Today’s Top Story
CMS releases final rule for hospital payment in 2016.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a final rule for Medicare hospital inpatient prospective payment systems for fiscal year 2016, which begins Oct. 1, 2015. As reported by Modern Healthcare, the agency plans to increase reimbursement to acute care hospitals by 0.9 percent—a reduction from the 1.1 percent increase in announced in April. In addition, long-term care hospitals will see a 4.5 percent reduction in payments. Although the rule has been announced as finalized, CMS states that it will accept comments through Sept. 30. Read more…(registration may be required)
Read the final rule…

Other News

Study: Women may have higher complication rates than men after MoM HRA.
Findings published in the August issue of the journal Clinical Orthopaedics and Related Research suggest that, compared to men, women may be at increased risk of complication after primary metal-on-metal (MoM) hip resurfacing arthroplasty (HRA). The researchers conducted a systematic review of 10 studies with minimum 2-year follow-up, and found that women displayed increased likelihood of adverse local tissue reaction, dislocation, aseptic loosening, and revision. Read the abstract…

Study: CTA may be poor predictor of glenoid component stability for arthroplasty patients with shoulder pain.
According to a study published online in the Journal of Shoulder and Elbow Surgery, computed tomography arthrography (CTA) may have low predictive value in evaluating potential glenoid component stability associated with shoulder pain after arthroplasty. The authors conducted a retrospective review of all shoulder arthroplasty patients who were treated at a single center over a 5.5-year period. Patients were excluded if they underwent reverse or hemi- arthroplasty procedures, had a clearly identifiable cause of pain, or had a culture-positive aspiration. Overall, 14 patients had suspected glenoid component loosening, but inconclusive plain radiographs. Of those, CTA suggested glenoid component loosening in 8 patients (57.1 percent), while arthroscopic inspection identified loosening in 10 patients (71.4 percent). Further, in 3 of 10 patients (30 percent), CTA suggested a well-fixed glenoid component, but gross loosening was identified during arthroscopy. Read the abstract…

IDSA releases guideline for treatment of vertebral osteomyelitis.
The Infectious Diseases Society of America (IDSA) has published a guideline for the treatment of vertebral osteomyelitis. Among the points included in the guideline are the following:

  • Elevated diagnostic markers of inflammation, such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may suggest vertebral osteomyelitis.
  • Treatment usually includes intravenous antibiotics for 6 weeks, based on the results of culture and in vitro susceptibility testing.
  • Plain radiographs of the spine are not sensitive for early diagnosis.
  • Patients with elevated ESR and CRP should undergo magnetic resonance imaging to distinguish infection from disk herniation or other structural cause of back pain.

The guideline was developed by an expert panel that included an orthopaedic surgeon, infectious disease specialists, and a radiologist. Read more…(registration may be required)
Read the complete guideline…

Study: Nutritional screening may help predict complications for patients with fracture or dislocation.
Data from a study published in the August issue of the Journal of Orthopaedic Trauma suggest that nutritional screening may serve as a predictor for the development of complications and hospital readmission for fracture or dislocation patients. The research team conducted a retrospective review of 796 patients, 459 (57.7 percent) of whom were of normal nutritional status and 337 (42.3 percent) of whom exhibited at least one sign of malnutrition based on the Malnutrition Universal Screening Tool. Among patients with normal nutrition, 2.8 percent developed at least one specified complication (infection, venous thromboembolism, respiratory failure, ulceration, or readmission), for a complication-to-patient ratio of 0.033. Among patients with signs of malnutrition, 8.0 percent developed at least one complication, for a complication-to-patient ratio of 0.101. A multivariate regression analysis found that each additional point in a patient’s nutrition score corresponded to a 49.5 percent increase in the likelihood of a complication developing. Read the abstract…

Study: ACA implementation corresponded with increases in coverage, access, and overall health.
According to information published in the July 28 issue of The Journal of the American Medical Association, the first two enrollment periods of the Affordable Care Act (ACA) were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health. The researchers analyzed data on 507,055 non-elderly adults who were surveyed in the Gallup-Healthways Well-Being Index in the period 2012 through 2015. Compared with the pre-ACA trends, they found decreases in the following measures by the first quarter of 2015:

  • Number of uninsured—down 7.9 percentage points
  • Individuals who lacked a personal physician—down 3.5 percentage points
  • Individuals who lacked easy access to medicine—down 2.4 percentage points
  • Individuals who were unable to afford care—down 5.5 percentage points
  • Individuals who reported fair/poor health—down 3.4 percentage points
  • Percentage of days with activities limited by health—down 1.7 percentage points

In addition, Medicaid expansion was linked to significant reductions among low-income adults in uninsured rate, lacking a personal physician, and difficulty accessing medicine. Read the abstract…

Studies look at chemical changes after brain trauma.
A pair of recent studies examine chemical changes in the body after experiencing traumatic brain injury (TBI). In the first, published online in the Journal of Neurotrauma, the authors investigated the diagnostic and prognostic values of serum brain-derived neurotrophic factor (BDNF) in TBI among two independent cohorts of TBI patients seen in two hospital emergency departments. They found that day-of-injury serum BDNF was associated with TBI diagnosis and also provided 6-month prognostic information regarding recovery from TBI. Read more…
Read the abstract…
      In the second study, published online in the journal JAMA Neurology, the research team conducted an observational assessment of U.S. military personnel who had been deployed within the previous 18 months. They found that, compared with control participants, concentrations of plasma tau were significantly elevated in patients with self-reported TBI. Read more…
Read the abstract…

Call for volunteers to help develop AUC for Surgical Management of OA of the Knee.
The Appropriate Use Criteria (AUC) Section seeks AAOS fellows to participate on the writing panel of the Surgical Management of Osteoarthritis (OA) of the Knee AUC. The writing panel is responsible for constructing a comprehensive patient factors list and a treatment list for OA of the knee. Writing panel members will be required to construct and review materials, correspond with AAOS staff electronically, and participate in approximately 5 to 10 conference calls, spanning 1 to 3 months, to produce the AUC materials. Members should have experience in the treatment of knee OA. Nominees for the writing panel may have relevant conflicts and will be required to complete the AAOS conflict of interest enhanced disclosure form online. To participate, please contact Erica Linskey by Monday, Aug. 10, 2015, at: