April 4, 2018 | Today’s News

CMS adjusts Medicare opioid proposal to address provider concerns

The U.S. Centers for Medicare & Medicaid Services (CMS) has updated a final rule proposal that among other things, impacts the prescribing of opioids to Medicare beneficiaries. The Hill reports that under the update, when pharmacists receive a prescription for 90 milligrams of morphine or more per day, they will be required to contact the prescriber, and document the discussion and prescriber approval prior to filling the prescription. An earlier proposal would have blocked Medicare payment for long-term, high-dose opioid prescriptions—a move that critics argued would interfere with the physician-patient relationship, and could force patients who lost access to the drugs into withdrawal or encourage them to seek illegal replacements.

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Read the CMS fact sheet…

Read a draft of the final rule (PDF)…

Study: Excision of degenerative portion of ECRB may offer little benefit in treatment of chronic lateral epicondylitis

Data from a small study published in the April issue of The American Journal of Sports Medicine suggest that surgical excision of the degenerative portion of the extensor carpi radialis brevis (ECRB) may offer little benefit to patients with chronic lateral epicondylitis. The researchers conducted a randomized, double-blind, placebo-controlled trial of 26 patients treated with either surgical excision of the macroscopically degenerated portion of the ECRB (n = 13) or sham surgery consisting of skin incision and exposure of the ECRB alone (n = 13). At six-month and 2.5-year follow-up, they found similar improvement in both cohorts in patient-rated pain frequency and severity, elbow stiffness, difficulty with picking up objects, difficulty with twisting motions, and overall elbow rating. In addition, both procedures were associated with improved epicondyle tenderness, pronation-supination range, grip strength, and modified Orthopaedic Research Institute–Tennis Elbow Testing System at six months. The researchers observed no significant difference across groups in any parameter at any stage. They write that a post hoc futility analysis showed, based on the magnitude of the differences between the groups, that more than 6,500 patients would be needed per cohort to demonstrate a significant difference in primary outcome—patient-rated frequency of elbow pain with activity—at 26 weeks.

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A Vital Signs report released by the U.S. Centers for Disease Control and Prevention (CDC) states that health departments working with the agency’s Antibiotic Resistance (AR) Lab Network found more than 220 instances of germs with “unusual” antibiotic resistance genes in the United States during 2017. Other findings in the report include the following:

• One in four germ samples sent to the AR Lab Network for testing had special genes that allow them to spread their resistance to other germs.
• Further investigation in facilities with unusual resistance revealed that about one in 10 screening tests, from patients without symptoms, identified a hard-to-treat germ that spreads easily, suggesting the germ could have spread undetected in that healthcare facility.
• For carbapenem-resistant Enterobacteriaceae alone, the researches project that implementation of the CDC containment strategy would be associated with a 76 percent reduction in new infections over three years.

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Read the Vital Signs report…

A study published in the April 4, 2018 issue of The Journal of Bone & Joint Surgery compares the surgical experience of orthopaedic residents with that of early practice in the United States. The authors conducted a retrospective, cohort study of 4,329,561 procedures reported by orthopaedic surgery residents who completed residency between 2010 and 2012 and 413,370 procedures reported by orthopaedic surgeons who took the American Board of Orthopaedic Surgery Part II certifying examination between 2013 and 2015. They found that the top 25 adult Current Procedural Terminology (CPT) code categories contributed 82.1 percent of the total case volume for residents and 82.4 percent for practitioners. Overall, knee and shoulder arthroscopy were the most frequently performed procedures in adults in both residency and early practice, while humerus/elbow fracture and/or dislocation procedures and “other musculoskeletal–introduction or removal” procedures were most frequently performed in pediatric cases in both residency and early practice. The authors found similarity between residency and early practice experience to be generally strong, but note several CPT code categories and individual CPT codes for which the level of exposure during residency varied substantially from early practice experience.

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Findings presented online in the Journal of the American College of Surgeons suggest that prehospital tourniquet application may help reduce mortality for trauma patients with peripheral vascular injury. Members of the research team reviewed information on 1,026 patients with peripheral vascular injury admitted to 11 Level I trauma centers over a six-year period. Traumatic amputations occurred in 98 patients, 35 of whom had received a tourniquet. The researchers found that overall mortality was 5.2 percent in the nontourniquet group and 3.9 percent in the tourniquet group. After multivariable analysis, they found that use of tourniquet was independently associated with survival. However, delayed amputation rates were not significantly different across cohorts.

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A study published in the April issue of the journal Mayo Clinic Proceedings suggests that online physician reviews may often be affected by factors outside the control of the physician. The authors compared Press Ganey patient satisfaction survey (PSS) scores for 98 physicians who had negative online reviews against 82 matched physicians who had no negative online reviews. They found that the mean raw PSS scores were not different between the two groups, and they noted no difference in mean scores on questions related to physician-patient communication and interaction skills between those with poor online reviews and those without. However, the authors did note that physicians with negative online reviews scored lower on factors beyond patient-physician interactions, such as interaction with desk staff, nursing, physical environment, appointment access, waiting time, problem resolution, billing, and parking.

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Read the complete study…

Call for volunteers: Health Care Systems Committee

April 15, 2018, is the last day to submit your application for a position on the Health Care Systems Committee (one member-at-large opening). This committee helps orthopaedic surgeons develop and improve relationships with other healthcare stakeholders, including other providers, the federal government, private and public payers, and patient groups. Applicants for this position must be active fellows with an interest in and knowledge of healthcare system mechanisms, payment, and policies.

Learn more and submit your application…  (member login required)