August 25, 2017

Today’s Top Story
AAOS, other healthcare groups, comment on QPP proposal.
Earlier this week, healthcare advocacy groups sent comments to the Centers for Medicare & Medicaid Services (CMS) regarding a 2018 proposed rule for the Quality Payment Program (QPP). Among other things, the proposed rule exempts more small providers from the Merit-Based Incentive Payment System (MIPS), allows hospital-based physicians to report at a facility level, introduces virtual reporting groups, and eases electronic health record requirements. Read more…(registration may be required)
The American Association of Orthopaedic Surgeons submitted comments that applauded the increase in the low-volume threshold, addressed new proposals for virtual groups, and stressed the need for provision of clinician/practice data. The comments also noted that AAOS looks forward to engaging with CMS, “especially on developing outcome-based measures for musculoskeletal care as well as on redesigning Medicare value-based payment models such that they are voluntary, are physician-led, have accurate price setting, and provide access to data for all participants.” Read the AAOS statement and comments…

Other News

Study identifies risk factors for adverse events.
A study published in The Journal of Bone & Joint Surgery identified risk factors for adverse events associated with orthopaedic surgeries as captured within a common clinical point-of-care system for documenting adverse events. The authors’ sample comprised 2,146 patients undergoing inpatient knee, hip, and, spine surgery; they were identified through recording in-hospital adverse events at the point of care over a 2-year period. The authors note that they “found increasing age, male sex, revision surgery, length of stay, and increasing operative duration to be common independent risk factors for an adverse event across the population studied.” Read the abstract…

Study: MR-HIFU is a safe and effective treatment for osteoid osteoma.
A study published in the Journal of Pediatrics finds that osteoid osteoma in children and young adults can be safely and effectively treated using magnetic resonance imaging-guided high-intensity focused ultrasound (MR-HIFU). The researchers compared two groups of patients who had radiologically confirmed, symptomatic osteoid osteoma. The first group comprised 7 males and 2 females aged 6 to 16 years treated with MR-HIFU. The second group comprised 8 males and 1 female aged 6 to 10 years treated with radiofrequency ablation. The researchers found that clinical response to treatment, evaluated in terms of analgesic requirement, visual analog scale pain score, and sleep quality, was comparable between the groups. They conclude that MR-HIFU treatment of osteoid osteoma refractory to medical therapy is feasible and can be performed safely in pediatric patients, without any incisions or exposure to ionizing radiation. Read the abstract…

Study: Elbow arthroscopy an option for selected pediatric conditions.
A review of pediatric patients undergoing elbow arthroscopy concluded that the procedure “has applications in the pediatric population with an acceptable safety profile.” The authors of the study, published in the Journal of Shoulder and Elbow Surgery, completed a retrospective review of a surgical database of such patients at a single institution spanning 2001 to 2015. Key data included indications for surgery, perioperative and postoperative complications, further surgical intervention, and descriptive demographic information. For purposes of the study, the authors identified 64 elbow arthroscopic procedures in 59 patients. Indications included contracture release (45.3 percent), closed reduction and fixation for fracture (20.3 percent), treatment of osteochondritis dissecans (20.3 percent), diagnostic arthroscopy (7.8 percent), and débridement (6.3 percent). The overall complication rate was 17.2 percent, with a major and minor complication rate of 6.3 percent and 10.9 percent, respectively. The safety profile was comparable to that in published results for adults. Read the study…

Study: Can risk stratification be a universal language?
A study published online in the journal Spine comparing predictors of surgical site infection (SSI) and hospital readmission after lumbar fusion in the United States, Denmark, and Japan found that these predictors vary between the three countries, suggesting that risk stratification models may need to be population specific or adjusted. The authors determined and compared predictors from three prospective databases: the National Neurosurgery Quality and Outcomes Database (N2QOD), DaneSpine, and the Japan Multicenter Spine Database (JAMSD). They authors found that predictive variables differed in the three databases, for both readmission and SSI. Factors predictive for hospital readmission were American Society of Anesthesiologists (ASA) grade in N2QOD, fusion levels in DaneSpine, and sex in the Japan database. For SSI, sex, diabetes, and length of stay were predictive in JAMSD , while no predictors were identified in N2QOD or DaneSpine. The authors noted that patient and procedure selection differ in the three countries, limiting the ability to directly pool data from different regions. Read the study…

Study: Lower-cost EACA reduces blood loss in TJA.
A study involving patients undergoing primary joint arthroplasty at Durham Veterans Affair Medical Center (Durham, N.C.) demonstrated that use of epsilon aminocaproic acid (EACA) yielded reductions in hemoglobin loss and transfusion, positioning it as an alternative to tranexamic acid. The study, published in The Journal of Arthroplasty, involved 185 total knee and hip arthroplasty patients from the year before and 184 from the year after an EACA protocol was introduced. Hemoglobin loss was significantly lower in the EACA group compared to the control group (2.7 ± 0.8 mg/dL versus 3.4 ± 1.1 mg/dL), and the incidence of blood transfusion was significantly lower (2.7 percent versus 25.4 percent) as well. The authors note that EACA has been used sparingly in orthopaedic surgery but has a lower cost than tranexamic acid and a “favorable side effect profile.” Read the study

Last call: Instructional Course Committees.
Aug. 31, 2017, is the last day to submit an application for a position on an Instructional Course Committee. Members of Instructional Course Committees grade instructional course lecture applications, provide feedback regarding faculty and curricula to the Central Instructional Courses Committee, and evaluate courses at the AAOS Annual Meeting. The following positions are open:

  • Adult Reconstruction Hip (one member)
  • Adult Reconstruction Knee (chair, one member)
  • Foot and Ankle Instructional Course Committee (chair )
  • Hand and Wrist (chair, one member)
  • Pediatrics (chair, one member)
  • Practice Management (chair, one member)
  • Shoulder and Elbow (chair, one member)
  • Spine (chair, one member)
  • Sports Medicine and Arthroscopy (chair, one member)
  • Tumor (chair )

Applicants must be active fellows with a practice emphasis in the relevant area. Learn more and submit your application…(member login required)

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