2014 October News Archive

October 1, 2014

Today’s Top Story
1. Open Payments website opens to public confusion, doubts about accuracy.
As mandated by the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) unveiled the Open Payments (Sunshine Act) website on Sept. 30, amid concerns among providers about the accuracy of the information it reveals to the public. The website is supposed to reflect payments made to doctors and teaching hospitals by medical device and drug manufacturers and group purchasing organizations during the period Aug. 1–Dec. 31, 2013. Medical association leaders have contended that the window for physicians to review and dispute payment information was too short, and many physicians and other users have reported that technical snafus prevented them from identifying errors in their profiles. Although the American Association of Orthopaedic Surgeons (AAOS) supports providing patients and others with accurate and easily understandable information about a physician’s relationship with an enterprise, it joined other organizations in asking CMS to delay the public launch until spring 2015. The newly unveiled database reveals that 546,000 doctors and 1,360 teaching hospitals received 4.4 million payments totaling $3.5 billion, according to Kaiser Health News, which reports that about 40 percent of those payments do not have a specified recipient due to uncertainty about accuracy or consideration of the short time frame allowed for corrections by providers. Another 199,000 records were not published because they detailed ongoing pharmaceutical research or because physicians were still disputing their contents. That information will be updated and published as it becomes ready, according to CMS.  Read more…
Read AAOS Advocacy Now…(member login required)

Other News
2. Judge rules subsidies limited to state-established exchanges under Affordable Care Act.
As reported by The New York Times and Politico, an Oklahoma federal district judge ruled on Tuesday that the federal government cannot subsidize health insurance in 36 states that have not established their own insurance exchanges, also known as insurance marketplaces. Judge Ronald A. White of the Federal District Court in Muskogee, Okla., ruled that the Obama administration’s decision to allow subsidies in states that relied upon the federally operated exchange exceeded the bounds of statutory authority, and was thus an improper reading of the Affordable Care Act. If the ruling is upheld, financial assistance could be cut off for more than 4.5 million people who were found eligible to receive subsidized insurance in the federal exchange. A Justice Department spokesperson said the federal government plans to file an appeal. Many analysts have speculated, however, that resolution of the issue will ultimately be left to the Supreme Court.
Read in The New York Times…
Read in Politico…

3. Study: Acupuncture provides little relief for chronic knee pain.
The results of a study published in The Journal of the American Medical Association indicate that needle and laser acupuncture do not provide long-term improvement in pain or function in patients with chronic knee pain. The Australian study involved 282 patients older than age 50 with mild to severe chronic knee pain. Patients were randomized to 8 to 12 weeks of needle acupuncture, laser acupuncture, sham laser acupuncture, or no treatment. Although patients receiving either needle or laser acupuncture reported modest improvements in pain control at 12 weeks, the researchers found no significant differences between acupuncture and sham acupuncture outcomes. Additionally, at one-year follow-up, the modest benefits reported by patients in the needle and laser acupuncture groups had not been maintained.   Read more…
Read the abstract…

4. PQRS Group Registration extended to Friday; penalties loom in 2015.
CMS has extended the deadline for registering in the Physician Value–Physician Quality Reporting System (PQRS) to 11:59 pm EDT Friday, Oct. 3. Groups registering must have an approved IACS (Individuals Authorized Access to the CMS Computer Services) account and indicate select their reporting method for the 12-month period. The 2014 PQRS data submission window will be in the first quarter of 2015. Available GPRO options include a qualified PQRS registry, electronic health record, or Web interface (for groups with 25 or more eligible professionals). CMS notes that receipt of approval for an IACS account can take up to 24 hours.
Use the CMS portal and reach the QualityNet Help Desk…
With the deadline imminent, medical group representatives have expressed concern about looming penalties for groups not in compliance. Although incentives in the form of Medicare Part B bonuses for physicians who meet PQRS quality-measure reporting criteria have been dwindling each year—to the current 0.5 percent—group providers may be more worried about the prospect of penalties, an executive for the Medical Group Management Association told Modern Healthcare. For 2015, the reduction imposed on nonparticipants could be 2 percent, yet PQRS requirements for 2015 will not be known until the release of the final 2015 Medicare physician fee schedule in November, with only performance data from 2013 currently available for guidance.   Read more…(registration may be required)

5. California.
The Sacramento Business Journal reports that California Governor Jerry Brown vetoed a bill on Monday that sought to establish minimum standards for the 9,000 surgical technicians who work in the state. According to the California State Council of Service Employees International Union, which sponsored Assembly Bill 2062, some surgical technicians have completed a certification process, while others have not. The measure would have mandated that healthcare facilities employ only surgical technicians with specific training and certification, with certain exceptions. Under the bill, the current workforce would have been grandfathered in, and new graduates would have had up to a year to become certified. In his veto message, Gov. Brown called the requirement “an unnecessary barrier to employment.”   Read more…

6. October AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the October issue of AAOS Now, but the online edition is already available on theAAOS Now website. This month’s issue includes full coverage of three Clinical Practice Guidelines and one Appropriate Use Criteria document/clinical app just approved by the Academy Board, a look at the implications of the rocky debut of the Open Payments Program, a rundown of what the movement of hydrocodone products from Schedule III to Schedule II means for clinicians, and much more!   Read more…
Read “AAOS Moves Forward on Quality Initiatives”…
Read “Cloudy Start for Sunshine Act Data Review and Dispute Resolution”…
Read “DEA Reschedules Hydrocodone Combination Products”…

7. Member Registration for the 2015 Annual Meeting Opens October 8!
AAOS Member Registration for the AAOS 2015 Annual Meeting opens in just 7 days! Plan now to take advantage of your most valuable member benefit—free Advance Registration for your Academy meeting.
Review the Preliminary Program online today and register on Wednesday, October 8…

8. Call for volunteers: CME Courses Committee.
Oct. 14 is the last day to submit your application for a position on the CME Courses Committee (two member openings—trauma). Members of the CME Courses Committee write questions for the Orthopaedic In-Training Examination annually and the Orthopaedic Self-Assessment Examination triennially. Applicants for this position must be active fellows, candidate member applicants for fellowship, candidate member applicants for fellowship osteopathic, associate members osteopathic, or emeritus fellows with a practice emphasis in trauma.
Learn more and submit your application…(member login required)

October 3, 2014

Today’s Top Story
1. Study: Preoperative PT reduces demand, costs for post-acute care in TJR patients.
A study of patients undergoing total joint replacement (TJR) found that those who received preoperative physical therapy (PT) showed a 29 percent reduction in post-acute care use, resulting in an adjusted cost reduction of $1,215. Most of the savings occurred through reduced payments for skilled nursing facility and home health agency care. The study, appearing in the October 1 issue of The Journal of Bone & Joint Surgery (JBJS), reviewed 4,733 index hip or knee replacement cases from the Centers for Medicare & Medicaid Services Limited Data Set. Overall, 77 percent of the patients used post-acute care services after surgery, but just 54.2 percent who received preoperative PT, or “prehabilitation,” used such services—versus the 79.7 percent of the non-preoperative PT cohort who used post-acute care services. Cost reductions included $871 in the episode of care payment, mostly through lower payments for skilled nursing facility, home health agency, and inpatient rehabilitation. The authors, who write that their study is the first to note an association between preoperative PT and the extent of post-acute care usage, say they cannot determine from the data or the literature whether the reduction in demand for overall rehabilitation was the result of the physiologic or psychologic effects of preoperative PT.   Read more…

Other News
2. Hydrocodone combinations to move to Schedule II October 6.
Effective October 6, all drugs that contain hydrocodone will shift from Schedule III to Schedule II classification under the federal Controlled Substances Act, resulting in stricter prescription rules for hydrocodone combination drugs, such as those containing acetaminophen or aspirin. Under the Schedule II rules, patients will have to receive a new prescription for each time the medication is filled and will generally have to present a paper prescription as opposed to the phone and email orders permitted under Schedule III protocols. A transition period lasting until April 8, 2015, permits prescriptions with authorized refills remaining to be dispensed if at least one order was filled before October 6, subject to state laws. Physicians should inform patients of the new restrictions and to be prepared to write new prescriptions.    Read more…

3. Study compares cost effectiveness of fixation options for patients with intertrochanteric hip fractures.
Research published in the October 1 issue of JBJS finds that sliding hip screw fixation may be more cost effective for treating stable intertrochanteric fractures, or those with questionable stability. In contrast, it may be more cost effective to treat reverse obliquity fractures with intramedullary (IM) nail fixation. The researchers used an expected-value decision-analysis model to estimate the total costs and healthy utility based on the type of fixation (sliding hip screw or IM nail) used to treat an intertrochanteric hip fracture. The investigators evaluated the following three scenarios: a clearly stable fracture (AO type 31-A1), a clearly unstable fracture (A3), or a fracture with questionable stability (A2). They found that the sliding hip screw was more cost effective for A-1 fractures, while the IM nail was always more effective for A3 fractures. The sliding hip screw was cost effective in 70 percent of cases of A2 fractures, although this finding was highly sensitive to the failure rate.    Read more…

4. Studies: Obese trauma patients may have hypercoagulability; antihypertension medications may help protect them against organ failure.
ACS Surgery News reports on two recent studies involving obese trauma patients. The first, a prospective trial performed at the University of California at San Francisco (UCSF), suggests obese trauma patients may have clotting properties that exceed those of normal patients. Researchers took information from the “Inflammation and the Host Response to Injury” database on 377 patients with an average body mass index (BMI) of 25.8 kg/m², approximately a quarter of whom were obese (average BMI 33 kg/m²). They found that obese patients had higher admission platelet counts and factor IX, and lower D-dimer counts compared to patients of normal weight. For every 5 kg/m² increase in BMI, there was an 85 percent increase in the odds of developing a clinically significant thromboembolic complication.
The second study, performed at Washington University in St. Louis, finds that ACE inhibitors and angiotensin receptor blocker (ARB) drugs may help protect against organ failure in obese trauma patients. The study involved 1,932 patients; of the 94 patients who took the hypertension drugs and had BMI data available, 55 were obese. The researchers found that obese patients on the drugs had Marshall Multiple Organ Dysfunction and Denver-2 Postinjury Multiple Organ Failure trauma scores similar to non-obese patients either taking or not taking the drugs.  Read more…

5. Hospitals face Medicare fines over readmission rates.
Medicare is fining 2,610 hospitals across the country for higher-than-expected readmission rates from July 2010 through June 2013,Kaiser Health News reports. Hospitals that had the highest readmissions within a month will receive 3 percent lower payments for every Medicare patient stay—not just readmissions—over the next year, an increase from a maximum penalty of 2 percent last year. One reason for the higher and more widespread fines is that Medicare is tracking more conditions, including elective hip and knee replacements.
Created by the Affordable Care Act, the penalties are intended to get hospitals to improve their focus on patients’ health after discharge. However, many believe that the punishments are too harsh and administered unfairly. Bills are pending in both houses of Congress that would require Medicare to consider the socioeconomic status of a hospital’s patients when calculating fines.  Read more…

6. New Jersey.
The New Jersey Supreme Court has ruled that patients who sue a hospital for medical malpractice are not entitled to access records that are part of a hospital’s internal examination into the incident, reports NJ.com. The ruling relates to a lawsuit brought by Esther and Gedalia Applegrad, who alleged that medical professionals at Valley Hospital in Ridgewood, New Jersey, made a series of mistakes during the delivery and subsequent care of their daughter, resulting in their daughter’s brain injury and seizure disorder. The ruling, which protects a hospital’s ability to perform a confidential review when medical malpractice is filed, upholds a 2004 law aimed at encouraging medical professionals to learn from and take action to prevent future medical mistakes.  Read more…

7. Call for volunteers: Exhibits Committee.
Oct. 9 is the last day to submit your application for a position on the Exhibits Committee (five member openings). Members of the Exhibits Committee manage the Annual Meeting exhibits program, consistent with the educational needs of the Academy’s Fellows and other attendees, and evaluate the effectiveness and member and exhibitor satisfaction of the programs. Applicants for this position must be active fellows, associate members orthopaedic, associate members osteopathic, or international affiliate members.
Learn more and submit your application…(member login required)

8. Call for volunteers: Orthopaedic Learning Center Board of Directors.
Oct. 31 is the last day to submit your application for a position on the Orthopaedic Learning Center Board of Directors (one member-at-large opening). Board members provide governance for strategic planning and oversight for ongoing facility operations. Applicants for this position must be active fellows with recent experience on a board of directors.
Learn more and submit your application…(member login required)

October 6, 2014

Today’s Top Story
1. Study: MRSA appears to form biofilm-like structures in human synovial fluid.
Findings from a study published online in The Journal of Infectious Diseases suggest that methicillin-resistant Staphylococcus aureus(MRSA) may form exceptionally strong biofilm-like aggregates in human synovial fluid, to a degree that exceeds biofilm formation observed in growth media or serum. The researchers grew several strains of MRSA in human synovial fluid, blood, and typical bacterial growth medium, and found that in synovial fluid, the MRSA bacteria formed macroscopic clumps that share many of the same properties as biofilms. The researchers noted that pretreatment of synovial fluid with plasmin led to a strongly reduced formation of aggregates and increased susceptibility to antibiotics.   Read more…
Read the abstract…

Other News
2. Studies: Concussion incidence may be significantly underreported by college football players.
Data from a series of studies published online in The Journal of Neurotrauma and The Journal of Law, Medicine & Ethics suggest that many head impacts associated with potential concussion are not reported by college football players. The authors surveyed 730 Division I football players on 10 teams during the 2012 season and in the first study, found that for every diagnosed concussion, players sustained six substantial hits that they suspected might have caused a concussion but did not report. In the second study, the authors noted that that colleges did an inconsistent job of giving players information about why and how to report a concussion, with about 40 percent of athletes not recalling having received information about concussions and the responsibility to report concussion symptoms. The third study found that freshmen were more likely than senior players to believe that their coaches would believe they did the right thing by reporting a concussion.   Read more…
Read the abstract of the first study…
Read the abstract of the second study…
Read the abstract of the third study…

3. FDA seeks permanent injunction against Pharmaceutical Innovations, Inc.
The U.S. Food and Drug Administration (FDA) has announced that it is seeking a permanent injunction to stop Pharmaceutical Innovations Inc., and its principal officer, Gilbert Buchalter, from manufacturing, marketing, selling, and distributing medical products until they come into compliance with all applicable FDA requirements. The company distributes ultrasound, mammography, and electrocardiogram gels and scanning pads. The FDA complaint alleges that the defendants did not manufacture their devices in conformity with the current good manufacturing practice requirements of the Federal Food, Drug, and Cosmetic Act, and that they distributed products nationwide without required premarket approval or clearance.   Read more…

4. Physician survey notes shift in demographics; many describe themselves as “overextended.”
A survey of physicians commissioned by The Physicians Foundation finds that 81 percent of physicians describe themselves as either “overextended” or “at full capacity,” while only 19 percent indicate they have time to see more patients. The research team surveyed 20,000 physicians between March 2014 and June 2014, and found that 44 percent of respondents have considered plans that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients, or seeking nonclinical jobs. The research team also notes that, in 2014, only 17 percent of physicians indicated that they are in solo practice—a reduction from 25 percent in 2012—and only 35 percent of physicians describe themselves as independent practice owners, down from 49 percent in 2012 and 62 percent in 2008.   Read more…
Read the complete survey (PDF)…

5. Survey: Many teaching hospitals’ conflict of interest policies fall short of ideals.
According to a according to a scorecard released by the American Medical Student Association, most teaching hospitals fall short of having acceptable conflict of interest policies. The researchers examined 204 teaching hospitals, with 35 receiving As (17 percent), 111 receiving Bs (54 percent), 31 receiving Cs (15 percent), and 27 being graded “incomplete” (13 percent). The scorecard finds that found that most of the hospitals studied had policies in place for internal disclosure of potential conflicts of interest, but no policies for disclosure to the public. Only 19 teaching hospitals met so-called “model” criteria for disclosing potential conflicts of interest both internally and externally.   Read more…
View the scorecard…

6. Are physicians, debt collectors, and patients on the same page?
An article in HealthLeaders Media looks at the issue of medical debt collection and argues that the practice is becoming more important for physician practices as some insurance plans shift more costs to the patient. The writer argues that practices should review their policies on payment and collection as well as their procedures for appealing denied reimbursement claims, and cites information from a stakeholder task force that noted a lack of clear communication to patients about payment and debt collection policies. “The debt collection folks don’t know what the physician practice is telling people, and the physician practice doesn’t know what the debt collectors are telling people,” a spokesperson for the Healthcare Financial Management Association is quoted as saying. “The patient is caught in the middle because they’re going with whatever they were told, when they might be held accountable for a different set of expectations.”   Read more…

7. Massachusetts.
A story from New England Public Radio profiles efforts by two hospital systems in Massachusetts to improve the apology process after possible medical errors. Under the CARe (communication, apology, and resolution) program, administrators review cases where the care did not go as planned and determine if they warrant an apology and resolution. Many patient safety advocates argue that the best way to reduce medical errors is for hospitals to openly acknowledge mistakes and learn from them, but the threat of medical liability suits often pressures providers and institutions to engage in a practice sometimes called “deny and defend.”   Read more…

