Today’s Top Story
Study: Clinical performance measures largely focus on underuse; downplay overuse.
A research letter published online in the journal JAMA Internal Medicine suggests that clinical performance measures may not adequately measure overuse of care. The research team identified all outpatient and emergency department process measures from major national measure programs and clearing houses. Of the 521 measures that met inclusion criteria, 477 (91.6 percent) targeted underuse, 34 (6.5 percent) targeted overuse, and 14 (2.7 percent) targeted misuse (4 measures addressed two target issues). Overall, of 16 measure collections, just 3 contained an “appreciable” representation of overuse measures, while 7 contained no overuse measures. Read more…
Read an extract…

Other News

Study: Use of a comanagement team for patients with osteoporotic hip fractures may reduce costs at moderate- to high-volume hospitals.
According to findings published online in the journal Clinical Orthopaedics and Related Research (CORR), use of a multidisciplinary team that includes orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists may decrease complication rates, improve time to surgery, and reduce hospital length of stay for patients with osteoporotic hip fractures. The researchers conducted an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be cost-effective at moderate-volume hospitals (at least 50 cases annually). They found that, for the base case, universal comanagement was more cost-effective than traditional care and risk-stratified comanagement. In addition, comanagement was more cost-effective than traditional management as long as the hip fracture case volume was more than 54 patients annually, and resulted in cost savings when there were more than 318 patients annually. Read the abstract…

Study: Preoperative antimicrobial prophylaxis may not significantly affect microbiologic sampling prior to revision THA or TKA.
Data from a small study published online in CORR suggest that preoperative antimicrobial prophylaxis may be safe before revision total hip arthroplasty (THA) or revision total knee arthroplasty (TKA) in which microbiologic sampling is planned. The authors conducted a prospective study of 40 patients (29 THA and 11 TKA) with suspected prosthetic joint infection of unknown cause. They obtained three tissue samples from each patient before and after the administration of antimicrobial prophylaxis. The authors found no difference in likelihood of infection diagnosis between the samples obtained before and after administration of antimicrobial prophylaxis. They write that the findings should be confirmed in larger, multicenter studies before the data can be assumed to apply to a broader patient population. Read the abstract…

GAO report finds evidence of prescription-medication fraud and abuse among Medicaid beneficiaries.
A report issued by the U.S. Government Accountability Office finds indicators of potential prescription-medication fraud and abuse among Medicaid beneficiaries. The researchers reviewed data from four states during FY 2011, and found evidence that more than 16,000 of 5.4 million beneficiaries potentially engaged in “doctor shopping,” by visiting five or more physicians to receive prescriptions for antipsychotics or respiratory medications valued at about $33 million. In addition, they noted that about 700 beneficiaries received more than a 1-year supply of the same drug during 2011—an indicator of possible diversion, or the redirection of prescription drugs for illegitimate purposes. The researchers recommend that the U.S. Centers for Medicare & Medicaid Services (CMS) require states to report information about specific drug-utilization review controls to determine whether additional guidance is needed. CMS concurred with the recommendation. Read more…
Read the complete report (PDF)…

Is better follow-up data needed for high-risk devices?
Findings from a study published in the Aug. 11 issue of The Journal of the American Medical Association suggest that more timely follow-up studies should be conducted for “high-risk” therapeutic devices approved via the U.S. Food and Drug Administration (FDA) Premarket Approval (PMA) process. The researchers reviewed data on 28 high-risk therapeutic devices that received initial marketing approval via the PMA pathway during 2010 and 2011. They identified 82 premarket and 204 postmarket studies of the devices. Of the postmarket studies, only 26 were reported as completed within 3 to 5 years of FDA approval. In addition, the researchers found no postmarket studies for five devices, and noted that 23 devices had three or fewer postmarket studies. Further, approximately half of the studies did not measure comparative effectiveness of the device against an existing product. Read more…
Read the abstract…

According to WUSF Public Media, a healthcare panel formed by the governor of Florida plans to discuss ambulatory surgery centers (ASCs). The Florida House of Representatives previously approved a bill that would have allowed patients to stay at ASCs for up to 24 hours, and allowed the creation of “recovery care centers,” where patients could stay for up to 72 hours after surgery. However, the bill failed to pass the state Senate. Read more…

Friday is last chance to nominate future AAOS leadership!
The 2016 Nominating Committee is actively soliciting your suggestions for individuals to serve in the following positions:

  • Second Vice President
  • Treasurer
  • Member-at-Large [age 45 or older] (age 45 or older on March 3, 2016)
  • Member-at-Large [under age 45] (younger than age 45 on March 3, 2016)
  • National Membership Committee Member
  • Nominees to the American Board of Orthopaedic Surgery (ABOS)

Nominations will close on Friday, Aug. 14. Please submit nominations to John R. Tongue, MD, chair, 2016 Nominating Committee, c/o AAOS Office of General Counsel, 9400 West Higgins Road, Rosemont, IL 60018, or online at:

Last call: Central Evaluation Committee.
Aug. 17 is the last day to submit your application for a position on the Central Evaluation Committee. Members of this committee write questions for the Orthopaedic In-Training Examination. The following positions are available:

  • Adult Reconstruction Hip and Knee (one member opening)
  • Basic Science (one member)
  • Sports Medicine (one member)
  • Trauma (one member)

Applicants for these positions must be active or emeritus fellows with a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)