April 2, 2014

Today’s Top Story
1. SGR patch signed into law; delays cuts until April 1, 2015.The U.S. Senate has passed, and President Obama has signed into law, another patch to delay until April 1, 2015, a cut to Medicare physician reimbursement called for under the Sustainable Growth Rate (SGR) formula. The bill passed the House of Representatives last week and marks the 17th time Congress has delayed cuts mandated by the SGR. Recent projections by the Congressional Budget Office had reduced the estimated cost of SGR repeal to what was perceived by many experts to be a manageable amount, and there was wide bipartisan support to replace the SGR with a system that would not require annual patches. However, Democrats and Republicans were unable to come to an agreement on how to fund the reduced cost of repeal. The patch legislation is viewed by many in the medical community as a missed opportunity; it is expected that the upcoming Congressional election cycle will make it even more difficult for legislators to find common ground.   Read more…
Read more in AAOS Advocacy Now

Other News
2. Study: rhBMP-2 appears to promote healing after trauma, but may also prolong wound drainage.
Data from a study published online in the Journal of Orthopaedic Trauma suggest that the use of rhBMP-2 in certain reconstructive extremity surgery may be beneficial, but may also increase the incidence of prolonged postoperative serous wound drainage. The authors conducted a retrospective review of 374 patients who underwent acute trauma or posttraumatic reconstruction between 2002 and 2009. They found that 31 percent of patients whose treatment included rhBMP-2 (n = 193) had documented wound complications, compared to 18 percent of patient treated without rhBMP-2 (n = 181). However, the rate of union was 90 percent in the rhBMP-2 group and 74 percent in the control group. The researchers noted that use of rhBMP-2 did not appear to correlate with an increased incidence of postoperative wound infection or need for re-operation.
Read the abstract…

3. Study: Methotrexate may improve pain and reduce swelling for patients with knee OA.
An Egyptian study published online in the journal Annals of the Rheumatic Diseases suggests that treatment with methotrexate may reduce pain and improve synovitis for patients with symptomatic knee osteoarthritis (OA). The research team conducted a randomized trial of 144 patients with primary knee OA who were treated with 25 mg/week oral methotrexate (n = 72) or placebo (n = 72). At 28-week follow-up, they noted a clinically relevant reduction in synovitis, knee pain, physical function, activities of daily living scores, and visual analog pain scale scores among the intervention group compared with the placebo group.   Read more…(registration may be required)
Read the abstract…

4. Study: Restrictive RBC transfusion strategy linked to reduced risk of HAI.
According to a study published in the April 2 issue of The Journal of the American Medical Association (JAMA), compared with a liberal transfusion strategy, use of a restrictive red blood cell (RBC) transfusion strategy may be associated with a reduced risk of healthcare-associated infection (HAI). The researchers conducted a meta-analysis of 18 randomized trials covering 7,593 patients. They found that the pooled risk of all serious infections was 11.8 percent among patients treated with a restrictive strategy and 16.9 percent among patients treated with a liberal strategy. The risk of infection remained reduced with a restrictive strategy, even with leukocyte reduction. The risk ratio was 0.70 among patients who underwent orthopaedic surgery and 0.51 among patients who presented with sepsis. There were no significant differences in incidence of infection by RBC threshold for patients with cardiac disease, the critically ill, those with acute upper gastrointestinal bleeding, or infants with low birth weight.   Read more…
Read the complete study…

5. Opinion: Physicians should assume that their Medicare claims data will eventually become public.
An opinion piece published in the April 2 issue of JAMA looks at the issue of increased disclosure of individual physician payment data. “Until [the U.S. Centers for Medicare & Medicaid Services] makes some determinations, or issues guidance on how it will balance the public interest and personal privacy in various circumstances, it is unclear how frequently payment information will be disclosed, what specific information will be released, and how the information will be reported,” the author writes. Given that, the author points out that it is reasonable for physicians and other professionals who bill Medicare to assume that their claims data may eventually become public. “Those who request information are likely to have to convince CMS that disclosure would serve the public interest by casting light on the agency’s performance of its statutory duties,” he states. “Nonetheless, it is likely that employers, other large purchasers of care, physician groups, hospitals, health care systems, researchers, journalists, and consumers will seek access to the data and that CMS will approve at least some of these requests.”   Read more…

6. Different courts have different standards for what constitutes informed consent.
An article published in Dermatology Times looks at two different standards regarding treatment information that physicians may be expected to have disclosed to patients for informed consent. In the “reasonable medical practitioner” standard, the physician must “disclose and explain to the patient in language as simple as necessary the nature of the ailment, the nature of the proposed treatment, the probability of success or of alternatives, and perhaps the risks of unfortunate results and unforeseen conditions within the body […].” In the so-called “reasonable patient” standard, certain courts have held that physicians should disclose what a patient would reasonably need to know in order to make an informed decision. Although the author notes that the second standard is a minority point of view in the United States, he points out that the variation in standards can affect the outcome of medical liability cases in different jurisdictions.   Read more…

7. Florida.
According to the Tampa Bay Business Journal, a bill under consideration in the Florida House of Representatives would, if enacted, remove medical liability cases from the tort system and institute an administrative law system that would include panels of physician specialists to review claims. The bill is currently being considered by the state’s House Judiciary Committee.   Read more…

8. Last call: AJRR Commission.
AAOS seeks to nominate three members to the American Joint Replacement Registry (AJRR) Commission. The commission is primarily charged with review of the AJRR annual report before it is released to the AJRR Board of Directors for final approval and public release. Commissioners will work in concert to evaluate the annual reports and determine if representations and interpretations of the data presented are fair, balanced, and valid. Applicants for this position should be orthopaedic surgeons without any personal conflicts of interest or financial relationships with members of the orthopedic industry. In addition, all applicants must provide the following: an online AAOS CAP Application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in subject area and a statement that he or she is able to participate in full capacity. Please submit supporting materials by Friday, April 4, 2014 at 11:59 p.m. CT, to Kyle Shah at  shah@aaos.org.
Learn more and submit your application…(member login required)

April 4, 2014

Today’s Top Story
1. CMS to release payment data on 550,000 physicians.
In a letter to the American Medical Association, the U.S. Centers for Medicare & Medicaid Services (CMS) states that it will publicly release certain physician payment information on its website. “No sooner than April 9, CMS plans to publicly release a data set on the types of medical services and procedures furnished by physicians and other health care professionals as well as certain payment and charge data related to those services […],” the letter states. “This public data set will include number of services, average submitted charges and standard deviation in submitted charges, average allowed amount and standard deviation in allowed amount, average Medicare payment and standard deviation in Medicare payment, and a count of unique beneficiaries treated.” As reported in Bloomberg, a federal judge last May lifted an injunction prohibiting CMS from releasing any payment information that could be used to identify individual physicians.   Read more…
Read the letter (PDF)…

Other News
2. Study: Younger TKA patients may have higher risk of periprosthetic joint infection, aseptic mechanical failure.
Findings of a study published in the April 2 issue of The Journal of Bone & Joint Surgery suggest that patients who are younger than 50 years have a significantly higher risk of undergoing revision total knee arthroplasty (TKA) due to periprosthetic joint infection or aseptic mechanical failures than older patients 1 year after undergoing primary TKA. Researchers conducted this large, population-based study by analyzing data from the California Patient Discharge Database, which enables serial linkage of discharge data from nonfederal hospitals in the state. The investigators identified all patients who underwent primary unilateral TKA between 2005 and 2009, and used multivariate analysis to perform risk adjustment for important clinical and demographic variables. At one year after primary TKA, the researchers found that 983 (0.82 percent) of 120,538 patients had undergone revision due to periprosthetic joint infection, while 1,385 patients (1.15 percent) had undergone revision surgery due to aspectic mechanical failure. Risk-adjusted models indicated that patients younger than 50 years were 1.8 times more likely to have periprosthetic joint infection than patients 65 years or older. In addition, younger patients had a 4.7 times greater risk of aseptic mechanical failure.   Read more…

3. Sequestration 2 percent fee reduction to continue into 2015.
The 2 percent payment reduction in Medicare’s Fee-for-Service reimbursement that was imposed last year through sequestration will continue through March 31, 2015, for claims made on or after April 1, 2013, the Centers for Medicare and Medicaid Services reminded providers in a weekly newsletter. The continuation also applies to claims for durable medical equipment (DME), including prosthetics, orthotics, and supplies and will include claims under the DME Competitive Bidding Program. Although beneficiary payments for deductibles and coinsurance are not subject to the 2 percent reduction, Medicare’s payment to beneficiaries for unassigned claims is subject to the reduction. CMS officials encourage physicians “to continue discussions with beneficiaries about the impact of sequestration on Medicare’s reimbursement.”
Read the Medicare statement (PDF, pp. 7–8)…

4. Study: Demand for TJR procedures continues to rise.
Medical News Today reports that, according to a study published in the published in the April issue of The Journal of Bone and Joint Surgery, demand for hip and knee arthroplasties in the United States will continue to grow through 2030, despite recent economic downturns. The study was conducted in response to criticism that existing total joint replacement (TJR) utilization model projections—which predicted a significant surge in demand for TJR—did not take into account macroeconomic shifts such as recessions.

