July 30, 2018 | Today’s News

Physicians press CMS on MIPS reporting and PTAC payment models

During a hearing before the health subcommittee of the Energy and Commerce committee, physicians called on the Centers for Medicare & Medicaid Services (CMS) to change course on opt-out policies for Merit-based Incentive Payment System (MIPS) reporting. CMS proposed that physician practices with less than $90,000 in Medicare revenue or fewer than 200 unique Medicare patients per year could be exempt from MIPS, leaving less than half (approximately 40 percent) of the 1.5 million doctors billing Medicare to comply with the system and reducing incentives for the program. In addition, CMS has not yet adopted any alternative pay models recommended by the Physician-Focused Payment Model Technical Advisory Committee (PTAC), despite receiving 10 payment model suggestions from specialty societies and physician groups.

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Study assesses changes in satisfaction following TKA after long-term follow-up

A retrospective cohort study published online in The Bone & Joint Journal found that the overall rate of satisfaction following total knee arthroplasty (TKA) did not change from one year to five years (91.7 percent versus 90.1 percent, respectively). Researchers identified 1,369 patients from an arthroplasty database who had undergone primary TKA but not revision TKA for osteoarthritis. Approximately half of patients (n = 53/114) who were dissatisfied with their outcomes at one-year post-TKA had become satisfied at five years. Among those who were satisfied at one year, just six percent (n = 74/1,255) became dissatisfied at five years. Patients with lung disease, depression, and back pain, and those who had undergone unilateral TKA or had a worse preoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score were more likely to be dissatisfied at one year following TKA. Patients with gastric ulceration and a worse WOMAC stiffness score were more likely to be persistently dissatisfied at five years following TKA. The researchers noted that acknowledging and addressing these patient factors may improve outcomes and satisfaction.

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The Trump administration announced that it will restart a risk adjustment program that pays billions to insurers under the Affordable Care Act (ACA), according to a report from The New York Times. The program was suspended three weeks ago, due to a federal court ruling in New Mexico. Under the program, insurers participating in the marketplace make payments into a pool that is redistributed to plans with sicker, more costly patients. The Department of Health and Human Services said the payments will resume Oct. 22.

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Beneficiaries of Medicare Advantage (MA) may experience a shorter course of rehabilitation, be more likely to be discharged to the community successfully, and less likely to experience a 30-day hospital readmission compared to those covered by Medicare fee-for-service (FFS), according to a retrospective cohort study published online in PLOS Medicine. Researchers assessed differences in health service utilization and outcomes in 211,296 FFS-covered patients and 75,554 MA-covered patients in skilled nursing facilities (SNF) following hip fracture hospitalization between Jan. 1, 2011, and June 30, 2015. The MA population spent 5.1 fewer days in the SNF and received 463 fewer minutes of total rehabilitation therapy during the first 40 days of admission compared to the FFS population. In addition, MA-covered patients had a 1.2 percentage point lower 30-day readmission rate, 0.6 percentage point lower rate of becoming a long-stay resident, and a 3.2 percentage point higher rate of successful discharge to the community.

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A study published online in The Lancet Infectious Diseases found several modifiable factors associated with risk of revision for prosthetic joint infection (PJI) after primary hip replacement. The prospective, observational cohort study included 623,253 hip procedures conducted between April 1, 2003, and Dec. 31, 2013, in England and Wales. During that time, 2,705 primary procedures were subsequently revised for an indication of PJI after a median follow-up of 4.6 years (interquartile range, 2.6–7.0 years). Factors associated with increased revision because of PJI were male sex, younger age (< 60 years), elevated body mass index, diabetes, dementia, previous septic arthritis, fractured femur, and lateral surgical approach. Ceramic bearings were associated with a lower risk of revision due to PJI than metal bearings.

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Will osseointegration become the standard of care for amputees?

When I arrived at the Ibn Sina Hospital in Baghdad, Iraq, I was stunned to see the conditions of some of the patients. Iraq is not a friendly place for the disabled. Recognizing the need for solutions to this mounting problem, the Iraqi minister of health and prime minister reached out to Iraqi-born Australian surgeon Munjed Al Muderis, MBChB, FRACS, FAOrthA, to begin a program to treat wounded anti-ISIS soldiers. In addition to specializing in lower-extremity reconstruction, Dr. Al Muderis is a pioneer in the field of osseointegration. After spending two months in Sydney, Australia, observing his techniques, I became fascinated with the technology and the potential it offered patients who had sustained limb loss. I was, therefore, excited to join Dr. Al Muderis’ team in Iraq and to work with the technology.

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Last Call: Nominate future AAOS leadership

The 2019 Nominating Committee is actively soliciting suggestions for individuals to serve in the following positions:

• Second vice-president
• Board member-at-large
• Board member-at-large (< 45 years on March 18, 2019)
• Nominees to the American Board of Orthopaedic Surgery

Nominations will close on Aug. 3.

Learn more and submit a nomination… (member login required)