8. Call for volunteers: NQF Performance Measurement for Rural Small-Practice and Low-Volume Providers Committee.
AAOS seeks to nominate members to the National Quality Forum (NQF) Performance Measurement for Rural Small-Practice and Low-Volume Providers Committee. The committee will provide recommendations to the U.S. Department of Health and Human Services regarding performance measurement issues for rural, low-volume providers, including critical access hospitals, rural health clinics, community health centers, and the clinicians who serve in such facilities. 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 with experience in rural health performance measurement, program implementation, quality measurement, and statistical methodology. 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 Sunday, Oct. 19, 2014 at 11:59 p.m. CT, to Kyle Shah at shah@aaos.org.
Learn more and submit your application…(member login required)

October 8, 2014

Today’s Top Story
1. CMS extends meaningful use hardship exception application deadline.
The U.S. Centers for Medicare & Medicaid Services (CMS) intends to reopen the submission period for hardship exception applications for eligible providers who may not be able to demonstrate meaningful use of Certified Electronic Health Record Technology due to significant hardship. To be considered for an exception, an eligible professional or eligible hospital must complete a hardship exception application and provide proof of the hardship. If approved, the hardship exception is valid for 1 payment year only. The new deadline for hardship exception applications is Nov. 30, 2014.   Read more…
View the CMS guidance document on hardship exceptions (PDF)…

Other News
2. Study: rhBMP-2 linked to higher rates of union, increased risk of wound drainage for extremity surgery patients.
Findings from a study published in the October issue of the Journal of Orthopaedic Trauma suggest that use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in acute traumatic and posttraumatic reconstructive extremity surgery may increase risk of prolonged postoperative serous wound drainage. The authors conducted a retrospective study of 193 patients whose treatment included rhBMP-2 (155 reconstructive and 38 acute open fractures) and a matched cohort of 181 patients treated without the use of rhBMP-2 (145 reconstructive and 36 acute open fractures). They found that overall, 31 percent of patients in the rhBMP-2 group and 18 percent in the control group had documented wound complications. However, they also noted that rates of union for acute trauma cases were 94 percent in the rhBMP-2 group and 74 percent in the control group. In addition, rates of union for reconstructive cases were 89 percent in the rhBMP-2 cohort and 73 percent in the control cohort.
Read the abstract…

3. Open Payments site lacks more than $1 billion in payments from late 2013.
ProPublica reports that the federal Open Payments (Sunshine Act) database does not include more than $1 billion in payments made between August and December 2013—nearly a quarter of the money drug and device makers dispensed in the last 5 months of 2013. CMS is not publishing any details on 9,000 payments that had been disputed by providers, because those disputes are pending resolution. The agency is also withholding data on 190,000 research payments related to drugs and devices that are not yet on the market, as mandated by law. The Open Payments site has been criticized for lack of data and difficulty of use.   Read more…

4. FDA: Sagent Pharmaceuticals recalls three lots of Ketorolac Tromethamine Injection.
The U.S. Food and Drug Administration (FDA) has announced that Sagent Pharmaceuticals, Inc., is implementing a voluntary nationwide recall of three lots of Ketorolac Tromethamine Injection, USP, 30mg/mL single-dose vials (NDC numbers 25021-701-01 and 25021-701-02) manufactured by Cadila Healthcare Limited and distributed by Sagent. The company states that the product has been labeled with an incorrect expiration date. The labeled expiration date is longer than the known stability of the product. The recalled lot numbers—MP5021, MP5024 and MP5025—were distributed to hospitals, wholesalers and distributors nationwide from Sept. 17, 2014 through Oct. 1, 2014. Ketorolac Tromethamine Injection, USP, 30mg/mL is an NSAID indicated for short-term management of moderately severe acute pain that requires analgesia at the opioid level, usually in a postoperative setting, and is supplied in a single-dose vial.   Read more…

5. FDA commissioner says agency is working to speed up device review process.
According to The Boston Globe, FDA is working to speed up the approval process for medical devices and diagnostics. The commissioner of FDA stated that the agency is considering an expedited approval process for devices to treat life-threatening or irreversibly debilitating diseases and for which other options are not available. However, she acknowledged that the agency has fewer programs to fast-track experimental medical equipment and diagnostics than it does for experimental drugs. Industry representatives have pointed out that devices may be approved as much as 3 years earlier in Europe than in the United States.   Read more…
Read the FDA draft guidance from April 2014 (PDF)…

6. Massachusetts.
WBUR reports that private insurers in Massachusetts have made publicly available pricing information for a variety of medical procedures. The writer notes that posted pricing often varies widely between insurers, because it is based on negotiated fees and is defined as each insurer sees fit. In addition, the costs of many inpatient procedures are not listed. The postings are the result of a 2012 state law that requires health insurers and hospitals to make such information available.   Read more…

7. Registration opens for the 2015 AAOS Annual Meeting!
Register now for the 2015 AAOS Annual Meeting in Las Vegas, March 24-28, 2015. Take advantage of your most valuable member benefit and the opportunity to earn up to 35 AMA PRA Category 1 CME Credits™. Registration and housing will open to non-members on Oct. 15.   Read more…(member login required)

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

• CME Courses Committee (one member opening—trauma; closes Oct. 14)
• Exhibits Committee (five members; Oct. 9)

Please visit the Committee Appointment Program website regularly to view new openings and find one that interests you.
Learn more and submit your application…(registration may be required)

October 10

Today’s Top Story
1. Study: Majority of pediatric fractures may be improperly splinted at EDs and urgent care facilities.
According to data to be presented at the annual meeting of the American Academy of Pediatrics, up to 93 percent of potential pediatric fractures may be splinted improperly at emergency facilities. The researchers reviewed case data on 275 pediatric patients who presented at emergency departments (EDs) or urgent care centers in Maryland and who were later evaluated by University of Maryland pediatric orthopaedic specialists. They found that in 77 percent of cases elastic bandages were placed directly on the skin, in 59 percent of cases joints were not immobilized correctly, and in 52 percent, the splint was not the appropriate length. The researchers observed skin and soft-tissue complications in 40 percent of patients.   Read more…

Other News
2. FDA announces recall of one lot of Hospira Vancomycin Hydrochloride for Injection.
The U.S. Food and Drug Administration (FDA) reports that Hospira, Inc. has issued a voluntary nationwide user-level recall of one lot of Vancomycin Hydrochloride for Injection, USP, Equivalent to 1 g Vancomycin (Sterile Powder), NDC 0409-6533-01, Lot 35-315-DD with expiration date of 01 NOV 2015. The product may have experienced temperature variations during shipment. Anyone with an existing inventory of the recalled lot should stop use and distribution, quarantine the product immediately, and notify any accounts or additional locations that may have received the recalled product and advise them of the recall.   Read more…

3. Study: Contact sport athletes more likely to be colonized with MRSA.
Findings presented at the annual meeting of the Infectious Diseases Society of America suggest that college athletes who play contact sports may be more likely than the general population to be colonized with methicillin-resistant Staphylocuccus aureus (MRSA). The research team conducted a 2-year study of 377 male and female Vanderbilt University varsity athletes playing 14 different sports, 224 who played contact sports such as football, soccer, basketball, and lacrosse, and 153 who played noncontact sports such as baseball, cross country, and golf. They found that contact-sport athletes were more than twice as likely as noncontact athletes to be colonized with MRSA. Over the course of the study, MRSA colonization ranged from 8 percent to 31 percent among contact sports athletes, and 0 percent to 23 percent among noncontact athletes. About 5 percent to 10 percent of the general population is estimated to be colonized with MRSA.   Read more…

4. Are EHRs reliable enough to be admitted into evidence in legal proceedings?
An analysis published in the summer issue of Ave Maria Law Review argues that electronic health records (EHR) systems may not necessarily reflect care actually provided to patients, and should therefore be verified for reliability and authenticity before being admitted into evidence in legal proceedings. “Currently there are no regulatory health information technology requirements or Federal [health information technology] program qualifications for these systems that assure, or reference, their fitness as business or clinical records,” the authors write. While some regulatory reference exists to supportive functions, such as ‘audit trails,’ at this writing, their use is not required in deployed systems, meaning that evidentiary non-reliability will persist as a challenge to e-Discovery and to all business record-supported or dependent processes in the healthcare industry for a long time.”   Read more…(registration may be required)
Read the complete analysis (PDF)…

5. Study: PRP injection may improve outcome after hamstring injury.
According to a study published in the October issue of The American Journal of Sports Medicine, single injection of autologous platelet-rich plasma (PRP) injection may improve outcomes for athletes with hamstring injuries who are being treated with a rehabilitation program. The authors conducted a randomized, controlled trial of 28 patients diagnosed with acute hamstring injury who were treated with rehabilitation only or autologous PRP therapy combined with a rehabilitation program. They found that the mean time to return to play was 42.5 days in the control group and 26.7 days in the PRP group. In addition, the authors noted significantly lower pain severity scores in the PRP group throughout the study. However, they found no significant difference in pain interference score between the two groups.   Read more…
Read the abstract…

