2014 December News Archive

December 1, 2014

Today’s Top Story
1. SGR reform has bipartisan support, but clock is ticking.
AMA Wire reports that support for the elimination of the Medicare Sustainable Growth Rate (SGR) formula is building in the U.S. Congress, but notes that lawmakers in the so-called “lame duck” session have a long agenda of items to address before both houses adjourn for the year. Earlier this year, Congress came close to passing the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, H.R. 4015/S. 2000, but instead passed another patch. Physicians are currently scheduled to see an estimated greater than 20 percent reduction in reimbursement under the SGR on April 1, 2015. Read more…

2. Study: What factors lead to delayed fracture fixation?
A study published in the December issue of the Journal of Orthopaedic Trauma looks at factors associated with delayed fracture fixation and transfer to level 1 trauma centers. The authors conducted a retrospective review of 1,549 skeletally mature patients (1,655 fractures) at a single, level 1 trauma center. They found that 814 patients were transferred from another center. Among acetabular fractures (n = 379), 66 percent were transfers; among pelvic ring fractures (n = 301) 62 percent were transfers. Transferred patients tended to be older, were more likely to carry commercial insurance, and were less often uninsured. However, the mean Injury Severity Score of uninsured transferred patients was lower than that of other transferred patients. Transfer was not related to weekday or time of injury. Overall, 973 patients (63 percent) underwent early definitive fixation, defined as less than 24 hours after injury. Delayed fixation was associated with surgeon preference 57 percent of the time. In addition, transferred patients were more likely to have delayed fixation.
Read the abstract…

3. Orthopaedic hospitalists strategically important to hospitals.
An article in HealthLeaders Media magazine looks at the increasing trend toward hiring of speciality hospitalists. The writer cites survey data that finds that orthopaedic hospitalists are expected to be the overall second-most strategically important specialty to hospitals and hospital systems during the next 2 to 5 years. According to a spokesperson for the Society of Hospital Medicine, the increase in the hiring of hospitalists may be due in part to the use of specific quality reporting metrics for certain conditions, along with associated penalties for failing to meet standards. The presence of specialty hospitalists, he says, may help healthcare systems improve their metrics in ways that general hospitalists can’t. Read more…

4. Pennsylvania.
The Associated Press reports that enrollment has begun in the Healthy Pennsylvania program—that state’s Medicaid expansion plan, under which about 600,000 people are expected to become newly eligible for coverage under guidelines set by the Affordable Care Act (ACA). Coverage under the program will go into effect Jan. 1, 2015. Read more…

5. Wyoming.
According to The New York Times, Wyoming has become the latest state to announce a plan to expand Medicaid under the ACA. Under the plan, those earning 100 to 138 percent of the federal poverty level would be required to pay monthly premiums, while those below the federal poverty level would not have pay premiums, but might owe small copayments for certain services. The federal government has to sign off on the plan because it deviates from regular Medicaid expansion under the ACA. Read more…

6. December AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the December issue of AAOS Now, but the online edition is already available on theAAOS Nowwebsite. This month’s issue includes an article on the 2015 Medicare Physician Fee Schedule, a wrap-up of the recent federal elections, a look at the use of shared decision making in orthopaedics, and much more! Read more…
Read “CMS Releases 2015 Fee Schedule Final Rule”…
Read “Midterm Elections Flip Senate, Shift Priorities”…
Read “Shared Decision Making in Orthopaedics”…

7. Call for volunteers: Task force to update appropriate care guidelines for athletes with spine injuries.
AAOS seeks to nominate one experienced spine surgeon to the Inter-Association Task Force on Appropriate Care of the Spine-Injured Athlete. The purpose of the task force is to develop an updated set of guidelines for handling possible spine injuries in light of recent research and newer procedures. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted to Kyle Shah by Sunday, Dec. 7, 2014 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)

8. Call for volunteers: Committee on Evidence-Based Quality and Value.
Members of the Committee on Evidence-Based Quality and Value plan, organize, direct, and evaluate evidence-based initiatives such as clinical practice guidelines and appropriate use criteria (AUCs), and oversee related educational products. The following positions are available:

Member (two openings; Dec. 15 deadline)
AUC section leader (one opening; Jan. 4. 2015 deadline)

Applicants for these positions must have an understanding of evidence-based practice principles and methodologies in either private practice or academic setting.
Learn more and submit your application…(member login required)

NOTE: AAOS is moving its headquarters offices to a new location! The move will begin Thursday, Dec. 4 at 1 p.m. CT and is scheduled to be complete by Monday, Dec. 8 at 10 a.m. CT. During this period, all AAOS websites and services will be unavailable, including Annual Meeting registration, OrthoPortal.org, OrthoInfo.org, all OrthoDoc websites, the ABOS CME transfer system, the AOSSM CME transfer system, and the AOSSM-AAOS linked disclosure system. The phone system will also be off-line, but staff will have access to email throughout the move and will endeavor to answer any queries in a timely manner. We apologize for any inconvenience.

December 3, 2014

Today’s Top Story
1. CMS unveils final rule to increase oversight of Medicare providers and remove those suspected of fraud.
The U.S. Centers for Medicare & Medicaid Services (CMS) has announced a new rule designed to strengthen oversight of Medicare providers and protect taxpayer dollars from bad actors. The agency estimates that the rules will save more than $327 million annually. Under the rules, CMS may:

Deny enrollment to providers, suppliers, and owners affiliated with any entity that has unpaid Medicare debt.
Deny or revoke the enrollment of a provider or supplier if a managing employee has been convicted of a felony offense that CMS determines to be detrimental to Medicare beneficiaries.
Revoke enrollments of providers and suppliers that demonstrate a pattern or practice of billing for services that do not meet Medicare requirements.
Make consistent the effective date of billing privileges across certain provider and supplier types.

