November 30, 2014

November 3, 2014

Today’s Top Story
1. CMS releases 2015 Physician Fee Schedule final rule.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released its 2015 Physician Fee Schedule final rule. The rule includes changes to fees for physician services, the Medicare Physician Quality Reporting System (PQRS), the Electronic Health Records (EHR) Meaningful Use program, and other quality and payment initiatives. A notable change is a proposal to eliminate all 10- and 90-day global payment periods for surgical services. The change will be phased in over the next 4 years, with 10-day global payments being transitioned out in 2017 and 90-day global payments in 2018. CMS has indicated an intent to evaluate alternative episode-based methods for bundled surgical payments during the transition period. In the long-term, single payments are expected to be made for all intraservice work performed for a given surgery, with surgical follow-up visits billed individually. AAOS expressed concerns about this “unbundling” proposal during a public comment period earlier this year.
On a separate note, the final rule reaffirms the values of hip and knee arthroplasty procedures that were announced in year 2014. Further examination of the final rule will be available in future issues of AAOS Now and AAOS Advocacy Now.   Read more…
Read the final rule (PDF)…

2. Supreme Court takes no action on ACA case…yet.
Reuters reports that observers continue to wait for the U.S. Supreme Court to announce whether it will take up a case that challenges a key part of the Affordable Care Act (ACA). The suit is based on an interpretation of wording in the ACA, which plaintiffs argue authorizes subsidies to ACA insurance purchasers only in states that have set up their own health insurance exchanges. In July, the 4th U.S. Circuit Court of Appeals upheld the subsidies. If the subsidies are found to be improper, observers say that 5 million consumers could be affected across the 36 states that use the federal healthcare.gov exchange, and the fiscal structure of the ACA could be in doubt.    Read more…

3. Study: Orthopaedic surgeons, neurosurgeons have similar complication rates for single-level ACDFs.
Findings published online in the journal Spine suggest that postoperative complication rates are similar for both orthopaedists and neurosurgeons performing single-level anterior cervical discectomy and fusions (ACDFs). The authors conducted a retrospective cohort study of 1,944 patients who underwent single-level ACDF between 2006 and 2012 and found that treating physician cohort (orthopaedic surgeons vs. neurosurgeons) was not associated with increased likelihood of overall complications, surgical site complications, or medical complications.   Read more…
Read the abstract…

4. AAOS and others argue for bill to clarify Open Payments reporting requirement.
In a letter to Rep. Michael Burgess, MD (R-Texas), the American Association of Orthopaedic Surgeons (AAOS), the American Medical Association, and more than 100 other medical organizations have expressed support for a U.S. House of Representatives bill that, if enacted, would clarify that certain applicable manufacturer payments to support independent medical educational programs and materials should be exempt from reporting under the Open Payments system (Sunshine Act). The writers explain that Congress outlined 12 specific exclusions from Open Payments reporting requirements, including “educational materials that directly benefit patients or are intended for patient use.” In its interpretation of the statute, CMS concluded that medical textbooks, reprints of peer-reviewed scientific clinical journal articles, and abstracts of such articles are neither directly beneficial to patients nor intended for patient use. “This conclusion is inconsistent with the statutory language on its face, congressional intent, and the reality of clinical practice where patients benefit directly from improved physician medical knowledge,” argue the physician organizations.
Read the letter (PDF)…

5. AAOS unveils new newsletter on evidence-based medicine.
AAOS has announced the first edition of the AAOS Evidence-Based Medicine Newsletter. The newsletter includes information on AAOS Clinical Practice Guidelines and Appropriate Use Criteria, news about ongoing evidence-based medicine projects, and links to further information. The newsletter is available online, or via email subscription, at disalvo@aaos.org?subject=EBM Newsletter Subscription&body=Please add me to the AAOS EBM Newsletter mailing list
Read the first newsletter…

6. November AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the November issue of AAOS Now, but the online edition is already available on theAAOS Now website. This month’s issue includes a look at the effect quality programs may have on reimbursement, a critical look at available Open Payments data, an examination of the Affordable Care Act in 2015, and much more!   Read more…
Read “What’s Ahead for Orthopaedic Payments?”…
Read “Problems Overshadow Sunshine Act Data”…
Read “The ACA in 2015: Where Does It Stand?”…

7. Call for volunteers: Workgroup for development of a clinical performance measure on OA.
The Performance Measures Committee seeks AAOS fellows to participate on a workgroup to re-evaluate the PQRS Measure #109—Osteoarthritis (OA): Function and Pain Assessment, which is now stewarded by AAOS. Final decisions regarding the project scope and design will be determined by the workgroup at the first workgroup meeting. Subject matter experts must apply no later than Nov. 21, 2014. For more information about the nominations process, please contact Jackie Ryan at 847-384-4337, or OAFPmeasure@aaos.org.
Learn more and submit your application…

8. Call for volunteers: AAOS Now Editorial Board.
AAOS Now seeks two members for its Editorial Board. This board serves as the strategic planning and content development body forAAOS Now, the Annual Meeting editions of AAOS Now, and AAOS Headline News Now. The following openings are available:

  • Member—foot and ankle
  • Resident-at-large

Applicants for the member position must be active or emeritus fellows with a practice emphasis in foot and ankle. Applicants for the resident-at-large position must be resident members (PGY- 2, PGY-3, or PGY-4). The deadline for applications is Dec. 5.
Learn more and submit your application…(member login required)

November 5, 2014

Today’s Top Story
1. Republicans to gain control of the Senate.
The Republican Party will represent a majority in the U.S. Senate for the next 2 years, while retaining a majority in the U.S. House of Representatives. Observers say the shift in power offers Republicans their best chance to alter the Affordable Care Act (ACA). Sen. Mitch McConnell (R-Ky.), who is likely to be named Senate majority leader, indicated a new Senate Republican majority will not be able to repeal the ACA in its entirety, but would instead most likely target pieces of the ACA for repeal, including the medical device tax, the law’s 30-hour workweek standard for the employer mandate, and the individual mandate.   Read more…
For ongoing election coverage, view the AAOS office of government relations Twitter account…

Other News
2. Republican Doctors Caucus calls for SGR reform.
The Republican Doctors Caucus has sent a letter to House Speaker John Boehner (R-Ohio) and House Majority Leader Kevin McCarthy (R-Calif.), asking them to prioritize permanent reform of the SGR before the end of the year. The letter notes that H.R. 4015—a bill that would have repealed the SGR—received bipartisan support, but failed to pass when lawmakers couldn’t agree on how to fund it. A bill that temporarily halted reimbursement cuts called for under SGR expires March 31, 2015.   Read more…
Read the letter (PDF)…

3. Study: Low-molecular-weight heparin may offer cost and efficacy benefit over unfractionated heparin for VTE prophylaxis.
Data from a study published online in The Journal of the American Medical Association suggest that low-molecular-weight heparin (LMWH) dalteparin for venous thromboembolism (VTE) prophylaxis may offer increased efficacy at lower cost than unfractionated heparin (UFH). The authors conducted a blinded, randomized trial of 2,344 patients across 23 centers in 5 countries, who were treated with either LMWH or UFH. Hospital costs averaged $39,508 for patients who received LMWH and $40,805 for patients who received UFH. In addition, in 78 percent of simulations, a strategy using LMWH was more effective and less costly than UFH. There was no acquisition cost threshold that favored prophylaxis with UFH over LMWH.
Read the abstract…

4. Study: Patient position may affect radiographic view of clavicle fracture.
According to a study published in the November issue of the Journal of Orthopaedic Trauma, patient positioning may affect radiographic view of displacement for patients with acute clavicle fracture. The research team obtained standardized clavicle radiographs in both supine and upright positions for 49 patients who were seen with acute clavicle fractures at a single, level 1 trauma center. They found that fracture displacement was significantly greater when measured from upright radiographs compared to supine radiographs. Overall, 41 percent of patients had greater than 100 percent displacement on upright but not on supine radiographs. In addition, compared with the uninjured side, 3.0 ± 10.7 mm of shortening was noted on upright radiographs and 1.3 ± 9.5 mm of lengthening on supine radiographs.
Read the abstract…

