Today’s Top Story
Senate passes bill to repeal bulk of ACA.
The U.S. Senate by a vote of 52-47 passed the “Restoring America’s Healthcare Freedom Reconciliation Act,” which if enacted, would dismantle much of the Affordable Care Act (ACA). The bill was passed through the budget reconciliation process, and so required only 51 votes instead of the usual filibuster-proof 60. Among other things, the bill would do the following:

  • Eliminate the individual and employer health insurance mandates
  • Reverse the expansion of state Medicaid programs after a 2-year transition period
  • Repeal certain taxes, including those on medical devices and prescription drugs
  • Move money that would remain unspent after enactment of the bill to the Medicare Trust Fund

The bill now returns to the U.S. House of Representatives, where it is expected to pass. President Obama has already pledged to veto the measure. Read more…

Other News

Report: Per-capita spending on health care increased by 4.5 percent during 2014.
Data released by the U.S. Centers for Medicare & Medicaid Services (CMS) finds that per-capita spending on health care in the United States increased by 4.5 percent during 2014, while overall health spending grew by 5.3 percent. CMS notes that healthcare spending grew 1.2 percentage points faster than the overall economy in 2014, resulting in a 0.2 percentage-point increase in the health spending share of gross domestic product, from 17.3 percent to 17.5 percent. The report states that the increase in spending growth was driven primarily by an expansion of coverage under the ACA and a rise in prescription drug costs. Read more…
Read the abstract as published in Health Affairs…

Study: IM and extramedullary hip screw may offer similar clinical outcomes for patients with AO/OTA Type-A2 intertrochanteric fracture.
Findings from a study conducted in Canada and published in the Dec. 2 issue of The Journal of Bone & Joint Surgery suggest that use of an intramedullary device (IM) for the management of intertrochanteric fracture may be associated with improved radiographic outcomes, but not improved functional outcomes. The authors conducted a prospective, randomized, multicenter study of 167 patients aged 55 years or older who sustained an isolated AO/OTA Type-A2 intertrochanteric fracture and who were treated with either an IM device (n = 87) or a traditional extramedullary hip screw (n = 80). At 12-month follow-up, they found no significant difference between cohorts in either primary (Lower Extremity Measure) or secondary (Functional Independence Measure, timed “Up & Go” test, or timed 2-minute walk test) clinical outcomes. However, they do note that radiographic parameters favored the IM cohort, which displayed less femoral neck shortening. Read the abstract…

Study: Worsening lesion status may predict higher risk of knee OA.
According to a study published online in the journal Annals of the Rheumatic Diseases, worsening lesion status as determined via magnetic resonance imaging (MRI) may predict a significantly higher risk of developing knee osteoarthritis (OA) or painful symptoms for patients with at-risk knees. The researchers used MRI to assess cartilage damage, bone marrow lesions (BMLs), and menisci at 12 months (baseline) and 48 months for 849 participants in the Osteoarthritis Initiative who had been determined to be Kellgren-Lawrence Grade-0 in both knees. They found that from baseline to 48-month status, worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs was associated with concurrent incident radiographic OA and subsequent persistent symptoms. The researchers write that the findings suggest that such lesions may represent early stages of OA. Read more…
Read the abstract…

Study: Hip pain and radiographic OA may not correlate.
Data from a study published online in the journal The BMJ suggest that hip pain and radiographic OA may not correlate in some patients. The research team assessed pelvic radiographs for hip OA among two cohorts: the Framingham Osteoarthritis Study and the Osteoarthritis Initiative. They found that in the Framingham study (n = 946), 15.6 percent of hips in patients with frequent hip pain displayed radiographic evidence of hip OA, while 20.7 percent of hips with radiographic hip OA were frequently painful. In the Osteoarthritis Initiative study (n = 4,366), 9.1 percent of hips in patients with frequent pain displayed radiographic hip OA, and 23.8 percent of hips with radiographic hip OA were frequently painful. The research team writes that hip pain was not present in many hips with radiographic OA, and many painful hips did not show radiographic hip OA. Thus, the evidence suggests that in many cases, hip OA might be missed if diagnosticians rely solely on hip radiographs. Read the abstract…

California.
A blog post on the California Medical Association website notes that a state law designed to require timely updates to insurer provider directories includes an obligation for providers to keep their information up-to-date. Among other things, the law will require providers to take the following steps:

  • Notify plans and insurers within 5 business days if they are no longer accepting new patients
  • Respond to plan and insurer notifications regarding the accuracy of information in the provider directory
  • Direct patients to the plan or insurer to find a new provider if the provider is not accepting new patients, or to the regulator to report a directory inaccuracy

The new law is scheduled to take effect July 1, 2016. Read more…

Academy issues new CPG on Surgical Management of Osteoarthritis of the Knee, three AUC (OCD knee and hip fractures in the elderly).
The AAOS Board has approved a new Clinical Practice Guideline (CPG) covering Surgical Management of Osteoarthritis of the Knee (SMOAK), along with three Appropriate Use Criteria (AUC), two for treatment and postoperative management for elderly patients with hip fractures, and one for young patients with osteochondritis dissecans of the femoral condyle (OCD). The CPG provides 14 recommendations backed by strong-quality evidence and 14 more by moderate evidence—a reflection of the continually expanding base of high-quality evidence in orthopaedics. According to David Jevsevar, MD, MBA, chair of the Committee on Evidence-Based Quality and Value (EBQV), the new CPG, “is a compendium of the best evidence that exists for patients undergoing knee replacement that physicians can use to guide their practice.” The AUC derive from existing CPGs, and reflect available best evidence and expert opinion. The online AUC apps feature algorithm-style applications that aid physicians in diagnosis and treatment decisions. “By plugging in the patient’s circumstances, you can see exactly where the evidence meets the expert recommendation,” says Robert Quinn, MD, AUC section leader for EBQV. The hip fracture AUC are accompanied by preoperative and prevention checklists. View the CPG “Surgical Management of Osteoarthritis of the Knee”…
View the AUC, “Diagnosis and Treatment of Osteochondritis Dissecans”…
View the AUC, “Hip Fractures for Elderly Patients: Treatment”…
View the AUC, “Hip Fractures for Elderly Patients: Postoperative/Rehabilitation”…

Last call: 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)