Today’s Top Story
Executive order implements “one in, two out” rule for new federal regulations.
President Trump has signed an executive order that, among other things, requires federal agencies such as the U.S. Centers for Medicare & Medicaid Services and the U.S. Food and Drug Administration to remove two previously implemented regulations for each new regulation issued. An article in Modern Healthcare notes that the new policy could strongly affect healthcare providers, as healthcare is one of the most regulated industries in the United States. The order also sets an annual cap that, for the rest of fiscal year 2017, will require the cost of any additional regulations to be completely offset by undoing existing rules.
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Other News
Study: What organisms are linked to poorest outcomes in hip periprosthetic infection treatment?
A study published online in The Journal of Arthroplasty attempts to identify organisms associated with poor outcomes in treatment for hip periprosthetic infection. The authors reviewed records on patients who underwent treatment for infected partial or total hip arthroplasty between 2005 and 2015. They found that, compared with patients infected with other organism(s), patients infected with pseudomonas, methicillin-resistant Staphylococcus aureus (MRSA), and Proteus had significantly decreased infection-free rates. In addition, infection with the following certain organisms was associated with 1.13 to 2.58 additional surgeries: methicillin-sensitive Staphylococcus aureus (MSSA), coagulase-negative Staphylococcus (CoNS), MRSA, Pseudomonas, Peptostreptococcus, Klebsiella, Candida, diphtheroids, Propionibacterium acnes, and Proteus species. Finally, the following organisms were associated with 8.56 to 24.54 additional days in hospital for infection: MSSA, CoNS, Proteus, MRSA, Enterococcus, Pseudomonas, Klebsiella, beta-hemolytic Streptococcus, and diphtheroids.
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Position paper offers recommendations to identify patients with low adherence to oral bisphosphonate treatment.
A position paper presented by the International Osteoporosis Foundation and the European Calcified Tissue Society recommends measuring bone turnover markers PINP and CTX at baseline and 3 months after starting oral bisphosphonate therapy to identify patients with low adherence to treatment. The writers cite data from the TRIO study specifically addressing the question of adherence, and recommend that clinicians check for a decrease above the least significant change (decrease of more than 38 percent for PINP and 56 percent for CTX). “If a significant decrease is observed,” they write, “the treatment can continue, but if no decrease occurs, the clinician should reassess to identify problems with the treatment, mainly low adherence.”
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Study: ED visit linked to increased risk of functional decline for older people.
According to a study published online in the journal Annals of Emergency Medicine, older patients who experience illness or injury leading to an emergency department (ED) visit without hospitalization may be at increased risk of clinically meaningful functional decline during the following 6 months. The researchers conducted a matched cohort study of 813 ED visits without hospitalization (ED only) and 813 observations without an ED visit or hospitalization among 754 community-living people with a mean age of 84 years. During the 6-month follow-up period, the researchers found that the ED-only group had significantly higher disability scores than the control group. Overall, both nursing home admissions and mortality during the 6-month follow-up period were significantly higher in the ED-only group compared to the control group. In a separate article, one researcher states that the findings suggest that “older adults who are medically appropriate for discharge from the [ED] may benefit from the kind of discharge planning that often occurs in the inpatient setting.”
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Medical coalition offers list of principles for prior authorization and utilization management.
A coalition of medical organizations has released a list of 21 principles designed to reform utilization management programs to help ensure timely access to treatment and to reduce administrative costs to the healthcare system. Among other things, the coalition argues that utilization management programs should be based on accurate and up-to-date clinical criteria and not cost alone, and that prior authorization approval should be valid throughout the duration of the ordered course of treatment.
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Read the complete set of principles (PDF)…
Maryland.
Stateline reports that the governor of Maryland has proposed legislation that would, if enacted, limit prescriptions for opioids to a 7-day supply. In addition, the governor’s proposed 2018 budget includes $4 million in new spending to increase treatment and support services for people with heroin and opioid addictions. He is also expected to sign an executive order creating an Opioid Operations Command Center to train and fund local anti-addiction teams, and collect data on opioid use and abuse.
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February AAOS Now is online now and in your mailbox soon!
AAOS members will soon receive the print edition of the February issue of AAOS Now, but the online edition is already available on the AAOS Now website. This month’s issue includes a point/counterpoint look at tenotomy versus tenodesis for the treatment of biceps tendon pathology, an examination of orthopaedic surgeons’ prescribing of opioids, a review of healthcare policy changes during 2016, and much more!
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Read “Face-Off: Tenotomy Versus Tenodesis”…(member login required)
Read “Opioids and the Orthopaedic Surgeon”…
Read “Healthcare Policy in 2016″…
