Today’s Top Story
CMS delays SHFFT start to Jan. 1, 2018.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released a final rule that, among other things, delays to Jan. 1, 2018, the start date for Episode Payment Models (EPMs), including the Surgical Hip/Femur Fracture Treatment Model (SHFFT) and Advanced APM requirements for the Comprehensive Care for Joint Replacement Model (CJR). Performance year 1 for SHFFT will run from Jan. 1, 2018 to Dec. 31, 2018. The agency states that the delay “will ensure that CMS has adequate time to undertake notice and comment rulemaking, if modifications are warranted.”
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Other News
Study: Preoperative opioid use linked to less pain reduction after TKA.
Data from a study published in the May 17 issue of The Journal of Bone & Joint Surgery suggest that preoperative opioid use may be linked to a reduction in pain relief following total knee arthroplasty (TKA). The authors reviewed data from a prospective, cohort study of 156 patients with a mean age of 65.7 years and mean body mass index (BMI) of 31.1 kg/m2, 36 of whom (23 percent) had had at least one opioid prescription. They found that the mean baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score was 43.0 points for patients with no prior opioid use and 46.9 points for those who had used opioids. At 6-month follow-up, they found that the non-opioid cohort saw a reduction in WOMAC pain score of 33.6 points, compared to a reduction of 27.0 points in the opioid cohort.
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Study: Intraoperative methadone may help improve pain management for spinal fusion patients.
According to a study published in the May issue of the journal Anesthesiology, administration of intraoperative methadone may help reduce postoperative opioid requirements, decrease pain scores, and improve patient satisfaction with pain management following spinal fusion surgery. The research team conducted a randomized, double-blind, controlled trial of 115 patients who received either methadone 0.2?mg/kg at the start of surgery or hydromorphone 2?mg at surgical closure. They found that median hydromorphone use was reduced in the methadone group on postoperative days 1, 2, and 3. In addition, pain scores at rest, with movement, and with coughing were lower in the methadone group at 21 of 27 assessments, and overall satisfaction with pain management was higher in the methadone group than in the hydromorphone group until the morning of postoperative day 3.
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Study: Physician age may affect patient mortality, but not among high-volume clinicians.
Findings from a study published online in the journal The BMJ suggest that physician age may be linked to increased risk of patient mortality. The researchers reviewed data on 736, 537 Medicare fee-for-service beneficiaries aged 65 years or older, who were managed by 18,854 hospitalist physicians (median age: 41 years). After adjustment, they found that 30-day mortality rates were 10.8 percent for physicians aged 40 years or younger, 11.1 percent for physicians aged 40-49 years, 11.3 percent for physicians aged 50-59 years, and 12.1 percent for physicians aged 60 years or older. However, among physicians with a high volume of patients, they found no association between physician age and patient mortality. They note that readmissions also did not vary with physician age, although costs of care were slightly higher among older physicians.
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Can virtual patient encounters help physicians more effectively address medical errors?
The writers of an article published online in the journal Medical Education argue that the culture of error disclosure in the medical community should be changed from a punitive approach “to one that is restorative and supportive.” They write that interactions with standardized patients can be used to simulate hospital encounters and help teach important behavioral considerations, and encourage the establishment of professional standards of competence, “potentially by incorporating difficult patient encounters, including disclosure of error, into medical licensing examinations that assess clinical skills”
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CDC updates info on emerging fungus C. auris.
The U.S. Centers for Disease Control and Prevention (CDC) has released updated information on the emerging, often multidrug-resistant fungus, Candida auris. The agency reports that, as of May 12, 2017, 77 clinical cases of C. auris had been reported from seven states: New York (53), New Jersey (16), Illinois (4), Indiana (1), Maryland (1), Massachusetts (1), and Oklahoma (1). Among the 77 clinical cases, median patient age was 70 years (range: 21–96 years). C. auris was cultured from the following sites: blood (45 isolates), urine (11), respiratory tract (8), bile fluid (4), wound (4), central venous catheter tip (2), bone (1), ear (1), and a jejunal biopsy (1). Antifungal susceptibility testing at CDC of the first 35 clinical isolates revealed that 30 (86 percent) were resistant to fluconazole, 15 (43 percent) were resistant to amphotericin B, and one (3 percent) was resistant to echinocandins.
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Call for volunteers: Communications Cabinet.
June 30 is the last day to submit your application for chair of the Communications Cabinet. The Communications Cabinet directs and evaluates AAOS communication vehicles, undertakes special communications projects, and provides public and media relations expertise to various AAOS governance units. Applicants for this position must be active fellows with strong knowledge, experience, and interest in communications, and experience in writing and editing nonclinical documents.
Learn more and submit your application…(member login required)