Using Nationwide Inpatient Sample (NIS) data from 1993 to 2010 combined with United States Census and National Health Expenditure data, the researchers quantified historical trends in TJR rates. Regression analysis was used to estimate TJR projections as a function of age, sex, race, and census region, using the National Health Expenditure as the independent variable.
“The actual NIS data from 2005 and 2010 correlate strongly with the predictions made in the previous model, despite the fact that both were post-recessionary years,” said Steven M. Kurtz, PhD, lead author of the study. “The results of this new study support the findings of our previous projections of arthroplasty demand through at least 2021.”   Read more…
Read the study…

5. Study: Real-time neuromonitoring can help prevent pedicle screw malpositioning during thoracic spine surgery.
A new intraoperative neuromonitoring method developed and tested by researchers from Syracuse, N.Y., can be used during thoracic spine surgery to prevent malpositioning of pedicle screws that might breach the spinal canal and possibly cause postoperative neurological impairment, Medical News Today reports. The findings are based on the results of a prospective, randomized, blinded study that involved 71 patients undergoing thoracic spine surgery at Upstate University Hospital and Crouse Hospital.
The researchers stimulated the pedicle screw after insertion and assessed electromyograph (EMG) responses to the stimulation from leg muscles and from intercostal and abdominal muscles. Postoperative computed tomography scans were later examined and compared with intraoperative EMG recordings by multiple reviewers who were blinded to intraoperative test results. The researchers found that postoperatively 32 pedicle screws were found to have breached the spinal canal to a clinically relevant extent. The medial malpositioning of all 32 pedicle screws had been predicted intraoperatively, prior to screw insertion, by EMG responses of leg muscles to the 4-pulse train stimulation delivered within the pedicle tracks.   Read more…

6. 2014 Physician Quality Reporting System open for business.
Resources for 2014 participation in the registry reporting method for the Physician Quality Reporting System (PQRS) quality measures are now available for individual physicians and group practices. Criteria call on individuals to:

  • Report on at least nine measures covering three National Quality Strategy (NQS) domains for at least 50 percent of the physician’s Medicare Part B Fee-for-Service (FFS) patients. (This is also the provision by which a group practice can earn a 2014 PQRS incentive.)
  • Report on at least one measures group on a 20-patient sample, a majority of which (at least 11) must be Medicare Part B FFS patients.

Group practices must have registered to report via qualified registry under the Group Practice Reporting Option for 2014. Registration ends September 30. Participants getting started should take the following steps:

  • Determine eligibility to participate.
  • Choose a PQRS qualified registry.
  • Work directly with the registry to submit 2014 data.

See the 2014 “PQRS Registry Reporting Made Simple” fact sheet (PDF)…
Visit the PQRS website…

7. New security risk assessment tool from HHS aims to help providers with HIPAA compliance.
The U.S. Department of Health and Human Services (HHS) has released a security risk assessment (SRA) tool designed to assist healthcare providers in small-to-medium–sized offices perform risk assessments for their organizations, as reported by MLN Connects,a publication of the Medicare Learning Network. Practices can use the tool while conducting and documenting a risk assessment to evaluate potential security risks under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. According to HHS, the tool will enable providers to “conduct and document a risk assessment in a thorough, organized fashion, at their own pace.” The tool, which is available for download, generates a report that practices can provide to auditors.  Read more (PDF, p. 6)…

8. Call for volunteers: AMA House of Delegates, Orthopaedic Section Council.
AAOS seeks one delegate representative to join the American Medical Association (AMA) House of Delegates, Orthopaedic Section Council. Members of the AMA House of Delegates serve as an important communications, policy, and membership link between the AMA and grassroots physicians. The delegate or alternate delegate is a key source of information on activities, programs, and policies of the AMA, and is also a direct contact for the individual member to communicate with and contribute to the formulation of AMA policy positions, the identification of situations that might be addressed through policy implementation efforts, and the implementation of AMA policies. Applicants must be AMA members and must be actively practicing orthopaedic surgeons. All applicants must provide an online AAOS CAP application; current curriculum vitae up to 20 pages, with complete contact information (including title, business address, telephone, fax, and email address); a letter of interest, highlighting his or her expertise in the relevant subject area and a statement that he or she is able to participate in full capacity; and a 100-word maximum biography. All supporting materials should be submitted by Sunday, April 6, 2014, at 11:59 p.m. CDT to Kyle Shah, clinical quality and medical affairs coordinator, at  shah@aaos.org 

April 7, 2014

Today’s Top Story
1. Study: Same-day and staged bilateral TKAs have similar safety profiles.
Data from a study published in the April issue of The Journal of Arthroplasty suggests that same-day bilateral total knee arthroplasty (TKA) is not associated with an increased incidence of major complications compared to staged bilateral arthroplasty. The authors examined prospective data on 6,672 patients who underwent TKA on both knees (2,441 same-day bilateral and 4,231 staged within 12 months). They found no significant difference in 90-day mortality, thrombotic events, and infections between the two groups.
Read the abstract…

Other News
2. Study finds aseptic failure more likely among younger TKA patients.
A study published in the April 2 issue of The Journal of Bone & Joint Surgery finds that TKA performed in younger patients may be associated with increased rates of aseptic failure, compared to older patients. The research team compared data on 84 patients 50 years or younger who underwent TKA and a similar cohort of 84 TKA patients aged 60 to 70 years. They found that the most common reasons for initial revision were aseptic loosening in the younger cohort and infection in the older cohort. The mean time from primary arthroplasty to initial revision was 36 months (range, 1 to 210 months) in the younger group, compared to 59 months (range 1 t0 230 months) in the older group (P = 0.0028). Overall, infection accounted for 32 percent of second revisions in the younger cohort and 50 percent of second revisions in the older cohort; mean times from the initial revision to second revision were similar in both groups.
Read the abstract…

3. Studies: CT-navigation may be safe and accurate for pedicle screw placement.
Several studies published in the March issue of the journal Neurosurgical Focus suggest that computed tomography image-guided navigation (CT-IGN) may be safe and accurate for the placement of pedicle screws. In one study, the researchers conducted a retrospective review of 48 consecutive adult patients who underwent minimally invasive percutaneous posterior spinal fusion with intraoperative CT-IGN, and found that authors’ high accuracy rate in minimally invasive spine surgery (MIS) compared favorably with historical published accuracy rates for fluoroscopy-based techniques, while being associated with lower occupational radiation exposure for the surgical team, reduced need for postoperative imaging, and decreased rates of revision surgery.
In a second study, the authors found that CT-IGN was associated with accurate screw placement in both small and large pedicles.  Read more…
Read the abstract of “Clinical and radiographic outcomes of minimally invasive percutaneous pedicle screw placement with intraoperative CT (O-arm) image guidance navigation”…
Read the abstract of “Instrumenting the small thoracic pedicle: the role of intraoperative computed tomography image–guided surgery”…

4. Survey: Many surgical residents fall short in understanding of ACGME core competencies.
A survey of general surgery residents published in the April 2 issue of the journal JAMA Surgery suggests that many may not be gaining enough knowledge in several areas of the nonclinical Accreditation Council for Graduate Medical Education (ACGME) core competencies. The research team surveyed 48 surgery residents on their understanding of the following 10 topics:

  • Negotiation and conflict resolution
  • Leadership styles
  • Healthcare legislation
  • Principles of quality delivery of care, patient safety, and performance improvement
  • Business of medicine
  • Clinical practice models
  • Role of advocacy in healthcare policy and government
  • Personal finance management
  • Team building
  • Roles of innovation and technology in healthcare delivery

They found that only 3 topics—leadership styles, team building, and roles of innovation and technology—had greater than 70 percent positive responses, and just two topics—negotiation and conflict resolution and principles of quality delivery—had between 60 percent and 70 percent positive responses. The remaining topics all had less than 40 percent positive responses.
Read the abstract…

5. ACOs find mixed results in improving value.
An article in HealthLeaders Media looks at information from the U.S. Centers for Medicare & Medicaid Services (CMS) and finds that just over half of the organizations that joined one of two Medicare accountable care organization (ACO) efforts in 2012 reported no decrease in healthcare spending below targets during the first 12 months, and only 29 reduced spending enough to keep some of the savings. The publication reports that the data correlate with information from the CMS Innovation Center’s Pioneer ACO model, in which 9 of 32 organizations left the program after its first year, and 9 of the remaining 23 organizations saved money.   Read more…

6. ACA modification slips quietly through Congress.
The Associated Press reports that Republican lawmakers have succeeded in passing a small modification to the Affordable Care Act (ACA). The provision, which eliminates a cap on small group policies, was passed last week as part of a larger bill that delays cuts to physician reimbursement called for under the Medicare Sustainable Growth rate formula until at least April 1, 2015. The U.S. Department of Health and Human Services had already waived such caps through 2015, but the legislation makes the waiver permanent. Although the change was supported by some vocal opponents of the healthcare law, observers say that it does not necessarily signal a retreat in efforts to overturn the ACA.   Read more…

7. Last call for input on future CPG topics.
The Committee on Evidence-Based Quality and Value is inviting AAOS members to submit topic suggestions for the next clinical practice guidelines (CPGs) to be developed. The topics will be submitted to the committee for review at their meeting on April 27, 2014. Please complete the online form by Thursday, April 10, 2014.
Access the form…

