Original Research

Total Joint Arthroplasty Quality Ratings: How Are They Similar and How Are They Different?

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  • TJA quality designation methodologies differ substantially across rating organizations.
  • Only 29% of TJA quality rating methodologies evaluated include a cost element.
  • Only 57% of TJA quality rating methodologies evaluated include patient experience.
  • Only 57% of TJA quality rating methodologies evaluated include process measurements, including antibiotic prophylaxis and standardized care pathways.
  • There is a need for consistent definitions of quality as healthcare stakeholders continue to shift focus from volume to value.




A patient’s perception of hospital or provider quality can have far-reaching effects, as it can impact reimbursement, patient selection of a surgeon, and healthcare competition. A variety of organizations offer quality designations for orthopedic surgery and its subspecialties. Our goal is to compare total joint arthroplasty (TJA) quality designation methodology across key quality rating organizations. One researcher conducted an initial Google search to determine organizations providing quality designations for hospitals and surgeons providing orthopedic procedures with a focus on TJA. Organizations that offer quality designation specific to TJA were determined. Organizations that provided general orthopedic surgery or only surgeon-specific quality designation were excluded from the analysis. The senior author confirmed the inclusion of the final organizations. Seven organizations fit our inclusion criteria. Only the private payers and The Joint Commission required hospital accreditation to meet quality designation criteria. Total arthroplasty volume was considered in 86% of the organizations’ methodologies, and 57% of organizations utilized process measurements such as antibiotic prophylaxis and care pathways. In addition, 57% of organizations included patient experience in their methodologies. Only 29% of organizations included a cost element in their methodology. All organizations utilized outcome data and publicly reported all hospitals receiving their quality designation. Hospital quality designation methodologies are inconsistent in the context of TJA. All stakeholders (ie, providers, payers, and patients) should be involved in deciding the definition of quality.

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