Today’s Top Story
Tom Price, MD, confirmed as HHS secretary.
The U.S. Senate has confirmed the nomination of Tom Price, MD, to serve as Secretary of the U.S. Department of Health and Human Services (HHS). Dr. Price is an AAOS member and a vocal opponent of the Affordable Care Act (ACA). As HHS secretary, he is expected to play a strong role in issuing department regulations aimed at weakening the ACA and helping to shape replacement legislation. Read more…

Other News

Study: What is the value of heparin for thromboprophylaxis following knee arthroscopy or lower leg casting?
Findings from a study conducted in Norway and published in the Feb. 9 issue of The New England Journal of Medicine shed doubt on the efficacy of administration of low-molecular-weight heparin for thromboprophylaxis following knee arthroscopy or lower leg casting. The authors conducted two parallel, pragmatic, multicenter, randomized, controlled, open-label trials with blinded outcome evaluation. In the first trial, 1,541 knee arthroscopy patients were randomized to receive 8 days of either low-molecular-weight heparin or placebo following arthroscopy. Venous thromboembolism (VTE) occurred in 5 of 731 patients (0.7 percent) in the treatment group and in 3 of 720 patients (0.4 percent) in the control group. In the second trial, 1,435 patients treated with casting of the lower leg were randomized to receive low-molecular-weight heparin or placebo during the full period of immobilization. VTE occurred in 10 of 719 patients (1.4 percent) in the treatment group and in 13 of 716 patients (1.8 percent) in the control group. Read the abstract…

BCPI participation may not have influenced growth in number of joint arthroplasty procedures.
A report released by the non-profit Altarum Institute suggests that an observed increase in the volume of lower extremity joint arthroplasty procedures may not have been linked to physician participation in the Medicare Bundled Payment for Care Improvement (BPCI) initiative. The researchers reviewed Medicare Part A claims for inpatient-based major lower joint arthroplasty procedures performed at any hospital from 2011 through 2015, and examined demographic and market trends associated with increases in those procedures. They found no significant difference in adjusted growth in average annual volume between BCPI and non-BCPI participants. Further, among facilities that experienced significant increases, the researchers noted the effect of common market forces, mostly related to hospital referral region characteristics, such as the growth in the Medicare population or the number of hospitals in the region. Read more…(member login required)
Read the report (PDF)…

GAO report notes issues in FDA medical device reporting system.
A U.S. Government Accountability Office report on the use of power morcellators notes potential issues in the U.S. Food and Drug Administration (FDA) reporting system. Following reports of several high-profile device safety issues occurring in hospitals, the agency initiated inspections at 17 hospitals linked to reports of adverse events related to the use of power morcellators and duodenoscopes. The director of the FDA Center for Devices and Radiological Health noted that, although such events appeared to fall under the agency’s medical device reporting requirements, the agency did not see corresponding adverse event reports submitted to the FDA adverse event report database. From the inspections, the agency learned several things:

  • Some hospitals did not submit required reports for deaths or serious injuries related to devices used at their facilities; and in some cases, they did not have adequate procedures in place for reporting device-related deaths or serious injuries to FDA or to the manufacturers. Although such reporting is mandatory, the agency believes that these hospitals are not unique, as there is limited to no reporting to FDA or manufacturers at some hospitals.
  • Hospital staff often were not aware of nor trained to comply with all of FDA’s medical reporting requirements.

Read more…
Read the report (PDF)…

Study: Physician burnout interventions help, but organization-directed interventions may be most effective.
Data from a study published in the February issue of the journal JAMA Internal Medicine suggest that physician burnout intervention programs may offer small benefits that may be increased through organization-directed approaches. The authors conducted a retrospective review and meta-analysis of 19 studies covering 1,550 physicians. They found that burnout interventions were associated with small but significant reductions in burnout, equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory. Subgroup analyses suggested significantly improved effects for organization-directed interventions, as compared with physician-directed interventions, suggesting that burnout may be a problem of the whole healthcare organization, rather than individuals. The authors note that interventions delivered among experienced physicians and in primary care were associated with higher effects compared with interventions delivered among inexperienced physicians and in secondary care, but the differences were not significant. Read the abstract…

ACGME to vote on increased shift limits for first-year residents.
Modern Healthcare reports that the Accreditation Council for Graduate Medical Education (ACGME) will soon vote on a proposal that among other things would allow first-year residents to work 28-hour shifts—an increase from the current 16-hour limit. The revised standards do not change the number of clinical and educational hours from the current maximum of 80 hours per week, averaged over 4 weeks. The proposed revisions also include:

  • An expanded section on patient safety and quality improvement
  • A new section on physician well-being
  • Strengthened expectations around team-based care
  • Consistent, nationwide resident clinical and educational work hours

Read more…(registration may be required)
Read the ACGME statement (PDF)…

Opportunity for young orthopaedic entrepreneurs—apply to earn a space in competitive 2017 symposium.
AAOS and the Orthopaedic Research Society (ORS) are calling early- to mid-career MDs, PhDs, and MD/PhDs with novel ideas to improve patient care looking to connect with entrepreneurs, CEOs, surgeons, and leaders in the field of orthopaedics. Submit your application for the opportunity to present your idea to an expert panel of judges and invited guests that span the fields of surgery, business, academia, and investors in orthopaedics at the AAOS/ORS Translating Orthopaedic Technologies into Clinical Practice: Pathways from Novel Idea to Improvements in Standard of Care Research Symposium, May 11-13, 2017 in Rosemont, Ill. As many as 20 young entrepreneurs will receive all-expenses-paid invitations to attend the symposium. Of those, the top five participants will be selected to pitch their ideas to an expert panel. Applications are open to AAOS and/or ORS members and must be submitted by Wednesday, Feb. 15, 2017. Learn more and submit your application…