May 2, 2014

Today’s Top Story
1. More than 300 orthopaedic surgeons meet with congressional representatives during NOLC. 
On Thursday, May 1, hundreds of orthopaedic surgeons met with their congressional representatives as part of the American Association of Orthopaedic Surgeons (AAOS) National Orthopaedic Leadership Conference (NOLC), the AAOS’ premier advocacy event. The NOLC is designed to raise awareness and explore issues affecting patient care and physicians’ practices. Orthopaedic surgeons had the opportunity to discuss with their members of congress issues such as correcting the imbalance between healthcare professionals and health plans through antitrust reform included in H.R. 4077, permanently repealing and replacing the sustainable growth rate (SGR), and enacting H.R. 3722/S. 2220 to protect sports medicine professionals who provide medical services in a secondary state.   Read more…

Other News
2. Report: CMS may have set a “soft date” of Oct. 1, 2015, for ICD-10 compliance. 
HealthData Management reports that the Centers for Medicare and Medicaid Services (CMS) may have set a soft date and a soft announcement of Oct. 1, 2015, for the new ICD-10 compliance date when it made a proposed rule available on April 30, 2014. The proposed rule, which sets hospital and long-term care inpatient payment rates and rules for fiscal 2015, includes a Request for Public Comments on ICD-10-CM/PCS Transition, which states the following: “The ICD-10-CM/PCS transition is scheduled to take place on Oct. 1, 2015. After that date, we will collect nonelectronic health record-based quality measure data coded only in ICD-10-CM/PCS.” CMS goes on to state that “specifically, we request comments on how, if at all, we should adjust performance scoring under the Hospital VBP Program to accommodate quality data coded under ICD-10-CM/PCS, or otherwise ensure fair and accurate comparisons under the Hospital VBP Program once the transition date has passed.” The request for comment will be formally published on May 15, 2014.  Read more…
Read the request for comment on pp. 648-650 of the proposed rule (PDF)…

3. Study: Experimental technique shows promise in regrowing muscle tissue. 
Findings of a study published this week in the journal Science Translational Medicine suggest that surgical treatment for volumetric muscle loss in both mice and people using xenogeneic extracellular matrix (ECM) scaffolds may improve tissue regrowth and functional improvement, raising questions regarding whether this experimental treatment could be used to treat devastating muscle injuries, such as those sustained by members of military in bomb explosions. In the study, which involved a preclinical rodent model as well as five male patients, porcine urinary bladder ECM scaffold implementation “was associated with perivascular stem cell mobilization and accumulation within the site of injury, and de novo formation of skeletal muscle cells,” according to the University of Pittsburgh researchers. The investigators found that the ECM-mediated constructive remodeling was linked to stimulus-responsive skeletal muscle in rodents, as well as functional improvement in three of five human patients.
Read the abstract…

Read an article about the study from National Public Radio (NPR), “Experimental Technique Coaxes Muscles Destroyed by War to Grow,” or listen to the story that aired on NPR’s “Morning Edition”…

4. CMS releases proposed inpatient payment rate update.
The Centers for Medicare & Medicaid (CMS) released this week a proposed rule that would update FY 2015 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals. The proposed rule is designed to strengthen the tie between payment and quality improvement. CMS projects that the payment rate update to general acute care hospitals will be 1.3 percent in FY 2015, and 0.8 percent for long-term care hospitals. Proposed changes include payment provisions intended to improve the quality of hospital care that reduce payment for readmissions, and hospital acquired conditions. The rule also includes proposed changes to the Hospital Inpatient Quality Reporting Program, and outlines how hospitals can comply with the Affordable Care Act’s requirements to disclose charges for their services online or in response to a request. CMS will accept comments on the proposed rule until June 30, 2014, and will respond to comments in a final rule to be issued by Aug. 1, 2014.  Read more…

5. Arthritis supplement recalled.
Nano Well-being Health, Inc. issued a voluntary recall for Super Arthgold (500 mg) after testing by the U.S. Food and Drug Administration (FDA) found it contained undeclared drug ingredients that could cause adverse and potentially fatal reactions, Arthritis Today reports. The dietary supplement had been marketed for joint pain and arthritis. Among the ingredients listed on the label are the organic compound Methylsulfonylmethane, the Chinese herb Angelica sinensis (also known as dong quai), and white peony root. The FDA also found the prescription drugs chlorzoxazone, diclofenac, and indomethacin in the supplement, which were not listed on the label.    Read more…
Read the FDA safety alert…

6. Planned system outage on May 6.
On Tuesday, May 6, new network equipment will be installed in the AAOS data center at 5 p.m. CDT that will result in a system outage that should last no more than 15 minutes. During this time, all AAOS web sites and the email system will be inaccessible.

7. May AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the May issue of AAOS Now, but the online edition is already available on the AAOS Now website. This month’s issue includes information on the release of Medicare physician payment data, a wrap-up on the failure of Congress to repeal the Medicare Sustainable Growth Rate payment formula, coverage from Specialty Day at the AAOS Annual Meeting, and much more.   Read more…
Read “CMS Releases Payment Data on Physicians”…
Read “Divided Congress Fails to Repeal SGR”…
Read “Conservative Treatment Effective for Most Apophyseal Fractures in Adolescents “…

May 5, 2014

Today’s Top Story
1. Physicians agree frequency of unnecessary tests and procedures is a problem.
A report released by Choosing Wisely finds that 73 percent of physicians believe the frequency of unnecessary tests and procedures to be a “very” or “somewhat” serious problem. The authors conducted phone interviews with 600 specialty and primary care physicians across the United States. Respondents cited issues such as medical liability, “just to be safe,” and “wanting more information for reassurance” as the primary reasons for ordering unnecessary tests and procedures. Additional drivers included patient insistence, patient happiness, not spending enough time with patients, the fee-for-service system, and new technology. Overall, 47 percent of respondents said that patients request an unnecessary test or procedure at least once a week.   Read more…
Read the report (PDF)…

Other News
2. Study: Use of electronic medication reconciliation tool may reduce medication errors.
According to data presented at the annual meeting of the Pediatric Academic Societies, use of an electronic tool for medication reconciliation may be associated with a reduction in medication errors among pediatric patients. The research team compared error rates before and after introduction of an electronic medication reconciliation tool at a pediatric hospital. After implementation of the tool, they found that intervention medication history recording improved from 89 percent to 93 percent of admissions, while the error rate decreased from 5.9 errors per 1,000 admissions to 2.5 errors per 1,000 admissions. The medication reconciliation tool was used for 75 percent of admissions during the post-intervention study period.   Read more…
Read the abstract…

3. Study: Male and female patients differ in hip structure, but not presentation, of symptomatic labral tears.
A study published online in The American Journal of Sports Medicine finds that male and female patients differ in hip structure, biomechanics, and operative findings of symptomatic labral tears, but do not differ substantially in clinical presentation. The authors conducted a prospective cohort study of 654 patients (320 males) who had symptomatic labral tears and underwent arthroscopic surgery. They found that male patients had a higher incidence of acute injury and workers’ compensation status than females, while females had a statistically significant increased range of motion compared with males. In addition, the anterior impingement test was positive in 94.4 percent of females and 92.9 percent of males, the flexion/abduction/external rotation test was positive in 59.5 percent of females and 61.5 percent of males, and the lateral impingement test was positive in 55.0 percent of females and 59.2 percent of males, but there was no statistically significant difference between sexes in any of the tests.
Read the abstract…

4. Study: Patients with asthma have significantly lower BMD, but cause is unclear.
Findings from a Korean study published in the May issue of the journal Annals of Allergy, Asthma & Immunology suggest that airway hyperresponsiveness (AHR) and asthma may be associated with a clinically meaningful decrease in bone mineral density (BMD). The researchers retrospectively reviewed information on 7,034 patients who had undergone a health checkup program—including BMD tests and methacholine bronchial challenge tests—at a single center. They found that 216 (3.1 percent) had a positive AHR test result, and 217 (3.1 percent) had a history of asthma. Lumbar spine and femur BMD were significantly lower among patients with AHR compared to those without AHR. In addition, after adjustment, the proportion of patients with osteopenia or osteoporosis was much higher in the AHR-positive group than in the AHR-negative group, and in the ever-asthma group than in the never-asthma group. The researchers state that the causal relationship remains unclear.   Read more…
Read the abstract…

5. Computer expert offers tips on EHR security.
According to information presented on the Massachusetts Medical Society (MMS) blog, physician practices should encrypt their data to help protect against theft and potential Health Insurance Portability and Accountability Act violations. Speaking at a recent MMS conference, one computer security expert offered the following list of steps physicians could take to increase the security of their electronic health records (EHR) systems:

  • Assign one person in the practice to serve as security or compliance officer, with appropriate resources to do the job
  • Conduct risk analyses regularly, ideally on an annual basis
  • Develop and document a security strategy and policies
  • Address any deficiencies in the computer security strategy
  • Make sure business associates also take steps to protect patients’ records
  • Train staff to comply with the practice’s cyber security rules and regulations
  • Evaluate security performance

Read more…

6. California.
A survey conducted by the California Medical Society finds that 80 percent of physician respondents report that they have been or are confused about their participation status in a Covered California plan, and that the situation may be negatively impacting patient care. The survey, which collected data from more than 2,300 physicians, finds that much of the uncertainty has been caused by intentionally vague “all products clauses” in provider contracts with insurers, which bind them to participating in unspecified current and future products offered by health plans. The survey also finds that almost 20 percent of physicians remain unclear about how they became a participating provider in plan network(s), and that many physicians report losing patients due to confusion over participation status.  Read more…

7. Ohio.
According to a report released by the Ohio Department of Insurance, medical liability cases and payouts have continued to drop in the decade since a 2003 law that shortened the time frame in which a patient could sue claiming injury and capped jury awards for non-economic damages. According to the report, about 79 percent of claims concluded during 2012 had no indemnity payments. The total amount paid to claimants was $177,323,025, for an average of $307,852 per claim in which an indemnity payment was made. Read more…
Read the report (PDF)…

8. Call for volunteers: Joint Commission Professional and Technical Advisory Committees.
AAOS seeks to nominate individuals to the American Medical Association (AMA) Alternate Representatives to two Joint Commission Professional and Technical Advisory Committees (PTACs): Home Care Accreditation Program PTAC and Hospital Accreditation Program PTAC. PTACs represent the views of a diverse group of professional associations and other interests, and assist The Joint Commission in the development and refinement of accreditation standards and elements of performance. Applicants for PTAC positions must provide an online AAOS CAP Application, current curriculum vitae (no more than 3 pages), a 100-word biosketch, 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 an AMA Nomination form. Supporting materials must be submitted to by Wednesday, May 7, 2014 at 11:59 p.m. CT to Kyle Shah, at shah@aaos.org.
Learn more and submit your application…(member login required)

Note: At 5 p.m. CT on Tuesday, May 6, the AAOS data center will undergo a maintenance upgrade that will result in a system outage. During this period, all AAOS websites and email will be inaccessible. The outage is expected to last no more than 15 minutes.

Today’s Top Story

1. Study: ASCs may offer “efficient” path to quality and cost savings.

 

Other News

2. Study: Hospital control of physician practices may increase costs overall.

 

3. Report: Rates for 30-day readmissions, hospital-acquired conditions drop.

 

4. Study looks at options for predicting fracture risk after discontinuation of alendronate.

 

5. Physician registration for CMS Open Payments (Sunshine Act) program to begin June 1.

 

In the States

6. California.

 

Your AAOS

7. AAOS seeks candidates for lay position on Board of Directors.

 

8. Call for volunteers: AHRQ U.S. Preventive Services Task Force.

Today’s Top Story

1. Study: ASCs may offer “efficient” path to quality and cost savings.

Findings published in the May issue of the journal Health Affairs suggest that ambulatory surgery centers (ASCs) offer an efficient approach to meeting predicted growth in demand for outpatient surgeries, and may reduce costs while improving the quality of healthcare delivery. The research team reviewed data from the U.S. Centers for Disease Control and Prevention on 52,000 surgical visits across 437 facilities over 4 years. They found that procedures performed in ASCs took 31.8 fewer minutes than those performed in hospitals—a 25 percent decrease—and estimated that patient costs were $363 to $1,000 lower per procedure in ASCs, while outcomes were similar in both ASCs and hospitals.
Read more…

Read the abstract…

  

Other News

2. Study: Hospital control of physician practices may increase costs overall.

Data from a study published in the May issue of Health Affairs suggest that contractual or ownership relationships between hospitals and physician practices may be associated with increased costs to privately insured patients. The authors drew data from Truven Analytics MarketScan on hospital claims from 2001 to 2007, and compared it against hospital-physician integration information from the American Hospital Association (AHA). They found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians was associated with higher hospital prices and spending. They also found that an increase in contractual integration had a positive effect on the frequency of hospital admissions, but noted that the effect was relatively small. The AHA notes that the period studied was prior to shifts in payment models that reward hospitals for cost containment efforts.
Read more…

Read the abstract…

  

3. Report: Rates for 30-day readmissions, hospital-acquired conditions drop.

According to a preliminary report released by the U.S. Department of Health and Human Services (HHS), there was a 9 percent decrease in hospital-acquired conditions nationally during 2011 and 2012. In addition, the report finds that after holding constant at 19 percent from 2007 to 2011 and decreasing to 18.5 percent in 2012, the Medicare all-cause 30-day readmission rate further decreased to approximately 17.5 percent during 2013. HHS estimates that national reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and saved approximately $4 billion in health spending over the same period.
Read more…

Read the report (PDF)…

  

4. Study looks at options for predicting fracture risk after discontinuation of alendronate.

A study analyzing the results of a placebo group in a randomized trial and published online in the journal JAMA Internal Medicineexamines methods of predicting fracture risk among women who have discontinued alendronate therapy. The researchers drew data from a randomized trial of postmenopausal women aged 61 to 86 years who had been previously treated with 4 to 5 years of alendronate therapy, and who were then randomized to 5 additional years of either alendronate or placebo. At the end of that period, 94 patients in the placebo group had sustained one or more symptomatic fractures; of these, 82 patients sustained fractures during the first year of taking the placebo. The researchers found that 1-year changes in hip dual-energy x-ray absorptiometry (DXA), urinary type 1 collagen cross-linked N-telopeptide (NTX), and serum bone-specific alkaline phosphatase (BAP) were not related to subsequent fracture risk, but noted that older age and lower hip DXA at time of discontinuation of alendronate were significantly related to increased fracture risk. Therefore, researchers concluded that “short-term monitoring with BMD, BAP or NTX after discontinuation of 4 to five 5 of alendronate therapy does not appear to improve fracture prediction.”
Read more…

Read the abstract…

  

5. Physician registration for CMS Open Payments (Sunshine Act) program to begin June 1.

On June 1, 2014, physicians and teaching hospital representatives will be able to register on the U.S. Centers for Medicare & Medicaid Services (CMS) Enterprise Portal. Registration is a voluntary process, but only registered users will be able to dispute information reported by industry that they believe to be inaccurate or incomplete. Registration will be conducted in two phases for the first Open Payments reporting year:

  • Phase 1 (begins June 1) includes user registration in CMS’ Enterprise Portal.
  • Phase 2 (begins in July) includes physician and teaching hospital registration in the Open Payments system, and allows them to review and dispute data submitted by applicable manufacturers and applicable group purchasing organizations prior to public posting of the data.

CMS states that disputed data, if not corrected by industry, will still be made public, but will be marked as disputed.

AAOS strongly encourages members to register.
Read more…

Learn more about the review and dispute process…

  

In the States

6. California.

The California Medical Association (CMA) reports that a state bill to eliminate the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy has died in the Senate Business and Professions Committee. CMA argues that the bill, if enacted, would have resulted in increased healthcare costs by driving those services to hospital settings.
Read more…

 

Your AAOS

7. AAOS seeks candidates for lay position on Board of Directors.

The AAOS is seeking candidates for the lay member position on the Board of Directors. This non-orthopaedist should have a background in business and hold a position in his or her organization at vice-president level or higher. Ideal candidates will have strong leadership skills, experience on other boards of directors, be technologically savvy, have a general understanding of health care, and be attuned to patients’ concerns, such as patient safety. The position is not compensated (except for expenses), and is a for a 2-year term with possibility of a 2-year renewal. AAOS members who would like to suggest a candidate for this position should contact AAOS Chief Executive Officer Karen L. Hackett, FACHE, CAE, at 847-384-4042 or via email at:
hackett@aaos.org

AAOS would like to thank members who have already submitted candidates for this position.