Under a program that went into effect in August 2014, CMS may now require providers of durable medical equipment (DME) to undergo an FBI background check and/or fingerprinting in certain specific situations, including an application to become a new DME provider or to reactivate a DME application after deactivation or revocation of a license. Read more…
Read the CMS fact sheet…
Read the complete rule (PDF)…
Read more on background checks for DME providers (PDF)…

2. Study: Meniscal repair may increase patients’ risk of knee OA.
Data presented at the annual meeting of the Radiological Society of North America suggest that surgery to repair meniscal tears may increase the risk of osteoarthritis (OA) and cartilage loss in some patients. The researchers reviewed magnetic resonance imaging scans of 355 knees in which OA developed during a 5-year period, and a control group matched for age, gender, arthritic severity in both knees, and body mass index. They found that OA developed in all 31 knees that underwent meniscal surgery during the prior year, compared with 59 percent of 165 knees with meniscal damage that didn’t have surgery. In addition, 80.8 percent of knees with surgery displayed cartilage loss, compared with 39.5 percent of knees with meniscal damage and no surgery. Read more…

3. Medical error rates fall from 2010 to 2013.
According to a report from the U.S. Agency for Healthcare Research and Quality, there appears to have been a 17 percent decline in hospital-acquired conditions (HACs) from 2010 to 2013, from 145 HACs per 1,000 discharges to 121 per 1,000 discharges. The findings suggest that 1.3 million fewer HACs occurred from 2011 through 2013 than if rates had remained at the 2010 level. In addition 50,000 fewer patients died in the hospital and approximately $12 billion in health care costs are estimated to have been saved from 2010 to 2013. There was an 18 percent reduction in venous thromboembolisms over that period, a 19 percent reduction in surgical site infections, and a 20 percent reduction in pressure ulcers. Read more…
Read the complete report (PDF)…

4. CMS proposes to delay ACO penalties for 3 more years.
CMS has issued a proposed rule to update and improve policies governing the Medicare Shared Savings Program for accountable care organizations (ACOs). Among other things, the rule would delay penalties for poor performance by an additional 3 years. However, under the rule, ACOs that opt to take advantage of the longer penalty-free period could keep no more than 40 percent of the money they save Medicare, compared to the 50 percent maximum they can retain during their first 3 years. Read more…
Read the CMS press release…
Read the CMS fact sheet…
Read the proposed rule (PDF)…

5. California.
The California Supreme Court has announced that it will hear a case that challenges the constitutionality of that state’s Medical Injury Compensation Reform Act of 1975, which caps noneconomic damages in medical liability cases at $250,000. California voters in the most recent election rejected Proposition 46, which would have raised the cap to $1.1 million and indexed it to inflation. Supporters of adjusting the cap argue that it doesn’t fairly compensate injured individuals who may not be eligible for economic damages because they don’t work. Opponents respond that raising the cap would increase medical liability insurance premiums, leading to higher costs overall. Read more…(registration may be required)

6. Ohio.
The Associated Press reports that a bill under consideration in the Ohio General Assembly would, if enacted, allow physicians to acknowledge responsibility for a medical error without that conversation being used later against them in court. The bill would expand the state’s existing “I’m sorry” law, which shields apologies by physicians. Supporters say that such a law could reduce the number of medical liability suits. Opponents argue that the proposal is unethical and point to a reduction in medical liability suits over the last decade as evidence that such a law is unneeded. Read more…

7. AAOS moves to new headquarters; temporary interruption in all services expected.
AAOS is moving its headquarters offices from the current building at 6300 N. River Road, Rosemont, Ill., to its new location at 9400 W. Higgins Road, Rosemont, Ill., beginning Thursday, Dec. 4 at 1 p.m. CT. The move is scheduled to be complete by Monday, Dec. 8 at 10 a.m. CT. During this period, all AAOS websites and services will be unavailable, including Annual Meeting registration, OrthoPortal.org, OrthoInfo.org, all OrthoDoc websites, the ABOS CME transfer system, the AOSSM CME transfer system, and the AOSSM-AAOS linked disclosure system. The phone system will also be off-line, but staff will have access to email throughout the move and will endeavor to answer any queries in a timely manner. AAOS Headline News Now will not be issued on Friday, Dec. 5.

8. Call for volunteers: Panel to develop AUC for osteochondritis dissecans of the knee.
The Appropriate Use Criteria (AUC) Section seeks AAOS fellows to participate on the voting panel of the osteochondritis dissecans (OCD) of the knee AUC. Up to 50 percent of voting panel members should be experts in the topic under study; the other 50 percent should be clinicians who may refer patients with OCD of the knee, but do not necessarily treat such patients themselves. All voting panel members are required to be free of relevant conflicts of interest and must complete the AAOS conflict of interest disclosure form online before participating. Voting panel members will be required to take part in an introductory webinar aimed at familiarizing them with the AUC process and their charges as voting panel members. If interested in participating on the voting panel for this AUC topic, please contact Erica Linskey by Monday, Dec. 15, 2014, at linskey@aaos.org.

9. Last call: Workgroup for development of a clinical performance measure on OA.
The Performance Measures Committee seeks AAOS fellows to participate on a workgroup to re-evaluate the PQRS Measure #109—Osteoarthritis (OA): Function and Pain Assessment, which is now stewarded by AAOS. Final decisions regarding the project scope and design will be determined by the workgroup at the first workgroup meeting. Subject matter experts must apply no later than Dec. 5, 2014. For more information about the nominations process, please contact Jackie Ryan at 847-384-4337, or OAFPmeasure@aaos.org.
Learn more and submit your application…

December 8, 2014

Today’s Top Story
1. Increase in healthcare spending in 2013 at lowest rate since 1960.
A report from the U.S. Centers for Medicare & Medicaid Services (CMS) finds that in 2013, healthcare spending grew at 3.6 percent—the slowest rate since 1960, and a reduction from the 4.1 percent in growth seen in 2012. The report attributes the 0.5 percentage point slowdown in healthcare spending growth to slower growth in private health insurance, Medicare, and investment in medical structures and equipment spending. However, faster growth in Medicaid spending helped to partially offset the slowdown. CMS notes that recent low rates of national health spending growth coincide with modest growth in gross domestic product, which has averaged 3.9 percent per year since 2010. The share of the economy devoted to health care has remained unchanged over this period, at 17.4 percent. Read more…
Read the CMS statement…
Read the complete report…

2. Study: Longer surgical duration associated with increased likelihood of VTE.
Findings published online in the journal JAMA Surgery suggest that increased duration of surgery may be directly associated with increased risk of venous thromboembolism (VTE). The research team retrospectively reviewed data on 1,432,855 patients who underwent surgery under general anesthesia across 315 hospitals in the United States. At 30-day follow-up, they found that the overall VTE rate was 0.96 percent (n?=?13,809), while the rates of deep vein thrombosis and pulmonary embolism were 0.71 percent (n?=?10,198) and 0.33 percent (n?=?4,772), respectively. Overall, compared with a procedure of average duration, patients undergoing the longest procedures experienced a 1.27-fold increase in the likelihood of developing a VTE, while the shortest procedures demonstrated an odds ratio of 0.86.
Read the abstract…

