February 28, 2014

February 4, 2014
Today’s Top Story
1. Johnson & Johnson to release study data through YODA.
Forbes reports that Johnson & Johnson has reached an agreement with the Yale School of Medicine Open Data Access Project (YODA) to review requests from researchers for study data on the company’s products. The program will initially cover only products from Johnson & Johnson’s drug division, but is planned to expand to include devices and consumer products. If a request is approved, raw, anonymous study data will be made available for scientific purposes. Medtronic previously engaged a similar project with YODA, but only for a single product: recombinant human bone morphogenetic protein (rhBMP-2).
Read more…
Learn more about the project and make a request for data…
Other News
2. Study: PRP may help accelerate recovery from patellar tendinopathy, but difference fades over time.

According to a study published online in The American Journal of Sports Medicine, a therapeutic regimen of standardized eccentric exercise and ultrasound-guided leukocyte-rich platelet-rich plasma (PRP) injection with dry needling (DN) may accelerate recovery from patellar tendinopathy compared to exercise and ultrasound-guided DN alone. The randomized controlled trial involved 23 patients with patellar tendinopathy on examination and magnetic resonance imaging in whom nonsurgical treatment had been unsuccessful. Patients received either ultrasound-guided DN alone (n = 13) or DN with injection of leukocyte-rich PRP (n = 10), along with standardized eccentric exercises. At 12-week follow-up, researchers found that Victorian Institute of Sports Assessment scores improved significantly more in the PRP group. However, at =26 weeks, the difference between groups was not significant. In addition, at 12 weeks, Lysholm scores were not significantly different between groups, but the no-PRP group had improved significantly more than the PRP group at =26 weeks.
Read the abstract…
3. Study: 6 hours of flexion after TKA may help reduce blood loss.
Data from a study published in the February issue of The Bone & Joint Journal suggest that positioning the knee in flexion after total knee arthroplasty (TKA) may reduce blood loss. The authors looked at data from two randomized, controlled trials: one in which 180 TKA patients were segregated to 6 hours of knee flexion using either a jig or knee extension, and a second in which 420 TKA patients were randomized to either postoperative flexion for 3 or 6 hours, or knee extension. They found that positioning of the knee in flexion for 6 hours immediately after surgery significantly reduced blood loss, with no significant differences in post-operative range of movement, swelling, pain, or outcome scores among the various knee positions in either study. However, the authors caution that 14 of 289 non-study patients who underwent prolonged knee flexion for more than 6 hours reported lower limb sensory neuropathy at their 3-month review.
Read the abstract…
4. Survey: Physician compensation methods vary widely across specialties, employment status.
A report from the American Medical Association (AMA) finds a great deal of variation in payment methods across physician specialty. The researchers drew data from 3,466 physicians who completed the organization’s 2012 Physician Practice Benchmark Survey (PPBS)—a nationally representative random sample of post-residency physicians who provide at least 20 hours of patient care per week and are not employed by the federal government. They found that 53.1 percent of non-solo physicians received all or the largest share of their compensation from salary, while 31.8 percent received their largest share based on personal productivity. The researchers note that final compensation may be based on a blend of different methods, as 30 percent of non-solo physicians depended on two payment methods, and 17.9 percent depended on at least three. Among employed physicians, all specialties reported a high reliance on salary for their compensation. In addition, 22 percent of owner physicians said that all or the largest share of their compensation was determined by practice financial performance.
Read the report (PDF)…
5. Study: Resected tissue from hip arthroplasty might serve as stem cell source.
According to findings published online in the journal Stem Cells Translational Medicine, arthritic tissue resected during hip arthroplasty could serve as a source of autologous stem cells, with possible implications for clinical use. The authors collected periosteum derived stem cells (PDCs) from patients with rheumatoid arthritis or osteoarthritis who were 30 and 72 years and had undergone joint replacement surgery. They found that PDCs showed no significant differences compared to bone marrow stem cells in their ability to differentiate into other cells, regardless of donor age or disease. The authors report that further studies will be required to determine the degree to which such stem cells can be banked for future use.
Read more…
Read the abstract…
6. Study: Specific WNT protein may enhance bone formation.
Data from a mouse study published online in the journal PLoS Genetics suggest that a specific member of the WNT family of proteins may enhance bone formation. The research team engineered mouse strains to express either WNT7B or WNT5A in a Cre-dependent manner. They found that the WNT7B, but not WNT5A, substantially increased the number of bone-building osteoblast cells by stimulating the mTOR pathway.
Read more…
Read the complete study…
7. Kentucky.
The Lexington Herald-Leader reports that a bill currently under consideration in the Kentucky House of Representatives would, if enacted, require physicians in that state to undergo continuing medical education training to help recognize and prevent abusive head trauma in children. The bill would apply primarily to pediatricians, radiologists, family practitioners, and emergency medicine and urgent-care physicians.
Read more…
8. Call for volunteers: Spine Instructional Course Committee.
March 31 is the last day to submit your application for chair of the Spine Instructional Course Committee. Members of instructional course committees grade Instructional Course Lecture applications in May, provide course input to the Instructional Courses Committee, and evaluate courses at the AAOS Annual Meeting. Applicants for this position must be AAOS fellows with a practice emphasis in spine.
Learn more and submit your application…(member login required)

February 5
Today’s Top Story
1. Study: Antibiotic microspheres may help reduce likelihood of infection after orthopaedic implant surgery.

Findings presented in the Jan. 15 issue of The Journal of Bone & Joint Surgery suggest that antibiotic delivery utilizing antibiotic microspheres may have efficacy for preventing implant-associated infections after orthopaedic surgery and for increasing the longevity of orthopaedic implants. The research team conducted a leporine study in which bioresorbable polymer microspheres containing tobramycin were manufactured and pressed into porous metal cylinders and implanted into radial defects in rabbits, with control implants lacking antibiotic microspheres implanted into contralateral limbs. All implants were then contaminated with Staphylococcus aureus prior to wound closure. The researchers found that use of antibiotic microspheres was associated with 100 percent infection prevention in limbs with treated implants, compared with an infection rate of 64 percent for limbs with control implants.
Read more…
Read the abstract…
Other News
2. Studies of concussed hockey players suggest brain changes on MRI.

