March 3, 2014

Today’s Top Story
1. AAOS announces national call-in effort in support of SGR repeal.AAOS is asking members to call 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. An agreement to prevent physician pay cuts called for under the SGR is set to expire on March 31, at which time providers will see an estimated 24 percent reduction in reimbursement. A toll-free hotline for calling members of Congress has been made available at 877-996-4464.  Read more…

Other News
2. CMS: No delay in ICD-10 or Meaningful Use, but hardship exemptions for meaningful use will be “flexible.”
Speaking at the 2014 conference of the Healthcare Information and Management Systems Society, Marilyn Tavenner, administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), emphasized that there would be no delay in the implementation of either ICD-10 or stage 2 of the Meaningful Use program. However, she did offer partial relief to physicians and medical systems that may be finding it difficult to adjust to meaningful use guidelines. “We have decided to permit flexibility on how hardship exemptions will be granted,” she said. “I must stress we expect all providers to meet requirements in 2015. I urge you to meet the requirements this year.”  Read more…

3. Study: MRI may not be cost-effective screening tool for patients with hip pain.
Findings from a study published in the March issue of the journal Clinical Orthopaedics and Related Research suggest that magnetic resonance imaging (MRI) may not be a cost-effective screening tool in older patients for hip pain that is not supported by history, clinical examination, and plain radiographic findings. The retrospective assessment of 218 consecutive hip MRI studies (213 patients, aged 40 to 80 years) at one institution during a 5-year period found that hip MRI most frequently influenced treatment when assessing for a tumor or infection, and least frequently when assessing for pain. In addition, hip MRI affected a treatment decision independent of plain radiographic findings in only 7 percent of studies, and hip MRI cost was least when assessing for a neoplasm and greatest when assessing undefined hip pain. The researchers also noted that, compared to orthopaedists, nonorthopaedic clinicians more frequently ordered hip MRI without a clinical diagnosis, before plain radiographs, and with less frequent impact on treatment.
Read the abstract…

4. ED physicians work to find balance between too little and too much imaging.
An article in The Wall Street Journal looks at moves by some hospitals and physicians to reduce the use of advanced imaging such as computed tomography (CT) and MRI in the emergency department (ED). According to the author, data from the National Center for Health Statistics suggest that between 2000 and 2010, the use of such scans increased from 5 percent to 17 percent ED visits. The author points out that many ED physicians have been trained to rely on medical-imaging techniques, and are challenged to find a reasonable balance between over-testing and a potential reduction in patient safety.  Read more…

5. OIG releases 2014 Work Plan.
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has released its FY 2014 Work Plan. The Work Plan provides a description of what OIG plans to focus on during the coming year, giving providers insight into what the OIG believes are areas prone to fraud, waste, and abuse. Ongoing initiatives on which OIG intends to focus include:

  • Diagnostic radiology—medical necessity of high-cost tests
  • Evaluation and management (E/M) services—inappropriate payments
  • Imaging services—payments for practice expenses
  • Physicians and suppliers—noncompliance with assignment rules and excessive billing of beneficiaries

OIG will continue to adjust its Work Plan by responding to emerging issues.  Read more…

6. 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…
Read “Why We Build—Bones and Playgrounds,” a report on the playground design day held at the Arthur Ashe campus…

7. March AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the March issue of AAOS Now, but the online edition is already available on theAAOS Now website. This month’s issue includes at look at proposed SGR repeal legislation, a set of tips for passing a HIPAA risk assessment, a look at developing a bundled pricing strategy, and much more.   Read more…
Read “SGR Repeal, Replacement Legislation Introduced”…
Read “25 Tips for Passing a HIPAA Risk Assessment”…
Read “Developing a Bundled Pricing Strategy”…

8. Call for volunteers: Physician Consortium for Performance Improvement.
AAOS seeks one member to serve as liaison to the AMA-convened Physician Consortium for Performance Improvement. The consortium is comprised of national and state medical societies, professional organizations, federal agencies, individual members, and others interested in improving the quality and efficiency of patient care. Applicants for this position should have experience in evidence-based clinical practice guideline or performance measures development, and must have a strong interest in measure development, testing, and implementation, as well as methodology concepts. In addition, all applicants must provide the following: an online AAOS CAP Application; current curriculum vitae (up to 20 pages) with complete contact information; a letter of interest, highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity; and a maximum 100-word biography. All supporting materials must be submitted by Sunday, March 23, 2014 at 11:59 p.m. CT, to Kyle Shah, MHA, AAOS regulatory, quality and medical affairs coordinator, at shah@aaos.org.
Learn more and submit your application…(member login required)

March 5, 2014

Today’s Top Story
1. AHRQ: Hospitalizations that involve OR procedures account for 48 percent of hospital costs.
A statistical brief released by the U.S. Agency for Healthcare Research and Quality (AHRQ) examines volume, characteristics, and costs of operating room (OR) procedures in the United States during 2011. Overall, the brief states that hospitalizations that involved OR procedures account for 29 percent of 38.6 million hospital stays and 48 percent of the total $387 billion in hospital costs. Six of the top 20 OR procedures with the highest aggregate hospital costs that year were musculoskeletal procedures. In addition, five musculoskeletal procedures—knee arthroplasty, laminectomy, spinal fusion, hip replacement, and treatment of hip or lower extremity fracture or dislocation—together account for about 17 percent of all OR procedures.  Read more…
Read the report (PDF)…

Other News
2. In light of increased scrutiny, some drug companies cut physicians’ speaking fees.
An analysis conducted by ProPublica finds that, amid increased scrutiny of pharmaceutical industry payments to physicians, use of speaker fees has dropped off significantly. According to the publication, at least three major drug companies reduced such payments by 40 percent to 62 percent from the previous year. In addition, a fourth company is no longer paying physicians to speak on behalf of its products. Among other things, the Physician Payment Sunshine Act—called for under the Affordable Care Act—will soon require all pharmaceutical and medical device companies to publicly report payments to physicians. The first disclosures, covering the period August–December 2013, are expected to be posted in September 2014.   Read more…

3. CDC: Hospital antibiotic prescribing patterns vary; some practices may lead to an increase in infection.
A Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC) examines antibiotic prescribing practices and finds that clinicians in some hospitals prescribe up to 3 times as many antibiotics as clinicians in similar areas of other hospitals. The report also projects that decreasing the use of antibiotics that most often lead to Clostridium difficile infection by 30 percent would lead to a 26 percent reduction in such infections. CDC offers the following checklist designed to help hospitals improve antibiotic prescribing:

  • Dedicate the necessary human, financial, and information technology resources
  • Appoint a single leader responsible for program outcomes
  • Appoint a single pharmacist leader to support improved prescribing
  • Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose, and duration
  • Monitor prescribing and antibiotic resistance patterns
  • Regularly report prescribing and resistance information to clinicians
  • Offer education about antibiotic resistance and improving prescribing practices

Read more…
Read the press release…
Read the report…

4. Study: Straight nails may be linked with fewer complications than curvilinear nails for treatment of displaced proximal humerus fractures.
According to a study published in the March issue of the Journal of Shoulder and Elbow Surgery, the use of straight intramedullary nails for treatment of displaced proximal humerus fractures may be associated with a comparable union rate and reduced likelihood of complication, compared to an accepted curvilinear design. The authors conducted a randomized, controlled trial of 52 patients with Neer’s 2- or 3-part proximal humerus fractures, 26 of whom were treated with a new, straight humeral nail and 26 of whom were treated with a curvilinear nail. At mean 14-month follow-up, they found that all but one fracture achieved radiographic union. However, rotator cuff disease was present in 9 of 26 patients (34.6 percent) in the straight nail cohort and 19 of 29 patients (73.0 percent) in the curvilinear nail cohort. In addition, the mean neck-shaft angle at final follow-up was 135° in the straight nail group and 130° in the curvilinear nail group, and the reoperation rate was 11.5 percent in the straight nail group and 42 percent in the curvilinear nail group.
Read the abstract…