3. Study: Factor XI-ASO may reduce likelihood of VTE in patients undergoing primary TKA.
A study published online in The New England Journal of Medicine (NEJM) suggests that reducing factor XI (FXI) levels in patients undergoing elective primary unilateral total knee arthroplasty (TKA) may help reduce risk of VTE. The researchers conducted a randomized, open-label, parallel-group study of 300 patients who received either 200 mg or 300 mg of FXI-antisense oligonucleotide (ASO), or 40 mg of enoxaparin once daily. They found that 36 of 134 patients (27 percent) who received the 200-mg dose of FXI-ASO, 3 of 71 patients (4 percent) who received the 300-mg dose of FXI-ASO, and 21 of 69 patients (30 percent) who received enoxaparin experienced major or clinically relevant nonmajor bleeding. The researchers write that the 200-mg regimen was noninferior, and the 300-mg regimen was superior, to enoxaparin. Read more…
Read the abstract…

4. Study: Topical administration of TXA may be noninferior to intravenous TXA for primary TKA.
According to data presented in the Dec. 3 issue of The Journal of Bone & Joint Surgery, topical administration of tranexamic acid (TXA) may be noninferior to intravenous TXA for primary TKA. The authors conducted a single-center, double-blind, randomized, controlled trial of 78 patients who received either topical intra-articular TXA (3 g of TXA in 100 mL of physiological saline solution; n = 39) or intravenous TXA (15 mg/kg in 100 mL of physiological saline solution, one dose before tourniquet release and another three hours after surgery; n = 39). They found that there were no transfusions in either group. In addition, drain blood loss at 24 and 48 hours was similar across both groups, and the authors noted no significant safety differences between groups.
Read the abstract…

5. AMA calls for changes to address RAC backlog.
In a letter to Marilyn B. Tavenner, administrator of CMS, the American Medical Association has called for improved efforts to resolve a 2-year backlog of appeals under the recovery audit contractor (RAC) program. AMA has asked for five strategic changes to fix the RAC program:

Contractors should be subject to financial penalties for inaccurate audit findings.
RAC audits of physicians should be performed by a physician of the same specialty or subspecialty and should be licensed in the same jurisdiction.
Physicians should be able to rebill for recouped claims for a full year following recoupment.
CMS should provide an optional appeals settlement to physicians, similar to that provided to hospitals for short-term care.
CMS should retain the current medical record request limits and allow medical record reimbursement for physicians.

“RACs are paid a sizeable commission of approximately 9.0-12.5 percent for denied claims,” the letter states. “Only if a claim is later overturned on appeal must the RAC pay back their contingency fee, providing little incentive for RACs to ensure that they limit their audits.” Read more…
Read the letter (PDF)…

6. NEJM perspective series offers suggestions to improve quality and value.
A series of perspective pieces published in the Dec. 3 issue of NEJM discuss quality measures and value of care. The first article notes that healthcare providers and payers now spend substantial resources collecting, analyzing, and reporting data on performance, yet notes that current measurement paradigms may not live up to their potential. The second article looks at efforts to link the delivery system, the community, and the patient in an integrated effort to improve quality and reduce costs. The writers argue for an approach that involves identifying so-called “positive outlier” patients and collaborating with them to develop strategies for patient care plans. The third article argues in favor of a quality measurement system guided by the principles of integrated care delivery, challenges faced by physicians, and individual patient preferences and goals.
Read “Getting More Performance from Performance Measurement”…
Read “Clinic–Community Linkages for High-Value Care”…
Read “Reimagining Quality Measurement”…

7. AAOS Rosemont has a new address!
The AAOS Rosemont office has completed its move to its new building. Contact phone numbers and email addresses remain unchanged. However, the new address is:

American Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, Illinois 60018-4976

Please update your files.

8. Last call: ACEP workgroup on acute care hospitals.
AAOS seeks to nominate one member to the American College of Emergency Physicians (ACEP) workgroup to develop recommendations for increasing the transparency of hospitals’ acute care capabilities. The goal of the project is to improve transparency of facilities’ capabilities so that the appropriate level of care can be delivered quickly, efficiently, and accurately. This will include development of an acute care classification system to:

Allow for informed patient decisions
Improve prehospital destination protocols
Ease referrals to the emergency department by primary care practitioners
Improve responses to disasters and public health emergencies

All applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in a at least one of the four areas listed above, and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted to Kyle Shah by Tuesday, Nov. 18, 2014 at 11:59 p.m. CT.
Learn more and submit your application…(member login required)
December 10, 2014

Today’s Top Story
1. Studies: 2011 ACGME resident duty hour reforms appear to have had little effect on patient safety.
A pair of studies published in the Dec. 10 issue of The Journal of the American Medical Association (JAMA) examine the effect on quality of resident duty hour limitations enacted in 2011 by the Accreditation Council for Graduate Medical Education (ACGME). The first study compared general surgery patient outcomes in both teaching and nonteaching hospitals for the 2 years before and the 2 years after the 2011 duty hour change, and found that reform was not associated with a significant change in death or serious morbidity in post-reform year 1, post-reform year 2, nor when both post-reform years were combined. The second study examined 30-day all-location mortality and 30-day all-cause readmission across 2,790,356 patients (6,384,273 admissions) in both teaching and nonteaching hospitals for the 2 years before and the 2 years after the 2011 duty hour change, and found “no significant post-reform differences in mortality accounting for teaching hospital intensity for combined medical conditions, combined surgical categories, or any of the individual medical conditions or surgical categories.”
Read “Association of the 2011 ACGME Resident Duty Hour Reform With General Surgery Patient Outcomes and With Resident Examination Performance”…
Read “Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients”…

2. Study: What are the risk factors for complications after ORIF of DRF?
A study published online in The Journal of Hand Surgery looks at risk factors for postoperative complication and mortality following open reduction internal fixation (ORIF) of distal radius fracture (DRF). The authors retrospectively reviewed information from 1,673 cases of closed DRF managed with internal fixation. At 30-day follow-up, they found that the overall incidence of any early complication was 3 percent. Major morbidity was 2.1 percent, including 4 patient deaths, and minor morbidity was 1 percent. The most common major morbidity was a return to the operating room (n = 16). The most common minor morbidity was urinary tract infection (n = 6). The authors noted that ASA class III or IV, dependent functional status, hypertension, and myocardial infarction/congestive heart failure were not significant risk factors for any early complication. Overall, there was a 10.0 percent complication rate in the inpatient group and a 1.3 percent complication rate among outpatients.
Read the abstract…

3. Study: Institution of an internal medicine MOC requirement was not linked to difference in ambulatory care–sensitive hospitalizations.
According to data published in the Dec. 10 issue of JAMA, imposition of a 10-year maintenance of certification (MOC) requirement by the American Board of Internal Medicine was not associated with a difference in the increase in ambulatory care–sensitive hospitalizations (ACSHs), but was associated with a small reduction in the growth differences of costs for some Medicare beneficiaries. The researchers compared outcomes for two groups of patients treated during 2001: one patient cohort (n = 84,215) was treated by a sample of 956 general internists initially certified in 1991 and required to fulfill an MOC program in 2001, the other (n = 69,830) was treated by a sample of 974 general internists initially certified in 1989 who were grandfathered out of the MOC requirement. They found that the annual incidence of ACSHs per 1,000 beneficiaries actually increased for both cohorts from the pre-MOC requirement period to the post-MOC requirement period. However, the researchers noted that the MOC requirement was not statistically associated with cohort differences in the growth of the annual ACSH rate, but was associated with a cohort difference in annual, per-beneficiary cost growth.
Read the abstract…