8. Submit your abstracts for the 2015 AAOS Annual Meeting!
It is now time to submit abstracts and applications for papers, posters, scientific exhibits, and multimedia for the 2015 Annual Meeting, which will take place March 24-28, 2015, in Las Vegas. Nowhere else will your research reach such a wide-ranging orthopaedic audience. The deadline for submitting abstracts on papers, posters, and scientific exhibits is June 2, 2014. The deadline for submitting program for the orthopaedic video theater is July 15, 2014.
Learn more and submit your abstracts…

April 9, 2014

Today’s Top Story
1. CMS publicly releases Medicare payment information.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released to the public Medicare payment information on more than 880,000 healthcare providers. As reported in Medpage Today, the data is available via two electronic spreadsheets, the first of which lists providers by name, address, national provider identifier, specialty, number of Medicare patients, number of services billed, submitted charges, and total Medicare payment. The second spreadsheet identifies common Medicare services and procedures, along with data on the number of providers performing the service, the number of times it was performed, number of patients who received the treatment, and the total amount paid by Medicare. The data was released in response to a federal court decision, which overturned an injunction that prevented disclosure of Medicare payment information.  Read more…

Other News
2. Meta-analysis questions impact of resident duty hour limits.
Findings from a study published online in the journal Annals of Surgery suggest that mandated restrictions in resident duty hours (RDH) may not be consistently associated with improvements in resident well-being, yet may have negative impacts on patient outcomes and residents’ performance on certification examinations. The researchers conducted a systematic review of 135 studies that looked at the effect of RDH changes. They found no overall improvement in patient outcomes as a result of RDH alterations, although some studies suggested there were increased complication rates among high-acuity patients. In addition, they found no improvement in education related to RDH restrictions, while performance on certification examinations declined in some specialties. The researchers did note some improvements in resident wellness after implementation of an 80-hour workweek, but found little improvement or negative effects on wellness after 16-hour duty maximums were implemented.
Read the abstract…

3. Study: Incidence of invasive MRSA infections appears to be decreasing.
A study published in the April 9 issue of The Journal of the American Medical Association estimates that there were 30,800 fewer invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States in 2011 compared with 2005. The authors examined data on MRSA cultures across nine metropolitan areas in the United States from 2005 through 2011. They estimated that there were 80,461 invasive MRSA infections nationally in 2011, and of those, 48,353 were healthcare–associated community-onset (HACO) infections, 14,156 were hospital-onset infections, and 16,560 were community-associated infections. Since 2005, adjusted national estimated incidence rates decreased among HACO infections by 27.7 percent and hospital-onset infections decreased by 54.2 percent, while community-associated infections decreased by only 5.0 percent.   Read the abstract…

4. IRS warns of tax scam targeting physicians.
According to information from the Indiana State Medical Association (ISMA), the U.S. Internal Revenue Service (IRS) has issued a warning regarding scam attempts directed at physicians, in which fraudulent federal income tax returns are filed using physician names and Social Security numbers. IRS officials believe the scam is an attempt to fraudulently recover tax refunds. Physicians who are victims of the fraud may receive a 5071C letter from the IRS with instructions to contact the IRS identity theft website. Physicians can also call IRS at 800-830-5084 to let officials know they did not file the returns referred to in the letters. The association notes that those who are victims of the fraud may not be able to electronically file their taxes this year, since a return with their Social Security number has already been filed. IRS recommends filing a paper return with Form 14039 Identity Theft Affidavit attached, along with copies of any relevant notices received from the IRS.   Read more…
A certified public accountant recommends that victims contact the three primary credit reporting agencies.   Read more…
ISMA has published an update containing further information.   Read more…

5. Connecticut.
The Connecticut Mirror reports on efforts among hospitals in Connecticut to reduce the incidence of preventable errors. The author notes that medical providers have taken cues from the airline and nuclear power industries, adopting the use of checklists and standardized approaches to treatment, determining the root cause when errors occur, and ensuring that front-line staff are trained in and comfortable with reporting potential problems to administration. In addition, nearly all hospitals in the state hold a daily “safety huddle,” in which hospital leaders discuss what happened the day before and any potential concerns for the day ahead.   Read more…

6. Kansas.
According to the Kansas City Business Journal, both houses of the Kansas Legislature have passed a bill that, if enacted, would gradually increase the limit on damages that can be awarded for pain and suffering in medical liability cases $350,000 by 2022. Currently, such awards are capped at $250,000. The Kansas Supreme Court has previously ruled that such a cap is constitutional.   Read more…

7. Did you know that AAOS Now is available as an ebook?
In addition to being available on the AAOS website, the April 2014 issue of AAOS Now magazine is now available for electronic devices and e-readers capable of reading files in ePub format. These include iOS devices such as the iPhone and iPad, Android devices, and desktop computers. (At this time, Amazon Kindle does not recognize ePub files.) To download and view the electronic version of AAOS Now, visit the link below and log in using your AAOS username and password. Instructions for most devices are provided on the site. If you have comments or questions about the ePub version of AAOS Now, please email Peter Pollack, electronic content specialist, at ppollack@aaos.org
Read the ePub version of AAOS Now(member login required)

8. Call for volunteers: Resident member to the ACGME Review Committee for Orthopaedic Surgery.
AAOS seeks to nominate one resident member to the Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Orthopaedic Surgery. The resident member serves a minimum 2-year term; participates as a full voting member in all review committee activities, including program review and policy discussion; and must be able to devote 15 to 20 hours to program review before each review committee meeting. Resident members may not serve on two review committees simultaneously, and must not be from the same institution or state as other members of the Review Committee for Orthopaedic Surgery (a complete list of institutions is available on the AAOS CAP page linked below). All applicants must provide the following: an online AAOS CAP application; current curriculum vitae (up to 20 pages maximum) with complete contact information; and a letter of recommendation from the nominee’s program director, highlighting his or her expertise in the subject area and a statement that he or she is able to review programs, attend review committee and ACGME Council of Review Committee Residents meetings, and participate in activities of the committee and ACGME as expected. Please submit all supporting materials by Friday, April 18 at 11:59 p.m. CT to Kyle Shah, at shah@aaos.org
Learn more and submit your application…(member login required)

April 11, 2014

Today’s Top Story
1. HHS secretary resigns; OMB director to be named as replacement.
Kaiser Health News reports that U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has resigned. Observers say the move may have been precipitated by problems with the rollout of the federal healthcare exchange website, which was mandated under the Affordable Care Act. The president announced that he plans to nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget (OMB), to replace the outgoing director.   Read more…

Other News
2. Study: Reoperation may be effective for patients with recurrent LDH.
Data from a Swedish study published in the journal Clinical Orthopaedics and Related Research suggest that repeat surgery for recurrent lumbar disc herniation (LDH) may be efficacious, although with less improvement, compared to primary LDH surgery. The research team reviewed data on 8,497 patients from the Swedish National Spine Register, 8,350 of whom underwent primary surgery for LDH and 147 of whom underwent reoperation for recurrent LDH within the first year. At 1- to 2-year follow-up, they found that 79 percent of patients in the primary LDH group and 58 percent of patients in the recurrent LDH group were satisfied with their outcomes. In addition, 74 percent of patients in the primary LDH group reported no or better leg pain, compared to 65 percent of patients in the recurrent group. However, reoperation for recurrent LDH represented the largest independent risk for dissatisfaction, while reoperation and smoking represented similar risks for less improvement in leg pain.
Read the abstract…

3. Study: Group exercise program linked to greater improvement in frozen shoulder than other nonsurgical options.
Findings from a study published in the April issue of the Journal of Shoulder and Elbow Surgery suggest that a hospital-based exercise class may be more effective than either individual physiotherapy or a home exercise program for the treatment of frozen shoulder. The authors conducted a randomized, single-blind trial of 75 patients with frozen shoulder who were treated with either a group exercise class, individual physiotherapy, or home exercises alone. At 12-month follow-up, they found that participants in the exercise group displayed greater improvement in Constant Score and Oxford Shoulder Score compared to participants in the other two groups, while participants in both physiotherapy groups had improved range of motion and scores on the Hospital Anxiety and Disability Scale compared to patients in the home exercise group.
Read the abstract…

4. Study: Transfemoral amputees may display increased levels of BMD loss.
A study published in the April issue of the Journal of Orthopaedic Trauma finds that transfemoral amputees may be at increased risk of bone mineral density (BMD) loss. The researchers conducted a retrospective, case–control comparison of 156 lower extremity amputees (182 amputations). They found that 42 percent of patients were considered to have low BMD. In addition, average Z score was -0.6 ± 1.1 among patients with unilateral amputations and -1.2 ± 1.0 among patients with bilateral amputations. Risk factors for low BMD included prolonged time to first ambulation, prolonged time to dual energy x-ray absorptiometry, and more proximal amputation level. Finally, among unilateral amputees, the researchers noted a significant difference in the BMD of the intact and amputated limbs.
Read the abstract…