5. Stryker settles ceramic-on-metal hip implant suit.
Stryker Corp. has agreed to a more than $1.4 billion settlement in a lawsuit over the company’s Rejuvenate and ABG II modular-neck implants. The company voluntarily pulled the devices from the market in 2012 after patients complained of pain and swelling from the devices, and testing revealed that many patients with the implant had metallosis—a toxic dose of metal in the blood related to potential fraying and erosion of the implant. Damages in the cases are not capped, and some observers say that the company’s estimate of $1.425 billion in total payouts is considered conservative.   Read more…

6. California.
The Wall Street Journal reports that California voters have voted down Proposition 46, which proposed to increase the state’s cap on medical liability awards, require routine drug and alcohol testing for hospital physicians, and require healthcare providers to check the prescription drug histories of patients against a state database. Currently, the state caps pain and suffering damages at $250,000, but Prop. 46 would have increased the cap to $1.1 million and allowed for inflation adjustments.   Read more…

7. Utah.
According to the AMA Wire, the Utah Supreme Court has upheld a state law requiring the confidentiality of physician peer review. A lower court had ruled that a physician’s peer review files could be introduced as evidence in medical liability cases, contrary to a 2012 law explicitly protecting that information to preserve the integrity of peer review proceedings.   Read more…

8. Last call: Program Committees.
Nov. 10 is the last day to submit your application for a position on a Program Committee. The following openings are available:

  • Foot & Ankle Program Committee (two members)
  • Musculoskeletal Tumor & Metabolic Disease Program Committee (one member)
  • Trauma Program Committee (two members)

Members of Program Committees grade symposia in May and abstracts in June and July, and may serve as moderators for paper sessions and critical evaluators of courses at the AAOS Annual Meeting. Applicants for these positions must be active fellows or international affiliate members with a practice emphasis in the relevant area.
Learn more and submit your application…(member login required)


November 7, 2014

Today’s Top Story
1. Supreme Court agrees to review ACA subsidy case.
SCOTUSblog reports that the U.S. Supreme Court has decided to take up a case that could have ramifications for the viability of the Affordable Care Act (ACA). The plaintiffs in King v. Burwell argue that the ACA authorizes insurance subsidies only to purchasers in states that have set up their own health insurance exchanges. In July, the 4th U.S. Circuit Court of Appeals upheld the subsidies. If the Supreme Court finds the subsidies to be improper, observers say that 5 million consumers could be affected across the 36 states that use the federal healthcare.gov exchange, placing the fiscal structure of the ACA in doubt. The Court is not expected to rule on the issue until June or early July, 2015.   Read more…

Other News
2. Study: Handoff program may reduce errors and preventable adverse events.
According to a study published in the Nov. 6 issue of The New England Journal of Medicine, implementation of a handoff program designed to improve communication between healthcare providers during shift changes may help reduce medical errors and preventable adverse events. The research team conducted a prospective intervention study of a resident handoff-improvement program across nine hospitals, and found that the rate of medical errors decreased by 23 percent and the rate of preventable adverse events decreased by 30 percent after implementation of a handoff intervention that included a mnemonic to standardize oral and written handoffs, handoff and communication training, a faculty development and observation program, and a sustainability campaign. In addition, the research team noted no significant changes after implementation of the program in duration of oral handoffs or in resident workflow, including patient–family contact and computer time.   Read more…
Read the complete study…

3. AJRR releases first annual report.
The American Joint Replacement Registry (AJRR) has released its “2013 Annual Report on Hip and Knee Arthroplasty Data.” This is the first annual report released by AJRR, a non-profit organization that works to optimize patient outcomes through collection of data on all primary and revision hip and knee replacement procedures in the United States. The report reflects an estimated 4.5 percent of the total joint replacements conducted in the U.S. during 2013, and covers 43,823 procedures performed at 123 participating institutions.   Read more (PDF)…
Read the complete report (PDF)…

4. Study: Men appear less likely to undergo evaluation and treatment for osteoporosis after DRF.
Data published in the Nov. 5 issue of The Journal of Bone & Joint Surgery suggest that men are less likely than women to be evaluated for osteoporosis after sustaining a distal radial fracture (DRF). The authors conducted a retrospective review of 95 men and 344 women older than 50 years who were treated for DRF at a single institution. They found that men overall had less severe fractures than women. However, 184 women (53 percent) were given a dual x-ray absorptiometry (DXA) scan after injury, compared to 17 men (18 percent). Among patients who underwent a DXA scan, nine men (9 percent of men overall) and 65 women (19 percent of women overall) had a diagnosis of osteoporosis. The authors found that male sex was an independent predictor of failure to undergo bone mineral density testing as well as to receive subsequent treatment with calcium and vitamin D or bisphosphonates.   Read more…
Read the abstract…

5. Study: Many youth baseball players may have arm pain.
According to findings published online in The American Journal of Sports Medicine, many healthy and actively competing youth baseball players report at least some baseline arm pain and fatigue. The researchers surveyed 203 healthy players and found that 26 percent reported that their arm never hurt when throwing, while 20 percent stated that their arm never hurt the day after throwing. In addition, 30 percent of players reported that arm pain at least sometimes caused them to have less fun playing, while 46 percent reported at least once being encouraged to keep playing despite having arm pain. Overall, pitchers were more likely than position players to report arm pain, and players with a prior overuse injury (23 percent of total) were more likely to have arm pain while throwing, to have arm fatigue during a game or practice, and to be encouraged to keep playing despite having pain.   Read more…
Read the abstract…

6. Meaningful Use hardship exemption deadline is less than 1 month away.
The American Medical Association is reminding physicians that they have until Nov. 30 to apply for a hardship exception under the federal Electronic Health Record (EHR) Meaningful Use program. To be considered for an exception, an eligible professional or eligible hospital must complete a hardship exception application and provide proof of the hardship. If approved, the hardship exception is valid for 1 payment year only.   Read more…

7. OIG releases 2015 work plan.
The U.S. Department of Health and Human Services Office of Inspector General (OIG) has released its FY 2015 work plan. Included in the work plan are the following objectives:

  • Risk assessment of U.S. Centers for Medicare & Medicaid Services administration of the Pioneer Accountable Care Organization model
  • Review of Medicare incentive payments for adopting EHRs and receiving incentive payments based on meeting meaningful use criteria
  • Reviews of hospital billing and payments, and quality of care

Read more…
Read the complete report (PDF)…

8. Call for volunteers: Patient Education Committee.
Nov. 21 is the last day to submit your application for a position on the Patient Education Committee (three member openings). The Patient Education Committee develops and updates patient education materials designed to assist members in their interactions with patients and improve patient information about orthopaedic diseases and injuries. Applicants for this position must be active fellows with writing and editing skills that target the lay audience.
Learn more and submit your application…(member login required)

Note: A headline in the Nov. 5 issue of AAOS Headline News Now reads “Stryker settles ceramic-on-metal hip implant suit.” Although both the Rejuvenate and ABG II incorporate ceramic components, the recalls and settlement are not related to the bearing surface, but to the modular neck system used in those devices. AAOS Headline News Now regrets the confusion.