4. Study: Young physicians trained in high-spending regions likely to spend more.
Findings from a study published in the Dec. 10 issue of JAMA suggest that spending patterns for the Dartmouth Atlas Hospital Referral Region (HRR) in which a residency program is located may be associated with expenditures for subsequent care provided by former residents as practicing physicians. The research team analyzed 2011 Medicare claims data for a random, nationally representative sample of 2,851 family medicine and internal medicine physicians who had completed residency between 1992 and 2010, and found that, for physicians practicing in high-spending regions, those trained in high-spending regions had a mean spending per beneficiary per year $1,926 higher than those trained in low-spending regions. For practices in average-spending regions, mean spending was $897 higher for physicians trained in high- vs low-spending regions. For practices in low-spending regions, the difference across training HRR levels was not significant. For physicians 1 to 7 years in practice, the research team found a 29 percent difference in spending between those trained in low- and high-spending regions; however, after 16 to 19 years, they found no significant difference in spending levels across groups.
Read the abstract…

5. Should shoulder pain among throwing athletes often be treated nonsurgically?
The authors of an article published in the November issue of the journal Physical Medicine and Rehabilitation Clinics state that the pathophysiology leading to pain in the shoulder of throwing athletes is often unclear and multifactorial, and argue that treatment for many conditions should be primarily nonsurgical. “Although the pathophysiology leading to pain in the shoulder of the throwing athlete is not entirely known, nonoperative modalities remain the mainstay of treatment,” they write. “In general, surgical intervention should be reserved as a last resort. Effective treatment often requires collaboration among trainers, players, physicians, and therapists to determine an appropriate course of action.” Read more…
Read the abstract…

6. Opioid prescribing declines in short term, but many patients on potentially dangerous medication regimens.
According to a report released by pharmacy benefits manager Express Scripts, recent trends suggest that physicians may be becoming more cautious when prescribing opioids. However, nearly 60 percent of patients taking opioid pain treatments for long-term conditions were prescribed potentially dangerous mixtures of medications during the same time period. The research team analyzed both short- and long-term trends in the prescribing of opioid pain medications and found that the number of Americans who filled prescriptions for opioids declined 9.2 percent between 2009 and 2013, but both the number of prescriptions filled and the number of days of medication per prescription rose approximately 8.4 percent. Additional findings include the following:

The number of short-term opioid users declined 11.1 percent between 2009 and 2013.
Nearly one-half of patients who took opiate painkillers for more than 30 days in the first year of use continued to use them for 3 years or longer, and nearly 50 percent of those patients were taking only short-acting opioids, putting them at higher risk of addiction.
The elderly have the highest prevalence of opioid use, but younger adults (age 20-44) filled more opioid prescriptions and had the greatest increase in the number of days of medication prescribed, per prescription, of any age group over the 5-year study period.
Nearly 60 percent of patients using opioids took a combination of drugs that are dangerous and potentially fatal; almost one-third of patients were prescribed benzodiazepines along with an opioid—the most common cause of overdose deaths involving multiple drugs.

7. Last call: Bylaws Committee; Resolutions Committee.
Dec. 12 is the last day to apply for a position on the Bylaws Committee (one member opening) or the Resolutions Committee (one member opening). The Bylaws Committee makes recommendations to the fellowship on all proposed amendments to the AAOS bylaws and Standards of Professionalism. The Resolutions Committee develops concise materials and offers recommendations on proposed resolutions for distribution to AAOS fellows. Applicants for these positions must be active or emeritus fellows who are familiar with the AAOS governance structure and decision-making processes.
Learn more and submit your application…(member login required)

Note: An item in the Dec. 3 issue of AAOS Headline News Now improperly stated that meniscal repair surgery may increase the risk of knee osteoarthritis. The relevant article referred to meniscectomy, not meniscal repair. We apologize for the confusion.

December 12, 2014

Today’s Top Story
1. Study: Nonsurgical treatment of type I open fractures may be safe for pediatric patients.
Findings from a study published online in the Journal of Children’s Orthopaedics suggest that type I open fractures in pediatric patients may often be treated nonsurgically with little risk of infection. The research team conducted a retrospective chart review of 40 patients younger than 18 years who were treated nonsurgically with irrigation and debridement, followed by closed reduction and casting, for type I open fracture of the forearm or tibia. They found no reported or documented infections. There was one case of a retained foreign body and one case of delayed union. All patients eventually had complete bony union, with minimal residual angulation in both upper and lower extremities at last follow-up. Read more…
Read the complete study…

2. Study: 3-D printed scaffold may help regenerate meniscus.
According to a sheep study published in the Dec. 10 issue of the journal Science Translational Medicine, a 3-D printed scaffold may have efficacy for the regeneration of meniscal tissue. The authors used magnetic resonance imaging to scan the intact meniscus of the undamaged knee, and used that data to generate a scaffold made of polycaprolactone—a biodegradable polymer. The scaffold was then infused with connective growth factor (CTGF) and transforming growth factor β3 (TGFβ3). The authors found that sequential delivery of the two proteins induced endogenous stem progenitor cells to differentiate and synthesize zone-specific type I and type II collagens, regenerating the meniscus with zone-specific matrix phenotypes reminiscent of the native meniscus. Read more…
Read the abstract…

3. Most physicians offices have already adopted an EHR; lack of resources is issue for many others.
According to a report released by the Office of the National Coordinator for Health Information Technology (ONC), 71 percent of physicians surveyed (n = 2,399) have already adopted an electronic health record (EHR), while an additional 10 percent have plans to adopt one. Overall, 11 percent of physicians remain undecided, and 8 percent have decided against adopting an EHR. The report notes that 85 percent of adopters have an EHR certified for meaningful use. Of physicians who do not plan to adopt an EHR, four in ten plan to retire soon. Additionally:

More than half of all physicians who planned to never adopt an EHR cited a lack of financial resources as a reason for the decision.
Physicians who planned never to adopt also cited other resource-based reasons for that decision: 48 percent cited a lack of time and 40 percent cited a lack of staff.
Four in ten physicians who planned to never adopt an EHR indicated that privacy and security concerns contributed to the decision to not adopt.
Two in ten physicians reported that they would not adopt an EHR because no EHR system fit the needs of their specialty.

