According to the Associated Press, tax reform legislation currently under consideration in the U.S. Congress could significantly impact a number of healthcare issues. Both the House of Representatives and the Senate have passed competing tax bills on party-line votes, and Republican legislators from both houses have started reconciling the two bills. Issues that could affect healthcare—such as elimination of the Affordable Care Act individual mandate, medical expense deductions, drug industry incentives, Medicare cuts, and pass-through provisions—are under consideration.
The American Association of Orthopaedic Surgeons (AAOS) is closely monitoring each of these issues and communicating to Congress issues that could negatively impact the business of orthopaedic practices and ability to care for Medicare patients.
Study: Use of fluoroscopy during direct anterior THA linked to relatively low radiation risk
Data from a study published in the Dec. 6 issue of The Journal of Bone & Joint Surgery suggest that use of fluoroscopy during direct anterior total hip arthroplasty (THA) may be associated with relatively low radiation exposure risk. The researchers reviewed data on 50 consecutive direct anterior approach THA procedures, 45 of which met study criteria. They found that no surgeons experienced a detectable radiation entrance surface dose. Overall, one patient had a detectable thyroid exposure equal to 1 mrem and seven patients had a detectable radiation entrance surface dose at the pubic symphysis in the range of 1 to 7 mrem. The researchers found that the mean fluoroscopic time was 13.72 seconds and the mean patient radiation exposure was 178 mrem. They conclude that direct anterior approach THA “typically results in a negligible or very low dose of absorbed radiation exposure to the patient and the surgeon.”
Study: TLIF may be safe option for adult patients with symptomatic lumbar spinal stenosis and spinal deformity
A study published online in The Spine Journal suggests that transforaminal lumbar interbody fusion (TLIF) may be a reasonable treatment option for older patients with symptomatic lumbar spinal stenosis and spinal deformity. The authors retrospectively reviewed data on 41 adult patients treated with limited fusion and TLIF. At minimum 5-year follow-up (mean 7.5 years), they found no statistical difference between patients with curves measuring between 10° and 20° and greater than 20° for EuroQol-5D, Patient Health Questionnaire-9, and Perceived Deficits Questionnaire. Overall, the revision surgery rate was 48 percent for patients who underwent 1-level TLIF and 18 percent among patients who underwent 2-level TLIF. The authors note moderate pain disability scores for 1-level TLIF patients (mean 75) compared to 2-level TLIF patients (mean 27) at final follow-up. They note that more comprehensive fusions are associated with increased complication rates, and recommend further study into the use of short segment fusions for treatment of adult spinal deformity.
Study: Demographics may affect normative values for PROM shoulder scores
A study conducted in Australia and Canada and published online in the Journal of Shoulder and Elbow Surgery attempts to identify normative patient-reported outcome measure (PROM) values for healthy patients. The researchers surveyed 653 individuals without dominant shoulder pathology for the American Shoulder and Elbow Surgeons shoulder score; Constant-Murley Shoulder Score; Oxford Shoulder Score; University of California, Los Angeles shoulder score; Shoulder Pain and Disability Index; and Stanmore Percentage of Normal Shoulder Assessment. They found that differences in sex, age, and geographical location may affect PROM shoulder scores in pathology-free individuals. The researchers recommend that demographic factors be taken into consideration when PROMs used to compare patient outcomes.
Report: CMS should increase efforts to prevent fraud
A report from the U.S. Government Accountability Office (GAO) examines U.S. Centers for Medicare & Medicaid Services (CMS) fraud risk management efforts. The report notes that the agency has demonstrated a commitment to combating fraud through establishment of the Center for Program Integrity. However, GAO notes that CMS does not require its employees to undertake regular fraud-awareness training, has not conducted a fraud risk assessment for Medicare or Medicaid, and has not designed and implemented a risk-based antifraud strategy. GAO recommends that CMS increase efforts in these areas. The U.S. Department of Health and Human Services concurred with the GAO recommendations.
AAOS members will soon receive the print edition of the December issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes articles on orthobiologic interventions, strategies to improve the value of hip fracture care, a look at benchmarking in an orthopaedic practice, and much more.
Dec. 31, 2017, is the last day to submit an application for a position on the Diversity Advisory Board (one opening—Communications Cabinet liaison). This board provides resources to assist AAOS members in providing culturally competent care to diverse populations as well as develops and implements strategies to overcome barriers faced by minorities when choosing orthopaedics as a career. The Communications Cabinet liaison is responsible for representing the Advisory Board’s issues and concerns to the Communications Cabinet. Applicants for this position must be active fellows, candidate members, or candidate member applicants for fellowship, with a demonstrated interest in advancing diversity in orthopaedics and fostering culturally competent care.