6. Study: Allergic reaction to orthopaedic implant may slightly increase risk of rare cancer.
Findings from a mouse study and a case study published online in The Journal of Clinical Investigation suggest that patients who develop persistent skin rashes after metal devices are implanted near the skin may be at increased risk of a rare and aggressive form of skin cancer. The researchers note that allergic contact dermatitis (ACD) is a well-recognized adverse event associated with implantable medical devices containing allergenic materials like nickel. They used a standard murine model of contact hypersensitivity to determine whether chronic ACD promotes skin carcinogenesis in mice and found that chronic application of 1-fluoro-2,4-dinitrobenzene (DNFB) to carcinogen-treated skin was associated with the development of papillomas and aggressive squamous cell carcinoma (SCC). Further, DNFB-driven chronic ACD was marked by type 2 inflammation in the mice. The researchers noted similar tumor-promoting inflammation in a patient diagnosed with Marjolin’s ulcer—an invasive SCC that developed in response to chronic ACD linked to an orthopaedic implant.   Read more…
Read the complete study…

7. Report argues for increased research into and awareness of fragility fractures in men.
A report released by the International Osteoporosis Foundation argues for increased attention of osteoporosis in men. The writers note that hip fractures in men are associated with greater mortality compared with women, with rates as high as 37 percent in the first year following fracture. In addition, many other non-hip fragility fractures in men are associated with increased mortality. The organization argues that measures must be taken to encourage and support efforts to increase awareness of osteoporosis risk among men. In addition, they suggest:

• Working to improve knowledge within the healthcare community so at-risk men can be identified and treated
• Development and dissemination of osteoporosis management guidelines targeted to men
• Further research into osteoporosis in men
• Reimbursement for osteoporosis testing and treatment in men at risk
• Implement of care systems to prevent secondary fragility fractures so that men who have suffered a fracture are identified and treated in a timely manner

Read more…
Read the report (PDF)…

8. Call for volunteers: Program Committees.
Nov. 10 is the last day to submit your application for a position on a Program Committee. The following openings are available:

• Foot & Ankle Program Committee (two members)
• Musculoskeletal Tumor & Metabolic Disease Program Committee (one member)
• Trauma Program Committee (two members)

Members of Program Committees grade symposia in May and abstracts in June and July, and may serve as moderators for paper sessions and critical evaluator of courses at the AAOS Annual Meeting. Applicants for these positions must be active fellows or international affiliate members with a practice emphasis in the relevant area.
Learn more and submit your application…(member login required)

October 13, 2014

Today’s Top Story
1. Study: Autograft linked to improved outcomes for revision ACL surgery at 2 years.
Data from a study published in the October issue of The American Journal of Sports Medicine suggest that use of autograft for anterior cruciate ligament (ACL) reconstruction may be associated with improved outcomes compared to allograft. The authors conducted a prospective cohort study of 1,205 patients who underwent revision ACL reconstruction at one of 52 sites. Overall, 583 patients (48 percent) received autografts, 590 (49 percent) received allografts, and 32 (3 percent) received both. At 2-year follow-up, the authors found that use of an autograft for revision reconstruction predicted improved scores on the IKDC knee form, the KOOS sports and recreation subscale, and the KOOS quality of life subscale. In addition, at 2 years, graft rerupture was reported in 37 of 1,112 patients: 24 allografts, 12 autografts, and 1 allograft and autograft.
Read the abstract…

Other News
2. Study: Inextensible LSO may reduce lower back pain more than extensible LSO or standard care.
According to a study published in the Oct. 1 issue of the journal Spine, use of an inextensible lumbosacral orthosis (iLSO) may offer a greater reduction in lower back pain compared to an extensible LSO (eLSO). The researchers conducted a single-blind, randomized trial of 98 patients with lower back pain who received either standard care (SC), including medication and physical therapy (n = 29); SC with eLSO (n = 32); or SC with iLSO (n = 37). Compared against the SC only group, patients in the iLSO cohort displayed greater improvement in Oswestry Disability Index score. However, the same did not hold true for patients in the eLSO group. In addition, both eLSO and iLSO groups displayed greater improvement over the SC group in Patient Specific Activity Scale scores, but the change did not meet the minimal clinically important difference.
Read the abstract…

3. Study: Many patients with hip pain may receive unnecessary MRIs.
Findings from a study published in the October issue of The Journal of Arthroplasty suggest that many patients referred to orthopaedists for hip pain due to arthritis may receive unnecessary magnetic resonance imaging (MRI) scans. The research team prospectively evaluated all patients referred to a single institution over a 36-month period and found that 15.4 percent had unnecessary MRIs. Extrapolated to the entire United States, the findings suggest a potential cost to the health system of $330 million to $440.5 million over the next 10 years.   Read more…

4. Oregon Compounding Centers recalls unexpired sterile products in Oregon and Washington.
The U.S. Food and Drug Administration reports that Oregon Compounding Centers, Inc., has issued a voluntary recall of certain unexpired human and veterinary sterile products due to lack of sterility assurance. All recalled products have a label that includes the Creative Compounds name as well as a lot number. The recalled products were made from July 1, 2014, through Sept. 22, 2014, and distributed to healthcare facilities, physicians, and patients in Oregon and Washington. The recall does not pertain to any non-sterile compounded medications prepared by the pharmacy.   Read more…

5. Letter: Antimicrobial stewardship program did not retain benefits after audits stopped.
A research letter published in the Oct. 10 issue of The Journal of the American Medical Association suggests that, following the removal of audit and feedback, initial benefits gained from an antimicrobial stewardship program may not be retained. In the original study, the authors found that implementation of an antimicrobial stewardship program across 18 pediatric practices was associated with a reduction in broad-spectrum antibiotic prescribing, from 26.8 percent to 14.3 percent. However, the follow-up research letter notes that when the audit and feedback program was discontinued, broad-spectrum antibiotic prescribing increased above the initial baseline, from 16.7 percent at the end of intervention to 27.9 percent at the end of observation, 18 months later.
Read the abstract…

6. Study: Resident duty hour limits may not negatively affect patient mortality or length of stay.
Data from a study published in the October issue of the journal Health Affairs suggest that resident duty hour reforms may not adversely affect hospital mortality and length of stay. The researchers drew data from a database of all hospitalizations in Florida from 2000 to 2009, and found no evidence that a cap of resident duty hours implemented in 2003 negatively affected hospital mortality and length of stay of patients cared for by new attending physicians who were partly or fully exposed to reduced duty hours during their own residency. However, the researchers write that assessment of the impact of the duty-hour reforms on other clinical outcomes is needed.   Read more…
Read the abstract…

7. CMS officials discuss Medicare appeals settlement offer.
An article in HealthLeaders Media summarizes information from a recent conference call with officials from the U.S. Centers for Medicare & Medicaid Services (CMS) regarding a settlement offer for Medicare appeals, in which CMS has offered to pay 68 cents on the dollar as part of an effort to reduce an appeals backlog. On Aug. 29, CMS announced that it would offer partial payments of 68 percent of denied inpatient claims, provided hospitals agreed to dismiss all associated claim appeals and accept the settlement as final administrative and legal resolution of the eligible claims.   Read more…
View the slides from the conference call (PDF)…
Learn more about the appeals process…

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

• Council on Legislation
• AMA Political Action Committee
• Council on Constitution and Bylaws
• Council on Medical Education
• Council on Medical Service
• Council on Science and Public Health
• Council on Long Range Planning and Development
• Council on Ethical and Judicial Affairs

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…

October 15, 2014

Today’s Top Story
1. National survey of medical liability rates finds costs dropping overall.
According to information from an annual rate survey conducted by Medical Liability Monitor, medical liability insurance premiums dropped by an average of 1.6 percent nationally over the past year. Since 2006, rate declines have significantly outnumbered and generally been more severe than rate increases. Additionally, the survey finds that 65 percent of all manual rates remained the same as the previous year. Regionally, the Northeast saw an average increase in rates of 0.1 percent, while Western states saw a 4.1 percent average rate decrease, and both the Midwest and South saw an average 0.7-percent drop.   Read more…

Other News
2. Study: Higher CCI, older age linked to increased risk of readmission after orthopaedic trauma surgery.
A study published in the October issue of the Journal of Orthopaedic Trauma assesses factors associated with increased likelihood of readmission after surgery for orthopaedic trauma. The researchers conducted a retrospective study of 3,452 procedures performed for skeletal trauma between 2008 and 2012 at a single center. They found a significant association between 30-day readmission and higher Charlson Comorbidity Index (CCI), older age, and widowed marital status. The researchers write that the best multivariable models predicted very little of the variability seen in readmissions, which they write “reflects the complexity of readmission and the difficulty of reducing the risk to a few specific factors.”
Read the abstract…

