Commentary: New IPO Policy May Impact Access to Surgical Care
In an op-ed published online on HealthCare Dive, AAOS President Joseph A. Bosco III, MD, FAAOS, discussed the unintended consequences of eliminating Medicare’s inpatient-only (IPO) list. As of Jan. 1, the Centers for Medicare & Medicaid Services removed all 266 musculoskeletal-related procedures from the IPO list. In theory, the change allows doctors and patients more freedom to account for individual circumstance when choosing setting of care. Without patient safeguards and clearer guidance to insurers about the reform, Dr. Bosco argues, this move may have health-related and financial impacts on patients in need of orthopaedic surgery.
Study Measures Effect of Obesity on Open-wedge HTO Outcomes
A prospective study published online in Knee Surgery, Sports Traumatology, Arthroscopy evaluated the role of obesity in clinical and radiological outcomes after open-wedge high tibial osteotomy (HTO). A total of 120 patients with medial compartment osteoarthritis who underwent open-wedge HTO were stratified according to BMI. Clinical and functional outcomes were assessed over a minimum of six years of follow-up. The entire cohort showed overall improvement in postoperative functional scores, although scores of overweight patients did not reach the peak values of those in the normal weight range. Rates and severity of complications were similar across patient groups.
Study: Mobility and Deformity After Arthroscopic Release for Brachial Plexus Birth Injury
A meta-analysis published online in the Journal of Shoulder and Elbow Surgery measured the effects of arthroscopic release on shoulder mobility and bone and joint deformity, as well as the benefit of tendon transfer in children with brachial plexus birth injury. Data from 17 studies were included, comprising 266 children. Arthroscopic release was associated with significantly improved Mallet scores (standard mean difference [SMD], 3.1) and passive external rotation (SMD, 3.6). Percentage humeral head anterior and glenoid retroversion were also improved. Concomitant tendon transfer was suggested to additionally improve mobility.
Study: Intra-articular Lesion Repair Following PAO for Hip Dysplasia
A study published online in Arthroscopy examined changes in intra-articular lesions after periacetabular osteotomy (PAO). A total of 64 patients with hip dysplasia who underwent PAO between 1990 and 2001 were included. Most hips had lesions in the acetabulum (93 percent) and labrum (97 percent), and 81 percent had lesions in the femoral head. Cartilage repair occurred in 24 percent and 17 percent of acetabula and femoral heads, respectively. Labral repair occurred in 10 percent of hips. Lesion change was not associated with procedure failure or survival. Severe femoral head lesions were an independent risk factor for PAO failure.
Study Evaluates Risk Factors for TMT Arthrodesis Complications
A retrospective study published online in Foot & Ankle International assessed complications following tarsometatarsal (TMT) arthrodesis in 101 patients with end-stage TMT arthritis. Functional evaluations included the European Foot and Ankle Society Score; the Foot and Ankle Outcome Score; the University of California, Los Angeles (UCLA) Activity Score; and a numeric pain rating. Only UCLA scores did not improve after surgery. Postoperative pain scores were reduced from 7.7 to 3.0. Overall nonunion rate was 12.6 percent. Locking plate plus compression screw fixation achieved the lowest nonunion rate, and higher BMI was associated with nonunion. A quarter of patients underwent reoperation.
New Law Repeals Antitrust Exemption for Health Insurers
Recently enacted legislation has removed the McCarran-Ferguson Act, an antitrust exemption that has protected insurers since 1945. Insurers will now be required to follow the same free-market rules as the other industries. On an episode of AAOS’ advocacy podcast “The Bone Beat,” George Slover, senior policy counsel for Consumer Reports, discusses why this repeal took so long and how the new law will introduce more choice and opportunity into the marketplace.
After more than a decade of developing Clinical Practice Guidelines (CPGs), AAOS has expanded its reach into the quality space. With the transition to value-based care, AAOS sought to produce quality products that provide the most benefit to the membership. AAOS continues to develop CPGs, with 20 currently available, but the Academy now uses them to create Appropriate Use Criteria (AUC) and performance measures. These tools help members answer the question, “What does quality care look like?” All AAOS quality resources are free to members.
