Today’s Top Story
CJR takes effect; report suggests that many hospitals will be under pressure to control costs.
As of today, April 1, the U.S. Centers for Medicare & Medicaid Services (CMS) has implemented the Comprehensive Care for Joint Replacement (CJR) model. Under the initiative, all eligible hospitals in 67 select geographic areas are accountable for all costs associated with hip and knee arthroplasty procedures, from the time of surgery through 90 days postoperative. The Wall Street Journal notes that the bundled-payment initiative is the first mandatory program under a CMS plan to shift at least 50 percent of Medicare spending to alternative-payment models by 2018. Read more…
An analysis conducted by Avalere Health finds that episodes of care at 60 percent of CJR participant hospitals currently cost more than episodes at their regional peers—a factor that could subject those hospitals to penalties if they do not rein in total episodic costs. In addition, the company finds that 39 percent of total spending on hip and knee arthroplasty episodes is tied to post-discharge care, suggesting that hospitals may be penalized in part for healthcare spending after discharge. Read more…
Learn more about the CJR…
An article in the February issue of AAOS Now looks at the CJR and possible unintended consequences. Read more…(registration may be required)
Learn more about CMS payment systems from AAOS…
Other News
Study: Teriparatide may not decrease risk of revision surgery for femoral neck fracture patients.
Data from a study published in the May issue of the journal Clinical Orthopaedics and Related Research suggest that treatment with teriparatide may not decrease risk of revision surgery, improve radiographic signs of fracture healing, or decrease pain, compared with placebo for patients with femoral neck fracture. The authors conducted a prospective, randomized, double-blind, placebo-controlled trial of 157 patients treated with either subcutaneous teriparatide (20 µg/day; n = 78) or placebo (n = 79) for 6 months. At 12-month follow-up, they found no significant difference between cohorts in proportion of patients who underwent revision surgery, proportion of patients who achieved radiographic fracture healing, or in measures of pain control. During the 6-month treatment period, 49 percent of patients in the placebo group reported adverse events, compared to 45 percent in the teriparatide group. Read the abstract…
Studies look at effects of bisphosphonate therapy.
Several studies published in the April issue of the Journal of Orthopaedic Trauma examine effects of bisphosphonates on patients with atypical fractures. In the first study, the researchers reviewed data on patients who presented with either periprosthetic fracture or femoral fracture to one of 15 orthopaedic centers in the United States and Canada over a 10-year period. They found that bisphosphonate use was associated with clinically significant differences in time to union, mortality, and complications. Read the abstract…
In a second study, the researchers conducted a retrospective review of 179 patients who underwent surgical treatment of bisphosphonate-related fracture. At mean 17-month follow-up, they found a 12 percent surgical failure rate and delayed average time to union. In addition, 21 percent of patients experienced contralateral femur fractures within 2 years. Read more…
A third study looked at 32 patients with 43 fractures and an average duration of bisphosphonate therapy of 7.57 years. The researchers noted an increasing trend of atypical femur fractures, and write that bisphosphonate therapy beyond 7 years may place patients at increased risk. Read more…
Study: Precollegiate knee surgery associated with increased likelihood of later orthopaedic surgery.
According to data published online in The American Journal of Sports Medicine, athletes with a history of precollegiate knee surgery may be at increased risk of subsequent surgery during college. The research team conducted a cohort study of 1,141 athletes, 186 of whom (16.3 percent) had a history of precollegiate orthopaedic surgery. Overall, there were 261 documented intracollegiate orthopaedic surgeries across 181 athletes (15.9 percent). The research team found precollegiate knee surgery to be an independent predictor of any orthopaedic surgery in college. When examining only surgeries resulting from acute or primary injuries, they found precollegiate knee surgery to be an independent predictor of primary knee injury requiring surgery in college. In addition, athletes with a history of precollegiate surgery were more susceptible to subsequent surgery in their ipsilateral extremity compared with their other extremities. In contrast, the research team noted no additional risk of receiving subsequent surgery in the contralateral extremity. Read the abstract…
Study: Cumulative head impacts may increase risk of neurological symptoms.
Findings presented online in the Journal of Neurotrauma suggest that cumulative exposure to concussive and subconcussive events may increase risk for later neurological consequences. The authors reviewed data on 93 former high school and collegiate football players who had completed objective cognitive and self-reported behavioral/mood tests as part of a larger ongoing longitudinal study. The investigators derived a cumulative head impact index (CHII) for each participant based on self-reported athletic history and impact frequencies reported in helmet accelerometer studies. The authors noted a threshold dose-response relationship between CHII and risk for later-life cognitive impairment, self-reported executive dysfunction, depression, apathy, and behavioral dysregulation. They state that overall, CHII demonstrated greater predictive validity relative to other individual exposure metrics. Read more…
Read the abstract…
Vote now! AAOS 2017 Nominating Committee, seven resolutions, and two bylaw amendments.
Voting has begun to elect the six members of the 2017 Nominating Committee and to determine action on seven AAOS resolutions and two bylaw amendments. Online voting is quick, secure, and confidential. For the resolutions and bylaw amendments, at least five percent of the total fellowship must cast ballots for the voting to be valid. Ballots must be submitted by Friday, April 29, 2016. If you have questions, please contact the AAOS Voting Hotline, at 800-999-2939. The ballot is available at: Read more…(member login required)
Please complete your 2016 AAOS Orthopaedic Surgeon Census now!
AAOS is asking all members to participate in the AAOS 2016 census of orthopaedic surgeons. The census is taken to ensure that AAOS members are accurately represented in advocacy, funding, and reimbursement efforts. The information also helps AAOS tailor programs, products, and services to address professional needs and interests of its members. All individual responses are kept confidential. Watch your email or postal mail for your census form. In addition, this year, AAOS is holding a census contest, with prizes awarded to the states with the highest per capita level of participation! Read more…
For further information, please contact the AAOS research department, at: aaosresearch@aaos.org
View the report from the 2014 census…
April AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the April issue of AAOS Now, but the online edition is already available on the AAOS Now website. This month’s issue includes an introduction to AAOS President Gerald R. Williams Jr, MD, an overview of new AAOS public relations campaigns, a discussion of integrated practice units in orthopaedics, and much more! Read more…
Read “Gerald R. Williams Jr, MD, Takes the Helm”…
Read “Academy to Public: When You’re on Your Feet, Stay on Your Toes”…
Read “The Role of Integrated Practice Units in the Treatment of Musculoskeletal Conditions”…
