Today’s Top Story
Physicians discuss MACRA implementation before House subcommittee.
Testifying before the U.S. House of Representatives Subcommittee on Health, physicians discussed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and advocated for steps needed to ensure optimal implementation of the law. Among other things, participants testified in favor of consolidating performance reporting, broadening alternative payment models, and improving measurement to address program flaws that may make practices with high-risk patients more susceptible to penalties.
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View the complete testimony, with related links…

Other News

Voluntary product recalls: Two batches of Smith & Nephew Trigen Humeral Nails; one lot of Hospira, Inc. 50% Magnesium Sulfate Injection.
Smith & Nephew, Inc. has initiated a voluntary recall on two batches of Trigen Humeral Nails 8/7 mm x 26 cm due to a packaging error. The outer label of the product packaging is missing the size description of the device. The company states that in the event the size designation omission is not noticed prior to entering the surgical field, the omission could potentially result in a surgical delay. The affected lots are product number 71770826, lots 15LM01686 and 15LM01692, shipped between Nov. 19, 2015 and Dec. 02, 2015. For more information, please contact the company at 901-396-2121, or via email at:
The U.S. Food and Drug Administration has announced a voluntary manufacturer recall of one lot of Hospira, Inc. 50% Magnesium Sulfate Injection, USP, 10 g/20 mL (0.5 g/ml), 20 mL single-dose vials, lot 50-343-DK, expiration 01FEB2017, NDC 0409-2168-02, due to a confirmed customer complaint for the presence of particulate matter within one single-dose fliptop vial. If the particulate is not observed prior to administration, it may result in localized swelling, redness, pain at the site of administration or veins, allergic reactions to the foreign particle, microembolic effects as well as possible fetal harm.
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CMS delays release of hospital star ratings.
Modern Healthcare reports that the U.S. Centers for Medicare & Medicaid Services (CMS) has postponed the public release of the new overall quality star ratings for U.S. hospitals until July. The ratings had been scheduled for release on April 21, but some stakeholders argued that the ratings system “oversimplifies the complexity of delivering high-quality care.” Over the next 2 months CMS plans to host calls with providers to clear up questions about current methodology and obtain feedback to refine the program. The set that was delayed this week gives hospitals one to five stars based on specific inpatient and outpatient reporting measures. According to the American Hospital Association, only 87 of more than 3,600 U.S. hospitals received five-star ratings, and just over half of the hospitals fell within the three-star range.
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Study: Opioid prescribing following low-risk surgical procedures increased over time.
A research letter published in the April 19 issue of The Journal of the American Medical Association (JAMA) looks at opioid prescribing patterns following low-risk surgical procedures. The researchers reviewed data on 155,297 opioid-naive adults who underwent one or more of the following surgical procedures during 2004, 2008, or 2012: carpal tunnel release, knee arthroscopy, laparoscopic cholecystectomy, or inguinal hernia repair. They found that patient characteristics changed over time, becoming more likely to be older and male and less likely to have inpatient surgery. Within 7 days, 80.0 percent filled a prescription for any opioid. Of these prescriptions, 86.4 percent were for hydrocodone/acetaminophen or oxycodone/acetaminophen. Mean morphine equivalents dispensed increased over time for all procedures, with the highest adjusted increase for patients undergoing knee arthroscopy. The researchers state that the increase was driven by an increase in the mean daily dosages, with little change in prescription duration.
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AAOS Board endorses ACS statement on concurrent surgery; JAMA publishes editorial on topic.
The AAOS Board of Directors on April 18 endorsed revisions to the Statements on Principles of the American College of Surgeons (ACS) that cover concurrent surgery. The ACS announced these revisions on April 14. Among other things, ACS states that “a primary attending surgeon’s involvement in concurrent or simultaneous surgeries on two different patients in two different rooms is not appropriate,” and that for a complex procedure at an academic medical center, multiple qualified medical providers in addition to the primary attending surgeon may be involved, and patients should be informed “of the different types of qualified medical providers that will participate in their surgery and their respective role explained.” In endorsing the ACS statement, AAOS President Gerald R. Williams, Jr., MD, said “the AAOS strongly supports open, ongoing and transparent dialogue between the orthopaedic surgeon and his/her patient. As part of that informed consent process, this discussion should include what the patient may expect throughout the course of treatment, including surgical timing, staffing, risks and outcomes.”
A related editorial published in the April 19 issue of JAMA also looks at the issue of concurrent surgeries. The writers state that concurrent procedures are not uncommon, particularly at teaching hospitals, but note that many patients may not understand the practice. The authors address two issues: the boundaries of safe practice (and who should set them), and how surgeons should communicate with patients. “When patients enter the operating room, they have every right to know what is being done to them and by whom,” the writers argue. “The medical community and surgical professionals must take the lead in addressing [patient] concerns; develop mechanisms to self-regulate if, when, and how overlapping operations are performed; and do so in a way that is free from perceived conflict of interest and that preserves public trust in surgical care.”
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Read the ACS Statements on Principles…

According to Healthleaders Media, Covered California officials have approved an initiative to create quality-of-care standards for providers that will include bonuses and penalties based on performance. Under the proposal, providers will be rewarded or penalized based on how they meet quality-of-care standards. The program will phase in over several years and eventually put at least 6 percent of reimbursement at risk or subject to a bonus payment. It also proposes to eliminate hospitals from health plans if they consistently fail to meet quality standards, but will include a provision to retain low-performing hospitals through corrective action plans. The plan is scheduled to take effect in 2017.
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Modern Healthcare reports that the governor of Florida has signed legislation to increase transparency of price and quality in health care. Under the new law, the state’s Agency for Health Care Administration must contract with a private vendor to provide a consumer-friendly, internet-based platform to enable consumers to research the cost of healthcare services. Among other things, hospitals and surgery centers will be required to provide access to searchable service bundles on their website, listing estimated payment ranges for each service bundle, by facility, within selected geographic boundaries, and nationally. In addition, health plans will be required to provide on their websites a method for plan members to estimate their cost-sharing responsibilities, including for both in-network and out-of-network providers. Finally, consumers may request good-faith estimates of charges for non-emergency services from hospitals, surgery centers, and individual healthcare professionals, and clear, specific itemized bills from healthcare providers.
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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:
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