5. Florida.
The Orlando Sentinel reports that participants in a Stark case have agreed in principle to settle for $85 million. A whistle blower had alleged that payments made by a Florida hospital to six cancer physicians and three neurosurgeons violated the federal Stark law, which makes it illegal for physicians to financially benefit from referring patients for hospital care. A second trial addressing allegations that the hospital made a practice of admitting patients unnecessarily, then billing government payers for their care, is planned to begin in July.   Read more…

6. Washington.
According to The Spokane Spokesman-Review, lawmakers have stripped plans to include a mandatory insurance claims database from a proposed state law designed to increase transparency in healthcare. A spokesperson for the state’s largest health insurer—which supported the change—argues that price information is not “actionable” unless presented alongside information about a consumer’s own coverage details such as deductibles and co-pays, and states that contributing to the database would be expensive and time-consuming. Critics respond that the move will reduce transparency, and point out that similar databases already exist in at least 10 states.   Read more…

7. Apply now for the 2014 AAOS/OREF/ORS Clinician Scholar Development Program.
March 31 is the last day to submit your application to participate in the Clinician Scholar Development Program (CSDP). The program is a joint project of AAOS, the Orthopaedic Research and Education Foundation (OREF), and the Orthopaedic Research Society (ORS). CSDP 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 CSDP 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. 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 Course 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)

March 7, 2014

Today’s Top Story
1. Individual mandate poses challenge to SGR reform bill.
Politico reports that some members of the U.S. House of Representatives are considering a proposal to fund replacement of the Medicare Sustainable Growth Rate (SGR) formula through a repeal of the individual mandate requirement in the Affordable Care Act (ACA). Recent legislation to replace the SGR has received wide bipartisan support, but negotiations have slowed as Republicans and Democrats have been unable to agree on a path to fund the legislation. House rules require that any spending increase must be balanced by cuts elsewhere. Although the individual mandate is controversial, it remains a key part of funding the ACA and the repeal proposal is viewed as a potential deal breaker for the Senate and President Obama. A short-term agreement to prevent physician pay cuts called for under the SGR is set to expire on March 31, 2014, at which time providers will see an estimated 24 percent reduction in reimbursement.   Read more…
Read the AAOS response…

Other News
2. Study: Synovial fluid biomarkers linked to presence of PJI.
Findings from a study published online in the journal Clinical Orthopaedics and Related Research (CORR) suggest that synovial fluid biomarkers may help diagnose periprosthetic joint infection (PJI). The authors conducted a prospective, diagnostic study in which they collected synovial fluid from 95 patients who were being evaluated for a revision hip or knee arthroplasty. They found five biomarkers—human alpha-defensin 1-3, neutrophil elastase 2, bactericidal/permeability-increasing protein, neutrophil gelatinase-associated lipocalin, and lactoferrin—that correctly predicted the Musculoskeletal Infection Society classification of all patients in the study, with 100 percent sensitivity and specificity for diagnosis of PJI. In addition, eight other biomarkers tested demonstrated excellent diagnostic strength.
Read the abstract…
A summary of the study, which was presented at the 2013 American Association of Hip and Knee Surgeons Annual Meeting, appeared in the January 2014 issue of AAOS Now.  Read more…

3. Study: BMAC plus PRP may slightly improve healing in patients undergoing distraction osteogenesis of the tibia.
A study published online in the journal CORR finds that an injection of autologous bone marrow aspirate concentrate (BMAC) combined with platelet-rich plasma (PRP) may have a small but positive effect on bone healing for patients undergoing distraction osteogenesis of the tibia. The researchers conducted a randomized trial of 20 patients (40 tibias) undergoing bilateral tibial lengthening. Overall, 10 patients (20 segments) received BMAC combined with PRP injection (treatment group) and 10 patients (20 segments) received no injection (control group). The researchers found no difference in mean external fixator index between groups. However, mean cortical healing indexes demonstrated faster healing in the treatment group at each cortex, and full weightbearing was permitted earlier in the treatment group than in the control group.
Read the abstract…

4. President’s proposed 2015 budget adjusts healthcare spending priorities.
An article in Modern Healthcare breaks down the healthcare aspects of President Obama’s proposed 2015 budget. The authors note that the proposal contains more than $400 billion in cuts to Medicare over the next decade, but many of those cuts take place in future years. Critics argue that the proposed cuts could jeopardize teaching hospitals due to a $14.6 billion reduction in spending for medical education. In addition, the budget includes $770 million in savings by prohibiting pharmaceutical companies from delaying the availability of generic drugs, and a 7.6 percent reduction in discretionary spending at the U.S. Department of Health and Human Services. The budget allocates $629 million to running the HealthCare.gov website and $25 million over 2 years to prevent fraud in both state and federal health insurance exchanges.
Read more…

5. Study: Chair stand and grip strength tests may predict decline in physical performance for patients with distal radial fracture due to a fall.
A study published in the March 5 issue of The Journal of Bone & Joint Surgery suggests that differences in chair stand test scores and grip strength may predict a decrease in physical performance among patients with distal radial fracture. The authors conducted a prospective case control study of 40 postmenopausal women older than age 50 who had sustained a distal radial fracture due to a fall and 40 age-matched controls without a recent history of falls. They found no significant difference in the Short Physical Performance Battery summary score between the two groups. However, patients with distal radial fracture demonstrated significantly lower scores for chair stand and grip strength, compared to patients in the control cohort.
Read the abstract…

6. Study: Resorbable silk screws may someday help fractures heal.
Data from a rat study published online in the journal Nature Communications suggest that self-tapping, resorbable screws prepared from silk fibroin may have efficacy for fracture fixation. The research team assessed the screws in vivo in rat femurs and found that the screws remained fixed in the bone at 4- and 8-week follow-up, exhibited biocompatibility, and promoted bone remodeling. They found that the silk-based devices compare favorably with current poly-lactic-co-glycolic acid fixation systems, in addition to displaying advantages such as ease of implantation, conformal fit to the repair site, sterilization by autoclaving, and minimal inflammatory response.   Read more…
Read the abstract…

7. OARSI releases evidence-based guidelines for nonsurgical treatment of knee OA.
The Osteoarthritis Research Society International (OARSI) has released new evidence-based guidelines for the non-surgical treatment of osteoarthritis (OA) of the knee. The guidelines recommend a set of core treatments— including land-based exercise, weight management, strength training, water-based exercise, and self-management and education—as appropriate for all individuals. In addition, for patients who have OA of the knee only and no other health problems, the guidelines recommend biomechanical interventions such as knee braces, corticosteroid injections to the joint, topical NSAIDs, walking canes, oral selective NSAIDs, capsaicin, oral non-selective NSAIDs, the prescription drug duloxetine, and acetaminophen/paracetamol as appropriate treatments. The international panel that developed the guidelines also determined that some treatments— including electrotherapy/neuromuscular electrical stimulation, and the drug risedronate—are inappropriate for any category of patients. In addition, the guidelines classify chondroitin and glucosamine as not appropriate for the purpose of reversing or slowing disease progression.   Read more…
Read the abstract…
AAOS has released its own set of guidelines and appropriate use criteria for management of knee OA.
Read the AAOS Clinical Practice Guideline on Treatment of Osteoarthritis of the Knee (PDF)…
Read the AAOS Appropriate Use Criteria for Non-Arthroplasty Treatment of Osteoarthritis of the Knee (PDF)…

8. Now is the time to complete your 2011 OSAE (SAE10).
The next scoring of the Academy’s 2011 Orthopaedic Self-Assessment Examination (OSAE/OKU10) scored and recorded exam is scheduled for March 31, 2014. The 2011 Orthopaedic Self-Assessment Examination, purchased with OKU10, allows you to earn up to 70 of the 120 CME Credits required by the American Board of Orthopaedic Surgery’s (ABOS) maintenance of certification (MOC) process. The 2011 OSAE completely fulfills the 20-credit Scored and Recorded Self-Assessment requirement of the ABOS MOC process. Submit your OSAE answers for confidential scoring to the AAOS Examinations and Scoring Center and complete the CME evaluation to receive CME credit. CME credit for this program expires on May 31, 2014.

March 11, 2014

Today’s Top Story
1. Another SGR extension likely.
According HealthLeaders Media, the co-chair of the Republican Doctors Caucus says that Congress is unlikely to repeal and replace the Medicare Sustainable Growth Rate (SGR) formula before March 31, making it likely that physicians will see at least one more extension agreement before the issue can be settled. On April 1, physicians face an estimated 24 percent reduction in Medicare reimbursement called for under the SGR. There has been generally bipartisan support for a new system to replace the SGR, but Republicans and Democrats have been unable to agree on a path to fund the legislation. Rules in the U.S. House of representatives require that any spending increase must be balanced by cuts elsewhere.   Read more…

Other News
2. Last chance to vote 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)

3. Study: Statins may reduce incidence of VTE in TKA, THA patients.
When statins are combined with conventional prophylactic therapy for venous thromboembolism (VTE), they significantly reduce the risk of VTE after total knee arthroplasty (TKA) and total hip arthroplasty (THA), according to data presented on Scientific Poster P204, currently on display at the AAOS Annual Meeting. Of 417 randomly selected patients who underwent TKA or THA during a 7-year period at a single institution, the control group (n = 221) was not on statin therapy, while the statin group (n = 196) had already been taking statins before surgery and continued taking hypercholesterolemia medications at the same dosage after surgery. At minimum 11-month follow-up, VTE events had occurred in 32 patients (14.5 percent) in the control cohort compared to just 15 patients (7.7 percent) in the statin group.   Read more…
Read the abstract…
AAOS has set up a website to view Scientific Posters electronically. To view this poster, simply click the following link, select the “search” button, and enter “#P204” (without quotes, with pound sign) in the search field, then click the “find” button. When the poster title comes up, click that, then click the “view ePoster” button.  Search AAOS Scientific Posters…

4. Study: Implant labeling system linked to fewer errors, decreased costs in TKA.
Data presented from Scientific Poster P170, currently on display at the AAOS Annual Meeting, suggest that a computer-based labeling and compatibility system may decrease costs and waste associated with TKA. The investigators conducted a 1-year prospective study of six orthopaedic surgeons who performed 461 TKAs while using an e.Label system, in which a standardized electronic label is created by scanning a barcode on each arthroplasty implant, and compared those findings against a retrospective analysis of a 1-year period before implementation of the e.Label system. They found that 83 implants (5.7 percent) were wasted by the same surgeons before implementation of the labeling system, while four implants (0.9 percent) were wasted after implementation of the system. During the study period, the e.Label system also helped avoid implantation of one wrong-sided implant.   Read more…
Read the abstract…
AAOS has set up a website to view Scientific Posters electronically. To view this poster, simply click the following link, select the “search” button, and enter “#P170” (without quotes, with pound sign) in the search field, then click the “find” button. When the poster title comes up, click that, then click the “view ePoster” button.
Search AAOS Scientific Posters…

5. Gov. Bobby Jindal to speak at AAOS Opening Ceremony.
Gov. Bobby Jindal of Louisiana will appear as a special guest of AAOS President Joshua J. Jacobs, MD, at the AAOS Opening Ceremony, Wednesday, March 12, 4 p.m., at the La Nouvelle Ballroom in the Morial Convention Center. Gov. Jindal has also served as Assistant Secretary for the U.S. Department of Health and Human Services, as Secretary of the Louisiana Department of Health and Hospitals, and represented Louisiana’s first Congressional district for two terms before being elected governor.   Read more…

Read the AAOS Now Daily Edition, which features reports from the AAOS Annual Meeting!

March 12, 2014

Today’s Top Story
1. MU hardship exemption expanded; Stage 3 recommendations approved.
FierceHealthIT reports that the U.S. Centers for Medicare & Medicaid Services (CMS) has updated language in its Meaningful Use (MU) hardship exception applications for FY 2015 to include “2014 EHR vendor issues.” The exemption would apply if the electronic health record (EHR) vendor was unable to obtain 2014 certification or the provider would be unable to implement Meaningful Use due to 2014 EHR certification delays. Eligible professionals will have until July 1, 2014, to apply for an exemption. A similar update is being made for hospitals as well, with an application deadline of April 1, 2014. If approved, an exemption will be valid for 1 payment year. CMS states that determinations on exemptions are final and cannot be appealed.   Read more…
Read the CMS statement (PDF)…
In addition, Government Health IT reports that members of the U.S. Health IT Policy Committee have approved a set of recommendations for Stage 3 MU. Among the objectives included in the recommendations:

  • Clinical decision support
  • Unique device identifiers
  • Patient generated health data
  • Patient education
  • Summary of care at transitions
  • Registries

Read more…

Other News
2. AAOS Board adopts new strategic plan, mission statement.
At the March 10 meeting of the AAOS Board of Directors, the Board adopted a new strategic plan, mission statement, and vision statement for AAOS. “Vision 20/20” outlines the Academy’s core values and strategic domains, which are supported by essential components, goals, objectives, and strategies. Based on a proposal from the Strategic Planning Project Team, the Board adopted the following mission statement: Serving our profession to provide the highest quality musculoskeletal care. In addition, the Board accepted the following core values:

  • Excellence—Develop, encourage, and reward the highest standards in all of our endeavors.
  • Professionalism—Be accountable for the highest professional, clinical, and ethical standards to our peers, our patients, and the public with integrity and transparency.
  • Leadership—Champion the development and advancement of future leaders, through example, education, and experience in our organization, our practices, and the world.
  • Collegiality—Embrace diversity and unity with our patients, our profession, and our stakeholders.
  • Lifelong Learning—Commit to professional education by advancing the science and art of orthopaedic medicine for the needs of our patients.

Read more…

3. Study: Disk herniation surgery may yield societal savings in the medium- to long-term.
Data from a study published in the April issue of the journal Clinical Orthopaedics and Related Research suggest that increased worker earnings after disk herniation surgery may offset increased medical costs associated with that surgery. The authors drew data from the National Health Interview Survey to assess the effects of lower back pain associated with disk herniation on earnings and missed workdays. They estimate that patients who undergo disk herniation surgery earn an average of $1,925 more per year than those who don’t, and miss 3 fewer days of work per year than those who are treated nonsurgically. After accounting for the effects on productivity, the authors find that disk herniation surgery yields net societal savings if the benefits of outpatient and inpatient surgery persist beyond 6 and 12 years, respectively.   Read more…

4. AAOS Now stem cell forum draws participation from wide range of experts.
At the AAOS Now-sponsored Forum: “Stem Cells in Orthopaedics: Myth, Miracle, or Something In-Between” on March 10, an international group of clinicians, scientists, and regulators examined the research behind orthopaedic applications of stem cells and addressed the clinical and ethical issues surrounding the growth of this treatment option. Participants covered areas ranging from basic science to stem cell use in regenerative medicine, nonunions and fractures, and spine and sports medicine, and also addressed practical concerns such as cost and availability; safety, culture, and storage; and regulatory issues. A series of in-depth reports on these issues is planned for upcoming issues of AAOS Now.   Read more…

5. CMS seeks healthcare providers to assist with ICD-10 test.
CMS seeks Medicare claims submitters to help conduct limited end-to-end testing of ICD-10, to demonstrate that CMS systems are ready for the ICD-10 implementation. Each Medicare Administrative Contractor and the Common Electronic Data Interchange contractor will post a volunteer form to their websites to collect information with which to select volunteers. Volunteers must submit the completed forms by March 24, 2014. Test claims will be submitted from July 21 to 25, 2014, and will be limited to a total of 50 claims for the entire testing week, submitted in no more than three files.   Read more (PDF)…

6. Presidential Guest Speakers Steve and Cokie Roberts to address Annual Meeting attendees.
Presidential Guest Speakers Steve and Cokie Roberts will address AAOS Annual Meeting attendees immediately following tomorrow’s Business and Ceremonial Meetings. Mr. Roberts spent 25 years with The New York Times, serving as bureau chief in Los Angeles and Athens, and as a Congressional and White House correspondent. He is the Shapiro Professor of Media and Public Affairs at George Washington University and appears regularly on National Public Radio (NPR), CNN’s Reliable Sources, and the ABC radio network. Ms. Roberts has been a broadcast journalist for more than 40 years and is currently the senior news analyst for NPR and provides political analysis for all ABC network news programming. The duo will present “A View from Washington,” beginning at 11 a.m., Thursday, March 13, in the La Nouvelle Ballroom of the Morial Convention Center.   Read more…

Read the AAOS Now Daily Edition, which features reports from the AAOS Annual Meeting!