A pair of studies published online in the Journal of Neurosurgery note changes in the brains of hockey players after concussion.
The authors followed 45 university-level ice hockey players (both male and female) during a single Canadian Interuniversity Sports season, with magnetic resonance imaging (MRI) conducted before and after the season. During the season, 11 players suffered a concussion, and of those, 7 had usable diffusion MRI scans taken within 72 hours of injury. In the first study, the authors observed a statistically significant increase in hypointensity burden for concussed male players at 2-weeks postconcussion. They also observed a smaller, nonsignificant rise in the hypointensity burden for female players with concussion within the same time period.
In the second study, the authors performed free-water imaging and found that paired comparison of the concussed players before and after injury revealed a statistically significant common pattern of reduced free-water volume and reduced axial and radial diffusivities following elimination of free-water. They note that the findings suggest decreased extracellular space and decreased diffusivities in white matter tissue, which might be explained by swelling and/or by increased cellularity of glia cells.
Read more…
Read the abstract for “Hockey Concussion Education Project, Part 1″…
Read the abstract for “Hockey Concussion Education Project, Part 2″…
3. Study: Hamstring tendon grafts for ACLR linked to increased risk of revision compared with patellar tendon grafts.
According to a Danish study published in the February issue of The American Journal of Sports Medicine, use of hamstring tendon grafts in anterior cruciate ligament reconstruction (ACLR) may be associated with an increased risk of revision compared with patellar tendon grafts. The researchers reviewed data on 13,647 patients in the Danish Knee Ligament Reconstruction Registry and found that the cumulative revision rates for hamstring tendon grafts at 1 and 5 years were 0.65 percent and 4.45 percent, respectively, compared to 0.16 percent and 3.03 percent for patellar tendon grafts at 1 and 5 years, respectively. In addition, they noted that the use of hamstring tendon grafts increased from 68 percent in 2005 to 85 percent in 2011.
Read the abstract…
4. Providers have until Feb. 28 to request informal review of Medicare eRx payment penalty.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released a fact sheet offering step-by-step guidance for eligible providers who have been notified that they will receive the 2014 Electronic (eRx) Prescribing Incentive Program 2 percent negative payment adjustment and who wish to request an informal review of their payment adjustment determination. All requests for informal review must be submitted by Feb. 28, 2014. The agency says that eligible professionals or support staff who submit valid requests for an informal review will be notified via email of the decision by CMS within 90 days of the submission of the original request for an informal review. CMS states that the informal review decision will be final, with no further review or appeal.
Read more (PDF)…
5. OIG releases 2014 work plan.
The U.S. Department of Health and Human Services Office of Inspector General has released its work plan for FY 2014. The work plan outlines OIG’s current focus areas and states the primary objectives of each project. Included among issues OIG plans to address during the coming year: Medicare costs associated with defective medical devicesImpact of provider-based status on Medicare billingDuplicate graduate medical education paymentsParticipation in projects with quality improvement organizationsHurricane Sandy—Case study of hospitals’ emergency preparedness and responseCompetitive bidding for medical equipment items and services—Mandatory postaward auditLower limb prosthetics—Supplier compliance with payment requirementsFrequently replaced supplies—Supplier compliance with medical necessity, frequency, and other requirementsAmbulatory surgical centers—Payment system
OIG states that work planning is a dynamic process, and adjustments may be made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available.
Read more (PDF)…
6. Alaska.
The Alaska Dispatch reports that members of the Alaska Department of Health and Social Services took questions and comments from healthcare providers and members of the state Senate Health & Social Services Committee regarding the state’s new Medicaid payment system, which went online in October 2013. Providers stated that the updated system has proven unreliable. Complaints addressed in the meeting included the following: Payments not being madeService authorizations not acceptedSome claims need to be submitted over and overPoor support from the system vendor, including long wait times for support calls, conflicting information, and providers being told not to submit any more claims
Additionally, observers say that the new system has been plagued with connectivity issues, programming glitches, and claims that would get bounced back due to slight inconsistencies in forms that were previously accepted under the old system.
Read more…
7. February AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the February issue of AAOS Now, but the online edition is already available on the AAOS Now website. This month’s issue includes a preview of the upcoming AAOS Annual Meeting, a look at new research priorities for AAOS and specialty societies, an article on avoiding billing service issues, and much more. A special online extra article offers orthopaedic surgeons’ humorous appreciation of the recent cold weather.
Read more…
Read “New Orleans Is the Place to Be, March 11–15″…
Read “Academy, Specialties Advance Unified Front with Revamped Research Agenda”…
Read “Avoid Billing Service Nightmares”…
Read “It’s So Cold…”
8. Call for volunteers: AAOS liaison to FDA Science Board.
AAOS seeks to nominate orthopaedic surgeons to serve as AAOS liaison to the U.S. Food and Drug Administration (FDA) Science Board. The board will provide advice to the FDA commissioner and other appropriate officials on specific complex scientific and technical issues important to FDA and its mission, including emerging issues within the scientific community. All applicants must disclose detailed information concerning financial holdings, employment, and research grants, and contracts to permit evaluation of possible sources of conflicts of interest. In addition, applicants must provide the following: an online AAOS CAP Application, current curriculum vitae, 100-word biosketch, and a letter of interest highlighting his or her expertise in relevant subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted by Tuesday, Feb. 25, 2014 at 11:59 p.m. CT, to Kyle Shah, at  shah@aaos.org
Learn more and submit your application…(member login required)

February 7, 2014
Today’s Top Story
1. Bipartisan group generates SGR repeal proposal.

A bipartisan proposal announced by the U.S. Senate and House of Representatives would, if enacted, repeal the Medicare sustainable growth rate (SGR) formula, and replace it with a 0.5 percent pay increase for physicians each year over a 5-year period. The deal combines separate repeal bills from the House Ways and Means, House Energy and Commerce, and Senate Finance committees. According to a summary released by legislators, the bill would also: Modify the fee-for-service system to ensure payment accuracy and reward valueProvide incentives for moving to alternate payment modelsExpand the use of Medicare data for transparency and quality purposes
The legislation is estimated to cost between $120 and $150 billion. As congressional rules require spending legislation to be budget-neutral, MedPage Today notes that the cost will need to be offset by cuts elsewhere.
According to AAOS President Joshua J. Jacobs, MD, “Congress has listened carefully to our input as reflected by the positive inclusion of many of our suggestions. Since this legislation currently does not include offsets, we will continue to work with Congress as the offsets are determined and speak out against any effort to remove in-office ancillary services from physician offices. Pending that effort and based on current knowledge, AAOS congratulates Congress for this legislation and looks forward to continue to successfully work closely with the relevant committees to ensure our voice is heard throughout this process.”
Read more…
Read a summary of the proposal (PDF)…
Other News
2. Some insurers trim specialty hospitals from networks in effort to cut costs.

Bloomberg News reports on a trend by insurance networks to cut some specialty hospitals in order to control costs. Observers say the move is an unintended consequence of the Affordable Care Act, which requires insurers to broaden health benefits while restricting variation in premiums. In response, some health insurers have elected to narrow their networks to include only hospitals willing to accept lower payments in exchange for higher patient volume.
Read more…
3. Study: Hinged external fixation may be superior to hinged knee brace for patients undergoing reconstruction for knee dislocation.
Hinged external fixation may reduce the likelihood of ligament reconstruction failure compared to knee bracing for patients who undergo knee reconstruction following dislocation, according to findings published in the Feb. 5 issue of The Journal of Bone & Joint Surgery. The authors conducted a prospective, randomized study of 77 patients with 79 knee dislocations. Patients underwent ligament reconstruction either with placement of an external, hinged knee brace (n = 32) or with placement of a hinged external fixator (n = 47). At mean 39-month follow-up, the authors noted that nine patients in the knee brace group (29 percent) and seven patients in the external fixator group (15 percent) had failed reconstructions. In addition, of 105 reconstructed individual ligaments in patients in the knee brace group, 22 failed (21 percent), compared with 11 failures (7 percent) among the 157 reconstructed ligaments in the external fixator group.
Read the abstract…
4. Study: Hospital staff often disregard HAI prevention policies.
A study published in the February issue of the American Journal of Infection Control suggests that, although most hospitals have implemented policies to prevent healthcare-associated infections (HAIs), many clinicians do not follow evidence-based guidelines established to prevent such infections. The researchers collated data on 1,653 intensive care units (ICUs) provided by 975 eligible hospitals. They found that more than 90 percent of ICUs had checklists for sterile catheter insertion, but the policies were followed only about half of the time, and about three in four ICUs had checklists for protecting against infections linked to ventilators, but staff followed the checklists just half the time. Finally, about one-third of hospitals surveyed had no prevention polices for catheter-associated urinary tract infections, and at hospitals with established guidelines, prevention measures were followed less than 30 percent of the time.
Read more…
Read the abstract…
5. California.HealthLeaders
Media reports that California has fined 13 hospitals a total of $770,000 for events linked to patient harm. Overall, 8 hospitals were fined administrative penalties for regulatory noncompliance linked to the deaths of five patients and other injuries, while five institutions were issued “immediate jeopardy fines” for harm to patients who were undergoing care related to mental or behavioral health. So far, the state has fined 166 hospitals a total of $14,105,000 under the immediate jeopardy statute, $10,897,626 of which has been collected.
Read more…
6. Missouri.
According to the St. Louis Post-Dispatch, a committee of the Missouri House of Representatives has endorsed legislation to limit noneconomic damages for medical liability lawsuits to $350,000. The state had previously implemented caps on noneconomic damages in medical liability cases, but in 2012 the Supreme Court of Missouri declared such caps unconstitutional. A parallel proposal would have amended the state constitution to give the legislature authority to cap noneconomic damages, but the committee instead approved the same limits under a statutory measure.
Read more…
7. Apply now for the 2014 AAOS/OREF/ORS Clinician Scholar Career Development Program.
March 31 is the last day to submit your application to participate in the Clinician Scholar Career Development Program (CSCDP). The program is a joint project of AAOS, the Orthopaedic Research and Education Foundation (OREF), and the Orthopaedic Research Society (ORS). CSCDP seeks applicants in years PGY2 to PGY 5 of orthopaedic residency, as well as those who have completed orthopaedic residency and are either in a post-residency fellowship or in the first 3 years of a faculty appointment in a department of orthopaedic surgery. Up to 15 applicants will be selected to participate in the 1.5-day training workshop, with up to 10 additional participants sponsored by orthopaedic specialty societies. The 2014 AAOS/OREF/ORS Clinician Scholar Career Development Program will take place Sept. 25-27, 2014, in Rosemont, Ill.
Learn more and submit your application…
Applications, along with curriculum vitae and a letter of support, must be submitted electronically by 11:59 PM CST on March 31, 2014 to csdp@aaos.org
8. Did you know that AAOS Now is available as an ebook?
In addition to being available on the AAOS website, the February 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)

