Today’s Top Story
IOM report argues for improvements in medical diagnosis.
According to a report from the Institute of Medicine, during their lifetimes, most people will experience at least one diagnostic error in the form of an inaccurate or delayed diagnosis. The writers note that efforts to improve diagnoses and reduce diagnostic errors have been quite limited, and that making a diagnosis is a collaborative and inherently inexact process that may unfold over time and across different healthcare settings. Based on available evidence, the writers state that diagnostic errors stem from a wide variety of causes, including the following:

  • Inadequate collaboration and communication among clinicians, patients, and their families
  • A healthcare work system ill-designed to support the diagnostic process
  • Limited feedback to clinicians about the accuracy of diagnoses
  • A culture that discourages transparency and disclosure of diagnostic errors, which impedes attempts to learn and improve

“Without a dedicated focus on improving diagnosis,” the writers note, “these errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity.” Read more…
Download the complete report…(registration may be required)

Other News

FDA cautions against use of pain reliever tramadol for pediatric patients.
The U.S. Food and Drug Administration (FDA) has announced an investigation into the use of tramadol in children aged 17 years and younger, due to a rare but serious risk of slowed or difficult breathing. Tramadol is not FDA-approved for use in children; however, the agency notes that it is often used “off-label” in the pediatric population. FDA states that healthcare professionals should be aware of this side effect and consider prescribing alternative FDA-approved pain medicines for children. The agency states that if parents and caregivers of children taking tramadol notice any signs of slow or shallow breathing, difficult or noisy breathing, confusion, or unusual sleepiness, they should stop giving the child tramadol and seek immediate medical attention for the child by taking him or her to the emergency room or calling 911. The agency also recommends that caregivers talk with their child’s healthcare professional if they have any questions or concerns about tramadol or other pain medicines the child is taking. Read more…

CMS updates guidance on ICD-10 flexibilities.
The U.S. Centers for Medicare & Medicaid Services (CMS) has updated its guidance document regarding ICD-10 flexibilities. Among other things, the document includes the following section:

How does the CMS 24-month look-back period for Medicare fee-for-service audits intersect with the 12-month period of audit flexibility? Will the auditors review and deny claims from the October 2015-October 2016 period for ICD-10 code specificity after October 2016?

Contractors conducting medical review (Medicare Administrative Contractors/Recovery Auditors/Supplemental Medical Review Contractor) will not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of potential fraud. This is consistent with current medical review policies and is not applicable to prepayment denials because of a National Coverage Determination or a Local Coverage Determination. Learn more about the ICD-10 transition…
View the guidance document (PDF)…
Find more resources from the AAOS…(member login required)

Study: What are the risk factors for VTE after ACL reconstruction?
A study published online in The American Journal of Sports Medicine attempts to assess risk factors for venous thromboembolism (VTE) after anterior cruciate ligament (ACL) reconstruction. The authors conducted a descriptive epidemiologic study of 16,558 ACL reconstructions performed on 15,767 patients. They noted a total of 87 VTE events—55 deep venous thrombosis (DVT) and 35 pulmonary embolism (PE), with three patients documented with both DVT and PE. The authors found that patient age of 35 years or older was associated with increased likelihood of VTE, that a history of nicotine was linked to an increased likelihood of DVT, and that concomitant high tibial osteotomy increased the likelihood of PE. Concomitant posterior cruciate ligament reconstruction was linked to increased likelihood of VTE and DVT, while nonsteroidal drug use was associated with decreased odds of both VTE and DVT. Use of anticoagulants was associated with increased risk of VTE, DVT, and PE. The researchers found no detectible difference in risk of VTE for patient sex, body mass index, or aspirin or cyclooxygenase-2 inhibitor use. Read the abstract…

Study: Shift to reference-based benefits linked to increased use of ASCs.
Findings published in the Sept. 16 issue of The Journal of Bone & Joint Surgery suggest that a shift to reference-based benefits may drive consumers to increased use of ambulatory surgery centers (ASCs). The research team reviewed data on 3,962 patients who underwent arthroscopy of the knee or shoulder prior to the implementation of reference-based benefits by the California Public Employees’ Retirement System, 2,505 who underwent arthroscopy after implementation, and 57,791 arthroscopy patients who were not subject to reference-based benefits. They found that, by the second year of the program, the shift to reference-based benefits was associated with an increase in the utilization of ASCs by 14.3 percentage points for knee arthroscopy and by 9.9 percentage points for shoulder arthroscopy, along with a corresponding decrease in the use of hospital-based facilities. The shift was not linked to a change in the rate of surgical complications. Read the abstract…

Study: Implementation of Pioneer ACO program linked to reductions in use of “low-value” services.
According to a data published online in the journal JAMA Internal Medicine, implementation of a Medicare accountable care organization (ACO) program was associated with modest reductions in low-value services, with greater reductions for organizations that initially provided higher amounts of more low-value care. The researchers compared the use of 31 services determined to provide low clinical benefit for two groups—Medicare fee-for-service beneficiaries among healthcare provider groups that entered the Pioneer ACO program and beneficiaries attributed to other healthcare providers—before and after the 2012 implementation of the program. They found that, during the pre-contract period, trends in the use of low-value services were similar for both ACO and control groups. However, the first year of ACO contracts was associated with a differential reduction of 0.8 low-value services per 100 beneficiaries for the ACO group, corresponding to a 1.9 percent differential reduction in service quantity and a 4.5 percent differential reduction in spending on low-value services. Further, the researchers noted that ACOs that exceeded mean baseline levels of low-value service use in their area experienced greater service reductions than did ACOs that were below the mean. Read the abstract…

California.
Modern Healthcare reports that the California Department of Insurance and Consumer Reports have launched an online tool for consumers to compare price and quality information for healthcare providers. The California Healthcare Compare website allows consumers to search for the average price of about 100 common medical procedures and conditions, including hip and knee arthroplasty and back pain. The data include the average price as well as price range based on county, including the total amount paid to providers, the amount insurance pays, and the amount that an insured patient would be expected to pay.Consumers also can search for procedures by hospital, which will present average total price providers receive in that area, but not provider-specific data. Read more…(registration may be required)
View the California Healthcare Compare website…

AAOS video series highlights dangers of distracted walking.
AAOS has announced the availability of its “No Small Distractions” video series, which uses absurdity to illustrate the dangers of distracted walking. Since 2011, the AAOS Decide to Drive campaign has sought to minimize distracted driving- and walking-related crash injuries. Join the social media conversation by sharing the video links using the hashtags #NoSmallDistractions and #DecidetoDrive on Facebook, Twitter, and Instagram. View all Decide to Drive videos…