Today’s Top Story
House heads for recess with Affordable Care Act repeal in the air.
The U.S. House of Representatives left for a 2-week recess yesterday not substantially closer to advancing a healthcare bill to replace the Affordable Care Act (ACA). Although House Speaker Paul Ryan (R-Wis.) pointed to an amendment that would marginally curb premium increases as a sign of progress, a comprehensive package to supersede the ACA lies out of reach as conservatives and moderates within the Republican numbers remain at odds over the terms of a repeal, the Associated Press reports. To assuage the Freedom Caucus wing in the wake of the collapse of the initial repeal-and-replace legislation, the Trump White House proposed waiving mandates on states for coverage of preexisting conditions and care categories such as substance abuse treatment, while some other Republicans share Democrats’ objections to such changes to the ACA on the grounds that they would drop or exclude large numbers of individuals from insurance coverage and access to health care.
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Other News

Study: What factors are linked to mortality following THA and TKA?
A study conducted in the United Kingdom and published in the April 5 issue of The Journal of Bone & Joint Surgery (JBJS) examines factors linked to mortality after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis (OA). The researchers reviewed registry data on 332,734 THA patients and 384,291 TKA patients. Overall, they found that the main causes of death were malignant neoplasms, followed by circulatory system disorders, respiratory system disorders, and digestive system diseases. During the first 90 days after surgery, they found that the primary cause of death was ischemic heart disease. They also noted an elevated risk of death from circulatory, respiratory, and digestive system-related causes within 90 days postoperative, compared with 91 days to 1 year postoperative.
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Study: Recent years have seen reduction in use of advanced imaging.
Findings published in the April issue of the journal Health Affairs suggest an overall reduction in the use of advanced imaging since 2008-2009. The research team drew data from Medicare Part B databases, and calculated utilization rates per 1,000 enrollees for all advanced imaging modalities, as well as professional component relative value unit (RVU) rates per 1,000 beneficiaries for all imaging modalities. They found that utilization rates and RVU rates grew substantially until 2008 and 2009, respectively, and then began to decrease, followed by a downward trend through 2014.
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Study: How do interscalene block and injectable liposomal bupivacaine compare for shoulder arthroplasty?
A study published in the April 5 JBJS compares the use of interscalene block and injectable liposomal bupivacaine in shoulder arthroplasty procedures. The authors conducted a randomized, controlled trial of 78 patients who received interscalene brachial plexus blockade treatment and 78 patients who received bupivacaine liposome injectable suspension treatment. During the first 24 hours after surgery, they found that the mean total postoperative opioid consumption was 14.8 ±11.3 morphine equivalent units in the blockade group and 14.4 ±16.8 morphine equivalent units in the suspension group. In addition, they found that mean visual analog scale (VAS) pain score was significantly lower in the blockade group than in the suspension group at 0 hours and 8 hours postoperative, but not at 16 hours postoperatively At 24 hours, VAS pain scores were significantly higher in the blockade group than in the suspension group.
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How accurate is the NSQIP Surgical Risk Calculator?
The writers of an article published in the Journal of the American College of Surgeons argue that published studies questioning validation of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC) “should not be misunderstood as disqualifying the SRC as an accurate and appropriate tool for its intended purpose of providing a general purpose risk calculator, applicable across many surgical domains, using easily understood and generally available predictive information.” The writers state that large, internal evaluations have demonstrated good accuracy for the SRC, while external validations are often inconsistent “and tend to favor a conclusion of inadequate performance.”
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Aetna announced yesterday that it plans to stop selling individual policies both on and off Iowa’s ACA exchange in 2018, reports Modern Healthcare. This change—which follows Wellmark Blue Cross and Blue Shield’s announcement that it will exit the state’s individual market next year—means that thousands of Iowa residents will need to switch to a different health insurer. An Aetna spokesperson cited “financial risk and an uncertain outlook for the marketplace” as prompting the decision. According to Cynthia Cox, an associate director at the Kaiser Family Foundation, five Iowa counties may be left with just two health insurers—Medica and Gunderson, while Medica may be the only health insurer in the rest of Iowa’s 99 counties.
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Last call: Political Action Committee of the AAOS.
April 9 is the last day to submit your application for a position on the Political Action Committee (PAC) of the AAOS (one resident-at-large opening). This committee promotes political action activities and participation among orthopaedic surgeons and prioritizes PAC campaign contributions to candidates. Applicants for this position must be PGY-3 or PGY-4 resident members.
Learn more and submit your application…(member login required)