Today’s Top Story

CMS reduces number of providers required to participate in CJR, cancels hip fracture bundled payment model

The U.S. Centers for Medicare & Medicaid Services (CMS) recently released a final rule and interim final rule with comment period that alters the Comprehensive Care for Joint Replacement (CJR) Model and cancels mandatory hip fracture and cardiac bundled payment models. The agency reduced the number of mandatory geographic areas participating in CJR from 67 to 34 and made CJR participation voluntary for all low-volume and rural hospitals participating in the model. CMS states that, moving forward, the agency expects to move away from mandatory bundled payment models in favor of increased opportunities for providers to participate in voluntary initiatives.

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Other News

Survey: Specialists in non-academic hospitals earn more than those in an academic settings

A survey released by MGMA finds that specialty care physicians in non-academic hospitals out-earn similar physicians working in academic systems by $122,795 per year. As reported in HealthLeaders Media, the survey notes that specialty care, non-academic physicians report an average of 1,200 more work Relative Value Units per year compared to academic physicians. The survey also reports that fully clinical specialty physicians earn $67,290 more per year in base compensation compared to those who spend 67 percent or more of their time conducting research.

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Study: Immune system factors may affect pain and disease progression for patients with knee OA

Findings published online in the journal Osteoarthritis and Cartilage suggest that immune system response may affect pain levels and disease progression experienced by osteoarthritis (OA) patients. The authors conducted a matched cohort study of 15 women with knee OA and healthy age- and sex-matched control participants. They analyzed soluble inflammatory mediator (tumor necrosis factor [TNF], interleukin [IL] 6, IL-10, and c-reactive protein [CRP]) levels in the serum and leukocyte numbers, surface expression of monocyte activation markers, and monocyte production of pro-inflammatory mediators (TNF and IL-1β) following stimulation. They found that women with knee OA displayed elevated levels of serum CRP and a lower proportion of circulating monocytes. In addition, monocytes from OA participants had elevated expression of the activation markers CD16, chemokine receptor type 2 (CCR2), and human leukocyte antigen–antigen D related (HLA-DR) and induced greater production of TNF and IL-1β compared to healthy participants. The authors note that monocyte CCR2 expression and serum TNF correlated with worse pain on a validated questionnaire.

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Study: How missing data are handled may influence results of some spine studies

A study published in the December issue of the journal Clinical Orthopaedics and Related Research suggests that the manner in which missing data are handled may influence the results of spine studies based on database information. The researchers reviewed data on 88,471 spine surgery patients from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. They found that 4,441 records (5 percent) had missing elements among demographic data, 69,184 (72 percent) among comorbidities, 70,892 (80 percent) among preoperative laboratory values, and 56,551 (64 percent) among operating room times. Based on three different treatments of missing data, the researchers found different risk factors for adverse events. Of 44 risk factors found to be associated with adverse events in any analysis, only 15 (34 percent) were common among the three regressions.

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Study: Air pollution may increase risk of fracture and osteoporosis

Data from a study published in the journal The Lancet—Planetary Health suggest that poor air quality may increase risk of bone fractures and osteoporosis. Members of the research team reviewed information on osteoporosis-related fracture hospital admissions among 9.2 million Medicare enrollees aged 65 years or older. They found that risk of bone fracture admissions at osteoporosis-related sites was greater in areas with higher concentrations of particulate matter in the atmosphere, particularly in low-income communities. In addition, the researchers found that black carbon concentration was associated with higher bone mineral density loss over time at multiple anatomical sites, including femoral neck and ultradistal radius.

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Study: Compared to males, female athletes may be more likely to experience concussion

A study published in the December issue of the Journal of the AAOS suggests that female athletes may be more likely than male athletes to experience concussion. The authors conducted a retrospective cohort study of 1,200 university varsity athletes (822 male, 378 female) who were at risk of sports-related concussion. Overall, 228 athlete experienced at least one concussion. The authors found that risk factors for collegiate concussion included female sex and precollegiate concussion, while prolonged recovery was predicted by the presence of eight or more post-concussion symptoms for all athletes and for female athletes only.

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Your AAOS

Call for volunteers: FDA Network of Experts Program

AAOS seeks to nominate multiple candidates to participate in the U.S. Food and Drug Administration (FDA) Network of Experts program. The Network of Experts is a vetted network of outside scientists, clinicians, and engineers who provide the FDA Center for Devices and Radiological Health with rapid access to scientific, engineering, and medical expertise when it is needed. 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, a current curriculum vitae, and a completed conflict of interest form (available from the email below). All supporting materials must be submitted to Kyle Trivedi by Dec. 5, 2017, at:

trivedi@aaos.org

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