The researchers based their findings on data from the 2011-2013 Physician Workflow Surveys conducted by the U.S. Centers for Disease Control and Prevention. Read more…(registration may be required)
Read the report (PDF)…

4. Some FDA advisory panelists may have undisclosed financial ties.
An analysis by The Wall Street Journal suggests that some physicians and other experts who participate in U.S. Food and Drug Administration (FDA) medical device advisory panels have undisclosed financial ties to manufacturers. The paper reviewed information from corporate, state, and federal sources and found that, in panels that evaluated devices involving orthopaedics, cardiology, and gynecology between 2012 and 2014, one third of 122 members received compensation such as money, research grants, or travel and food from manufacturers, and nearly 10 percent of FDA advisers received something of value from the specific company whose product they were evaluating. Overall, FDA disclosed 1 percent of the connections. The agency states that financial interests of advisory panel members are disclosed only when agency officials have determined panel members need a waiver in order to serve, and officials voice concerns that broader disclosure could discourage people from sitting on advisory panels. Between October 2013 and June 2014, panel vacancies ranged from 13 percent to 17 percent. Read more…
In March 2014, FDA issued a guidance on the public availability of advisory committee members’ financial interest information and waivers. Read more (PDF)…

5. Millions of Americans have medical debt.
The Associated Press reports that among Americans with credit records, nearly 20 percent (42.9 million) have unpaid medical debt, and that more than half the debt on U.S. credit reports stems from medical expenses. The findings, which are detailed in a new report by the Consumer Financial Protection Bureau (CFPB), indicate that many consumers are confused by the medical bills sent out by hospitals and insurance companies about the costs of treatment and payment due dates, leading them to dispute charges. As a result, CFPB plans to require major consumer reporting agencies to provide regular updates on how they investigate and respond to disputed charges. In addition, the Fair Isaac Corp. (FICO) is reportedly updating its credit score model to put less weight on unpaid medical bills when predicting the likelihood of repayment. Read more…

6. Register to take part in the free Resident Assembly webinar!

AAOS will hold an introduction to the AAOS Resident Assembly webinar on Tuesday, Dec. 16, at 7 p.m. CT. The webinar will explain the Resident Assembly and how residents and residency programs can get involved. Participants will learn about volunteer leadership opportunities within the Resident Assembly as well as how the Resident Assembly serves as a communication vehicle for residents and residency programs. The webinar will be hosted by Young-Jo Kim, MD, chair of the Candidate, Resident, and Fellow Committee as well as the Resident Workgroup. The webinar is free, but the deadline for registration is Tuesday, Dec. 16, at 12 p.m. CT.
Learn more and register…
An article about the AAOS Resident Assembly ran in the Dec. 2014 issue of AAOS Now. Read more…

7. Free ePub edition of December AAOS Now is now available for download!
The December edition of AAOS Now magazine is now available for electronic devices capable of reading files in ePub format, including the iPhone and iPad, Android devices, and desktop computers (unfortunately, Amazon Kindle does not currently accept ePub files). To download and view the ePub version of AAOS Now, visit the link below and log in using your AAOS username and password. If you have comments or questions about the ePub version of AAOS Now, please email Peter Pollack, electronic content specialist, at ppollack@aaos.org.
Download and read AAOS Now in ePub format…(member login required)

8. Call for volunteers: Commission on Motion Lab Accreditation board of directors.
AAOS seeks to nominate two members to serve on the Commission on Motion Lab Accreditation (CMLA) board of directors. CMLA is a nonprofit organization established and operated to enhance the clinical care of persons with disorders of human movement by evaluating and accrediting clinical motion laboratories by a set of evaluative criteria. The board is comprised of professionals from several disciplines with expertise in clinical motion analysis, and includes two directors from each of four member societies: AAOS, the American Academy of Physical Medicine and Rehabilitation, the American Physical Therapy Association, and the Gait and Clinical Movement Analysis Society. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted by Feb. 15, 2015 at 11:59 p.m. CT, to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)

December 15, 2014

Today’s Top Story
1. Physicians must review 2013 Open Payments data by Dec. 31.
Physicians have until Dec. 31, 2014, to file disputes regarding their 2013 Open Payments (Sunshine Act) data. The Open Payments website made 2013 data publicly available on Sept. 30, 2014. However, corrections can be still made before the next data release. The Open Payments website is designed to reflect payments made to physicians and teaching hospitals by medical device and drug manufacturers and group purchasing organizations.
View the Open Payments website…
Learn more at the American Medical Association Open Payments web page…
Learn more at the AAOS Open Payments web page…

2. Study: Antegrade IM pinning may offer short-term clinical advantages over percutaneous retrograde IM pinning for displaced fifth metacarpal neck fractures.
Data from a study published online in the journal Clinical Orthopaedics and Related Research (CORR) suggest that antegrade intramedullary (IM) pinning may offer very short-term clinical advantages over percutaneous retrograde IM pinning for treatment of displaced fifth metacarpal neck fractures. The authors conducted a randomized, prospective study of 46 patients who had displaced fifth metacarpal neck fractures with an apex dorsal angulation greater than 30°. At 3-month follow-up, they found that patients treated with antegrade IM pinning displayed improved outcomes for all clinical parameters compared to patients treated with percutaneous retrograde IM pinning. However, they noted that there were no significant differences in outcomes between cohorts at 6 months.
Read the abstract…

3. Report projects as many as 10 million deaths linked to superbugs a year by 2050.
A report from the U.K.-based Review on Antimicrobial Resistance estimates that by 2050, 10 million deaths could potentially be attributable at least in part to antimicrobial resistance (AMR), including 317,000 deaths in North America. The projections are based on scenarios developed by two teams working independently of each other. The researchers note that countries that already have high malaria, human immunodeficiency virus, or tuberculosis rates are likely to be at increased risk as resistance to current treatments increases. In addition, the researchers were tasked with assessing the economic impact of AMR, and project a worldwide gross domestic product loss of $100.2 trillion due to AMR by 2015.
Read the report (PDF)…
In related news, Modern Healthcare reports that a bill to streamline the approval of new antibiotics was introduced near the end of the recent congressional session. The Senate bill has bipartisan support and observers expect it to be reintroduced when the new U.S. Congress convenes in January. A similar bill has been introduced in the House of Representatives. Read more…

4. Study: Shorter waits may improve patient satisfaction.
Findings from a study published online in CORR suggest that shorter time in the waiting room may be more important to patient satisfaction than amount of time spent with the patient. The researchers prospectively surveyed at visit and at 2-week follow-up 51 patients visiting a single hand and upper extremity surgery outpatient clinic. They found that time spent with the hand surgeon was not associated with patient satisfaction when measured directly after the visit, but longer wait times correlated with decreased patient satisfaction. In a multivariable model, the researchers found that factors associated with increased satisfaction directly after visiting the office and at 2-week follow-up were shorter waiting time and being married or living with a partner.
Read the abstract…

