Today’s Top Story

There’s still time to participate in the SGR “virtual lobby day!”
Today, Feb. 4, the American Association of Orthopaedic Surgeons (AAOS) is asking members to participate in a “virtual lobby day” to advocate for a permanent fix to the SGR. To participate, please call your member of Congress or visit the AAOS SGR information page to send an email or tweet. In addition, you can post your own messages to Twitter using the hashtag #FixSGR. Read more…
Visit the AAOS SGR information page…
Follow the AAOS office of government relations on Twitter…

Other News

Study: SSI may be most common factor leading to readmission after surgery.
Data published in the Feb. 3 issue of The Journal of the American Medical Association (JAMA) suggest that surgical site infection (SSI) may be the most common cause for readmission after a surgical procedure. The researchers reviewed data on 498,875 surgical procedures across 346 hospitals in the United States. Overall, the unplanned readmission rate was 5.7 percent. The researchers found that the most common reason for unplanned readmission was SSI (19.5 percent overall, 18.8 percent of arthroplasty procedures). Only 2.3 percent of patients were readmitted for the same complication they had experienced during their index hospitalization, and only 3.3 percent of patients readmitted for SSIs had experienced an SSI during their index hospitalization. The researchers noted that early (≤7 days post-discharge) and late (>7 days post-discharge) readmissions were associated with the same three most common reasons: SSI, ileus or obstruction, and bleeding. Patient comorbidities, index surgical admission complications, non-home discharge, teaching hospital status, and higher surgical volume were also associated with a higher risk of readmission. Read more…
Read the abstract…

Study: No significant difference found in long-term mortality between two blood transfusion methods for severely injured trauma patients.
A study published in the Feb. 3 issue of JAMA examines a relationship between plasma/platelet/red blood cell ratio and mortality for patients with severe trauma. The authors conducted a pragmatic, randomized clinical trial of 680 severely injured patients across 12 level 1 trauma centers in North America. Patients were given plasma/platelet/red blood ratios of 1:1:1 (n = 338) or 1:1:2 (n = 342). No significant differences in mortality at 24 hours or 30 days were found. However, more patients in the 1:1:1 group achieved hemostasis and fewer experienced death due to exsanguination by 24 hours. The authors did note an increased use of plasma and platelets transfused in the 1:1:1 group, but identified no other safety differences between the two cohorts. Read more…
Read the abstract…

Study: CMS standards for coverage determinations increased over 13 years.
According to a study published in the February issue of the journal Health Affairs, over a 13-year span, the U.S. Centers for Medicare & Medicaid Services (CMS) has raised the evidentiary bar for coverage of expensive medical items, services, treatment procedures, and technologies. The research team examined Medicare national coverage determinations and found that, after adjustment for strength of evidence and other factors known to influence the determinations, CMS was about 20 times more likely to deny coverage in recent years compared to earlier in the study period. In addition, coverage during the study period was increasingly and positively associated both with the degree of consistency of favorable findings in CMS-reviewed clinical evidence and with recommendations made in clinical guidelines. The research team writes that the rising evidence standards raise questions about patient access to new technologies. Read more…(registration may be required)
Read the abstract…

Are quality improvement programs helping to improve surgical outcomes?
Three studies published in the Feb. 3 issue of JAMA call into question the effect of quality improvement efforts on surgical outcomes. In the first, the authors looked at Medicare data on 1,226,479 patients undergoing general and vascular surgery at 263 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) and 526 nonparticipating hospitals. After accounting for patient factors and preexisting time trends toward improved outcomes, they found no statistically significant improvements in outcomes at 1, 2, or 3 years after enrollment in the program. The authors suggest that feedback on outcomes alone may not be sufficient to improve surgical outcomes. Read the abstract…
    In the second study, the authors reviewed data on 345,357 hospitalizations of patients for elective general or vascular procedures at academic hospitals in the United States, with 172,882 (50.1 percent) occurring in hospitals participating in the NSQIP. They found no association between hospital-based participation in the NSQIP and improvements in postoperative outcomes over time. The authors suggest that a surgical outcomes reporting system may not provide a clear mechanism for quality improvement. Read the abstract…
    The third study was a retrospective cohort study of 59,273 surgical procedures performed at 112 Department of Veterans Affairs hospitals. Researchers found that, although readmission is associated with complications, almost half of readmissions were not associated with a complication currently assessed by the Veterans Affairs Surgical Quality Improvement Program. Read the abstract…

White House budget proposal would cut $399 billion in HHS spending over 10 years.
According to The New York Times, President Obama’s proposed budget would, if adopted, reduce spending on Medicare, Medicaid, and other programs run by the U.S. Department of Health and Human Services (HHS) by $399 billion over the next decade. Among other things, the budget calls for a reduction in scheduled Medicare payments to teaching hospitals, many small rural hospitals, nursing homes, and health maintenance organizations, and a reduction in the projected growth of Medicare payments for graduate medical education by $16 billion over 10 years; savings of $116 billion in Medicare payments to drug companies for medicines prescribed for low-income patients are also anticipated. Other items in the budget include:

  • A surcharge on premiums for new beneficiaries who buy private insurance to supplement Medicare
  • A reduction in inflation updates for providers who care for Medicare beneficiaries after discharge
  • An increase in premiums for higher-income Medicare beneficiaries
  • A ban on deals between brand-name and prescription drug manufacturers to delay marketing of lower-cost generic medicines
  • A continuation of the Children’s Health Insurance Program through 2019

Read more…
View the budget proposal…

MedPAC supports much of ACO proposed rule, but argues for adjustments in the longer-term.
In a letter to the administrator of CMS, the U.S. Medicare Payment Advisory Commission (MedPAC) has commented on a proposed rule released by CMS in December. The agency supports several aspects of the proposed rule, which addresses the next phase of the Medicare Shared Savings Program (MSSP), including a CMS proposal to create a new Track 3 with prospective attribution of beneficiaries and two-sided risk, and a provision for regulatory relief to Track 3 accountable care organizations (ACOs) to provide for more innovative care management, as well as extension of the transition period for ACOs participating in the one-sided risk model. In the longer term, MedPAC argues that MSSP ACOs should have a common benchmark in a market and that benchmark should eventually be based on local fee-for-service spending rather than the individual ACO’s historical experience. “The MSSP is at a critical stage,” the authors write. “While many ACOs have joined the program and it has considerable momentum, issues about how to set benchmarks and other aspects of the program have become more apparent.” Read the letter (PDF)…
Read the CMS proposed rule…

Call for volunteers: Joint Commission Tobacco Treatment TAP.
AAOS seeks to nominate one member to participate as an ad hoc representative on the Joint Commission’s Tobacco Treatment Technical Advisory Panel (TAP) to discuss the use of U.S. Food and Drug Administration-approved tobacco cessation medications for surgical patients. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, 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 biosketch, 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. Please submit supporting materials to Kyle Shah by Thursday, Feb. 12, 2015 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)