March 13, 2014

Today’s Top Story
1. Study: Trauma center closures linked to increase in mortality for injured patients.
A study to be published in the April issue of The Journal of Trauma and Acute Care Surgery finds a strong association between closure of trauma centers in California and increased mortality for patients with injuries. The researchers retrospectively reviewed data on all adult patient visits for injuries at Level I and II nonfederal trauma centers in California from 1999 through 2009. They found that the odds of inpatient mortality increased by 21 percent among trauma patients who experienced an increased drive time to their nearest trauma center as a result of a trauma center closure.   Read more…

Other News
2. Study: Aseptic protocol may reduce incidence of SSI among hip arthroplasty patients.
Data from Scientific Poster P001, presented at the AAOS Annual Meeting, suggest that use of a comprehensive aseptic protocol may reduce the likelihood of surgical site infection (SSI) for high-risk patients undergoing hip arthroplasty. The researchers conducted a prospective cohort study of 774 patients undergoing primary or revision hip arthroplasty at a single center. All patients were treated with the same aseptic protocol, consisting of preoperative mupirocin nasal ointment and surgical-site chlorhexidine wipes, modified instrument care, perioperative prophylactic vancomycin and cefazolin, and surgical site skin preparation with chlorhexidine, alcohol, and iodophor. They found that the overall SSI rate among protocol patients was 0.39 percent—significantly lower than the institution’s historic rate and significantly lower than that of six previously published reports.
Read the abstract…

AAOS has set up a website to view Scientific Posters electronically. To view this poster, simply click the following link, select the “search” button, and enter “#P001” (without quotes, with pound sign) in the search field, then click the “find” button. When the poster title comes up, click that, then click the “view ePoster” button.
Search AAOS Scientific Posters…

3. Kappa Delta and OREF Awards presented.
During yesterday’s Opening Ceremonies at the AAOS 2014 Annual Meeting in New Orleans, the 2014 Kappa Delta and Orthopaedic Research and Educational Foundation (OREF) Awards were presented. The award winners will present their papers on Sunday, March 16, during the Orthopaedic Research Society (ORS) annual meeting, being held at the Hyatt Regency New Orleans. AAOS Annual Meeting attendees are invited to attend at no cost; however, they must have a sticker for their badges. Stickers can be obtained at the ORS satellite check-in/registration desk in Lobby E of the Morial Convention Center on Friday. The award winners are:

  • Brian T. Feeley, MD—2014 Kappa Delta Young Investigator Award for research into the molecular pathways that govern muscle atrophy and fatty infiltration in rotator cuff tears.
  • Freddie H. Fu, MD—2014 Kappa Delta Elizabeth Winston Lanier Award for his paper detailing the results of three decades of research into techniques and concepts to repair ruptured anterior cruciate ligaments.
  • Ken Yamaguchi, MD, MBA—2014 Ann Doner Vaughn Kappa Delta Award for his longitudinal, prospective follow-up study of a large cohort of patients with asymptomatic rotator cuff tears.
  • James N. Weinstein, DO, MS—OREF Clinical Research Award for his paper comparing surgical and nonsurgical outcomes for intervertebral disk herniation, spinal stenosis, and degenerative spondylolisthesis.

Read more about Dr. Feeley…
Read more about Dr. Fu…
Read more about Dr. Yamaguchi…
Read more about Dr. Weinstein…

4. AAOS public service campaign addresses a variety or orthopaedic topics.
AAOS has unveiled its new print and radio public service campaign. This year’s campaign features a new radio spot with the theme of “Patient Safety: It Takes a Team.” The ad encourages patients “not just to lie there but, instead, to join their surgical team and to take an active role in their medical care for the best outcomes.” In addition, print ads touch on scoliosis awareness, falls prevention, and the Academy’s successful Decide to Drive® campaign. On the television side, AAOS is reprising its award-winning “Lazy Bones” spot, in which overweight family members go to absurd lengths to avoid activity.   Read more…
Access all current AAOS Public Service Announcements…

5. Adapting to the post-healthcare reform era—don’t miss Symposium W!
“Health Care Reform: How Can We Adapt?” (Symposium W) will examine the changing landscape of orthopedic practice and provide real solutions necessary to not only weather those changes but to excel. The symposium will feature presentations from AAOS PresidentJoshua J. Jacobs, MD; Thomas C. Barber, MD; M. Bradford Henley, MD, MBA, FACS; Alexandra E. Page, MD; Peggy L. Naas, MD, MBA; and Craig A. Butler, MD, MBA. It will be moderated by Dr. Butler and Thomas J Grogan, MD. Symposium W will be held 8 a.m. to 10 a.m. CT in La Nouvelle Ballroom at the Morial Convention Center in New Orleans.

6. Did you know that AAOS Now is available as an ebook?
In addition to being available on the AAOS website, the March 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)

Read the AAOS Now Daily Edition, which features reports from the AAOS Annual Meeting!


March 14, 2014

Today’s Top Story
1. House passes SGR repeal along with individual mandate delay.
Modern Healthcare reports that the U.S. House of Representatives has passed a bill that, if enacted, would repeal the Medicare Sustainable Growth Rate (SGR) formula, and fund the cost of that repeal in part by placing a 5-year delay on the individual mandate called for under the Affordable Care Act (ACA). Although the individual mandate is controversial, it is a key part of funding the ACA and its repeal is viewed as a deal breaker for the Senate and President Obama. A short-term agreement to prevent physician pay cuts called for under the SGR is set to expire on March 31, 2014, at which time providers will see an estimated 24 percent reduction in reimbursement.  Read more…

Other News
2. Best Poster awarded to study of autograft versus allograft in ACL reconstruction.
During the “Breakfast in the Posters” event at the AAOS Annual Meeting this morning, Brian J. Cole, MD, recognized Poster P427, “Prospective Comparative Study of ACL Reconstruction between Using Hamstring Autograft and Soft-Tissue Allograft” as the best overall poster for the 2014 Annual Meeting. The authors conducted a prospective study of 161 patients who underwent anterior cruciate ligament (ACL) reconstruction using either hamstring autograft or soft-tissue (tibialis anterior) allograft. At 4-year follow-up, they found that although both cohorts showed similar functional and radiological outcomes, patients in the autograft group displayed fewer complications compared with those in the soft tissue allograft group.
Read the list of best posters from the AAOS Annual Meeting…

Read the abstract of Poster P427…
AAOS has set up a website to view Scientific Posters electronically. To view this poster, simply click the following link, select the “search” button, and enter “#P427” (without quotes, with pound sign) in the search field, then click the “find” button. When the poster title comes up, click that, then click the “view ePoster” button.
Search AAOS Scientific Posters…

3. New AAOS Board members announced.
At the end of the AAOS Business Meeting during the 2014 AAOS Annual Meeting, AAOS President Joshua J. Jacobs, MD, introduced the new members of the AAOS Board of Directors. They include:

  • Gerald R. Williams, Jr., MD—Second Vice President
  • Ken Yamaguchi, MD, MBA—Treasurer-elect
  • Raj D. Rao, MD—Member-at-large (Age 45 or older)
  • Jennifer M. Weiss, MD—Member-at-large (Under age 45)
  • Lawrence S. Halperin, MD—Board of Councilors Secretary
  • Brian G. Smith, MD—Board of Specialty Societies Secretary

Read more…

4. Study: Variety of factors affect complication rates after knee arthroscopy.
Scientific Presentation 452 at the AAOS Annual Meeting examines factors affecting the likelihood of complication following elective knee arthroscopy. The researchers drew data on 12,271 cases of elective knee arthroscopy from the American College of Surgeons National Surgical Quality Improvement Program database and found that the overall incidence of any complication was 1.6 percent (199 patients). They noted that the most frequent major complication was a return to the operating room, while the most common minor complication was deep venous thrombosis or thromboplebitis. Risk factors for any complication included Black race, prior operation within 30 days, American Society of Anesthesia class 3 or 4, and operative time greater than 1.5 hours.   Read more…
Read the abstract…

5. Don’t miss out on Specialty Day!
Saturday, March 15, is Specialty Day at the AAOS Annual Meeting. Specialty Day is a day set aside for scientific programs presented by organizations that are members of the Board of Specialty Societies. Seventeen orthopaedic specialty societies—from the American Orthopaedic Foot & Ankle Society to the Pediatric Orthopaedic Society of North America—will be presenting the latest research and updates on surgical techniques.   Read more…

Read the AAOS Now Daily Edition, which features reports from the AAOS Annual Meeting!


March 17, 2014

Today’s Top Story
1. Study: Growth in prescribing of opioid analgesics in U.S. EDs appears to outpace increase in pain-related complaints.
Findings from a study published in the March issue of the journal Academic Emergency Medicine suggest that growth in the prescribing of opioid analgesics in U.S. emergency departments (EDs) has outpaced a rise in pain-related complaints over the last 10 years. The research team drew data from the National Hospital Ambulatory Medical Care Survey and found that between 2001 and 2010, the percentage of overall ED visits where any opioid analgesic was prescribed increased from 20.8 percent to 31.0 percent. Overall, use of schedule III through V agents increased from 12.6 percent in 2001 to 15.6 percent in 2010, an absolute increase of 3.0 percent and a relative increase of 23.8 percent. The prescribing of hydrocodone, hydromorphone, morphine, and oxycodone all increased significantly during that period, while codeine and meperidine use declined. Over the same span, prescribing of nonopioid analgesics did not change significantly, increasing from 26.2 percent in 2001 to 27.3 percent in 2010. The percentage of visits for painful conditions during the period increased from 47.1 percent in 2001 to 51.1 percent in 2010, an absolute increase of 4.0 percent.   Read more…
Read the abstract…

Other News
2. Study: Suture loaded with MSCs could promote healing of Achilles tendon after repair.
Data from a rat study published in the March issue of Foot and Ankle International suggest that embedding stem cells directly into a suture may enhance healing after Achilles tendon repair. The researchers conducted a randomized study of 108 rat tendons repaired with either suture only, suture plus injection of mesenchymal stem cells (MSCs), or suture loaded with MSCs. They found that both MSC groups were associated with increased ultimate failure strength compared to controls. In the MSC injection cohort, ultimate failure strength decreased significantly at 28 days compared to 14 days. In addition, histology score in the suture-loaded group was significantly improved compared to both other groups.   Read more…
Read the abstract…

3. Study: Implementation of surgical checklists not associated with significant reductions in surgical mortality or complication rates.
A Canadian study published in the March 13 issue of The New England Journal of Medicine suggests that implementation of surgical safety checklists may not be associated with significant reductions in surgical mortality or complications. The research team surveyed all acute care hospitals in Ontario for 3-month periods before and after adoption of a surgical safety checklist, and found that the adjusted risk of death during a hospital stay or within 30 days after surgery was 0.71 percent before implementation of a surgical checklist and 0.65 percent afterward. The adjusted risk of surgical complications was 3.86 percent before implementation and 3.82 afterward.
Read the abstract…

An accompanying editorial suggests that time periods examined by the researchers (3 months before and after introduction) may be too short to fully gauge the impact of checklist use. “It is not the act of ticking off a checklist that reduces complications,” the author writes, “but performance of the actions it calls for.” The author notes that implementation of a checklist system is difficult, and many hospitals may “lack the resources or expertise to organize and lead a checklist-implementation effort or to manage the changes needed, collect data, and build teams.”   Read more…

4. Study: Blood biomarkers appear to indicate concussion.
According to data from a Swedish study published online in the journal JAMA Neurology, blood biomarkers may indicate concussion in athletes. The authors conducted a multicenter, prospective cohort study of 228 players in the Swedish Hockey League. They found that concussed players had increased levels of the axonal injury biomarker total tau and the astroglial injury biomarker S-100 calcium-binding protein B, compared against baseline, preseason values. The highest biomarker concentrations of total tau and S-100 calcium-binding protein B were measured immediately after a concussion, and decreased during rehabilitation. The authors detected no significant changes in levels of neuron-specific enolase from preseason to post-concussion values. The authors suggest that such factors may be developed into clinical tools to guide sports medicine physicians in return-to-play decisions.   Read more…
Read the complete study…

5. Study: ACL reconstruction associated with increased risk of OA in the long term.
Study data presented at the Specialty Day meeting of the American Orthopaedic Society for Sports Medicine suggest that adolescents who undergo anterior cruciate ligament (ACL) reconstruction may be at long-term increased risk of osteoarthritis (OA) in their injured knees. The research team evaluated 29 patients aged 12 years to 16 years who underwent reconstruction for symptomatic unilateral ACL rupture using bone-patellar bone-tendon or hamstring tendon autograft. At a mean follow-up of 14 years, 7 months, they found that reconstructed knees displayed significantly more osteoarthritic changes compared to the non-involved contralateral knee.   Read more…
Read the abstract (PDF, paper 6)…

6. Arizona.
The Arizona Republic reports that stronger credential checks have been linked to growing wait times for the processing of physician license applications. Last year, a report from the Arizona Ombudsman—Citizens’ Aide found that Arizona Medical Board staff had inadequately vetted more than 2,000 physicians, requiring the board to recheck their credentials. Arizona law requires physicians to provide “primary source” credentials such as medical school transcripts, certifications from medical specialty boards, and verification of work history, but state officials accused the board of attempting to streamline the process by allowing paperless applications and online database checks. According to the paper, the increased scrutiny has caused wait times for physician licenses to increase from an average of 11 days to 61 days.   Read more…

7. Last call: 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, 2014, at 11:59 p.m. CT to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)

March 19, 2014

Today’s Top Story
1. FDA announces recall of 1 percent Lidocaine HCl Injection from Merit Medical Systems Custom Procedural Trays/Kits.
The U.S. Food and Drug Administration (FDA) has announced a manufacturer recall of 1 percent Lidocaine HCl Injection contained in Custom Procedural Trays/Kits manufactured by Merit Medical Systems, Inc. The trays/kits were recalled due to one confirmed customer report of visible particulate, which has been identified as oxidized stainless steel. The presence of oxidized stainless steel particulate may potentially put a patient at risk from a strong magnetic field exposure such as with magnetic resonance imaging. If a metal particle in the lung becomes dislodged and pulled through tissue, possibly causing a collapsed lung (pneumothorax) or blood in the space between the chest wall (hemothorax), urgent and significant medical intervention may be required. The presence of oxidized stainless steel particulate could also result in blood clots in the lung and a stroke.   Read more…

Other News
2. CMS to accept comments on proposal to identify improper PQRS and eRx payments.
The U.S. Centers for Medicare & Medicaid Services (CMS) has unveiled a proposal to evaluate incentive payments made under the Physician Quality Reporting System (PQRS) and the Electronic Prescribing Incentive (eRx) Program, with the goal of identifying and recovering improper payments made under those initiatives. CMS plans to analyze data submission, processing, and reporting for potential errors, inconsistencies, and gaps related to data handling, program requirements, and clinical quality measure specifications of the PQRS and eRx programs. CMS will accept public comments on the proposal for 60 days, starting with its March 17 publication in theFederal Register.   Read more…
Read the CMS statement…

3. Study: No significant differences in outcomes for three septic shock treatments.
Data from a study published online in The New England Journal of Medicine suggest that protocol-based resuscitation of patients with septic shock diagnosed in the emergency department (ED) may not improve outcomes. The authors conducted a randomized, multicenter trial of 1,341 patients across 31 EDs in the United States. Overall, 439 were randomly assigned to protocol-based early goal-directed therapy, 446 to protocol-based standard therapy, and 456 to usual care. The authors found no significant differences between cohorts in 90-day mortality, 1-year mortality, or need for organ support.   Read more…
Read the abstract…
An accompanying editorial notes that one important contribution of the study is “the evidence it provides regarding the ongoing role of early recognition of and antibiotic treatment for sepsis in improving survival.”   Read more…

