Today’s Top Story
Study: Nonmedical use of prescription opioids increased sharply from 2001-2002 to 2012-2013.
A study from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and reported in the June issue of the Journal of Clinical Psychiatry finds that nonmedical use of prescription opioids more than doubled among adults in the United States from 2001-2002 to 2012-2013. The researchers analyzed data from the NIAAA National Epidemiologic Survey on Alcohol and Related Conditions-III and found that more than 11 percent of Americans report nonmedical use of prescription opioids at some point in their lives—up from 4.7 percent 10 years earlier. In addition, the number of people who meet the criteria for prescription opioid addiction has substantially increased during this timeframe, with 2.1 million adults reporting signs and symptoms of “nonmedical prescription opioid use disorder” as defined by the “Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.”
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Read the abstract…
     In related news, a study published online in the journal Health Affairs finds that implementation of state-level prescription drug monitoring programs to detect high-risk prescribing and patient behaviors may be linked to an average reduction of 1.12 opioid-related overdose deaths per 100,000 population in the year following implementation. In addition, states whose programs had robust characteristics—including monitoring greater numbers of drugs with abuse potential and updating their data at least weekly—saw greater reductions in deaths, compared to states whose programs lacked such characteristics.
Read the abstract…

Other News

Boards of Trustees for Medicare say program will be insolvent by 2028.
The Boards of Trustees for Medicare have released their 2016 annual report regarding federal hospital insurance and federal supplementary medical insurance trust funds. The report projects the Medicare trust fund to be insolvent by 2028—2 years earlier than an estimate of 2030 projected in the previous two reports, but later than a 2026 estimate from the U.S. Congressional Budget Office. The report does not include alternative payment models (APMs) currently being tested by the U.S. Center for Medicare and Medicaid Innovation, but does include the Medicare Shared Savings Program for ACOs [accountable care organizations].
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Download the report, with related links…

Study: Index could help identify women at risk for faster bone loss during menopause.
Data from a study published online in the Journal of Clinical Endocrinology & Metabolism suggest that an index that quantifies net bone formation compared to resorption may help predict which women may experience faster bone loss during menopause. The authors drew data on 685 women with stable bone mineral density (BMD) from the Study of Women’s Health Across the Nation database. All participants were 42 to 52 years old and premenopausal or early perimenopausal at baseline. The authors estimated the bone balance index (BBI) of participants by estimating the relationship between resorption (urinary N-telopeptide) and formation (osteocalcin) markers and comparing the relationship to bone turnover markers in 216 women who were beginning to lose bone. They found that BBI was greater (more favorable) in women with a greater body mass index and lower (less favorable) in women closer to the final menstrual period. Further, they noted that each standard deviation decrement in BBI was associated with 0.27 percent per year faster decline in BMD at the lumbar spine (LS) and a 38 percent greater likelihood of faster-than-average loss of LS bone mass. The authors note that BBI was not associated with decline in femoral neck (FN) BMD, and that urinary N-telopeptide level alone was not associated with either LS or FN BMD decline.
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Study: How well do physicians understand CT radiation dosage and risk?
A survey conducted in Canada and published online in the Journal of Medical Imaging and Radiation Sciences attempts to assess provider knowledge regarding risks and radiation doses of computed tomography (CT) scans. The researchers surveyed 308 healthcare professionals and found that 73 percent of physicians, 97 percent of radiologists, and 76 percent of technologists correctly believed that there is a risk for cancer from an abdomen–pelvic CT scan. However, only 18 percent of physicians, 28 percent of radiologists, and 22 percent of technologists selected the most appropriate estimate of abdominal–pelvic CT dose in terms of chest radiograph equivalents. The researchers note that physicians and technologists who use CT were more likely to select the correct dose than those who do not. Overall, 93 percent of respondents expressed interest in receiving dose feedback from medical imaging procedures.
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New York.
The New York Times reports that the governor of New York has signed into law a bill that limits opioid drug prescriptions to 7 days following a patient’s initial visit to a physician. Among other things, the new law also requires insurers to cover initial inpatient drug abuse treatment without prior approval; extends from 48 to 72 hours the time someone can be held for emergency treatment; and adds 2,500 addiction-treatment slots statewide. Data from New York State suggest that opioid-related emergency rooms visits increased 73 percent from 2010 to 2014, with 952 opioid-related deaths during 2013.
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Oregon.
The Oregon Health Authority has released its fourth annual Coordinated Care Organization (CCO) Metrics Report. The report finds that CCOs received a combined total of $168 million in incentive payments during 2015. Among other things, the report notes that:

  • Since 2011, the number of all-cause adult hospital readmissions has been reduced by 33 percent
  • Access to primary care for children and adolescents has been improved
  • CCO members report improved satisfaction with CCO program customer service

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Read the report (PDF)…

AAOS comments on CMS proposed rule for physician reimbursement framework.
The American Association of Orthopaedic Surgeons (AAOS) has submitted comments to the U.S. Centers for Medicare & Medicaid Services (CMS) regarding a proposed rule for physician reimbursement called for under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Among other things, the proposal consolidates the Physician Quality Reporting System, the Value-Based Modifier Program, and Meaningful Use into the single Merit-based Incentive Payment System (MIPS), and lays out details for an Advanced Alternative Payment Model pathway. In its comments, AAOS noted that the reduction of required quality measures and greater flexibility in reporting requirements are positive steps, but interoperability and infrastructure readiness remain obstacles to successful reporting. Further, AAOS expressed concern that the reporting period has been expanded to a full calendar year. Finally, AAOS expressed disappointment that the proposed rule does not list either the Bundled Payments for Care Improvement (BPCI) models or the Comprehensive Care for Joint Replacement Model (CJR) as Advanced APMs.
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Read the proposed rule (PDF)…
Visit the AAOS MACRA page…

AAOS representatives named to PSH Learning Collaborative Steering Committee.
The American Society of Anesthesiologists (ASA) has announced the appointment of two AAOS representatives to the ASA Perioperative Surgical Home (PSH) Learning Collaborative Steering Committee. The PSH is a patient-centered, team-based model of care coordination designed to help meet the demands for a surgical system that emphasizes quality, patient satisfaction, and reduced cost. The PSH learning collaborative seeks to develop and evaluate the usefulness of the PSH model in enhancing clinical quality, controlling costs, and improving patient experiences, by eliminating cancellations and delays in surgery, lowering complication rates and readmissions, and reducing length of stay.
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Learn more about the PSJ model…

Call for volunteers: Annual Meeting Committee.
Aug. 15 is the last day to submit your application for a position on the Annual Meeting Committee. The Annual Meeting Committee plans and implements the AAOS Annual Meeting and provides oversight for the Scientific Program Committee, the Instructional Courses Committee, and the Exhibits Committee. The following positions are available:

  • Resident-at-large (one opening)
  • Member-at-large (one opening)

Applicants for the resident-at-large position must be PGY-2, PGY-3, or PGY-4 and provide a letter of support from the residency program director. Applicants for the member-at-large position must be active fellows.
Learn more and submit your application…(member login required)