February 10
Today’s Top Story
1. Article outlines key points of SGR repeal bill.

An article in MedPage Today summarizes a bipartisan bill (HR 4015, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014) to repeal and replace the Medicare Sustainable Growth Rate (SGR) formula. According to the author, key aspects of the bill include: A 0.5 percent payment increase each year though 2018, with the current payment system remaining otherwise untouched during that span A new merit-based incentive payment system to take effect in 2018, consolidating the Physician Quality Reporting System (PQRS), value-based modifier, and meaningful use program for electronic health records (EHRs). Starting in 2018, a 5 percent bonus for physicians who significantly participate in alternative payment models Development of a billing code for care management services for patients with complex chronic conditions An attempt to limit inappropriate use of advanced diagnostic imaging Broader availability of Medicare claims data A requirement that EHRs be interoperable by 2017
Read more…
Read the legislation (PDF)…
Other News
2. CMS extends deadline for Medicare EHR attestation.

Modern Healthcare reports that the U.S. Centers for Medicare & Medicaid Services (CMS) has pushed back the deadline for physicians and other eligible professionals to attest to meaningful use for the Medicare EHR incentive program for 2013 from Feb. 28 until March 31. In addition, the agency will offer hospitals that experienced difficulty submitting attestation data by their Nov. 30, 2013, deadline a “one-time opportunity” to submit the data retroactively to avoid 2015 payment adjustments. Hospitals seeking to submit retroactively must contact CMS for assistance by 11:59 p.m. on March 15, 2014. Neither of the new relief provisions affects the Medicaid portion of the EHR incentive payment program.
Read more…(paid subscription required)
3. Study: Patellar retraction and eversion linked to similar short-term outcomes for TKA patients.
Data from a study published in the Feb. 5 issue of The Journal of Bone & Joint Surgery suggest no early clinical benefit to retracting rather than everting the patella during total knee arthroplasty (TKA). The authors conducted a prospective, randomized, double-blinded trial of 68 patients who underwent TKA using a standard medial parapatellar approach. At 3-month and 1-year follow-ups, the authors found no significant clinical difference between retraction or eversion groups in Oxford knee score, SF-12, visual analog scale pain scores, extension, or alignment. They did note an increased percentage of lateral tibial overhang in the retraction group, but it did not correlate with functional outcome. In addition, at 1 year after surgery, no difference was found between the two groups in Insall-Salvati ratio, although a correlation between the percentage reduction in the ratio and functional outcome was noted. Finally, two partial divisions of the patella tendon occurred in the subluxation group, but no patella-related complications occurred in the eversion group.
Read the abstract…
4. Study examines incidence rates for infection-related reoperation after arthroscopic shoulder surgery.
A study published in the February issue of The American Journal of Sports Medicine looks at infection rates associated with reoperation after arthroscopic shoulder surgery. The researchers reviewed data on 165,820 arthroscopic shoulder surgeries from a single insurer’s database. They found that 450 infections requiring additional surgery occurred, for an overall infection rate of 0.27 percent. The incidence of infections varied significantly across age groups, with the highest infection rate (0.36 percent) in patients 60 years or older, and the lowest infection rate (0.18 percent) in the 10- to 39-year age group. Incidence of infection also varied by region, with the highest incidence in the South (0.37 percent) and the lowest in the Midwest (0.11 percent). Likelihood of reoperation for infection was highest for rotator cuff repair (0.29 percent) and lowest for capsulorrhaphy (0.16 percent). Incidence did not significantly vary by year or sex.
Read the abstract…
5. Reminder: CMS to conduct ICD-10 testing week.
CMS has announced a national testing week for providers and clearinghouses to test the ICD-10 code set. From March 3-7, 2014, trading partners will be given access to the Medicare Administrative Contractors and Common Electronic Data Interchange for testing with real-time help desk support. Providers who wish to take part in the testing week must register with CMS.
Learn more (PDF)…
Register…
6. California.
The Los Angeles Times reports that the Covered California health insurance exchange has removed its online physician directory because it contained too many errors. The exchange has touted the physician directory as an important tool, due to moves on the part of some insurers to limit the number of physicians and hospitals in their networks, but some consumers have located physicians thought to be in their plan and subsequently discovered they were not. This is the second time Covered California has removed the database for containing inaccurate information.
Read more…(paid subscription required)
7. Last call for abstracts for AAOS/ORS musculoskeletal infection research symposium.
Feb. 17 is the last day to submit abstracts for a Young Investigator Poster Presentation at the upcoming AAOS/Orthopaedic Research Society (ORS) Musculoskeletal Infection: Where Are We in 2014? symposium, to be held May 8-10, 2014, in Rosemont, IL. Selected young Investigators (YIs) will have the opportunity to attend the symposium and present their research in musculoskeletal infection while learning from principal investigator mentors in the field. YI applicants must be no more than 7 years beyond training. Selected YI attendees will receive airfare, lodging, and meals provided at the event only. Please submit application forms, abstracts, curriculum vitae, and letters of support by February 17 to Erin Ransford, at ransford@aaos.org
Learn more and download an application…
Read more…
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. CT to Kyle Shah, clinical quality and medical affairs coordinator, at shah@aaos.org
Learn more and submit our application…

February 14
Today’s Top Story
1. Physicians’ shift to hospital employment continues.

An article in The New York Times looks at the ongoing shift in employment patterns as physicians transition from private practices to hospital employment. The author cites data from the placement firm Merritt Hawkins, which noted that 64 percent of job offers filled through that company during 2013 involved hospital employment, compared with only 11 percent in 2004. The firm expects that proportion of hospital offers to increase to 75 percent over the next 2 years. In addition, the American Medical Association states that 60 percent of primary care physicians, 50 percent of surgeons, and 25 percent of surgical specialists are now employed rather than independent. The author says that hospitals that obtain the right mix of physicians may see cost-efficient and coordinated patient care. However, she notes that some mergers between hospitals and physician practices have been linked to increased payer costs.
Read more…(registration may be required)
Other News
2. Study: Children who are obese are more likely to sustain more complex supracondylar humeral fractures, increased complications.

