Today’s Top Story

Senators introduce bill to protect patients with preexisting conditions

Last week, 10 Senate Republicans proposed a bill that would prevent insurers from discriminating against beneficiaries with preexisting conditions. The introduction of the Ensuring Coverage for Patients with Pre-Existing Conditions Act comes after several states signed onto a lawsuit that argues the Affordable Care Act is unconstitutional following Congress’ decision to repeal the law’s penalty for those who choose not to purchase insurance. Senate Republicans said their bill would amend federal law to guarantee the availability of health insurance to all Americans, regardless of the outcome in the federal lawsuit. The legislation would also seek to prevent insurers from increasing premiums for patients with preexisting conditions. Some critics, however, say the bill would allow insurers to exclude coverage of preexisting conditions.

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Other News

Study: Psychosocial versus physical predictors of pain after arthroscopic rotator cuff repair

Psychosocial factors may be more indicative of pain than structural factors following arthroscopic rotator cuff repair, according to a prospective study published online in the Journal of Shoulder & Elbow Surgery. Researchers gathered data on 93 patients (mean age, 56 years; 54 percent male) who were evenly categorized by tear size; 68 percent of tears were traumatic. They analyzed pre- and postoperative visual analog scale (VAS) pain scores, narcotic usage, range of motion (ROM), and functional and psychological assessments via the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, Simple Shoulder Test, Western Ontario Rotator Cuff Index (WORC), and RAND 36-item Short Form Survey questionnaires. At one-year follow-up, ROM, VAS, ASES, and WORC scores had improved greatly. Preoperative narcotic use, high VAS scores prior to the procedure, and lower WORC index and emotion scores were associated with higher pain scores at one-year follow-up.

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Study finds association between OA and levels of adiponectin

A meta-analysis published online in the journal Lipids in Health and Disease found that levels of adiponectin were higher in patients who had osteoarthritis (OA) compared to those who did not. Researchers used data from 10 articles detailing 13 case-control studies that included 1,255 patients. Results indicated stronger evidence of high adiponectin levels among patients with OA of the knee than those with OA in the hand or hip. Data were divided to differentiate between white and Asian patients, and the study identified adiponectin as a biomarker in both cohorts.

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GAO calls for CMS to take action

In a follow-up to its testimony in June, the Government Accountability Office (GAO) released a report identifying three areas of risk in the Medicaid program that should be addressed: improper payments, supplemental payments, and demonstrations. GAO says that of the 86 recommendations it has made to improve and strengthen Medicaid, the Centers for Medicare & Medicaid Services (CMS) has implemented 30 and that more work remains to be done.

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In the States

Study finds outpatient orthopaedic care limited for Louisiana residents on Medicaid

A study published online in the Journal of the National Medical Association found that Louisiana Medicaid beneficiaries have significantly limited access to outpatient orthopaedic care, despite Medicaid expansion. Researchers called the offices of 309 orthopaedic surgeons at 93 different practices between Aug. 1, 2016, and Jan. 31, 2017, to make an appointment for a simulated Medicaid patient. Only 17 practices, representing 41 orthopaedic surgeons, offered to schedule an appointment with the patient. When excluding surgeons practicing at safety-net facilities, just 22 were willing to take on new Medicaid patients. The researchers noted that although Medicaid expansion has decreased the uninsured rate, access to outpatient orthopaedic care is still significantly limited for this patient population.

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Perspectives on out-of-network billing

Out-of-network (OoN) billing, or “surprise billing” consisting of unexpected charges for OoN services, is an increasingly recognized issue. Twenty-one states have laws providing limited (n = 15) or comprehensive protection (n = 6). Although much attention has been given to OoN billing in the emergency room (ER) setting, OoN billing can affect outpatient and inpatient settings, as well. A complicating factor can be determining whether a particular ER is in or out of network. To gain insight into the problem at a personal level, AAOS Now interviewed a patient who faced a surprise bill in Texas, an ER physician in Texas, a surgery center administrator in Texas, and a finance director of an orthopaedic surgery practice in New York.

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Apply for Biomedical Engineering Committee member position

The Biomedical Engineering Committee has an open member position, a two-year term that runs from March 17, 2019, through March 21, 2021. The committee monitors and reviews scientific regulatory developments in the field of biomedical engineering as they relate to orthopaedic surgery. The deadline to apply is Oct. 13.

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