4. Study: Most physician practices say they have no plans to participate in an ACO.
A study published online in the journal Health Services Research finds that more than half of physician practices surveyed have no plans to become involved in an accountable care organization (ACO). The researchers conducted a series of 40-minute phone surveys across a variety of physician practices and found that 23.7 percent (n = 280) reported joining an ACO, 15.7 percent (n = 186) were planning to become involved within the next 12 months, and 60.6 percent (n = 717) reported having no involvement and no plans to become involved. The researchers note that, compared to nonparticipating practices, physician practices involved with ACOs tended to be larger, to be members of an independent practice association or a physician-hospital organization, and to use more care-management processes. They were less likely to be hospital-owned.   Read more…(registration may be required)
Read the abstract…

5. AMA offers resources for dealing with ACA insurance “grace period.”
The American Medical Association (AMA) has announced the availability of a set of resources designed to guide physicians on navigating a little-known rule in the Affordable Care Act (ACA) that provides individuals who purchase subsidized coverage through the state insurance exchanges a 90-day grace period before their coverage is cancelled for nonpayment. Under the rule, insurers in health exchanges are required to pay any claims incurred during the first 30 days of the grace period, but they are not required to pay claims incurred during the last 60 days for any patient whose coverage is terminated, placing healthcare providers at risk for uncompensated care. The AMA resources include:

  • Guide to the ACA grace period
  • Grace period collections policy checklist
  • Model financial agreement language for patients who receive Advance Premium Tax Credits
  • Sample grace period notice to patients

Read more…

6. Florida.According to the South Florida Business Journal, the Florida Supreme Court has overturned a statewide cap on noneconomic damages in certain medical liability cases. The court voted 5-2 to scrap the cap on noneconomic damages of $500,000 for doctors and $1 million for hospitals and clinics when a patient dies, but left in place noneconomic damage caps when a patient survives. A spokesperson for the Florida Medical Association states that the ruling will make it more difficult to practice medicine in the state. One observer notes that the caps may have prevented attorneys from taking cases that didn’t have a high level of economic damages, and removing the caps may open the door for such cases to be filed.   Read more…

7. Apply now for the 2014 AAOS/OREF/ORS Clinician Scholar Development Program.March 31 is the last day to submit your application to participate in the Clinician Scholar Development Program (CSDP). The program is a joint project of AAOS, the Orthopaedic Research and Education Foundation (OREF), and the Orthopaedic Research Society (ORS). CSDP seeks applicants in years PGY2 to PGY5 of orthopaedic residency, as well as those who have completed their 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 CSDP 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. Call for volunteers: CMS TEP to develop quality measures to assess quality of outpatient care.
AAOS seeks to nominate members to serve on a technical expert panel (TEP) convened by CMS and the Yale-New Haven Hospital Center for Outcomes Research and Evaluation (CORE). CORE is developing a measure of hospital visits following outpatient surgery conducted in ambulatory surgery centers and potentially in hospital outpatient departments. TEP members are chosen to provide input based on their personal experience and training or organizational perspective, and to represent a diversity of perspectives and backgrounds. All applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, a letter of interest highlighting his or her expertise in the subject area, and a TEP conflict of interest form. The TEP conflict of interest form can be obtained by emailing Kyle Shah, Clinical Quality & Medical Affairs Coordinator, at the address below. All supporting materials must be submitted to Kyle Shah by April 1, 2014 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)
Learn more about TEPs and member responsibilities…

March 21, 2014

Today’s Top Story
1. Study: Higher metal ion levels correlated with larger MOM hip devices.
A study published in the March 19 issue of The Journal of Bone & Joint Surgery (JBJS) compares metal ion levels for patients who have undergone total hip arthroplasty (THA) using 28 mm and 36 mm metal-on-metal (MOM) hip devices, and 28 mm metal-on-polyethylene (MOP) hip devices. The authors conducted a blinded, randomized trial of 105 patients to one of the three treatment groups. At 5-year follow-up, they found that—with the exception of chromium in erythrocytes—cobalt and chromium ion levels in all blood sample types were significantly lower in patients who received MOP devices than in either of the two MOM groups. Cobalt in serum and erythrocytes showed significant increases from 2 to 5 years in the 36 mm MOM group, but similar increases were not seen in the 28 mm MOM group. At 5 years, five patients in the 36 mm MOM group and none in the 28 mm MOM group had cobalt or chromium levels of >7 parts per billion.
Read the abstract…

Other News
2. CBO estimates cost of SGR repeal at about $180 billion for 10 years.
A report released by the U.S. Congressional Budget Office (CBO) estimates that, if enacted now, repeal of the Medicare Sustainable Growth Rate (SGR) formula will cost $180.3 billion through 2024. The U.S. House of Representatives has already passed a bill to repeal the SGR. However, the bill funds the cost of that repeal in part by placing a 5-year delay on the individual mandate called for under the Affordable Care Act (ACA). Repeal or delay of the mandate is a deal breaker for the Senate and President Obama. Modern Healthcare notes that the Senate returns from recess on March 24. Legislators will need to act quickly on the SGR, as a short-term agreement to prevent physician pay cuts is set to expire on March 31, 2014, at which time providers will see an estimated 24 percent reduction in reimbursement.   Read more…(paid subscription may be required)
Read the report (PDF)…

3. Study: Opioid use after surgery for musculoskeletal trauma associated with increased psychological distress; greater symptoms and disability.
According to findings published in the March 19 JBJS, patients who continue to use opioid pain medication after surgery for musculoskeletal trauma are more likely to have psychological distress, less effective coping strategies, and greater symptoms and disability, compared to patients who do not take opioids. The research team compared outcomes for 145 patient operatively treated for musculoskeletal trauma, and found that those who scored higher on catastrophic thinking, anxiety, posttraumatic stress disorder, and depression questionnaires were significantly more likely to report taking opioid pain medications 1 to 2 months after surgery, regardless of injury severity, fracture site, or treating surgeon. In addition, patients using opioids had greater disability as measured by the Short Musculoskeletal Function Assessment score compared to those who reported not using opioids.
Read the abstract…

4. MedPAC offers 2015 payment analysis to Congress; continues to argue for replacement of SGR.
The Medicare Payment Advisory Commission (MedPAC) has released its March 2014 report to the U.S. Congress. Among other things, the report includes the commission’s analyses and recommendations for 2015 rate adjustments in fee-for-service (FFS) Medicare. MedPAC continues to advocate for repeal of the SGR. “The Commission sees SGR repeal as urgent because, after a decade of year-end legislative overrides, the policy is causing uncertainty for physician and other clinician practices and has the potential to create instability for beneficiaries,” the authors write. “The SGR also bogs down the policy process by focusing efforts on the yearly need to override negative fee schedule updates.” In addition, the authors argue that Congress should direct the Secretary of Health and Human Services (HHS) to identify overpriced fee-schedule services and reduce their relative value units accordingly, eliminate the update to the payment rates for ambulatory surgical centers (ASCs) for calendar year 2015, require ASCs to submit cost data, and direct the HHS secretary to implement a value-based purchasing program for ASC services no later than 2016.   Read more (PDF)…
Read the complete report (PDF)…

5. Monday deadline to volunteer for Medicare ICD-10 test.
March 24 is the last day to submit your application to participate in end-to-end testing with Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor to demonstrate that CMS and provider systems are ready for ICD-10 implementation on Oct. 1, 2014. The U.S. Centers for Medicare & Medicaid Services seeks Medicare claims submitters to help conduct limited end-to-end testing of ICD-10. Test claims will be submitted from July 21 to 25, 2014, and will be limited to a total of 50 claims for the entire testing week, submitted in no more than three files.   Read more (PDF, scroll down to “Volunteers Sought for ICD-10 End-to-End Testing: July 21-25”)…

6. Lawmaker urges greater accountability for RACs.
In a letter to HHS Secretary Kathleen Sebelius, Rep. Jim McDermott (D-Wash.) has expressed concern about a backlog in appeals related to payment denials from Medicare recovery audit contractors (RACs) that are currently pending with the Office of Medicare Hearings and Appeals (OMHA). The representative notes that RACs have been identified as a proximate cause of much of the additional workload that has fallen to OMHA, and points out that there is no associated penalty if an RAC collects money from a healthcare provider and the decision is overturned on appeal. The representative argues RAC accountability could be increased by assessing a financial penalty when decisions are successfully appealed.   Read more…
Read the letter (PDF)…

