Today’s Top Story
CMS proposes to cover outpatient hip and knee arthroplasty; may cut reimbursement at off-campus hospital facilities.
Two rules recently released by the U.S. Centers for Medicare & Medicaid Services (CMS) could impact reimbursement for orthopaedic surgeons. Under the first, the agency proposes to reduce 340B drug payments to hospitals by 22.5 percent, and in order to allow Medicare to pay for outpatient hip and knee arthroplasty procedures. For CY 2018, the agency proposes “to remove total knee arthroplasty from the inpatient-only list” and is “soliciting comment on whether partial and total hip should also be removed from the inpatient only list and added to the [ambulatory surgical center] Covered Surgical Procedures List.” Read more…(registration may be required)
Read the rule…
Under a second rule, CMS proposes to reduce Medicare payments for patients who receive treatment at hospital-owned medical facilities that are located off-campus. Observers say the proposed change could save CMS $25 million during CY 2018.
The American Association of Orthopaedic Surgeons (AAOS) is reviewing both rules and plans to submit comments to CMS. Read more…(registration may be required)
Read the rule…
Other News
Study: Minimally stabilized TKA linked to reduced risk of revision compared to posterior stabilized TKA.
Data from a study conducted in Australia and published in the July 5 issue of The Journal of Bone & Joint Surgery suggest an increased risk of revision for patients who undergo posterior-stabilized total knee arthroplasty (TKA) compared to those who receive a minimally stabilized TKA. The researchers drew data from the Australian Orthopaedic Association National Joint Replacement Registry for two cohorts of patients: those treated by high-volume surgeons who preferred a minimally stabilized approach, and those treated by high-volume surgeons who preferred posterior-stabilized approach. At 13-year follow-up, they found a 5.0 percent cumulative revision rate for surgeons who preferred minimally stabilized arthroplasty and a 6.0 percent cumulative revision rate for surgeons who preferred posterior-stabilized arthroplasty. In addition, they note that the revision risk for surgeons who preferred posterior-stabilized arthroplasty was significantly higher for all causes, for loosening or lysis, and for infection, irrespective of patient age. The higher revision risk was also evident with cemented fixation, and with both cross-linked polyethylene and non-cross-linked polyethylene. However, the increased risk was only evident in male patients. Read the abstract…
Study: How much does it cost when patients with transfemoral amputation fall?
A study published online in the journal Prosthetics and Orthotics International examines the direct medical costs of falls for adults who have undergone transfemoral amputation. The authors conducted a retrospective, population-based, cohort study of patients who underwent transfemoral amputation between 2000 and 2014. They found that the mean 6-month direct medical costs of falls for six hospitalized adults with transfemoral amputation was $25,652 (range $10,468 to $38,872), while the mean costs for 10 adults admitted to the emergency department was $18,091 (range $7,820 to $57,368). The authors suggest that such estimates can provide policy makers with additional insight when determining whether or not to cover a prescription for microprocessor-controlled prosthetic knees. Read more…
Read the abstract…
Medicare estimated solvent until 2029; IPAB not triggered.
The Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds have released their annual report, which projects that Medicare will remain solvent though 2029—one year longer than previously estimated. In addition, the report states that spending on Medicare was not high enough to trigger creation of the Independent Payment Advisory Board (IPAB)—a panel called for under the Affordable Care Act that has the authority to propose cuts to Medicare if spending growth exceeds certain levels. Read more…
Read the report (PDF)…
DOJ charges 412 people with $1.3 billion in Medicare fraud.
The New York Times reports that the U.S. Department of Justice (DOJ) has charged 412 people, including approximately 50 physicians, with Medicare fraud. Collectively the group is accused of defrauding the government of $1.3 billion. Among the charges: billing Medicare and Medicaid for drugs that were never purchased, billing for false rehabilitation treatments and tests, and accepting kickbacks, and writing medically unnecessary prescriptions. Read more…(paid subscription may be required)
Read the DOJ statement…
Washington.
The Washington Supreme Court has unanimously ruled that the state’s trial courts lack jurisdiction to take action against a physician over care delivered in Idaho. As reported by AMA Wire, at issue was a case in which a high school football player received written clearance from his family physician in Idaho to play in Washington state. During his next game, he was hit hard by an opposing player and died 2 days later. His parents filed suit against the school, the volunteer coach, and the Idaho primary care provider. The court ruled that the family had standing to sue the coach and the school, but not the physician. Read more…
Read the decision…
Call for volunteers: Communications Cabinet.
Aug. 1 is the last day to submit your application for a position on the Communications Cabinet. The cabinet directs and evaluates AAOS communication vehicles, undertakes special communications projects, and provides public and media relations expertise to various AAOS governance units. The following positions are available:
- Member-at-large (two openings)
- Resident member (one opening)
Applicants for the member-at-large position must be active fellows, associate members osteopathic, candidate members, or resident members; applicants for the resident member position must be PGY-2, PGY-3, or PGY-4. All applicants should have interest and experience in strategic public and media relations planning. Learn more and submit your application…(member login required)