Today’s Top Story

MedPAC projects MIPS will not meet goals; proposes alternative approach.
In a public meeting of the U.S. Medicare Payment Advisory Council (MedPAC), representatives of the advisory agency argued that the Merit-based Incentive Payment System (MIPS) is too complex and places a significant burden on physicians. Among other things, the presenters noted the following:

  • Most MIPS measures are not associated with high-value care.
  • MIPS is structured to maximize clinician scores, leading to score compression and limited ability to track performance.
  • Under MIPS, clinicians can choose their own measures, leading to inequality in tracked performance.

The agency projects that MIPS will not achieve its goal of identifying and rewarding high-value clinicians, and proposes implementation of a new, voluntary value program, under which all clinicians would have a small percentage of payments withheld, with the opportunity to earn back the withheld payments by joining an advanced alternative payment model. Read more…(registration may be required)
View the MedPAC presentation (PDF)…

Other News

Dec. 1, 2017, is the deadline for physicians to dispute 2016 PQRS and QRUR findings.
The California Medical Association notes that the U.S. Centers for Medicare & Medicaid Services (CMS) has released data indicating which physicians are subject to 2018 payment penalties associated with the Physician Quality Reporting System and Value-Based Payment Modifier (Value Modifier) programs. Value Modifier penalties can be found in the Quality and Resource Use Reports (QRUR). Physicians concerned about findings in their reports must submit a request for informal review by Dec. 1, 2017. Read more…
Learn more about the 2016 QRUR and the 2018 Value Modifier…

Study: Documented penicillin allergy linked to increased risk of SSI.
Data from a study published online in the journal Clinical Infectious Diseases suggest that patients with a reported penicillin allergy may have a 50 percent increased chance of contracting a surgical site infection (SSI). The researchers conducted a retrospective cohort study of 8,385 patients who had undergone 9,004 surgical procedures, including hip arthroplasty or knee arthroplasty, and found that SSI developed in 241 patients (2.7 percent) of whom 3.5 percent reported a penicillin allergy and 2.6 percent reported no allergy. Patients with a documented penicillin allergy received less effective antibiotics, including clindamycin, vancomycin, and gentamicin. The authors note that most patients with a documented penicillin allergy may not be allergic. Read more…
Read the abstract…

Study: TXA may not provide better blood conservation than EACA following TKA.
Findings from a study published online in The Journal of Bone & Joint Surgery suggest that epsilon-aminocaproic acid (EACA) may be an acceptable alternative to tranexamic acid (TXA) for blood conservation following total knee arthroplasty (TKA). The authors conducted a prospective, randomized, controlled trial of 194 TKA patients, of whom 96 received EACA and 98 received TXA. They note that, although the estimated blood loss was significantly greater in the EACA cohort, no transfusions were required in either group and no significant differences were noted in change in hemoglobin or serum creatinine level, postoperative complications, or length of hospital stay. Read the abstract…

Study: TDA and MDR offer significant improvement for patients with chronic LBP and lumbar disk degeneration.
A study conducted in Norway and published in the October issue of The Spine Journal suggests that both total disk arthroplasty (TDA) and multidisciplinary rehabilitation (MDR) may be associated with significant improvement for adult patients with chronic low back pain (LBP) and localized degeneration in the lumbar intervertebral disks, although the data favor surgical intervention. The authors conducted a multicenter, randomized, controlled trial of 151 patients aged 25 to 55 years who received either TDA (n = 77) or MDR (n = 74). At 8-year follow-up, they found that mean improvement in Oswestry Disability Index was 20.0 points in the surgery cohort and 14.4 points in the rehabilitation cohort. In addition, 21 patients (24 percent) randomized to rehabilitation had undergone back surgery since inclusion, and 12 patients (14 percent) randomized to surgery had undergone additional back surgery. The authors write that 18 patients (24 percent) in the surgery group and four patients (6 percent) in the rehab group reported full recovery. They found no significant difference across cohorts in quality of life, occupational status, satisfaction with care, or drug use. Read the abstract…

Study: How might a productivity-based compensation plan impact academic medicine?
A study published in the August issue of the journal Academic Medicine examines how a physician compensation plan based on productivity may impact academic missions. Faculty at an academic medical center elected a committee to restructure the physician compensation plan, which was implemented in FY 2013. The new compensation plan tied physician pay to productivity, as measured by relative value units (RVUs), and included incentives for education and research. Since 2012, clinical RVUs per faculty increased 7 percent, incentives paid per faculty increased 250 percent, and publications per faculty increased 15 percent. The authors note that grant submissions, external funding, and teaching hours also increased per faculty, but not significantly. According to a survey distributed at the end of FY 2015, 76 of 125 faculty (61 percent) were more satisfied with the new plan than the previous plan. Read more…
Read the complete study…

Call for volunteers: FDA Science Board.
AAOS seeks to nominate orthopaedic surgeons to serve as an AAOS liaison to the U.S. Food and Drug Administration (FDA) Science Board. The Science Board advises the agency on ensuring safe and effective drugs for human use, along with other products over which the agency has regulatory responsibility. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a 100-word biography, and a letter of interest highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted to Kyle Trivedi by Monday, Oct. 30, 2017, at 11:59 p.m. CT, at: trivedi@aaos.org