November 10, 2014

Today’s Top Story
1. Study: Performance improvement program may reduce time to evaluation and antibiotics for patients with open fractures.
Data from a study published in the November issue of the Journal of Orthopaedic Trauma suggest that implementation of a multifaceted performance improvement program concentrating on education, accountability, and antibiotic availability may improve compliance with standards for early and appropriate antibiotic treatment of patients with open fractures. The authors conducted a retrospective comparative cohort study of patients treated for open fracture before and after implementation of a performance improvement program designed to address early open fracture care at a single center. They found that patients treated before implementation of the program received intravenous (IV) antibiotics an average of 70.5 minutes after arrival, while those treated after implementation received antibiotics an average of 32.4 minutes after arrival. In addition, the average time from arrival to physician evaluation dropped from 6.5 minutes to 4.5 minutes, and for antibiotic order to antibiotic delivery from 37 minutes to 13 minutes.
Read the abstract…

Other News
2. Study: Hinged external fixator may offer enough stability for early mobilization after elbow injury.
Findings from a small study published online in the journal Clinical Orthopaedics and Related Research suggest that use of a hinged external elbow fixator may provide enough stability to begin early mobilization after acute complex elbow dislocation and residual instability. The researchers conducted a prospective study of 26 patients 18 years or older treated with a hinged, external fixator and available at 1-year follow-up. From 6-week to 1-year follow-up, they found functional improvements (median Quick Disabilities of the Arm, Shoulder, and Hand score decreased from 30 to 7, median Mayo Elbow Performance Index score increased from 80 to 100, and median Oxford Elbow Score increased from 60 to 90). In addition, median pain levels (VAS) decreased from 2.8 at 2 weeks to 0.5 at 1 year with a median difference of -2.1 (P = 0.001), and range-of-motion also improved. Overall, 10 patients (37 percent) experienced a fixator-related complication, and seven patients (26 percent) required secondary surgery. One patient reported recurrent instability.
Read the abstract…

3. Study: Use of a virtual reality knee simulator may improve residents’ arthroscopy skills.
A study published in the Nov. 5 issue of The Journal of Bone & Joint Surgery (JBJS) suggests that use of a virtual reality arthroscopic knee simulation may help improve residents’ surgical arthroscopy skills. The authors conducted a randomized, controlled study of 48 PGY-3 orthopaedic residents across seven academic institutions. Participants in the experimental group trained on the simulator to a predetermined proficiency level, while those in the control group continued their institution-specific orthopaedic education and training. Residents in the experimental group averaged 11 hours of training to reach proficiency. Compared to the control group, the experimental cohort performed significantly better based on a procedural checklist that weighted probing skills double the weight of visualization skills. However, the authors point out that the global rating scale failed to achieve significance due to the presence of one extreme outlier.
Read the abstract…

4. Study: Patients with RA display improved outcomes after TAA.
According to data published in the Nov. 5 issue of JBJS, patients with rheumatoid arthritis (RA) who undergo total ankle arthroplasty (TAA) have similar pain outcomes compared to TAA patients with noninflammatory arthritis. The research team conducted a matched cohort study of 50 patients with RA and 50 patients with noninflammatory arthritis, all of whom underwent TAA. At mean 64.7-month follow-up, they found that mean Ankle Osteoarthritis Scale (AOS) pain scores were similar in both cohorts, despite baseline differences between groups. After surgery, both groups displayed significant improvement in AOS pain and disability scores and SF-36 physical component summary scores, although both AOS disability and SF-36 physical component summary scores were better for patients with noninflammatory arthritis. Overall, there were seven revisions and one major wound complication in the RA group and five revisions and no major wound complications in the control group.
Read the abstract…

5. CMS: Sunshine Act exempts most CME payments from public reporting on Open Payments site.
Modern Healthcare reports that the federal Open Payments (Sunshine Act) database will continue to exclude most payments made by medical manufacturers to physicians for participation in continuing medical education (CME) programs. A final rule released by the U.S. Centers for Medicare & Medicaid Services (CMS) deleted the CME exclusion in its entirety. However, CMS clarifies that the Sunshine Act makes most CME payments exempt from public reporting under the exclusion for indirect payments. The agency is expected to issue guidance clarifying the policy.   Read more…(registration may be required)

6. Awareness of sports concussion has increased over the last decade.
An article in The New York Times profiles the recent history of sports-related concussion, particularly as it applies to the National Football League (NFL). The writer notes that, beginning in 2002, autopsies performed on several former NFL players revealed brain degeneration and markers similar to that of Alzheimer’s Disease, despite the fact that the players were young enough to be at low risk of such conditions. A 2005 paper published in the journal Neurosurgery identified the condition as chronic traumatic encephalopathy (CTE) and argued that head injuries from football may have been a causative factor. The writer outlines the transition in the sports community from skepticism to acceptance, and notes parallels with other previously common practices that have undergone some recession from the mainstream, such as tobacco smoking and the sport of boxing.   Read more…

7. Call for volunteers: Practice Management Instructional Course Committee.
Dec. 5 is the last day to submit your application for a position on the Practice Management Instructional Course Committee (two member openings). Members of this committee grade Instructional Course Lecture applications in May, and provide input to the Central Instructional Courses Committee regarding course curriculum and faculty. Applicants for this position must be active fellows with an emphasis in practice management.
Learn more and submit your application…(member login required)

November 12, 2014

Today’s Top Story
1. Study: Approach, procedure choice make a difference in development of adjacent-segment pathology after cervical spine surgery.
Findings published in the Nov. 5 issue of The Journal of Bone & Joint Surgery suggest that patients treated with posterior or combined anterior and posterior arthrodesis may be at increased likelihood to develop clinical adjacent-segment pathology requiring surgery compared to patients treated using posterior decompression or anterior arthrodesis. The authors conducted a retrospective analysis of 1,358 consecutive patients with radiculopathy, myelopathy, or myeloradiculopathy who underwent cervical spine surgery performed by a single surgeon. Patients who underwent posterior-only or combined anterior and posterior arthrodesis (n = 57) were at a 7.5 times greater risk of adjacent-segment pathology requiring reoperation than patients who underwent posterior decompression (n = 214), and a 3.0-times greater risk than patients who underwent anterior arthrodesis (n = 1,038). Factors that increased risk of clinical adjacent-segment pathology were smoking, female sex, and type of procedure. Age, neurologic diagnosis, diabetes, and number of surgically treated segments were not significant risk factors.
Read the abstract…

Other News
2. Study: Surgical treatment may be more effective for ASD than nonsurgical alternatives.
Data presented at the annual meeting of the North American Spine Society suggest that surgical treatment for symptomatic adult spinal deformity (ASD) may offer greater improvement in health-related quality of life compared to nonsurgical alternatives. At minimum 2-year follow-up, the researchers assessed outcomes for 286 adults with ASD treated surgically, and 403 adults with ASD treated nonsurgically. They found significant improvement from baseline among surgically-treated patients across multiple measures of health-related quality of life that assessed general health, pain, and disability. However, they noted no significant improvement over baseline among patients treated nonsurgically.   Read more (PDF)…

3. Study: Low birth weight and preterm babies may be at increased risk for hip arthroplasty later in life.
According to an Australian study published online in the journal Arthritis Care & Research, individuals born preterm or with low birth weight (LBW) may be at increased risk of hip arthroplasty for osteoarthritis (OA) in adult life. The research team drew data on 3,604 participants older than age 40 who reported their birth history and weight in the Australian Diabetes, Obesity and Lifestyle Study. Records were linked to hip and knee arthroplasties in the Australian Orthopaedic Association National Joint Replacement Registry. They found that 116 patients underwent knee arthroplasty and 75 underwent hip arthroplasty for OA. Both LBW and preterm birth were associated with increased incidence of hip arthroplasty, independent of age, sex, body mass index, education level, hypertension, diabetes, smoking and physical activity. They observed no significant association between LBW or preterm birth and likelihood of knee arthroplasty.   Read more…
Read the abstract…

4. Study: Early data suggest blocking ion channels may protect against traumatic cartilage injury.
Findings published online in the journal Proceedings of the National Academy of Sciences suggest potential drug targets for protecting joints that have sustained cartilage trauma. The research team evaluated cartilage cells in vitro for the presence of two mechanically-sensing ion channels: Piezo1 and Piezo2. They found that the channels activated together in response to the kinds of compressions that would cause cartilage injury. They noted that the addition of the peptide GsMTx4 blocked both channels and protected joint tissue from cell death following compressive injury. In addition, they found that knocking out each Piezo channel using gene expression interference made individual chondrocytes more resilient to forceful compression. The research team writes that the data suggest “a possible therapy for reducing cartilage injury and posttraumatic osteoarthritis by attenuating Piezo-mediated cartilage mechanotransduction of injurious strains.”   Read more…
Read the abstract…