3. Study: High pitch counts in young pitchers may be linked to chronic pathology.
Data from a study published online in the journal Radiology suggest that some young baseball pitchers may be at increased risk of permanent shoulder injury. The authors conducted a retrospective report review of 2,372 consecutive patients, 15 to 25 years of age, who underwent magnetic resonance imaging (MRI) for shoulder pain. In 2.6 percent (n = 61) of patients they found acromial edema that was associated with superior shoulder tenderness and incomplete fusion. A pitch count of more than 100 pitches per week was shown to be a risk factor for acromial apophysiolysis, and follow-up imaging demonstrated that acromial apophysiolysis was significantly associated with the development of an os acromiale and rotator cuff tears after age 25 years.   Read more…
Read the abstract…

4. Study: Disadvantaged populations less likely to receive autologous blood transfusion for elective orthopaedic surgery.
According to a study published in the November issue of the journal Clinical Orthopaedics and Related Research, members of historically disadvantaged populations are less likely than others to receive autologous blood transfusions for elective orthopaedic surgery. The researchers reviewed data on more than 3,500,000 patients from the Nationwide Inpatient Sample between 2008 and 2011 and found that 2.4 percent received autologous blood transfusions, while 12 percent received allogeneic blood transfusions. Compared against white patients, Hispanic patients had lower odds of autologous blood use for elective hip and knee arthroplasties, and black patients had lower odds of receiving autologous blood transfusion for hip arthroplasty. Even at comparable income and insurance levels, Hispanic and black patients tended to be less likely than white patients to receive autologous blood transfusion.
Read the abstract…

5. Policy brief suggests ACA-driven ED usage may be temporary.
Data from a policy brief released by the UCLA Center for Health Policy Research suggest that Affordable Care Act (ACA)-driven cost and utilization increases among newly eligible Medicaid beneficiaries may be largely temporary. The research team reviewed 2 years of claims data on 182,000 low-income, uninsured people enrolled in state-run health insurance programs in California. They found that those who had previously had the least medical care used hospital emergency departments (EDs) at a high rate of 600 visits per 1,000 people. However, during the first quarter of the study period, usage declined 29 percent, to 424 visits per 1,000 people, followed by an additional 25 percent decline the following quarter. Between 2011 and 2013, the overall decline was 69.5 percent. The report additionally notes that hospital admissions among this population declined 78.5 percent over the term of the study, from 194 to 42 per 1,000 people.   Read more…
Read the complete policy brief (PDF)…

6. Study: Current models for predicting outcomes after mTBI may be unsatisfactory.
Findings from a study published online in the Journal of Neurotrauma suggest that existing prognostic models of mild traumatic brain injury (mTBI) may perform unsatisfactorily. The authors reviewed data on 386 participants with mTBI from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury pilot study and found that 75 percent presented with a Glasgow Coma Score (GCS) of 15. Among that population, previously developed prognostic models were poor predictors of outcomes. In multivariable analyses, the authors found that the strongest predictors of lower 3- and 6-month Glasgow Outcome Scale Extended (GOS-E) scores were older age, pre-existing psychiatric conditions, and lower education. In addition, injury caused by assault, extracranial injuries, and lower GCS were also predictive of lower GOS-E.   Read more…
Read the complete study (PDF)…

7. What factors lead to overtreatment, and what can be done?
An article published online in The BMJ looks at factors that lead toward overtesting and overtreatment. The authors note that the practice of defensive medicine is generally considered by physicians to be a leading cause of medical excess—in a randomized survey of physicians practicing in six high-risk specialties, more than 90 percent acknowledged engaging in defensive medicine. “We must try to change both the incentives that currently reward overtesting and overtreatment and the disincentives of public shaming and potential lawsuits whenever a diagnosis is ‘missed’ or a possible treatment withheld,” the writers state. They suggest that efforts such as the Choosing Wisely campaign, in which more than 60 specialty societies have identified a list of low-value tests, treatments, or services; and greater involvement of patients in the decision-making process are steps in the right direction.   Read more…

8. Call for volunteers: Evaluation Committees.
Dec. 15 is the last day to submit your application for an opening on an Evaluation Committee. Members of Evaluation Committees write questions for orthopaedic self-assessment examinations. The following positions are available:

• Anatomy-Imaging (chair; two members—hand and wrist; two members—tumors)
• Hand & Wrist (chair, nine members)

Applicants for chair openings must be active fellows. Applicants for member openings must be active fellows, candidate members, candidate member applicants for fellowship, or emeritus fellows with a practice emphasis in the relevant topic.
Learn more and submit your application…(member login required)

October 17, 2014

Today’s Top Story
1. U.K. studies look at outcome data for TKA, UKA.
A pair of studies published in the Oct. 18 issue of The Lancet use large data cohorts from the United Kingdom to examine outcome data (mortality) for knee arthroplasty procedures. In the first study, researchers drew data on 467,779 knee arthroplasties for osteoarthritis from the National Joint Registry for England and Wales (NJR), and found that 1,183 patients overall died within 45 days of surgery, with a substantial secular decrease in mortality from 0.37 percent in 2003 to 0.20 percent in 2011. Overall, use of unicompartmental knee arthroplasty (UKA) was associated with lower mortality than was total knee arthroplasty (TKA). The researchers noted that myocardial infarction, cerebrovascular disease, moderate/severe liver disease, and renal disease were associated with increased likelihood of mortality, while factors such as surgical approach and thromboprophylaxis were not.
In the second study, researchers drew data on 25,334 UKA patients who were matched to 75,996 TKA patients from the NJR. At 8 years, they found that UKA was associated with worse implant survival for revision, compared to TKA, but mortality was significantly higher for TKA patients at all time points. In addition, length of stay, complications, and rate of readmission were all higher for TKA compared to UKA.
Read the abstract of the first study…
Read the abstract of the second study…
Read the accompanying editorial…

Other News
2. Study: FAI disease pattern may be sex-dependent.
Data from a study published in the Oct. 15 issue of The Journal of Bone & Joint Surgery suggest a sex-dependent disease pattern among patients with symptomatic femoroacetabular impingement (FAI). The authors compared cohorts of 50 consecutive male and 50 consecutive female patients who underwent surgery for symptomatic FAI. Based on four scoring systems, they found that female patients had significantly greater disability than males at presentation. However, female patients displayed greater hip motion and less severe cam-type morphologies, while males were significantly more likely to have advanced acetabular cartilage lesions and larger labral tears with more posterior extension of these abnormalities. In addition, males were more likely than females to have mixed-type FAI and thus a component of pincer-type FAI.
Read the abstract…

3. Study: Two-stage approach to THA infection offers effective infection control.
A study published in the October issue of The Bone & Joint Journal looks at outcomes of a two-stage approach for infected total hip arthroplasty (THA). The research team conducted a prospective study of 125 patients who underwent THA by a single surgeon at a tertiary care center in the United Kingdom. At 5-year follow-up, they found that the rate of control of infection was 96 percent. Overall, 19 patients died during the study period, representing a 1-year mortality of 0.8 percent and an overall mortality of 15.2 percent at 5 years. The research team reports “excellent control of infection in a series of complex patients and infections using a two-stage revision protocol supported by a multidisciplinary approach,” however, they point out a “high rate of mortality” in the patient cohort that remains unexplained.
Read the abstract…

4. Study: Associated USF may not affect long-term outcomes for patients with DRF.
Findings published in the October issue of the Journal of Hand Surgery suggest that the presence of an ulnar styloid fracture (USF) may not negatively affect long-term outcomes for adult patients with distal radius fracture (DRF). The authors conducted a prospective study of 312 patients aged 18 to 64 years with surgically and nonsurgically treated DRF. They found that patients with an associated USF had a slower recovery of wrist flexion and grip strength compared to isolated DRF, but at 12-month follow-up, pain and disability values were comparable between cohorts. The authors additionally noted that united USFs and nonunited USFs had similar Patient-Rated Wrist Evaluation scores at 3, 6, and 12 months.
Read the abstract…

5. CDC, AMA offer Ebola resources for providers and public.
The U.S. Centers for Disease Control and Prevention (CDC) has established a web page with information about the Ebola outbreak. In addition, the American Medical Association (AMA) has set up an Ebola resource center. Both sites are updated with relevant information as it becomes available.
View the CDC page…
View the AMA page…

6. Does altering the medical liability standard affect cost or imaging rates?
A study published in the Oct. 16 issue of The New England Journal of Medicine finds that legislation that substantially changed the medical liability standard for emergency physicians in three states had little effect on imaging rates, average charges, or hospital admission rates. The research team identified all emergency department (ED) visits from a 5 percent sample of Medicare fee-for-service beneficiaries in Texas, Georgia, and South Carolina and six neighboring states. During the study period (1997 to 2011), the three relevant states enacted legislation to change the medical liability standard for emergency care to gross negligence. The research team detected no policy-attributable reduction in the rates of computed tomography or magnetic resonance imaging utilization or hospital admission in any of the three reform states, and no reduction in charges in Texas or South Carolina. However, they noted that in Georgia, reform was associated with a 3.6 percent reduction in per-visit ED charges.
Read the complete study…

