Today’s Top Story

Study finds value-based payment models and healthcare marketplace competition may not reduce costs

Early value-based payment models did not reduce the total cost of care or improve clinical quality outcomes, according to a report from the Healthcare Financial Management Association, Leavitt Partners, and McManis Consulting, with support from the Commonwealth Fund. Researchers assessed commercial data from 2012 to 2014 and Medicare data from 2007 to 2015 and found no statistically significant correlation between the value-based payment models and growth in the total cost of care for Medicare (2012–2015) or commercial payers (2012–2014) in more than 900 U.S. markets. Investigators said these findings were due to limited prevalence of these models in many markets, lack of strong financial incentives for managing the total cost of care, healthcare organizations’ preference for an incremental approach to risk, and employers’ reluctance to change benefit design. The study also indicated that the number of competitors in a market may be less important than the type of competitors.

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Other News

Study: Mortality following TKA may be declining

A study published in the June 20 issue of The Journal of Bone & Joint Surgery observed an ongoing worldwide temporal decline in mortality following total knee arthroplasty (TKA), which researchers said may be due to improved patient selection and perioperative care and a healthy population effect. Researchers conducted a literature review of MEDLINE, AMED, CAB Abstracts, and Embase to identify 37 studies published between 2006 and 2016 that reported on 30- or 90-day mortality following TKA. The selected studies represented 1.75 million TKAs performed in 15 different countries. Thirty- and 90-day mortality were 0.20 percent and 0.39 percent, respectively, both of which decreased during the 10-year study period. By 2015, 30-day mortality following TKA decreased to 0.10 percent, and 90-day mortality decreased to 0.19 percent. The leading cause of death was cardiovascular disease.

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Study: Graft augmentation and interposition may reduce retear rates in rotator cuff reconstruction

Both graft augmentation and interposition may yield lower retear rates than rotator cuff reconstruction (RCR) alone, according to a study published online in The American Journal of Sports Medicine. Researchers conducted a literature review and analyzed 36 studies with a minimum of one-year follow-up and minimum sample size of 10 patients who received RCR with graft augmentation or interposition and compared them to studies in which patients underwent RCR alone (control group). Graft augmentation or interposition resulted in significantly lower retear rates and higher American Shoulder and Elbow Surgeons scores compared to RCR alone. However, improvements in University of California, Los Angeles and pain scores were not significantly different.

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Study: Humeral and ulnar far cortical button suspension effective as a UCL fixation alternative

According to a study published online in the Journal of Shoulder and Elbow Surgery, humeral and ulnar far cortical button suspension may be a viable option for ulnar collateral ligament (UCL) fixation. In a retrospective evaluation of 23 consecutive athletes who had UCL reconstruction with ulnar and humeral-sided far cortical button fixation, researchers used data from electronic medical records and patient phone calls to analyze resumption of sport participation (primary outcome). They observed that 19 patients (82.6 percent) returned to sport. At final follow-up, the average range of motion was zero to 140 degrees, and 20 patients (87 percent) achieved full range of motion. The average Disabilities of the Arm, Shoulder and Hand score was 3.8. There was one reconstruction failure.

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Study: Prosthetic hand may perceive touch, pain

A team of researchers at Johns Hopkins University developed electronic skin, called e-dermis, for prosthetic devices that can experience touch sensations, including pain, according to research published online in Science Robotics. Researchers worked with an amputee volunteer and applied electric pulses that stimulated the participant’s nerves in a prosthetic hand. The volunteer was asked to rate the level of discomfort from the sensation, and the investigators used those stimulation patterns to provide sensory feedback to the volunteer’s brain as he picked up smooth, curved objects or sharp, pointed ones. In a pain detection task, researchers showed the ability of the prosthesis and amputee to differentiate nonpainful or painful tactile stimuli using sensory feedback and a pain reflex feedback control system.

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AAOS Now

Early exposure and education increases likeliness of orthopaedic surgeons supporting advocacy and policy efforts

Advocacy is vital to the future of medicine as a profession. Founded by the Academy in 1997, the American Association of Orthopaedic Surgeons—together with the Office of Government Relations—advocates on Capitol Hill throughout the year on behalf of all orthopaedic surgeons. During this time of rapid change in health care, however, additional advocacy efforts are needed to effect change on the myriad policies and policy proposals that will directly impact orthopaedic surgeons and their patients. During the AAOS 2017 Annual Meeting, William J. Maloney, MD, and Gerald R. Williams Jr, MD, expressed the need for increasing orthopaedic surgeons’ investment in advocacy.

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Your AAOS

Apply for Council on Research and Quality member-at-large position

The Council on Research and Quality has an open member-at-large position, a two-year term that runs from March 18, 2019, to March 12, 2021. The council works to advance the application of scientific knowledge to improve the safety and effectiveness of musculoskeletal care. Some of the council’s responsibilities include promoting policies that are in the best interest of patients with musculoskeletal injuries and diseases, developing and disseminating evidence-based clinical practice guidelines and appropriate use criteria, promoting the development of orthopaedic clinician-scientists, and providing programming to assist orthopaedic researchers to compete for grant funding. The last day to submit an application is Aug. 3.

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