 

8. Call for volunteers: AHRQ U.S. Preventive Services Task Force.

AAOS seeks to nominate members to serve on the U.S. Agency for Healthcare Research and Quality (AHRQ) U.S. Preventive Services Task Force (USPSTF). The task force is an independent body of experts in prevention and evidence-based medicine, and makes evidence-based recommendations about the effectiveness of clinical preventive services and health promotion. Applicants for this position must have no substantial conflicts of interest that would impair the scientific integrity of the work of the task force, and must be willing to complete regular conflict of interest disclosures. All applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the relevant subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted by Monday, May 12, 2014 at 11:59 p.m. CT, to Kyle Shah at:
shah@aaos.org

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

  

May 7, 2014

Today’s Top Story
1. Study: ASCs may offer “efficient” path to quality and cost savings.
Findings published in the May issue of the journal Health Affairs suggest that ambulatory surgery centers (ASCs) offer an efficient approach to meeting predicted growth in demand for outpatient surgeries, and may reduce costs while improving the quality of healthcare delivery. The research team reviewed data from the U.S. Centers for Disease Control and Prevention on 52,000 surgical visits across 437 facilities over 4 years. They found that procedures performed in ASCs took 31.8 fewer minutes than those performed in hospitals—a 25 percent decrease—and estimated that patient costs were $363 to $1,000 lower per procedure in ASCs, while outcomes were similar in both ASCs and hospitals.   Read more…
Read the abstract…

Other News
2. Study: Hospital control of physician practices may increase costs overall.
Data from a study published in the May issue of Health Affairs suggest that contractual or ownership relationships between hospitals and physician practices may be associated with increased costs to privately insured patients. The authors drew data from Truven Analytics MarketScan on hospital claims from 2001 to 2007, and compared it against hospital-physician integration information from the American Hospital Association (AHA). They found that an increase in the market share of hospitals with the tightest vertically integrated relationship with physicians was associated with higher hospital prices and spending. They also found that an increase in contractual integration had a positive effect on the frequency of hospital admissions, but noted that the effect was relatively small. The AHA notes that the period studied was prior to shifts in payment models that reward hospitals for cost containment efforts.   Read more…
Read the abstract…

3. Report: Rates for 30-day readmissions, hospital-acquired conditions drop.
According to a preliminary report released by the U.S. Department of Health and Human Services (HHS), there was a 9 percent decrease in hospital-acquired conditions nationally during 2011 and 2012. In addition, the report finds that after holding constant at 19 percent from 2007 to 2011 and decreasing to 18.5 percent in 2012, the Medicare all-cause 30-day readmission rate further decreased to approximately 17.5 percent during 2013. HHS estimates that national reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and saved approximately $4 billion in health spending over the same period.   Read more…
Read the report (PDF)…

4. Study looks at options for predicting fracture risk after discontinuation of alendronate.
A study analyzing the results of a placebo group in a randomized trial and published online in the journal JAMA Internal Medicineexamines methods of predicting fracture risk among women who have discontinued alendronate therapy. The researchers drew data from a randomized trial of postmenopausal women aged 61 to 86 years who had been previously treated with 4 to 5 years of alendronate therapy, and who were then randomized to 5 additional years of either alendronate or placebo. At the end of that period, 94 patients in the placebo group had sustained one or more symptomatic fractures; of these, 82 patients sustained fractures during the first year of taking the placebo. The researchers found that 1-year changes in hip dual-energy x-ray absorptiometry (DXA), urinary type 1 collagen cross-linked N-telopeptide (NTX), and serum bone-specific alkaline phosphatase (BAP) were not related to subsequent fracture risk, but noted that older age and lower hip DXA at time of discontinuation of alendronate were significantly related to increased fracture risk. Therefore, researchers concluded that “short-term monitoring with BMD, BAP or NTX after discontinuation of 4 to five 5 of alendronate therapy does not appear to improve fracture prediction.”   Read more…
Read the abstract…

5. Physician registration for CMS Open Payments (Sunshine Act) program to begin June 1.
On June 1, 2014, physicians and teaching hospital representatives will be able to register on the U.S. Centers for Medicare & Medicaid Services (CMS) Enterprise Portal. Registration is a voluntary process, but only registered users will be able to dispute information reported by industry that they believe to be inaccurate or incomplete. Registration will be conducted in two phases for the first Open Payments reporting year:

  • Phase 1 (begins June 1) includes user registration in CMS’ Enterprise Portal.
  • Phase 2 (begins in July) includes physician and teaching hospital registration in the Open Payments system, and allows them to review and dispute data submitted by applicable manufacturers and applicable group purchasing organizations prior to public posting of the data.

CMS states that disputed data, if not corrected by industry, will still be made public, but will be marked as disputed.

AAOS strongly encourages members to register.   Read more…
Learn more about the review and dispute process…

6. California.
The California Medical Association (CMA) reports that a state bill to eliminate the in-office exception to the self-referral law for advanced imaging, anatomic pathology, radiation therapy, and physical therapy has died in the Senate Business and Professions Committee. CMA argues that the bill, if enacted, would have resulted in increased healthcare costs by driving those services to hospital settings.   Read more…

7. AAOS seeks candidates for lay position on Board of Directors.
The AAOS is seeking candidates for the lay member position on the Board of Directors. This non-orthopaedist should have a background in business and hold a position in his or her organization at vice-president level or higher. Ideal candidates will have strong leadership skills, experience on other boards of directors, be technologically savvy, have a general understanding of health care, and be attuned to patients’ concerns, such as patient safety. The position is not compensated (except for expenses), and is a for a 2-year term with possibility of a 2-year renewal. AAOS members who would like to suggest a candidate for this position should contact AAOS Chief Executive Officer Karen L. Hackett, FACHE, CAE, at 847-384-4042 or via email at  hackett@aaos.org.
AAOS would like to thank members who have already submitted candidates for this position.

8. Call for volunteers: AHRQ U.S. Preventive Services Task Force.
AAOS seeks to nominate members to serve on the U.S. Agency for Healthcare Research and Quality (AHRQ) U.S. Preventive Services Task Force (USPSTF). The task force is an independent body of experts in prevention and evidence-based medicine, and makes evidence-based recommendations about the effectiveness of clinical preventive services and health promotion. Applicants for this position must have no substantial conflicts of interest that would impair the scientific integrity of the work of the task force, and must be willing to complete regular conflict of interest disclosures. All applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the relevant subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted by Monday, May 12, 2014 at 11:59 p.m. CT, to Kyle Shah at  shah@aaos.org.
Learn more and submit your application…(member login required)

May 9, 2014

Today’s Top Story
1. Study: Concussion diagnosis rates on the rise in high school sports.
According to findings published online in The American Journal of Sports Medicine, national concussion diagnosis rates for high school sports increased significantly between 2005 and 2012. The authors used the High School Reporting Information Online sports injury surveillance system to calculate concussion rates over a 7-year period. They found that, during the study period, there were 4,024 concussions, with overall concussion diagnosis rates increasing significantly from 0.23 per 1,000 athlete-exposures in academic year 2005-2006 to 0.51 per 1,000 exposures during 2011-2012.   Read more…
Read the abstract…

Other News
2. Study: Higher BMI linked to longer stays and increased costs after TKA.
A study published in the May 7 issue of The Journal of Bone & Joint Surgery suggests that obesity may be associated with longer hospital stays and higher costs in total knee arthroplasty (TKA), and the effect of obesity on costs may be independent of obesity-related comorbid conditions and complications. The research team reviewed data on 8,129 patients who had undergone 6,475 primary TKAs and 1,654 revision TKAs at a single center. They found that length of stay and direct medical costs were lowest for patients with body mass index (BMI) values in the normal to overweight range, while increasing BMI was associated with significantly longer hospital stays and costs. After adjustment, the research team found that every 5-unit increase in BMI beyond 30 kg/m2 was associated with approximately $250 to $300 higher hospitalization costs in primary TKA and $600 to $650 higher hospitalization costs in revision TKA.
Read the abstract…

3. Study: Ipsilateral weakness and pain after hip surgery may be linked to inflammatory neuropathy.
Data from a small study published in the journal Mayo Clinic Proceedings suggest that inflammatory neuropathy may be an important etiologic consideration in some patients with ipsilateral weakness and pain after hip surgery. The researchers conducted a case series review of seven patients (eight surgeries) who developed unexplained ipsilateral leg weakness and pain within 1 month of hip surgery. They found that the results of all nerve biopsies were abnormal, displaying axonal damage (all patients), inflammation (all patients), signs of ischemic injury (all patients), and nerve microvasculitis (six patients). The researchers suggest that identification of such patients through clinical suspicion and subsequent nerve biopsy may help improve outcomes.   Read more…
Read the abstract…

4. CMS to host National Provider Call on Stage 2 Meaningful Use.
The U.S. Centers for Medicare & Medicaid Services (CMS) will host an MLN Connects™ National Provider Call, Thursday, May 29, 2014, from 1:30 to 3 p.m. ET, for eligible professionals participating in Meaningful Use to help them understand the differences between Stage 1 and Stage 2 criteria. The call will be conducted in an office hours format, with CMS experts offering a concise overview of Stage 2 requirements, reporting options, and data submission processes, followed by answers to questions submitted prior to the call and an opportunity for participants to interact with subject matter experts during a live question-and-answer session. Participants are encouraged to email questions no later than May 21 to be considered for inclusion in the office hours session, to  e-measures@mathematica-mpr.com.  Registration will close at 12:00 p.m. ET on the day of the call or when available space has been filled.
Register for the call…

5. Medicaid expansion may increase procedure volume for some surgeons.
A study published in the May issue of the Journal of the American College of Surgeons suggests that expansion of a state’s Medicaid system may be associated with an increase in the volume of procedures performed by specialty surgeons. The research team drew data on all patients who underwent selected procedures (breast cancer reconstruction, panniculectomy, and lower-extremity trauma management) between 1998 and 2006 from the New York State Inpatient Database, and compared against New York Census data. They found the likelihood of Medicaid as the primary payer increased significantly after expansion—0.34 percent per quarter—without a decrease in uninsured patients receiving these procedures, resulting in a 7.2 percent increase in the proportion of Medicaid beneficiaries receiving these procedures. In a subgroup analysis, the proportion of Medicaid beneficiaries increased for breast reconstruction and panniculectomy without a decrease for the uninsured, while lower extremity trauma procedures had a decreasing trend in use by uninsured patients with a slight, non-significant increase for Medicaid beneficiaries.   Read more…
Read the abstract…

6. Study examines predictors for readmission due to C. difficile infection.
A paper presented at the annual meeting of The Society for Surgery of the Alimentary Tract offers a look at predictors linked to readmission for Clostridium difficile infection. The authors queried a 5 percent random sample of Medicare claims data from 2009 to 2011 and identified hospitalized patients with C. difficile infection. They found that, of 8,998 beneficiaries surviving a hospitalization withC. difficile, 1,267 (14 percent) were readmitted for C. difficile during the study period. The median time to readmission was 23 days. Readmitted patients were more likely to be female, 75 to 84 years of age, have more comorbidities, and have a history of inflammatory bowel disease, compared to patients who were not readmitted. In addition, readmitted patients were significantly more likely to have hadC. difficile as the primary diagnosis, shorter length of stay, and lower rates of intensive care unit care during the index admission.   Read more…
Read the abstract…

7. Reminder: Submit your 2013 OITE answer file by May 31 to be included in the final scoring.
To be included in the final scoring, 2013 Orthopaedic In-Training Examination (OITE) answer files must be submitted no later than May 31, 2014. The 20 scored and recorded CME credits will be posted to transcripts immediately.

8. Call for volunteers: AAHKS THA Quality Measures Committee.
AAOS seeks to nominate one individual to serve on the American Association of Hip and Knee Surgeons (AAHKS) Total Hip Arthroplasty (THA) Quality Measures Committee. AAHKS, AAOS and the Hip Society are partners in this process, which will develop quality measures for THA. Applicants for this position must have a strong interest in measure development, testing, and implementation, as well as methodology concepts, and ideally should have experience in evidence-based clinical practice guideline and/or performance measures development. All applicants must provide the following: an online AAOS CAP Application, current curriculum vitae; a 100-word biosketch, and a letter of interest highlighting his or her expertise in the relevant subject area. All supporting materials must be submitted by Sunday, May 18, 2014 at 11:59 p.m. CT, to Kyle Shah at  shah@aaos.org.
Learn more and submit your application…(member login required)

May 12, 2014

Today’s Top Story
1. Study: Salvaged blood from surgery patients may be higher quality than stored allogeneic RBCs.
Findings published online in the journal Anesthesia & Analgesia suggest that the use of autologous salvaged red blood cells (RBCs) may be more beneficial to surgery patients than the use of stored allogeneic RBCs. The research team conducted a prospective cohort study of 32 patients undergoing cardiac surgery with cardiopulmonary bypass. Patients were grouped by transfusion status: autologous salvaged RBCs alone (n = 12), autologous salvaged RBCs + minimal (less than 5 units) stored allogeneic RBCs (n = 10), and autologous salvaged RBCs + moderate (5 units or more) stored allogeneic RBCs (n = 10). They found that, in the autologous only group, RBC elongation index did not change significantly from the preoperative baseline, while it decreased among patients in both groups receiving allogenic RBCs. The research team states that the findings suggest that autologous salvaged RBCs may be of higher quality than stored RBCs.   Read more…
Read the abstract…

Other News
2. Study: Post-discharge complications may be strongest predictors of readmission.
A study published in the April issue of the journal JAMA Surgery looks at predictors for readmission after hospital discharge. The authors conducted a retrospective cohort study of 59,273 surgical procedures performed at 112 Department of Veterans Affairs hospitals. They found an overall complication rate of 22.6 percent, 28.1 percent of which were postdischarge complications. The overall 30-day readmission rate was 11.9 percent; more than half of readmissions (56.0 percent) were associated with a currently assessed complication. Readmission was predicted by patient comorbid conditions, procedure factors, and the occurrence of postoperative complications. After adjustment, the authors found that the occurrence of postdischarge complications had the highest odds of readmission, compared with predischarge complications.
Read the abstract…

3. Study: Functional status at discharge linked to likelihood of readmission.
According to information published in the May issue of the Journal of Hospital Medicine, a patient’s functional status near the time of discharge from an acute care hospital may be strongly associated with acute care readmission. The researchers conducted a retrospective cohort study of 9,405 consecutive patients admitted to an inpatient rehabilitation facility from an acute care hospital between July 1, 2006 and Dec. 31, 2012. They found that there were 1,182 readmissions (13 percent), and that Functional Independence Measure (FIM) score was significantly associated with readmission. The relationship between FIM score and readmission held across diagnostic category, with medical patients who had low functional status having the highest readmission rate, compared to medical patients with high FIM scores.   Read more…
Read the abstract…

4. ACS offers policy outline on medical liability.
The American College of Surgeons (ACS) has released a policy paper on medical liability concerns. The authors note that a number of states have taken action not only to cap noneconomic damages, but also to study alternative dispute resolution, injury funds, and statutes of limitations. The authors suggest nine approaches that they argue “should be incorporated into a multifaceted medical liability reform initiative,” including the following:

  • Continued focus on patient safety and prevention of medical errors
  • Tort reform, including caps on noneconomic damages
  • Minimum standards and qualifications for expert witnesses
  • Oversight of medical liability insurers
  • Testing communication and disclosure programs
  • Pilot tests of alternative dispute resolution models
  • Safe harbor protections
  • Testing of health courts and administrative compensation systems
  • Research into the effect of team-based care on medical liability

Read more…
Read the policy paper (PDF)…
Read the AAOS position statement on medical liability reform…

5. Study: Hydrogel might serve as scaffold to help regrow bone and other tissue.
A study published online in the journal Biomacromolecules describes a hydrogel that shows potential to serve as a bioscaffold to support the regrowth of bone and other three-dimensional tissues. The authors developed a hydrogel that is liquid at room temperature but, after injection, becomes a gel that would fill and stabilize a space while natural tissue grows to replace it.   Read more…
Read the abstract…

6. CMS cancels plan to run ICD-10 test in July.
Health Data Management reports that the U.S. Centers for Medicare and Medicaid Services (CMS) has canceled a round of ICD-10 testing scheduled for this summer. The agency had previously announced that it would offer end-to-end ICD-10 testing for a small sample group of providers, to take place July 21–25, 2014. However, in response to action by the U.S. Congress to delay ICD-10 implementation for an additional year, CMS has altered its plans, and will instead offer providers additional opportunities to participate in end-to-end testing during 2015.   Read more…

7. Nominate a colleague for the Diversity, Humanitarian, or Tipton Leadership Award!
June 13, 2014 is the last day to submit nominations for the 2015 Humanitarian and Diversity Awards, and the William W. Tipton Jr., MD, Orthopaedic Leadership Award. These awards are presented annually at the AAOS Annual Meeting. Each award recipient is recognized for his or her endeavors to further encourage diversity or culturally competent care, humanitarian activities, or leadership activities in the orthopaedic profession.   Read more…

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

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

May 14, 2014

Today’s Top Story
1. The Joint Commission updates sentinel event database through 2013.
The Joint Commission has updated its sentinel event information to cover 2013. Overall, 887 sentinel events were reported during the year, the most common being “delay in treatment” (n = 113), followed by “wrong-patient, wrong-site, or wrong-procedure” (n = 109), and “unintended retention of a foreign object” (n = 102). Since 2004, The Joint Commission has tracked sentinel events covering 7,881 patients, of which 4,686 (59.1 percent) were associated with patient death. The organization defines a sentinel event as “an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.”   Read more…
View The Joint Commission sentinel event web page…

Other News
2. FDA study compares dabigatran etexilate and warfarin.
The U.S. Food and Drug Administration (FDA) has issued a Drug Safety Communication comparing the use of dabigatran etexilate to warfarin. Study data from 134,000 Medicare patients aged 65 years or older suggest that, among new users of blood-thinning medications, dabigatran etexilate may be associated with a lower risk of clot-related strokes, bleeding in the brain, and death, but an increased risk of gastrointestinal bleeding, compared to warfarin. The risk of myocardial infarction was similar for both drugs.   Read more…
Read the Drug Safety Communication…