7. Florida.
According to AMA Wire, a federal appeals court has upheld a Florida law requiring plaintiffs to release their relevant protected health information before proceeding with allegations of medical liability. The law requires a person seeking to bring a medical liability lawsuit to authorize the release of health information so that the prospective defendant may obtain documents and obtain information on matters pertinent to the liability claim. A lower court had previously found the release requirement to be impermissible under the federal Health Insurance Portability and Accountability Act.   Read more…

8. Call for volunteers: AAOS Now Editorial Board.
AAOS Now seeks two members for its Editorial Board. This board serves as the strategic planning and content development body forAAOS Now, the Annual Meeting editions of AAOS Now, and AAOS Headline News Now. The following openings are available:

• Member—foot and ankle
• Resident-at-large

Applicants for the member position must be active or emeritus fellows with a practice emphasis in foot and ankle. Applicants for the resident-at-large position must be resident members and PGY- 2, PGY-3, or PGY-4. The deadline for applications is Dec. 5.
Learn more and submit your application…(member login required)

October 20, 2014

Today’s Top Story
1. Study: Resident involvement not linked to increased complications after THA.
Data from a study published in the October issue of The Journal of Arthroplasty suggest that resident involvement may not increase complication rates following primary total hip arthroplasty (THA). The authors drew data on 13,109 primary THAs from the American College of Surgeons National Surgical Quality Improvement Program database. Of these, 3,462 had resident involvement. Researchers found no increase in 30-day complication rates associated with resident involvement. However, the authors note that increased operative time, comorbidities, age, obesity, and prior history of stroke or cardiac surgery were all independent risk factors for short-term complications.
Read the abstract…

Other News
2. Study: Female sex, high ASA class, longer operative times linked to greater readmission rates after THA and TKA.
A study published in the October issue of The Journal of Arthroplasty examines factors that may affect readmission rates after primary total hip (THA) and total knee arthroplasty (TKA). The researchers retrospectively assessed 30-day readmissions rates following THA and TKA procedures performed by a single surgeon between 2007 and 2012. They found that female sex, high American Society of Anesthesiologists (ASA) class, and increased operative time were significantly associated with increased likelihood of readmission, while surgical complications and gastrointestinal discomfort were cited as the most common causes for readmission. The researchers also noted that most readmissions occurred within the first week after the patient was discharged.
Read the abstract…

3. Study: ARCR may be efficacious for majority of patients.
Findings from a study published online in the Journal of Shoulder and Elbow Surgery suggest that arthroscopic rotator cuff repair (ARCR) may reduce pain and improve function and tendon healing for many patients. The research team prospectively evaluated 365 patients who underwent ARCR, and found that 305 were able to return to previous professional or spare-time activities within 6 months, while 60 were not. The research team noted that female gender and heavy manual labor prior to surgery were associated with later unsatisfactory outcome. Postoperative bursitis on ultrasound at 6 months was also associated with unsatisfactory outcomes.
Read the abstract…

4. Manufacturers and GPOs should submit corrections to Open Payments site by Oct. 31 to be reflected in next data refresh.
The U.S. Centers for Medicare & Medicaid Services states that applicable manufacturers and group purchasing organizations (GPOs) must submit corrections to any 2013 disputed records on the CMS Open Payments (Sunshine Act) website by close of business, Oct. 31, 2014, for publication when the site is next refreshed, on or before Dec. 31, 2014. The agency states that data corrections can be performed in the Open Payments system at any time, but corrective action taken after Oct. 31 will not be reflected in the next refresh.  Read more…
In related news, CMS has released a developmental version of its Open Payments search tool that allows users to search physicians by name and includes more detailed information on the data released. The agency is also requesting user feedback so that it can improve the website.   Read more…
Access the new search tool…

5. Study: High-dose resveratrol may positively affect bone in obese men with metabolic syndrome.
According to a study published online in The Journal of Clinical Endocrinology & Metabolism, high-dose supplementation with resveratrol may have a positively effect on bone in obese men with metabolic syndrome. The authors conducted a randomized, double-blind, placebo-controlled trial of 66 middle-aged obese men with metabolic syndrome who were recruited from the general community. They found that bone alkaline phosphatase increased with resveratrol dosage. In addition, lumbar spine trabecular volumetric bone mineral density also increased on a dose-dependent basis with resveratrol.   Read more…
Read the abstract…

6. FDA approves labeling for third extended-release opioid analgesic with abuse-deterrent features.
The U.S. Food and Drug Administration (FDA) has approved new labeling for morphine sulfate and naltrexone hydrochloride (Embeda) extended-release capsules. The new label describes the product’s abuse-deterrent properties consistent with FDA 2013 draft guidance, Abuse-Deterrent Opioids—Evaluation and Labeling. FDA notes that abuse or misuse of morphine sulfate and naltrexone hydrochloride can cause an overdose that may result in death, and can also cause withdrawal in people who are dependent on or tolerant to opioids. The agency further requires postmarketing studies of the drug to further assess the effects of the abuse-deterrent features. FDA states that morphine sulfate and naltrexone hydrochloride is not approved—and should not be used—for as-needed pain relief.   Read more…

7. CDC, HHS offer Ebola resources for office-based practices and ambulatory care settings.
The U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services have posted Ebola resources for office-based practices, including an algorithm for evaluating returned travelers for Ebola, a checklist for patients being evaluated for Ebola, and Ebola screening criteria for outpatient and ambulatory care settings.
View the algorithm for evaluating returned travelers (PDF)…
View the evaluation checklist (PDF)…
View the ambulatory care screening criteria (PDF)…
View the CDC outbreak information page…

8. Last call: Patient Safety Committee.
Oct. 27 is the last day to submit your application for a position on the Patient Safety Committee (three member openings). This committee is responsible for monitoring current trends in patient safety and infectious disease as they relate to orthopaedic surgery. Applicants for this position must be active fellows with an interest in and clinical experience with spine or adult reconstruction in relation to patient safety issues and musculoskeletal infections.
Learn more and submit your application…(member login required)

October 24, 2014

Today’s Top Story
1. JBJS Case Connector issues “watch” over flexible reamer breakage during anatomic ACL reconstruction.
Two case reports and a commentary in the Oct. 22 issue of The Journal of Bone & Joint Surgery (JBJS) Case Connector raise concerns regarding breakage of flexible reamers during anatomic anterior cruciate ligament (ACL) reconstruction. The journal cites two cases of intraoperative complications involving breakage of the starting reamer. The reamers broke approximately 60 mm from the tip. The authors suggest that the breakages may have been caused by abnormal stress concentration at the transitional zones. The JBJS Case Connector has designated the issue a “watchable” intervention to “encourage others to report related difficulties and enlist the orthopaedic community to either demonstrate that these are isolated, unrelated cases or sharpen the focus further on rigorously evaluating the intervention.”   Read more…
Read the case studies…

Other News
2. Study: Acute SCI associated with reduction in proximal femoral strength.
Data from a study published in the September issue of The Journal of Bone and Mineral Research suggest that acute spinal cord injury (SCI) may be associated with a reduction in proximal femoral strength. The authors scanned 13 patients with acute SCI using dual-energy X-ray absorptiometry (DXA) and clinical computed tomography (CT) at serial time points at a mean of 3.5 months. They found that, during the acute period of SCI, femoral neck and total proximal femur areal bone mineral density (aBMD) decreased by 2.0 percent per month and 2.2 percent per month, respectively. Further, the observed reductions in aBMD were associated with a 6.9 percent per month reduction in femoral strength. Based on the evidence, the authors argue that therapeutic interventions to halt bone loss and decrease fracture risk should be implemented soon after SCI. In addition, they state that clinicians who us DXA to monitor bone health after SCI should be aware of the potential discrepancy between changes in aBMD and strength.   Read more…
Read the abstract…

3. HHS to spend $840 million to assist with transition to quality-based business models.
The Business Journals reports that the U.S. Department of Health and Human Services (HHS) plans to spend $840 million over the next 4 years to help physicians move their practices from volume- to quality-based business models. The funding will be used to develop networks of group practices and health systems that share their expertise with other practices, especially in rural areas and underserved communities. Additional funding will be made available to networks formed by medical associations that share information with each other, and to study and promote practices and policies that result in the best patient outcomes.   Read more…

4. Study: Blood conservation measures may improve outcomes and reduce costs.
Findings presented at the annual meeting of the American Society of Anesthesiologists suggest that use of appropriate blood conservation measures for patients who do not accept allogeneic blood transfusion (ABT) may be associated with improved outcomes and lower costs. The research team conducted a risk-adjusted, propensity-matched, case-control study of 294 patients who did not accept ABT and 1,157 who did accept ABT. They found that mortality was lower in the bloodless cohort compared to controls. After adjustment for risk, they also noted that bloodless care was not an independent predictor of composite adverse outcome. Discharge hemoglobin concentrations were similar across both groups, while total and direct hospital costs were 12 lower in the bloodless group. The report did not indicate whether any of the surgeries performed were to treat orthopaedic conditions.   Read more…
Read the abstract…