According to a study published in the Feb. 5 issue of The Journal of Bone & Joint Surgery, children who are obese and sustain a supracondylar humeral fracture are more likely to experience more complex fractures and increased postoperative complications than children who are not obese. The researchers identified 354 children who met inclusion criteria, were aged 2 to 11 years, and had undergone surgical treatment for extension-type supracondylar humeral fractures. Overall, 41 children were classified as underweight, 182 as normal weight, 63 as overweight, and 68 as obese. Obesity was associated with an increased likelihood of complex fracture, preoperative nerve palsy, postoperative nerve palsy, and postoperative complications. In addition, the researchers noted that obese patients were more likely to sustain complex fractures from a fall on an outstretched hand than normal-weight patients.
Read more…
Read the abstract…
3. Study: Spines of children with ILBP react differently from other children under backpack load.
Data published in the Feb. 1 issue of the journal Spine suggest that typical backpack loads have a different impact on the lumbar spine of children with idiopathic low back pain (ILBP) than in children without ILBP. The authors conducted upright magnetic resonance imaging on 15 pediatric and adolescent patients with ILBP, and compared data against previously published findings. They found that, compared to normal children, children with ILBP experienced significantly less disk compression at T12–L1 to L4–L5, less lumbar lordosis, and more pain with increasing load.
Read the abstract…
4. FDA rule to require vendors to electronically submit certain device-related adverse events.
The U.S. Food and Drug Administration (FDA) has published a final rule that will require manufacturers and importers to electronically submit Medical Device Reporting information on certain device-related adverse events and product problems. In addition, although not covered under the new electronic reporting rule, so-called “device user facilities” such as hospitals, ambulatory surgical facilities, and outpatient treatment facilities (excluding physician offices) must report suspected medical device-related deaths to both the FDA and the manufacturer, and medical device-related serious injuries must be reported to the manufacturer, or to FDA if the manufacturer is unknown.
Read more…
5. Three years after receiving a 3-D printed pelvis, the patient is walking.
According to Healthpoint Capital, a British orthopaedist successfully implanted a pelvis created through 3-D printing. The medical team scanned the biological pelvis of the patient, who was undergoing treatment for chondrosarcoma. They then loaded data into the printer, which used a laser to fuse titanium powder into the shape of the implant. The implant was then coated with a mineral designed to allow remaining bone cells to grow. At 3-year follow-up, the team reports that the patient is now able to ambulate using a cane.
Read more…
6. Colorado.
An article in The Denver Post looks at provider disparities and pressures across Colorado. The author cites a report from the Colorado Health Institute (CHI), which notes that some counties have 5,636 residents for each full-time primary care physician. CHI also predicts an influx of new patients due to the Medicaid expansion under the Affordable Care Act. The author states that some physicians have blamed the transition to electronic health records for a reduction in productivity.
Read more…
Read the report (PDF)…
7. Connecticut.
Modern Healthcare reports that a federal appeals court has rejected a request by UnitedHealthcare to overturn a preliminary injunction that prohibits the insurance company from dropping providers from its Medicare Advantage networks in Connecticut. The judge instead modified the injunction to give the affected physicians 30 days to file for arbitration contesting their removal. The publication notes that the UnitedHealthcare case could set national precedent as insurers in many markets seek to narrow their networks. A similar lawsuit filed by the Medical Society of the State of New York is pending.
Read more…(paid subscription required)
8. Help build a Safe and Accessible Playground in New Orleans.
Join the AAOS on Tuesday, March 11, 2014, for the 15th annual Safe and Accessible Playground Build. This year’s project will take place at Arthur Ashe Charter School, a FirstLine School, starting at 8:30 a.m. and concluding with a ribbon-cutting ceremony at 2:30 p.m. Be a playground build sponsor, or register as a build day volunteer. No experience is necessary to take part in this fun and rewarding activity!
Learn more and register…

February 17
Today’s Top Story
1. Study: More than 28 percent of complications discovered after hospital discharge.

Data from a study published online in the journal JAMA Surgery suggest that hospital discharge may be an insufficient end point for quality assessment based on readmissions. The researchers conducted a retrospective cohort study of 59,273 surgical procedures performed at 112 Department of Veterans Affairs hospitals. They found the overall complication rate to be 22.6 percent (71.9 percent predischarge complications, 28.1 percent postdischarge complications). The overall 30-day readmission rate was 11.9 percent, and although 56.0 percent of readmissions were associated with a currently assessed complication, more than one quarter of assessed complications were diagnosed after hospital discharge. In addition, the researchers noted that the proportion of postdischarge complications varied significantly based on type of complication, with surgical site infection accounting for 55.7 percent overall.
Read the abstract…
Other News
2. Study: Local anesthetic may be as effective as oral analgesic following arthroscopic elbow surgery.

A study published in the March issue of the Journal of Shoulder and Elbow Surgery suggests that both oral analgesics and local anesthetic may be effective for managing postoperative pain levels after arthroscopic elbow surgery. The authors prospectively randomized 36 patients undergoing arthroscopic elbow surgery under general anesthesia to receive either axillary nerve block or portal site injections of local anesthetic. They found no intergroup differences between the two groups at any time point after surgery, up to 48 hours. The mean number of loxoprofen tablets required during the 48-hour study period was 5.1 in the nerve block group and 4.5 in the local anesthetic group, and both groups had mean overall patient satisfaction scores of 91.
Read the abstract…
3. Study: Direct beam radiation exposure may often be avoided with more careful technique.
Information published in the March issue of the Journal of Pediatric Orthopaedics suggests that surgeon exposure to direct beam radiation may be reduced or avoided with improved awareness about the risk of direct beam radiation exposure and cautious surgical technique. The authors conducted a double-blind study of 3,842 fluoroscopic still images from 78 closed reduction and percutaneous pinning surgeries for supracondylar humerus fractures, performed or supervised by six attending surgeons. They found that fluoroscopy lasted for a median of 34 seconds, and the surgeon was exposed to direct beam radiation in a median of 13 percent of fluoroscopy films, with exposure ranging from 0 percent to 97 percent per surgery. Fluoroscopy was significantly longer when the C-arm position was inverted when compared with the standard position, and surgeons’ exposure to direct beam radiation was also slightly greater when the C-arm position was inverted. The authors noted that the duration of fluoroscopy exposure and the percentage of films with the body exposed to radiation did not differ based on whether the surgery was performed by an attending, a resident, or both, but the percentage of films with bodily radiation exposure did significantly differ between attending physicians.
Read the abstract…
4. Study: Risk-calculator may predict mortality, morbidity, after hip fracture surgery.
A study published in the February issue of the Journal of Orthopaedic Trauma suggests that a risk-calculator may be predictive of 30-day morbidity and mortality for patients undergoing surgery for hip fracture. The researchers use the American College of Surgeons National Surgical Quality Improvement Program database to identify 4,331 patients who underwent surgery for hip fracture between 2005 and 2010. They found that 30-day mortality was 5.9 percent and morbidity was 30.0 percent. Predictors of mortality and morbidity included patient age—especially age greater than 80 years, morbidity, and male sex. An increased American Society of Anesthesia class had the highest negative impact on total complication incidence. In addition, complete functional dependence, active malignancy, patient race, cardiopulmonary disease, laboratory derangements, prolonged operating time, and open versus percutaneous surgery independently influenced outcomes.
Read the abstract…
5. Study: Use of MRI increases confidence in diagnosis, may alter treatment for patients with knee disorders.
Findings from a study published in the February issue of the journal Orthopedics suggest that use of magnetic resonance imaging (MRI) may frequently change diagnosis and management and improve diagnostic confidence among a large minority of patients with internal derangement of the knee. The authors collected pre- and post-MRI survey data from six orthopaedic specialists (93 knees). They found that MRI changed the diagnosis in 29.3 percent of cases and changed the management in 25.3 percent of cases. In addition, confidence in diagnoses after MRI increased on average by 10.6 percent. The 3 most significant predictors for change in management were ligament pathology, medial-sided pain/tenderness, and age.
Read the abstract…
6. IOM report examines available data on long-term effects of blast injuries.
A report released by the Institute of Medicine attempts to summarize relevant scientific information and to draw conclusions regarding an association between exposure to blast and other long-term health effects. The report notes that some evidence suggests that blast exposure can result in long-term muscle or bone impairment such as osteoarthritis, but the data on these outcomes is not strong enough to draw a direct cause-and-effect relationship. The authors of the report outline recommendations for further research to inform decisions on how to prevent and better diagnose blast injuries, and how to treat, rehabilitate, and support victims of battlefield trauma in the immediate aftermath and in the long term.
Read more…
A prepublication version of the report in electronic (PDF) format is available for free on the IOM website.
Read more…
7. Massachusetts.
According to information on the Massachusetts Medical Society (MMS) website, the Massachusetts House of Representatives has approved changes in state law that would, if adopted, disconnect medical licensure from a physician’s use of electronic health records (EHRs). Under current law, physicians who wish to renew their license after January 2015 must demonstrate that they use EHRs at the level of the federal government’s meaningful use program. MMS has argued that if the requirement is enforced, more than 10,000 physicians could lose their licenses.
Read more…
8. Call for volunteers: Spine Instructional Course Committee.
March 31 is the last day to submit your application for chair of the Spine Instructional Course Committee. Members of instructional course committees grade Instructional Course Lecture applications in May, provide course input to the Instructional Courses Committee, and evaluate courses at the AAOS Annual Meeting. Applicants for this position must be AAOS fellows with a practice emphasis in spine.
Learn more and submit your application…(member login required)