5. Proposed legislation would clarify licensure for traveling team physicians and trainers.
A bill introduced in the U.S. Senate would, if enacted, clarify licensure for sports medicine professionals who offer medical services while traveling outside of their home state. Supporters of the bill note that, while some states offer legal protection to shield healthcare providers from risk under such circumstances, others do not, leaving providers to balance treatment of an injured athlete against increased risk of liability.
“Sports medicine providers should not have to choose between either treating injured athletes at great professional risk, or reducing athletes’ access to timely healthcare services,” states American Association of Orthopaedic Surgeons (AAOS) President Frederick M. Azar, MD. “This bill will ensure injured athletes have timely access to the highest quality of care so they can return to their active lifestyle as soon as possible.”
Learn more about the bill…
Read the AAOS response…

6. Data suggest increased compliance with concussion guidelines among high school athletes.
According to information presented at the annual meeting of the American Medical Society for Sports Medicine, the percentage of high school athletes with concussion who comply with Zurich return-to-play guidelines may be on the rise. The research team used a database of high school sports-related injuries to track compliance between 2005 and 2013. Athletes were considered compliant if they waited to return to play 6 or more days after their symptoms had resolved. The researchers found that, in 2007, just over 50 percent of athletes were non-compliant. By 2012-2013, non-compliance had been reduced to about 20 percent.   Read more…

7. Oklahoma.
The Oklahoman reports that the chair of the Public Health Committee of the Oklahoma House of Representatives has stalled a bill that would have required physicians to check their patients’ drug histories before writing narcotic prescriptions. The legislator cited concern over several elements of the bill, including a provision that could allow the state Bureau of Narcotics and Dangerous Drugs to fine physicians $2,000 for failing to check the state’s online Prescription Monitoring Program.   Read more…

8. Last call: Trauma Instructional Course Committee.
April 18 is the last day to submit your application for a position on the Trauma Instructional Course Committee (one member opening). Members of instructional course committees grade Instructional Course Lecture applications in May, provide course input to the Central Instructional Courses Committee, and evaluate courses at the AAOS Annual Meeting. Applicants for this position must be AAOS fellows with a practice emphasis in trauma.
Learn more and submit your application…(member login required)

April 14, 2014
Today’s Top Story
1. Study: EM physicians may need more training in musculoskeletal medicine.
Other News
2. Study: Community factors may affect hospital readmission rates.
3. Study: BMP may attract stem cells to produce bone.
4. Study: On average, girls may take longer than boys to recover from concussion.
5. Study: Patient-clinician relationship may affect healthcare outcomes.
6. ACP position paper proposes outline for medical liability reform.
7. Release of Medicare billing data could bolster whistleblower cases.
8. Apply now to take part in the AAOS Leadership Fellows Program.
Today’s Top Story
1. Study: EM physicians may need more training in musculoskeletal medicine.
Findings published in the April issue of the Journal of Orthopaedic Trauma suggest that additional resources should be committed to the training of emergency medicine (EM) physicians in the area of musculoskeletal medicine. The researchers surveyed 23 EM residents and 21 attending physicians working at a Level 1 trauma center. They found that 35 percent of residents and 43 percent of attending physicians failed to demonstrate proficiency on a validated musculoskeletal medicine competency examination. Overall, 23 percent of respondents indicated that they were dissatisfied with their musculoskeletal education.
Read the abstract…
Back to top
Other News
2. Study: Community factors may affect hospital readmission rates.
According to information published online in the journal Health Services Research, a substantial amount of variation in hospital readmission rates may be attributed to community factors. The authors examined 4,073 U.S. hospitals with publicly reported 30-day readmission rates for patients discharged between July 1, 2007, and June 30, 2010, with acute myocardial infarction, heart failure, or pneumonia, and compared that information against publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets. They found that 58 percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. The authors noted that the factors most strongly associated with higher readmission rates were measures related to access of care, which accounted for almost half of the total variation across counties.  Read more…
Read the complete study…
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3. Study: BMP may attract stem cells to produce bone.
Data from a mouse study published online in the journal PLoS One suggest that bone morphogenetic protein (BMP) might be used to attract stem cells that in turn produce bone. The research team identified a large number of multipotent mesenchymal stem cells (MSCs) in the peritoneal lavage fluid from mice with peritoneal catheter implants. They found that, when poly(l-lactic acid) scaffolds loaded with BMP-2 were implanted into the peritoneum, signs of osteogenesis were seen within 8 weeks of implantation. The research team writes that their findings support the concept that scaffolds containing BMP-2 can stimulate the formation of bone in the peritoneum via directed autologous stem and progenitor cell responses.   Read more…
Read the complete study…
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4. Study: On average, girls may take longer than boys to recover from concussion.
According to research presented at the annual meeting of the American Medical Society for Sports Medicine, concussion symptoms may last longer in girls than they do in boys. The researchers tracked 549 patients (235 girls) aged 10 to 18 years, who sought treatment at a pediatric concussion clinic. They found that, in addition to reporting more severe symptoms, girls took an average of 56 days to be symptom-free, compared to 34 days for boys. The researchers did not find age to be a factor in severity of symptoms. They also point out that the apparently long length of time to recovery for all patients may be suggestive of a patient population (those who sought treatment at a dedicated concussion clinic) with a greater overall severity of injury.   Read more…
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5. Study: Patient-clinician relationship may affect healthcare outcomes.
Information published online in PLoS One suggests that the patient-clinician relationship may have a small but statistically significant effect on healthcare outcomes. The research team conducted a meta-analysis of 13 randomized, controlled trials of adult patients in which the patient-clinician relationship was systematically manipulated and either objective or validated subjective healthcare outcomes were recorded. They found that the observed effect sizes for individual studies ranged from d = -0.23 to 0.66. Using a random-effects model, they estimated the overall effect size to be small (d = 0.11), but statistically significant.   Read more…
Read the complete study…
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6. ACP position paper proposes outline for medical liability reform.
A policy paper released by the American College of Physicians (ACP) calls for all stakeholders to work together to reform the nation’s medical liability system, without diverting focus from efforts to improve patient safety and prevent errors. The paper outlines a series of recommendations, including the following:

  • An emphasis on patient safety and promotion of a culture of quality improvement and coordinated care
  • Caps on non-economic damages
  • Minimum standards and qualifications for expert witnesses
  • The establishment of “communication and resolution” (early disclosure and apology) pilot programs
  • Federal support for alternative dispute resolution models, including mediation
  • Conditional safe harbor protections that cover care consistent with evidence-based guidelines

Read more…
Read the policy paper (PDF)…
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7. Release of Medicare billing data could bolster whistleblower cases.
Reuters reports that, with the release of physician Medicare billing information last week, lawyers who specialize in representing whistleblowers in healthcare fraud cases have begun to comb through the data for evidence of improper billing. A whistleblower who prevails in a Medicare fraud case receives up to 30 percent of whatever the government recovers, and 40 percent of that reward typically goes to the whistleblower’s lawyer. Observers say that access to the Medicare data could be used to bolster existing whistleblower cases or to produce leads for new lawsuits.   Read more…
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8. Apply now to take part in the AAOS Leadership Fellows Program.
The AAOS Leadership Fellows Program (LFP) offers an exciting opportunity to all AAOS fellows age 45 and younger as of Jan. 31, 2015. The LFP is a 1-year program, which begins at the AAOS Annual Meeting and combines didactic and experiential leadership training with an ongoing mentoring program. Among the goals of the program are the following:

  • Introduce Fellows to the AAOS Governance structure
  • Observe AAOS leadership at work
  • Participate in interactive leadership development programs
  • Engage in opportunities for peer-to-peer interactions and learning
  • Experience service on an AAOS committee

Applications are now available online. This is a year-long commitment with 6 mandatory meetings. Please review the LFP schedule prior to completing the application to ensure you will be able to attend all meetings. The deadline for applications is July 15, 2014.
Learn more and submit your application…
For more information, contact Kristen Erickson at 847-384-4343, or via email at  erickson@aaos.org

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April 16, 2014

Today’s Top Story
1. AMA: Physicians generated $1.6 trillion in economic activity during 2012.
An analysis released by the American Medical Association (AMA) estimates that physicians in the United States are associated with a direct and indirect economic impact of $1.6 trillion in 2012. The research team looked at four barometers of impact: output, jobs, wages and benefits, and state and local tax revenue. They found that, at the state level, the mean total output of physicians was $22.5 billion. At the national level, physicians created a total of $1.6 trillion in direct and indirect economic output (i.e., sales revenues) in 2012. On average, each physician supported $2,195,26 in output, 13.84 jobs (including his or her own job), $1,076,462 in total wages and benefits, and $90,444 in local and state tax revenues.   Read more…
Read the complete report (PDF)…

Other News
2. Study: Imageless navigation may improve position accuracy of acetabular component in cementless THA.
A study published in the April issue of The Journal of Arthroplasty finds that imageless computer-assisted navigation may more accurately position the acetabular component in cementless total hip arthroplasty (THA) compared to conventional technique. The authors conducted a prospective, randomized study of 130 patients who were assigned to undergo THA using an imageless navigation system (n = 65) or freehand conventional technique (n = 65). Based on postoperative computed tomography scans of the pelvis, they found no significant difference for postoperative mean inclination between cohorts, but there was a significant difference for mean postoperative acetabular component anteversion, for mean deviation of the postoperative anteversion from the target position of 15°, and for outliers regarding inclination and anteversion between the computer-assisted and the freehand-placement groups.
Read the abstract…