5. New York.
The New York State Department of Health has released a proposed rule covering the formation of accountable care organizations (ACOs). According to an analysis by law firm Epstein, Becker and Green, PC, to qualify as an ACO, an applicant must establish its ability to “provide, manage and coordinate health care for a defined population,” and demonstrate how “clinically integrated health care providers and administrative support organizations” will be “accountable for the quality, cost and delivery of health care to the individuals it serves.” In addition, certified ACOs will have a leadership and management structure that is reasonably and equitably representative of at least 75 percent of ACO participants and the ACO’s patients.   Read more (PDF)…
Read the rule…

6. Call for abstracts: 2015 EWI research symposium.
AAOS seeks abstracts for combat casualty and trauma-related research for poster presentations at the 2015 Extremity War Injuries X: Return to Health and Function Research Symposium (EWI), to be held Jan. 26–28, 2015, in Washington, D.C. Up to 16 abstracts will be selected for display. The $600 EWI registration fee will be waived for poster presenters. Accepted posters will be displayed Jan. 27–28, with a poster session from 6 p.m. to 8 p.m. on Jan. 27. Presenters must be available to participate in the poster session. Selected authors will also be invited to give a brief podium presentation on Jan. 28. Presenters are responsible for their own hotel and travel costs associated with attending the EWI symposium. Abstract submissions, along with current curriculum vitae, must be submitted by Dec.1, 2014, to Erin Ransford, manager, research advocacy, at ransford@aaos.org.
Learn more and obtain an abstract submission form…

7. AAOS updates privacy policy.
AAOS has updated its privacy policy to specify how the organization uses personal information such as email addresses to communicate with fellows, members, and others. Specifically, AAOS has clarified:

• How email addresses are used to communicate important association information
• How to unsubscribe to AAOS emails
• How to unsubscribe to AAOS print publications, such as AAOS Now and the Journal of the AAOS

For more information, please see the complete AAOS privacy policy and refer to the sections “How Does AAOS use Personal Information (Email Addresses) to Communicate with Fellows, Members and Others?” and “Opt Out of Receipt of Print Publications?”   Read more…

8. Call for volunteers: OLC Board of Directors.
Oct. 31 is the last day to submit your application for a position on the Orthopaedic Learning Center (OLC) Board of Directors (one member-at-large opening). Board members provide governance for strategic planning and oversight for ongoing facility operations. Applicants for this position must be active fellows with recent experience on a board of directors.
Learn more and submit your application…(member login required)

October 27, 2014

Today’s Top Story
1. Study: Multimodal drug injections may reduce pain for some tibial osteotomy patients.
According to a Korean study published in the October issue of the journal Arthroscopy, periarticular multimodal drug injections may be associated with reduced postoperative pain in patients undergoing medial opening-wedge high tibial osteotomy for unicompartmental osteoarthritis (OA) of the knee. The researchers conducted a prospective, double-blind, randomized study of 70 patients who underwent medial opening-wedge high tibial osteotomy and received either intraoperative periarticular multimodal drug injection (n = 35) or no injection (n = 35). They found that patients in the intervention group demonstrated a significant benefit in pain management based on visual analog scale scores at 2 weeks postoperative.
Read the complete study…

Other News
2. Study: RSA may be associated with increased risk of complication compared to ASA.
Data from a study published online in the Journal of Shoulder and Elbow Surgery suggest that reverse shoulder arthroplasty (RSA) may be an independent risk factor for inpatient morbidity, mortality, and increased hospital costs compared with anatomic shoulder arthroplasty (ASA). The authors drew data on 51,052 patients from the Nationwide Inpatient Sample database who underwent either anatomic total shoulder arthroplasty (58 percent) or reverse total shoulder arthroplasty (43 percent). Compared to ASA patients, they found that patients who underwent RSA were at higher risk for in-hospital death, multiple perioperative complications, prolonged hospital stay, increased hospital cost, and nonroutine discharge. The authors suggest that physicians may need to be more judicious in offering the procedure and should make sure it is performed only by appropriately trained shoulder specialists.
Read the abstract…

3. Study: Mupirocin protocol may reduce MSSA and MRSA population in TJA patients.
Findings published online in The Journal of Arthroplasty suggest that a decolonization protocol using nasal mupirocin may effectively reduce positive cultures of methicillin-sensitive Staphylococcus aureus (MSSA), and methicillin-resistant Staphylococcus aureus (MRSA) in patients who undergo total joint arthroplasty (TJA). The research team instructed 289 consecutive primary or revision TJA patients at a single center to use 3-day preoperative chlorhexidine washes. Patients with positive cultures were treated with a 5-day course of intranasal mupirocin. Overall, 44 patients tested positive for preoperative MSSA colonization, while 12 tested positive for MRSA. On the day of surgery, the research team noted that only 15 patients had MSSA positive cultures, while one patient had a positive culture for MRSA.
Read the abstract…

4. Florida.
AMA Wire reports that the Florida Supreme Court is considering a case that could potentially overturn a state law that requires expert medical opinion in medical liability suits to come from a medical expert who practices in the “same specialty” or “similar specialty” to the physician defendant. A friend-of-the-court brief filed by the Florida Medical Association and others argues that physicians “should be judged by others who are trained in the same standards of care,” and that allowing expert testimony from healthcare professionals who practice in other specialties could lead to so-called “expert shopping.”   Read more…

5. Call for volunteers: CPG for the Management of Postoperative Surgical Site Infections.
The Clinical Practice Guideline (CPG) Section seeks AAOS fellows to participate in the work group of the Management of Postoperative Surgical Site Infections CPG. Work group members must be available for two to three conference calls and be able to attend two in-person meetings. Applicants must be knowledgeable about postoperative surgical site infections and must have no relevant financial conflicts of interest to this guideline topic. If you are interested in participating on the work group for this CPG topic, please contact Erica Di Salvo by Monday, Nov. 10, 2014, at disalvo@aaos.org.
Learn more and view all AAOS CPGs…

6. OKOJ November updates now online!
Check out the new topics and video in the Orthopaedic Knowledge Online Journal (OKOJ) on the AAOS OrthoPortal website. The following topics have been recently added or updated: “Acute Proximal Hamstring Rupture: Surgical Technique,” “Arthrodesis of the Ankle: New Approaches,” and “Tarsal Tunnel Syndrome: Diagnosis and Management.” Two new videos: “Surgical Repair of Acute Proximal Hamstring Rupture,” and “Tibial Nerve Release for Treatment of Tarsal Tunnel Syndrome,” have also been made available. In addition, OKOJ now offers full-text, downloadable PDFs for articles in recent issues, with more on the way!
View these topics and more…(member login required)

7. Help show support for the AAOS A Nation in Motion^® campaign!
Orthopaedic care is a journey upon which thousands of people embark each day. The Academy’s A Nation in Motion^® website is a place where patients can hear directly from other patients about their experiences. AAOS members are asked to show their support for the campaign by linking to the A Nation in Motion^® website, or by embedding the Second First video on their practice websites or social media pages. For assistance, please contact Kelly King at 847-384-4033, or via email at king@aaos.org.
Visit the A Nation in Motion^® website…

8. Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program website are closing over the next few days. Act now to apply for the following positions:

• Education Enhancement Fund Governance Committee (expires Oct. 31: one member)
• Orthopaedic Learning Center Board of Directors (Oct. 31; one member)
• Patient Safety Committee (Oct. 27; three members)

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

October 29, 2014

Today’s Top Story
1. Study: Ibuprofen associated with reduced risk of adverse effects compared to morphine for pediatric fracture patients.
Findings from a Canadian study published online in CMAJ suggest that oral morphine may increase risk yet offer no benefit over ibuprofen for pain management of pediatric fractures. The authors conducted a parallel group, randomized, blinded superiority study of 134 children who were seen in an emergency department (ED) after sustaining an uncomplicated extremity fracture. Patients were assigned to receive either morphine (0.5 mg/kg orally; n = 66) or ibuprofen (10 mg/kg; n = 68) for 24 hours after discharge. The authors found no significant difference in change in pain scores between cohorts across four different time points. However, 56.1 percent of patients in the morphine group experienced at least one adverse effect, compared to 30.9 percent of patients in the ibuprofen group.  Read more…
Read the abstract…

Other News
2. Study: Prescription opioids involved in 67.8 percent of overdose patients seen in EDs during 2010.
According to a research letter published online in the journal JAMA Internal Medicine, prescription opioids may be involved in tens of thousands of overdoses in the United States each year. The research team drew data on 135,971 ED visits coded for opioid overdose from the 2010 Nationwide Emergency Department Sample database. They found that 67.8 percent of all overdoses involved prescription opioids, including methadone. Overall, heroin was involved in 16.1 percent of cases, unspecified opioids in 13.4 percent, and multiple opioid types in 2.7 percent. The research team notes that the total number of cases likely represents only a portion of all opioid overdoses, because many individuals who die are never seen in an ED or activate an emergency medical services system.   Read more…
Read the abstract…

