Today’s Top Story
Study: Medicare may penalize providers more for excess readmissions than excess mortality.
Findings from a study published online in the journal JAMA Cardiology suggest that current Medicare financial penalties may not meet the goals of aligning incentives and fairly reimbursing hospitals for patient-centered outcomes. The research team reviewed hospital-level data on readmission penalties, excess readmission ratio, and 30-day mortality rates for heart failure, pneumonia, and acute myocardial infarction during FY 2014. They found that readmission penalties closely tracked excess readmissions, were minimally and inversely related with excess mortality, and correlated modestly with excess readmission and mortality combined. The research team writes that during FY 2014, financial penalties would have been substantially altered for one-third of hospitals in the United States if 30-day readmission and mortality had been considered equally important. According to the researchers, under most circumstances, patients would rather avoid death than rehospitalization. The authors concluded that “current Medicare financial penalties do not meet the goals of aligning incentives and fairly reimbursing hospitals for patient-centered outcomes.” Read more…
Read the abstract…

Other News

Study: mFI may help identify THA/TKA patients at increased risk of grade IV complications.
According to a study published in the November issue of The Journal of Arthroplasty, the modified frailty index (mFI) may be an independent predictor of Clavien-Dindo grade IV complication (cardiac arrest, myocardial infarction, septic shock, pulmonary embolism, postoperative dialysis, reintubation, and prolonged ventilator requirement) in patients undergoing total hip (THA) or total knee (TKA) arthroplasty. The researchers analyzed data on 14,583 THA and 25,223 TKA patients from the National Surgical Quality Improvement Program database. They found that increase in mFI was associated with increased risk of Clavien-Dindo grade IV complications, hospital-acquired conditions, any complications, and mortality. After adjusting for demographics, they found that mFI was the strongest independent predictor of Clavien-Dindo grade IV complications for both THA and TKA patients. Read the abstract…

Study: High-frequency SCS linked to improved outcomes compared to low-frequency SCS for patients with back and leg pain.
Data from a study published in the November issue of the journal Neurosurgery suggest that 10-kHz high-frequency (HF10) spinal cord stimulation (SCS) may offer improved outcomes compared to low-frequency SCS for patients with back and leg pain. The authors conducted a pragmatic randomized, controlled, pivotal trial of 171 patients treated with either HF10 (n = 90) or low-frequency SCS (n = 81). At 3-month follow-up, they found that in the HF10 cohort, 84.5 percent of patients were responders for back pain and 83.1 percent for leg pain, compared to the low-frequency cohort, in which 43.8 percent were responders for back pain and 55.5 percent for leg pain. At 24 months, the authors found that for HF10 patients, 76.5 percent were responders for back pain and 72.9 percent were responders for leg pain, compared to the low-frequency cohort, in which 49.3 percent were responders for back pain and 49.3 percent were responders for leg pain. Read more…
Read the abstract…

Study: Use of antibiotics associated with increased risk of sepsis.
Findings presented by the U.S. Centers for Disease Control and Prevention at the IDWeek conference suggest that use of antibiotics may associated with increased risk of sepsis, compared with no antibiotic therapy. The researchers conducted a retrospective, cohort study of 12.7 million hospital stays across 516 centers, including 18,307 that were associated with a sepsis admission within 90 days of discharge following previous admission. They found that, compared with no antibiotics, the odds ratio for sepsis was:

  • 1.78 following treatment with high-risk antibiotics
  • 1.10 following treatment with low-risk antibiotics
  • 1.22 following treatment with no-risk antibiotics

In addition, the researchers found that patients treated for more than 14 days had more than twice the risk of later sepsis as those given shorter therapy, regardless of antibiotic type. Read more…

Michigan.
An article in HealthLeaders Media reports on efforts by the Michigan Opioid Prescribing Engagement Network to reduce the amount of opioids prescribed to surgical patients and the number of patients still using opioids months after surgery. Among other things, the program will work with various provider networks to distribute information regarding best practices for pain control following surgery, and analyze and share information about opioid prescribing patterns in the state. The initiative will also focus on Medicaid patients, who account for 12 percent of surgical patients in Michigan but account for 30 percent of those who develop a dependence on opioids after surgery. Read more…

Vermont.
The U.S. Centers for Medicare & Medicaid Services (CMS) has announced details of the Vermont All-Payer Accountable Care Organization (ACO) Model, designed to incentivize healthcare value and quality by implementing the same payment structure for the majority of providers throughout the state’s care delivery system. The initiative will begin on Jan. 1, 2017, and conclude on Dec. 31, 2022, with start-up funding made available the first year, and full implementation during the next 5 years. The program goal is to have 70 percent of all Vermont insured residents attributed to an ACO by 2022. CMS states that ACOs will continue to have payer-specific benchmarks and financial settlement calculations, but the ACO design will be closely aligned across payers. Read more…

Call for volunteers: Women’s Health Issues Advisory Board.
Nov. 18 is the last day to submit your application for a position on the Women’s Health Issues Advisory Board (one member position—liaison to the Council on Research and Quality). The purpose of the board is to advocate, advance, and serve as a resource on sex and gender differences in musculoskeletal health. Applicants for this position must be active fellows, candidate members, or emeritus members with in-depth knowledge of women’s musculoskeletal health research issues. Learn more and submit your application…(member login required)