Today’s Top Story
Senate begins process to repeal ACA.
Sen. Mike Enzi (R-Wyo.) has introduced a resolution to repeal the Affordable Care Act (ACA). Reuters reports that the U.S. Senate could vote on the resolution as early as next week, with action in the House of Representatives expected to follow. However, the repeal process requires several committees to agree on the reconciliation procedure and both houses to vote on the final proposal.
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     In a letter to congressional leadership, the American Medical Association notes flaws in the ACA and states that the organization welcomes proposals “to make coverage more affordable, provide greater choice, and increase the number of those insured.” However, the organization also argues that, “before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.”
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Other News

Study: Many OR surfaces contaminated with bioburden.
A study published online in the journal Clinical Orthopaedics and Related Research compares orthopaedic operating room (OR) surfaces contaminated with bioburden. The research team used adenosine triphosphate (ATP) bioluminescence technology to determine the degree of contamination of 13 surfaces in six orthopaedic ORs that had been cleaned and prepped for surgery, but prior to patients entering the room. They found that all tested surfaces had bioburden. Surfaces with the greatest bioburden included (in descending order) the right side of the OR table headboard, computer keyboard, tourniquet machine buttons, Bair Hugger™ buttons, Bovie machine buttons, and patient positioners used for total hip and spine positioning. The research team writes that the study did not examine correlation between ATP bioluminescence and clinical infection.
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Study: Longer intervals between zoledronic acid treatment may be safe for some cancer patients with bone metastases.
Findings from a study published in the Jan. 3 issue of The Journal of the American Medical Association suggest that longer intervals between treatment with zoledronic acid may not be linked to an increased risk of short-term skeletal events among patients with bone metastases due to breast cancer, prostate cancer, or multiple myeloma. The authors conducted a randomized, open-label clinical trial of 1,822 patients with breast cancer, metastatic prostate cancer, or multiple myeloma who had at least one site of bone involvement and who were randomized to receive intravenous zoledronic acid every 4 weeks (n = 911) or every 12 weeks (n = 911). At 2-year follow-up, they found that 260 patients in the 4-week cohort and 253 patients in the 12-week cohort had experienced at least one skeletal-related event. In addition, there was no significant difference across cohorts in pain scores, performance status scores, incidence of jaw necrosis, or kidney dysfunction. The authors write that skeletal morbidity rates were numerically identical in both groups, but bone turnover was greater among patients in the 12-week cohort.
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HHS report finds social risk factors may affect care for Medicare beneficiaries.
A report released by the U.S. Department of Health and Human Services (HHS) finds that social risk factors among Medicare beneficiaries may be associated with poorer clinical outcome and patient experience measures, and provider quality measures. The writers reviewed data from nine Medicare payment programs and found that beneficiaries with social risk factors had poorer outcomes on many quality measures, including process measures, clinical outcome measures, safety, and patient experience measures. They were also associated with higher spending per hospital admission episode, even when comparing beneficiaries at the same hospital, health plan, accountable care organization, physician group, or facility. Overall, dual enrollment in both Medicare and Medicaid was the most powerful predictor of poor performance among the social risk factors examined. In addition, across every care setting examined, providers that disproportionately cared for beneficiaries with social risk factors tended to perform worse than their peers on quality measures. However, the writers note that in every setting, there were some providers who served a high proportion of beneficiaries with social risk factors who achieved high levels of performance, suggesting that high performance is feasible with the right strategies and supports.
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Study: Bundled payment initiatives linked to savings and reduced Medicare payments.
A study published online in the journal JAMA Internal Medicine finds that implementation of bundled payment models was associated with overall hospital savings and reduced Medicare payments. The authors conducted an observational study of 3,942 patients who underwent lower extremity joint arthroplasty at a single health system that participated in the voluntary Acute Care Episodes (ACE) and Bundled Payments for Care Improvement (BPCI) Medicare demonstration projects. Across 3,738 episodes of joint arthroplasty without complications, they found that average Medicare episode expenditures declined from $26,785 to $21,208 (20.8 percent) between July 2008 through June 2015. Among 204 episodes with complications, expenditures declined from $38,537 to $33,216 (13.8 percent). The authors write that, by 2015, 51.2 percent of overall hospital savings had come from internal cost reductions and 48.8 percent from postacute care (PAC) spending reductions. They found that average PAC spending declined 27 percent per case, “largely from reductions in inpatient rehabilitation and skilled nursing facility spending but only when bundles included financial responsibility for PAC.” The authors note that reductions in implant costs contributed the greatest proportion of hospital savings.
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Study: Medicare readmissions program associated with improvements in 30-day readmission rates.
According to a study published online in the journal Annals of Internal Medicine, implementation of the Medicare Hospital Readmissions Reduction Program (HRRP) was linked to a reduction in readmission rates. The researchers analyzed data on 15,170,008 Medicare discharges from 2000 to 2013. After controlling for prelaw trends, they found that passage of the HRRP was associated with improved reduction in 30-day risk-standardized readmission rates for myocardial infarction, heart failure, and pneumonia. Overall, they noted that hospitals with the lowest prelaw performance saw the greatest improvement in readmission rates.
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Last call: CMS panel on hospital harm performance measure.
AAOS seeks to nominate members to the CMS Technical Expert Panel on Hospital Harm Performance Measure. The goal of the panel is to develop a hospital-level electronic health record-based performance measure of multiple dimensions of patient harm or adverse patient safety events that can be improved with high-quality care. 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, a 100-word biosketch, a letter of interest highlighting their expertise in the subject area, and a signed nomination form, available from the email below. All supporting materials must be submitted by Sunday, Jan. 8, 2017 at 11:59 p.m. CT, to Stephanie Hazlett at shazlett@aaos.org.
Learn more and submit your application…(member login required)