Today’s Top Story

Study: Simultaneous door openings may compromise sterile field in the OR

A study published in the March 1 issue of the Journal of the AAOS suggests that single door opening may not defeat positive pressure in the operating room (OR), but simultaneous opening of two doors may allow contaminated air to enter. The researchers used digital manometers to collect pressure data during off-hours at the thresholds of both the outer and the inner substerile doors for six empty ORs used for total joint arthroplasty. They found that positive pressure was not defeated during any door-opening event, and the average time for recovery of initial pressurization regardless of door used was between 14 and 15 seconds. Smoke studies confirmed that no contaminated outside air entered the OR with the opening of a single door. However, outside and potentially contaminated air entered the OR if two doors were open simultaneously.

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Other News

Study: Large, metal femoral heads with XLPE may be appropriate for certain patients

Data from a study published online in The Journal of Arthroplasty suggest that large, metal femoral heads with highly cross-linked polyethylene (XLPE) may not be associated with liner fracture, loosening, or symptomatic trunnion corrosion in certain patients. The authors retrospectively reviewed information on 107 hips (93 patients; mean age 76 years) with one design of uncemented acetabular component, a 36 mm (90 hips) or 40 mm (17 hips) metal femoral head, and one electron beam 100 kGy irradiated and remelted XLPE. At mean 8-year follow-up, they found that the median linear wear rate was 0.041 mm/year and the median volumetric wear rate was 34.6 mm 3/year. They found no difference in linear or volumetric wear between the 36 mm and 40 mm head sizes within the available patient population. They noted small, asymptomatic osteolytic lesions in three hips (2 percent), and dislocations without revision in three patients. The researchers found no revisions for loosening, no liner fracture, and no patient with symptomatic trunnion corrosion.

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Study: How common is APM in the Medicare population?

A research letter published online in the journal JAMA Surgery examines practice patterns for the use of arthroscopic partial meniscectomy (APM) among older patients in the United States. The researchers reviewed Medicare data on 121,624 knee arthroscopy procedures performed by 12,504 surgeons, and found that APM-only (not associated with a ligament, cartilage, or meniscus repair) procedures comprised 66.7 percent of all knee arthroscopies. They state that among 4,138 high-volume surgeons (n = 4,138), 286 (6.9 percent) never performed APM-only procedures and 518 (12.5 percent) exclusively performed APM-only procedures. The researchers note that multiple randomized clinical trials have “revealed no benefit from [APM] in patients with degenerative meniscal tears compared with exercise and physical therapy,” and write that although APM-only procedures may be appropriate for certain patients with an acute traumatic meniscal tear, such injuries typically occur in younger, non-Medicare patients.

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Study: Decline in sepsis mortality linked to increase in number of patients at risk for readmission

According to a study published in the March issue of the journal Critical Care Medicine, the number of sepsis survivors at risk for hospital readmission rose significantly between 2010 and 2015. Members of the research team conducted a retrospective, observational cohort study of 17,256 sepsis or severe sepsis hospitalizations from three validated, claims-based databases. They found that, from 2010 to 2015, sepsis as a proportion of medical and surgical admissions increased while in-hospital mortality for sepsis hospitalizations declined, leading to an increase from 2.7 percent to 7.8 percent in the proportion of medical and surgical discharges at risk for hospital readmission after sepsis. The researchers note 30-day hospital readmission rates for sepsis declined from 26.4 percent in 2010 to 231 percent in 2015, but that decline was offset by an increase in emergency department treat-and-release visits, from 2.8 percent in 2010 to a peak of 5.4 percent in 2014.

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CMS seeks clinicians to help improve MIPS workflow

The U.S. Centers for Medicare & Medicaid Services (CMS) is seeking clinician volunteers to help identify reporting burdens under the Merit-based Incentive Payment System (MIPS). The agency is specifically looking into clinicians’ workflow under MIPS. A limited number of clinicians who are not eligible for MIPS in 2018 will also be included in the study to serve as a control group. The agency expects to use the study findings to make recommendations to eliminate burdens and improve quality data capture and reporting, and enhance clinical care.

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Read the CMS information sheet (PDF)…

Insurer backs away from planned reimbursement cuts for certain E&M services

Becker’s Hospital Review reports that Anthem, Inc. has dropped plans to cut reimbursement on certain same-day services. The insurer had originally announced that starting Jan. 1, 2018, it would reduce by 50 percent payment for significant, separately identifiable evaluation and management (E&M) services provided on the same day a procedure is performed or a wellness exam is conducted. The company later reduced the cut to 25 percent with a delayed start date of March 1. In a letter this week to the American Medical Association, the company fully rescinded the cuts.


The American Association of Orthopaedic Surgeons worked with state orthopaedic societies to address this issue.

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Call for volunteers: CMS Electronic Medical Documentation Interoperability Program

AAOS seeks to nominate members to the Electronic Medical Documentation Interoperability (EMDI) Program. CMS established the EMDI program to promote provider-to-provider interoperable health information exchange by gradually removing redundant or obsolete requirements that were developed before the transition to electronic information exchange. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, and a 100-word biography. All supporting materials must be submitted to Kyle Trivedi by March 1, 2018, at 11:59 p.m. CT, at:

Learn more and submit your application…  (member login required)