3. Report: ACA could affect medical liability costs.
A study conducted by The Rand Corporation projects that the Affordable Care Act (ACA) could slightly increase medical liability costs, at least in the short-term. The authors summarize the estimated range of effects of five impact channels as of 2016, when the ACA is expected to be in full force. They project that “individual substitution effect,” “provider treatment effect,” and “direct fee effect” will not affect medical liability costs, but they estimate that “collateral source effect” (shift of costs away from liability insurers and toward health insurers) may have a 0 percent to -3.0 percent impact on medical liability costs, while “medical malpractice volume effect” (increased contact with physicians) may have a 0.4 percent to 7.8 percent impact. The authors note that the accuracy of their projections remains uncertain, state that all projected effects are “modest,” and explain that long-term effects of the ACA are unclear.  Read more…
Read the complete report…

4. Study: Zolendronate may impede some cell membrane repair.
Research presented at the annual Internal Medicine meeting of the American College of Physicians suggests that zolendronate may impede the ability of certain cells to repair their outer membranes. The research team found that kidney epithelial cells from monkeys and muscle cells from mice both lost their ability to quickly repair their outer membranes after exposure to zoledronate, while cells that were not exposed to the drug quickly recovered from a laser injury. The research team points out that their data cannot distinguish whether the effect is localized or carried throughout the body, but theorizes that the observed effect on cell membrane repair may be related to bisphosphonate-associated osteonecrosis of the jaw.   Read more…

5. Study: Sleep apnea linked to increased likelihood of osteoporosis.
Data from a Taiwanese study published online in The Journal of Clinical Endocrinology & Metabolism (JCEM) suggest that patients diagnosed with obstructive sleep apnea (OSA) may be at increased risk of osteoporosis. The authors conducted a matched cohort study of 1,377 patients with newly diagnosed OSA and compared them against 20,655 individuals without OSA. At 6-year follow-up, they found that the incidence rates of osteoporosis in the OSA cohort were 2.52 per 1,000 person-years, compared to 1.00 per 1,000 person-years in the non-OSA cohort. After adjustment, they found that patients diagnosed with OSA were at 2.74 times the risk of osteoporosis than patients without OSA.   Read more…
Read the abstract…

6. Study: Low vitamin D levels linked to reduced mobility among obese people.
According to information published online in JCEM, lower vitamin D levels may contribute to reduced mobility among severely obese people. The researchers conducted a clinic-based, cross-sectional study of 252 severely obese participants and stratified them into three groups based on Institute of Medicine vitamin D status categorization. They found that participants in the cohort with the highest levels of vitamin D (25OHD > 50 nmol/L) had higher activity levels and shorter 500-meter walk times compared with participants in the cohort with the lowest levels of vitamin D (25OHD < 30 nmol/L). Overall, the researchers noted that serum 25OHD concentrations had a weakly positive association with activity level and a moderately negative association with 500-meter walk time.   Read more…
Read the abstract…

7. Florida.
The Tampa Tribune reports that the five members of a 2002 task force on medical liability reform have written to leaders in the Florida Legislature in support of a constitutional amendment to cap non-economic damages in medical liability cases. The state Supreme Court recently ruled that existing caps violated the equal protection guarantee in the state’s constitution. The authors of the letter state that including caps in the state constitution would remove questions about their constitutionality. However, officials in both houses say the request comes too late for any action to be taken this during the current legislative session.   Read more…

8. Call for volunteers: NAEMT steering committees.
AAOS, in cooperation with The National Association of Emergency Medical Technicians (NAEMT), seeks to nominate members to two distinct steering committees: one dedicated to the second edition of “Advanced Medical Life Support,” the other dedicated to second edition of “EMS Safety.” Steering committee members will be asked to participate in a conference call in the summer of 2014 and to review program materials as needed. Applicants for these positions must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic with trauma experience. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area and steering committee of interest. Please submit supporting materials by Monday, May 19, 2014 at 11:59 p.m. CT, to Kyle Shah at  shah@aaos.org
Learn more and submit your application…(member login required)

April 18, 2014

Today’s Top Story
1. OIG: CMS could save billions of dollars by encouraging use of ASCs and reducing payments to hospital outpatient departments.
A report released by the U.S. Department of Health and Human Services Office of Inspector General (OIG) recommends that the U.S. Centers for Medicare & Medicaid Services (CMS) take steps to reduce hospital outpatient department payment rates to match ambulatory surgical center (ASC) payment rates, for certain “ASC-approved” procedures. The authors note that Medicare generally saves when outpatient surgical procedures that do not pose significant risk to patients are performed in an ASC instead of an outpatient department. OIG estimates that CMS could potentially save $15 billion from 2012 through 2017 by reducing outpatient procedure payments to match those of ASCs, and argues that Medicare beneficiaries would also save through reduced cost sharing. CMS did not concur with the OIG recommendations.   Read more…
Read the complete report (PDF)…

Other News
2. Compensation report finds orthopaedists lead other specialties.
Medscape has released its “Physician Compensation Report 2014.” The publication finds that orthopaedists are the highest compensated physicians, with an average of $413,000 per year. Cardiologists are second, at $351,000 per year. Orthopaedics also leads other specialties in offering ancillaries, with 33 percent of responding orthopaedists offering such services. The report also compares earnings for male and female physicians, and breaks down average reimbursement by factors such as geographic region, employment status, and practice setting. According to the report, 3 percent of U.S. physicians participated in an accountable care organization (ACO) during 2011, while 24 percent participated in 2013 and an additional 10 percent are expected to participate in an ACO in the coming year.   Read more…

3. Wide variety of stakeholders expect to make use of Medicare payment data.
An article in Modern Healthcare examines some of the potential ramifications of last week’s release of Medicare physician payment information. The author states that stakeholders such as insurers, hospitals, fraud investigators, and consumer groups are expected to make use of the data for various purposes. “…it’s expected that the data will inform important business decisions by healthcare industry groups,” the author writes. “Hospitals can now take a more detailed look at individual physicians’ practice patterns and their patient bases and decide whether to partner with them or try to acquire their practices. The data may reveal which doctors are treating the most patients in each ZIP code and for what diagnoses. […] Insurers and self-insured employers also plan to examine the information closely […]. They want to know which doctors order expensive services, procedures and drugs more than their peers.” CMS expects to release similar data on an annual basis.   Read more…

4. Study: Treatment with sprifermin may may reduce femorotibial cartilage thickness loss.
According to a study published online in the journal Arthritis & Rheumatology, treatment with sprifermin (recombinant human fibroblast growth factor 18) may reduce total femorotibial cartilage thickness loss. The research team conducted a double-blind, placebo-controlled, randomized pilot study of 168 patients. At 6- and 12-month follow-up, they found no statistically significant dose-response in change in central medial femorotibial compartment (cMFTC) cartilage thickness. However, the researchers found that sprifermin was associated with statistically significant, dose-dependent reductions in loss of total and lateral femorotibial cartilage thickness and volume, and in joint space width narrowing in the lateral femorotibial compartment. There was no significant difference in serious adverse events, treatment-emergent adverse events, and anesthesia incident reports between sprifermin and placebo groups.   Read more…
Read the abstract…

5. Study: Patients 80 years and older at the time of fracture may see positive outcomes after THA for hip fracture.
Data from a study published online in the journal Geriatric Orthopaedic Surgery & Rehabilitation suggest that patients older than 80 years with previously good functional status may have quality outcomes after total hip arthroplasty (THA) for hip fracture. The researchers followed previously independent ambulatory patients who were at least 80 years old at the time they were diagnosed with intracapsular hip fracture and who were treated with THA. They found that 3 (3.2 percent) patients had postoperative hip dislocations (2 patients had dislocation twice), and 2 reoperations were needed within the first postoperative month. After the first year, there were no hip dislocations or reoperations in the study group. At 5-year follow-up, radiographs obtained on 88 percent of the 57 surviving patients displayed that all remained unchanged from their immediate postoperative images, and nearly half of the patients were still able to ambulate as they did preoperatively.
Read the abstract…

6. Authors propose new term—”osteosarcopenic obesity”—to describe triad problem among older women.
The authors of a study published online in the journal Ageing Research Reviews propose a new concept—”osteosarcopenic obesity”—through which obese individuals face increased likelihood of falls and fractures. The authors reviewed information on 200 women who had participated in previous studies and found that about one-third had more than 30 percent fat tissue, along with osteopenia and sarcopenia. The authors discuss identification and possible diagnosis, along with interactions of muscle, fat, and bone tissues on a cellular level, with special emphasis placed on the mesenchymal stem cell commitment into osteoblastogenic, adipogenic, and myogenic lineages.   Read more…
Read the abstract…

7. Alaska.
The Associated Press reports that the Alaska State Legislature has passed a bill that would, if enacted, make expressions of apology or compassion inadmissible as evidence in medical liability cases. The bill’s sponsor states that the proposal is designed to improve physician-patient relationships and clear up a “gray area” that exists between apologies and admissions of negligence.   Read more…
Read the bill…

8. Submit papers now for Kappa Delta and OREF Clinical Research Awards.
July 1, 2014, is the deadline for receipt of manuscripts submitted for the 2015 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work generally reflecting years of investigation. If the submission reflects a single project, it should be of high significance and impact. Manuscripts must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society, Canadian Orthopaedic Association (COA), or Canadian Orthopaedic Research Society (CORS). Please note that submissions for the 2015 Kappa Delta and OREF Clinical Research Awards will be accepted in electronic format only. A PDF of the entire submission must be emailed no later than 11:59 p.m. CT on July 1, 2014. Late submissions will not be considered.   Read more…
Please submit your manuscript to  kappadelta@aaos.org

