Today’s Top Story
Details emerge on proposed MACRA payment rule.
A post on the blog of the journal Health Affairs outlines key elements of a proposed rule recently released by the U.S. Centers for Medicare & Medicaid Services (CMS), which details the physician reimbursement framework required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Among other things, the proposal consolidates the Physician Quality Reporting System, the Value-Based Modifier Program, and Meaningful Use into the single Merit-based Incentive Payment System. Under the proposal, eligible clinicians would receive a composite score based on four annually selected categories. In the first year, those categories would include:

  • Quality: 50 percent of total score
  • Advancing Care Information: 25 percent of total score (formerly Meaningful Use)
  • Clinical Practice Improvement Activities: 15 percent of total score—a new domain
  • Cost or Resource Use: 10 percent of total score, based on Medicare claims data—no reporting necessary

In addition, CMS proposes an approach to implementing the MACRA Alternative Payment Model (APM) pathway. Advanced APMs would need to meet three proposed requirements:

  • Required use of certified EHRs
  • Payment for covered professional services based on comparable quality measures
  • Either being an enhanced medical home or bearing more than “nominal risk” for losses

CMS will accept comments on the proposed rule for 60 days following publication in The Federal Register.
Read more…
Read the complete rule (PDF)…
     AAOS is developing a summary of the proposed rule, and will coordinate formal written comments with state and specialty societies.
Visit the AAOS MACRA page…

Other News

Study: Can a prediction model help determine risk of nonunion following tibial fracture?
According to a study published online in the journal Clinical Orthopaedics and Related Research, use of a nonunion prediction model may potentially help determine which patients may be at increased risk of tibial fracture nonunion. The authors retrospectively reviewed data on 382 patients treated with intramedullary nails for tibial shaft fracture. Based on 35 factors theorized to contribute to delayed bone healing, they developed the Nonunion Risk Determination (NURD) score, which assigns 5 points for flaps, 4 points for compartment syndrome, 3 points for chronic condition(s), 2 points for open fractures, 1 point for male gender, and 1 point per grade of American Society of Anesthesiologists Physical Status and percent cortical contact. One point each is subtracted for spiral fractures and for low-energy injuries, which were found to be predictive of union. The authors found that a NURD score of 0 to 5 had a 2 percent chance of nonunion; 6 to 8, 22 percent; 9 to 11, 42 percent; and >12, 61 percent. They state that further work must be done to prospectively validate and enhance the model.
Read the abstract…

Study: Supply of orthopaedic trauma surgeons increased as operative fracture injuries decreased.
Findings from a study published in the May issue of the Journal of Orthopaedic Trauma suggest that the number of orthopaedic trauma surgeons increased over a 10-year period, alongside a decline in the number of operative pelvic and acetabular cases. The researchers estimated surgeon supply using 2002 to 2012 census data from AAOS and the Orthopaedic Trauma Association, and the annual number of operative pelvic and acetabular fractures reported by American College of Surgeons verified trauma centers in the National Trauma Data Bank (NTDB) over the same term. They found that, from 2002 to 2012, the number of operative pelvic and acetabular injuries increased by an average of 21.0 percent per year, while the number of reporting trauma centers increased by 27.2 percent per year. At the same time, the mean number of orthopaedic surgeons per NTDB center increased an average of 1.5 percent per year. Overall, the annual number of operative pelvic and acetabular fractures per NTDB center decreased from 27.1 in 2002 to 19.03 in 2012—a reduction of 2.0 percent per year.
Read the abstract…

Study: What is the satisfaction rate for patients with Dupuytren disease who are treated with CCH?
Data from a study published online in The Journal of Hand Surgery suggest high satisfaction for patients with Dupuytren disease who are treated with collagenase clostridium histolyticum (CCH) injection. The research team conducted a cross-sectional study of 213 patients who had been treated for Dupuytren disease with CCH. They found that 73 percent of patients were very satisfied or satisfied, and 21 percent were dissatisfied. Overall, 75 percent said they would probably or definitely undergo CCH treatment again, and 17 percent probably or definitely would not. The research team found that satisfaction and willingness to undergo a second treatment decreased over time, and had a negative relationship with recurrence. Dissatisfaction was greater in those with a poor initial outcome but not in those with an initial complication.
Read the abstract…

The New York Times reports on a ballot proposal in Colorado that, if enacted, would create a taxpayer-financed public health system guaranteeing coverage for everyone. The initiative, which is estimated to cost $38 billion a year, would eliminate deductibles, allow patients to choose healthcare providers without distinguishing between in-network and out-of-network, and cover everyone in the state. Supporters say most people would end up saving money. The proposal had enough support to garner 100,000 signatures and be added to the November ballot, but is opposed by many insurance companies and business leaders.
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North Carolina.
An article in the Charlotte News & Observer notes that technology issues at Blue Cross and Blue Shield of North Carolina have been linked to a payment backlog that could take months to resolve. The paper reports that 90 providers have complained to the North Carolina Department of Insurance about the payment delays. A spokesperson for the company states that about 15 percent of claims have seen delays. The company is manually reviewing claims for accuracy and warns providers they might not receive payment until mid-July for patients they saw early this year.
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Last call: NQF Surgery Standing Committee.
AAOS seeks to nominate individuals for membership to the National Quality Forum (NQF) Surgery Standing Committee. This project seeks to identify and endorse surgical performance measures for accountability and quality improvement across a variety of surgical topic areas including orthopaedic, neurologic, and general surgery. Applicants for this position must be active fellows, emeritus fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application; a letter of interest highlighting their experience relevant to the committee; a short biography (maximum 100 words) highlighting experience/knowledge relevant to the expertise described above and involvement in candidate measure development; and a curriculum vitae or list of relevant experience (maximum 20 pages). All supporting materials must be submitted to Kyle Shah by May 1, 2016 at 11:59 p.m. CT, at
Learn more and submit your application…(member login required)