, but also for its potential to fill an important gap in our health knowledge and give people information to help them weigh the effectiveness of their care options,” said PCORI Executive Director Joe Selby, MD, MPH. “We look forward to following the study’s progress and working with the University of Massachusetts Medical School team to share the results.”
This study was selected for PCORI funding through a highly competitive review process in which patients, clinicians, and other stakeholders joined clinical scientists to evaluate the proposals. Applications were assessed for scientific merit, how well they will engage patients and other stakeholders, and their methodological rigor among other criteria.
PCORI is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. For more information about PCORI’s funding, visit www.pcori.org. Link to project page. Link to announcement on Orthopedicstodaywebsite.


Bundled payments for joint replacement target a key quality measure: patient satisfaction 

April 7, 2016

David Ayers and Patricia Franklin co-authored a letter to the editor in the Boston Globe regarding CMS new bundled-payment initiative for TJR. Read here


How Patients' Reports On Their Health Can Help Doctors Do A Better Job

April 5, 2016

This article provides a concrete example of the importance of incorporating patient-reported outcomes into clinical care. Read here.


Incorporating Patient-Reported Outcomes Into Health Care To Engage Patients And Enhance Care 

April 2016

Patricia Franklin co-authored this Health Affairs article on incorporating patient-reported outcomes to enhance care delivery and outcomes. Read in Health Aff April 2016 35:575-582. 


CJR and the Rise of Bundled Payments Drive Conversations at AAOS
Health Reform Watch
Carolyn LaWell
March, 2016
The advent of the Centers for Medicare & Medicaid’s Comprehensive Care for Joint Replacement (CJR) program fueled AAOS Annual Meeting conversations regarding the best response by hospitals, surgeons and device companies to bundled payment reimbursement models, including those that extend beyond joint reconstruction.​ (Read more here).


Successful use of patient reported outcomes in bundled patient contracts

Becker’s Hospital CFO
Patricia Franklin & David Ayers
March 18, 2016
In light of the upcoming launch of the Comprehensive Care for Joint Replacement (CJR) program by the Centers for Medicare & Medicaid Services (CMS), Dr. Ayers and Dr. Franklin detail five lessons learned from the more than 250 surgeons and 25,000 TJR patients who have used FORCE-TJR over the past four years for successful TJR episode management. (Read more here)


Survey shows half of orthopedic programs unprepared for CJR

March 2016

A recent survey of more than 100 orthopedic department and hospitals, conducted by FORCE-TJR and Welbe, found that more than half of surveyed orthopedic programs felt unprepared for the Comprehensive Care for Joint Replacement (CJR) model, CMS' first mandatory bundled-payment initiative, coming into effect April 1, 2016. The data was reported in various articles: read more in Becker's Hospital CFO, Becker's Orthopedic Review, Health Leaders Media, Managed Care, This Week Orthopedics.


All Eyes on Hips and Knees

AthenaHealth blog

Patricia Franklin

February 29, 2016

Dr Franklin explains how the FORCE-TJR Value Management System can help surgeons and hospitals as CMS is moving to implement its first mandatory bundled-payment initiative, for the first time linking payment to quality and patient satisfaction measures, in addition to cost measures.(read more here)


Bundled Payments Are Coming To Joint Replacement Surgery

Forbes Magazine

Dave Chase

February 1, 2016

...Medicare moved faster than many expected and announced that 67 metropolitan areas will be mandated to move to bundled payments for joint replacement... In parallel, forward-looking healthcare organizations recognize that patient reported outcomes (PROs) are central to ensuring that quality and appropriate care is being delivered... In order to prepare the industry for the inevitability of bundled payments and PROs, the AHRQ awarded $12 million to the University of Massachusetts Department of Orthopedics and Physical Rehabilitation to develop the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR) project. This project is co-led by Patricia Franklin, M.D., M.B.A., M.P.H., who directs the registry data coordination center, and David Ayers, M.D., who is the lead surgeon. I spoke with the two doctors to learn more about their pioneering program. (read more here)