Today’s Top Story
CMS proposes change to site of care payment policy
The Centers for Medicare & Medicaid Services (CMS) proposed expanding its site-neutral payment policy to clinic visits, which are the most commonly billed service under the outpatient payment rule and often cost more in the hospital outpatient setting than in the physician office setting. If finalized, this rule could save Medicare $610 million and patients approximately $150 million through lower copayments for off-campus hospital outpatient department visits, according to a report from Modern Healthcare. CMS estimates that it pays approximately $75 to $85 more, on average, for the same service in the hospital outpatient settings, and beneficiaries are responsible for 20 percent of that cost. “We believe the difference in payment for these services is a significant factor in the shift in services from the physician’s office to the hospital outpatient department, thus unnecessarily increasing hospital outpatient department volume and Medicare program and beneficiary expenditures,” according to the agency. AAOS will comment on the rule.
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Other News
Study: 3D versus 2D planning for corrective osteotomy for malunited distal radial fractures
A study published in the July 18 issue of The Journal of Bone & Joint Surgery showed an apparent trend toward a minimal clinically important difference in patient-reported outcome measures following 3D computer-assisted guidance versus conventional 2D planning for corrective osteotomy of extra-articular distal radial malunion. The difference, however, was not significant because of insufficient power. Researchers randomized 40 adults with a symptomatic extra-articular malunited distal radial fracture between September 2010 and May 2015. At 12-month follow-up, the reduction in the mean Disabilities of the Arm, Shoulder and Hand score (primary outcome) was −30.7 in the 3D cohort compared to −20.1 in the 2D group. There were no significant differences in pain, satisfaction, range of motion, and grip strength between the groups, and the duration of preoperative planning and surgery and complication rates were comparable. A larger trial is needed to provide a definitive conclusion, according to the investigators.
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CMS administrator says ‘no’ to single-payer health care
CMS Administrator Seema Verma said the agency will reject a single-payer healthcare proposal, according a report from The Associated Press. “Medicare for All [would] only serve to hurt and divert focus from seniors. Medicare for All would become Medicare for none,” Ms. Verma said during a speech at the Commonwealth Club of California. She also said she disapproved of California’s efforts to institute a state-run healthcare system. Her speech came after Sen. Bernie Sanders (I-Vt.) called for a national health plan. More than 60 House Democrats launched a “Medicare for All” caucus, and 33 of the 57 Democrats who won primaries in swing districts this year mentioned support for some form of Medicare for All policy, according to data from the Progressive Change Campaign Committee.
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Study: Underdosing prophylactic antibiotics may be common in open tibial fractures
A study published in the July issue of the Journal of Orthopaedic Trauma found that one-third of patients with open tibial fractures (n = 21) were underdosed with cefazolin at the time of initial presentation, and that this underdosing may lead to infection Researchers included 63 adult patients from a Level I trauma center who had high-grade open extra-articular tibial fractures. Among the 20 patients who subsequently developed deep infection, 55 percent were appropriately dosed with cefazolin. Of the patients who did not develop deep infection, 72 percent received an appropriate antibiotic dose. Appropriate weight-based dosing (defined as at least 1 g for patients < 80 kg, 2 g for patients 80–120 kg, and 3 g for patients > 120 kg) of cefazolin for prophylaxis in high-grade open tibial fractures reduces the frequency of infection due to cefazolin-sensitive organisms.
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Study: Incidence of atypical femoral fractures may be low in those with hip and femoral fractures
Among hip and femoral fractures, the incidence of atypical femoral fractures (AFFs) was 2.95 percent, according to a retrospective study published online in Osteoporosis International. Researchers assessed medical records and radiographs of 6,644 hip and femoral fractures of patients from eight tertiary referral hospitals. Of the AFFs, 90 were subtrochanteric and 106 were femoral shaft fractures. Independent risk factors for AFFs included osteopenia or osteoporosis, use of bisphosphonates (BPs), rheumatoid arthritis, increased anterior and lateral femoral curvatures, and thicker lateral femoral cortex. Patients with AFFs who received treatment with BPs were more likely to have problematic fracture healing than those with did not receive BPs.
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AAOS Now
Debate: Are ultrasounds necessary for routine knee and shoulder injections in the office?
The use of ultrasound guidance for routine knee and shoulder injections in the office is increasing. There is no doubt that ultrasound can improve the accuracy of injections, yet questions remain. How much accuracy is gained and at what cost? Moreover, are patient outcomes negatively affected if ultrasound is not used for these injections? Two respected sports medicine physicians debate the issue.
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Your AAOS
Last Call: Apply for Adult Spine Evaluation Committee member position
The AAOS International Committee has an open member position, a three-year term that runs from March 18, 2019, to March 25, 2022. The committee prepares the Adult Spine Self-Assessment Examination every two years and acts as a resource as requested for providing examination questions for other AAOS educational programs. The last day to submit an application is Aug. 3.
Learn more and submit your application… (member login required)

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