Today’s Top Story
CMS: Providers not allowed to “balance bill” QMB enrollees.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a report that, in part, addresses the issue of “balance billing” of Qualified Medicare Beneficiaries—those beneficiaries with limited assets and incomes lower than the federal poverty level. The authors state that “federal statute allows states to limit reimbursement by paying the ‘lesser-of’ Medicaid or Medicare rates, and most do. As a result, the existing financing mechanism often means the provider must forgo the cost-sharing amounts. By law, providers may not attempt to collect any cost-sharing from QMB enrollees.” The authors note that an unintended consequence of the policy may be reduced access for QMB enrollees because providers may limit their patient pools to non-QMB enrollees. Read the report (PDF)…
FDA states that oxycodone is approved for certain pediatric patients.
The U.S. Food and Drug Administration (FDA) has approved the use of oxycodone for certain pediatric patients aged 11 years and older. The drug is approved for use in patients to manage pain severe enough to require daily, around-the-clock, long-term opioid treatment for which alternative treatment options are inadequate. A spokesperson for FDA states that the program is “not intended to expand or otherwise change the pattern of use of extended-release opioids in pediatric patients. Prior to this action, doctors had to rely on adult clinical data to shape their decision-making in treating pediatric patients. This program was intended to fill a knowledge gap and provide experienced healthcare practitioners with the specific information they need to use [oxycodone] safely in pediatric patients.” Read more…(registration may be required)
Read more from the FDA…
Study: Fibrin may not be essential for fracture repair, but inefficient fibrinolysis may inhibit healing.
Data published online in The Journal of Clinical Investigation suggest that fibrin may not be essential for fracture repair, but inefficient fibrinolysis may decrease endochondral angiogenesis and ossification and inhibit fracture repair. The research team studied mice with genetic- and pharmacologic-imposed deficits in the fibrin precursor fibrinogen and fibrin-degrading plasminogen, and found fibrin to be “entirely dispensable” for long-bone fracture repair, because healing fractures in fibrinogen-deficient mice were indistinguishable from those in controls. Yet they noted that failure to clear fibrin from the fracture site in plasminogen-deficient mice severely impaired fracture vascularization, precluded bone union, and resulted in robust heterotopic ossification. Read more…
Read the complete study…
Study: Insufficient external rotation on the throwing shoulder may increase likelihood of injury for professional pitchers.
According to a study published online in The American Journal of Sports Medicine, insufficient external rotation on the throwing side shoulder may increase the likelihood of shoulder injury and subsequent surgery for professional baseball pitchers. The researchers conducted a prospective, cohort study of 296 professional pitchers. They found 75 shoulder injuries and 20 surgeries recorded among 51 pitchers, resulting in 5,570 total days on the disabled list. The researchers note that glenohumeral internal rotation deficit, total rotation deficit, and flexion deficit were not significantly related to shoulder injury or surgery. However, pitchers with insufficient external rotation (<5° greater external rotation in the throwing shoulder) were 2.2 times more likely to be placed on the disabled list for a shoulder injury and 4.0 times more likely to require shoulder surgery.> Read the abstract…
Study: Benefits may outweigh risks of radiographic follow-up for infants with DDH who achieve normal clinical and ultrasonographic examinations.
Findings from a study published in the September issue of the Journal of Pediatric Orthopaedics suggest there may be benefit to radiographic follow-up for infants with developmental dysplasia of the hip (DDH) who achieve normal clinical and ultrasonographic examinations. The authors reviewed data on 115 infants with DDH who had achieved normal in both ultrasonographic and clinical examinations at mean 3.1 months of age. At mean 6.6 months of age, they found that 17 percent demonstrated radiographic signs of acetabular dysplasia. In addition, of 106 infants left untreated, 33 percent had dysplasia on subsequent radiographs at mean 12.5 months of age. The authors argue that the findings may warrant radiographic follow-up of such infants through at least walking age to allow timely diagnosis and early intervention of residual acetabular dysplasia. Read the abstract…
CMS to host provider call on ICD-10 transition.
On Thursday, Aug. 27, 2015, CMS will host an MLN Connects provider call to assist healthcare providers and other stakeholders with the transition to ICD-10. Topics on the agenda include:
- National implementation update
- Coding guidance
- How to get answers to coding questions
- Claims that span the implementation date
- Results from acknowledgement and end-to-end testing weeks
- Provider resources
CMS states that more than 2,100 facilities have agreed to assume financial risk for episodes of care.
CMS has announced that more than 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies have transitioned from a preparatory period to a risk-bearing implementation period in which they assume financial risk for episodes of care. The participants include 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative, and an additional 1,755 providers who have partnered with those organizations. This is a separate initiative from the recently announced Comprehensive Care for Joint Replacement Model, although both are part of a framework established by the Affordable Care Act to shift reimbursement to a quality-of-care model. Read more…
Call for volunteers: NQF Disparities Committee.
AAOS seeks to nominate members to the National Quality Forum (NQF) Disparities Committee. The primary role of the committee would be to serve as a resource for all of NQF activities, including measure evaluation, selection, consideration of use, and improvement. Applicants for this position must be active 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 current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted by Thursday, Oct. 1, 2015 at 11:59 p.m. CT, to Kyle Shah at: email@example.com
Learn more and submit your application…(member login required)