Today’s Top Story
Article highlights potential concerns with proposed CCJR payment model.
An article on the Health Affairs blog examines a recently released U.S. Centers for Medicare & Medicaid Services (CMS) proposal to bundle payments and quality measures for hip and knee arthroplasty at hospitals in 75 randomly selected geographic areas. Under the Comprehensive Care for Joint Replacement (CCJR) payment model, the hospital in which the procedure is performed would be accountable for costs associated with the entire episode of care, from the time of surgery through 90 days postoperative. The writer outlines the following areas of concern:
- The proposal is hospital-centric. Leaving physicians, post-acute care providers, and others out of the program may encourage conflicts instead of collaboration between providers.
- The model prevents the possibility of using outpatient or other suitable sites of care for such surgeries, possibly promoting increased consolidation in the healthcare industry.
- The proposal does not vary payments to hospitals based on severity of the patient’s condition.
- The diagnosis-related groups targeted by the program are broad, and include procedures unrelated to replacing a hip or knee.
- Provider payments would not be reconciled until the end of the year.
Study: Meniscal transplant improves function in short- to mid-term, but procedure may not be curative in the long-term.
According to findings published in the Aug. 5 issue of The Journal of Bone & Joint Surgery (JBJS), patients who undergo meniscal transplantation demonstrate good outcomes in the short- to mid-term, but additional surgery may be required in the long-term. The researchers conducted a prospective study of 40 consecutive medial and lateral bone-meniscus-bone transplants using cryopreserved menisci in 38 patients. At mean 11-year follow-up, they found that the estimated probabilities of transplant survival were 88 percent at 5 years, 63 percent at 10 years, and 40 percent at 15 years. The researchers noted that overall mean time to failure was 8.2 years for medial transplants and 7.6 years for lateral transplants. They write that patients who undergo meniscal transplantation “should be advised that the procedure is not curative in the long term and additional surgery will most likely be required.” Read more…
Read the abstract…
Study: Chronic suppression with oral antibiotics may increase the infection-free prosthetic survival rate following surgical treatment for PJI.
Data published in the Aug. 5 issue of JBJS suggest that chronic suppression with oral antibiotics may increase the infection-free prosthetic survival rate following surgical treatment for periprosthetic joint infection (PJI). The authors reviewed records of 92 patients who received chronic oral antibiotics for a minimum of 6 months and a matched cohort (ratio of 1:3) who did not receive chronic oral antibiotics. They found that the 5-year infection-free prosthetic survival rate was 68.5 percent among patients in the antibiotic-suppression group and 41.1 percent in the non-suppression group. The authors noted that the 5-year survival rate among patients who underwent irrigation and debridement with polyethylene exchange was 64.7 percent for patients in the suppression cohort and 30.4 percent for patients in the non-suppression cohort. Similarly, the 5-year survival rate among patients with Staphylococcus aureus infection was 57.4 percent for patients in the suppression group and 40.1 percent for patients in the non-suppression group. Read the abstract…
Study: Many seniors appear to overestimate their own mobility.
Findings from a study published online in the journal Annals of Emergency Medicine suggest that many older adults overestimate their mobility. The research team conducted a cross-sectional study of 272 cognitively intact patients aged 65 years or older who were neither nursing home residents nor critically ill. Each participant was asked if he or she could get out of bed, walk 10 feet, turn around, and get back into bed without assistance, and if not, whether he or she could perform the task with a cane, walker, or assistance. They found that 161 (59 percent) said they could perform the task unassisted, 45 (17 percent) said they could do it with a cane or walker, 21 (8 percent) said they could do it with assistance, and 45 (17 percent) said they would be unable to do it even with assistance. However, of those who said they could perform the task without assistance, 12 percent required some assistance or were unable to complete the task. Of those who said they could perform the task with a cane or walker, 48 percent required either assistance or were unable to perform the task. And of those who said they could perform the task with assistance, 24 percent were unable to perform the task even with assistance. Read more…
Read the abstract…
Do third-party educational sponsors reduce commercial influence?
An article in The Boston Globe looks at the issue of pharmaceutical and medical device companies that pay independent companies to sponsor medical lectures for physicians. An analysis by the paper finds that, since 2011, drug industry payments to such companies have increased by 25 percent. The writer notes that physicians who deliver the lectures generally receive between $2,000 and $3,000 per appearance. Critics of the system say that payments from such companies to provide medical education are designed to influence physicians to prescribe expensive drugs and order expensive tests. Supporters argue that commercial bias is minimized through the use of third-party sponsors. Read more…
Study: Music played in the operating room may hinder communication between team members.
Data from a study published online in the Journal of Advanced Nursing suggest that music played in the operating room may interfere with team communication. The researchers reviewed video recordings of 5,203 responses and requests across 20 surgical procedures performed in the United Kingdom. They found that repeated requests were five times more likely to occur in cases that played music than those that did not. The researchers note that each repeated request can add 4 to 68 seconds to operation time and may increase tensions due to frustration at ineffective communication. Read more…(registration may be required)
Read the complete study…
WUSF Public Media reports that, in a 2-1 decision, a federal appeals court has upheld a controversial Florida law restricting physicians and other healthcare providers from asking questions and recording information about patients’ gun ownership. Among other things, the law prevents physicians from entering information about gun ownership into medical records unless they believe the information to be relevant to the medical care of patients or safety of other people. The law has been opposed by medical groups. The dissenting judge argued that the law violates physicians’ First Amendment rights, and “prohibits or significantly chills doctors from expressing their views and providing information to patients about one topic and one topic only, firearms.” Read more…
Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program website are closing this week. Act now to apply for the following positions:
- ACGME Review Committee for Orthopaedic Surgery (one member opening; closes Aug. 15)
- Adult Spine Evaluation Committee (chair; Aug. 15)
- Communications Cabinet (liaison to Council on Advocacy; Aug. 15)
- Diversity Advisory Board:
- Three members-at-large (Aug. 15)
- Research and Quality Council Liaison (Aug. 15)
- Foot & Ankle Evaluation Committee (chair, seven members; Aug. 15)
- Hip, Knee & Adult Reconstruction Evaluation Committee (five members; Aug. 15)
- Orthopaedic Basic Science Evaluation Committee (11 members; Aug. 15)
- Performance Measures Committee (one resident-at-large; Aug. 14)
- Publications Committee (three members; Aug. 14)
- Trauma Evaluation Committee (seven members; Aug. 15)
Learn more and submit your application…(member login required)