Today’s Top Story
AAOS issues Member Alert regarding precertification process for TJA.
On Jan. 1, 2016, Cigna, using eviCore, implemented a precertification system for total joint arthroplasty (TJA) patients. Prior to the implementation of this new process, leadership from AAOS and the American Association of Hip and Knee Surgeons (AAHKS) met with representatives from Cigna and eviCore to discuss concerns regarding the procedural and clinical aspects of this precertification process. Also at this meeting, AAOS and AAHKS educated Cigna and eviCore regarding AAOS evidence-based quality initiatives. eviCore stated that it did not use the same high-quality, evidence-based processes as AAOS in developing its precertification system. AAOS asks that physicians who have any problems with denials or timely Cigna precertification approvals or who are experiencing denials notify Cigna and eviCore about their concerns. To help AAOS prepare for an upcoming conference call with Cigna and eviCore, physicians should also email their concerns to: precert@aaos.org.
Read the Member Alert (PDF)…

Other News

Study: Patient-specific instrumentation may offer little or no benefit for UKA.
Findings from a study published in the January issue of the journal Clinical Orthopaedics and Related Research (CORR) suggest little or no functional benefit to the use of patient-specific instrumentation (PSI) in unicompartmental knee arthroplasty (UKA) procedures. The authors conducted a randomized trial of 60 patients who underwent UKA using either a PSI technique or a conventional technique. At 3-month and 1-year follow-ups, blinded, independent observers found no significant difference between cohorts in analyzed gait spatiotemporal parameters, lower limb alignment, implant positioning, or functional scores (SF-12, new Knee Society Score [KSS], Knee Injury and Osteoarthritis Outcome Score). Read the abstract…

Study: Motor control exercises may help reduce lower back pain.
An exercise program called motor control exercise (MCE), which enhances coordination of the muscles that support and control the spine, may help alleviate lower back pain, according to a study published on Jan. 7 in the Cochrane Library. The researchers reviewed data on 2,431 patients with lower back pain (age range, 22 years to 55 years) from 29 clinical trials that compared the effectiveness of motor control exercise to other kinds of exercise, or to doing nothing. Treatment programs spanned from 20 days to 12 weeks, and included one to five sessions per week. The researchers, who used pain intensity and disability as primary outcomes, focused on outcomes at the following time points: short-term follow up (<3 months after randomization), intermediate follow up (at least 3 months but <12 months after randomization), and long-term follow up (≥12 months after randomization). Some of their findings included low- to moderate-quality evidence that MCE is effective in improving pain at short-, intermediate-, and long-term follow up with medium effect sizes. The investigators also identified a clinically important difference for the global impression of recovery and outcomes function compared with minimal intervention. Read more…
Read the abstract…

Study: Reoperation and implant removal following surgical fixation of olecranon fractures more common among women and younger patients.
A study published in CORR indicates that a majority of patients who undergo surgical fixation of isolated olecranon fractures keep their implants, and that only 3 percent of patients experience implant migration. However, women and younger patients were more likely to undergo reoperation for any reason and more likely to request implant removal. The study involved 392 adult patients who had undergone surgical treatment of a displaced olecranon fracture not associated with other fractures, dislocation, or subluxation at two hospitals between January 2002 and May 2014. Overall, 138 patients (35 percent) were treated with plate and screw fixation and 254 (65 percent) with tension band wiring. All patients were followed for a minimum of 4 months; 203 patients (52 percent) were followed for one year or more. Overall, 99 patients (25 percent) had a second operation. Reoperation and requests for implant removal were less common in men compared to women and in older versus younger patients. Read the abstract…

President vetoes ACA repeal bill.
President Obama has vetoed the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which would have repealed major provisions of the Affordable Care Act (ACA). The bill, approved by the Senate in December under reconciliation, is the first ACA repeal bill to pass both houses of Congress. Read more…

AMA releases guide to physician-focused APMs.
Beginning in 2019, the Medicare Access and CHIP Reauthorization Act (MACRA) will provide a 5 percent annual bonus payment to physicians who participate in alternative payment models (APMs). To help physicians qualify for the annual bonus payment, the American Medical Association (AMA) and the nonprofit Center for Healthcare Quality and Payment Reform have released a “Guide to Physician-Focused Payment Models,” which describes seven ways to structure APMs to address the most common types of opportunities and barriers that physicians face, including:

  • Payment for a High-Value Service
  • Condition-Based Payment for Physician Services
  • Multi-Physician Bundled Payment
  • Physician-Facility Procedure Bundle
  • Warrantied Payment for Physician Services
  • Episode Payment for a Procedure
  • Condition-Based Payment

The authors note that the ideal APM for a particular provider or practice may depend on a variety of factors, including practice demographics, and opportunities and barriers faced by particular physicians. Read more…
Read the guide (PDF)…

Study: Illegal hits linked to concussions in youth ice hockey players.
A study published online on Jan. 8 in the journal Pediatrics suggests that concussions in youth hockey players may often be the result of players breaking the rules of the game and delivering illegal hits. The investigators followed 397 ice hockey players (age range, 12 years to 18 years) who participated in more than 23,000 games and practices throughout the 2012-13 and 2013-14 hockey seasons. In total, 37 players were diagnosed with concussions, all of which were sustained after checking, collision, or other player-to-player contact. The investigators determined that 43 percent of concussions occurred during illegal plays that resulted in penalties. They also found that players were three times more likely to sustain a concussion during a game, rather than during a practice. Most concussions occurred in players ages 12 years to 14 years, rather than in older players, suggesting that younger hockey players may be at increased risk of concussion. Read more…
Read the abstract…

Call for volunteers: Musculoskeletal Tumor Society Systematic Review work group.
AAOS seeks participants for a work group to develop, in association with the Musculoskeletal Tumor Society, a Systematic Review on the Use of Imaging Prior to Referral to a Musculoskeletal Oncologist. Applicants must have a good understanding of evidence-based methods and no financial conflicts of interest relevant to this review topic (all applicants will be required to complete the AAOS Orthopaedic Disclosure Program prior to starting any work). To participate, or for more information, please contact Erica Linskey by Monday, Feb. 1, 2016, at: linskey@aaos.org