5. Use of perioperative protocol may help reduce costs and length of stay.
An article in Modern Healthcare profiles one hospital’s adoption of the ERAS Protocol—an evidence-based system that includes recommendations for patient care at various steps in the perioperative process. The system is designed to reduce lengths of stay, improve outcomes, and lower costs. A spokesperson for the Mayo Clinic Arizona campus states that implementation of the protocol for the health system’s colorectal and gynecological procedures was associated with a 1.2 day reduction in average lengths of stay for laparoscopic surgery patients and a 2.6 day reduction for open-surgery patients. In addition, costs per case fell 7 percent for laparoscopic procedures and 16 percent for open cases, with no increases in readmissions. Read more…(registration may be required)
Learn more about the ERAS Protocol…

6. Many teaching hospitals find themselves on the outside of the ACA.
According to an article in the St. Louis Post Dispatch, many teaching hospitals have been excluded from healthcare exchange insurance plans. Observers say that cost concerns are a likely reason for the exclusions, as insurers narrow their networks to reduce spending. Representatives of teaching hospitals say that the lack of access has so far had little effect on their bottom lines, but some healthcare experts note that the exclusions suggest a potential problem with the Affordable Care Act (ACA), which has increased access to affordable health insurance, but the coverage may exclude access to some of the highest quality care. Read more…

7. Massachusetts.
The Massachusetts Medical Society notes that new regulations for the Massachusetts Prescription Monitoring Program (PMP) have gone into effect. Under the new rules, PMP participants must check the PMP database and review a patient’s prescription history prior to prescribing schedule II or III narcotics or a benzodiazepine to that patient for the first time. The regulations also allow prescribers to designate delegates to access on the database on their behalf, and the Massachusetts Department of Public Health is working to determine who may serve as delegates and how delegates will be registered for the program. Read more…

8. Call for volunteers: AMA Councils.
AAOS seeks to nominate members to the following American Medical Association (AMA) Councils for 2015:

Council on Constitution and Bylaws
Council on Ethical and Judicial Affairs
Council on Legislation
Council on Long Range Planning & Development
Council on Medical Education
Council on Medical Service
Council on Science and Public Health

Applicants for these positions must be AMA members, as well as AAOS active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP Application, current curriculum vitae, a 100-word biosketch, a letter of interest highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity, and an AMA disclosure form. All supporting materials must be submitted to Kyle Shah by Dec. 22, 2014 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)
Learn more at AMA and download the AMA disclosure form…

December 17, 2014

Today’s Top Story
1. Congress adjourns, leaves SGR on the table.
The U.S. Congress has adjourned without passing a repeal of the Medicare Sustainable Growth Rate (SGR) formula. Earlier in 2014, Congress came close to passing the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, H.R. 4015/S. 2000, but instead passed another patch. Physicians are currently scheduled to see an estimated greater than 20 percent reduction in reimbursement under the current SGR formula, beginning April 1, 2015. A post on the California Medical Association website notes that although three committees across both houses of Congress agreed on reform, whether to and how to offset the legislation remained an issue. However, there remains bipartisan support for replacing the SGR with an alternative payment system.
The American Association of Orthopaedic Surgeons and other organizations are planning a virtual fly-in during February to stress the importance of passing a permanent SGR fix. Read more…

2. Some payments for CME activities may be reported to CMS Open Payments program.
The U.S. Centers for Medicare & Medicaid Services (CMS) has updated its website in an attempt to clarify when manufacturers are required to report information about payments made for continuing medical education (CME) activities. In new guidance provided by CMS on Dec. 15, starting in 2016, when an applicable manufacturer provides an indirect payment or other transfer of value to a continuing education organization for a continuing education event to physicians, and knows or finds out the identity of the physician attendees/speakers within the reporting year or by the end of the second quarter of the following reporting year, that payment must be reported to CMS in 2017. This statement appears to contradict provisions in the Open Payments Final Rule issued in October, which provided that payments for educational events need not be reported so long as they are not directed by manufacturers to specific physicians. Read more…(registration may be required)
Read more on the CMS website…

3. Vivek Murthy, MD, confirmed as Surgeon General.
CNN reports that, in a 51 to 43 vote, the U.S. Senate has confirmed Vivek Murthy, MD, as Surgeon General. Dr. Murthy’s nomination received support from a variety of medical and public health organizations, but some legislators had opposed his confirmation prior to the November elections due to his support for the Affordable Care Act, as well as comments he had made regarding gun control that were perceived by some to be controversial. At 37, Dr. Murthy is America’s youngest-ever surgeon general and the first of Indian-American descent. Read more…

4. Study: Anterior compartment intramuscular compartment pressure may help diagnose chronic exertional compartment syndrome.
Data from a study published online in The American Journal of Sports Medicine support the use of anterior compartment intramuscular compartment pressure (IMCP) as a diagnostic indicator of chronic exertional compartment syndrome (CECS). The researchers conducted a cohort study of 40 men aged 21 to 40 years, 20 of whom displayed symptoms of CECS of the anterior compartment and 20 asymptomatic controls. They continuously measured IMCP before, during, and after participants exercised on a treadmill, wearing identical footwear and carrying a 15-kg load. The researchers found that participants in the case cohort had higher IMCP immediately upon standing at rest compared with controls—a relationship that persisted throughout the exercise protocol, with the greatest difference corresponding to the period of maximal tolerable pain. The researchers write that sensitivity and specificity were consistently higher than existing criteria with improved diagnostic value.
Read the abstract…

5. Officials charge 14 in meningitis cases linked to compounding pharmacy.
The New Hampshire Union Leader reports that federal officials have arrested and charged 14 people in conjunction with a 2012 outbreak of fungal meningitis linked to New England Compounding Center (NECC). Two of those arrested face murder charges in connection with the outbreak, which affected about 700 patients and was linked to the deaths of 25 people in seven states. According to the 72-page indictment, NECC presented itself as a compounding-only pharmacy, but authorities contend that the company was actually manufacturing and distributing drugs in bulk to customers without prescriptions. As a manufacturer, it was subject to increased regulatory oversight by the U.S. Food and Drug Administration (FDA). Read more…
In related news, FDA has announced the membership of the Pharmacy Compounding Advisory Committee—a 14-member committee that will provide advice on scientific, technical and medical issues concerning drug compounding under sections 503A and 503B of the Federal Food, Drug, and Cosmetic Act. Read more…

