Today’s Top Story
Senate opposition could hinder passage of SGR repeal.
The U.S. Senate has reconvened, with 2 days remaining to consider legislation to repeal the Medicare Sustainable Growth Rate (SGR) formula. An article carried by Reuters notes that objections from some conservative lawmakers could derail a deal to quickly approve an SGR repeal bill passed 2 weeks ago by the U.S. House of Representatives. The writer notes that procedural rules in the Senate could result in considerable delay, even if only a minority of legislators objects to its passage. Some senators have stated opposition to the bill, as it would increase the federal deficit, at least in the short-term. Read more…
    The American Medical Association is offering a toll-free hotline for physicians to call their senators, at (800) 833-6354. In addition, AAOS members can email their senators through the AAOS legislative action center. Access the AAOS legislative action center…
Read more about the bill in AAOS Advocacy Now…

Other News

CMS issues proposed rule to simplify reporting under EHR incentive programs.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs that the agency says will reduce complexity, simplify reporting, and align meaningful use Stage 1 and Stage 2 objectives and measures with long-term proposals for Stage 3. Included among the proposed changes are the following:

  • A 90-day meaningful use reporting period in 2015
  • A reduction in the overall number of objectives to focus on advanced use of EHRs
  • Removal of measures that have become redundant, duplicative or have reached wide-spread adoption
  • Realignment of the reporting period so hospitals would participate on the calendar year instead of the fiscal year

The proposed rule is scheduled to be published in the April 15 Federal Register. CMS will accept public comments for 60 days following publication. Read more…
Read the complete rule (PDF)…

MedPAC recommends new limits on RACs.
The Medicare Payment Advisory Commission (MedPAC) has outlined a series of recommendations for changes to CMS rules that, according to HealthLeaders Media, could be included in proposed rules issued later this year. Among other things, MedPAC recommends that the U.S. Department of Health and Human Services take the following steps:

  • Direct recovery audit contractors (RACs) to focus on short inpatient stays in hospitals with the highest rates of this type of stay
  • Modify each RAC’s contingency fee based on its claim denial overturn rate
  • Ensure that the RAC look-back period is shorter than hospital’s rebilling period for resubmitting claims
  • Withdraw the “two-midnight” rule

In addition, MedPAC suggests that the U.S. Congress revise the 3-day inpatient day hospital eligibility requirement to allow for up to 2 outpatient observation days to count toward meeting the criteria. Read more…
Read the transcript of the meeting (PDF)…

Study highlights need for provider-patient communication about pain management in the ED.
Survey data published online in the journal Annals of Emergency Medicine suggest a need for improved communication in the emergency department (ED) between providers and patients regarding opioid risk and pain management options. The researchers interviewed 23 patients after discharge from a single urban, academic ED where they were seen for conditions such as acute pain related to fracture, musculoskeletal back injury, or renal colic. They found that, from patient perspectives, emergency physicians typically did not present alternative pain management options or discuss risks of opioid dependence. Overall, patients with negative experiences related to pain management described deficiencies in patient-provider communication that led to misunderstanding of clinical diagnoses, fragmentation of care among healthcare providers, and a desire to be involved in the decision making process regarding their pain management. Patients with positive experiences commented on regular communication with the care team, rapid pain management, and the empathetic nature of their care providers. Read more…
Read the abstract…

Study: Microdecompression, laminectomy may offer similar outcomes for central stenosis of the lumbar spine.
Findings from a study published online in the journal The BMJ suggests that, in the short-term, microdecompression may be equivalent to laminectomy for surgical treatment of central stenosis of the lumbar spine. The authors conducted a multicenter, observational study in Norway of prospectively collected data on 721 patients with central stenosis of the lumbar spine who underwent surgery in orthopaedic or neurosurgical departments. At 1-year follow-up, they found no significant difference between cohorts based on Oswestry disability index or quality of life. They noted that the number of patients with complications was higher in the laminectomy group and duration of surgery for single-level decompression was shorter in the microdecompression group, but after propensity matching, there was no significant difference between groups in either area. The authors did note that patients in the microdecompression group had shorter hospital stays, both for single-level decompression and two-level decompression. Read the abstract…

Study: Mental practice may help improve team response in trauma care.
According to a study published online in the Canadian Journal of Emergency Medicine, mental rehearsal of activity may help improve team-based skills in trauma care. The research team randomized 78 surgery, anaesthesiology, and emergency medicine residents to two-member teams who participated in either 20 minutes of mental practice (MP) or 20 minutes of Advanced Trauma Life Support (ATLS) training. All teams then participated in a high-fidelity, simulated adult trauma resuscitation and received debriefing on communication, leadership, and teamwork. They found that participants in the MP group outperformed the ATLS group with significant effect on teamwork behavior as assessed by two blinded observers. Read more…
Read the abstract…

Pennsylvania.
Healthcare providers who practiced in Pennsylvania during 2009, 2010, 2011, 2012, or 2014, may be eligible for a refund payment from the Mcare Fund. The refunds are required as a result of a 2014 settlement of litigation involving the Mcare Fund brought by the Pennsylvania Medical Society (PAMED) and other provider organizations. The settlement requires the Mcare Fund to refund $139 million for assessment overcharges in the listed years. The Mcare Fund will be mailing notices to eligible healthcare providers about their refunds, with the first round of payments tentatively scheduled for early 2016. PAMED states that providers who may be eligible for refunds should verify that their mailing addresses are up-to-date with the Pennsylvania physician licensing boards. Learn more about the refund process…

Call for volunteers: Quality Outcomes Data workgroup.
The AAOS Council on Research and Quality seeks a qualified candidate to participate as a member of the Quality Outcomes Data (QOD) workgroup. The QOD workgroup was established by the AAOS Board of Directors in March 2015, and has been tasked with evaluating data collection tools and investigating partnership opportunities for collection of quality data. The QOD work group will present their recommendations to the Council on Research and Quality. Applicants for this position must be active fellows and should have experience with implementation of outcomes measurement systems in clinical practice. Learn more and submit your application…(member login required)