Today’s Top Story
CMS issues proposed rule to address changes to physician fee schedule; reminds physicians of concerns regarding inappropriate balance billing.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released the annual Medicare Physician Fee Schedule proposed rule that addresses changes to the physician fee schedule and other Medicare Part B payment policies. The proposed rule also includes proposals related to the Medicare Shared Saving Program as well as to the release of certain pricing data from Medicare Advantage bids and medical loss ratio reports from Medicare health and drug plans. Among other things, the proposed rule reminds Medicare providers that federal law prohibits them from collecting Medicare Part A and Medicare Part B deductibles, coinsurance, or copayments from beneficiaries enrolled in the Qualified Medicare Beneficiaries (QMB) program—a Medicaid program that helps certain low-income individuals with Medicare cost-sharing liability.
The American Association of Orthopaedic Surgeons (AAOS) is currently preparing comments in response to the proposed rule. Read the rule…
     In July 2015, CMS released a study that found that confusion and inappropriate balance billing persist despite laws prohibiting Medicare cost-sharing charges for QMB individuals. Read the study (PDF)…

Other News

Study: Initial opioid prescribing pattern may affect likelihood of long-term use.
According to a study published online in the Journal of General Internal Medicine, opioid prescribing patterns during the initiation month may affect the likelihood of long-term opioid use. The authors conducted a retrospective, cohort study of 536,767 opioid-naïve patients who filled an opioid prescription, of whom 26,785 (5.0 percent) became long-term users. They found that higher numbers of fills and cumulative morphine milligram equivalents (MME) during the initiation month were associated with increased risk of long-term use. Among patients younger than 45 years who used short-acting opioids and who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25. In addition, compared to those who received less than 120 total MMEs, those who received between 400 and 799 total MMEs had an OR of 2.96 for long-term use. Finally, the authors note that patients who initially received long-acting opioids had a higher risk of long-term use than those who received short-acting drugs. Read more…
Read the abstract…

Study: No clear advantage between two prophylaxis regimens for patients with type 3 open fracture.
Findings published in the August issue of the Journal of Orthopaedic Trauma suggest similar rates of surgical site infection (SSI) for patients with type 3 open fractures who undergo antibiotic prophylaxis with either cefazolin plus gentamicin or piperacillin/tazobactam. The research team conducted a retrospective, cohort study of 72 patients with type 3 open fractures at a single center. At 1-year follow-up, they found that SSI occurred in 12 of 37 patients (32.4 percent) in the cefazolin plus gentamicin group and 11 of 35 patients (31.4 percent) in the piperacillin/tazobactam group. In addition, at 1 year, rates of nonunion, death, and rehospitalization were similar across cohorts. The research team notes that the 30-day rate of SSI was higher in the cefazolin plus gentamicin group, although the difference did not reach significance. Read the abstract…

Study: Use of surgical treatment for rotator cuff tear increased over time.
A study published online in the Journal of Shoulder and Elbow Surgery examines trends in surgical and nonsurgical treatment of rotator cuff tears among Medicare patients. The researchers reviewed data on 878,049 patients diagnosed with rotator cuff tear, 397,116 of whom underwent rotator cuff repair. From 2005 through 2012, the percentage of patients treated initially with physical therapy fell from 30.0 percent to 13.2 percent, and the percentage who received subacromial/glenohumeral injections decreased from 6.00 percent to 4.19 percent. Over the same period, the percentage of patients who underwent rotator cuff repair increased from 33.8 percent to 40.4 percent from 2005 to 2012. The researchers note that overall, Charlson Comorbidity Indexes were significantly lower in surgically treated patients compared with each nonsurgical treatment examined. Read the abstract…

NYT article calls arthroscopic partial meniscectomy “useless.”
An article published in the Aug. 3 issue of The New York Times (NYT) questions the efficacy of arthroscopic partial meniscectomy. The writer cites information from a study published in 2013 in The New England Journal of Medicine, reporting on a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. In an intention-to-treat analysis, the researchers found no significant differences in functional improvement between the experimental and control groups at 6-month follow-up, but noted that 30 percent of patients assigned to physical therapy alone underwent surgery within 6 months. Read more…
Read the study…
     The AAOS Clinical Practice Guideline (CPG), “Treatment of Osteoarthritis of the Knee (2nd edition),” reads in part, “We are unable to recommend for or against arthroscopic partial meniscectomy in patients with osteoarthritis of the knee with a torn meniscus.” Read the CPG…
View the AAOS Appropriate Use Criteria for “Osteoarthritis of the Knee: Non-Arthroplasty Treatment”…

Less than 10 days left to submit nominations for future AAOS leadership!
The 2017 Nominating Committee is actively soliciting your suggestions for individuals to serve in the following positions:

  • Second Vice President
  • Member-at-Large [No Age Designation]
  • Member-at-Large [Under Age 45] (younger than age 45 on March 16, 2017)
  • National Membership Committee Member

Nominations close Friday, Aug. 12, 2016. Nominations may be submitted by mail to Joshua J. Jacobs, MD, chair, 2017 Nominating Committee, c/o AAOS Office of General Counsel, 9400 West Higgins Road, Rosemont, Ill. 60018, or (preferred) electronically. Descriptions of the responsibilities, desired experience, and time commitments associated with the positions are available online. Learn more about the positions and access the nomination form…

Call for volunteers: National Quality Registry Network Steering Committee.
AAOS seeks to nominate one member to the National Quality Registry Network (NQRN) Steering Committee. The Steering Committee provides oversight for NQRN to promote the increased use and utility of clinical registries to support healthcare reform and improve patient health outcomes. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, and a signed nomination form (obtained from the email address below). All materials must be submitted to Kyle Shah by Aug. 14, 2016 at 11:59 p.m. CT, at: shah@aaos.org
Learn more and submit your application…(member login required)