5. Phase-out of global payments for surgery may burden physicians.
An article in HealthLeaders Media outlines concerns that implementation of a Medicare rule eliminat global surgical payments in two phases beginning in 2017 may be an administrative burden for surgeons. A U.S. Centers for Medicare & Medicaid Services (CMS) final rule released on Oct. 31 phases out all 10- and 90-day global payment periods for surgical services over 4 years, with 10-day global payments being transitioned out in 2017 and 90-day global payments in 2018. After the transition, physicians will be required to issue claims for each service delivered before, during, and after surgery, rather than bundled claims or bills based on the current global rate. In a comment letter to CMS over the proposed rule, AAOS echoed concerns over the administrative burdens of eliminating the proposed rule, but also the general uncertainty this would create over the mechanism on how physicians are paid moving forward. CMS states that the change is in response to findings by the Office of Inspector General that physicians often provided fewer services than those covered under the global payments.   Read more…
Read the AAOS comment letter (PDF)…

6. HHS may waive certain HIPAA privacy provisions during emergency situations.
In response to Ebola outbreak concerns, the U.S. Department of Health and Human Services (HHS) has issued a bulletin regarding Health Insurance Portability and Accountability Act (HIPAA) rules in emergency conditions. The agency states that HIPAA-covered entities and their business associates should be “aware of the ways in which patient information may be shared under the HIPAA Privacy Rule in an emergency situation, and to serve as a reminder that the protections of the Privacy Rule are not set aside during an emergency.” HHS states that if the president of the United States announces an emergency, the secretary of HHS may waive certain provisions under the Project Bioshield Act of 2004 and section 1135(b)(7) of the Social Security Act, including:

  • Gaining a patient’s agreement to speak with family members
  • Requests to opt out of a listing in a hospital or health facility’s directory
  • Distribution of a notice of privacy practices
  • Requests on the distribution and disclosure of protected health information
  • Requests for confidential methods for communications of health information

HHS states that if such a waiver is issued, it only applies in the emergency area and for the emergency period identified in the public health emergency declaration; to hospitals that have instituted a disaster protocol; and for up to 72 hours from the time the hospital implements its disaster protocol.   Read more…
Read the HHS bulletin (PDF)…

7. Free ePub edition of November AAOS Now is now available for download!
The November edition of AAOS Now magazine is now available for electronic devices capable of reading files in ePub format, including the iPhone and iPad, Android devices, and desktop computers (unfortunately, Amazon Kindle does not currently accept ePub files). To download and view the ePub version of AAOS Now, visit the link below and log in using your AAOS username and password. If you have comments or questions about the ePub version of AAOS Now, please email Peter Pollack, electronic content specialist, at ppollack@aaos.org.
Download and read AAOS Now in ePub format…(member login required)

8. Call for volunteers: Orthopaedic Video Theater Committee.
Nov. 30 is the last day to submit your application for a position on the Orthopaedic Video Theater Committee (one member opening—hand and wrist). Members of this committee evaluate video and multimedia submissions, and select distinguished programs to be shown in the Orthopaedic Video Theater at the AAOS Annual Meeting. Applicants for this position must be active fellows, candidate members, candidate member applicants for fellowship, associate members osteopathic, or resident members with a practice emphasis in hand and wrist.
Learn more and submit your application…(member login required)

November 14, 2014

Today’s Top Story
1. Report finds hospitals continue to improve on quality measures.
The Joint Commission has released its annual report on top performing hospitals based on key quality measures. The report looks at information on 46 individual accountability measures of evidence-based care supplied by more than 3,300 Joint Commission-accredited hospitals in the United States, and finds that 36.9 percent (n = 1,224) earned recognition under the organization’s Top Performer on Key Quality Measures® program—an increase from 1,099 in 2012 and 620 in 2011. The report also summarizes the performance of 3,300 Joint Commission-accredited hospitals on 46 accountability measures of evidence-based care processes closely linked to positive patient outcomes. The authors note that overall hospital performance on accountability measures has improved significantly over time, greatly enhancing quality of care. In 2013, Joint Commission-accredited hospitals achieved 97.6 percent composite accountability measure performance on 17.5 million opportunities to perform care processes closely linked to positive patient outcomes—an improvement of 15.8 percentage points since 2002.   Read more…
Read the report (PDF)…

Other News
2. IOM recommends additional domains for collection in EHRs.
The Institute of Medicine (IOM) has released its recommendations for eight additional domains to be included in all electronic health records (EHRs). Currently, four domains are routinely collected:

  • Alcohol use
  • Race and ethnicity
  • Residential address
  • Tobacco use and exposure

IOM recommends the following domains be prioritized for inclusion:

  • Census tract-median income
  • Depression
  • Education
  • Financial resource strain
  • Intimate partner violence
  • Physical activity
  • Social connections and social isolation
  • Stress

“Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research,” the authors write.
Read the report, with links to additional resources…

3. Lame duck Congress likely to pass the buck on healthcare issues.
Modern Healthcare reports that a number of medical organizations are pressuring the U.S. Congress to address healthcare issues such as reform of the Medicare Sustainable Growth Rate (SGR) formula, which currently calls for a 21.2 percent reduction in Medicare reimbursement to take effect on April 1, 2015. A proposal to repeal the SGR saw bipartisan support earlier this year, but negotiations collapsed. There is also a push to extend funding for the Children’s Health Insurance Program, which has enjoyed bipartisan support in the past and is set to run out of money at the end of September 2015. However, observers say the current Congress is unlikely to address major issues that involve tens of billions of dollars in funding.   Read more…(registration may be required)
According to Reuters, there appears to be support for the next Congress to repeal the medical device tax, which was implemented as part of the Affordable Care Act. The repeal has received bipartisan support in the past, and with an incoming Republican legislative majority, such a move may be perceived as a way to gradually chip away at the healthcare reform law.   Read more…

4. Study: Frequent osteoporosis testing may offer little benefit to postmenopausal women without osteoporosis on first BMD test.
Data to be published in the journal Menopause suggest that postmenopausal women who did not have osteoporosis on their first bone mineral density (BMD) test may be unlikely to benefit from frequent rescreening before age 65 years. The authors reviewed data on 4,068 postmenopausal women, aged 50 to 64 years, who did not have hip or clinical vertebral fracture or antifracture treatment at baseline, and who were participating in the Women’s Health Initiative BMD cohort study. They found that, for women aged 50 to 54 years without osteoporosis, the adjusted estimated time for 1 percent to experience a hip or clinical vertebral fracture was 12.8 years; for women aged 60 to 64 years without osteoporosis, the estimated time was 7.6 years. Among all women aged 50 to 64 years with baseline osteoporosis, the adjusted estimated time for 1 percent to experience hip or clinical vertebral fracture was 3.0 years.   Read more…
Read the abstract…

5. New AAOS Now podcast on use of collagenase for recurrent Dupytren contracture.
AAOS Now has released an audio interview in which Clayton A. Peimer, MD, speaks with AAOS Now Assistant Managing Editor Maureen Leahy about the use of collagenase for the treatment of recurrent Dupytren contracture.
Listen to the current podcast (MP3)…
Read the related article in the November issue of AAOS Now
Other podcasts are available by clicking on “podcast” in the left navigation column of the AAOS Now home page.   Read more…

6. Call for volunteers to help develop mastery model for education.
AAOS seeks participants for a 2-day meeting to help develop a specific orthopaedic competency model (the Mastery Model for Education). The model will serve as a content development roadmap for future development efforts, including meeting the educational needs of Academy members throughout their careers. The goal is to have representation from all anatomic and domain areas throughout the orthopaedic profession. At this time, oncology, spine, and pediatric surgeons are needed. The meeting will be held Dec. 5–6, 2014, at the Loew’s Hotel in Rosemont, Ill., and AAOS will pay for all expenses. To participate, please contact Randall Towns as soon as possible, at towns@aaos.org.

