Today’s Top Story
Study: For morbidly obese patients, bariatric surgery prior to TKA may be cost-effective solution for improving outcomes.
Data from a study published in the Jan. 20 issue of The Journal of Bone & Joint Surgery suggest that bariatric surgery prior to total knee arthroplasty (TKA) may help improve outcomes and reduce costs for morbidly obese patients (body mass index ≥30 kg/m2) with end-stage knee osteoarthritis (OA) for whom TKA is indicated. The authors used a state-transition Markov model to compare the cost utility of immediate TKA against that of bariatric surgery conducted 2 years prior to TKA. They found that morbidly obese patients who underwent TKA alone gained fewer quality-adjusted life-years (QALYs) compared to those who underwent bariatric surgery prior to TKA, with an incremental cost-effectiveness ratio between cohorts of approximately $13,910 per QALY. Read more…
Read the abstract…

Other News

Meaningful Use program still alive for now.
An article in Health Data Management discusses the recently announced transition away from the Meaningful Use program. In a recent speech, U.S. Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt stated that meaningful use “as it has existed—with [the Medicare Access and CHIP Reauthorization Act (MACRA)]—will now be effectively over and replaced with something better.” However, Karen DeSalvo, MD, National Coordinator for Health Information Technology, clarifies that although the U.S. Department of Health and Human Services has set a goal of basing 30 percent of Medicare payments in 2016 and 50 percent of Medicare payments in 2018 on alternative payment models such as bundled payments and accountable care organizations (ACOs), that transition will not necessarily spell the end of Meaningful Use. Among other requirements, MACRA modifies participation and payment for Meaningful Use for Medicare-eligible professionals and requires participants to use certified health information technology. Read more…

ACOs face challenges in sharing EHR data with specialists.
Survey data released by Premier, Inc. and eHealth Initiative suggest that a lack of interoperability across electronic health records (EHR) systems is an important challenge faced by ACOs. The researchers surveyed 68 ACOs and found that 64 percent reported that data integration was a challenge to developing and operating their ACO. Among other things, the researchers write that many primary care information systems aren’t designed to incorporate data from specialists, noting that 69 percent of ACOs “report having a harder time integrating specialty care data, almost double the number for any other care setting. Compounding the problem is that many specialty care settings lie outside of the ACO network to which a patient is assigned. Obtaining data from settings outside a network requires complex data sharing agreements and new interfaces between systems. Often, these practices lack the proper incentives to share their data.” Read more…(registration may be required)
Access the survey data, with related links…

CMS updates and enhances Open Payments website.
Lexology reports that CMS has released updated data on the agency’s Open Payments website. According to the publication, the updated dataset “reflects changes made to records, changes to delays in publication flags, changes to disputed records, and records that were deleted since original publication.” In addition, website functions have been enhanced with the addition of a tool for searching by physician name, a “snapshot” of Open Payments data, and additional sections to explore and download data. Read more…
Visit the Open Payments website…

Florida.
The Orlando Sentinel reports that a panel in the Florida House of Representatives has approved a proposal that, if enacted, would make insurers responsible for paying for emergency services and include an arbitration process to resolve differences between insurers and healthcare providers. The bill is meant to reduce the incidence of “balance billing,” in which patients are billed for differences between what their insurers pay and additional amounts that are charged by out-of-network providers. An industry organization of insurers has offered support for the bill, but some physicians and hospital groups have criticized a provision that requires insurers to pay a “reasonable reimbursement” for care, without defining what would constitute reasonable reimbursement. Read more…

Massachusetts.
According to a report issued by the Massachusetts Health Policy Commission, wide variations in the cost of medical services in the commonwealth may drive overall health costs higher, as the most expensive providers tend to treat the most patients. The report argues that increased transparency is needed to enable consumers to make high-value choices. In addition, the report recommends that the commonwealth act to:

  • Implement safeguards for consumers and improve market function related to out-of-network billing
  • Equalize payments for the same services for similar patients between hospital outpatient departments and physician offices
  • Reduce unwarranted variation in provider prices

Read more…
Read the report (PDF)…

Oregon.
A report released by the Oregon Health Authority Office of Health Analytics examines progress made by the state’s coordinated care organizations (CCOs) on quality measures from the period July 1, 2014 through June 30, 2015. Among other things, the report finds that emergency department (ED) visits by people served by CCOs decreased 23 percent since 2011—an improvement that may be linked in part to a number of best practices implemented by CCOs, such as the use of ED navigators. In addition, all-cause readmissions fell to just under 10 percent in the state, from a level of nearly 13 percent in 2011. Read more…
Read the complete report (PDF)…

Call for volunteers: Members needed for work group on clinical performance measures for management of ACL injuries.
The Performance Measures Committee seeks AAOS fellows to participate in a work group to develop performance measures for management of anterior cruciate ligament (ACL) injuries. The Committee encourages subject matter experts to apply no later than Feb. 26, 2016. There will be a mandatory orientation webinar on Tuesday, May 24. Final decisions regarding the project scope and design will be determined at the mandatory first work group meeting in Rosemont, Ill., on Saturday, June 25. For more information, please contact Jackie Ryan, at 847-384-4337, or via email at: ryan@aaos.org
Learn more and submit your application (DOC)…