Today’s Top Story
Study: RAC audits increase even as hospitals win more challenges.
Information published in the April issue of the Journal of Hospital Medicine suggests a need for reform of the Medicare Recovery Audit Contractor (RAC) program. The research team reviewed RAC activity at three academic medical centers from 2010 to 2013. Among 101,862 inpatient Medicare encounters, they found that RACs audited 8,110 (8.0 percent), alleging overpayment in 31.3 percent (n = 2,536). Overall, hospitals disputed 91.0 percent (n = 2,309) of alleged overpayments. The research team noted a nearly 3-fold increase in RAC overpayment determinations over a 2-year period, despite the fact that hospitals contested and won a larger percent of cases each year. In addition, no overpayment determinations contested the need for care delivered, only that the care should have been delivered under outpatient—not inpatient—status. Read more…
Read the abstract…
Other News
Study: Younger age, higher activity level, and allograft graft type may affect odds of ACL retear.
A study published online in The American Journal of Sports Medicine examines factors that may be linked to anterior cruciate ligament (ACL) reinjury. The authors analyzed data on 2,683 participants in the Multicenter Orthopaedic Outcomes Network study. All patients had undergone primary ACL repair, had no history of contralateral knee surgery, and had a minimum of 2-year follow-up data. Researchers found that the likelihood of ipsilateral ACL retear was 5.2 times greater for an allograft compared to bone–patellar tendon–bone (BTB) autograft, but the odds of retear were not significantly different between BTB autograft and hamstring autograft. The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age, and increased by 0.11 for every increased point in Marx score. The authors noted that likelihood of retear was not significantly influenced by sex, smoking status, sport played, medial or lateral meniscal tear, or consortium site. The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age (P = 0.04) and increased by 0.12 for every increased point on the Marx score. Read more…
Study: Collagenase treatment may offer clinical improvement to patients with Dupuytren PIP joint contracture.
Findings published in the May issue of The Journal of Hand Surgery suggest that the use of collagenase clostridium histolyticum (CCH) may be effective for the treatment of Dupuytren proximal interphalangeal (PIP) joint contracture. The authors reviewed data from four phase 3 clinical trials covering 506 adult patients. They found that one injection of CCH was associated with clinical success in 27 percent of PIP joints, and clinical improvement in 49 percent. Overall, 60 percent of patients received one injection; 24 percent received two; 16 percent, three; and 1 percent, four. Final injection was associated with clinical success in 34 percent of patients and clinical improvement among 58 percent. Most common adverse events included peripheral edema (58 percent of patients), contusion (38 percent), injection site hemorrhage (23 percent), injection site pain (21 percent), injection site swelling (16 percent), and tenderness (13 percent), and there were two tendon ruptures. However, no further ruptures occurred after adoption of a modified injection technique. Read more…
Who is responsible for maintaining patient safety when new technology is introduced?
A perspective piece in the April 7 issue of The Journal of the American Medical Association argues that the introduction of new technologies opens the door to a potential “blind spot” in the credentialing and privileging of surgeons. The U.S. Food and Drug Administration (FDA) “exerts minimal oversight for new devices and no oversight for new surgical techniques,” the writers note, yet the responsibility for the safe introduction of new devices and techniques is less clearly defined. The writers cite the example of a lawsuit involving the introduction of a robotic surgery system, in which the surgeon received just one day of hands-on training at the manufacturer’s headquarters along with proctoring on two robotic cases by a more experienced surgeon. In a medical liability suit, the plaintiffs argued that the manufacturer had failed to provide the attending surgeon with sufficient training and oversight to properly perform the operation. However, a jury ruled in favor of the defense, and the case has been appealed. The writers state that the case “highlights the importance of hospitals’ credentialing and privileging mechanisms for maintaining the quality and safety of surgical care,” and argue that “strengthening hospitals’ credentialing and privileging for new procedures should be a high-yield target for improving patient safety.” Read more…
Despite concerns, Medicaid systems in 33 states list methadone as a “preferred drug.”
An article on the Pew Charitable Trusts website notes that, in 33 states, the state’s Medicaid system lists methadone as a “preferred drug,” despite the fact that the federal government has issued warnings about its use for nearly a decade and methadone overdose is implicated in about 5,000 deaths each year. If a drug is not on a Medicaid preferred list, physicians must explain why they are prescribing it before the prescription can be filled and paid for by a state’s Medicaid system. According to the U.S. Centers for Disease Control and Prevention, methadone represents only 2 percent of all opiate painkillers prescribed in the United States, but the drug is involved in about one of every three accidental overdose deaths. Read more…
The American Pain Society and other organizations have issued a clinical practice guideline on the use of methadone. Read more…
New York.
According to Lexology, the New York State Department of Health’s Office of Professional Medical Conduct (OPMC) has begun enforcing an often-ignored legal requirement that requires physicians in that state to maintain a regularly updated profile on the New York State Physician Profile website. “Although at present a failure to comply with the law is most likely to come to light only in the context of an OPMC investigation of the physician for other reasons,” the publication notes, “two OPMC representatives confirmed on April 20 that the initiative was being taken seriously and would be expanded.” Read more…
Visit the Physician Profile website…
Call for volunteers to help develop AUC on Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.
The Appropriate Use Criteria (AUC) Section seeks AAOS fellows to participate on the writing panel of the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures AUC. The writing panel is responsible for constructing a comprehensive patient factors list and a treatment list for implant infections in patients resulting from undergoing dental procedures. Writing panel members will be required to construct and review materials, correspond with AAOS staff electronically, and participate in approximately 5 to 10 conference calls, spanning 1 to 3 months, to produce the AUC materials. Applicants should have experience in treating patients for implant infections resulting from undergoing dental procedures, and will be required to complete the online AAOS conflict of interest enhanced disclosure form. To participate, please contact Erica Linskey by Monday, May 18, 2015, at: linskey@aaos.org
Nominate a colleague for the Diversity, Humanitarian, or Tipton Leadership Award!
June 12, 2015 is the last day to submit nominations for the 2016 Humanitarian and Diversity Awards, and the William W. Tipton Jr., MD, Orthopaedic Leadership Award. These awards are presented annually at the AAOS Annual Meeting. Each award recipient is recognized for his or her endeavors to further encourage diversity or culturally competent care, humanitarian activities, or leadership activities in the orthopaedic profession. Read more…
