December 18, 2017
Today’s Top StoryProvider organizations prepare for increased use of risk-based payment models

A survey released by trade organization AMGA finds that 60 percent of respondent healthcare organizations expect to be ready to accept Medicare payments that include downside risk within 2 years. The research team surveyed 80 AMGA member groups, including multispecialty medical groups and independent physician associations. The researchers found that survey respondents continue to move away from fee-for-service (FFS) payments to risk-based payment models. Respondents expect Medicare FFS payments to decrease 17 percent by 2019, and commercial FFS payments to decline by 11 percent.

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Other NewsAHRQ offers toolkit to help improve surgical care and prevent SSI

The U.S. Agency for Healthcare Research and Quality (AHRQ) recently released a safe surgery toolkit designed to help perioperative and surgical units in hospitals identify opportunities to improve safety practices and prevent surgical site infection (SSI). The toolkit consists of evidence-based resources that reflect the real-world experiences of various stakeholders from approximately 200 hospitals that successfully reduced incidence of SSI. The Toolkit to Promote Safe Surgery includes two complimentary guides that address both adaptive and technical work, along with 15 instructional modules to help clinical teams address specific areas of competency.

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Study: Community-based screening program may help reduce incidence of hip fracture in older womenData from a study conducted in the United Kingdom and published online in the journal The Lancet suggest that implementation of a community-based fracture risk screening program could help reduce incidence of hip fracture among older women. The authors conducted a randomized, controlled trial of 12,483 women aged 70 to 85 years, 6,233 of whom were randomly assigned to a screening program using the Fracture Risk Assessment Tool. They found that treatment was recommended for 898 (14 percent) of screened participants. At 1-year follow-up, use of osteoporosis medication was significantly higher in the screening group compared with those in the control group. The authors found that screening was not associated with a reduction in incidence of all osteoporosis-related fractures, nor the overall incidence of all clinical fractures. However, screening was associated with a reduction in incidence of hip fracture.

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Study: PTS of 12° or more may increase risk of repeat ACL injuryFindings from a study published online in The American Journal of Sports Medicine suggest that posterior tibial slope (PTS) of 12° or more may be the strongest predictor of repeat anterior cruciate ligament (ACL) injury, with the effect most pronounced in adolescents. The researchers conducted a prospective, case-control study of 200 consecutive patients who underwent isolated primary ACL reconstruction with hamstring tendon autograft. Among 179 patients available at 20-year follow-up, the researchers found that ACL graft rupture occurred in 37 patients, and 22 patients experienced contralateral ACL injury. Of participants with intact ACL grafts at 20 years, the researchers found that outcomes were not statistically different between adolescents and adults for the variables of International Knee Documentation Committee subjective score, return to preinjury activity level, current activity level, or degree of radiological degenerative change. Overall, ACL graft survival at 20 years was 86 percent for adults and 61 percent for adolescents, but ACL survival for adolescents with a PTS of ≥12° was 22 percent. Compared with adults with a PTS <12°, the hazard for ACL graft rupture was increased by 11x in adolescents with a PTS of ≥12°.

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Study: Protein variation may affect postsurgical painA study conducted in China and published online in the journal Anesthesiology suggests that genetic variation of brain-derived neurotrophic factor (BDNF) may be linked with an increased risk of chronic postsurgical pain. Members of the research team genotyped 638 polymorphisms within 54 pain-related genes across 1,152 surgical patients enrolled in the Persistent Pain after Surgery Study. At 12-month follow-up, they found that 21.4 percent (n = 246) of patients reported chronic postsurgical pain. Overall, 42 polymorphisms were associated with chronic postsurgical pain—19 decreased the risk of pain and 23 increased the risk of pain. In both the discovery cohort and matched validation cohorts of 103 patients each, researchers found that patients carrying allele A of rs6265 polymorphism in BDNF had a lower risk of chronic postsurgical pain.

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In the StatesCalifornia

In support of residents displaced by and recovering from wildfires ravaging southern portions of California, the acting secretary of the U.S. Department of Health & Human Services has declared a public health emergency (PHE) in the state, retroactive to Dec. 4, 2017. The move allows the U.S. Centers for Medicare & Medicaid Services (CMS) to waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program requirements if necessary to provide health services. Among other things, the agency has established a toll-free hotline intended to assist non-certified Part B suppliers, physicians, and nonphysician practitioners helping with recovery efforts to enroll in federal health programs and receive temporary Medicare billing privileges. CMS is temporarily waiving the application fee, finger print-based criminal background checks, site visits, and in-state licensure requirements usually required for providers to access Medicare billing privileges. The toll-free hotline telephone number is 855-259-2396.

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Your AAOSLast call: Evaluation committees

A number of positions are open on two Evaluation Committees. Members of the Evaluation Committees write questions for the orthopaedic self-assessment examinations. The following openings are available:

  • Hand & Wrist (chair, four members; deadline is Dec. 31. 2017)
  • Shoulder & Elbow (chair; deadline is Dec. 22, 2017)

All applicants must have a practice emphasis in the relevant topic. In addition, applicants for member positions must be active fellows, emeritus fellows, candidate members, or candidate member applicants for fellowship; applicants for a chair position must be active fellows.

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

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