February 19
Today’s Top Story
1. Study: Rates of CS-SSI for ambulatory surgery patients low, but not low enough.

Data from a study published in the Feb. 19 issue of The Journal of the American Medical Association (JAMA) suggest that, for patients who undergo ambulatory surgery, rates of postsurgical visits for clinically significant surgical site infections (CS-SSIs) may be low relative to all causes, but still represent a substantial number of adverse outcomes. The researchers conducted a retrospective analysis of 284,098 low- to moderate-risk ambulatory surgical procedures—including orthopaedic procedures such as spinal laminectomy or diskectomy and anterior cruciate ligament repair—performed on adults with low surgical risk, across eight states during 2010. They found that postsurgical acute care visits for CS-SSIs occurred in 3.09 per 1,000 ambulatory surgical procedures at 14-day follow-up and in 4.84 per 1,000 procedures at 30-day follow-up. Overall, 63.7 precent of all visits for CS-SSI occurred within 14 days of surgery, and of those visits, 93.2 percent involved treatment in the inpatient setting. The researchers write that the incidence of such serious infections “merit quality improvement efforts to minimize their occurrence.”
Read more…
Read the abstract…
Other News
2. Study: Home-based exercise program may improve physical function for hip fracture patients.
According to findings published in the Feb. 19 JAMA, use of a home-based functionally oriented exercise program may be linked to a modest improvement in physical function for patients who have completed rehabilitation for hip fracture. The authors conducted a randomized clinical trial of 195 patients who received either functionally oriented exercises taught by a physical therapist and performed independently by the participants in their homes (n = 100), or in-home and telephone-based cardiovascular nutrition education (n = 95). At 6 months, they found that patients in the intervention group demonstrated significant improvement relative to controls. In multiple imputation analyses, the authors noted that between-group differences remained significant for Short Physical Performance Battery and Activity Measure for Post-Acute Care daily activity, but not for mobility. In addition, significant between-group differences persisted at 9 months for all functional measures with and without imputation.
Read more…
Read the abstract…
3. Study: Increased magnesium intake linked with reduced likelihood of hip fracture.
Information from a Norwegian study published in the journal Bone suggests that higher concentrations of magnesium in drinking water may be associated with a reduced likelihood of hip fracture. The researchers compared data from a trace metal survey of 556 waterworks from 1986 to 1991 against geographic distribution of hip fractures around the country from 1994 to 2000. They noted an inverse association between concentration of magnesium and risk of hip fracture in both genders, but no consistent association between calcium and hip fracture risk. They also found that increased urbanization was linked to an increase in hip fracture risk in men and women, although the association between magnesium and hip fracture did not explain the variation in hip fracture risk between city and rural areas. The researchers suggest that the association between magnesium and hip fracture risk should be further investigated.
Read more…
Read the abstract…
4. Study: Virus-based gene therapy may help grow cartilage.
A study published online in the journal Proceedings of the National Academy of Sciences suggests that use of a gene therapy technique combined with a synthetic scaffold may help regenerate cartilage. The authors developed a technique incorporating viruses used to deliver gene therapy to induce stem cells to produce growth factor proteins. According to the authors, their method circumvents the need for ex vivo tissue generation by enabling the long-term goal of in situ tissue engineering.
Read more…
Read the abstract…
5. New Jersey.
NJ Spotlight reports that, under a proposal being considered by the New Jersey State Board of Medical Examiners, physician assistants with doctoral degrees would be barred from using the title “doctor” in clinical settings. The board’s physician assistant advisory committee stated that confusion may result when physician assistants who hold doctoral degrees are referred to as “doctors,” and patients believe they are medical doctors or doctors of osteopathic medicine.
Read more…
6. New York.
According to information released by HEALTHeLINK—a nonprofit clinical information exchange supported by hospitals, insurers, and other medical stakeholders—one in 10 of the three most common computed tomograhpy scans done in Western New York may be an unnecessary duplication that increases healthcare expenditures and poses a radiation risk to the patient. The authors reviewed CT scan claims data from July 1, 2011, through Dec. 31, 2012 provided by three insurers covering about 65 percent of commercially insured residents in the region. They found that about 90 percent of potentially unnecessary CT scans of the chest, abdomen, and head and neck were ordered by physicians who either infrequently used or did not use the HEALTHeLINK database.
Read more…
7. Voting for AAOS slate of officers to begin Wednesday, Feb. 26.
Beginning on Feb. 26 and continuing until 1 p.m. CT on Wednesday, March 12, AAOS fellows will be able to vote online for the slate of officers proposed by the 2014 Nominating Committee. The ballot will be sent electronically on Wednesday, Feb. 26 and will also be available on the AAOS website. Ballot results will be announced on Thursday, March 13, during the 2014 business meeting, which is scheduled for at 9 a.m. CT in the La Nouvelle Ballroom of the Morial Convention Center in New Orleans, La. The new leaders will take office at the conclusion of the 2014 Annual Meeting.
The 2014 Nominating Committee has identified and announced the following candidates for the named positions:
Second Vice-President: Gerald R. Williams, Jr., MD
Treasurer-Elect: Ken Yamaguchi, MD, MBA
Board Member-at-Large (Age 45 or older): Raj D. Rao, MD
Board Member-at-Large (Under age 45): Jennifer M. Weiss, MD
National Membership Committee representative: Col. Edward D. Arrington, MD
Please plan to participate in voting for your AAOS leadership!
8. Call for volunteers: American College of Cardiology Foundation panel on peripheral vascular intervention.
AAOS seeks to nominate three to five members to serve as external reviewers and/or Rating Panel members to the American College of Cardiology Foundation for their appropriate use criteria (AUC) documents on peripheral vascular intervention. The Rating Panel will consist of 15 to 17 members appointed with the goal of balancing representation from all stakeholders and ensuring a diverse representation of perspectives. All applicants must provide the following: an online AAOS CAP application, current curriculum vitae, 100-word biosketch, and 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. Please submit supporting materials by 4 p.m. CT, Thursday, Feb. 20, 2014 to Kyle Shah at shah@aaos.org
Learn more and submit your application…(member login required)

February 21
Today’s Top Story
1. Study: Critically injured patients with health insurance may be less likely to be transferred to trauma centers.

