Today’s Top Story
CMS releases final 2016 Medicare payment rules for physicians and other providers.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued the final rule for the 2016 Physician Fee Schedule (PFS). Among other things, the rule initiates the Value-Based Payment Modifier, which provides for differential payments under the PFS to physicians, groups of physicians, and other eligible professionals based on quality and cost of care furnished under the traditional Medicare fee-for-service program. The rule also outlines the Medicare Shared Savings Program, which was established to promote accountability for a patient population, coordinate items and services under Medicare parts A and B, and encourage investment in infrastructure. Read more…
Read the CMS fact sheet…
Other News
CMS modifies “two-midnight” rule to allow for case-by-case exceptions.
Another CMS final rule released last week revises the exceptions policy for the so-called “two-midnight” rule. Under the two-midnight rule, an inpatient admission is generally appropriate for Medicare Part A payment if the practitioner admits the patient as an inpatient based upon the expectation that the patient will need hospital care that crosses at least two midnights. CMS plans to allow exceptions to the two-midnight benchmark to be determined on a case-by-case basis by the physician responsible for the care of the beneficiary, subject to medical review. However, the agency states that stays of less than 24 hours should rarely qualify for an exception to the two-midnight benchmark. An article in Modern Healthcare notes that the rule was implemented to correct a spike in observation stays after hospitals feared Medicare audit contractors would challenge admissions. Read more…(registration may be required)
Read the rule (PDF)…
WSJ: CMS to limit claims reviewed by RACs.
According to The Wall Street Journal (WSJ), CMS plans to sharply reduce the number of claims recovery audit contractors (RACs) can review. A spokesperson for the agency states that the changes are based on feedback received from stakeholders. Starting in January, RACs will be able to review only 0.5 percent of claims the agency pays to each hospital or provider every 45 days. The prior threshold was 2.0 percent of claims. Read more…(paid subscription required)
Study: What factors are associated with surgery for shoulder instability?
A study published online in the Orthopaedic Journal of Sports Medicine (OJSM) attempts to identify variables associated with surgical intervention among patients with shoulder instability. The researchers conducted a retrospective cohort study of 377 patients treated for shoulder instability. They found that, compared to patients treated nonsurgically, patients who had surgery tended to be younger, have recurrent instability, and have incurred their initial injury while playing a sport. The researchers stated that the surgically treated group also had a higher proportion of patients with posterior instability. However, severity of dislocation was not significantly associated with eventual surgery. The researchers write that imaging was not available for all patients, but note that surgical patients were more likely to have magnetic resonance imaging findings of anterior labral injury and less likely to have a supraspinatus or subscapularis tear than patients treated nonsurgically. Read the complete study…
Study: Training program for football coaches could reduce overall number of head impacts.
Findings from a study published online in OJSM suggest that training football coaches trained using the Heads Up Football (HUF) program may help reduce head impacts among youth football players during practice. The authors conducted a cohort study of 38 players from seven teams that participated in the HUF program and 32 players from eight teams that did not. Players were aged 8 to 15 years old, and head impact exposure was measured using accelerometers. Overall, players experienced 7,478 impacts that measured more than 10 g, of which 4,250 (56.8 percent) occurred in practices and 3,228 (43.2 percent) occurred during games. Based on the 10-g impact threshold, the mean number of impacts during practice per individual event was lower in the HUF group than in the non-HUF group. The authors state that changing the threshold to 20 g attenuated but did not eliminate the significant difference. There was no significant difference between cohorts in game-based impacts at either threshold. Read the complete study…
California.
The Los Angeles Times reports that the Medical Board of California has unanimously denied a petition requesting that body to require physicians who have been placed on probation by the board to disclose their probationary status to their patients. The board determined that the proposal was too broad and could damage the physician-patient relationship in cases in which physicians are placed on probation for minor violations. In response to the petition, the board agreed to create a new task force to investigate the issue and offer recommendations. Read more…
November AAOS Now is now available online and in ePub format!
AAOS members will soon receive the print edition of the November issue of AAOS Now, but the electronic editions are already available on the AAOS Now website. This month’s issue includes an article on new AAOS Appropriate Use Criteria on treatment of anterior cruciate ligament injury and injury prevention programs, a look at efforts to reduce opioid consumption, risk management advice for when patients want to record their conversations with physicians, and much more. Read more…
Read “Two New ACL AUC, Checklists Now Available”…
Read “Curbing Opioid Consumption: No Easy Task”…
Read “Physicians on Record–Without Their Knowledge”…
Download and read the ePub edition of AAOS Now…(member login required)
Call for volunteers: Committee on Evidence-Based Quality and Value.
Dec. 10 is the last day to submit your application for a position on the Committee on Evidence-Based Quality and Value (one section leader opening). This committee directs and evaluates evidence-based initiatives such as Clinical Practice Guidelines (CPGs) and Appropriate Use Criteria, and oversees related educational and implementation products. The CPG Section Leader spearheads initiatives that involve development and implementation of AAOS CPGs, and also serves as a member of the Council on Research and Quality. Applicants for this position must be active fellows with significant knowledge of evidence-based medicine methodology and process. Learn more and submit your application…(member login required)