7. FDA: Number of device recalls increased 97 percent in 10 years.
According to a report from the U.S. Food and Drug Administration (FDA) Center for Devices and Radiological Health (CDRH), the annual number of medical device recalls increased 97 percent between FY 2003 and FY 2012, in part due to enhanced awareness by device manufacturers and specific CDRH efforts to improve safety. The report states that most Class I recalls were in the anesthesia, cardiovascular, chemistry, and general hospital specialties, while the orthopaedic, radiology, general hospital, and cardiovascular areas had the most Class II recalls. In addition, the report finds that in the last 3 years, CDRH reduced the average classification times for high risk Class I recalls by 9 days, and Class II by 26 days. CDRH states that the most frequent causes for recalls were related to device design, software, and non-conforming material or component issues.
Read the report (PDF)…

8. Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program (CAP) website are closing this week. Act now to apply for the following positions:

  • American Joint Replacement Registry Commission (three member openings)
  • Council on Graduate Medical Education (one liaison)
  • Physician Consortium for Performance Improvement (one liaison)

Learn more and submit your application…(member login required)

March 24, 2014

Today’s Top Story
1. CMS proposal marks shift from ACA implementation to refinement.
HealthLeaders Media reports that, under a proposal from the U.S. Centers for Medicare & Medicaid Services (CMS), health insurance exchanges created under the Affordable Care Act (ACA) would be adjusted to improve user experience and minimize the influence of state officials over consumer advisors. The proposed changes include adjustments for insurance companies, including:

  • Reallocating required reinsurance contributions so that the U.S. Department of Treasury is paid last
  • Increasing insurers’ permitted administrative expenses by 2 percent
  • Raising insurers’ “profit floor” from 3 percent to 5 percent for purposes of risk corridor adjustments

Observers say the move marks a shift on the part of CMS from launch and enrollment efforts under ACA to refining the operation of the exchanges.   Read more…
Read the proposal (large PDF)…

Other News
2. Study: Infection and instability most common causes of revision TKA.
A study published online in the journal Clinical Orthopaedics and Related Research attempts to identify reasons for revision of total knee arthroplasty (TKA). The research team reviewed the records of all (n = 253) first-time revision TKAs performed between 2001 and 2011 at a single institution. They found that early failure—defined as revision within 2 years—accounted for 46 percent of all revisions. Leading causes for early failure were instability (26 percent), infection (24 percent), and stiffness (18 percent). Late failure was most commonly associated with infection (25 percent), instability (18 percent), and stiffness (14 percent). Polyethylene wear was implicated as the failure mechanism in 2 percent of early revisions and 9 percent of late revisions.
Read the abstract…

3. Study: Delayed debridement associated with greater risk for higher grade open fractures.
Findings from a study published in the March issue of The Bone & Joint Journal suggest that delayed debridement may be safe for Gustilo-Anderson grade 1 open fractures, but not for higher grade fractures. The authors reviewed data on 364 consecutive patients (459 open fractures) from a single center. They found 46 deep infections and that the mean delay to debridement for all fractures was 10.6 hours (range 0.6 to 111.5 hours). No infections were found among the 55 grade I open fractures, while among the grade II and III injuries, the authors noted a statistically significant, linear increase in the rate of deep infection of 3 percent for each hour of delay. The authors found that risk of deep infection was additive and associated with tibial fractures, higher grade, and contamination of the fracture.
Read the abstract…

4. CMS rule change would set minimum advance notice for Medicare Advantage network changes.
According to Kaiser Health News, a set of rules proposed by CMS would, if adopted, help protect seniors when insurers remove physicians and other healthcare providers from their Medicare Advantage networks. The proposals would require insurers to notify providers at least 60 days in advance of a contract termination, and to provide beneficiaries at least 30 days notice of network changes. In addition, insurers would be required to notify CMS of any such changes at least 90 days in advance, so the agency can ensure that the remaining providers “will continue to meet required network standards.” The publication reports that final rules may be released as early as April 7.   Read more…
Read the proposal (large PDF)…

5. California.
Bloomberg reports that supporters of a change in California’s 40-year-old cap of $250,000 for pain and suffering damages in medical liability cases say that they have gathered enough signatures to place their proposal—which would adjust the cap to account for inflation—on the state’s November ballot. Observers say the adjustment would effectively increase the limit to more than $1 million. If enacted, the proposal would also require physicians to undergo drug and alcohol testing.   Read more…

6. Washington.
A report released by the Washington State Health Care Authority finds that an initiative developed through the partnership of physicians, hospitals, and state Medicaid representatives is linked to reduced emergency department (ED) utilization, improved quality of care, and savings of more than $33 million. Among other things, the “ER is for Emergencies” campaign includes sharing of information between EDs to identify frequent users, patient education initiatives, strict narcotics guidelines, referral to primary care providers, and feedback reports for ED staff. The agency states that, during FY 2013, the overall rate of ED visits declined by 9.9 percent, and the rate of “frequent visitors” (defined as five or more visits annually) dropped by 10.7 percent from the previous year.   Read more (PDF)…
Read the complete report (PDF)…

7. Now is the time to complete your 2011 OSAE (SAE10).
The next scoring of the Academy’s 2011 Orthopaedic Self-Assessment Examination (OSAE/OKU10) scored and recorded exam is scheduled for March 31, 2014. The 2011 Orthopaedic Self-Assessment Examination, purchased with Orthopaedic Knowledge Update 10, allows you to earn up to 70 of the 120 CME Credits required by the American Board of Orthopaedic Surgery’s (ABOS) maintenance of certification (MOC) process. The 2011 OSAE completely fulfills the 20-credit Scored and Recorded Self-Assessment requirement of the ABOS MOC process. Submit your OSAE answers for confidential scoring to the AAOS Examinations and Scoring Center and complete the CME evaluation to receive CME credit. CME credit for this program expires on May 31, 2014.

8. Last call: 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 Course 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)

March 26, 2014

Today’s Top Story
1. Congress introduces 12-month SGR patch; AAOS expresses concern.
Modern Healthcare reports that leaders in the U.S. Senate and the U.S. House of Representatives have reached an agreement to delay a reduction in Medicare physician reimbursement called for under the Sustainable Growth Rate (SGR) formula. If enacted, the SGR patch would prevent the 24 percent pay cut scheduled for April 1, and replace it with a 0.5 percent update through Dec. 31, 2014. There would be no percentage changes for the 3 months following that through April 1, 2015. A previous proposal to repeal the SGR and replace it with an alternative had bipartisan support, but legislators have been unable to agree on a path to fund the repeal and replacement. House rules require that any increases in spending must be balanced by reductions elsewhere.   Read more…(paid subscription may be required)
Although the SGR patch measure contains language to delay the transition to ICD-10 until at least Oct. 1, 2015, a number of medical associations have serious concerns because the bill uses misvalued codes to pay for the legislation. Medical groups such as the American Association of Orthopaedic Surgeons (AAOS) would prefer a permanent, rather than a temporary, fix of the SGR. In a press release, Frederick M. Azar, MD, president of the AAOS stated, “The AAOS is extremely disappointed with the introduction of another flawed patch to address the flawed SGR formula. Temporary patches do not fix the problem and the cost to enact these patches has done nothing to move us closer to reform. A permanent solution, such as the policy found in H.R. 4015/S. 2000, ensures Medicare’s solvency in a patient-centric, fiscally-responsible way and must be enacted before the current patch expires.”   Read more…

Other News
2. Study: Physicians better than nurses at reducing radial head subluxation in small children.
Findings from a Canadian study published online in the Canadian Medical Association Journal suggest that physicians are more likely to successfully reduce radial-head subluxation in small children, compared to nurses. The researchers performed an open, noninferiority, cluster-randomized control trial of 245 children aged 6 years and younger who were seen at the emergency department at a single institution with a presentation consistent with radial-head subluxation and who had sustained a known injury in the previous 12 hours. Patients were assigned to either nurse-initiated or physician-initiated treatment, depending on the day. The researchers found that, of children assigned to receive physician-initiated care, 96.7 percent (117 of 121) had a successful reduction performed by the physician; among children assigned to nurse-initiated care, 84.7 percent (105 of 124) had a successful reduction performed by the nurse.   Read more…
Read the abstract…