7. Call for volunteers: ACEP workgroup on acute care hospitals.
AAOS seeks to nominate one member to the American College of Emergency Physicians (ACEP) workgroup to develop recommendations for increasing the transparency of hospitals’ acute care capabilities. The goal of the project is to improve transparency of facilities’ capabilities so that the appropriate level of care can be delivered quickly, efficiently, and accurately. This will include development of an acute care classification system to:

  • Allow for informed patient decisions
  • Improve prehospital destination protocols
  • Ease referrals to the emergency department by primary care practitioners
  • Improve responses to disasters and public health emergencies

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 a at least one of the four areas listed above, and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted to Kyle Shah by Tuesday, Nov. 18, 2014 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)

8. Call for volunteers: Exhibits Committee.
Dec. 8 is the last day to submit your application for a position on the Exhibits Committee (five member openings). The Exhibits Committee plans and organizes technical and scientific exhibits for the AAOS Annual Meeting. Applicants for this position must be active fellows, associate members orthopaedic, associate members osteopathic, or international affiliate members with an interest in planning educational programs.
Learn more and submit your application…(member login required)

November 17, 2014

Today’s Top Story
1. Study: ICD-10 conversion likely to cost small physicians offices less than $6,000.
Information published online in the Journal of AHIMA suggests that converting to ICD-10 is likely to cost small physicians offices between $1,960 and $5,900. The researchers reviewed data from surveys, published reports, and ICD-10 conversion experience with various stakeholders to estimate conversion costs for a typical small, physician-owned practice (defined as three physicians and two affected staff). They argue that previous estimates have overstated conversion costs due to the following factors:

  • Costs related to EHR adoption and other healthcare initiatives are often included in cost estimates, despite not being directly related to ICD-10.
  • The coding industry is more knowledgeable about ICD-10 than previously reported.
  • Free or inexpensive electronic training and documentation are now available.

The researchers note that a recent 2014 update of a 2008 report by Nachimson Advisors to the American Medical Association estimated the cost for a small practice to implement ICD-10 to be in the range of $22,560 to $105,506.   Read more…
Read the study (PDF)…

Other News
2. Study: MRI not as sensitive as radiograph for diagnosis of DS.
According to research presented at the annual meeting of the North American Spine Society, magnetic resonance imaging (MRI) alone may not be enough to accurately diagnose the existence or extent of degenerative spondylolisthesis (DS). The research team conducted a retrospective imaging study of 103 patients diagnosed with L4-L5 DS using standing lateral flexion-extension radiographs as well as supine MRI. They found that conventional supine MRI had a sensitivity of 78 percent for detecting DS, compared to 100 percent for flexion-extension radiographs and 98 percent for lateral standing radiographs. In addition, they noted significant differences in slip distance, slip percentage, and disk height between lateral radiographs and MRIs.   Read more (PDF)…

3. Study: Treatment with denosumab linked to BMD gain at the radius.
According to findings presented at the annual meeting of the American College of Rheumatology (ACR), treatment with denosumab may increase cortical bone density at the radius for women with postmenopausal osteoporosis. The researchers evaluated 2,207 women participating in the FREEDOM trial and its extension. All participants received daily calcium, vitamin D, and placebo during the original trial, and were converted to calcium, vitamin D, and denosumab during the extension. The researchers found that during the FREEDOM trial, participants experienced progressive and significant loss of bone mineral density (BMD) at the 1/3 radius. During the extension trial, treatment with denosumab was linked to significant gain in BMD (+1.5 percent over original FREEDOM baseline at 5 years). Overall, the wrist fracture rate during the placebo period in FREEDOM was 1.02 per 100 subject-years. During the first 3 years of the extension trial, the wrist fracture rate remained comparable to the FREEDOM placebo rate. With 2 additional years of denosumab treatment, wrist fracture rate declined to levels significantly lower than the FREEDOM placebo rate.   Read more…
Read the abstract…

4. Study: Non-elite running may reduce risk of symptomatic OA.
Data presented at the annual meeting of ACR suggest that non-elite running may not be associated with increased risk of osteoarthritis (OA). The authors conducted a cross-sectional study of 2,439 participants in the Osteoarthritis Initiative. They found that running at any time in life was associated with a reduced risk of symptomatic OA. In addition, the authors noted that participants with the lowest BMI were most likely to identify running as a habitual activity. “Non-elite running at any time in life does not appear detrimental,” they write, “and may be protective of [symptomatic OA].”   Read more…
Read the abstract…

5. Pennsylvania.
AMA Wire reports that negotiators have reached a settlement in a lawsuit over the Pennsylvania government’s diversion of money from the state’s Mcare Fund—which was set up to help cover medical liability payouts for participating healthcare providers. During 2009, the state diverted $100 million from the fund to use for general state purposes—an action that plaintiffs argued was contrary to state law. Under terms of the settlement, $139 million will be returned to physicians and other providers who paid into the fund for assessment overpayments, while $61 million will go toward reducing assessments in 2015.   Read more…

6. Call for applications for Washington Health Policy Fellowships.
Dec. 15, 2014 is the last day to submit your application for the 2015 Washington Health Policy Fellowships (WHPF). This program is a unique opportunity to join a distinguished community of fellows to gain a greater understanding of legislative and regulatory issues facing orthopaedists. By working closely with the AAOS office of government relations in Washington, D.C., fellows exercise their political involvement by writing articles for AAOS Now, attending the National Orthopaedic Leadership Conference, and following an issue of their choice throughout their fellowship. For more information, please contact Julie Williams, at 202-546-4430 or via email at jwilliams@aaos.org.
Learn more and submit your application (PDF)…

7. Call for volunteers: Workgroup for development of a clinical performance measure on OA.
The Performance Measures Committee seeks AAOS fellows to participate on a workgroup to re-evaluate the PQRS Measure #109—Osteoarthritis (OA): Function and Pain Assessment, which is now stewarded by AAOS. Final decisions regarding the project scope and design will be determined by the workgroup at the first workgroup meeting. Subject matter experts must apply no later than Nov. 21, 2014. For more information about the nominations process, please contact Jackie Ryan at 847-384-4337, or OAFPmeasure@aaos.org.
Learn more and submit your application…

8. Last call: Patient Education Committee.
Nov. 21 is the last day to submit your application for a position on the Patient Education Committee (three member-at-large openings). This committee develops and updates a wide variety of patient education materials designed to assist members in their interactions with patients and improve patient understanding of orthopaedic diseases and injuries. Applicants for this position must be active fellows with writing and editing skills to target the lay audience.
Learn more and submit your application…(member login required)

November 19, 2014

Today’s Top Story
1. Study: Younger patients with JIA appear to do well after THA.
Findings presented at the annual meeting of the American College of Rheumatology suggest that total hip arthroplasty (THA) may be an acceptable treatment option for younger patients with juvenile idiopathic arthritis (JIA). The researchers reviewed data on 56 patients with JIA and younger than 35 years who underwent THA at a single center. They found that the 10-year survival rate was 80 percent, and the 20-year survival rate was 64 percent. They noted that primary THA with standard implants was associated with longer survival compared to custom implants, and they found no other significant differences in implant survival stratified by patient age and sex, implant bearing surface, or use of cement for implant fixation. The mean Hip disability and Osteoarthritis Outcome Scores (HOOS) were 89 for pain, 87 for symptoms, 86 for activities of daily living, and 76 for sports. Overall, male patients reported better HOOS-symptom scores compared to female patients, and patients with standard implants reported better HOOS-pain and -symptom scores compared to patients with custom implants.   Read more…
Read the abstract…

