New tool now in place for total joint replacements

As of Nov. 1, 2012, Providence Health Plan now requires a WOMAC (Western Ontario and McMaster Universities Arthritis Index) as part of the prior authorization process for total hip and total joint replacements.

The WOMAC is a set of standardized questionnaires used by health professionals to evaluate the condition of patients with osteoarthritis of the hip and knee, including pain, stiffness and physician functioning of the joints. It was developed at Western Ontario and McMaster Universities in 1982.

The WOMAC measures five items for pain, two for stiffness and 17 for functional limitations. Physical functioning questions cover everyday activities such as stair use; standing up from a sitting or lying position; standing, bending and walking; getting in and out of a car; shopping; putting on or taking off socks; and heavy or light household duties.

Providence Health Plan would like to partner with our orthopedic surgeons who perform these surgeries to assess functional outcomes. The data submitted will go into a database in which, together, we can look at functional outcomes and practice variations along local and national benchmarks. We can utilize this information to make sure we are getting the best possible outcomes for patients.

The assessment will be completed by your patient in your office and submitted along with the prior authorization request. If your practice submits authorizations via Clear Coverage, you may submit the assessment the same way. You also may fax the assessment to 503-574-6464. The authorization will be considered “pending” if the WOMAC is not received with the prior authorization request.

The follow-up assessment/questionnaire is expected to be filled out by the member on or around the six-month follow-up appointment. The completed follow-up form can be faxed to 503-574-6464. These forms are available on ProvLink.

Thank you for your support of this new prior authorization requirement and tool. We appreciate the care you provide for our members, who are your patients. Please contact your Provider Relations representative with any questions.