February 23, 2018 | Today’s News

Federal economic report notes challenges in healthcare industry

The White House released its February 2018 Economic Report of the President, which includes The Annual Report of the Council of Economic Advisers. Among other things, the report states that:

• Burdens from measures reporting initiatives have contributed to healthcare provider consolidation.
• Many solo providers and small physicians’ groups cannot afford to purchase and maintain electronic health records to comply with government reporting requirements.
• Prescription drug monitoring program databases have had “some success in limiting prescription opioid diversion and abuse,” although some patients have turned to heroin as an alternative.

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Study: Aspirin and rivaroxaban may offer similar VTE outcomes after THA and TKA

Data from a study published in the Feb. 22 issue of The New England Journal of Medicine suggest that extended prophylaxis with aspirin may not significantly differ from rivaroxaban for the prevention of symptomatic venous thromboembolism (VTE) following primary total joint arthroplasty. The authors conducted a multicenter, double-blind, randomized, controlled trial of 3,424 total hip arthroplasty (THA; n = 1,804) and total knee arthroplasty (TKA; n = 1,620) patients. All patients received once-daily oral rivaroxaban (10 mg) until postoperative day 5 and then were randomly assigned to continue rivaroxaban or switch to aspirin (81 mg daily) for an additional 30 days after THA or for 9 days after TKA. After 90 days, they found that VTE had occurred in 11 of 1,707 patients (0.64 percent) in the aspirin group and in 12 of 1,717 patients (0.70 percent) in the rivaroxaban group, while major bleeding complications had occurred in eight patients (0.47 percent) in the aspirin group and five patients (0.29 percent) in the rivaroxaban group. Further, clinically important bleeding occurred in 22 patients (1.29 percent) in the aspirin group and in 17 (0.99 percent) in the rivaroxaban group.

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A study published in the March issue of the Journal of Orthopaedic Trauma suggests that early surgery may linked to reduced risk of mortality for older hip fracture patients. The researchers reviewed data on 720 hip fracture surgery patients aged 66 years or older and found that 159 (22 percent) died within 1 year. They noted a linear relationship between surgical timing and 1-year mortality; each 10-hour delay in surgery was significantly associated with a 5 percent increase in 1-year mortality. The researchers suggest that hip fractures be treated urgently in a manner similar to other time-sensitive pathologies such as stroke and myocardial ischemia.

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Findings from a study published in the March issue of the Journal of Pediatric Orthopaedics suggest that increases in the length of magnetically controlled growing rods (MCGRs) may often be lower than programmed for children with early onset scoliosis. The researchers conducted a retrospective chart review of 31 patients (18 male, 13 female) with an average age of 8.1 years old and major curves at time of MCGR insertion. They found that the average total length increase relative to the programmed distraction was 86 percent. Length increases for patients with and without prior surgery were 87 percent and 86 percent, respectively. The researchers note that greater distance between the rod and the skin surface negatively affected the magnitude of distraction; the decrease in lengthening achieved was 2.1 percent/mm of tissue depth.

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A study published in the Feb. 21 issue of The Journal of Bone & Joint Surgery suggests that bundled payment proposals such as the canceled Medicare Surgical Hip and Femur Fracture Treatment (SHFFT) model should adopt robust risk-adjustment methods to ensure fair provider reimbursement and continued patient access to care. Members of the research team reviewed a 5 percent random sample of Medicare data from 2008 to 2012 and identified 27,898 patients who met SHFFT inclusion criteria. They found that most comorbidities were associated with higher reimbursement, but dementia was associated with an average decrease in payment of $2,354. In addition, diagnosis related groups (DRGs) showed significant differences in reimbursement (DRG 480 was reimbursed by an average of $10,421 more than DRG 482), and payments varied significantly by state. The researchers write that risk adjustment that incorporated specific comorbidities demonstrated better performance than use of DRG alone.

The American Association of Orthopaedic Surgeons notes that the U.S. Centers for Medicare & Medicaid Services withdrew the SHFFT model in 2017.

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Florida

Healthcare IT News reports that the Florida House of Representatives Appropriations Subcommittee on Health and Human Services has unanimously approved a bill that, if enacted, would require providers to check the state’s prescription drug monitoring program database before prescribing opioids. The bill would also limit most initial opioid prescriptions to 3 days, but the bill would also allow up to 7 days for acute pain exceptions. In addition, all healthcare professionals would be required to participate in a statewide database that would monitor their prescribing habits and complete a board-approved 2-hour continuing education course on safe prescribing of controlled substances.

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Call for volunteers: Health Care Systems Committee

June 1, 2018, is the last day to submit your application for a position on the Health Care Systems Committee (one member-at-large opening). This committee helps orthopaedic surgeons develop and improve relationships with other healthcare stakeholders, including other providers, the federal government, private and public payers, and patient groups. Applicants for this position must be active fellows with an interest in and knowledge of healthcare system mechanisms, payment, and policies.

Learn more and submit your application…  (member login required)