Other News
2. Study: Weight loss of 10 percent or more may increase risk of hip fracture in older people.
Data from a Chinese study presented at the International Osteoporosis Foundation Regionals Asia-Pacific Osteoporosis Meeting suggest that weight loss of 10 percent or more may significantly increase the risk of hip fracture in older people. The research team drew data on 775 incident hip fracture cases from the Singapore Chinese Health Study—a population-based cohort of 63,257 Chinese men and women aged 45 to 74 years at recruitment. At mean 5.7-year follow-up, they found that, compared to subjects with stable weight (defined as loss or gain of less than 5 percent) and after adjustment for health conditions and follow-up body mass index (BMI) subsequent to weight change, participants with weight loss of 10 percent or more saw a 39 percent increase in hip fracture risk. Overall, participants who were overweight at recruitment (BMI>25 kg/m2) and subsequently lost 10 percent or more in weight saw the greatest increase in risk, while those who were already very lean at recruitment (baseline BMI<20 kg/m>2) and lost 10 percent or more in weight saw no significant difference in risk of hip fracture. The research team noted that weight gain was not associated with hip fracture risk.  Read more…

3. Popularity of ASCs is likely to increase quality, safety scrutiny.
An article in the October issue of HealthLeaders magazine looks at recent growth in the number of ambulatory surgery centers (ASCs). A report from the Medicare Payment Advisory Commission (MedPAC) finds that the number of Medicare-certified ASCs increased by 19 percent, to 5,364, between 2006 and 2013, and a separate MedPAC report found that approximately 3.4 million fee-for-service Medicare beneficiaries had a procedure done in an ASC during 2011. A spokesperson for the Ambulatory Surgery Center Association states that procedures for Medicare beneficiaries are performed at payment rates that are about 55 percent of the level reimbursed by Medicare to hospital outpatient departments. Some observers say that the increased popularity of ASCs is likely to result in an increased level of scrutiny regarding quality and safety. However, a spokesperson from the Ambulatory Care Accreditation Program at The Joint Commission observes that the number of adverse events reported by ASCs is “significantly below the rates reported for inpatients in the hospital setting.”   Read more…

4. GAO: CMS transparency websites need improvement.
A report from the U.S. Government Accountability Office (GAO) recommends that the U.S. Centers for Medicare & Medicaid Services (CMS) take steps to improve the information in its transparency tools, and develop procedures and metrics to ensure that those tools address the needs of consumers. The authors reviewed data from the five online transparency tools operated by CMS, including Physician Compare and Hospital Compare, and found that all tools lacked relevant information on cost and provided limited information on key differences in quality of care, hindering consumers’ ability to make meaningful distinctions among providers based on their performance. Further, because none of the tools contain information on patients’ out-of-pocket costs, they do not allow consumers to combine cost and quality information to assess the value of healthcare services or anticipate the cost of such services in advance. Finally, the authors found substantial limitations in how CMS tools present information, such as lacking clear language and symbols, not summarizing or organizing information to highlight patterns, and not enabling consumers to customize how information is presented.  Read more…
Read the report (PDF)…

5. Will there be a physician shortage?
A report from National Public Radio questions whether a predicted physician shortage will be as profound as estimated, or whether a shortage exists at all. The reporter notes that the Association of American Medical Colleges has estimated that by 2025, the United States will experience a shortfall of approximately 130,000 physicians, mostly primary care providers, based on factors such as an increase in the number of insured under the Affordable Care Act and the aging of the so-called “Baby Boom” generation. However, at least one health economist notes that previous predictions of physician shortages have been inaccurate, and argues that a growing number of nonphysician primary care providers such as physician assistants and nurse practitioners may be able to reduce the impact of a shortage of primary care physicians. Another expert argues that having a surplus of physicians could produce the negative effect of increasing overall health system costs.   Read more…

6. California.
The Los Angeles Times reports that, according to the California Department of Managed Health Care, two major health insurers violated state law by overstating the number of physicians available to patients. The agency finds that more than 25 percent of physicians listed by Anthem Blue Cross and Blue Shield of California weren’t accepting Covered California patients or were no longer at the location listed by the companies—errors that may have led to unforeseen medical bills when patients unwittingly ventured to out-of-network physicians for medical tests or procedures. The two companies account for nearly 60 percent of enrollment in Covered California.   Read more…

7. Call for volunteers: Workgroup for development of clinical performance measure on management of hip fractures in the elderly.
The Performance Measures Committee seeks AAOS fellows to participate on a workgroup to develop clinical performance measure(s) on management of hip fractures in the elderly. Final decisions regarding the project scope and design will be determined by the workgroup at the first workgroup meeting. The committee encourages subject matter experts to apply no later than Dec. 19, 2014. For more information, please contact Jackie Ryan at 847-384-4337 or via email at HipFxMeasure@aaos.org.
Submit your application…

8. Call for volunteers: Medicare Evidence Development & Coverage Advisory Committee.
AAOS seeks to nominate an orthopaedic surgeon for membership to the U.S. Department of Health and Human Services (HHS) Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). MEDCAC provides advice and guidance to the secretary of HHS and the CMS administrator concerning the adequacy of scientific evidence in making coverage determinations under the Medicare program. In addition, MEDCAC reviews and evaluates medical literature and technology assessments, and hears public testimony on the evidence available to address the impact of medical items and services on health outcomes of Medicare beneficiaries. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae [up to 20 pages maximum] with complete contact information and list of areas of expertise, a letter of interest, highlighting his or her expertise in the relevant subject area and a statement that he or she is able to participate in full capacity, and a 100-word maximum biosketch. Please submit supporting materials to Kyle Shah by Monday, Dec. 1, 2014 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)
View the MEDCAC charter, with links to related material…

November 21, 2014

Today’s Top Story
1. FDA announces approval of abuse-deterrent opioid analgesic.
The U.S. Food and Drug Administration (FDA) has announced the approval of hydrocodone bitartrate, an extended-release opioid analgesic designed to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate. The product has properties that are expected to reduce—but not totally prevent—abuse of the drug when chewed and then taken orally, or crushed and snorted or injected. Hydrocodone bitartrate is not approved for, and should not be used for, as-needed pain relief. FDA emphasizes that the product should only be prescribed to people for whom alternative treatment options are ineffective, not tolerated, or would be otherwise inadequate to provide sufficient pain management. The agency is requiring postmarketing studies of hydrocodone bitartrate to assess the effects of the abuse-deterrent features.   Read more…

Other News
2. Study: Grading system could help predict complications for THA, TKA patients.
Data published online in the journal Clinical Orthopaedics and Related Research suggest that use of a dedicated orthopaedic complications grading system may help predict complication severity, likelihood of increased length of stay (LOS), and increased unplanned readmissions or reoperation rates for patients undergoing total hip or total knee arthroplasty (THA or TKA). The authors reviewed data on 188 patients who underwent primary THA or TKA at a single center. They found that 254 complications were documented in 135 patients (137 procedures), while 53 patients (60 procedures) had no complications. They found that maximum complication grade on a proposed grading system was associated with a longer LOS, as well as increased likelihood of readmission and reoperation. Total grade could account for 38 percent of the variation in LOS and readmissions or reoperations, making it a slightly better predictor of LOS than maximum complication grade.   Read the abstract…

3. Endocrine Society issues CPG regarding Paget’s disease of the bone.
The Endocrine Society has issued a clinical practice guideline (CPG) for the diagnosis and treatment of Paget’s disease of the bone. The recommendations include:

  • Obtaining plain radiographs of the pertinent regions of the skeleton in patients with suspected Paget’s disease
  • If Paget’s disease is confirmed, performing a radionucleotide bone scan to determine the extent of the disease
  • After diagnosis, measuring serum total alkaline phosphatase or a more specific marker of bone formation or resorption
  • Treating most patients with active Paget’s disease who are at risk for future complications with bisphosphonates
  • Treating patients with a bisphosphonate before surgery on pagetic bone