 

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April 21, 2014

Today’s Top Story
1. Study: Tamoxifen may offer short-term benefit for Dupuytren patients treated with surgery.
Findings published in the April 16 issue of The Journal of Bone & Joint Surgery suggest that tamoxifen may have a short-term beneficial effect on the outcome of surgery for Dupuytren disease. The authors conducted a prospective, randomized, double-blind study of 26 patients with a strong predisposition toward fibrosis and who were treated with subtotal fasciectomy and either tamoxifen (n = 12) or placebo (n = 14) from 6 weeks preoperative to 3 months postoperative. At 3-month follow-up, they found that patients in the experimental cohort had a smaller total passive extension deficit and higher satisfaction compared with the placebo group. However, the authors report that the positive effect was lost over 2 years following cessation of the medication. “Although tamoxifen use should not be considered in every patient with Dupuytren disease,” the authors write, “this study does support the development of neoadjuvant pharmacotherapy in patients with a predisposition toward fibrosis.”
Read the abstract…

Other News
2. Data offer predictive model for rotator cuff retear.
A study published online in The American Journal of Sports Medicine examines factors that may predict rotator cuff retear. The research team conducted a retrospective study of 1,000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon, using an arthroscopic inverted-mattress knotless technique. At 6-month follow-up, they found that the overall retear rate was 17 percent, with retears occurring in 27 percent of full-thickness tears and 5 percent of partial-thickness tears. The best independent predictors of retear were anteroposterior tear length, tear size area, mediolateral tear length, tear thickness, age at surgery, and operative time. Based on the study data, the research team offers a predictive model to determine the chance of retear at 6 months after surgery.
Read the abstract…

3. Healthcare spending growth may again be on the rise.
According to an article in The New York Times, preliminary data on healthcare spending suggest that heathcare spending growth, which displayed historical lows over the last 5 years, may again experience an increase. Many economists say that the reduction in spending was due in large part to the economic downturn. Improvements in the economy coupled with expanded coverage under the Affordable Care Act appear to be contributing to growth in healthcare spending. Observers say that it is too early to predict how much spending might increase, or whether the data are indicative of a long-term surge or a one-time bump in spending growth.   Read more…

4. Study: Polylevolactic acid screws provide adequate fixation of the distal tibiofibular syndesmosis, but may increase likelihood of foreign body reaction.
Findings from a study published in the April issue of The Bone & Joint Journal suggest that both polylevolactic acid and titanium screws provide adequate fixation and functional recovery when used for fixation of the distal tibiofibular syndesmosis, but polylevolactic acid screws may be associated with a higher incidence of foreign body reactions. The researchers randomly allocated 168 patients to receive either polylevolactic acid (n = 86) or metallic (n = 82) screws. At mean 55.8-month follow-up, they found that Baird scoring system scores were similar in the two groups. However, 18 patients in the polylevolactic acid group had a mild foreign body reaction and 8 had a moderate foreign body reaction. In the metallic groups, only 8 patients a foreign body reaction, all mild. In addition, heterotopic ossification developed in 3 patients who received polylevolactic acid screws.
Read the abstract…

5. Report: Decline in office ADI services not entirely driven by accreditation requirement.
A report released by the U.S. Government Accountability Office suggests that an overall decline in the number of advanced diagnostic imaging (ADI) services provided to Medicare beneficiaries in the office setting was driven at least in part by factors other than an accreditation requirement that went into effect on Jan. 1, 2012. The research team found that the rate of decline from 2009 to 2010 was similar to the rate from 2011 to 2012 for magnetic resonance imaging; computed tomography; and nuclear medicine, including positron emission tomography services. The Medicare Improvements for Patients and Providers Act of 2008 required that as of Jan. 1, 2012, suppliers that produce images for Medicare-covered ADI services in office settings, such as physician offices, be accredited by an organization approved by the U.S. Centers for Medicare & Medicaid Services.   Read more (PDF)…
Read the complete report…

6. Study: Use of health information exchange tool may reduce duplicate diagnostic procedures and help identify drug-seeking patients.
Findings from a study published in the journal Applied Clinical Informatics suggest that use of a point-to-point health information exchange (HIE) tool may help eliminate duplicative diagnostic imaging and testing in the emergency department (ED), and reduce resource utilization associated with those procedures. The authors retrospectively reviewed data collected at four large hospital EDs between January 2012 and June 2012. They found that the HIE tool was used in approximately 1.46 percent of ED encounters, and a review of ED provider notes revealed that the tool’s use resulted in the avoidance of 560 duplicate diagnostic procedures and the identification of 28 cases of drug-seeking behavior among patients.   Read more…
Read the abstract…

7. Hospitals and researchers work to put lessons from marathon bombing to good use.
HealthLeaders Media reports that healthcare experts have been examining the medical response to the 2013 bombing at the Boston Marathon in an effort to improve the handling of patients after a mass casualty event. Among other things, the tracking of unidentified patients in the ED has been improved to reduce errors. In addition, the Federal Emergency Management Agency noted in a report on the marathon bombing that the use of tourniquets had fallen out of favor, despite their contribution to successful treatment of battlefield injuries in Iraq. Members of the Boston police force are now equipped with military-quality tourniquets. Observers expect more lessons to come out of the response, as researchers begin to analyze data on the injuries, surgeries, and outcomes for each of the more than 240 injured people.   Read more…

8. Submit your abstracts for the 2015 AAOS Annual Meeting!
It is now time to submit abstracts and applications for papers, posters, scientific exhibits, and multimedia for the 2015 Annual Meeting, which will take place March 24-28, 2015, in Las Vegas. Nowhere else will your research reach such a wide-ranging orthopaedic audience. The deadline for submitting abstracts on papers, posters, and scientific exhibits is June 2, 2014. The deadline for submitting program for the orthopaedic video theater is July 15, 2014.
Learn more and submit your abstracts…

April 23, 2014

Today’s Top Story
1. Medicare director to resign.
Reuters reports that Jonathan Blum, Medicare director and principal deputy administrator of the U.S. Centers for Medicare and Medicaid Services (CMS) has tendered his resignation, effective May 16. CMS Administrator Marilyn Tavenner states in a memo that Mr. Blum’s accomplishments were “too many to list,” but include the introduction of competitive bidding for medical supply purchases and care delivery reforms intended to reward healthcare providers for quality outcomes and cost savings. The announcement comes in the wake of controversy over proposals to scale back Medicare Advantage payments to private health insurers for 2015 and to reform the program’s popular Part D prescription drug benefits.   Read more…

Other News
2. FDA proposes new program to increase access to certain medical devices; agency panel votes against new painkiller.
The U.S. Food and Drug Administration (FDA) has proposed a new program to provide earlier access to high-risk medical devices that are intended to treat or diagnose patients who have serious conditions and whose medical needs are unmet by current technology. The agency states that the proposed Expedited Access Premarket Approval Application for Unmet Medical Needs for Life Threatening or Irreversibly Debilitating Diseases or Conditions (EAP) program is not a new pathway to market, but a collaborative approach designed to facilitate product development under the agency’s existing regulatory authorities. Although existing device programs have focused on reducing the time for the premarket review, EAP also seeks to reduce the time associated with product development. To be eligible for participation in the program, the medical device must meet the following criteria:

  • Be intended to treat or diagnose a life-threatening or irreversibly debilitating disease or condition
  • Represent one of the following:

1.     no approved alternative treatment or diagnostic exists

2.     a breakthrough technology that provides a clinically meaningful advantage over existing technology

3.     offers a significant, clinically meaningful advantage over existing approved alternatives

4.     availability is in the patient’s best interest

  • Have an acceptable data development plan that has been approved by FDA

In addition to the EAP, FDA has published a separate draft guidance that outlines the agency’s current policy on when data can be collected after product approval and what actions are available to FDA if approval conditions are not met. The agency seeks public comment on both documents. The AAOS Biological Implants and Biomedical Engineering Committees plan to develop and submit comments on the draft guidances.   Read more…
Read the FDA statement…
In separate news, an FDA panel has voted unanimously against approval of a new drug that combines morphine sulfate and oxycodone hydrochloride in the same capsule.  Read more…
View the meeting materials…

3. Study: Smoking may prolong fracture healing, increase likelihood of nonunion.
According to a study published in the April 16 issue of The Journal of Bone & Joint Surgery, smoking may increase the risk of nonunion of certain fractures. The authors conducted a retrospective review of 19 studies—7 prospective and 12 retrospective cohort studies—and found that the adjusted odds ratio of nonunion in the smoking group compared to the nonsmoking group was 2.32. In addition, smokers with tibial and open fractures had higher nonunion rates than nonsmokers. The mean healing time was longer for smokers than for nonsmokers across all fracture types, and the authors noted trends toward more superficial and deep infections of postoperative or traumatic wounds among smokers. However, the differences in superficial and deep infection rates were not significant across cohorts.
Read the abstract…

