Medicare Physician Fee Schedule Finalized for 2021
On Dec. 1, the Centers for Medicare & Medicaid Services (CMS) released the much-anticipated 2021 Medicare Physician Fee Schedule final rule. Despite yearlong requests from the medical community to preserve the value of services and waive budget neutrality in light of the COVID-19 public health crisis, the agency finalized changes that will result in a 10 percent reduction for the Medicare payment rate, including an estimated 4 percent cut for orthopaedic services. AAOS and a large coalition of healthcare organizations are urging Congress to address the cuts in any year-end legislative package before they are scheduled to go into effect on Jan. 1, 2021. For some orthopaedic surgeons, these cuts are further compounded by CMS’ decision to decrease the value of hip and knee arthroplasty (CPT codes 27130 and 27447) despite compelling evidence provided by AAOS and the American Association of Hip and Knee Surgeons that these physicians invest significant time in value-based patient care. Members will receive more details on the final rule and updates on AAOS advocacy efforts in the coming days.
Study: Is Lymphedema Associated with TKA Infection, Failure?
A study published in the Dec. 1 issue of the Journal of the AAOS ® observed a correlation between lymphedema and revision, reoperation, and infection in patients who underwent total knee arthroplasty (TKA). A total of 147 knees with a preoperative diagnosis of ipsilateral lymphedema were matched 1:2 to TKA patients without a lymphedema diagnosis. Lymphedema was associated with an increased hazard ratio for revision (7.60), reoperation (2.87), and infection (6.19), as well as an increased risk for periprosthetic fracture and tibial component loosening. Knees with lymphedema tended to have a later time to infection.
Study: Arthroscopic Labral Treatment with Versus Without Endoscopic Repair
A study published in the November issue of Arthroscopy assessed midterm outcomes in patients who underwent endoscopic gluteus medius (GM) repair with arthroscopic labral treatment and compared them to controls who did not undergo endoscopic repair. Of 46 patients with GM repair identified, 43 had five-year follow-up. The modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), and Hip Outcome Score-Sports Specific Subscale (HOS-SSS) all significantly improved. When matching the GM repair cohort, there were 37 cases compared to 78 controls. Outcomes compared favorably between the case and control cohort for mHHS (82.3 versus 82.6), NAHS (81.9 versus 82.3), and HOS-SSS (66.3 versus 67.5).
Study Assesses Reliability of Patients’ Self-reported Smoking Cessation
A study published online in the Journal of Orthopaedic Trauma evaluated the accuracy of self-reported smoking cessation among orthopaedic trauma patients. Patients at a level 1 trauma center underwent in-office exhaled carbon monoxide (CO) measurements. A total of 247 patients completed 906 surveys over four follow-up visits. Of the 174 responses indicating smoking cessation, 12.6 percent had positive CO readings. Of the patients who inaccurately reported smoking cessation, more than one in five did so multiple times. Factors associated with inaccurate self-reporting were having no or government insurance and being unemployed.
Study Assesses Clinical Complications After Transosseous Repair for Flexor Tendon Injuries
A retrospective study published in the December issue of The Journal of Hand Surgery observed a high rate of clinical complications following zone I flexor tendon injury repair using the transosseous technique. Eight patients (all male; average age, 31 years) were identified in a single institution’s database. To perform the repair, nonabsorbable sutures were passed from volar to dorsal by transosseous tunnels and tied dorsally over the distal phalanx proximal to the germinal matrix. There were seven closed injuries and one open. Five patients sustained complications, and three patients’ complications necessitated further surgery.
Tactics to Ensure Device Safety After Approval Are Changing
Each year, more than 2,000 novel medical devices enter the U.S. market, often representing new technologies and offering significant advantages over older treatment options for patients. Although it is important to encourage innovation, balance is necessary to prove a “reasonable assurance of safety and effectiveness.” Premarket approval is the difficult process required for FDA approval of a truly novel device. Many inventors take the shorter route of gaining approval based on similarity to an already approved device—the 510(k) pathway. Most patient safety discussions have focused on these premarket review processes.
Follow the Office of Government Relations on Twitter
Looking for AAOS advocacy updates on Twitter? Follow the Office of Government Relations for timely news and information. The Association arm of the Academy identifies, analyzes, and directs all health policy activities and initiatives to position AAOS as the trusted leader in advancing musculoskeletal health. Members are encouraged to follow this handle and engage with tweets to help promote the viewpoint of the orthopaedic community.