As reported by Kaiser Health News, a study from Stanford University suggests that when critically injured patients are sent to emergency departments not designated as trauma centers, patients with insurance—either Medicaid coverage or private insurance—were more likely to be admitted than to be transferred to more skilled facilities. The retrospective analysis, published in JAMA Surgery, used data from the 2009 Nationwide Emergency Department Sample on 4,513 trauma cases and 636 hospitals across the country. Patients ranged from 18 years to 64 years, and were seen for major trauma (Injury Severity Score>15). Researchers found that, compared with uninsured patients, the adjusted absolute risk of admission versus transfer was 14.3 percent higher for Medicaid patients (95 percent CI, 9.2 percent – 19.4 percent) and 11.2 percent higher for patients who had private insurance (95 percent CI, 6.9 percent – 15.4 percent). “Timely care in a designated trauma center has been shown to reduce mortality by 25 percent,” wrote the researchers, who also noted that “efforts in monitoring and optimizing trauma interhospital transfers and outcomes at the population level are warranted.”
Read more…
Read the abstract…
Other News
2. Study: Narcotic painkiller prescriptions from multiple physicians may put Medicare patients at risk.

HealthDay reports that one-third of Medicare patients who take narcotic painkillers have prescriptions for those drugs from more than one physician, raising the patients’ risk for hospitalization, according to a study recently published in BMJ. The retrospective cohort study involved data from 1,808,355 Medicare beneficiaries who filled a minimum of one prescription for an opioid from a pharmacy in 2010. Researchers found that, of 1,208,100 Medicare patients with an opioid prescription, 34.6 percent filled prescriptions for opioids issued by two providers,14.2 percent filled prescriptions for opioids from three providers, and 11.9 percent filled prescriptions from four or more providers. The investigators found that hospital admissions related to opioid use increased depending on the number of providers issuing opioid prescriptions, ranging from an annual unadjusted rate of admission of 1.63 percent (95 percent CI, 1.58 percent to 1.67 percent) for patients with one prescriber, to 4.83 percent (4.70 percent to 4.96 percent) for patients with four or more providers.
Read more…
Read the study…
3. Opinion: More bipartisan cooperation needed to pay for Medicare SGR repeal.
A bipartisan, bicameral proposal announced on Feb. 6, 2014, pairs repeal of the Sustainable Growth Rate (SGR) formula used to calculate Medicare payments to physicans with bipartisan reforms that move away from volume-based reimbursement and would instead pay physicians based on the quality and value of care they provide, as noted in an opinion piece on the Health Affairs Blog. And yet, the authors—including John Rother, president and CEO of the National Coalition on Health Care—call for Congress to do the following to strengthen Medicare: Bundle Medicare payments for all services related to some common hospital procedures, with the aim of creating incentives to better coordinate care and lower costs.Improve medication adherence by aligning incentives in Medicare Parts C and D to accomplish goals such as synchronizing prescription fills.Lower costs and improve patient safety through strategies such as expanding over time the number of penalties that apply to hospital-acquired conditions and providing more incentives for improving patient safety.Find better ways to curb unnecessary readmissions by broadening the types of conditions that are tracked, and comparing providers who serve similar populations. The authors assert that billions of dollars could be produced in budgetary savings by expanding readmissions policies to post-acute and other providers.Negotiate better Medicare reimbursement through payment adjustments or competitive bidding.
Read more…
4. InformationWeek.com offers physicians tips for controlling their online reputations.
As it becomes more and more common for patients to write online reviews of physicians on rating sites such as Healthgrades, Rate MDs, Vitals, and ZocDoc—as suggested by a recent study published in the Journal of the American Medical Association (JAMA) —it is important for physicians to maintain their digital reputations, according to a recent article on InformationWeek.com. Some of the strategies proposed include the following: If patients leave negative reviews, contact those patients to see if there is anything the office can do to improve the situation. Note that many sites allow a service provider to send a private message to a reviewer without revealing the reviewer’s identity.Ask satisfied patients to provide their ratings on issues such as doctor’s services, waiting room times, and courtesy.Hire a reputation management firm to perform such duties as monitoring online posts, helping to build a brand, and providing search engine management.Learn from warranted criticism to improve the practice.
Read more…
Read the JAMA study on online physician rating sites…
5. Study: No correlation between structural integrity of rotator cuff repair and functional outcomes, pain.
Results of a meta-analysis published in the Feb. 19 issue of The Journal of Bone & Joint Surgery (JBJS) suggest that, on the basis of validated shoulder outcome measures after rotator cuff repair, no difference exists in patient pain or function, regardless of the structural integrity of the repair. The researchers conducted a systematic review and meta-analysis of Level-I and Level-II studies showing outcome measures after rotator cuff repair and an imaging assessment of the structural integrity of the repair. The studies were pooled and patients were divided into two groups: those with an intact rotator cuff repair and those with a retear. The researchers found that the average University of California Los Angeles, Constant, and American Shoulder and Elbow Surgeons scores increased and the visual analog scale score decreased in patients, regardless of the structural integrity of the repair.
Read the study…
6. Study: Allogeneic blood transfusions increase risk of postoperative infection in hip, knee arthroplasty patients.
A study published in the Feb. 19 issue of JBJS reports that postoperative infection rates were significantly increased in patients undergoing elective total hip or total knee arthroplasty who received allogeneic blood transfusion, compared with those who received autologous blood transfusion or no blood transfusion. Using data from Phase-III RECORD (Regulation of Coagulation in Orthopedic Surgery to Prevent Deep Venous Thrombosis and Pulmonary Embolism) studies, the researchers stratified patients into the following three groups: no transfusion (n = 6313), autologous blood transfusion (n = 1902), and allogeneic blood transfusion with or without autologous blood transfusion (n = 3962). Because infection rates in patients receiving no transfusion or autologous blood transfusion were similar, data from these two groups were combined.
The rate of any infection was 9.9 percent in patients receiving allogeneic blood transfusion and 7.9 percent in patients not receiving allogeneic blood transfusion, with or without autologous blood transfusion (P= 0.003). The rates of lower or upper respiratory tract and lung infection (2.1 percent vs 1.3 percent; P = 0.002) and of wound inflammation or infection (2.4 percent vs 1.7 percent; P = 0.046) were significantly higher in patients receiving allogeneic blood transfusion, compared with patients not receiving allogeneic blood transfusion. The rates of bone and joint infection, urinary tract infections, and other infections were not significantly different between the groups.
Read the study…
7. Study: At-home exercises help seniors recover after hip fracture surgery.
According to a study published in JAMA, simple at-home exercises could help elderly patients recovering from hip fracture regain mobility and independence. The researchers conducted a randomized trial from September 2008 to October 2012 of 232 people aged 60 years and older (average age=78 years) who had experienced a hip fracture and had completed traditional rehabilitation. The exercise group (n=120) was taught an at-home exercise program by a physical therapist and instructed to perform the exercises three times a week for 6 months. The control group (n=112) received in-home and telephone-based cardiovascular nutrition education. Overall, 195 patients were included in the primary analysis at 6 month follow-up. The exercise group participants scored an average of 7.2, compared to an average of 6.2 among those in the control group. The exercise group also improved on measures of mobility and daily activity, compared to those in the control group.
Read more…
Read the study…

February 24, 2014
Today’s Top Story
1. Study: As many as 32 percent of patients who undergo MAT may require reoperation.