4. Physicians in group practices should register now for PQRS to avoid 2016 pay penalty.
The American Medical Association is reminding physicians who practice in a group that they can register for the 2014 Physician Quality Reporting System (PQRS) Group Practice Reporting Option (GPRO) now through Sept. 30. Practices with 10 or more physicians must successfully participate in PQRS in 2014 to avoid a 2 percent value-based modifier penalty in 2016. To avoid the penalty, at least 50 percent of the physicians in a group practice must successfully participate in PQRS in 2014, either individually or through GPRO.   Read more…

5. Visits to specialty physicians rose last year, as primary care visits fell.
A report released by the IMS Institute for Healthcare Informatics finds that the total number of office visits to specialists exceeded the number of office visits to primary care physicians during 2013. Among other things, the report finds that the number of patient office visits to primary care physicians fell by 0.7 percent last year, while visits to specialists increased by 4.9 percent overall and by 9.5 percent for seniors. In addition, the overall number of physician office visits, hospitalizations, and prescriptions filled all increased in 2013.   Read more…
Read the IMS Institute release…
Request a copy of the report…

6. California.
According to The Los Angeles Times, the University of California, Los Angeles has agreed to pay $10 million to the former chairman of its orthopaedic surgery department, who had alleged that industry payments to some physicians may have compromised patient care. The surgeon sued the university and its regents, fellow surgeons, and other university officials, alleging they failed to act on and later retaliated for his complaints regarding conflicts of interest. The university denied the allegations and stated that an internal investigation had found no wrongdoing.   Read more…

7. Ohio.
The Wall Street Journal Law Blog reports that a federal appeals court has ordered a major health system in northwest Ohio to undo its merger with a local hospital on antitrust grounds. The dispute began in 2010 when a nonprofit healthcare system signed a merger agreement with a community hospital. The U.S. Federal Trade Commission moved to block the merger, claiming that it would drive up prices for inpatient services. The health system argued that it was rescuing a struggling hospital from insolvency.   Read more…

8. Vote now! AAOS 2015 Nominating Committee, 3 resolutions, and 3 bylaw amendments.
Voting has begun to elect the six members of the 2015 Nominating Committee and to determine action on three AAOS resolutions and three bylaw amendments. Online voting is quick, secure, and confidential. Those individuals receiving the greatest number of votes on the Nominating Committee ballot will be elected to serve, regardless of the number of ballots cast, provided that no more than two practice in the same state. For the resolutions and bylaw amendments, at least 20 percent of the total fellowship must cast ballots for the voting to be valid. Ballots must be submitted by Friday, May 23, 2014. If you have questions, please contact the AAOS Voting Hotline, at 800-999-2939. The ballot is available at http://www.aaos.org/aaosvote(member login required)

April 25, 2014

Today’s Top Story
1. Study: Resident survey suggests communication, safety are issues across U.S. training programs.
Survey data published in the April 9 issue of the journal JAMA Dermatology suggest that medical training should be modified to reduce injuries, improve communication, and create an environment free of intimidation. The research team surveyed 142 dermatology residents from 44 residency programs in the United States. They found that 45.2 percent failed to report needle-stick injuries incurred during procedures, 82.8 percent reported cutting and pasting a previous author’s patient history information into a medical record without confirming its validity, and nearly 80 percent said they witnessed attending physicians purposefully disregarding required safety steps. In addition, 59.7 percent of respondents reported working with at least 1 attending physician who intimidates them, reducing the likelihood of reporting safety issues they witness.   Read more…
Read the abstract…

Other News
2. Zimmer plans to buy Biomet.
Reuters reports that Zimmer Holdings Inc. plans to purchase rival orthopaedic products maker Biomet Inc. in a transaction valued at more than $13 billion. The deal is expected to take Zimmer from the fourth-largest seller of orthopaedic products to the second, behind Johnson & Johnson.   Read more…
Read the statement from Zimmer…

3. Study: Open SDH approach may have efficacy for adolescents with FAI and complex hip deformities.
A study published in the April/May issue of the Journal of Pediatric Orthopaedics suggests that open femoroacetabular impingement (FAI) surgery through surgical dislocation of the hip (SDH) should be considered for management of adolescents with FAI and complex hip deformities associated with pediatric disorders. The research team conducted a retrospective review of 29 young athletes (mean age 17 years) treated for symptomatic FAI. Postoperatively, they found significant improvement in WOMAC-Pain subscale, and marginally significant improvement in median UCLA physical activity level. In addition, the femoral a-angle improved an average of 22.7 degrees after surgery. The research team found no statistically significant correlation between change in UCLA score and the addition of a second procedure other than femoral head-neck osteochondroplasty, and no statistically significant correlation between severity of cartilage injury and change in UCLA or WOMAC scores.
Read the abstract…

4. Study: Compared to non-obese patients, obese pediatric trauma patients more likely to sustain fractures involving the physis.
According to findings published online in the Journal of Orthopaedic Trauma, obese pediatric trauma patients are more likely to sustain fractures involving the physis than non-obese patients. The authors conducted a retrospective chart review of 331 patients with a total of 394 femur or tibia fractures; 70 of the patients (21 percent) were obese, defined as weight for age >95th percentile. They found that patients who were obese were twice as likely to have fractures involving the physis, although severity did not differ between cohorts. Overall, physeal fracture risk was greater for femur fractures than tibia fractures. The authors also found that patients with femur fractures were more likely to be treated with locked nails.
Read the abstract…

5. Medscape report looks at positives, negatives of physician employment.
A report released by Medscape compares survey data on employed (defined as a physician who does not run a private practice) and self-employed physicians. The researchers queried more than 4,600 physicians and found that 38 percent of employed physicians indicated “financial security/less risk” as their primary reason for choosing employment. Addition reasons included “fewer administrative responsibilities” (29 percent), “better hours/work-life balance” (19 percent), and “other” (15 percent). Cited negatives to physician employment included “limited influence in decision-making” (45 percent), “more limited income potential” (44 percent), “too many rules” (34 percent), and “less control over work/schedule” (32 percent).   Read more…
View the report…

6. Maine.
According to the Bangor Daily News, more than 30 physicians in Maine reported fraudulent tax returns using their names and Social Security numbers had been filed this year. A spokesperson for the Maine Medical Association states that the apparent fraud has had no immediate financial impact on the physicians, but as there is no apparent connection between physicians, the matter raises questions about how someone gained access to their data. A representative of the U.S. Secret Service, which investigates cases of credit card fraud and identity theft, confirms that the agency is investigating.   Read more…

7. AAOS seeks public comment on Guideline on Management of ACL Injuries.
The AAOS guideline on Management of Anterior Cruciate Ligament (ACL) Injuries has completed peer review by specialty organizations and will be ready for public comments soon. If you wish to participate in the commentary, please submit your name, phone number, and email address by Friday, May 2, to Jayson Murray, at  jmurray@aaos.org.

 

April 28, 2014

Today’s Top Story
1. NQF: Medical payment policies “inadvertently” exacerbate disparities in access to health care.
The New York Times reports that a panel convened by the National Quality Forum (NQF) has found that existing payment policies may unintentionally worsen disparities between rich and poor patients, by shifting money away from physicians and hospitals that care for disadvantaged patients. The 26-member panel noted that many provisions of the Affordable Care Act seek to improve care by tying Medicare payments to provider performance measures such as readmission rates, but for hospitals with large numbers of poor patients, “readmissions are difficult to avoid in patients who can’t afford post-discharge medications, have no social support to help with recovery at home, have no way to get to follow-up doctor appointments or are homeless.” The Obama administration commissioned the study, but officials say that it does not completely agree with the panel’s determinations. Existing NQF and government policies state that performance scores should generally not be adjusted or corrected to reflect differences in patient income, race, or socioeconomic status.   Read more…

Other News
2. Study: Simultaneous ACL/MCL reconstruction may improve stability for patients with chronic ACL/MCL lesions.
Findings from a small study published online in The American Journal of Sports Medicine suggest that simultaneous reconstruction of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) may improve knee stability for patients with chronic ACL/MCL lesions. The authors conducted a case series study of 21 patients who had chronic ACL/MCL injuries and reconstruction of both ligaments during the same surgical procedure. At minimum 2-year follow-up, they observed no valgus and sagittal laxity in any of the patients, and mean medial knee opening was significantly reduced compared to preoperative measurements. In addition, 71 percent (n = 15) of patients displayed preoperative anteromedial instability, compared to zero at the last follow-up. Overall, 20 of 21 patients had normal or nearly normal range of motion of the knee joint at last follow-up, while 1 patient had a limitation of flexion of 15° compared with the contralateral knee.
Read the abstract…

3. FBI warns healthcare providers: Computer security needs to be increased.
According to information obtained by Reuters, the U.S. Federal Bureau of Investigation (FBI) has warned healthcare providers that their computer and network security systems are in general less secure than those found in other sectors. Security experts say that demand for medical information is strong due to the variety of ways stolen healthcare information can be used; criminals may be paid as much as $20 for health insurance credentials on some underground markets, compared with $1 to $2 for U.S. credit card numbers. Observers note that victims of stolen healthcare information rarely realize that their information has been stolen until significant time has passed.  Read more…