3. EHRs are the “single most important piece of evidence” in many medical liability suits.
An article in Modern Healthcare looks at the issue of electronic health records (EHRs) in medical liability cases. The writer notes that incorrect use of EHRs may lead to liability problems for healthcare providers. A spokesperson for one prominent law firm calls EHRs the “single most important piece of evidence” in most medical liability suits. Issues related to EHRs include the following: manipulation of time stamps and contents, failure to enter comments when warranted, and the use of templates, which automatically fill in information that may not be correct. Another expert explains that some providers attempt to make retroactive changes to records, “in the mistaken belief it will not be discovered.”   Read more…

4. Federal quality programs are a mixed bag for medical practices.
According to a survey released by the Medical Group Management Association (MGMA), medical practices have had mixed experiences with Medicare Part B quality reporting programs. The researchers surveyed more than 1,000 medical groups covering more than 48,000 physicians. Among their findings are the following:

• 83 percent of respondents reported that their practices are already engaged in internal clinical quality improvement processes
• 77 percent reported that their practices use evidence-based clinical protocols to ensure the delivery of high-quality patient care
• 84 percent reported that Medicare’s quality reporting programs do not enhance their physicians’ ability to provide high-quality patient care
• 85 percent reported that Medicare’s quality reporting programs have had a negative impact on clinician productivity
• 12 percent reported that Medicare’s quality reporting programs have had a positive impact on clinical decision-making

Read more…

Read the complete report (PDF)…

5. Teaching hospitals linked to quality outcomes.
An article in U.S. News and World Report examines the topic of surgery performed at teaching hospitals. The writer notes that teaching hospitals are often at the forefront of medical research and often serve as referral centers for rare and extreme medical cases. Such an environment encourages attending physicians and other providers to keep up with the most recent literature. A study cited in the article and published in the January 2014 issue of the journal Medical Care compared outcomes for acute myocardial infarction, heart failure, and pneumonia between teaching hospitals and nonteaching hospitals, and found that treatment in a teaching hospital was associated with a 6 percent to 10 percent relative reduction in adjusted odds of mortality. In addition, the top five hospitals listed in the U.S. NewsBest Hospitals report for 2014-2015 all have surgical residency programs. However, a spokesperson for the Patient Advocate Foundation encourages patients to research their physician’s education and medical experience and to consider speaking directly to the supervising team of physicians when surgical residents may be involved in their care.   Read more…
Read the abstract of the cited study…

6. Study: Gene may be linked to cartilage degeneration after trauma.
Data from a study published online in the journal Arthritis & Rheumatology suggest that the gene PPARdelta may promote cartilage degeneration in a mouse model of post-traumatic osteoarthritis (OA). The researchers treated mouse chondrocytes and knee explants with a pharmacological agonist of PPARdelta, and found that PPARdelta activation was associated with increased expression of several proteases in chondrocytes, as well as aggrecan degradation and glycosaminoglycan release in joint explants. In addition, the researchers noted that PPARdelta-knockout mice did not display abnormalities in skeletal development, but did demonstrate a protective aspect in mice who had undergone surgical destabilization of the medial meniscus.   Read more…
Read the abstract…

7. Call for volunteers: AMA Measures Advisory Committee.
AAOS seeks to nominate one member to fill a vacant seat on the American Medical Association (AMA) Measures Advisory Committee. The Measures Advisory Committee advises the AMA-convened Physician Consortium for Performance Improvement on matters related to performance measures and support activities. 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 with health informatics expertise. In addition, all applicants must provide the following: an online AAOS CAP application, current curriculum vitae, a 100-word biosketch, a Conflict of Interest form, 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 to Kyle Shah by Tuesday, Nov. 4, 2014 at 11:59 p.m. CT, at shah@aaos.org.

8. Call for volunteers: Resolutions Committee.
Dec. 5 is the last day to submit your application for a position on the Resolutions Committee (one member opening). The Resolutions Committee develops concise materials and offers recommendations on proposed resolutions for distribution to AAOS fellows. Applicants for this position 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)

October 31, 2014

Today’s Top Story
1. Study: Rates of paid medical liability claims against physicians fell from 2002 to 2013.
According to information published online in The Journal of the American Medical Association (JAMA), rates of paid medical liability claims against physicians have decreased during the last decade. The authors drew data from the National Practitioner Data Bank and the American Medical Association’s Physician Masterfile to describe trends in the rate of paid claims against doctors of medicine (MDs) and doctors of osteopathy (DOs) between 1994 and 2013. Between 2002 and 2013, the rate for MDs decreased from 18.6 to 9.9 paid claims per 1,000 physicians. Using regression analyses, the authors estimate an annual average decrease of 6.3 percent for MDs and 5.3 percent for DOs over that 12-year period.   Read more…
Read the complete study…

Other News
2. Study: Frailty index may help predict mortality and complications among THA and TKA patients.
Findings presented at the annual meeting of the American College of Surgeons suggest that a simplified frailty index, based on medical history and comorbidities, may serve as a reliable tool for assessing risk of mortality and serious complications among older patients who may be considering total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures. The researchers drew data from the American College of Surgeons National Surgical Quality Improvement Program database and calculated frailty scores for 40,469 patients. They found that patients with no frailty associated values (frailty score = 0) had a mortality rate of 0.08 percent, while those with four values (frailty score = 0.36), had a mortality rate of 2 percent. They also found that the risk of serious postoperative complications increased from 0.67 percent for patients with no frailty-associated values to 6.24 percent for patients with four frailty values. The frailty test was demonstrated to be a more reliable predictor of death and serious complications than patient age.   Read more…

3. Study: Eczema linked to increased risk of bone or joint injury.
Data from a study published online in the journal JAMA Dermatology suggest that eczema in adulthood may be a risk factor for fracture and other injury causing limitation. The authors conducted a prospective, questionnaire-based study of 34,500 adults using the 2012 National Health Interview Survey. After adjustment for confounding factors, they found that a history of eczema within the previous 12 months was associated with increased likelihood of any injury causing limitation, particularly fracture and bone or joint injury (FBJI). In addition, the prevalence of FBJI-causing limitation increased gradually with age, peaking at 50 to 69 years and decreasing thereafter.  Read more…
Read the abstract…

4. Study: Increased competition associated with lower payments to physician practices.
According to a study published in the Oct. 22/29 issue of JAMA, increased competition among physicians may be associated with reduced payments for office visits by private preferred provider organizations (PPOs). The research team conducted a retrospective study of physician practices in 1,058 counties in urbanized areas and found that prices were higher in less competitive markets. In addition, price increases between 2003 and 2010 were greater in areas that were less competitive in 2002 than in areas that were initially more competitive.   Read more…
Read the abstract…

5. Study: Alternative pay program linked to reduced costs and improved quality.
A study published online in The New England Journal of Medicine suggests that spending and quality measures implemented in Massachusetts were associated with quality improvements and a reduction in spending growth over 4 years. The authors reviewed data on physician organizations that took part in the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC) program from 2009 through 2012. Compared against control states, they found that medical spending on claims grew an average of $62.21 less per enrollee per quarter over the 4-year period. They noted that claims savings were concentrated in outpatient-facility setting and in procedures, imaging, and tests. From 2009 through 2011, they found that claims savings were exceeded by incentive payments to providers. However, during 2012, savings from claims exceeded incentive payments and generated net savings. In addition, improvements in quality among AQC cohorts generally exceeded those seen elsewhere in New England and nationally.   Read more…
Read the abstract…

6. New Jersey.
According to NJ Spotlight, legislators in New Jersey are discussing possible solutions to high out-of-network medical bills in the state. Proposals include:

• So-called “baseball arbitration,” in which hospitals and insurers submit offers to an arbitrator, and the arbitrator picks one offer or the other
• Requiring hospitals to disclose beforehand whether one of the physicians treating a patient is not in the patient’s insurance network
• Prohibiting hospitals from sending some unpaid patient bills to collection agencies

The Financial Institutions and Insurance Committee of the New Jersey Legislature has so far held two hearings on the out-of-network fees issue.   Read more…

7. South Dakota.
HealthLeaders Media reports that an measure on the ballot in South Dakota could end restrictions by insurers as to which providers enrollees may choose. If adopted, Initiated Measure 17 would allow any healthcare provider to join an insurance company’s network, assuming the provider agrees to the company’s terms and conditions and works within the company’s coverage area. Supporters of the proposal argue that, given South Dakota’s relatively large area and sparse population, narrow provider networks severely limit the ability of patients to choose providers.   Read more…

8. Call for volunteers: Bylaws Committee.
Dec. 5 is the last day to apply for a position on the Bylaws Committee (one member opening). The Bylaws Committee makes recommendations to the fellowship on all proposed amendments to the AAOS bylaws and Standards of Professionalism. Applicants for this position 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)