Today’s Top Story

Will MIPS cost measures properly account for more complex patients?

An article in Modern Healthcare discusses measures under the U.S. Centers for Medicare & Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS). The measures track cost data for eight procedures, including knee arthroplasty and lower limb revascularization. As part of a pilot program, the agency created reports for about 17,000 medical practices based on claims data from June 1, 2016 to May 31, 2017, and surveyed those practices regarding accuracy of the results. CMS plans to use the measures in 2019 to calibrate payments for 2021. Some observers have voiced concerns that the measures will not properly account for factors such as patient clinical complexity and socio-demographic status.

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Other News

Study: What factors are linked with joint space narrowing after ACL reconstruction?

Data from a study published online in The American Journal of Sports Medicine looks at predictors of radiographic joint space narrowing in younger patients who undergo anterior cruciate ligament (ACL) reconstruction. The authors conducted a prospective, cohort study of 358 patients aged 33 years or younger who received a sports-related ACL injury and who had never undergone surgery on the contralateral knee. At 2- to 3-year follow-up, they found that the mean lateral joint space width was 0.11 mm narrower on the ACL-reconstructed knee compared with the contralateral healthy knee. Statistically significant predictors of narrower joint space width on the ACL-reconstructed knee included lateral meniscectomy and a Marx activity score of less than 16 points.

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Study: Oxygenation monitoring may not reduce incidence of CDEs for certain patients undergoing arthroscopic shoulder surgery

According to a study published online in the Journal of Shoulder and Elbow Surgery, cerebral oxygenation monitoring may not help reduce incidence of cerebral desaturation events (CDEs) for patients who undergo arthroscopic shoulder surgery in the beach chair position. Members of the research team conducted a randomized, blinded study of 41 consecutive patients in which anesthetists were either aware of or blinded to near-infrared spectroscopy (NIRS) information. They found that seven (17.5 percent) patients experienced a CDE, five in the aware group and two in the blinded group. At 2- and 6-week follow-ups, the researchers found no significant difference across cohorts in Montreal Cognitive Assessment scores. However, they did note a correlation of NIRS with systolic blood pressure, diastolic blood pressure, and mean arterial pressure.

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Study: Male sex linked to increased risk of failure following nonsurgical treatment of acute Achilles tendon rupture

A study published online in the journal Foot and Ankle International suggests that male sex may be associated with increased risk of rerupture and failure of nonsurgical treatment of acute Achilles tendon rupture. The researchers retrospectively reviewed information on 210 patients diagnosed with acute Achilles tendon rupture and who underwent 8 weeks of nonsurgical treatment with functional rehabilitation. They found that 15 patients sustained a rerupture and six patients otherwise failed treatment. The researchers write that male sex was associated with both rerupture and failed nonsurgical treatment for any reason.

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CMS issues APM information table

CMS has published a table displaying all Alternative Payment Models (APMs) that CMS operates. Among other things, the table identifies which APMs the agency has determined to be MIPS APMs and Advanced APMs. CMS plans to update the list as needed based on changes in APM designs and as new APMs are announced.

Learn more and view the table (PDF)…

Some states consider state-level individual mandate

The Wall Street Journal ( WSJ) reports that, following repeal of the Affordable Care Act (ACA) individual mandate, nine states are currently considering laws that would require their residents to purchase health insurance. The states that are considering such legislation are California, Connecticut, Hawaii, Maryland, Minnesota, New Jersey, Rhode Island, Vermont, and Washington, as well as Washington D.C. Massachusetts already has an individual mandate that predates passage of the ACA.

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Call for volunteers: Panel to develop AUC on management of postoperative SSI

AAOS seeks fellows to participate on the writing panel for the Management of Postoperative Surgical Site Infections (SSIs) appropriate use criteria (AUC). The writing panel will be responsible for constructing a comprehensive patient indications list and a treatment list for the indicated condition. Writing panel members will be required to construct and review materials, correspond with AAOS staff electronically, participate in approximately five to 10 conference calls over a period of 1 to 3 months, and produce the AUC materials. Members should have experience managing postoperative SSIs. Nominees for the writing panel may have relevant conflicts, but will be required to complete the AAOS conflict of interest enhanced disclosure form online. To participate, please contact Mary DeMars by Monday, Feb. 19, 2018, at: