Today’s Top Story
Study: Physicians spend more time on “desktop medicine,” less on face-to-face interaction.
A study published in the April issue of the journal Health Affairs suggests that over time physicians spend less time on face-to-face interaction with patients and more time working on computers. The researchers reviewed electronic health record (EHR) time stamp information from 471 primary care physicians from 2011 to 2014. They found that physicians logged an average of 3.08 hours on office visits and 3.17 hours on so-called “desktop medicine” each day, with desktop medicine defined as communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, reviewing test results, etc. Over time, the log records demonstrated a decline in the time allocated to face-to-face visits and an increase in time allocated to desktop medicine. Read more…
Read the abstract…

Other News

GAO: Medicare contractors should improve provider education efforts to reduce improper billing.
A report from the U.S. Government Accountability Office finds that Medicare administrative contractors (MACs) should strengthen provider education to reduce improper billing The agency examined the focus of MAC provider education departments and US. Centers for Medicare & Medicaid Services (CMS) oversight of those efforts, as well as the extent to which CMS measured their effectiveness. The writers found that CMS does not require MACs to educate providers who refer patients for durable medical equipment and home health services regarding proper billing documentation, nor does it explicitly require MACs to work together to provide this education. In addition, GAO found that CMS collects limited information about how education efforts focus on the areas MACs identify as vulnerable to improper billing. GAO recommends that CMS should do the following:

  • Increase detail in MAC reporting
  • Explicitly require MACs to work together to educate referring providers on proper documentation
  • Establish performance metrics for future reviews

Read the complete report…

Study: Radiographs may offer reliable approach to judge healing of knee OCD femoral condyle lesions.
Findings from a study published online in The American Journal of Sports Medicine suggest that plain radiographs may offer high reliability for judging overall healing of knee osteochondritis dissecans (OCD) femoral condyle lesions. The authors conducted a cohort study in which 10 orthopaedic sports surgeons rated the radiographic healing of 30 knee OCD lesions based on pretreatment and multiple time points to 24 months. Using a continuous scale, they found excellent interrater and intrarater reliability regarding overall healing of the OCD lesions from pretreatment to 2-year follow-up. In addition, they found reliability of five subfeatures of healing (OCD boundary, sclerosis, size, shape, and ossification) was also excellent. However, the authors note that use of a 7-tier ordinal scale rating of overall healing displayed lower interrater and intrarater reliability. Read the abstract…

Study: Lower dose of CT radiation may not negatively impact evaluation of articular fractures.
According to a study published online in the Journal of Orthopaedic Trauma, reducing the dose of computed tomography (CT) scans may not negatively affect evaluation of articular fractures. The research team conducted a cadaveric study of 11 adult distal tibia specimens with distal tibia fractures with varying displacements in two planes. Each specimen was scanned at three modified protocols and subsequently read by both qualified attending orthopaedists and mid-level residents. The research team found no significant difference in measurements in gap, pattern, and treatment plans between CT images acquired with standard (110 mAs), medium (60 mAs), and low protocols (45 mAs). In addition, they found no significant difference in measuring step-off across standard, medium, and low radiation doses. Read the abstract…

Study: What factors affect unplanned readmissions after hand and elbow surgery?
A study published in the April 5 issue of The Journal of Bone & Joint Surgery examines factors associated with unplanned readmission following outpatient hand and elbow surgery. The authors reviewed data on 4,106 outpatient hand or elbow surgery procedures from the American College of Surgeons National Surgical Quality Improvement Program database. They found that 169 (1.2 percent) were followed by an unplanned readmission within 30 days. Leading causes of readmission included postoperative infections (19.5 percent), pain (4.7 percent), thromboembolic events (4.1 percent), and pulmonary complications (3.0 percent). Independent predictors of readmission included age of 70 to 84 years, smoking, lower hematocrit, renal dialysis, and elbow procedure (with or without hand procedure). The authors note that the causes of approximately one-third of readmissions were missing from the database. Read the abstract…

The Columbus Dispatch reports that the governor of Ohio has announced new rules that will limit to 7 the number of days for which clinicians can prescribe opioids. The rules will also require prescribers to provide a specific diagnosis or procedure code on every prescription written for a controlled substance. The limits apply to patients with acute pain, but will not apply to cancer patients, palliative and hospice care, and medication-assisted treatment for people dealing with addictions. The rules will be enacted by the Ohio Board of Pharmacy, the State Medical Board, the Dental Board, and the Board of Nursing, but must first pass review by the Joint Committee on Agency Rule Review—a process that is expected to take several months. Read more…

Last call: Central Evaluation Committee.
April 15 is the last day to submit your application for a position on the Central Evaluation Committee. Members of this committee write questions for the Orthopaedic In-Training Examination. The following positions are available:

  • Hand and wrist (two members)
  • Oncology (one member)
  • Shoulder and elbow (one member)

Applicants for these positions must be active or emeritus fellows with a practice emphasis in the relevant area. Learn more and submit your application…(member login required)