Today’s Top Story
CMS releases bundled payment rule for hip and knee arthroplasty procedures.
Modern Healthcare reports that the U.S. Centers for Medicare & Medicaid Services (CMS) has finalized the rule for its Comprehensive Care for Joint Replacement payment model. Under the model, all eligible hospitals in the affected geographic areas will be accountable for all costs associated with hip and knee arthroplasty procedures, from the time of surgery through 90 days postoperative. CMS has scaled back the initiative from a proposed 75 geographic areas to 67, and moved the start date to April 1, 2016, from an anticipated Jan. 1, 2016. Read more…(registration may be required)
The proposed final rule is scheduled to be published in the Federal Register on Nov. 24, 2015. Read the rule (PDF)…
The American Association of Orthopaedic Surgeons (AAOS) submitted a number of comments to CMS prior to the release of the final rule, and will continue its efforts with CMS to further refine the program and address ongoing concerns. When available, the AAOS response statement will be posted to the AAOS Newsroom page. Read more…
Other News
IOM report addresses strategies to combat obesity.
The U.S. Institute of Medicine (IOM) has released a report based on a recent 2-day workshop on obesity. The report summarizes presentations and discussions from the workshop, looks at the state of the science regarding the impact of physical activity in the prevention and treatment of overweight and obesity, and highlights strategies to promote physical activity across different segments of the population. A PDF file of the report can be downloaded for free. Read more…
Study: Use of warfarin linked to slight increase in complications after hand and wrist surgery.
Data from a study published online in The Journal of Hand Surgery suggest that uninterrupted use of warfarin in patients who undergo surgery of the hand and wrist may be linked to an increased risk of bleeding complications that require reoperation. The research team conducted a prospective, matched cohort trial of 47 surgical patients who received uninterrupted warfarin (50 procedures) and 48 surgical patients (50 procedures) who were not prescribed warfarin. At 2-week follow-up, they found that 28 percent of patients receiving warfarin had hematomas, compared to 10 percent of patients in the control group. However, at 4 weeks, they found no significant difference between cohorts in hematoma presence or extent of ecchymosis. The research team notes that one procedure in a patient taking warfarin was complicated by hematoma requiring reoperation, and there were similar incidents among controls. Read the abstract…
Study: What factors may predict VTE risk after plaster casting of lower extremity?
A study conducted in the Netherlands and published online in the journal PLOS Medicine finds that information on environmental risk factors, coagulation factors, and genetic determinants may help predict risk of venous thromboembolism (VTE) among patients with plaster casts. The authors reviewed information on 4,446 patients who had experienced VTE and 6,118 controls. Overall, 230 patients had undergone plaster cast immobilization of the lower extremity. The authors used multivariate logistic regression to generate three models: a full prediction model (32 variables), a restricted model (minimum number of predictors with a maximum predictive value) and a clinical model (environmental risk factors only, no blood draw or assays required). They found that the full model produced an area under the curve (AUC) of 0.85 for individuals with plaster cast immobilization. The AUC for the restricted model was 0.84, and the clinical model resulted in an AUC of 0.77. The authors write that the clinical model may be preferred, “as its factors are most easy to determine.” Read the complete study…
Study: Women and men see similar functional outcomes after arthroscopy for FAI, despite differing baselines.
Findings published online in The American Journal of Sports Medicine suggest that men and women may see similar functional outcomes 2 years after arthroscopic surgery for femoroacetabular impingement (FAI). The researchers conducted a cohort study of 229 patients (68.4 percent women) who underwent arthroscopic hip surgery for unilateral symptomatic FAI. Prior to surgery, women reported poorer hip function compared to men on both the International Hip Outcome Tool (iHOT-33) and the Hip Outcome Score activities of daily living subscale (HOS-ADL). However, at 3-, 6-, 12-, and 24-month follow-up, there was no significant difference across sexes in either scale. In addition, the researchers note that both measures displayed significant improvement between the preoperative baseline and each of the four follow-up points. Read the abstract…
Study: History of AMI or stent may increase risk of AMI after TKA.
According to a study conducted in Taiwan and published online in the journal Clinical Orthopaedics and Related Research, the risk of acute myocardial infarction (AMI) remains high within 1 year after total knee arthroplasty (TKA) surgery among patients with a history of AMI or stent. The authors conducted a retrospective, matched cohort study of 4,826 patients who underwent TKA, 2,413 of whom had a history of AMI or coronary stent placement within 1 year prior to surgery and 2,413 of whom did not. They found that patients who had undergone AMI + stent were at the highest risk of AMI within 1 year following surgery (hazard ratio [HR], 5.23 compared to no history of AMI/stent), followed by AMI without stent (HR, 4.88), and stent alone (HR, 3.16). Among all patients, risk of AMI after TKA was not different than reference values after 1 year of initial AMI or stent. The authors suggest that elective TKA be performed at least 1 year after an episode of AMI or stent placement. Read the abstract…
Physician interaction offers “critically important” opportunity to identify elder abuse.
A review article published in the Nov. 12 issue of The New England Journal of Medicine examines the issue of elder abuse. “Elder abuse has a range of negative sequelae that extend well beyond the obvious traumatic injury and pain to which the victims may be subjected,” the writers note. They point out that victims of elder abuse may be at increased risk for death, placement in a nursing home, and hospitalization. “Because victims of elder abuse tend to be isolated, their interactions with physicians, which may be intermittent or rare, present critically important opportunities to recognize elder abuse and to intervene or refer the victims to appropriate providers,” they write. Read the complete article…
Call for volunteers: OKU Evaluation Committee.
Nov. 30 is the last day to submit your application for a position on the OKU Evaluation Committee (two member openings). The OKU Evaluation Committee develops and reviews the Orthopaedic Knowledge Update (OKU) self-assessment examination. The committee currently seeks two members to write basic science items. Applicants for this position must be active fellows, emeritus fellows, candidate members, or candidate member applicants for fellowship with broad orthopaedic practice experience. Learn more and submit your application…(member login required)
