January 9, 2015

Today’s Top Story
1. Release of Medicare payment data unlikely to initiate fraud cases, but could bolster them.
An article in Modern Healthcare looks at the issue of public release of U.S. Centers for Medicare & Medicaid Services (CMS) payment data and how it might affect cases of suspected Medicare fraud. According to a spokesperson for a law firm that often represents whistle-blowers, “There’s nothing inherently fraudulent about doing a large number of procedures,” and thus being among the highest-paid physicians. That same spokesperson notes however, that whistle-blowers are required to have independent knowledge of wrongdoing, and the release of Medicare payment data could bolster a case based on information from a whistle-blower.   Read more…(registration may be required)

Other News
2. Study: Patients who undergo TKA may experience significant worsening of symptoms prior to surgery.
According to a study published online in the journal Osteoarthritis and Cartilage, patients who undergo total knee arthroplasty (TKA) may experience substantial worsening of pain and function during the 2-year preoperative period, compared to those who do not undergo surgery. The research team conducted a matched cohort study of 167 patients with isolated TKA and 300 patients with symptomatic knee osteoarthritis (OA) who did not undergo TKA. They found that, during the 2 years prior to TKA, worsening by at least one Kellgren and Lawrence (KL) grade occurred in 27.4 percent of surgical knees, compared to 6.6 percent of matched non-surgical knees. In addition, OA radiographic progression was strongly associated with reduced WOMAC Function and increased KOOS Pain during the 2 years prior to TKA; after adjustment, KL worsening was strongly associated with future TKA.   Read more…
Read the abstract…

3. Study: What is the long-term efficacy of surgery for spinal stenosis?
Findings published in the Jan. 15 issue of the journal Spine question whether surgical treatment offers long-term efficacy for patients with symptomatic spinal stenosis. The authors conducted a randomized trial and a concurrent observational cohort study of surgical candidates from 13 centers; patients had at least 12 weeks of symptoms and confirmatory imaging of spinal stenosis. In the randomized study, patients in the surgical cohort were found to demonstrate benefits out to 4 years, but outcomes converged over time, with no significant treatment effect of surgery seen between cohorts in years 6 to 8 for any primary outcome (SF-36 Bodily Pain and Physical Function scales and modified Oswestry Disability Index). In comparison, patients in the observational group displayed a stable advantage for surgery in all outcomes between years 5 and 8. The authors write that a high percentage of patients with worse early outcomes who were lost to follow-up in both treatment groups “could lead to overestimates of long-term outcomes but likely not bias treatment effect estimates.”  Read more…
Read the abstract…

4. Study: New antibiotic suggests possible treatment for resistant bacteria.
A study published online in the journal Nature suggests that a recently discovered antibiotic called teixobactin may have efficacy against resistant bacteria. The research team notes that most antibiotics are produced by screening microorganisms in soil, but many bacteria resist being cultured in a laboratory environment. New processes allowed the research team to reproduce such “uncultured bacteria” in situ or by using specific growth factors. Teixobactin was produced in this manner. In mouse and test tube studies, the research team found that teixobactin killed methicillin-resistant Staphylococcus aureus, Mycobacterium tuberculosis, and other Gram-positive bacteria, but it did not kill the mice. The research team writes that “teixobactin inhibits cell wall synthesis by binding to a highly conserved motif of lipid II (precursor of peptidoglycan) and lipid III (precursor of cell wall teichoic acid).” They note that they did not obtain any mutants of S. aureus or M. tuberculosis that were resistant to teixobactin.   Read more…
Read the abstract…

5. Study: Reduced time to antibiotics and wound coverage linked to reduced risk of infection of type III open tibia fracture.
Data published in the January issue of the Journal of Orthopaedic Trauma suggest that reducing the time from injury to antibiotics and wound coverage may be linked to reduced risk of infection in type III open tibia fractures. The researchers conducted an observational study of 137 patients who were seen with type III open tibia fracture at a single, level 1 trauma center. On univariate analysis, they found that age, smoking, diabetes, injury severity score, type IIIA versus IIIB/C injury, and time to surgical debridement were not associated with infection. However, greater than 5 days to wound coverage and greater than 66 minutes to antibiotics were predictors of infection on both univariate and multivariate analysis.   Read the abstract…

6. Last chance to register for CMS Provider Call on Quality Reporting Programs.
CMS will hold a National Provider Call on Medicare Quality Reporting Programs, including the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier, and Electronic Health Record Incentive Programs on Jan. 13 from 1:30–3 p.m. ET. The call will provide guidance on how eligible professionals and PQRS group practices can earn the 2014 PQRS incentive and avoid the 2016 negative PQRS payment adjustment. Advance registration is required.
Learn more and register…

7. AJRR opens Orthopaedic Quality Resource Center website.
The American Joint Replacement Registry (AJRR) has launched a web portal through which participating surgeons can report to the CMS PQRS program. As a Qualified Clinical Data Registry, AJRR is one of 41 organizations designated by CMS to provide expanded, comprehensive medical procedure outcome information, including patient safety data. The AJRR Orthopaedic Quality Resource Center currently includes nine approved PQRS measures for total knee arthroplasty. Total hip arthroplasty measures are planned for a future update.
Visit the AJRR Orthopaedic Quality Resource Center…

8. Read the January AAOS Now on your tablet!
The January edition of AAOS Now magazine is now available for electronic devices capable of reading files in ePub format, including the iPhone and iPad, Android devices, and desktop computers (unfortunately, Amazon Kindle does not currently accept ePub files). To download and view the ePub version of AAOS Now, visit the link below and log in using your AAOS username and password. If you have comments or questions about the ePub version of AAOS Now, please email Peter Pollack, electronic content specialist, at ppollack@aaos.org.
Download and read AAOS Now in ePub format…(member login required)