3. Study: Database selection may affect results when studying comorbidities and adverse events.
A study published in the June issue of the journal Clinical Orthopaedics and Related Research compares two databases commonly used in orthopaedic research and finds that they identify very different results for specific comorbidities and adverse events. The authors conducted a retrospective cohort study of patients who underwent operative stabilization of transcervical and intertrochanteric hip fractures between 2009 and 2011, based on data from 122,712 patients in the Nationwide Inpatient Sample (NIS) and 5,021 patients in the National Surgical Quality Improvement Program (NSQIP). Although demographics and hospital lengths of stay were similar between the two databases, the authors found that the prevalence of nonmorbid obesity, coagulopathy, and anemia found in the NSQIP were more than twice those in the NIS. In contrast, the prevalence of peripheral vascular disease in the NIS was more than twice that in the NSQIP. In addition, the frequency of acute kidney injury and urinary tract infection in the NIS were more than twice that found in the NSQIP. The authors write that, “because it does not collect data after patient discharge, it can be implied from the NSQIP data that the NIS does not capture more than ½ of the deaths and surgical site infections occurring during the first 30 postoperative days.”
Read the abstract…

4. Study: Overuse of low value services may cost Medicare up to $8.5 billion per year.
Findings published in the May 12 issue of the journal JAMA Internal Medicine suggest that the overuse of “low value” services may cost Medicare between $1.9 billion and $8.5 billion per year. The researchers developed 26 claims-based measures of low-value services from evidence-based lists of services found to provide minimal clinical benefit. They compared those measures against claims for 1,360,908 Medicare beneficiaries during 2009 using versions of the measures with different sensitivity and specificity. The researchers found that services detected by more sensitive versions of measures affected 42 percent of beneficiaries and constituted 2.7 percent of overall annual spending, while services detected by more specific versions of measures affected 25 percent of beneficiaries and constituted 0.6 percent of overall spending.   Read more…
Read the abstract…

5. CBS report uses raw Medicare data to question surgeon volume.
A report by CBS News uses recently released U.S. Centers for Medicare & Medicaid Services payment data to identify surgeons who performed the highest volume of spinal fusions on four or more vertebrae among Medicare beneficiaries during 2011 to 2012. The writer cross-referenced that data against financial disclosure records and legal depositions, and used the information to question the necessity of some of the procedures. The writer notes that billing is a sometimes complicated and inconsistent process; that some surgeons see more referrals and as a result, tend to handle more complicated and severe cases; and that some surgeons work in areas with a greater number of Medicare beneficiaries. Such information is not available using billing code information alone.   Read more…

6. AAOS and HRET seek ASCs to participate in educational and quality improvement program.
AAOS and the Health Research and Educational Trust (HRET) of the American Hospital Association are collaborating on a new educational and quality improvement program for Ambulatory Surgery Centers (ASCs). AAOS and HRET will select 9 to 12 ASCs to take part in the year-long program, which involves an educational component focusing on improving teamwork, communication, infection prevention, and safety, along with data collection and monitoring. Reducing surgical site infections and other complications are important program outcomes. The program is open to any ASC owned by AAOS fellow(s) or operated under a joint venture with another entity, as long as orthopaedic surgeons participate in governance. ASCs that qualify for the program meet the following criteria: at least 4,000 cases annually; case mix including arthroscopy patients, arthroplasty patients, and patients undergoing other orthopaedic procedures that require a surgical incision; and orthopaedic surgeon ownership and/or governance. Data collection involves reporting sentinel events including wrong site surgery, wrong patient surgery, surgical site infections, and more. The deadline for submitting an application is June 30, 2014; selection will be made by July 31, 2014. The 12-month program is expected to begin in September 2014.  Read more…
Submit your application…
Questions regarding the program can be submitted at ascorthopaedic@aaos.org.

7. Submit your 2011 OSAE/SAE answer files by May 31 to be included in the final scoring.
Submit your 2011 Orthopaedic Self-Assessment Examination (OSAE/SAE) answer file by May 31, 2014, to be included in the final scoring. If you purchased the OKU10 and the self-assessment examination, you can earn a maximum of up to 70 American Medical Association Physician’s Recognition Award (AMA PRA) Category 1 Credits (of which 20 can be applied toward the Scored and Recorded Self-Assessment requirement mandated by the American Board of Orthopaedic Surgery Maintenance of Certification process). If you only purchased the scored and recorded examination, you can still earn 20 AMA PRA Category 1 Credits. You will receive immediate CME credits when you submit your answers to AAOS for confidential scoring.

8. Call for volunteers: Judiciary Committee.
June 30 is the last day to submit your application for a position on the Judiciary Committee (chair and one member opening). The Judiciary Committee is responsible for hearing and adjudicating appeals of the Committee on Professionalism Grievance Hearing Panels’ reports, and making recommendations regarding complaints against AAOS fellows and members for alleged violations of the AAOS Standards of Professionalism. Applicants for these positions must have a demonstrated understanding of and experience with legal issues related to orthopaedic surgery, including expert opinion and testimony.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

May 16, 2014

Today’s Top Story
1. Federal government to allow insurers to use “reference pricing.”
The Associated Press reports that the Obama administration has granted approval for insurers and employers to implement a “reference pricing” plan for certain procedures, including hip and knee arthroplasty. Reference pricing allows insurers to place a hard limit on what they will pay for a given procedure, with any excess cost being passed on to the patient. Under the Affordable Care Act, most plans have to pick up the entire cost of care after a patient hits an annual out-of-pocket limit, and observers had noted that it was unclear whether reference pricing would be permitted. Supporters of the move say that reference pricing helps drive the cost of care downward, as patients are more likely to choose less expensive hospitals. Critics point out that reference pricing can leave patients on the hook for high hospital bills, and note that the strategy is most suitable for common procedures and tests that may have wide variation in price but not quality.   Read more…

Other News
2. Study: Morbid obesity linked to increased risk of complications after TKA.
Morbid obesity may be associated with a higher risk for certain postoperative complications and mortality after total knee arthroplasty (TKA), according to a study published online in the journal Clinical Orthopaedics and Related Research. The authors reviewed data on 90,045 morbidly obese patients who had undergone primary TKA, and a matched cohort of non-obese patients. They found that, compared with non-obese patients, morbidly obese patients had an increased risk of postoperative in-hospital infection, wound dehiscence, genitourinary-related complications, and in-hospital death. In addition, total hospital cost, length of stay, and rate of discharge to a facility were all higher in morbidly obese patients. The authors found no increase in the prevalence of cardiovascular or thromboembolic-related complications.
Read the abstract…

3. Study: Complication rates after THA, TKA vary widely across hospitals.
Data published in the April 16 issue of The Journal of Bone & Joint Surgery suggest a wide range of complication rates among hospitals that perform elective total hip arthroplasty (THA) and TKA. The researchers conducted a cross-sectional analysis of 878,098 Medicare fee-for-service beneficiaries, aged 65 years or older, who underwent elective THA or TKA across 3,479 hospitals in the United States. They found that the median risk-standardized complication rate averaged 3.6 percent, yet ranged from 1.8 percent to 9.0 percent. The most common complications were pneumonia (0.86 percent), pulmonary embolism (0.75 percent), and periprosthetic joint infection or wound infection (0.67 percent).   Read more…
Read the abstract…

4. What strategies are most effective at reducing readmissions?
A study published online in the journal JAMA Internal Medicine examines strategies for reducing 30-day readmissions. The research team conducted a meta-analysis of 42 randomized trials and found that the most effective interventions were ones that covered many components, involved more individuals in care delivery, and supported patient capacity for self-care. In addition, a post hoc regression model showed incremental value in providing comprehensive, post-discharge support to patients and caregivers. The research team also noted that trials published before 2002 reported interventions that were 1.6 times more effective than those tested later.   Read more…
Read the abstract…

5. German report suggests therapeutic arthroscopy may offer little benefit for patients with knee OA.
A report released by the German Institute for Quality and Efficiency in Health Care suggests that there may be little benefit to therapeutic arthroscopy of the knee joint for knee osteoarthritis (knee OA, referred to as gonarthrosis in the report), compared to non-active comparator interventions. The authors conducted a meta-analysis of 11 published, randomized, controlled trials in which therapeutic arthroscopy of the knee joint with lavage and possible additional debridement was compared against no additional treatment, sham treatment, or another active treatment. “There was no hint, indication or proof of a benefit of therapeutic arthroscopy for any patient-relevant outcome in comparison with no active comparator intervention,” the authors write. “There was also no hint, indication or proof of a benefit of therapeutic arthroscopy for any outcome in the comparisons with lavage, oral administration of NSAIDs, intraarticular hyaluronic acid injection or strengthening exercises under the supervision of a physical therapist.”  Read more…
View the report and related materials…
The AAOS Clinical Practice Guideline (CPG) “Treatment of Osteoarthritis (OA) of the Knee” recommends against performing arthroscopy with lavage and/or debridement in patients with a primary diagnosis of symptomatic osteoarthritis of the knee.   View the AAOS CPG and related materials…

