September 27, 2017

Today’s Top Story
Latest ACA repeal measure falls short of votes needed to pass Senate.
The New York Times reports that Republican legislators in the U.S. Senate have shelved their most recent effort to repeal and replace the Affordable Care Act (ACA). Progress was halted when a number of influential senators announced their opposition to the proposal, which among other things sought to replace the federal ACA bureaucracy with block grants to the states. Senate filibuster rules required ACA repeal legislation to pass via simple majority vote under reconciliation by Sept. 30 of this year, or via a 60-vote majority with bipartisan support. Solid Democratic opposition to any repeal and replace efforts made the second pathway unlikely. A bipartisan group of senators had previously been working on legislation to stabilize ACA insurance markets and reduce premiums, and some observers now expect those talks to move forward.
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Other News

Oct. 1 is the last day to file hardship exemption under MIPS and avoid 2018 penalty.
An article in Healthcare IT News reminds Medicare providers that Oct. 1, 2017, is the deadline to file a hardship exemption under the Merit-Based Incentive Payment System (MIPS). Providers who have not filed a hardship exemption must have demonstrated meaningful use of electronic health records in 2016, or face a payment penalty during 2018.
Read more…
Learn more about Medicare quality payment programs, including MIPS…

Study: What is the optimal length for an opioid prescription following common surgical procedures?
A study published online in the journal JAMA Surgery attempts to identify optimal ranges of initial durations of opioid prescriptions among opioid-naive surgical patients. The researchers conducted a cohort study of 215,140 opioid-naïve patients who had undergone one of eight common surgical procedures, including anterior cruciate ligament repair, rotator cuff repair, or diskectomy. They observed that the median prescription lengths were 4 days for general surgery procedures, 4 days for women’s health procedures, and 6 days for musculoskeletal procedures. However, the initial prescription lengths associated with the lowest requirements for refills were 9 days for general surgery, 13 days for women’s health, and 15 days for musculoskeletal procedures. The researchers write that the data suggest an optimal length of opioid prescription of 6 to 15 days for the musculoskeletal procedures studied.
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Read the complete study…

Study: Genetic testing may help determine appropriate dose of warfarin among patients undergoing hip or knee arthroplasty.
Findings from a study published online in The Journal of the American Medical Association suggest that, compared to clinically guided dosing, genotype-guided warfarin dosing may reduce the risk of adverse events for joint arthroplasty patients. The authors conducted a multicenter, randomized, clinical trial of 1,597 patients aged 65 years or older who underwent hip or knee arthroplasty, and of whom 808 were assigned to genotype-guided warfarin dosing. They found that adverse events (major bleeding, international normalized ratio of 4 or greater, or venous thromboembolism) occurred in 87 patients (10.8 percent) in the genotype-guided group and 116 patients (14.7 percent) in the clinically guided warfarin dosing group. There were no deaths in either cohort.
Read the complete study…

Study: Long-term, physically demanding jobs linked to increased risk of hip OA and THA.
Data from a study published in the Sept. 4 issue of the journal Deutsches Ärzteblatt International suggests an association between heavy lifting or long-term physical strain and risk of hip osteoarthritis (OA). The researchers conducted a meta-analysis of five cohort studies and 18 case control studies conducted primarily in Europe. They found that regular lifting of heavy loads at work increased the risk of hip OA or total hip arthroplasty (THA) by more than 100 percent in men and by approximately 40 percent in women. In addition, physically demanding work consisting of a combination of activities such as dealing with heavy loads, heavy manual work, or prolonged walking and standing increased the risk of hip OA or THA by roughly 150 percent in men and 40 percent in women.
Read the complete study…

AHRQ releases fall reduction training program.
The U.S. Agency for Healthcare Research and Quality (AHRQ) has released a new training program to help acute care hospitals prevent patient falls. The Fall Prevention in Hospitals Training Program is an evidence-based, structured fall-prevention initiative based on quality improvement principles. Data from 10 hospitals indicated a 14 percent decrease in the average number of falls and a 20 percent decrease in falls with injury following implementation of the program.
Learn more and download the information guide…


October
AAOS Now is available online.
AAOS members will soon receive the print edition of the October issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes a discussion of Medicare fee schedule updates, a look at how prescription drugs are priced, strategies for preventing TJA infection, and much more.
Read “Unsustainable Physician Reimbursement Rates”…
Read “Pharmacy Benefit Managers Play Significant Role in Drug Pricing”…
Read “Strategies for Preventing TJA Infections”…
Read AAOS Now in the Access app…

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