Today’s Top Story

Study: Naproxen with IA corticosteroids may be most effective treatment option for certain patients treated conservatively for knee OA

According to a study published in the May 1 issue of the Journal of the AAOS, naproxen coupled with intra-articular (IA) corticosteroids may be an effective treatment for patients treated conservatively for knee osteoarthritis (OA). The authors conducted a network meta-analysis of 53 randomized, controlled trials that included a minimum of 30 patients in each study group. For pain, they found that all active treatments were more effective than oral placebo, with IA corticosteroids having the largest magnitude of effect and significant difference only over IA placebo. For function, the authors noted that no IA treatments showed significance compared with either placebo, and naproxen was the only treatment that displayed clinical significance compared with oral placebo. They write that cumulative probabilities showed naproxen to be the most effective individual treatment, and when combined with IA corticosteroids, was the most likely to improve pain and function.

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Other News

Study: BPCI participation linked to slight increase in lumbar fusion procedure volume

A study published in the May 15 issue of the journal Spine examines trends associated with hospital participation in the Medicare Bundled Payment for Care Improvement (BPCI) program for lumbar fusion, which initiated on Jan. 1, 2013. The researchers reviewed data on 89,605 Medicare patient claims from 2012 and 2013 and found that over the study period, nonparticipating hospitals displayed a 1.6 percent decrease in fusion procedure volume, while participating hospitals displayed a 3.4 percent increase. In addition, BPCI participation was associated with increases in 90-day readmission rates and repeat surgery rates, but no reduction in 90-day episode-of-care costs. The researchers note that BPCI participant hospitals had overall greater procedure volume, bed size, and total discharges.

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Study: Later readmissions less likely to be preventable

Findings from a study published in the May 1 issue of the journal Annals of Internal Medicine suggest that, compared to early readmissions, late readmissions are less likely to be preventable and amenable to hospital-based interventions. Members of the research team conducted a prospective, cohort study of 822 adults readmitted to one of 10 academic medical centers in the United States. They determined that 36.2 percent of readmissions within seven days of discharge and 23.0 percent of readmissions between eight and 30 days of discharge were preventable. The researchers state that hospitals were identified as better locations for preventing early readmissions, while outpatient clinics and home-based interventions were more likely to prevent late readmissions.

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How might Medicare direct-provider contracting impact physicians?

An article in Modern Healthcare looks at possible ramifications of a direct-provider-contracting payment model recently proposed by the U.S. Centers for Medicare & Medicaid Services (CMS) Innovation Center. Under the proposal, CMS would directly contract with provider practices and pay a fixed per-beneficiary per-month payment to cover various services, such as office visits, certain office-based procedures, and time spent managing care for a patient, with practices eligible for incentive payments if they meet savings and quality goals. Observers say that the proposal could potentially save billions of dollars in reduced administrative costs. However, a spokesperson for the nonprofit Families USA states that some specialists could see a reduction in revenue if the agency makes participating practices responsible for a beneficiary’s total cost of care and imposes enrollment lock-ins.

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Study: Pitch counts may not accurately reflect strain on the arms of high school pitchers

Data from a study published online in the Orthopaedic Journal of Sports Medicine suggest that pitch-count monitoring of high school baseball players may not account for the substantial volume of pitching that occurs during warm-up and bullpen activity during the playing season. The authors conducted a cross-sectional study of 115 varsity high school baseball starting pitcher outings across 34 high schools during the 2017 season. They recorded 13,769 total pitches thrown, of which 42.4 percent were not accounted for in player pitch-count monitoring. The authors note that the number of bullpen pitches thrown varied widely among players, with 25 percent of participants in the data set throwing fewer than 22 pitches and 25 percent throwing more than 33 pitches per outing.

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In the States

North Carolina

According to the Raleigh News & Observer, thousands of providers may be in violation of the NC STOP Act—a recent state law that limits opioid prescriptions to five to seven days for patients who are prescribed the drugs for the first time. In a preliminary report presented to the North Carolina Medical Board, the state Department of Health and Human Services found that more than 16,000 physicians prescribed too many opioids in March alone. In addition, an analysis conducted by the state’s largest health insurer suggests that about 4,500 physicians, dentists, and other medical professionals wrote prescriptions exceeding the law’s limits between Jan. 1 and April 13, 2018.

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Your AAOS

Call for volunteers: Resident Bowl Question Workgroup

Sept. 15 is the last day to submit an application for a position on the Resident Bowl Question Workgroup (15 member openings). The Resident Bowl, which takes place during the AAOS Annual Meeting, offers residents the opportunity to compete against one another in a quiz-bowl setting. Applicants for this position must be active fellows, emeritus fellows, or candidate members skilled at writing interesting and varied questions.

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

 

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