6. Study: Medicaid patients often start in poorer health, see worse outcomes.
Information published online in the journal JAMA Surgery suggests that surgical patients covered by Medicaid are more likely to have poorer health at baseline, see worse outcomes, have longer hospital stays, and are more likely to be readmitted, compared to patients covered by private insurance. The researchers conducted a retrospective review of all adults (nearly 14,000 patients) aged 64 years and younger not covered by Medicare and who underwent inpatient general surgery within the Michigan Surgical Quality Collaborative from July 2012 to June 2013. They found that those with Medicaid coverage were twice as likely as other patients to have certain health risk factors prior to surgery had more emergency operations, experienced two-thirds more complications after surgery, and used 50 percent more hospital resources than patients with other forms of insurance. In addition, Medicaid patients were twice as likely to smoke, and had higher rates of conditions such as diabetes, lung disease, and blood vessel blockage.   Read more…
Read the abstract…

7. NASS task force releases insurance recommendations for spine procedures.
The North American Spine Society (NASS) has released a set of insurance policy coverage recommendations covering 13 treatments, surgical procedures, and diagnostics, covering such topics as:

  • Cervical Artificial Disc Replacement
  • Endoscopic and Lumbar Discectomy
  • Interspinous Device with and without Fusion
  • Lumbar Artificial Disc Replacement
  • Lumbar Fusion
  • Lumbar Laminotomy
  • Percutaneous Thoracolumbar Stabilization
  • Recombinant Human Bone Morphogenetic Protein

The organization states that the recommendations were developed by a task force that drew heavily on level 1 data, and in the absence of such, the “best available evidence.” In addition, NASS lists 14 more coverage policy recommendations it expects to address at a future date.   Read more…
Read the recommendations…

8. Call for volunteers: International Committee.
June 30 is the last day to submit your application for a position on the International Committee (one member, one resident member position). The International Committee oversees a variety of international initiatives, including physician education programs, scholarships, humanitarian activities, international relations, and more. Applicants for these positions are recommended, but not required, to have skills in a second language.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

May 19, 2014

Today’s Top Story
1. Study: Health status of Medicaid patients raises questions about the ACA’s financial implications.
As reported by The New York Times, a study recently published in the journal JAMA Surgery suggests that Medicaid patients may be in worse health prior to surgery and may have higher postoperative complication rates, longer hospital stays, and higher healthcare costs than patients covered by private insurance. The article notes that this may have implications due to the increasing numbers of previously uninsured patients who gained Medicaid coverage under the Affordable Care Act. Based on data from the 52-hospital Michigan Surgical Quality Collaborative in the year prior to approval of Medicaid expansion (July 2012 to June 2013) in the state of Michigan, researchers found that, compared to patients with private insurance, Medicaid patients were twice as likely to be smokers and had higher rates of conditions such as diabetes, lung disease, and blood vessel blockage. The investigators note that, “given that the Affordable Care Act also mandates a reduction in payments to disproportionate share hospitals, increased Medicaid enrollment could have substantial clinical and financial implications.”   Read more…
Read the abstract…

Other News
2. Report: Top wages in health care may not always go to physicians.
Physicians’ wages may be lower than those of others in the healthcare realm, such as insurance executives, hospital executives, and hospital administrators, according to an analysis performed for The New York Times by Compdata Surveys. The report finds that insurance chief executive officers, hospital chief executive officers, and hospital administrators receive average base salaries of $584,000, $386,000, and $237,000, respectively, while surgeons receive average base salaries of $306,000, and general doctors receive average base salaries of $185,000. According to The New York Times, the gap between physicians’ salaries and those of top executives may actually be larger than these statistics indicate, given that top executives often earn most of their income from nonsalary compensation, such as stock options.    Read more…

3. FDA releases updated safety information for several drugs.
Drug safety information issued last month by the U.S. Food and Drug Administration (FDA) and updated May 16, 2014, relates to drugs such as opiods and antibiotics that orthopaedic surgeons may use to treat patients. The Drug Safety Labeling Changes relate to the following: boxed warning, contraindications, warnings, precautions, adverse reactions, or patient package insert/medication guide sections. Drug names and modified sections are listed in the “Quick View” table, while the “Detailed View” of each drug, which can be accessed by clicking on the drug name, includes sections and subsections modified, a description of new or modified safety information in the boxed warning, contraindications, or warnings sections, and a link to the revised prescribing information.   Read more…

4. Study: Joints may hold key to protection from OA.
Findings from a University of Edinburgh study suggest a strong link between osteoarthritis (OA) and the cannabinoid receptors and their ligands found in the synovial tissue and fluid that surround joints, Medical News Today reports. Specifically, the type 2 cannabinoid receptor (CB2) was found to be a significant source of defense against OA. The study revealed that CB2-deficient mice with destabilized knee joints had up to 40 percent more severe cartilage degeneration compared to normal mice. In aged mice, the amount rose up to 60 percent. In addition, the synthesized cannabinoid ligand, HU308, was found to significantly inhibit the progression of arthritis in younger mice with normal levels of CB2 and had no effect on those with CB2 receptor deficiency. The researchers plan next to investigate the role of the CB2 pathway in humans.   Read more…

5. Residency bottleneck could lead to physician shortage.
The Minneapolis Star Tribune reports that the number of medical school applicants is far outpacing the number of openings; however, schools claim they cannot increase the number of openings due to a federal cap on Medicare funding for residency programs. Healthcare analysts fear that the bottleneck could lead to a shortage of doctors in the United States—90,000 by one estimate—over the next decade. In 2006, the Association of American Medical Colleges called on schools to increase admissions 30 percent by 2015 to avert a shortage. The schools are reportedly on track to reach that goal by 2017. Meanwhile, however, the applicant pool continues to grow, increasing competition for limited slots.    Read more…

6. California.
In November, Californians will be able to vote on increasing the monetary sum victims can recover in medical malpractice lawsuits, The Sacramento Bee reports. Supporters of the initiative want to raise the cap on pain and suffering damages from $250 million to approximately $1.1 million. The measure would also mandate random drug and alcohol testing of doctors and require physicians to check the state’s prescription drug database before prescribing drugs to curb abuse. Opponents of the initiative, including the California Medical Association, California Hospital Association, and California Chamber of Commerce, argue that the measure would increase the number of medical lawsuits as well as overall healthcare costs.   Read more…

7. Call for volunteers: Committee on Professionalism.
June 30 is the last day to submit your application for a position on the Committee on Professionalism (two member openings). The Committee on Professionalism oversees all aspects of the AAOS Professional Compliance Program, conducts hearings on filed professional compliance grievances, and develops recommendations for the Board of Directors. Applicants for this position must have a demonstrated understanding of and experience with legal issues related to orthopaedic surgery, and be willing to thoroughly understand the AAOS Bylaws, the AAOS Standards of Professionalism (SOPs) and the Professional Compliance Program and Grievance Procedures. Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

May 21, 2014

Today’s Top Story
1. Study: Physical therapy may not improve pain, function in patients with hip OA.
As reported by Medical News Today, a study recently published in the Journal of the American Medical Association finds that patients with painful hip osteoarthritis (OA) who underwent physical therapy did not have greater improvement in pain or function than patients with painful hip OA who received sham treatment. The randomized, placebo-controlled, participant- and assessor-blinded trial involved 102 community volunteers with hip OA confirmed by radiograph and hip pain levels of at least 40 on a visual analog scale of 0–100 (100 indicates worst pain possible). Forty-nine patients were placed in the “active” group and received education and advice, manual therapy, home exercise, and gait aid, if appropriate. Fifty-three patients were placed in the “sham” group and received inactive ultrasound and inert gel. All patients underwent 12 weeks of intervention and 24 weeks of follow up (May 2010–February 2013). Patients in the active group continued unsupervised home exercise for 24 weeks after treatment, while participants in the sham group self-applied gel 3 times weekly during that 24-week period. The researchers found that, at 13 and 36 weeks, the active treatment did not lead to additional benefits compared with sham treatment as measured by pain and physical function scores, which had improved in both groups. The active group, however, had significantly more adverse events; 41 percent of patients in the active group reported a total of 26 mild adverse events and 14 percent of those in the sham group reported a total of 9 mild adverse events.    Read more…
Read the study…

Other News
2. CMS proposes rule to allow healthcare providers more time to stay at Stage 1 under EHR incentive program.
The U.S. Department of Health and Human Services published a new proposed rule from the U.S. Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) that would give healthcare providers an extra year to use 2011 Edition software in their electronic health record (EHR) systems under the federal incentive program for health IT meaningful use. As reported by Modern Healthcare, this proposed rule would give hospitals, physicians, and other eligible professionals scheduled to jump to the program’s Stage 2 criteria another year to remain at Stage 1, using the 2011 Edition software to meet the program’s Stage 1 meaningful use criteria. It would also allow healthcare providers to use a combination of 2011 and 2014 Edition certified EHR software for the EHR reporting period in 2014 for the Medicare and Medicaid EHR incentive programs. CMS and the ONC cited the slow delivery and implementation of the upgraded 2014 edition software as prompting the need to allow healthcare providers more time to implement to the new software. In addition, under the proposed rule, Stage 2 would be extended through 2016, and Stage 3 would begin in 2017.   Read more…
Read the press release from CMS…
Download a pre-publication PDF version of the proposed rule…

