Today’s Top Story
Study: EDs may have seen greater strain in wake of ACA.
Two studies published online in the journal Annals of Emergency Medicine examine emergency department (ED) trends in the wake of implementation of the Affordable Care Act (ACA). In the first study, researchers reviewed hospital administrative data from 2011 through 2015 for patients aged 18 to 64 years in 201 nonfederal Illinois hospitals. They found that average monthly ED visit volume increased by 5.7 percent after ACA implementation. They noted a large reduction in ED visits by uninsured patients was overcome by a large post-ACA increase in Medicaid visits and a modest increase in privately insured visits. Read more…
Read the complete study…
     In the second study, a research team surveyed ED directors in Massachusetts in 2006, 2009, and 2015, and found increases in the following:

  • median number of annual ED visits per center—from 32,025 in 2005 to 42,000 in 2014
  • number of full-time attending physicians—from 11 to 12
  • number of full-time ED nurses—from 27 to 42

In adjusted models, they found a significantly reduced odds of consultant availability in 2014 versus 2005 for general surgery, neurology, obstetrics/gynecology, orthopaedics, pediatrics, plastic surgery, and psychiatry. Read the complete study…

Other News

MedPAC submits comments on CMS proposed fee schedule rule.
The U.S. Medicare Payment Advisory Commission (MedPAC) has submitted comments on a U.S. Centers for Medicare & Medicaid Services (CMS) proposed rule regarding revisions to payment policies under the Physician Fee Schedule. Among other things, MedPAC notes that CMS has proposed a requirement that all practitioners who bill for global surgical services report claims for pre- and postoperative services, contending that a sample would not provide enough data to accurately value all surgical procedures. The agency agrees with those concerns, but recommends that CMS “design a survey that captures the most relevant information on services delivered during the global period, such as the number and level of pre- and postoperative visits, the setting, the length of time of each visit, the presence of post-surgical complications, and direct practice expense inputs,” and stratify the sample by practitioner specialty, geography, setting, and types of services furnished. Read the letter (PDF)…
Read the proposed rule…

Study: Nonsurgical treatment may offer improved outcomes for initial treatment of idiopathic clubfoot.
Data from a study published in the September issue of the Journal of Pediatric Orthopaedics may support a nonsurgical approach in the treatment of idiopathic clubfoot. The authors reviewed gait data on 181 children (276 idiopathic clubfeet) at ages 2 and 5 years. Overall, 132 feet were treated with the Ponseti method and 144 feet with the French physical therapy method. At age 5 years, 30 feet in the Ponseti cohort and 61 feet in the physical therapy cohort required surgery. Overall, gait outcomes showed limitations primarily in clubfeet treated with surgery. Normal ankle motion was present in only 17 percent of Ponseti and 21 percent of physical therapy feet following surgical management. Within the surgery group, feet initially treated with physical therapy had a clinically significant reduction in ankle power compared with those treated initially by the Ponseti method. In addition, at age 5 years, feet treated with posteromedial release had significantly less ankle power than those treated with limited or no surgery. Read the abstract…

Study: Removal from play may reduce recovery time for younger athletes with concussion.
According to a study published in the August issue of the journal Pediatrics, younger athletes may recover from sport-related concussion more quickly if they are removed from participation. The research team conducted a prospective study of 35 athletes who were immediately removed from play and 34 who continued to play following concussion. They found that patients who continued to play took significantly longer to recover and were 8.8 times more likely to demonstrate protracted recovery (defined as 21 days or longer). Overall, return to play status was associated with the greatest risk of protracted recovery compared with other predictors. In addition, athletes who continued to play exhibited significantly worse neurocognitive and greater symptoms than those who were removed from play. Read more…
Read the abstract…

Arkansas.
An article in the Arkansas Times argues that defunding of the nonprofit Arkansas Trauma Education and Research Foundation (ATERF) may negatively affect mortality rates in the state’s trauma system. Some experts say that the education portion of the Arkansas Trauma System is responsible for much of the improvement in the reduction of preventable deaths seen in the state in recent years. However, the Trauma Section of the Arkansas Department of Health canceled its contract with ATERF in May, citing concerns over the organization’s billing practices. Read more…

Massachusetts.
Masslive.com reports that Massachusetts has rolled out a revamped prescription monitoring program that the state says will be easier for physicians to use and will enable data sharing across state lines. In addition, beginning Oct. 15, 2016, physicians will be required to check the prescription monitoring program any time they prescribe a Schedule II or III drug. Currently, physicians must only check the database the first time they prescribe such a drug to a patient. Read more…

Michigan.
According to Modern Healthcare, the state of Michigan has opened an investigation into Midtown hospitals of Detroit Medical Center. The Detroit News recently released emails and reports indicating that surgeons and other staffers have complained for at least 11 years regarding improperly cleaned, broken, and missing surgical instruments. Read more in Modern Healthcare(registration may be required)
Read more in The Detroit News

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:

  • Biological Implants Committee (closes Aug. 30; two members, one resident member opening)
  • Biomedical Engineering Committee (one resident member)
  • CMS Technical Expert Panel (TEP) on Cross-Setting Quality Measure Domain (Sept. 1; one liaison)

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