6. Celebrity death increases scrutiny on ASCs.
An article published in Kaiser Health News looks at the issue of safety in ambulatory surgery centers (ASCs). ASCs have come under increased scrutiny since the much-publicized death of comedian Joan Rivers, who died Sept. 4 after sustaining brain damage while undergoing a routine throat procedure at an ASC in New York City. The writer states that investigating officials found numerous violations at the accredited clinic. An anesthesiologist who works at an ASC argues that patient selection and preoperative evaluation are important factors to consider when performing procedures outside of a hospital environment. As noted in the Nov. 19 issue of AAOS Headline News Now, a spokesperson from the Ambulatory Care Accreditation Program at The Joint Commission has observed that the number of adverse events reported by ASCs is “significantly below the rates reported for inpatients in the hospital setting.” Read more…

7. Last call: AMA House of Delegates.
AAOS seeks one delegate representative to join the American Medical Association (AMA) House of Delegates. Members of the AMA House of Delegates serve as an important communications, policy, and membership link between the AMA and grassroots physicians. The delegate/alternate delegate is a key source of information on activities, programs, and policies of the AMA. The delegate/alternate delegate is also a direct contact for the individual member to communicate with and contribute to the formulation of AMA policy positions, the identification of situations that might be addressed through policy implementation efforts, and the implementation of AMA policies. Applicants for this position must be AMA members as well as AAOS active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae (no longer than 20 pages) with complete contact information, a letter of interest, highlighting his or her expertise in subject area and a statement that he or she is able to participate in full capacity and a 100-word maximum biography. All supporting materials should be submitted by Dec. 21, 2014 at 11:59 p.m. CT, to Kyle Shah, clinical quality and medical affairs coordinator, at shah@aaos.org.
Learn more and submit your application…(member login required)

December 19, 2014

1. Deadlines loom for PQRS submissions.
An article in Modern Healthcare reminds physicians to review recently released data submission deadlines for the Physician Quality Reporting System (PQRS) program. Physicians who do not satisfy U.S. Centers for Medicare & Medicaid Services (CMS) reporting requirements for 2014 will see a 2 percent Medicare payment penalty during 2016. The program is also shifting its requirements from providing a bonus for participation in the PQRS to penalizing nonparticipation. In addition, CMS has announced that it plans to “significantly expand” the number of quality measures reported on the Physician Compare website, and the agency plans to post more quality measures for group practices and individual physicians in late 2015. Read more…(registration may be required)
View the CMS submission time frames (PDF)…

2. JBJS supplement examines data from orthopaedic device registries.
A supplementary issue published by The Journal of Bone & Joint Surgery (JBJS) offers data on orthopaedic registries. Authors of the included studies analyzed data from the International Consortium of Orthopedic Registries—a collaborative effort of seven national and regional registries—to examine the performance and safety of hip and knee implants. In general, the findings illustrate the importance of registries and unique device identification implementation for post-market surveillance of medical devices. The U.S. Food and Drug Administration has made the development of device registries and the creation of a universal device identifier system for medical devices key priorities. Read more…
View the supplement table of contents…

3. Study: Risk factors for cardiac complication after TKA and THA include older age, hypertension, and history of cardiac disease.
A study published in the Dec. 17 issue of JBJS looks at risk factors for cardiac complications within 30 days after primary unilateral total knee arthroplasty (TKA) and total hip arthroplasty (THA). The researchers reviewed data on 46,322 patients from the American College of Surgeons National Surgical Quality Improvement Program data set, and found that the overall cardiac complication rate per patient was 0.33 percent (n = 153) at 30-days postoperative. Across both TKA and THA cohorts, risk factors for cardiac complication included age of 80 years or older, hypertension requiring medication, and history of cardiac disease. Among patients who had a cardiac complication, 79 percent experienced it within 7 days of surgery.
Read the abstract…

4. Study: Hot flashes linked to increased likelihood of lower BMD and hip fracture.
Findings published online in The Journal of Clinical Endocrinology & Metabolism suggest that women who experience moderate or severe vasomotor symptoms (VMS; hot flashes) may be at increased risk for lower bone mineral density (BMD) and hip fracture. The authors conducted a prospective, observational study of 23,573 participants in the Women’s Health Initiative Clinical Trial and 4,867 participants of the BMD substudy. They found that, after adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate or severe VMS was 1.78, compared to no VMS. In addition, the authors found that VMS severity was inversely associated with BMD during follow-up. They noted no association between VMS and vertebral fracture. Read more…
Read the abstract…

5. Medicare to penalize 721 hospitals for HACs.
Kaiser Health News reports that 721 hospitals in the United States will see a 1 percent reduction in compensation under Medicare for the fiscal year that began Oct. 1. The ACA mandates the penalties for the 25 percent of institutions with the highest levels of avoidable hospital-acquired conditions (HACs). An analysis by the publication notes that roughly half of academic medical centers are being penalized under the initiative. Critics of the initiative argue that there may by almost no statistical difference between hospitals that are penalized and those that narrowly avoid falling into the top quartile. In addition, some observers point out that institutions that do the best job identifying HACs may end up looking worse than their counterparts who are not as diligent. Read more…

6. Study: Newly insured ACA patients may be more likely to use the ED.
According to a data published online in The American Journal of Emergency Medicine, patients insured under the Affordable Care Act (ACA) may be more likely than other insured patients to use hospital emergency departments (EDs). The research team conducted a cross-sectional analysis of adult sample respondents to the 2013 National Health Interview Survey who reported on or more ED visits in the preceding 12 months. They found that more than a quarter of ED users who had no usual source of care reported that a lack of access forced them to the ED. In addition, they found that these users did not have actual emergencies, but were using the ED as a source of primary care. Read more…
Read the abstract…

7. Vermont.
The Associated Press reports that the governor of Vermont has called off plans to institute a statewide, single-payer healthcare system. Legislation passed in 2011 called for the administration to develop a plan to implement a universal healthcare system similar to Canada’s by 2017. However, state officials estimated that the plan would require an 11.5 percent payroll tax on businesses and the levy of an additional income tax on individuals. Read more…
Read the governor’s statement on the decision (PDF)…

8. Call for volunteers: Education Enhancement Fund Governance Committee.
Dec. 31 is the last day to submit your application for a position on the Education Enhancement Fund Governance Committee (one member opening). This committee serves as the governing body of the new AAOS Education Enhancement Fund, which was established in late 2010 to raise funds to maintain, expand, and enhance AAOS education programs. Applicants for this committee must be active members, emeritus fellows, or candidate members with experience and knowledge of fund raising.
Learn more and submit your application…(member login required)

