Today’s Top Story
MedPAC, AAOS offer comments on CMS proposal to revamp CJR and define episode-based payments.
In a letter to the acting administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC) has submitted comments on a CMS proposed rule that, among other things, describes an episode-based payment model (EPM) for surgical hip and femur fracture treatment (SHFFT), seeks to qualify EPMs as advanced alternative payment models (APMs), and revises the existing Comprehensive Care for Joint Replacement (CJR) model. MedPAC states that SHFFT is “a good candidate for bundled payment,” as 93 percent of SHFFT episodes include at least some post-acute care use, and such spending comprises one-third of total episode spending. However, the commission argues that “EPM and CJR should not be considered Advanced APMs, as they “are not substantive alternatives to [fee-for-service] payment and do not represent the type of comprehensive delivery system payment reform that should be rewarded with an APM incentive payment.”
Read the MedPAC letter (PDF)…
In its own letter submitted in response to the proposed rule, the American Association of Orthopaedic Surgeons (AAOS) supported CMS’ recognition of the difference between the patient population undergoing joint arthroplasty in the CJR model and the elderly patients with multiple chronic conditions and frailty who will be impacted by the SHFFT model. AAOS also expressed support for proposals to allow participants in CJR and SHFFT models to be considered for qualifying Advanced APM participant determination and thereby receive higher reimbursements under APMs in the Quality Payment Program. However, AAOS also outlined concerns with the proposed model, including mandatory participation, 2017 implementation, lack of designated physician leadership, and the absence of risk-adjustment.
Read the AAOS letter (PDF)…
Read the proposed rule…
Other News
HHS updates HIPAA risk assessment tool.
The U.S. Department of Health and Human Services (HHS) has updated its Health Insurance Portability and Accountability Act (HIPAA) Security Risk Assessment tool, which is designed to help small and medium-sized practices assess the information security risks in their organizations under HIPAA. The application also produces a report that can be provided to auditors. The updated tool includes Windows 10 compatibility and improved reporting features. A version of the tool is also available for the iPad.
Read more…
Access the tool and learn more about risk assessment…
Study: Mobilization program may help reduce length of stay, mobilization at discharge for SICU patients.
Findings from a study published in the Oct. 1 issue of the journal The Lancet suggest that early, goal-directed mobilization shorten length of stay and improve mobilization at discharge for surgical intensive care unit (SICU) patients. The authors conducted a multicenter, parallel-group, assessor-blinded, randomized controlled trial of patients 18 years or older at SICUs of five university hospitals in the United States, Austria, and Germany. They found that use of an early, goal-directed mobilization program was associated with improved mobilization levels, decreased SICU length of stay, and functional mobility at hospital discharge. The authors note that more adverse events were reported in the intervention group (25 cases; 2.8 percent) than in the control group (10 cases; 0.8 percent), although they noted no serious adverse events. Prior to hospital discharge 25 patients died—17 (16 percent) in the intervention group and eight (8 percent) in the control group. At 3 months after hospital discharge 36 patients had died—21 (22 percent) in the intervention group and 15 (17 percent) in the control group.
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Read the abstract…
Study: Patients without insurance but with severe knee pain may be less likely than those with no pain to choose TKA.
A study published online in the journal Arthritis Care & Research examines the relationship between knee pain, socioeconomic status, healthcare coverage, and patient willingness to undergo total knee arthroplasty (TKA). The researchers conducted a cross-sectional analysis of 3,530 participants in the Osteoarthritis Initiative study. Among patients without health insurance, they found that those with severe knee pain were less willing to undergo TKA than those without knee pain. However, that trend did not hold true for patients with health insurance.
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Read the abstract…
Study: Use of some NSAIDs may be linked to increased risk of hospital admission for heart failure.
According to data from a study conducted in Europe and published online in the journal The BMJ, some NSAIDs may increase the risk of hospital admission for heart failure. The research team conducted a nested, case-control study of 92,163 hospital admissions for heart failure compared to 8,246,403 matched controls. They found that current use of any NSAID in the previous 14 days was associated with a 19 percent increased risk of hospital admission for heart failure, compared with use of any NSAIDs more than 183 days in the past. In addition, the research team noted an increased risk of admission for heart failure for diclofenac, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, and piroxicam, as well as the COX 2 inhibitors etoricoxib and rofecoxib. The research team found no evidence that celecoxib was associated with increased risk of admission for heart failure at commonly used doses.
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Read the abstract…
Study: Female high school athletes may underreport concussion.
A study published in the September/October issue of the Journal of Trauma Nursing suggests that female high school athletes may underreport signs and symptoms of concussion. The researchers examined data on 77 female athletes representing 14 high school sports. They found that 31 participants reported a suspected concussion, but 10 of the 31 refrained from reporting symptoms to training staff after injury. Overall, only 66 percent of participants reported receiving concussion education. The researchers state that concussion education appeared to have no relationship with diagnosed concussion rates, removal of athletes from play, or follow-up medical care after injury.
Read more…
Read the abstract…
Call for volunteers: AAOS Emergency Medical Services Program Product Line series editor.
Oct. 28 is the last day to submit your application for the position of series editor designee for AAOS’s Emergency Medical Services product line. Applicants for this position must be active or emeritus fellows with extensive knowledge or current experience as an emergency medical technician, paramedic, or emergency medical services director.
Learn more and submit your application…(member login required)
Call for volunteers: Council on Education.
Dec. 16 is the deadline to apply for a position on the Council on Education (one board preparation and MOC course chair opening). The Council on Education plans and evaluates Academy educational programs in accordance with the policies and standards of the Accreditation Council for Continuing Medical Education. Applicants for this position must be active fellows with experience as a faculty member in Academy courses.
Learn more and submit your application…(member login required)
