Today’s Top Story
Most physicians expected to take MIPS path under MACRA.
An article in Modern Healthcare on payment options under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) notes that many physicians still have questions about the new system and are not ready to assume the downside risk of alternative payment models (APMs). The writer explains that under MACRA, physicians will be reimbursed for Medicare patients under the Merit-based Incentive Payment System (MIPS) or an Advanced APM. Under MIPS, providers will be graded on quality, resource use, clinical practice improvement, and meaningful use of certified electronic health records technology. According to the article, about 90 percent of physicians are expected to choose the MIPS path. Under the Advanced APM path, physicians will receive lump-sum incentive payments and higher annual provider payments and will be exempt from MIPS reporting measures; however, they will also bear an increased financial risk, making it a more difficult path for the average physician. Read more…(registration may be required)

Other News

FDA announces recall of one lot of Hospira 0.25% Bupivacaine Hydrochloride Injection.
The U.S. Food and Drug Administration has announced a voluntary recall of one lot of Hospira 0.25% Bupivacaine Hydrochloride Injection, USP (NDC: 0409-1159-02, Lot 59-064- DK, Expiry 1NOV2017) at the hospital/retail level, due to the presence of particulate matter within a single vial. The agency states that anyone with an existing inventory of the recalled lot should stop use and distribution and quarantine the product immediately. Read more…
Read the press release…

Study: Subsequent radiographs may have little effect on treatment approach for certain shoulder injuries.
Findings from a study published in the August issue of the Journal of Shoulder and Elbow Surgery suggest that post-diagnosis radiographs may not alter treatment of radial head fractures that do not have any associated ligament injuries or fractures. The researchers identified 415 adult patients with nonsurgical treatment for isolated Broberg and Morrey modified Mason type 1 or 2 fractures at a single center. Of 255 patients (262 fractures) with subsequent radiographs, they found that just one patient (0.4 percent) was offered surgery but declined. Based on multivariable analysis, the researchers note that surgeon-to-surgeon variation was the most influential factor in likelihood of subsequent radiography. Read the abstract…

Study: Does the use of TEG-adjusted prophylactic enoxaparin reduce VTE in trauma and surgical patients?
A study published online in the journal JAMA Surgery examines the efficacy of thrombelastogram (TEG)-adjusted prophylactic enoxaparin to prevent venous thromboembolism (VTE) in surgical and trauma patients. The authors note that recent data suggest a difference in reaction time (to initial fibrin formation) of more than 1 minute between heparinase and standard TEG may be associated with decreased risk of VTE. They conducted a randomized trial of 185 surgical and trauma patients who were screened for VTE at three level I trauma centers, and who received either standard dosing (30 mg, twice daily; n = 85) or TEG-adjusted dosing (35 mg, twice daily; n = 100) of enoxaparin. Across cohorts, they found similar time to enoxaparin initiation, similar reaction times, and similar numbers of patients who missed at least one dose. In addition, rates of VTE were similar and the difference in bleeding complications was not statistically significant. The authors identified older age, higher body mass index, increased Acute Physiology and Chronic Health Evaluation II score, and increased percentage of missed doses per patient as risk factors for VTE. Read the abstract…

Survey suggests many patients comfortable using physician-owned ancillary services.
Survey data published in the August issue of The Journal of Arthroplasty suggest that many patients believe surgeon ownership of orthopaedic-related businesses to be an ethical practice and feel comfortable receiving care at such a facility. The research team surveyed 280 consecutive patients at two centers regarding three surgeon ownership scenarios: owning a surgery center, providing in-office physical therapy (PT), and owning advanced imaging facilities. Among patients who responded (n = 214), 73 percent agreed that it is ethical for a surgeon to own a surgery center, 77 percent supported physician ownership of a PT practice, and 77 percent said it would be ethical to own an imaging facility. In addition, 67 percent indicated that surgeon ownership of such a business would have no effect on their trust of the provider. However, many respondents agreed that surgeon owners might perform more surgery (47 percent), refer more patients to PT (61 percent), or order more imaging (58 percent). Read the abstract…

How accurate are estimates of deaths linked to medical errors?
An opinion piece in The New York Times argues that some estimates of death rates associated with medical errors may be artificially inflated. The writer argues that some studies have failed to take into account patients’ underlying medical conditions as a factor. “Doing research in this area is very difficult,” he writes. “When someone dies in a car accident, it’s clear what caused the death. … But when an 86-year-old with dementia and cancer dies and also had been given a drug in a slightly-too-high dose a few weeks earlier, is it the error that killed her or the underlying disease and age?” Read more…

Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program website are closing soon. Act now to apply for the following positions:

  • AMA House of Delegates (one delegate; closes Aug. 21)
  • AAOS Now Editorial Board (Aug. 19)
    • Pediatrics (one member)
    • Trauma (one member)
  • Bylaws Committee (two members; Aug. 22)
  • Content Committees (Aug. 19)
    • Basic Science (chair, one resident-at-large)
    • Foot & Ankle (chair, one resident-at-large)
    • Hand & Wrist (chair, one resident-at-large)
    • Hip & Knee (chair, one resident-at-large)
    • Musculoskeletal Oncology (chair, one resident-at-large)
    • Pediatrics (chair, one resident-at-large)
    • Shoulder & Elbow (chair, one resident-at-large)
    • Spine (chair, one resident-at-large)
    • Sports Medicine (chair, one resident-at-large)
    • Trauma (chair, one resident-at-large)
  • Council on Education (Aug. 19)
    • CME Courses Program (chair)
    • Online Learning and Pubs Program (chair)
    • Board Preparation Course (chair)

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