June 22, 2018 | Today’s News

Trump administration proposes HHS restructuring as part of large government overhaul

As part of a 132-page plan titled Delivering Government Solutions in the 21st Century, the White House proposed to move all major public-assistance programs, including the Department of Health and Human Services (HHS), into one large agency called the Department of Health and Public Welfare. The proposal serves as an initiative to move toward a “small government.” The proposal describes the initiative as a “leaner and more efficient organization that would be better prepared to respond to public health emergencies and provide vital health services.” Part of the consolidation includes shifting the $70 billion food stamp program Supplemental Nutrition Assistance Program to HHS, as well as moving the U.S. Food and Drug Administration under the Agriculture Department. The plan is expected to face Congressional hurdles.

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CMS requests feedback on Stark law

The Centers for Medicare & Medicaid Services (CMS) issued a request for information on the Stark law, or physician self-referral law, which prohibits a physician from making referrals for certain healthcare services to an entity with which he or she (or an immediate family member) has a financial relationship. “Many of the recent statutory and regulatory changes to payment models are intended to help incentivize value-based care and drive the Medicare system to greater value and quality,” said CMS Administrator Seema Verma in a blog post. “The Stark law and regulations, in its current form, may hinder these types of arrangements.” When CMS asked providers for comment about regulations that create burdensome regulatory hurdles, it received more than 2,600 comments. According to Ms. Verma, Stark law was one of the top areas identified. Comments are due Aug. 24, and AAOS will be commenting.

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Read the message from CMS…

Read the CMS notice…

Use of opioids may be associated with nonunion risk in traumatic injuries, according to a cohort study published online in the journal Injury. Researchers used patient-level health claims for medical and drug expenses from a payer database to evaluate patients with fractures occurring in 2011 and had continuous enrollment from one month prior to trauma to 12 months after. They then evaluated 309,330 fractures, 45,085 of which (14.6 percent) occurred in patients chronically using opioids. Nonunion odds ratio was elevated for both acute and chronic use of schedule II opioids (including acetaminophen/oxycodone, hydromorphone, oxycodone, and acetaminophen/hydrocodone bitartrate), as well as schedule III-IV opioids (including tramadol).

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According to a study published online in The American Journal of Sports Medicine, meniscocapsular and meniscotibial lesions of the posterior horn of the medial meniscus increased knee anterior tibial translation, internal and external rotation, and the pivot shift in anterior cruciate ligaments (ACL)-deficient knees. Researchers subjected 12 matched pairs of human cadaveric knees to various loads and rotational torques. Knees were randomized to severance of either meniscocapsular or meniscotibial attachments after ACL reconstruction (ACLR) and several states were tested, including intact (n = 24), ACL deficient (n = 24), ACL deficient with a meniscocapsular lesion (n = 12), ACL deficient with a meniscotibial lesion (n = 12), ACL deficient with both meniscocapsular and meniscotibial lesions (n = 24), ACLR with both meniscocapsular and meniscotibial lesions (n = 16), and ACLR with repair of both meniscocapsular and meniscotibial lesions (n = 16). ACL reconstruction in the presence of both lesions restored anterior tibial translation but not internal or external rotation or pivot shift. ACLR and lesion repair were necessary to restore pivot shift but were not effective in restoring internal and external rotation.

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A study published in the June 15 issue of the Journal of the AAOS showed that trauma-trained orthopaedic surgeons (TTOS) and nontrauma-trained orthopaedic surgeons (NTTOS) may yield rotational ankle fracture reductions of similar quality but different costs. Researchers assessed 208 fractures—119 treated by TTOS and 89 by NTTOS—and evaluated differences in both surgical cost and quality of reduction. Adequacy of fracture reduction did not differ between groups at final follow-up; however, the median cost of surgery in the NTTOS group was more than twice that of the TTOS cohort ($2,940 versus $1,233, respectively).

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The impact of corticosteroid injections

Corticosteroid injections (CSI) are frequently used in the nonsurgical management of rotator cuff tears. According to the authors of Scientific Paper 838 presented at the AAOS 2018 Annual Meeting, however, individuals who undergo rotator cuff repair (RCR) surgery within a year of receiving a CSI are at much higher risk of needing a revision RCR than those who had not been treated with CSI.

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Apply for Committee on Evidence-based Quality and Value member position

The AAOS Committee on Evidence-Based Quality and Value has an open member position, a two-year term that runs from March 18, 2019, to March 12, 2021. The committee plans, organizes, directs, and evaluates evidence-based initiatives such as the Clinical Practice Guidelines, Systematic Reviews, Performance Measures, and Appropriate Use Criteria, as well as oversees related education, dissemination, validation, and implementation activities. The last day to submit an application is Aug. 10.

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