Today’s Top Story

CMS to offer new voluntary payment bundle

The U.S. Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) has announced the launch of a new voluntary bundled payment model. Under the Bundled Payments for Care Improvement (BCPI) Advanced model, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on specific quality measures. Participants will bear financial risk, have payments under the model tied to quality performance, and be required to use Certified Electronic Health Record Technology. The 32 types of clinical episodes in BPCI Advanced add outpatient episodes to inpatient episodes offered in the existing BCPI initiative. BPCI Advanced will be an Advanced Alternative Payment Model (APM) under the Medicare Access and CHIP Reauthorization Act. The Model Performance Period for BPCI Advanced is scheduled to run from Oct. 1, 2018, through Dec. 31, 2023.

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The American Association of Orthopaedic Surgeons (AAOS) released a statement saying that more opportunities for specialty participation within the Advanced APM track of the Quality Payment Program are needed, and that the BCPI Advanced model may help to remedy that issue.

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In related news, a research letter published in the Jan. 9 issue of The Journal of the American Medical Association examines participation and dropout rates for hospitals in the existing BCPI initiative model 2, and finds that only 12 percent of eligible hospitals signed up for BPCI, and the dropout rate was 47 percent.

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Other News

Study: STO procedure with Ilizarov technique may help improve clinical status for patients with symptomatic varus knee deformity

Data from a study published in the Jan. 3 issue of The Journal of Bone & Joint Surgery suggest that subtubercle tibial osteotomy (STO) procedures using the Ilizarov technique for symptomatic varus knee deformity may be associated with high knee survival rates without arthroplasty and significant improvement in clinical status. The authors reviewed information on 72 STO procedures (61 patients) treated with STO using the Ilizarov technique to correct a varus deformity of the proximal part of the tibia. They found that radiographic measurements, including mechanical axis deviation, medial proximal tibial angle, and joint line congruence angle, significantly improved after deformity correction. In addition, among patients with a preoperative flexion contracture, proximal posterior tibial angle significantly increased toward normal values. A survival analysis demonstrated a rate of native knee-joint survival without conversion to arthroplasty of 94.2 percent at 5 years, 84.0 percent at 10 years, and 513 percent at 15 years.

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Study: U.S. Preventive Services Task Force issues recommendation on AIS screening

The U.S. Preventive Services Task Force has released a final recommendation statement on screening for adolescent idiopathic scoliosis (AIS). The group reports insufficient evidence to recommend for or against screening for idiopathic scoliosis in children and adolescents aged 10 to 18 years who do not have any signs or symptoms. The task force reviewed data on 448,276 patients across 14 studies and found that screening can detect AIS, and that bracing and possibly exercise treatment can interrupt or slow progression of curvature in adolescence. “However,” the authors write, “there is little or no evidence on long-term outcomes for AIS treated in adolescence, the association between curvature at skeletal maturity and adult health outcomes, the harms of AIS screening or treatment, or the effect of AIS screening on adult health outcomes.

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Study: Communication strategy may help ease patient concerns regarding diagnostic uncertainty

A study published online in the International Journal for Quality in Health Care suggests that the way diagnostic uncertainty is communicated may affect patient perceptions of trust and physician competence. The researchers surveyed 71 participants regarding their responses to three vignettes, each of which demonstrated a different strategy for communicating diagnostic uncertainty. They found that explicit expression of uncertainty was associated with lower perceived technical competence, less trust and confidence, and lower patient adherence, while implicit strategies, such as broad differential diagnoses or most likely diagnoses, were linked to increases in perceived physician competence, physician confidence and trust, and intention to adhere to instructions.

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Issues with Medicaid data system may increase risk of payment errors

A report from the U.S. Government Accountability Office (GAO) suggests that issues with a national Medicaid data repository may be linked to payment errors. The agency states that, with implementation of the Transformed Medicaid Statistical Information System (T-MSIS), CMS has taken “an important step toward developing a reliable national repository for Medicaid data.” However, although 49 states had begun reporting data to T-MSIS by November 2017, eight states reviewed for the report identified converting data to T-MSIS format to be the primary challenge in reporting efforts. In addition, CMS has not compiled and shared information about states’ data limitations, which would help states accurately compare their T-MSIS data to that of other states. GAO recommends that CMS work to improve T-MSIS’s completeness and comparability, and articulate a specific oversight plan.

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In the States

North Dakota

The Bismarck Tribune reports that a judge in North Dakota has found the state’s $500,000 medical liability cap to be unconstitutional A jury had previously awarded a patient $3.5 million in a medical liability suit, including $2 million for economic losses and $1.5 million for noneconomic damages. The hospital sought to reduce the noneconomic portion of the award by $1 million to meet the mandated cap. However, the judge ruled that the cap arbitrarily reduces damages for people who sustain the most severe injuries, and therefore violates equal protection guaranteed under the state constitution.

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Your AAOS

Last call: Annual Meeting Committee

Jan. 15 is the last day to submit an application for chair of the Annual Meeting Committee. This committee coordinates all components of the AAOS Annual Meeting. Applicants for this position must be active fellows with a strong interest in the AAOS Annual Meeting.

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