4. Some physicians continue to bill Medicare, despite loss of medical license.
Bloomberg reports that at least seven physicians collected a total of $6.5 million from Medicare during 2012, in spite of having lost their medical licenses due to misconduct. Records show that all of the physicians notified Medicare of the loss of their licenses, and their continued participation in Medicare reflects what some critics have called a permissive approach that lets providers with questionable backgrounds keep billing taxpayers.   Read more…

5. California.
A report released by the office of Sen. Barbara Boxer (D-Calif.) summarizes actions taken by 149 hospitals in California to reduce medical errors. The report notes both common and unique approaches various hospitals have taken to reduce the nine most common medical errors, including:

  • Adverse drug events
  • Injuries from Falls and Immobility
  • Pressure Ulcers
  • Surgical Site Infections
  • Venous Thromboembolism

Read more…
Read the report (PDF)…

6. Massachusetts.
The Massachusetts Executive Office of Health and Human Services has announced several initiatives to restrict the availability of hydrocodone-only extended-release medication that is not in abuse-deterrent form (hydrocodone bitartrate). Among them, the Massachusetts Board of Registration in Medicine voted to require individual prescribers to complete a risk assessment and pain management treatment agreement prior to prescribing hydrocodone bitartrate, and the agreement with each patient must address drug screening, pill counts, safe storage and disposal, and other requirements as appropriate in the prescriber’s judgment. In addition, the Massachusetts Commissioner of Public Health issued an emergency order to require prescribers to use the state’s Prescription Monitoring Program prior to prescribing hydrocodone bitartrate.   Read more…
Read the emergency regulation (PDF)…

7. Last call for Instructional Course, Symposia Applications for 2015 AAOS Annual Meeting.
May 1, 2014 is the deadline to submit an application for an instructional course or symposium for the 2015 AAOS Annual Meeting. A new type of instructional course for 2015 is the case presentation course. These 2-hour courses are focused on a specific topic and built around six to eight cases, each one carefully selected to teach and illustrate specific points. Participants and faculty participate in round-table discussions about each situation. Applications can be found at http://www.aaos.org/abstracts.

8. OKOJ May updates now online!
Check out the new topics and video in the Orthopaedic Knowledge Online Journal (OKOJ) on the AAOS OrthoPortal website. The following topics have been recently added or updated: “Arthroscopic Treatment of Scapulothoracic Bursitis,” “Radiation Exposure in Pediatric Orthopaedic Imaging,” and “Tissue Engineering of the Intervertebral Disk.” In addition, a new video has been made available: “Arthroscopic Scapulothoracic Bursectomy and Superomedial Angle Scapuloplasty.”
View these topics and more…(member login required)

April 30, 2014

Today’s Top Story
1. Study: Randomized trial finds intraarticular analgesia an effective alternative to epidural plus nerve block in TKA.
A continuous intraarticular infusion of ropivacaine can serve as a safe, effective alternative to epidural analgesia plus single-injection femoral nerve block (FNB) after total knee arthroplasty (TKA), concludes a study published in Clinical Orthopaedics and Related Research. The randomized double-blind trial compared the side-effect profile, analgesic efficacy, and functional recovery among 94 patients assigned to one of the two treatments. During the first 12 and 24 postoperative hours, the mean maximum VAS pain scores were higher in the ropivacaine group than in the epidural group, but after 24 hours, pain scores were similar between groups. Narcotic consumption was significantly higher in the ropivacaine group on the day of surgery, but overall in-hospital narcotic usage was similar between groups. No differences in complication frequency were seen. The authors note that any improved analgesia seen in patients who receive epidural analgesia plus single-injection FNB “must be weighed against the disadvantage of a higher likelihood of knee buckling and delayed ambulation with that treatment approach.” Possible side effects of epidural analgesia include nausea, hypotension, pruritis, somnolence, dizziness, and respiratory depression.   Read more (PDF)…

Other News
2. AAP report provides recommendations to physicians, coaches for diagnosis, treatment, and prevention of ACL injuries.
The American Academy of Pediatrics (AAP) has released a clinical report on the diagnosis and treatment of anterior cruciate ligament (ACL) injuries in young athletes. The report covers the epidemiology of ACL injuries, injury mechanisms, risk factors, diagnostic tests, treatment options, and injury prevention. Among the findings are the following:

  • Neuromuscular control may be the most important and modifiable factor in preventing noncontact ACL injuries.
  • The best physical examination test for an ACL tear is the Lachman test.
  • MRI can be valuable for diagnosing ACL tears and associated meniscal and chondral injury.
  • ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation.
  • Pediatricians and orthopaedic surgeons treating young people with ACL injuries should advise them that, regardless of treatment choice, they are at increased risk of early onset osteoarthritis in the injured knee.

The report appears online and in the May 2014 issue of Pediatrics. The AAOS is currently developing a clinical practice guideline on the management of ACL injuries; it will be released later this year.   Read more…
Read the report…

3. Study: Trampoline use leads to high number of fractures and other injuries in children.
As reported by Medical News Today, a study published online in the Journal of Pediatric Orthopaedics finds that approximately 288,876 people—mostly children—received care at emergency departments (EDs) between 2002 and 2011 for fractures sustained during trampoline use, with associated healthcare costs of more than $400 million. In addition, all injuries (including fractures) from trampoline use led to more than 1 million ED visits during the decade, resulting in more than $1 billion in healthcare costs. The researchers analyzed data on trampoline injuries from the National Electronic Injury Surveillance System, which contains data from a sample of 100 hospitals nationwide, and found that the average age of patients with trampoline-related fractures was 9.5 years. Approximately 60 percent of fractures occurred in the upper extremities, such as fingers, hands, forearms, and elbows, while lower extremity fractures, which accounted for nearly 36 percent of fractures, were most often fractures of the tibia/fibula and ankles. In addition, 4.4 percent of fractures occurred in the axial skeleton, defined as the spine, skull/face, or rib/sternum.   Read more…
Read the abstract…
Read the AAOS Position Statement on Trampolines and Trampoline Safety…

4. FDA urges healthcare professionals to stop dispensing prescription drugs with high doses of acetaminophen.
The U.S. Food and Drug Administration (FDA) reminds healthcare professionals to stop dispensing prescription combination drug products that contain more than 325 mg of acetaminophen. No longer considered safe because of the risk of severe liver damage associated with high doses of acetaminophen, the drugs have been voluntarily withdrawn by the manufacturers at the FDA’s request. Pharmacists who receive a prescription for a combination product with more than 325 mg of acetaminophen per dosage unit should contact the prescriber to discuss alternative medications, the FDA recommends. The FDA also asks that wholesalers remove the product codes for the combination drugs from their ordering systems and return all products to the manufacturers.   Read more…

5. Florida.
An article in HealthLeaders Media focuses on Florida in looking at the issue of medical liability caps. The author notes that a recent decision by the Florida Supreme Court overturning the state’s cap is the most recent of a series of setbacks for supporters of such legislation. The court ruled that the law violated the equal protection clause of the state constitution, and challenged the validity of a purported medical liability crisis, writing that “between the years of 2003 and 2010, four insurance companies that offered medical malpractice insurance in Florida cumulatively reported an increase in their net income of more than 4300 percent.” A spokesperson for the Florida Medical Association predicts that medical liability premiums will increase in the state now that the cap has been invalidated and more suits are filed.   Read more…

6. Connecticut.
The Connecticut House of Representatives this week approved a bill giving advanced practice registered nurses (APRNs) greater independence to diagnose and treat patients without doctors’ direction, The Hartford Courant reports. The proposal will allow APRNs to diagnose patients and prescribe drugs, among other duties. APRNs would have to work in collaboration with a physician for 3 years before being able to practice on their own. Gov. Dannel P. Malloy is expected to sign the bill into law. The Connecticut State Medical Society expressed its disappointment with the bill. “It is fundamentally an issue of patient safety and healthcare transparency,” said Michael F. Saffir, MD, the society’s president. “Studies have shown that the team-based model, where physicians and APRNs collaborated to provide coordinated patient care, is the most effective approach to quality patient care. This bill moves in the opposite direction, by removing collaboration and fragmenting the care team.”   Read more…

7. Young investigator applicants sought for Musculoskeletal Sex Differences throughout the Lifespan Research Symposium.
The American Academy of Orthopaedic Surgeons seeks young investigator applicants for the Musculoskeletal Sex Differences throughout the Lifespan Research Symposium, to be held July 30–Aug. 1, 2014, in Rosemont, Ill. The symposium will bring basic scientists and engineers together with clinicians who treat the musculoskeletal patient at all stages of care, to discuss advances in the understanding of how sex differences in biomechanics, biology, and physiology affect musculoskeletal health and patient outcomes and identify new areas of research related to sex and gender issues. Selected young investigators will receive airfare, lodging, and meals at the event, and have the opportunity to present their research during the poster session. The AAOS seeks abstracts featuring research highlighting sexual dimorphism / sex differences in musculoskeletal health. Applications are open to any MD, PhD, or MD/PhD whose research involves sexual dimorphism in a musculoskeletal topic. Post docs, research associates, medical residents in any specialty, and junior faculty (no more than 7 years beyond training) are invited to apply. Applicants must submit a completed application, a poster abstract (one page limit), current curriculum vitae, and a letter of support from your department chair no later than May 20, 2014, to Erin L. Ransford, AAOS Manager, Research Development, at  ransford@aaos.org.
Learn more and download the application…

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