3. Future orthopaedic surgeons connect with residency programs on Match Day.
The National Resident Matching Program® reports that 25,687 applicants successfully matched to first-year residency positions in this year’s Match Day. This year’s match included 40,394 registrants. The overall match rate to first-year positions was 75 percent, the highest since 2006. The match rate for U.S. seniors was 94.4 percent, 0.7 percentage points higher than last year. Of the applicants who matched, 54 percent of U.S. seniors and nearly 50 percent of all other applicants matched to their first choice for training. In orthopaedic surgery, 162 programs offered 695 positions.   Read more (PDF)…
View the Match Day data (PDF)…

4. Increasing spine surgery volumes elicit increased scrutiny from insurers.
Modern Healthcare reports that a rapid growth in spine surgery volume during the last 20 years has led some payers, policy experts, and spine surgeon groups to advocate for a reappraisal of spine care in the United States. One expert explains that the volume of spine surgery in the United States is about double the rate in Canada, Western Europe, and Australia, and about five times the rate in the United Kingdom, and some observers expect that volume to continue to grow. The author notes that scientific indications for spine surgery are inexact, but insurers have responded to the high volume by increasing scrutiny of spine treatments, and encouraging the use of behavioral and physical therapy treatment approaches for a period of time before surgery is authorized.   Read more…(paid subscription may be required)

5. Study: Viscous fluid in bone structure may help prevent mineral platelets from shattering.
Data published online in the journal Proceedings of the National Academy of Sciences suggest that bones contain a viscous fluid that enables calcium phosphate nanocrystals to move so they do not shatter under pressure. Using Oxygen-17, the authors conducted nuclear magnetic resonance (NMR) studies of bone and compared their findings against similar data for octacalcium phosphate (OCP)-citrate and other calcium phosphate minerals relevant to bone. From the findings, they deduced that bone mineral is a layered structure with thin apatitic platelets sandwiched between OCP-citrate–like hydrated layers. “Such a structure,” they write, “can explain a number of known structural features of bone mineral: the thin, plate-like morphology of mature bone mineral crystals, the presence of significant quantities of strongly bound water molecules, and the relatively high concentration of hydrogen phosphate as well as the maintenance of a disordered region between mineral platelets.”   Read more…
Read the abstract…

6. Simulation lab works to reduce communication hurdles and improve trauma care.
An Associated Press article reports on an ongoing project to design the “operating room of the future.” The initiative uses real healthcare providers working in a simulation lab, testing different methodologies and technological solutions to reduce workflow disruptions and hone communication skills. Before the laboratory went online, researchers followed real trauma patients from ambulance to intensive care unit and documented obstacles that slowed down care: They found that delays in care were often caused by a lack of communication and logistical hurdles.   Read more…

7. 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 survey by Thursday, April 10, 2014.
Take the survey…

8. JAAOS now available for iOS!
The latest issue of the Journal of the AAOS (JAAOS) is now available for iOS through the App Store. To read this and future issues, please download the app via the App Store on any iPad device using iOS 6.0 or later. Click “Featured” at the bottom of the screen, then enter “JAAOS” (no quotes) in the search box in the upper right hand corner. An editorial written by Jeffrey S. Fischgrund, MD, JAAOSeditor-in-chief, looks at the advantages of the Academy’s decision to partner with Wolters Kluwer Health/Lippincott Williams and Wilkins to publish future issue of JAAOS.
Read the editorial…

March 31, 2014

Today’s Top Story
1. Senate to consider SGR patch; healthcare leaders call for permanent solution.
HealthLeaders Media reports that the U.S. Senate is expected to vote today on legislation to prevent a 24 percent reduction in Medicare reimbursement called for under the Sustainable Growth Rate (SGR) formula. A related bill has already passed the House of Representatives. According to MedPage Today, in an unusual move, a number of physicians organizations have opposed the bill and argued that they would be willing to accept the 24 percent pay reduction, in an effort to force legislators in both houses of Congress to address a separate proposal to would repeal and replace the SGR with an alternative reimbursement system. Congress has delayed cuts mandated under the SGR 17 times since the system’s inception.
Read more in HealthLeaders Media
Read more in MedPage Today
Read the statement from AAOS President Frederick M. Azar, MD, on the ongoing SGR discussion…

Other News
2. CMS to hold claims for 10 days in anticipation of SGR patch.
In anticipation of a likely patch to delay Medicare reimbursement cuts under the SGR, the U.S. Centers for Medicare & Medicaid Services (CMS) has instructed Medicare Administrative Contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of April (through April 14). The agency expects the hold to have a minimal effect on provider cash flow because electronic claims are generally not paid any sooner than 14 calendar days, and paper claims take 29 days to process. CMS states that claims for services delivered on or before March 31 will be processed and paid under normal procedures.   Read more…

3. Study: Team approach may reduce complication rates for patients who undergo complex spinal reconstructions for adult spinal deformity.
According to information published in the March issue of the journal Spine Deformity, adoption of team-based methods—including a team approach in the operating room and an intraoperative protocol for managing coagulopathy—may significantly reduce perioperative complication rates for patients who undergo complex spinal reconstructions for adult spinal deformity. The research team conducted a retrospective, consecutive case review of 40 consecutive control patients and 124 consecutive patients treated with a dual–attending surgeon approach, a live multidisciplinary preoperative screening conference, and the intraoperative protocol. They found that the control group had a 52 percent complication rate, compared to a 16 percent complication rate in the intervention group. In addition, the intervention group displayed significantly lower rates for return to the operating room during the perioperative 90-day period, wound infection requiring debridement, deep vein thrombosis/pulmonary embolism, and urinary tract infection requiring antibiotics; rates of postoperative neurological complications were also lower in the intervention group, but did not reach statistical significance.   Read more…
Read the abstract…

4. Report: 56 percent of hip fracture patients in the U.K. receive nerve block.
An audit published jointly by the Royal College of Physicians and the Association of Anaesthetists of Great Britain and Ireland finds that that 56 percent of hip fracture patients in the United Kingdom receive a peri-operative nerve block for pain relief, while 44 percent do not. The authors note that the statistics indicate a growing adoption of the technique, the use of which was endorsed by the U.K. National Institute for Health and Care Excellence in 2011.   Read more…
Read the report (PDF)…

5. Healthcare spending increased faster than usual in fourth quarter of 2013.
According to USA Today, information released by the U.S. Bureau of Economic Analysis finds that healthcare expenses rose at a 5.6 percent annual rate during the fourth quarter of 2013—the fastest pace in a decade. One expert suggests that the increase may be driven in part by an improving economy, as many people have limited their own spending during a sluggish economic recovery.   Read more…

6. April 1 is deadline for using ICD-10-compliant forms.
AAOS reminds providers that, effective tomorrow (April 1, 2014), payers will no longer accept paper claims submitted on the old 1500 Claim Form (version 08/05). The revised 1500 Claim form (version 02/12), which accommodates the change to ICD-10, must be used. The revised form requires letters instead of numbers as diagnosis code pointers, and expands the number of possible diagnosis codes on a claim to 12. Providers should indicate which ICD code set is being reported in Box 21 (diagnosis box). ICD-9 codes may be used until Oct. 1, 2014.
Learn more about changes to the 0212 1500 claim form…

7. OKOJ April 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: “Proximal Oblique Sliding Closing-wedge Osteotomy for Wide-angle Hallux Valgus,” “Tendon Transfers for Scapular Winging,” and “Use of Systemic Pharmaceutical Adjuncts to Enhance Bone Healing After Surgery.” In addition, four new videos have been made available: “Patient With 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. New AAOS Now podcast on the Washington scene and health care.
AAOS Now has released an audio interview in which Stuart J. Fischer, MD, talks with 2014 AAOS Annual Meeting Presidential Guest Speakers Steve and Cokie Roberts about Washington politics and its influence on health care.
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…

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