Read more…
Read the complete guideline (PDF)…

4. Provider mergers raise concerns among payers, regulators.
An article in HealthLeaders Media looks at the response of health insurers to increased consolidation among providers. At least one expert observes that such consolidation is sparking an “adversarial struggle” with payers, as insurance companies narrow their networks to offset a surge in provider market power. In January, a U.S. district court ruled that one health systems acquisition of the largest independent physicians practice in Idaho violated antitrust law, in a decision that was supported by America’s Health Insurance Plans. In addition, the author notes that accountable care organizations (ACOs) have so far escaped serious antitrust scrutiny, but regulators are already wary of the potential for ACOs to become anticompetitive market players.   Read more…
Back to top
5. Connecticut.
ACS Surgery News reports that the Connecticut Supreme Court has ruled that patients can sue physicians for negligence after alleged privacy breaches under the Health Insurance Portability and Accountability Act (HIPAA). The decision stems from a case in which the plaintiff instructed a health center not to release her medical records to her ex-boyfriend. The center was subsequently served with a subpoena for the records for a paternity proceeding, but did not alert the plaintiff about the subpoena. The trial court ruled that HIPAA precludes individual liability claims pertaining to confidentiality of medical information, but the Connecticut Supreme Court overturned the decision, ruling that HIPAA does not preempt such negligence lawsuits.   Read more…
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6. Young Investigators urged to apply for USBJI Grant Mentoring Program.
The United States Bone and Joint Initiative (USBJI) has developed a grant mentoring program to provide early-career investigators an opportunity to work with experienced researchers to assist them in securing funding and other survival skills required for pursuing an academic career. The program is open to promising junior faculty, senior fellows or post-doctoral researchers nominated by their department or division chairs, as well as to senior fellows or residents that are conducting research and have a faculty appointment in place or confirmed. Basic and clinical investigators, without or with training awards (including K awards) are invited to apply. Investigators selected to take part in the program attend two workshops, 12 to 18 months apart, and work with faculty between workshops to develop their grant applications. The next workshop is scheduled to take place April 24 to 26, 2015 in Rosemont, Ill. The deadline to apply for the spring 2015 workshop is Jan. 15, 2015.
Submit your application…

7. Call for abstracts: 2015 EWI research symposium.
AAOS seeks abstracts for combat casualty and trauma-related research for poster presentations at the 2015 Extremity War Injuries X: Return to Health and Function Research Symposium (EWI), to be held Jan. 26–28, 2015, in Washington, D.C. Up to 16 abstracts will be selected for display. The $600 EWI registration fee will be waived for poster presenters. Accepted posters will be displayed Jan. 27–28, with a poster session from 6 p.m. to 8 p.m. on Jan. 27. Presenters must be available to participate in the poster session. Selected authors will also be invited to give a brief podium presentation on Jan. 28. Presenters are responsible for their own hotel and travel costs associated with attending the EWI symposium. Abstract submissions, along with current curriculum vitae, must be submitted by Dec.1, 2014, to Erin Ransford, manager, research advocacy, at ransford@aaos.org.
Learn more and obtain an abstract submission form…

8. Call for volunteers: Evaluation Committees.
Dec. 15 is the last day to submit your application for an opening on an Evaluation Committee. Members of Evaluation Committees write questions for orthopaedic self-assessment examinations. The following positions are available:

  • Anatomy-Imaging (chair; two members—hand and wrist; two members—tumors)
  • Hand & Wrist (chair, nine members)

Applicants for chair openings must be active fellows. Applicants for member openings must be active fellows, candidate members, candidate member applicants for fellowship, or emeritus fellows with a practice emphasis in the relevant topic.
Learn more and submit your application…(member login required)

 

 November 24, 2014

Today’s Top Story
1. U.S. House files suit against ACA implementation.
The U.S. House of Representatives has filed a lawsuit against Department of Health and Human Services Secretary Sylvia Mathews Burwell, Treasury Secretary Jack Lew, and their respective departments over certain provisions in the Affordable Care Act. The suit alleges that the Obama administration improperly delayed enforcement of the Act’s employer mandate, which requires employers of a certain size to offer health insurance to their employees. In addition, the suit claims that an “offset program” that authorizes the government to pay back insurance companies for discounts offered to low-income enrollees has been operated in an unconstitutional manner, as Congress never approved funding for the program.   Read more…

Other News
2. Study: Nurse practitioners and physician assistants more likely than physicians to request imaging.
According to a study published online in the journal JAMA Internal Medicine, nurse practitioners and physician assistants (advanced practice clinicians, APCs) may be more likely to order imaging services than primary care physicians (PCPs) for similar patients during evaluation and management (E&M) office visits. The authors reviewed a 5 percent sample of Medicare beneficiaries from 2010 to 2011 claims data and found that APCs ordered imaging in 2.8 percent of episodes of care, compared to PCPs, who ordered imaging 1.9 percent of the time. Overall, APCs were associated with increased radiography orders on both new and established patients, and with increased advanced imaging on established patients. APCs were not significantly different from PCPs in ordering imaging on new patients.   Read more…
Read the abstract…

3. Study: Glucosamine and chondroitin offer no improvement for knee OA.
Data published online in the journal Arthritis & Rheumatology suggest that glucosamine and chondroitin offer little efficacy in relieving symptoms and slowing disease progression among patients with knee osteoarthritis (OA). The research team drew data on 1,625 patients participating in the Osteoarthritis Initiative study and who were not using either supplement at baseline. At 4-year follow-up, they found that 18 percent of participants had initiated treatment with glucosamine or chondroitin. After adjustment, the research team found no clinically significant differences between users at all assessments and never-users of glucosamine or chondroitin in WOMAC pain, stiffness, or function scales, or joint space width. These findings support the recommendations in the AAOS clinical practice guideline (CPG) on the Treatment of Osteoarthritis of the Knee. Read more…
Read the abstract…
View the AAOS CPG…

4. Study: More research needs to be done on improving medication adherence.
According to findings published online in the journal The Cochrane Library, research is needed to find ways to improve medication adherence for chronic health problems. The researchers reviewed 182 randomized, controlled trials (RCTs) of interventions to improve adherence with prescribed medications. They found that most studies had high risk of bias, with only 17 classified as having the lowest risk of bias for study design features and their primary clinical outcome. RCTs at lowest risk of bias generally involved complex interventions with multiple components, and attempted to overcome barriers to adherence by means of tailored ongoing support from allied health professionals. Only five RCTs reported improvements in both adherence and clinical outcomes, and no common intervention characteristics were apparent. Further, even the most effective interventions did not lead to large improvements in adherence or clinical outcomes.   Read more…
Read the abstract…

5. Massachusetts.
The Massachusetts Medical Society has issued reminders to physicians about two state regulatory changes:

  • Effective Dec. 5, 2014—all users of the state Prescription Monitoring Program must use that program prior to prescribing a schedule II or III narcotic or a benzodiazepine to a patient for the first time
  • Effective January 2015—physicians renewing their licenses are required to demonstrate proficiency in electronic medical records and skills to achieve the federal Meaningful Use standard

Read more, with related links…

6. AAOS Nominating Committee releases nominations list.
The 2015 AAOS Nominating Committee has recommended the following individuals to serve in the specified AAOS leadership positions, to begin service following the 2015 AAOS Annual Meeting:

  • Second Vice President: William J. Maloney, MD
  • Member-at-Large (no age designation): Howard R. Epps, MD
  • Member-at-Large (younger than age 45): Daniel C. Farber, MD
  • National Membership Committee representative: Robert M. Orfaly, MD

Nominees to the American Board of Orthopaedic Surgery:

  • Joshua J. Jacobs, MD
  • Keith Kenter, MD
  • Gregory A. Mencio, MD
  • Dean C. Taylor, COL, MD

The AAOS fellowship will have the opportunity to cast online ballots on these recommendations prior to and during the first part of the 2015 Annual Meeting. Balloting will begin on Wednesday, March 11, 2015, and continue through 1:00 p.m. PT on Wednesday, March 25, 2015. The results will be announced during the business meeting of the American Association of Orthopaedic Surgeons on Thursday, March 26, 2015, during the 2015 AAOS Annual Meeting in Las Vegas.
Read the nominations announcement (PDF)…

