Today’s Top Story
Senate committee seeks to address large uptick in Medicare appeals claims.
The Hill reports that the U.S. Senate Finance Committee wants to address a backlog of Medicare appeals claims. According to the Office of Medicare Hearings and Appeals, the office handled about 60,000 claims during FY 2011, but received 700,000 claims during FY 2013. Despite the growth in the number of appeals, there was no increase in the number of officers handling claims. A budget proposal from President Obama would, if enacted, increase the agency’s budget to double the office’s capacity to process cases. At least one member of the Finance Committee has suggested adopting a refundable filing fee to help weed out providers who attempt to “game the system.” Read more…

Other News

Leapfrog Group safety ratings suggest general improvement across hospitals.
The not-for-profit Leapfrog Group has released updated and enhanced data for the organization’s Hospital Safety Score website. For the first time, users have the opportunity to view a hospital’s current score alongside its previous scores over the past 3 years, so consumers can evaluate whether a hospital’s performance has improved over time. Overall, 182 hospitals have consistently received an “A” grade for safety. Additional findings include:

  • Of 2,523 hospitals issued a Hospital Safety Score (Spring 2015), 782 earned an A, 719 earned a B, 859 earned a C, 143 earned a D, and 20 earned an F.
  • Hospitals have generally demonstrated overall improvement on some Hospital Safety Score process measures since the Fall 2014 grading cycle.
  • 45 hospitals (less than 2 percent) changed by two or more grades since fall 2014, with 33 displaying significant improvement and 12 showing significant decline.

Read more…
View the Hospital Safety Score website…

OIG: Medicare system could save money by obtaining additional drug rebates.
A report from the U.S. Centers for Medicare & Medicaid Services (CMS) Office of Inspector General (OIG) finds that CMS could potentially save millions of dollars by obtaining additional rebates for drugs purchased under Medicare Part D. The authors compared rebates obtained by the Medicare and Medicaid programs for 200 selected brand-name drugs. They found that total rebates under Medicaid were substantially higher than total rebates under Medicare Part D. In addition, during 2012, Medicaid’s net unit costs were much lower than net unit costs under Part D, and statutorily defined Medicaid rebates exceeded Part D rebates by a substantial margin. According to The New York Times (NYT), included in President Obama’s budget proposal is a request to let CMS negotiate prices with drug manufacturers—a practice forbidden under current law. Read the OIG report (PDF)…
Read more in NYT…

Study: Injectable hydrogel with molecular signaling factor could help the body repair damaged cartilage.
According to findings from a bovine study published in the May issue of the journal Arthritis and Rheumatology, use of an injectable hydrogel containing a molecular signaling factor could help the body regenerate damaged cartilage in the knee. The researchers filled full-thickness bovine chondral defects with a hydrogel composed of fibrin and hyaluronic acid and containing rhSDF-1a, which acts as a homing beacon for chondrogenic progenitor cells (CPCs). At 12-day follow-up, they found that the use of rhSDF-1a was associated with dramatically improved CPC recruitment to the chondral defects. In addition, at 6 weeks under chondrogenic conditions, cell morphology, proteoglycan density, and ultrastructure of repair tissue were all similar to that found in native cartilage. “Compared with empty controls, neocartilage generated in rhSDF-1a–containing defects showed significantly greater interfacial strength, and acquired mechanical properties comparable to those of native cartilage,” the researchers write. Read more…
Read the abstract…

Study: Women may be at increased risk of memory impairment after MTBI.
Data from a study published online in the journal Radiology suggest that women may take longer to recover and be at greater risk of working memory impairment compared to men after concussion. The authors used functional magnetic resonance imaging (MRI) to assess working memory brain activation patterns in 30 patients (15 consecutive men and 15 consecutive women) with mild traumatic brain injury (MTBI) and 30 control participants. They found that, among female participants, the total digit span score was lower in the MTBI group than in the control group. In initial working memory functional MRI studies, compared against controls, hyperactivation was found in the male MTBI group and hypoactivation was found in the female MTBI group. At 6-week follow-up, the female MTBI group displayed persistent hypoactivation, whereas male MTBI patients displayed a regression of hyperactivation at visual comparison of activation maps. In addition, the male MTBI group was found to have a higher initial ß value compared to male controls, and at follow-up evaluation, the researchers found no significant difference between the male MTBI group and the male control group. In the female MTBI group, average ß values at both initial and follow-up studies were lower compared with those in the female control group, but were not statistically significant. Read more…
Read the abstract…

AAP updates recommendations for evaluating suspected physical abuse in children.
The American Academy of Pediatrics (AAP) has updated its recommendations for evaluating suspected physical abuse in children. The recommendations call for clinicians who treat children to be alert for injuries that raise suspicion of abuse but may be overlooked by unsuspecting physicians, including:

  • Any injury to a nonmobile infant, including bruises, oral injuries, or fractures
  • Injuries in unusual locations, such as over the torso, ears or neck
  • Patterned injuries
  • Injuries to multiple organ systems
  • Multiple injuries in different stages of healing
  • Significant injuries that are unexplained

Among other things, the guidelines state that a skeletal survey for any child younger than 2 years with suspicious injuries “can identify occult injuries that may exist in abused children and is very useful in the evaluation of suspected abuse,” and recommend that pediatricians “may need to hospitalize children with suspicious injuries for medical evaluation, treatment, and/or protection.” Read the complete recommendations (PDF)…
     AAOS has released an information statement on child abuse or maltreatment, elder maltreatment, and intimate partner violence. Read more…

OKOJ May updates now online!
Check out the new topics and video in the Orthopaedic Knowledge Online Journal (OKOJ) on the AAOS OrthoPortal website. The following topics have been recently added or updated: “Open and Closed Management of Pediatric Forearm Fractures,” “Removal Versus Retention of Orthopaedic Trauma Implants,” and “Repair of a Chronic Ruptured Quadriceps Tendon With a Medial Gastrocnemius-Hemisoleus-Calcaneal Block Flap.” A new video has also been made available: “Repair of a Chronic Ruptured Quadriceps Tendon Using a Medial Gastrocnemius-Hemisoleus-Calcaneal Block Flap.” OKOJ now offers full-text, downloadable PDFs for articles in recent issues, with more on the way! View these topics and more…(member login required)

Enhance the waiting room experience with a free copy of AAOS TV DVD.
AAOS TV is a patient-focused DVD featuring educational and inspiring bone and joint health content. The looping DVD, which is designed to be played in waiting rooms, includes 30 segments on injury prevention, advocacy-related calls to action, orthopaedic health messages, and public awareness campaigns. Run-time is approximately 1 hour and 20 minutes. AAOS TV is available at no charge to all Academy members. Please consider playing the DVD for patients in the waiting room and sharing the news about this new patient engagement resource with your colleagues. To order the free DVD, please contact the AAOS public relations department at media@aaos.org.