December 22, 2014

Today’s Top Story
1. Hospitals prepare for CMS mandate targeting antibiotic overuse.
Modern Healthcare reports that a growing number of hospitals are instituting antibiotic stewardship programs to improve patient outcomes, reduce costs and lengths of stay, and lower antibiotic-resistance rates. The efforts are in response to a proposal by the Centers for Medicare & Medicaid Services (CMS) that would make a stewardship program a requirement for Medicare participation, beginning in 2017. According to the Centers for Disease Control and Prevention (CDC), the core elements of a stewardship program include commitment from senior leadership, tracking and reporting of antibiotic prescribing patterns and resistance, clinician education, and the appointment of a single person to lead the effort. CDC also recommends that stewardship programs implement at least one intervention, such as prior authorization for certain restricted antibiotics, antibiotic dose optimization, or prospective audit and feedback. Currently, California is the only state that mandates that hospitals have stewardship programs. Read more…(registration may be required)

2. MedPAC may recommend keeping Medicare payments flat.
During its meeting on Thursday, Dec. 18, the Medicare Payment Advisory Commission (MedPAC) reinforced its opposition to the current sustainable growth rate (SGR) formula. Although commissioners noted that current payments seem adequate based on access indicators, disparities in compensation raise concerns about the accuracy of fee schedules. They continued to call for repeal of the SGR, noting that temporary overrides create uncertainty, administrative burdens, and barriers to broad-based reform and that the recent slowdown in spending has reduced the cost of repeal. MedPAC suggested a “per beneficiary” payment for primary care to replace the primary care bonus that expired this year. In addition, MedPAC is likely to recommend eliminating payment updates for ambulatory surgical centers, kidney dialysis, inpatient rehabilitation facilities, hospice care and long-term care hospitals in its report to Congress in March.
View the presentations…
Read the meeting transcript (PDF)…

3. Study: Bisphosphonate use may help prevent endometrial cancer.
A new study suggests that women who take bisphosphonates containing nitrogen have approximately half the risk of developing endometrial cancer as women who do not use the medication, Medical News Today reports. The study, published online in the journalCancer, involved data from 29,254 women who were followed over a nearly 20-year period. The researchers analyzed data only for patients taking bisphosphonates containing nitrogen, as these are known to have stronger anticancer activity. Because almost all of the endometrial cancer cases studied were of one particular type, the findings cannot be considered significant for patients with type 2 endometrial cancer, the authors noted. The authors also acknowledged that they were unable to include an analysis of the duration of exposure to bisphosphonates.
Read the abstract…

4. Study: Foot discomfort may discourage overweight children from exercise.
An Australian study found that overweight children who exercise may be at risk of pain and discomfort in the feet that may discourage such children from participating in physical activity. Although the researchers stated that changes to structure and function of developing feet in overweight/obese children could not be attributed to participating in the physical activity program followed by the study subjects, further research is warranted to gauge whether the increased plantar pressures and pressure-time integrals observed in the exercising children has an anatomical effect. They noted that the greater pressure and flatter arches in obese children can be an impediment to compliance with an exercise program. The study, appearing in the Journal of Science and Medicine in Sport, looked at a control group among a larger group of children participating in some type of a weight-control program, including diet modification alone. The feet in all the children—all of whom lost weight—showed growth in length and arch height, and while the researchers told Reuters they were surprised to detect no structural differences between those who exercised and those who didn’t, they noted that the measurement at 6 months may have taken place too long after the 10-week weight-loss trial ended to detect changes caused by exercise. One conclusion they made is that recommendation of non–weight-bearing exercise may be appropriate for overweight children. Read more…
Read the abstract…

5. Court denies AHA request for action on payment backlogs.
The American Hospital Association (AHA) will appeal a judge’s decision not to mandate the federal government to act to clear a massive backlog of Medicare reimbursements. The Hill reports that while the judge agreed that the lengthy processing time for appeals of payment appeals the backlog of Medicare reimbursements is “a problem in need of a fix,” it is “not so egregious” to require legal intervention. The judge declared that Congress is the appropriate body to address the problem. The AHA expressed its disapproval in a statement: “We are extremely disappointed that a court entirely insulated from the devastating effects of multi-year delays in payments for medical care as a result of bureaucratic mismanagement would find in favor of the government.” The AHA had argued that the “excrutiatingly slow” appeals process—with delays in handling claims of up to 2 years—bogged down with the introduction of private auditors (Recovery Audit Contractors) who sift through claims and are entitled to a share of payments deemed improper. The Hilldescribes the process as a “four-step administrative review laden with red tape.” Read more…

6. Massachusetts.
The Massachusetts Medical Society has praised the state Board of Registration in Medicine for its interpretation of the law governing demonstration of proficiency in electronic health records (EHRs) in a way the society says gives physicians a number of options for showing proficiency. Physicians will be deemed proficient if they meet any one of the following:

Participate in the Meaningful Use program as an Eligible Professional
Have a relationship with a hospital that has been certified as a Meaningful Use participant. Participation may be employment or credentialing by the hospital or having a contractual relationship with it.
Complete 3 hours of accredited CME program on electronic health records.
Participate or be an authorized user in the Massachusetts Health Information Highway.

There also are exemptions for certain license categories in which EHR use is intrinsic or not relevant. The new regulations will go into effect January 2, 2015, but all physicians renewing their licenses before March 31, 2015 will receive a one-time waiver from the requirements. Read more…
Read the state’s new proficiency regulation…

7. New AAOS Now podcast on risk factors for revision hip preservation surgery.
AAOS Now has released an audio interview in which Ernest L. Sink, MD, speaks with AAOS Now Electronic Content Specialist Peter Pollack about factors that may increase the risk of revision hip preservation surgery.
Listen to the current podcast (MP3)…
Read the abstract of the related article online in The American Journal of Sports Medicine…
Other podcasts are available by clicking on “podcast” in the left navigation column of the AAOS Now home page. Read more…

8. Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program website are closing before the end of the year. Act now to apply for the following positions:

AMA House of Delegates (expires Dec. 21; one delegate opening)
American Medical Association (AMA) councils (Dec. 22)
- Council on Constitution and Bylaws
- Council on Ethical and Judicial Affairs
- Council on Legislation
- Council on Long Range Planning & Development
- Council on Medical Education
- Council on Medical Service
- Council on Science and Public Health
Education Enhancement Fund Governance Committee (Dec. 31; one member)
Orthopaedic Video Theater Committee (Dec. 31; one member—hand and wrist)
Practice Management Instructional Course Committee (Dec. 31; two members)

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

Note: The AAOS offices will be closed on Dec. 24, Dec. 25, and Jan. 1. AAOS Headline News Now will not be published Dec. 24 through Jan. 1. It will return on Friday, Jan. 2, 2015.

2014 December News Archive

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