3. Infection tracking at ASCs scrutinized.
Gaps in infection tracking at ambulatory surgery centers (ASCs) are fueling concern among healthcare experts, according to an article inScientific American. Unlike hospitals, outpatient surgical centers are not required to track healthcare-associated infections. Although ASCs that receive Medicare funding are required to have a staff member tasked with infection prevention in general, he or she is required only to have received some training, but no formal certification, the article reports. In addition, if and how infections after surgery are tracked often differ among ASCs because no central reporting entity exists. Daniel Pollack, surveillance branch chief in the U.S. Centers for Disease Control and Prevention’s Division of Healthcare Quality Promotion, however, is not convinced that ASCs should employ infection tracking systems that mirror what hospitals use, noting that ASC patients return home long before signs and symptoms of infection develop. “That’s a question that I think is still open to an ongoing exploration,” he said. “To date, I think that experience suggests the yield [for infections] will be fairly low for those procedures that would be included.”   Read more…

4. Study: Diphosphonate fails to halt bone erosion in gout.
Treatment with the diphosphonate zoledronate did not prevent bone erosion in patients with tophaceous gout, a randomized, double-blind clinical trial found. It has been proposed that osteoclasts have a role in bone erosion in gout and investigators at the University of Auckland in New Zealand sought to discover if use of zoledronate, a powerful antiosteoclast agent, would have a beneficial effect. No differences in changes on computed tomography (CT) erosion scores of the feet were seen among patients treated with zoledronate (5 mg intravenously once yearly) versus those given placebo at either year 1 or year 2 (P = 0.49 for treatment, P = 0.47 for time, P = 0.23 for interaction of treatment by time). Bone mineral density (BMD) in the 100 total patients was rated “excellent” at baseline, and those with 2 years of zoledronate exhibited greater BMD at the spine, total hip, femur neck, and total body. Diphosphonates have commonly been used to prevent fractures in older patients, but concern has arisen that long-term use (>5 years) may lead to atypical femur fractures. The findings in the gout study raise questions “about the processes of bone erosion in gout, particularly about the natural history of bone erosion” and “whether bone erosions can heal in those with long disease duration,” the researchers wrote in the June Annals of the Rheumatic Diseases, as reported by MedPage Today.   Read more…
Read the abstract…

5. Point/counterpoint: Authors debate how to manage provider consolidation.
Four articles in Health Affairs address the issue of consolidation of healthcare providers, examining “strategies that purchasers and payers can pursue to combat the rising prices that may result from growing provider leverage.” The overview article concludes that the success of private- and public-sector initiative will determine whether governments shift from supporting competition to directly regulating payment rates. A second article notes that an entrenched history of regulation has both distorted prices and altered the nature of the products that the system buys and sells. A viewpoint piece contends that the proposals to achieve a more cost-effective environment through prudent regulation while giving emerging sectors room to prosper is fundamentally flawed and calls for a greater understanding by the public of “what kind of health system we really want and how much we are prepared to pay for it.” The final article counters that regulators must maintain antitrust enforcement and consumer protection in health care markets.   Read more…

6. At hearing, Congressmen call for fix to “broken” Medicare appeals system.
During a congressional hearing yesterday, legislators expressed concern about oversight of Medicare programs to recapture improper payments. According to Modern Healthcare, members of the House Committee on Oversight and Government Reform stressed that they want transgressors punished, but that they worried that the system for appealing Medicare payment decisions is so “broken” that it offers little protection for providers. Members expressed concern about delays in getting an appeals hearing, about the due process system, about contractors used by CMS to track down wrongful payments, and about potential access to care issues.   Read more…(registration may be required)

7. Last call for voting for AAOS 2015 Nominating Committee; resolutions, bylaw votes need 20 percent participation.
Ballots for electing six members of the 2015 Nominating Committee and establishing a valid vote on three AAOS resolutions and three bylaw amendments must be submitted by 11:59 p.m. on Friday, May 23, 2014. At that time, voting for individuals to serve on the Nominating Committee will close, regardless of the number of ballots cast. At least 20 percent of those eligible to vote must vote for the decision on AAOS resolutions and bylaw amendments to be valid. Online voting is quick, secure, and confidential. Direct questions to the AAOS Voting Hotline at 800-999-2939. Cast your ballot at:
Cast your ballot…(member login required)

8. Call for volunteers: AJRR Board of Directors.
July 25 is the last day to submit your application for a position on the American Joint Replacement Registry (AJRR) Board of Directors (one member-at-large opening). The AJRR is a separate entity from the Academy and the Association, with its own board of directors. The initial role of AJRR is to foster a national center for data collection and research on total hip and total knee replacement. Applicants for this position must be willing to complete the AAOS mandatory enhanced disclosure information required of AAOS Board members, and be willing to declare how any potential conflicts of interest would be managed if the individual is selected as a board member.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(password protected)

Note: AAOS Headline News Now

will not be published on Memorial Day, Monday, May 26. Publication will resume on May 28.

May 28, 2014

Today’s Top Story
1. MGMA survey notes practice challenges dealing with ACA patients.
A Medical Group Management Association (MGMA) survey of 728 medical groups covering more than 40,000 physicians assesses the impact of Affordable Care Act (ACA) exchanges on those practices during the first 120 days of 2014. The researchers found that more than 80 percent of respondents said their practices are participating with products sold on the ACA exchanges, and that more than 90 percent of those practices have already seen patients covered under the new law. However, 62 percent of respondents reported moderate to extreme difficulty identifying patients with ACA exchange coverage (compared to traditional commercial coverage), and 60 percent stated that factors such as eligibility, cost-sharing, and network coverage were somewhat or much more difficult to determine. Overall, MGMA notes three primary themes, based on the survey responses:

  • Practices have experienced difficulty in identifying patients with ACA coverage and obtaining essential information related to that coverage.
  • Practices are facing a number of challenges related to patient cost-sharing for ACA insurance exchange coverage.
  • Practices have concerns about the impact of the network design of many ACA exchange products.

Read more…
Read the complete report (PDF)…

Other News
2. Study: Arthrodesis without instrumentation associated with decreased cost and similar outcomes for certain spinal stenosis patients.
Findings from a study published in the May 20 issue of the journal Spine suggest that use of arthrodesis without instrumentation may be linked with decreased costs and similar outcomes for patients with spinal stenosis if fusion is warranted. The authors conducted a retrospective cohort analysis of 12,657 patients who underwent spinal stenosis surgery between 2002 and 2009. They found that early complication rates were significantly higher for patients who underwent laminectomy with fusion than for those who underwent laminectomy alone, but reoperation rates did not differ significantly between the groups. Among patients with 5-year follow-up data, reoperation rates were similar for those undergoing decompression alone versus decompression with fusion. The authors noted that patients with instrumented fusions had a slightly higher rate of reoperation than patients with noninstrumented fusions. At 5 years, the total cost—including initial procedure and hospital, outpatient, emergency department, and medication charges—was similar for patients who received decompression alone and those who received decompression with fusion. The long-term costs for instrumented and noninstrumented fusions were also similar.
Read the abstract…

3. Study: Physical activity program may reduce major mobility disability in older adults.
A study published online in The Journal of the American Medical Association suggests that a moderate-intensity physical activity program may reduce major mobility disability among older adults, compared to a health education program. The researchers conducted a multicenter, randomized trial of 1,635 sedentary men and women aged 70 to 89 years, who had physical limitations but were able to walk 400 meters. Participants took part in either a structured, moderate-intensity physical activity program (n?=?818) conducted in a center twice per week and at home three to four times per week, or to a health education program (n?=?817) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises. At mean 2.6-year follow-up, the researchers found that incident major mobility disability (defined as the loss of the ability to walk 400 meters) occurred in 30.1 percent (n = 246) of the physical activity group and in 35.5 percent (n = 290) of the health education group. Overall, 14.7 percent (n = 120) of participants in the activity group experienced persistent mobility disability, compared to 19.8 percent (n = 162) of participants in the education group. However, serious adverse events were reported by 49.4 percent (n = 404) in the activity group and 45.7 percent (n = 373) in the education group.   Read more…
Read the abstract…

