January 22, 2018
Today’s Top Story

Studies suggest shortening initial opioid prescriptions may reduce misuse

Two new studies examine the issue of opioid prescribing as it relates to likelihood of continued opioid use. The first, published online in the journal The BMJ, suggests that prescription duration may be more strongly associated than dosage with opioid misuse in the early postsurgical period. The authors conducted a retrospective cohort study of 568,612 opioid-naïve patients who received postoperative opioids. They found that total duration of opioid use was the strongest predictor of misuse; each refill and additional week of opioid use was linked with an adjusted increase in the rate of misuse of 44.0 percent and with a 19.9 percent increase in hazard.

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A second study, to be published in the Journal of General Internal Medicine, suggests that reducing the default opioid prescription size in an electronic medical record (EMR) system may help reduce prescription sizes ordered by providers. The research team found that reducing the default setting to 10 opioid tablets was linked to an increase of 22 percent in the number of initial 10-tablet prescriptions, a nearly 7 percent decrease in the number of 20-tablet prescriptions, and a more than 13 percent decrease in prescriptions of 11 to 19 tablets.

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In related news, The Hill reports that the acting secretary of the U.S. Department of Health & Human Services has extended for another 90 days President Donald J. Trump’s declaration of opioids as a public health emergency.

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Other News

Pending “extenders” legislation, CMS withholds pay for certain PT and OT claims

According to Congressional Quarterly, the U.S. Centers for Medicare & Medicaid Services (CMS) is currently not processing certain claims for physical therapy (PT), occupational therapy (OT), and speech therapy treatments, due to the expiration of certain provisions that allow Medicare patients to exceed an annual cap on such “Medicare extenders” services. The agency began holding claims affected by the caps on Jan. 1, 2018. The cap on such services for 2018 is $2,010.

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Study: Discharging patients to home after TJA may be safe, even when they live alone

Data from a study published in the Jan. 17 issue of The Journal of Bone & Joint Surgery suggest that it may be safe for total joint arthroplasty (TJA) patients to be discharged directly home, even if they live alone. The authors conducted a prospective study of 769 patients who underwent primary, unilateral total hip or total knee arthroplasty, 138 of whom lived alone. They found that patients living alone more commonly stayed an additional night in the hospital and used more home health services. However, the authors found no significant difference across cohorts in complications, unplanned clinical events, functional outcomes, pain relief, or 90-day satisfaction scores.

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Study: What factors are linked to unplanned returns to the ED after elective, outpatient RCR?

A study published online in the Journal of Shoulder and Elbow Surgery looks at unplanned visits to the emergency department (ED) following elective outpatient rotator cuff repair (RCR). The researchers reviewed data on 1,306 outpatient RCRs performed at a single healthcare system. They found that 90 RCR patients returned to the ED or an urgent care center within 7 days, 34 for avoidable diagnoses. The researchers found that pain was the most common avoidable diagnosis, but also noted that return visits for urinary retention were significantly more common among RCR patients compared to a control cohort of 5,825 non-RCR patients.

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Some Medicare ACOs may see benefit by assuming risk under a different APM track

An analysis conducted by consulting firm Avalere suggests that some Medicare accountable care organizations (ACOs) might benefit by assuming greater financial risk under an advanced alternative payment model (APM). Researchers simulated how Track 1 (non-risk bearing) ACOs would have performed if they had assumed risk under Track 1+, making them eligible for a 5 percent bonus payment. Based on 2016 performance data, they found that 91 percent of ACOs would have financially benefited from bearing risk and receiving the incentive payment. However, the report also notes that if the 5 percent incentive was not available, only 5 percent of such ACOs would have achieved net positive earnings.

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In the States

Missouri

Kansas City Business Journal reports that several healthcare systems in Missouri, along with the U.S. Department of Veterans Affairs, have announced plans to form a nonprofit drug manufacturer to increase availability of certain medications and reduce costs. The company will manufacture only generic drugs, and will seek U.S. Food and Drug Administration approval to do its own manufacturing along with contract manufacturing to other organizations.

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Your AAOS

Public comments sought on MSTS guideline on use of imaging prior to referral

The Musculoskeletal Tumor Society (MSTS) Systematic Literature Review on the Use of Imaging Prior to Referral to a Musculoskeletal Oncologist has completed peer review and is entering the public commentary stage. Public comments on the guideline will be accepted through Friday, Jan. 26, 2018. For more information and to provide comments, contact Mary DeMars, at:

demars@aaos.org

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