Today’s Top Story
ACA restrictions affect formation of new physician-owned hospitals.
A study published online in the journal Health Affairs claims that restrictions under the Affordable Care Act (ACA) may have effectively eliminated the formation of new physician-owned hospitals. The researchers reviewed data on 106 physician-owned hospitals in Texas and found significant increases in formation, physician ownership, and physical capacity of physician-owned hospitals following passage, but prior to implementation, of the ACA. After ACA provisions took effect, they noted improved use of hospital assets to generate increased levels of services, revenue, and profits. However, the researchers found no evidence that existing physician-owned hospitals had stopped accepting Medicare to avoid ACA restrictions, “although some investors adopted a seemingly unsuccessful strategy of not accepting Medicare at physician-owned hospitals formed after implementation of the ACA.”
Read the abstract…

Other News

Study: How do ACI and microfracture compare for treatment of cartilage and osteochondral lesions in the knee?
A study published in the Aug. 17 issue of The Journal of Bone & Joint Surgery compares autologous chondrocyte implantation (ACI) with microfracture for the treatment of cartilage and osteochondral lesions in the knee. The authors report on long-term follow-up of a randomized trial of 80 patients who had a single symptomatic chronic cartilage defect on the femoral condyle without general osteoarthritis (OA). At 15-year follow-up, no significant difference across treatment cohorts were found in International Cartilage Repair Society, Lysholm, Short Form-36 (SF-36), and Tegner forms. However, the authors noted 17 failures and 6 total knee arthroplasties (TKAs) in the ACI group, compared to 13 failures and 3 TKAs in the microfracture group. In addition, 57 percent of surviving patients in the ACI group and 48 percent of surviving patients in the microfracture group had radiographic evidence of early OA, although the difference was not determined to be significant.
Read the abstract…

Study: What factors make a specialty more competitive to residents?
A research letter published online in the journal JAMA Internal Medicine compares recent trends in specialty competitiveness (defined as percentage of residency spots filled by U.S. graduates) and physician salary. The research team looked at information from the National Residency Match Program for 2014, Medical Group Management Association specialty salary data for 2015, the Medscape Lifestyle Report 2016, and the Careers in Medicine webpage from the American Association of Medical Colleges. They found a strong positive correlation between residency competitiveness and median specialty salary. Overall, primary care specialties had lower mean salaries than nonprimary care specialties and lower rates of competitiveness, with the three lowest-earning specialties being primary care fields. Of all specialties, family medicine had the lowest median salary ($221,419) and competitiveness (43 percent), while neurosurgery had the highest median salary ($747,066) and otorhinolaryngology had the highest competitiveness (94 percent). The research team notes that lifestyle factors displayed a weak, but positive correlation with specialty competiveness, as determined by severity of burnout, presence of bias toward patients, happiness at work, happiness outside of work, hours worked per week, and the sum of happiness at and outside of work. The research team also observed a negative correlation between presence of burnout and specialty competitiveness.
Read the preview…

HHS tells Medicaid patients to avoid double coverage under ACA exchanges.
The New York Times reports that the U.S. Department of Health & Human Services (HHS) is acting to end duplicate coverage for patients who are both enrolled in Medicaid and simultaneously receiving ACA subsidies to help pay for private health insurance. Letters mailed to certain consumers state that they “should immediately end marketplace coverage with premium tax credits for each person” in the household who is also enrolled in Medicaid or in the Children’s Health Insurance Program. A report from the U.S. Government Accountability Office noted that the federal government may pay twice if the person is in both Medicaid and a subsidized insurance policy bought through the marketplace. Most insurance exchanges are run at the federal level, while states oversee Medicaid programs, making synchronization difficult across computer systems.
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Modern Healthcare reports that the governor of Illinois has signed legislation that will require hospitals to be better prepared to treat patients with sepsis or septic shock. Under the legislation, hospitals must adopt protocols for the early recognition and treatment of patients who have sepsis, and the protocols are required have components specific to treating children and adults.
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New York.
According to the Associated Press, legislation signed by the governor of New York will require hospitals to post statements explaining patient protections against surprise medical bills and a patient’s right to designate a caregiver to receive instructions about post-discharge care. The notices will inform patients of the right to submit surprise bills to independent dispute resolution and to view a list of the hospital’s standard charges and health plan participation.
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Last call: Medical Liability Committee.
Aug. 25 is the last day to submit your application for a position on the Medical Liability Committee (one member opening). The Medical Liability Committee monitors trends in professional liability and tort reform and serves as a support and policy-making resource for the AAOS office of government relations and the Council on Advocacy. Applicants for this position must be active fellows with an interest in legal issues involved in orthopaedic practice.
Learn more and submit your application…(member login required)