HHS releases guidance on information sharing for patients incapacitated by opioids
The U.S. Department of Health & Human Services (HHS) has released new guidance on sharing patient health information when a patient may be in crisis and incapacitated, such as during an opioid overdose. The agency states that current Health Insurance Portability and Accountability Act (HIPAA) regulations allow healthcare providers to share information in certain situations, including:
Sharing health information with family and close friends who are involved in care of the patient if the provider determines that doing so is in the best interests of an incapacitated or unconscious patient and the information shared is directly related to the family or friends’ involvement in the patient’s healthcare or payment of care.
Informing persons in a position to prevent or lessen a serious and imminent threat to a patient’s health or safety.
HHS notes that HIPAA anticipates that a patient’s decision-making capacity may change during the course of treatment and recognizes a patient’s personal representatives as determined by state law.
Some participants find positive results in CJR participation
Two recent articles explore positive impacts experienced by some providers participating in the Medicare Comprehensive Care for Joint Replacement (CJR) program. An article in Modern Healthcare notes that 47.8 of participants received gain-sharing payments for meeting cost and quality targets from April 1, 2016, to Dec. 31, 2016, with gain-sharing payments and quality bonuses of $37.6 million for 33,152 episodes of care—a strong increase over the $11 million expected when the program was proposed.
The second article, in the Kansas City Business Journal, profiles two orthopedic practices that saw a 21 percent reduction in the average cost of joint arthroplasty procedures under the program, and a medical group that reported a 27 percent reduction in hospital readmission rates, a 43 percent reduction in surgical site infection, and a 72 percent reduction in deep vein thrombosis.
The American Association of Orthopaedic Surgeons (AAOS) supports the efforts of all stakeholders to develop payment models that incentivize care coordination and address rising healthcare costs. However, it has criticized the mandatory nature of the CJR program.
Study: T-scale value linked to outcomes for large to massive full-thickness rotator cuff tears
According to a study published online in the Journal of Shoulder and Elbow Surgery, negative T-scale value may predict poorer clinical outcomes and higher retear rates for certain patients with full-thickness rotator cuff tears. The researchers reviewed data on 120 consecutive patients undergoing primary rotator cuff repair and found that preoperative T-scale correlated significantly with postoperative forward elevation and clinical scores for patients with large to massive tears but not among patients with small to medium tears. Overall, the relative risk of retear was 2.0 to 7.9 times greater for patients with negative T-scale values.
Study: Conserving muscle mass may help preserve function for non-obese OA patients
Findings from a study published online in the journal Seminars in Arthritis and Rheumatism suggest that conserving muscle mass could have functional and antalgic benefits for certain patients with knee and hip osteoarthritis (OA). The authors conducted a cross-sectional study of 358 patients participating in the Knee and Hip OsteoArthritis Long-term assessment cohort. They found that low lean mass and appendicular lean mass divided by body mass index (ALM/BMI) were associated with impaired quality of life and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores on bivariate analysis but not on multivariate analysis after adjustment for fat mass index. Among patients with normal BMI, WOMAC scores were higher and SF-36 physical component score was lower for patients with low lean mass compared to those with normal body composition. Among patients with obesity, low lean mass displayed no additional effect.
Study: Minimally invasive screw fixation may be appropriate for certain elderly patients with odontoid fracture
A small study published online in the journal Spine suggests that percutaneous transarticular atlantoaxial screw fixation may be an effective, minimally invasive operative treatment for elderly patients with odontoid fracture and multiple morbidities. Members of the research team conducted a prospective study of 20 multimorbid patients older than 65 years who underwent minimally invasive surgical treatment for odontoid fracture type II. At 18-month follow-up, they found that fracture healing had occurred in 15 patients (88.2 percent), and revision surgery was not necessary in any patient. At final follow-up, the researchers noted that mean visual analog scale was 2.4, and mean patient satisfaction score was 7.1. Three patients died within 3 months of surgery.
Still time for Medicare providers to meet minimal reporting requirements and avoid 2019 payment penalty
The California Medical Association is reminding providers that they need only report on one quality measure for one patient during 2017 in order to avoid a Medicare payment penalty in 2019. Providers that submit 90 days of 2017 data to Medicare may earn a neutral or small positive payment adjustment during 2019 under the Merit-Based Incentive-Payment System (MIPS) track of the Medicare Access and CHIP Reauthorization Act (MACRA). However, practices can begin data collection as late as Dec. 31, 2017, to submit a minimum amount of data and still avoid a payment penalty in 2019. In 2019, the U.S. Centers for Medicare & Medicaid Services will cut Medicare pay 4 percent for providers who do not submit any 2017 MIPS data.
Call for volunteers: Research Development Committee
Dec. 15, 2017, is the last day to submit your application for a position on the Research Development Committee (two member openings). This committee promotes oversees the annual research symposia, the Kappa Delta orthopaedic research awards, the Clinician Scholar Career Development Program, and the Unified Orthopaedic Research Agenda as well as serves as the AAOS liaison group to the National Institutes of Health. Applicants for this position must be active fellows or associate members—basic science.