A study published online in The American Journal of Sports Medicine finds a 32 percent reoperation rate for meniscal allograft transplantation (MAT) at mean 5-year follow-up (minimum 2 years). The authors conducted a retrospective review of a prospectively collected database of 172 patients who underwent MAT performed by a single surgeon between 2003 and 2011. They found that 64 patients (32 percent) had undergone surgery after their index procedure. Mean time to subsequent surgery was 21 months (range, 2-107 months), with 73 percent of subsequent surgeries occurring within 2 years of the index procedure. Simple arthroscopic debridement was the most common subsequent surgical treatment, performed in 38 of 64 patients (59 percent). Overall, eight of the 172 patients (4.7 percent) eventually required either revision MAT or total knee arthroplasty. Patients who required secondary surgery within 2 years had an odds ratio of 8.4 for future arthroplasty or MAT revision.
Read the abstract
Other News
2. Study: Better education in cast saw use may reduce risk of injury.

Findings published in the Feb. 19 issue of The Journal of Bone & Joint Surgery suggest that improving education and training in cast saw use may reduce the likelihood of cast saw injuries. The research team collected information on all cast cuttings at a single institution between January 2010 and December 2012. Of 23,615 cast cuttings, they found 29 injuries. Overall, the emergency department had the highest rate of cast saw injuries, with a significantly greater rate of injuries at night compared to day. Key risk factors for cast saw injury included provider inexperience, patient sedation, and poor cast saw blade condition. All injuries were minor.
Read the abstract
3. University program uses baseline data to quantify effects of concussion.
According to information from South Dakota State University, researchers at that school have implemented a sports concussion protocol using the ImPACT neuro-cognitive assessment tool to provide pre-injury baseline measurements for student athletes in southeastern South Dakota. The researchers perform yearly testing for nine area schools, and have more than 1,000 current students in their database. The researchers note that having baseline data offers the opportunity for an objective look at the effect of concussion on a student’s cognitive functions, memory, and reaction time—factors that are otherwise difficult to evaluate.
Read more
4. Drive toward pricing transparency likely to continue.
An article in The Wall Street Journal looks at the issue of healthcare pricing transparency, noting that in health care, unlike other industries, prices often vary widely based on payer. A spokesperson for the Robert Wood Johnson Foundation opines that price transparency could destabilize traditional healthcare sector economics. However, the author points out that with an increasing number of Americans who have high-deductible insurance policies, pressure to increase transparency and reduce healthcare costs is likely to continue to grow.
Read more
5. Survey ranks residency programs based on physician response.
A survey published in U.S. News and World Report ranks U.S. residency programs based on responses from 3,410 physicians. The data, drawn only from internal medicine specialists, ranks programs based on 9,174 nominations. The highest rank programs included Massachusetts General Hospital, Boston; Johns Hopkins University, Baltimore; Brigham and Women’s Hospital, Boston; and the University of California, San Francisco. The publication states that the survey may be “the first major effort to measure doctors’ views on a formative part of medical training.”
Read more
6. Massachusetts.
An article in The Boston Globe looks at factors under consideration in mergers involving the Boston region’s largest healthcare system. Supporters of the mergers argue that the alliance will lead to better integrated care and eliminate waste and inefficiencies. However, a report from the Massachusetts Health Policy Commission predicts that the merger would result in higher costs and reduced competition.
Read more…(registration may be required)
7. OKOJ March 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 Ankle Fusion: The Posterior Approach,” “Current Concepts in the Management of Metastatic Disease of the Cervical Spine,” “Midcarpal Instability,” and “Surgical Exposures of the Hand.” In addition, four new videos have been made available: “Videofluoroscopy of a Patient With Palmar Midcarpal Instability: Effect of Simulated Dorsal Ligament Reefing.” “Ankle Arthrodesis: Posterior Arthroscopic Approach,” “Videofluoroscopy of a Patient With Palmar Midcarpal Instability,” and “Midcarpal Shift Test.”
View these topics and more…(member login required)
8. Call for volunteers: AAOS liaison to the Surgical Quality Alliance.
AAOS seeks one member to serve as liaison to the Surgical Quality Alliance—a group of surgical specialties and anesthesiology collaborating to define the principles of surgical patient quality measurement and develop awareness among interested parties about issues related to surgical care and quality in all surgical settings. Applicants for this position must have experience with and interest in performance measures and quality assessment. In addition, all applicants must provide the following: an online AAOS CAP Application; current curriculum vitae; 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 maximum 100-word biography. Please submit supporting materials by 11:59 p.m. CT, Sunday, March 16, 2014 to Kyle Shah at shah@aaos.org
For additional information, please contact William Shaffer, MD, AAOS medical director, at shaffer@aaos.org
Learn more and submit your application…(member login required)

February 27, 2014
Today’s Top Story
1. Study: Antihypertensive medication may increase risk of falls in older patients.
According to a study published online in the journal JAMA Internal Medicine, use of antihypertensive medications may be associated with an increased risk of serious fall injuries for older patients. The authors analyzed data on 4,961 community-living adults older than 70 years with hypertension listed in the Medicare Current Beneficiary Survey. Overall, 14.1 percent of participants received no antihypertensive medications, while 54.6 percent were in the moderate-intensity and 31.3 percent in the high-intensity antihypertensive groups. At 3-year follow-up, 446 participants (9.0 percent) had experienced serious fall injuries and 837 (16.9 percent) had died. Compared against nonusers, adjusted hazard ratios for serious fall injury were 1.40 in the moderate-intensity and 1.28 in the high-intensity antihypertensive groups. The authors note that the difference in adjusted hazard ratios across groups did not reach statistical significance, but state that results were similar in a propensity score–matched sub-cohort.
Read the abstract…
Other News
2. ACA’s premium “grace period” may increase practice overhead for some physician practices.An article jointly produced by Kaiser Health News and NPR looks at the verification process physician offices must undertake when accepting patients who have purchased insurance through Affordable Care Act (ACA) exchanges. The author notes that physician offices traditionally verify insurance using an online verification system, but for exchange patients, practices also have to call the insurer to verify that the patient has paid his or her premium. A provision of the ACA grants exchange patients who neglect to pay their premium a grace period of up to 90 days, but insurers are only required to pay claims incurred during the first 30 days of that term. “At the end of the 90-day grace period,” the author writes, “if the patient has not paid the premium, the insurer can cancel the coverage and refuse to pay the pended claims, or recoup [from the provider] the payments it’s already made.” Wait times for phone verification can vary, but some practices report that it has taken more than an hour to verify that a particular patient is up-do-date in his or her premiums.
Read more…
3. Study: Overall obesity rates remain steady, but some progress seen in toddlers.A study published in the Feb. 26 issue of The Journal of the American Medical Association analyzes trends in childhood obesity and finds that, although prevalence remains high, there has been a significant decrease in obesity among 2- to 5-year-old children during the last several years. The research team measured weight and height or recumbent length for 9,120 participants in the 2011-2012 National Health and Nutrition Examination Survey and compared that data against similar data collected by the same survey during 2003-2004, 2005-2006, 2007-2008, and 2009-2010. Overall, they found no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. However, the research team noted a significant decrease in obesity prevalence among 2- to 5-year-old children between the 2009-2010 and 2011-2012 surveys—from 13.9 percent to 8.4 percent. A significant increase in obesity among women aged 60 years and older—from 31.5 percent to 38.1 percent—was noted over the same span.
Read more…
Read the abstract…
4. Study: Nurse staffing levels, education may affect patient outcomes after surgery.
Findings from a European study published online in the journal The Lancet suggest that nurse caseloads and training may affect patient outcomes after surgery. The researchers compared discharge data on 422,730 patients aged 50 years or older, who underwent common surgeries in 300 hospitals across nine European countries, against surveys of 26,516 nurses practicing in study hospitals to determine staffing and education levels. They found that, on average, a one-patient increase in a nurses’ workload was associated with a 7 percent increased likelihood of an inpatient dying within 30 days of admission. Similarly, a 10 percent increase in the proportion of nurses with bachelor’s degrees at an institution was linked with a 7 percent decrease in the likelihood of an inpatient dying within 30 days of admission.
Read more…
Read the abstract…
5. California.
The California Medical Association reports that the Medical Board of California plans to warn physicians with outstanding tax obligations that their medical licenses may be suspended if they do not pay their obligation or enter into a payment plan within 90 days. Under a 2011 state law, the board is authorized to deny medical license applications and to suspend the license of any licensee who has outstanding tax obligations due to the Franchise Tax Board (FTB) or the State Board of Equalization (BOE) and appears on either the FTB or BOE’s certified lists of top 500 tax delinquencies over $100,000. In addition, the law prohibits the board from refunding any money paid for the issuance or renewal of a license where the license is denied or suspended. Tax liabilities can be found on the FTB and BOE websites. Physicians are encouraged to check both websites and contact FTB or BOE if they believe a listing to be in error.
Read more…
Visit the FTB site…
Visit the BOE site…
6. Vote now for 2014 AAOS leadership!
Online voting is now open on the AAOS website. Voting will be available until 1 p.m. CT on Wednesday, March 12, with the results of the balloting announced on Thursday, March 13, during the 2014 Association business meeting at the AAOS Annual Meeting. The new leaders will take office at the conclusion of the 2014 Annual Meeting.
Learn more and vote…(member login required)
7. New AAOS Now podcast on reverse shoulder arthroplasty.AAOS Now has released a roundtable discussion in which Richard J. Hawkins, MD; Joseph D. Zuckerman, MD; Mark A. Frankle, MD; and T. Bradley Edwards, MD; discuss subscapularis repair and functional outcomes after reverse shoulder arthroplasty.
Listen to the current podcast (MP3)…
Other podcasts are available by clicking on “podcast” in the left navigation column of the AAOS Now home page.
Read more…
8. Call for volunteers: Council on Graduate Medical Education.
AAOS seeks to nominate members to the Council on Graduate Medical Education. The council provides an ongoing assessment of physician workforce trends, training issues, and financing policies, and recommends appropriate federal and private sector efforts on those issues. The membership term is 4 years, and members are expected to attend no fewer than two meetings per year (one in-person and one virtual). Travel and housing expenses for the in-person meeting will be paid for by the U.S. Health Resources and Services Administration. Applicants for this position 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 relevant subject area and a statement that he or she is able to participate in full capacity. Please submit supporting materials by Sunday, March 23, 2013 at 11:59 p.m. CT to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)

February 28, 2014
Today’s Top Story
1. AAOS president calls on members to contact their representatives in support of SGR repeal.
A statement from American Association of Orthopaedic Surgeons (AAOS) president Joshua J. Jacobs, MD, calls for AAOS members to contact their congressional representatives in support of H.R. 4015/S. 2000—a bicameral, bipartisan bill that would, if enacted, permanently repeal the Medicare Sustainable Growth Rate (SGR) formula. “Since the first patch in 2003, Congress has spent over $150.3 billion in patches, a price greater than this current SGR repeal legislation would cost,” writes Dr. Jacobs. “They need to hear from you. They need to be held accountable to their promises for stability in the Medicare payment system.”
Read the complete statement…
Other News
2. Inpatient stay costs explain almost all of the wide variation in costs for hip, knee arthroplasty.
A research brief issued by the National Institute for Health Care Reform finds that hospital inpatient price differences account for the vast majority of spending variation on “episodes of care” rather than differences in spending on physician and other non-hospital services during and after discharge or spending on readmissions. Researchers found wide variation across institutions in the cost for hip and knee arthroplasty, with total spending for such procedures ranging from $17,000 to more than $35,000. “These spending variations appear even though the procedure and the recuperative process are fairly standardized, the population is fairly uniform (nonelderly manufacturing workers and retirees), and payments are adjusted for local input prices,” the authors write. The data is based on detailed 2011 facility, professional and prescription drug claims data for current and retired autoworkers and their dependents under age 65 years, across nine markets.
Read the brief…
3. DEA proposal would upgrade hydrocodone combination products to schedule II regulations.
According to a notice in the Federal Register, the U.S. Drug Enforcement Administration (DEA) proposes to reschedule hydrocodone combination products from schedule III to schedule II of the Controlled Substances Act. The proposal is based on a rescheduling recommendation from the Assistant Secretary for Health of the U.S. Department of Health and Human Services and an evaluation of all other relevant data by the DEA. If finalized, the move would impose regulatory controls and administrative, civil, and criminal sanctions applicable to schedule II controlled substances on persons who handle or propose to handle hydrocodone combination products.
Read more…
4. Study: Little change in SSI or readmission rates for obese patients who gain or lose weight prior to hip or knee arthroplasty.
Findings published in the March issue of The Journal of Arthroplasty suggest that preoperative weight loss or gain may have little effect on the risk of surgical site infection (SSI) and readmission for obese patients undergoing total hip and total knee arthroplasty (THA and TKA). The research team reviewed information on 10,718 TKAs and 4,066 THAs performed on obese patients between January 2008 and December 2010. Overall, during the 1 year before TKA surgery, 7.6 percent of patients gained weight, 12.4 percent lost weight, and 79.9 percent remained at the same weight. Similarly, during the 1 year before THA surgery, 6.3 percent of patients gained weight, 18.0 percent lost weight, and 75.7 percent remained at the same weight. After adjustment, the research team found that the risk of SSI and readmission was not significantly different among patients who gained or lost weight before surgery, compared to those who remained the same.
Read the abstract…
5. CMS to “pause” RAC operations as program is improved.
The U.S. Centers for Medicare & Medicaid Services (CMS) has announced that it plans to “transition down” current Recovery Audit Contractor (RAC) operations, in order to allow the agency to “continue to refine and improve the Medicare Recovery Audit Program.” CMS states that providers should be aware of the following dates:

  • Feb. 21—the last day a Recovery Auditor may send a postpayment Additional Documentation Request (ADR)
  • Feb. 28—the last day a Medicare Administrative Contractor (MAC) may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration
  • June 1—the last day a Recovery Auditor may send improper payment files to the MACs for adjustment

Read more…
Read the CMS statement…
6. Missouri.
The Associated Press reports that the Missouri House of Representatives has endorsed legislation that would, if enacted, re-impose a $350,000 cap on noneconomic damages in medical liability cases that was previously struck down by the Missouri Supreme Court. The court had ruled that the 2005 law violated defendants’ rights to a jury trial that have been part of the state constitution since 1820. The legislation attempts to sidestep that issue by declaring that medical liability claims are not covered through common law that existed when the constitution was adopted.
Read more…
7. JAAOS to gain features as part of LWW journal portfolio.
AAOS has reached an agreement with Wolters Kluwer Health, under which the Journal of the AAOS (JAAOS) will be published as part of the Lippincott Williams & Wilkins (LWW) journal portfolio. The transition will take effect with the March 2013 issue. The company plans to enhance JAAOS publication channels via print, digital, and mobile platforms. In addition, LWW plans to add a publish-ahead-of-print feature to the JAAOS website, through which selected articles will be made available online soon after acceptance. Also planned forJAAOS is an open access option: following a manuscript’s acceptance for publication, authors will, for a fee, be able to stipulate that the article be made freely available to all who wish to read it.
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8. Call for volunteers: 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 Sunday, March 23, 2014 at 11:59 p.m. CT, to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)

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