4. How well do patients cope with “fast track” THA?
According to an article in Medscape, patients may see improvement in movement and reduction in pain during the first month after undergoing “fast track” total hip arthroplasty (THA). Under the fast track program, patients are admitted on the day of surgery and are mobilized and allowed full weight bearing within a few hours after surgery. The mean hospitalization time of the participants in the study was 2.5 ± 0.1 days, after which patients were discharged to their homes. The Danish research team conducted a pilot study of 32 patients who underwent fast track primary THA. At 31-day follow-up, they found that patients had improved Oxford Hip Scores and reduced pain both at rest and during activity compared to preoperative levels. However, patients’ daily use of prescribed analgesia increased by 11 percent, compared with preoperative consumption and use of over-the-counter analgesia increased by 21 percent, compared with preoperative levels. Overall, patient satisfaction was high, with 100 percent of participants willing to repeat treatment.  Read more…(registration may be required)

5. New York.
A report released by the New York Public Interest Research Group calls on policymakers in that state to allow consumers to have access to a website that would allow them to file complaints against healthcare providers, ensure that patients are aware of the state’s online physician profiles, and provide consumer access to the state Office of Professional Medical Conduct database of its actions against physicians and other providers. The report, which relied on data provided by New York State government agencies, states that more than 77 percent of physicians who are sanctioned for negligence by the New York State Department of Health are allowed to continue to practice, and that nearly 60 percent of actions against physicians in the state are based on sanctions taken by other states, the federal government, or the courts.   Read more (PDF)…
Read the complete report (PDF)…

6. Submit your AAOS 2015 Annual Meeting Abstracts now!
Share your knowledge with orthopaedic surgeons from around the world at the 2015 AAOS Annual Meeting, to be held March 24–28, 2015, in Las Vegas. June 2, 2014, is the submission deadline for paper presentations, posters, and scientific exhibits. The deadline for the Orthopaedic Video Theater is July 15. Nowhere else will your discoveries reach such a wide-ranging orthopaedic audience!
Submit your abstract…

7. OKOJ June 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: “Angular Deformities of the Lower Extremity in Children,” “Common Acute Hand Infections,” and “Distal Tibia Allograft for the Management of Anterior Glenoid Bone Loss.” In addition, a new video on “Distal Tibial Allograft for Management of Anterior Glenoid Bone Loss,” has been made available.
View these topics and more…(member login required)

8. Submit your 2011 OSAE/SAE answer files by May 31 to be included in the final scoring.
Submit your 2011 Orthopaedic Self-Assessment Examination (OSAE/SAE) answer file by May 31, 2014, to be included in the final scoring. If you purchased both OKU10 and the self-assessment examination, you can earn a maximum of 70 American Medical Association Physician’s Recognition Award (AMA PRA) Category 1 Credits (of which 20 can be applied toward the Scored and Recorded Self-Assessment requirement mandated by the American Board of Orthopaedic Surgery Maintenance of Certification process). If you purchased only the scored and recorded examination, you can still earn 20 AMA PRA Category 1 Credits. You will receive immediate CME credits when you submit your answers to AAOS for confidential scoring.

9. Call for volunteers: Anatomy-Imaging Evaluation Committee.
July 11 is the last day to submit your application for a position on the Anatomy-Imaging Evaluation Committee. Members of this committee write questions for the Anatomy-Imaging Self-Assessment Examination. Committee members are needed with the following expertise:

  • Foot and Ankle (one member opening)
  • Hand and Wrist (two members)
  • Spine (two members)
  • Tumors (two members)

Applicants for these positions must be active fellows, emeritus fellows, or candidate member applicants for fellowship with a practice emphasis in the relevant subject area.

Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

May 30, 2014

Today’s Top Story
1. June 1 is first day to register at CMS “Sunshine Act” portal.
The “Sunshine Act” provisions of the Affordable Care Act require that data on payments and gifts made to physicians and teaching hospitals by medical device and pharmaceutical companies be publicly available on a searchable federal database, starting in September 2014. Before the data is publicly posted, physicians and representatives of teaching hospitals can review it and dispute any inaccurate or incomplete information—but only if they have registered to do so. On June 1, 2014, physicians and teaching hospital representatives will be able to register on the U.S. Centers for Medicare & Medicaid Services (CMS) Enterprise Portal for what CMS is calling the “Open Payments Program.” Registration is voluntary, and this year it will be conducted in two phases:

  • Phase 1 (begins June 1) includes user registration in CMS’ Enterprise Portal.
  • Phase 2 (begins in July) includes physician and teaching hospital registration in the Open Payments system.

During a 45-day period, registered physicians and teaching hospital representatives will be allowed to review and dispute data submitted by applicable manufacturers and applicable group purchasing organizations. If the dispute is resolved during that time, CMS will publish the corrected information; if resolution cannot be reached, the data will still be published but marked as disputed.

AAOS has set up a web page to help members connect to resources and recent news about the Open Payments system, and strongly encourages members to register at the CMS Portal.   Read more…
View the instructional presentation on steps to complete EIDM registration (PDF)…
Register on the portal (June 1 or later)…

Other News
2. CMS to maintain partial code freeze for ICD-9-CM and ICD-10 code sets.
CMS has announced that the partial code freeze for ICD-9-CM and ICD-10 will continue through Oct. 1, 2015. The partial freeze will continue to be implemented as follows:

  • On Oct. 1, 2014 only limited code updates will be made to both the ICD-9-CM and ICD-10 code sets to capture new technologies and diseases.
  • On Oct. 1, 2015, only limited code updates will be made to ICD-10 code sets to capture new technologies and diagnoses. There will be no updates to ICD-9-CM.
  • On Oct. 1, 2016 (one year after implementation of ICD-10), regular updates to ICD-10 will begin.

Read more (PDF)…
CMS has previously stated that the U.S. Department of Health and Human Services (HHS) expects to soon release an interim final rule, including a new compliance date that will require the use of ICD-10 beginning Oct. 1, 2015.   Read more…

3. Study: Use of a continuous adductor canal block may reduce opioid consumption in first days after TKA.
Findings from a study published in the June issue of the journal Anesthesia & Analgesia suggest that a continuous adductor canal block for total knee arthroplasty (TKA) may reduce opioid consumption compared with that of placebo during the first 48 hours after surgery. The authors conducted a randomized study of 76 patients who presented for primary TKA and received either a continuous ultrasound-guided adductor canal block with 0.2 percent ropivacaine or a sham catheter. They found that the least-square mean difference in cumulative morphine consumption over 48 hours (block – sham) was -16.68 mg, and that total morphine use between 24 and 48 hours also differed by least-square mean -11.17 mg. Additionally, patients in the adductor canal catheter group had better quadriceps strength and further distance ambulated on postoperative day 2.   Read more…
Read the abstract…

4. OIG report finds $6.7 billion in improper Medicare claims due to incorrect coding or lack of documentation.
A report released by the HHS Office of Inspector General (OIG) finds that Medicare inappropriately paid $6.7 billion for claims for evaluation and management (E/M) services during 2010 due to incorrect coding or lack of documentation. According to OIG, the figure represents 21 percent of Medicare payments for E/M services the year. OIG conducted a medical record review of a random sample of Medicare Part B claims for E/M services, and found that 42 percent of claims for E/M services in 2010 were incorrectly coded, including billing at levels both higher and lower than warranted, and that 19 percent of claims lacked documentation. In addition, OIG found that claims from high-coding physicians were more likely to be incorrectly coded or insufficiently documented than claims from other physicians.
Read the report (PDF)…

5. AAOS seeks public comment on Guideline on Management of Hip Fractures in the Elderly.
The AAOS Guideline on Management of Hip Fractures in the Elderly has completed peer review by specialty organizations and will be ready for public comment soon. Members who wish to participate in the public commentary period should submit their names, phone numbers, and email addresses by Friday, June 6, to Jayson Murray, at  jmurray@aaos.org.

6. Nominate a colleague for the Diversity, Humanitarian, or Tipton Leadership Award!
June 13, 2014, is the last day to submit nominations for the 2015 Humanitarian and Diversity Awards, and the William W. Tipton Jr., MD, Orthopaedic Leadership Award. These awards are presented annually at the AAOS Annual Meeting. Each award recipient is recognized for his or her endeavors to further encourage diversity or culturally competent care, humanitarian activities, or leadership activities in the orthopaedic profession.   Read more…

7. New AAOS Now podcast on orthopaedist-designed diet plan.
AAOS Now has released an audio interview in which Frank B. Kelly, MD, speaks with Nicholas J. Meyer, MD, about Dr. Meyer’s novel approach to weight control.
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: Bylaws, Ethics, and Resolutions Committees.
July 18 is the last day to submit your application for a position on the Bylaws Committee (one member opening), Ethics Committee (chair, one member opening), and Resolutions Committee (one member opening). The Bylaws Committee makes recommendations to the fellowship on all proposed amendments to AAOS Bylaws and Standards of Professionalism. The Ethics Committee is responsible for the ethics and professionalism initiatives of the Academy and Association. The Resolutions Committee makes recommendations to the fellowship on resolutions proposed for adoption.
Openings also exist on a number of other committees, subcommittees, councils, and cabinets. Visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(member login required)

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