Today’s Top Story
CMS issues rule to reform ACA insurance markets in 2018.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for 2018, designed to stabilize the Affordable Care Act (ACA) insurance markets. Among other things, the rule would shorten the open enrollment period, and put in place stricter verification processes during special enrollment periods. According to Modern Healthcare, insurers have advocated for such changes to reduce the likelihood of consumers purchasing insurance when they require medical care and later dropping coverage. Other items in the rule include:

  • Insurers would be allowed to collect premiums for unpaid coverage prior to enrolling a patient in the next year’s plan with the same issuer.
  • Greater flexibility to issuers to provide patients with more coverage options.
  • Deference to state reviews of network adequacy.
  • An announced intention to release a revised proposed timeline for the Qualified Health Plan certification and rate review process for plan year 2018.

Read more…
Read the CMS statement…
Read the rule…

Other News

Study: Acetabular component position may affect risk of dislocation after THA.
Data from a study published in the March issue of The Journal of Arthroplasty suggest that acetabular component positioning may be an important variable in decreasing risk of dislocation following primary and revision total hip arthroplasty (THA). The authors conducted a retrospective, matched cohort study of 96 primary THAs and 60 revision THAs that sustained a dislocation, and 156 control participants. They found that the proportion of acetabular components within the safe zone for both inclination and anteversion was 23 of 96 (24 percent) in primary THA dislocators, compared to 48 of 96 (50 percent) in controls. The proportion of acetabular components within the safe zone for both inclination and anteversion was 28 of 60 (47 percent) in revision THA dislocators, and 40 of 60 (66 percent) in controls. The authors write that “patients sustaining a dislocation following a primary or revision THA had acetabular components less frequently positioned within the safe zone compared to control patients.” Read the complete study…

ACP issues recommendations for noninvasive treatment of low back pain.
The American College of Physicians (ACP) has released a new guideline regarding clinical recommendations on noninvasive treatment of low back pain. The recommendations are based on a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for acute, subacute, or chronic low back pain. The guideline offers the following strong recommendations:

  • Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence).
  • For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence).

Read the complete guideline…

Study: Patients of surgeons with more unsolicited patient observations may be at increased risk for postoperative complication.
A study published online in the journal JAMA Surgery suggests that patients whose surgeons have large numbers of unsolicited patient observations in the 24 months prior to a surgical procedure may be at increased risk of complications. The researchers conducted a retrospective cohort study of 32,125 adult patients who underwent inpatient or outpatient operations at one of seven academic medical centers. They found that 3,501 (10.9 pecent) experienced a complication, including 1.754 (5.5 percent) surgical and 2,422 (7.5 percent) medical complications. The researchers noted that prior unsolicited patient observations for a surgeon in the preceding 24 months were significantly associated with the risk of a patient having any complication, any surgical complication, any medical complication, and readmission. Compared with patients whose surgeon was in the lowest quartile of unsolicited patient observations, the adjusted rate of complications was 13.9 percent higher for patients whose surgeon was in the highest quartile. Read more…
Read the abstract…

According to The Lund Report, the Oregon Legislative Assembly is considering a bill that, if enacted, would allow certain ambulatory surgery centers (ASCs) to admit patients for up to 48 hours. The bill limits the number of “extended care” or “convalescent care” ASCs to 16 during the first 5 years, and requires them to share data with the Oregon Health Authority to track costs and outcomes. The bill is reported to have broad bipartisan and bicameral support. Read more…
Read the bill (PDF)…

A memo from the Massachusetts Department of Public Health clarifies the term “narcotic” as it applies to a recent state law that requires licensed prescribers to use the Massachusetts Prescription Awareness Tool (MassPAT) each time a prescription is issued for a Schedule II or III narcotic drug. As of December 2016, the state considers the following generic medications to be narcotics:

  • Buprenorphine
  • Codeine (and its derivatives), including hydrocodone
  • Fentanyl (and its derivatives)
  • Meperidine
  • Methadone
  • Morphine (and its derivatives), including hydromorphone
  • Opium (including diluted tincture of opium)
  • Oxycodone

Read the memo (PDF)…

Call for volunteers: Health Care Systems Committee.
March 31 is the last day to submit your application for a position on the Health Care Systems Committee. This committee helps orthopaedic surgeons develop and improve relationships with other healthcare stakeholders, including providers, the federal government, private and public payers, and patient groups. The following positions are available:

  • Member (two openings)
  • Member-at-large—health information technology (one opening)

Applicants for these positions must be active fellows. Applicants for the member-at-large position must have knowledge of healthcare system mechanisms, payment, and policies that affect quality, access, and resources for musculoskeletal conditions and disorders. Learn more and submit your application…(member login required)