Today’s Top Story

Study: Which Common Surgeries Yield Out-of-network Bills?

A retrospective study published online in JAMA evaluated out-of-network (OoN) billing across common elective surgeries when in-network primary surgeons and facilities are involved. A large U.S. commercial insurance database was queried for data on seven common elective surgeries, including arthroscopic meniscal repair (n = 116,749) and total knee replacement (TKR) (n = 42,313), performed between Jan. 1, 2012, and Sept. 30, 2017, by an in-network primary surgeon at an in-network facility. In total, 347,356 patients underwent one of the seven surgeries; 20.5 percent of episodes yielded an OoN bill. When OoN billing was present, the mean potential balance bill per episode was $2,011. OoN bills were associated with surgical assistants in 37 percent of episodes (mean potential balance bill, $3,633) and anesthesiologists in 37 percent of episodes (mean potential balance bill, $1,219). Health insurance exchange plans, compared to nonexchange plans, were significantly associated with OoN bills. Surgeries with complications, compared to those without, were more likely to yield OoN bills. A total of 83,021 procedures took place at ambulatory surgical centers with in-network primary physicians; 6.7 percent included an OoN facility bill and 17.2 percent included an OoN professional bill.

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In Other News

Study Identifies Nonaccidental Trauma Risk Factors in Pediatric Fracture Patients

A study published in the Feb. 15 issue of the Journal of the AAOS detailed the development of an evidence-based likelihood of nonaccidental trauma in a child with a fracture. Data from 2012 from the Kids’ Inpatient Database were used to identify pediatric patients with an extremity or spine fracture. Patients were stratified by whether they were diagnosed with nonaccidental trauma. The database yielded 57,183 pediatric fracture cases, of which 881 (1.54 percent) also had a nonaccidental trauma diagnosis. Among this group, patients with multiple fractures had the highest nonaccidental trauma rate (2.8 percent). Patients with abuse had nearly double the mortality rate of children without abuse. Multivariate analysis identified the following risk factors for nonaccidental trauma: younger age, black race, intracranial injury, concomitant rib fracture, and burns.

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Study Compares Lateral versus Medial Unicompartmental Knee Arthroplasty

A study published online in The Journal of Arthroplasty evaluated survivorship data on lateral unicompartmental knee arthroplasty (UKA) compared to medial UKA. The Dutch Arthroplasty Register was queried for data on lateral (n = 537) and medial (n = 19,295) UKAs performed between 2007 and 2017. The five-year revision rate for lateral UKA was 12.9 percent compared to 9.3 percent for medial UKA. Upon multivariable regression analyses, revision risks were not significantly different between lateral and medial UKAs. Patient characteristics affected revision rates similarly between the groups, but mobile-bearing design was correlated with an increased revision risk in lateral UKA. For medial UKA, the main reason for revision on both sides was osteoarthritis progression accompanied by aseptic loosening.

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Study: Outcomes of Concomitant Tibia and Fibula Osteotomies with Total Ankle Replacement

A retrospective study published in the February issue of Foot & Ankle International observed good outcomes when tibia, fibula, and combined tibia and fibula osteotomies were performed at the same time as total ankle replacement (TAR). Patients who had a concomitant tibia, fibula, or combined tibia and fibula osteotomy at the same time as TAR underwent routine radiographs to determine osteotomy union rates and changes in alignment. Pre- and postoperative outcome questionnaires were completed. Final analysis included 26 patients (mean follow-up, 3.9 years): 12 combined tibia and fibula osteotomies, nine isolated tibia osteotomies, and five isolated fibula osteotomies. The individual tibia and fibula osteotomies both had a 100 percent union rate, and the combined procedures had a 92 percent union rate. Patient-reported outcome measures improved significantly. Mean improvement in coronal alignment ranged from 15.2 degrees to 2.1 degrees. One failure was reported.

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HHS Releases Strategy Targeting Clinician Burdens

The Department of Health and Human Services (HHS) issued a strategy designed to improve patient-doctor relationships by reducing clinician burdens. The report, titled, “Strategy on Reducing Burden Relating to the Use of Health IT and EHRs,” focuses on three main goals: (1) reduce the effort and time clinicians must spend recording information in electronic health records (EHRs); (2) reduce the effort and time spent by clinicians, hospitals, and healthcare organizations on regulatory reporting requirements; and (3) make EHRs easier to use.

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Looking Back at a Very Good Year for Registries

For the AAOS Family of Registries, 2019 was a year full of proud accomplishments and successes. There were welcome new arrivals—beginning with the January 2019 launch of the Musculoskeletal Tumor Registry pilot, followed in March 2019 by the addition of the rotator cuff and elbow arthroplasty modules to the Shoulder and Elbow Registry.

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Hundreds of Surgical Techniques Modules Available Free to AAOS Members

Build your surgical and clinical decision-making skills with unique educational experiences available on the AAOS online learning platform. Explore the surgical instruction interactive learning modules that assess your knowledge, patient management, and clinical decision making. Available free to AAOS members, these microlearning experiences provide quick and exciting lessons for hundreds of procedural techniques. Topics include advanced reconstruction, foot and ankle, hand and wrist, shoulder and elbow, hip and knee, spine, and sports medicine.

View the learning platform…(member login required)