Today’s Top Story
IRS ruling could impede formation of certain ACOs.
According to The New York Times, a determination by the U.S. Internal Revenue Service (IRS) may serve as a significant obstacle to the formation of accountable care organizations (ACOs) called for under the Affordable Care Act. In a recent ruling, IRS denied a tax exemption sought by an ACO that coordinates care for patients with commercial insurance, saying that the organization did not meet the test for tax-exempt status because it was not operated exclusively for charitable purposes and provided private benefits to certain physicians. The paper states that the ruling does not affect ACOs formed solely to participate in Medicare, but could affect similar entities serving privately insured patients. A spokesperson for the American Hospital Association states that the ruling “is in conflict with the direction that the Department of Health and Human Services has given to the hospital field,” and argues that the federal government must clarify how hospitals can participate in ACOs without “incurring the catastrophic loss of their tax-exempt status.”
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Other News
Study: Only minor differences in long-term outcomes for ACL patients treated with PT or HT autograft.
A study published online in The American Journal of Sports Medicine finds minor differences in long-term outcomes for patients who undergo anterior cruciate ligament (ACL) reconstruction using a patellar tendon (PT) autograft compared to a hamstring tendon (HT) autograft. The research team conducted a randomized, controlled trial of 147 patients who underwent unilateral primary ACL reconstruction using either a PT autograft (n = 61) or an HT autograft (n = 86). At mean follow-up of 202.6 months for the PT group and 191.9 months for the HT group, they found no significant differences across cohorts according to the manual Lachman test, KT-1000 arthrometer manual maximum test, radiographic osteoarthritis, patient-reported outcomes, or range of motion. However, the research team notes that knee laxity measurements revealed significantly more patients with a normal pivot-shift test finding in the HT group compared with the PT group, and that patients in the PT group had significantly more difficulty knee walking.
Read the abstract…
Study: Evidence lacking on effects of opioids for LBP.
Findings from a study published online in the journal JAMA Internal Medicine suggest a lack of evidence regarding the efficacy of opioid analgesics for relief of acute low back pain (LBP). The researchers conducted a meta-analysis of 20 randomized, placebo-controlled trials covering 7,925 patients. Overall, 13 trials covering 3,419 participants evaluated short-term effects on chronic LBP, while no placebo-controlled trials enrolled patients with acute LBP. In half of the 13 trials, at least 50 percent of participants withdrew due to adverse events or lack of efficacy. The researchers noted moderate-quality evidence that opioid analgesics reduce pain in the short-term, but clinically important pain relief was not observed within the dose ranges evaluated (40.0-240.0-mg morphine equivalents per day).
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Read the abstract…
MedPAC outlines support for certain proposed changes to quality programs, but objects to use of condition-specific cost measures.
In a letter to the acting administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), the Medicare Payment Advisory Commission (MedPAC) has offered comments on several Medicare proposed rules. Among other things, MedPAC supports a CMS proposal to decrease the number of process measures and increase the number of outcome measures for quality reporting and value-based purchasing (VBP) programs. However, the agency “strongly objects” to the use of proposed condition-specific cost measures in the Inpatient Quality Reporting or VBP programs. “We believe hospitals should be provided actionable service-line specific relative cost information,” the authors write, “but be rewarded or penalized based on a broad all-condition 30-day cost measure.” They note that the proposed condition-specific cost measures “would have smaller numbers of hospital-specific observations than the current all-condition measure which pools information from all inpatient conditions. Splitting the pool of information on costs into condition-specific measures would result in more random variation without providing clear additional information about the average costliness of the hospitals’ care.”
Read the letter (PDF)…
Study: ED-based estimates of pediatric concussion rates may substantially underestimate true incidence of injury.
A study published online in the journal JAMA Pediatrics suggests that estimates of pediatric concussion incidence based solely on emergency department (ED) visits may underestimate the true incidence of injury. The authors reviewed data on 8,083 patients aged 17 years or younger who had one or more in-person clinical visits for concussion at a single center. They found that 81.9 percent (n = 6,624) presented at primary care, 5.2 percent (n = 418) within specialty care, and 11.7 percent (n = 947) within the ED. Overall, healthcare entry varied by age, with 52 percent of children aged 0 to 4 years entering via the ED, and more than three-quarters of patients aged 5 to 17 years entering via primary care. In addition, Medicaid patients were more likely than private payer and self-pay patients to use the ED for concussion care.
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Read the complete study…
California.
AMA Wire reports that the Supreme Court of California has ruled that the Elder Abuse Act does not apply in medical liability cases “unless the defendant health care provider had a substantial caretaking or custodial relationship, involving ongoing responsibility for one or more basic needs, with the elder patient.” At issue was a case in which an elderly patient was treated over a period of time by a medical group. The plaintiffs alleged that the healthcare providers had violated the Elder Abuse Act by failing to provide the patient with proper care by not referring her to a specialist. However, the act specifically states that professional negligence should be governed by laws that apply to professional negligence. The court determined that the Elder Abuse Act “does not apply unless the defendant health care provider had a substantial caretaking or custodial relationship, involving ongoing responsibility for one or more basic needs, with the elder patient.”
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Call for volunteers: International Committee.
July 31 is the last day to submit your application for a position on the International Committee (one resident member opening). The International Committee directs and reviews a variety of international education initiatives, including education programs and humanitarian activities. Applicants for this position must be PGY2 or PGY3 with an interest in expanding educational opportunities to a broad global audience.
Learn more and submit your application…(member login required)
