Today’s Top Story
President signs SGR repeal; some claims processed with SGR cut.
President Obama has signed a bill to repeal the Medicare Sustainable Growth Rate (SGR) formula, averting a 21 percent reduction in Medicare reimbursement that took effect April 1. The U.S. Centers for Medicare & Medicaid Services (CMS) had previously instituted a 10-business day processing hold for impacted claims. However, The Hill reports that, due to a time delay in updating its payment systems, the agency was forced to process a small volume of claims that included the 21 percent cut. CMS states that the affected claims will be reprocessed, and providers will be reimbursed the difference at a later date. Read more about the signing…
Read more about the processing delay…
Read more in AAOS Advocacy Now…
Read the response from the American Association of Orthopaedic Surgeons…
Other News
Study: Both modifiable and nonmodifiable factors contribute to THA readmission rates.
Data published online in the journal Clinical Orthopaedics and Related Research identify factors associated with increased likelihood of readmission after primary total hip arthroplasty (THA). The researchers reviewed data on 12,030 primary THAs from the Kaiser Permanente Total Joint Replacement Registry, and found that the most common reasons for 30-day readmission were infection and inflammatory reaction resulting from internal joint prosthetic, other postoperative infection, unspecified septicemia, and dislocation of a prosthetic joint. After adjustment, the researchers noted the following factors were associated with increased risk of readmission: medical complications; discharge to facilities other than home; length of stay of 5 or more days versus 3 days; morbid obesity; surgeries performed by high-volume surgeons compared with those performed by medium-volume surgeons; procedures at lower-volume and medium-volume hospitals compared with those performed at high-volume hospitals; sex; obesity; race; increasing age; and certain comorbidities such as pulmonary circulation disease, chronic pulmonary disease, hypothyroidism, and psychoses. The researchers write that modifiable factors, including obesity, comorbidities, medical complications, and system-related factors have the potential to be addressed prior to elective procedures such as THA, while nonmodifiable factors such as age, sex, and race can be used to establish patient and family expectations regarding readmission risk. Read the abstract…
Studies compare treatments for displaced midshaft clavicular fracture.
A pair of studies published in the April 15 issue of The Journal of Bone & Joint Surgery examine treatment options for displaced midshaft clavicular fractures. In the first, the authors conducted a prospective, randomized, controlled trial of 59 patients with displaced midshaft clavicular fractures who received fixation with either a reconstruction plate (n = 33) or elastic stable intramedullary nailing (n = 26). At 12-month follow-up, no significant differences were found between cohorts in Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant-Murley score, visual analog scale pain score, time to union, major complications, or satisfaction rate. The authors note that residual shortening was 0.4 cm greater in the plate group, and implant-related pain was more frequent in the nail group. Read the abstract…
In the second study, the research team conducted a multicenter, randomized controlled trial of 120 patients treated with open reduction and plate fixation (ORIF; n = 58) or intramedullary nailing (IM; n = 62). At 6-month follow-up, they found no significant differences between cohorts in DASH score, Constant-Murley score, or mean numbers of complications per patient, irrespective of severity. However, the research team noted that patients in the ORIF group recovered faster than those in the IM group. Read the abstract…
Study: First year of Pioneer ACO program saw about 1.2 percent savings.
According to a study published online in The New England Journal of Medicine, the first year of the Medicare Pioneer accountable care organization (ACO) program saw modest reductions in Medicare spending. The authors compared spending for beneficiaries attributed to Pioneer ACOs against other beneficiaries before and after the start of Pioneer ACO contracts. They found that, during the pre-contract period, adjusted Medicare spending and spending trends were similar across both the ACO group and the control group. In 2012—the first year of the Pioneer ACO program—there was a 1.2 percent savings in total adjusted per-beneficiary spending in the ACO group as compared with the control group. Overall, the authors found that savings were significantly greater for ACOs with baseline spending above the local average, as compared with those with baseline spending below the local average, and for those serving high-spending areas, as compared with those serving low-spending areas. Read more…
Read the abstract…
Do patient satisfaction surveys do more harm than good?
An article in The Atlantic looks at the issue of patient satisfaction surveys, and argues that financial incentives based on higher satisfaction scores may detract from more important issues of health and wellness. The writer notes that the Affordable Care Act (ACA) implements a policy of withholding 1 percent of total Medicare reimbursements, with top-performing hospitals (based on patient satisfaction) earning the money back, but references a study that found that patients who reported being most satisfied with their physicians actually had higher healthcare and prescription costs, and were more likely to be hospitalized than patients who were less satisfied. The writer notes that some hospitals have gone so far as to offer amenities such as valet parking, live music, custom-order room-service meals, and VIP lounges. Further, the writer argues that, because many patient satisfaction survey questions involve nursing care, some hospitals have forced nursing staff to undergo nonmedical training and spend extra time on superfluous activities to ensure increased satisfaction scores. Read more…
Arizona.
The Associated Press reports that an Arizona law enacted to prevent the state from developing its own healthcare exchange could affect residents who sign up through the federal exchange. The U.S. Supreme Court is currently considering King v. Burwell—a case in which plaintiffs claim the ACA allows subsidies to insurance purchasers only in states that set up and run their own healthcare exchanges. Observers say that, should the court rule in agreement with the plaintiffs, legislation barring the state from setting up its own exchange would prevent as many as 150,000 Arizona residents who currently receive federal subsidies from being able to afford health insurance. Read more…
Florida.
The New York Times reports that the governor of Florida plans to sue CMS, claiming that the federal government has used “coercion tactics” to pressure the state into expanding its Medicaid program. CMS states that, unless Florida expands Medicaid, the state could lose as much as $2.1 billion in federal funding to help hospitals care for the uninsured. Leaders in the state legislature are divided on Medicaid expansion, and the governor recently announced his opposition to expanding the program—an initiative he had previously supported. Read more…
Submit papers now for Kappa Delta and OREF Clinical Research Awards.
July 1, 2015 is the deadline for receipt of manuscripts submitted for the 2016 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work, generally reflecting years of investigation. If the submission reflects a single project, it should be of high significance and impact. Manuscripts must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society (ORS), Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society. Please note that submissions for the 2016 Kappa Delta and OREF Clinical Research Awards will be accepted in electronic format only. A PDF of the entire submission must be emailed no later than 11:59 p.m. CT on July 1, 2015. Late submissions will not be considered. Read more…
kappadelta@aaos.org