7. OKOJ December 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: “Diagnosis and Management of Dorsal Wrist Ganglions,” “Polymeric Scaffolds in Orthopaedic Tissue Engineering: A Review of Current Research and Future Technology,” and “Selection of Fusion Levels in Idiopathic Scoliosis.” A new video, “Dorsal Wrist Ganglion” has also been made available. In addition, OKOJ now offers full-text, downloadable PDFs for articles in recent issues, with more on the way!
View these topics and more…(member login required)

8. Call for volunteers: AMA House of Delegates.
AAOS seeks one delegate representative to join the American Medical Association (AMA) House of Delegates. Members of the AMA House of Delegates serve as an important communications, policy, and membership link between the AMA and grassroots physicians. The delegate/alternate delegate is a key source of information on activities, programs, and policies of the AMA. The delegate/alternate delegate is also a direct contact for the individual member to communicate with and contribute to the formulation of AMA policy positions, the identification of situations that might be addressed through policy implementation efforts, and the implementation of AMA policies. Applicants for this position must be AMA members as well as AAOS active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae (no longer than 20 pages) with complete contact information, a letter of interest, highlighting his or her expertise in subject area and a statement that he or she is able to participate in full capacity and a 100-word maximum biography. All supporting materials should be submitted by Dec. 21, 2014 at 11:59 p.m. CT, to Kyle Shah, clinical quality and medical affairs coordinator, at shah@aaos.org.
Learn more and submit your application…(member login required)

November 26, 2014

Today’s Top Story
1. CMS Extends deadlines for hospitals to report meaningful use, quality.
The U.S. Centers for Medicare & Medicaid Services has extended by one month the deadlines for eligible hospitals to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program and to electronically submit clinical quality measures (CQM) to meet that requirement of both meaningful use and the Hospital Inpatient Quality Reporting program. Hospitals now have until Dec. 31, 2014, to attest meaningful use and to submit their CQM data.   Read more…(registration may be required)
Read the CMS announcement (PDF)…
Learn more about the EHR incentive program…

Other News
2. Study: Use of vancomycin in dual-antibiotic prophylaxis regimen may increase risk of acute kidney injury.
Findings from a study published online in the journal Clinical Orthopaedics and Related Research suggest that use of vancomycin as part of a dual-antibiotic prophylaxis regimen against surgical site infection (SSI) may increase the risk of acute kidney injury (AKI) while not reducing the likelihood of SSI. The authors conducted a retrospective review of 1,828 patients who underwent primary hip or knee arthroplasty and who received either cefazolin (n = 500) or cefazolin and vancomycin (n = 1,328) as perioperative antibiotic prophylaxis. They found that patients receiving dual antibiotics were more likely to develop AKI compared with those receiving cefazolin alone. In addition, dual-antibiotic prophylaxis was associated with increased AKI severity.
Read the abstract…

3. Study: P. acnes present in more than one-third of first-time shoulder surgery patients.
According to data published in the December issue of the Journal of Shoulder and Elbow Surgery, Propionibacterium acnes may be present in more than one-third of patients who are undergoing first-time shoulder surgery. The researchers examined data on 118 consecutive patients and found positive P. acnes cultures in 36.4 percent (n = 43) of patients. Ten patients had positive skin samples; 9 patients had positive superficial samples; 16 patients had positive deep samples, and 18 had positive superficial and deep samples. In addition, the researchers detected P. acnes in 27.1 percent of procedures performed using an anterolateral approach, and in 9.3 percent of those performed using a deltopectoral approach. Overall, the relative risk for obtaining a positive P. acnes culture was 2-fold greater for the anterolateral approach than for the deltopectoral approach.
Read the abstract…

4. Study: Magnetic nanoparticles coated with targeting proteins may help stem cells regenerate bone.
A study published in the November issue of the journal Stem Cells Translational Medicine suggests that magnetic nanoparticles coated with targeting proteins may stimulate stem cells to regenerate bone. The research team coated magnetic nanoparticles with specific targeting proteins, and controlled them remotely with an external magnetic field to simulate exercise. In models using fetal chicken femurs and tissue-engineered collagen, they demonstrated an increase in bone formation and density without causing any mechanical stress to the construct or surrounding tissue. “In both models, the combination of mechanical stimulation and sustained release of bone morphogenetic protein 2 (BMP-2) from polymer microspheres showed a significant additive effect on mineralization, increasing the effectiveness of BMP-2 delivery and demonstrating that nanoparticle-mediated mechanotransduction can be used synergistically with pharmacological approaches for orthopedic tissue engineering to maximize bone formation,” they write.   Read more…
Read the abstract…

5. Practice transitions may encourage some physicians to retire early.
A report from National Public Radio looks at the costs to small medical practices of implementing EHRs and ICD-10. The story profiles an ophthalmologist in Alaska who employs one part-time nurse and has been maintaining paper records for more than 3 decades. “No possible business model would endorse [EHR] implementation in a practice situated like mine,” he says. The reporter notes that, starting next year, Medicare will penalize the physician 1 percent for not using EHRs, as well as an additional 1.5 percent for failure to report quality data. A spokesperson for the Alaska State Medical Association opines that the situation may force many physicians into early retirement.   Read more…

6. Study: Serum SNTF levels may offer diagnosis tool for concussion.
Data published online in the Journal of Neurotrauma suggest that elevated levels of brain-enriched protein calpain-cleaved alpha-spectrin N-terminal fragment (SNTF) in the blood shortly after sports-related concussion may predict the severity of post-concussion symptoms. The authors conducted a longitudinal analysis of serum SNTF in professional ice hockey players, 28 of whom had a concussion, along with 45 players evaluated during the preseason, 17 of whom were also tested after a concussion-free training game. They found that, compared to preseason levels, serum SNTF increased at 1 hour after concussion and remained significantly elevated from 12 hours to 6 days before declining to preseason baseline. In eight players, post-concussion symptoms resolved within a few days, and the authors noted that in those players serum SNTF levels had returned to baseline. Among 20 players withheld from play for 6 days or longer, serum SNTF levels rose from 1 hour to 6 days post-concussion, and at 12 to 36 hours differed significantly from less severe concussions. The authors suggest that serum SNTF may serve as a diagnostic and prognostic tool for sports-related concussion.   Read more…
Read the abstract…

7. Call for volunteers: ACSM Team Physician Consensus Conference.
AAOS seeks one member to represent the Academy at the 2015 American College of Sports Medicine (ACSM) Team Physician Consensus Conference. The proposed topic for review this year is “Selected Issues in Injury and Illness Prevention and the Team Physician: A Consensus Statement,” with a focus on the young athlete. The meeting will take place Feb. 16 and 17 in Indianapolis, Ind. Applicants for this position must be Active Fellows, Candidate Members, Candidate Members Osteopathic, Candidate Member Applicants for Fellowship, or Candidate Member Applicant for Fellowship Osteopathic with experience in sports medicine. In addition, all applicants must provide the following: an online AAOS CAP Application, a 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 to Kyle Shah by Sunday, Dec. 7, 2014 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)

8. Last call: Orthopaedic Video Theater Committee.
Nov. 30 is the last day to submit your application for a position on the Orthopaedic Video Theater Committee (one member opening—hand and wrist). Members of this committee evaluate video and multimedia submissions, and select distinguished programs to be shown in the Orthopaedic Video Theater at the AAOS Annual Meeting. Applicants for this position must be active fellows, candidate members, candidate member applicants for fellowship, associate members osteopathic, or resident members with a practice emphasis in hand and wrist.
Learn more and submit your application…(member login required)

Note: The AAOS offices will be closed Nov. 27 and 28 for the Thanksgiving holiday. AAOS Headline News Now will not be published on Friday, Nov. 28. Publication will resume on Monday, Dec. 1.

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