Today’s Top Story
CMS proposed rule addresses discriminatory behavior, antibiotic stewardship, and infection control.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released a proposed rule to update the requirements that hospitals and critical access hospitals must meet to participate in the Medicare and Medicaid programs. Among other things, CMS proposes revising the conditions of participation to address the following:

  • Discriminatory behavior by healthcare providers that may create real or perceived barriers to care
  • Use of the term “Licensed Independent Practitioners” that may inadvertently exacerbate workforce shortage concerns
  • Requirements that do not fully conform to current standards for infection control
  • Requirements for antibiotic stewardship programs to help reduce inappropriate antibiotic use and antimicrobial resistance
  • The use of quality reporting program data by the hospital Quality Assessment and Performance Improvement program

Comments on the proposed rule must be submitted by Aug. 15, 2016.
Read more…(registration may be required)
Read the rule…

Other News

House bill would ease payment for some outpatient services and adjust readmissions penalties to account for socioeconomic disparities.
HealthLeaders Media reports that the U.S. House of Representatives has passed legislation that would, if enacted, ease payment restrictions for some hospital outpatient services and adjust 30-day readmissions penalties to account for socioeconomic disparities. Among other things, the bill would do the following:

  • Modify the treatment of ambulatory surgery center patient encounters under the Meaningful Use program
  • Require that CMS report Medicare enrollment data by congressional district
  • Extend the Rural Community Hospital Demonstration Project for an additional 5 years

The U.S. Senate is considering companion legislation.
Read more…
Read the bill…
     In a letter to legislators, the American Association of Orthopaedic Surgeons (AAOS) expressed concern that the bill does not provide legislative relief for hospitals with physician ownership.
Read the letter (PDF)…

Study: Lumbar fusion surgery may be appropriate for certain obese and overweight patients.
Findings from a study published online in The Spine Journal suggest that obesity may not contraindicate lumbar fusion surgery for appropriate obese and overweight patients. The researchers conducted a propensity-matched case control study of 246 patients who underwent posterior instrumented lumbar spinal fusion at a single center. There were 82 matched cases across three cohorts: body mass index (BMI) ≥20-25 kg/m,2 (normal), BMI ≥25 to <30 kg/m2 (overweight) and BMI ≥30-40 kg/m2 (obese). The researchers found that estimated blood loss and operative time were significantly greater among overweight and obese patients. However, improvements in Oswestry Disability Index, Short Form-36 Physical Composite Summary scores, and back pain and leg pain scores were similar across cohorts, as were revision rates as well as time between index and revision surgery.
Read the abstract…

Study: Physical activity may positively affect bone in children even if they are predisposed to lower adult BMD.
A study published online in The Journal of Bone and Mineral Research finds that physical activity (PA) may have a beneficial effect on bone in children, even when the child may be genetically predisposed to lower adult bone mineral density (BMD). The research team surveyed 918 children of European ancestry to estimate hours per day spent in total, high-, and low-impact PA. They found that BMD genetic score (based on percent of BMD-lowering alleles) was negatively associated with bone mineral content Z-score. However, total PA was positively associated with bone Z-scores, with the associations observed even for children with lower than average bone Z-scores. The research team writes that some of its findings are exploratory, and that independent verification is warranted.
Read more…
Read the abstract…

Hospitals and vendors attempt to address the issue of alert fatigue.
An article in Kaiser Health News looks at the issue of alert fatigue, in which healthcare providers are prompted by an overwhelming number of alerts in electronic health records (EHR) systems. Some studies suggest that clinicians ignore between 49 and 96 percent of all EHR safety notifications. In response, EHR developers say they are attempting to design systems that issue targeted, relevant warnings, and some hospitals have begun disabling warnings deemed to be less relevant. The writer notes, however, that such choices are inherently subjective, and can lead to further consequences.
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JAMA retracts study on effects of folate and mecobalamin on hip fractures in patients with stroke.
The Journal of the American Medical Association (JAMA) has issued a retraction of a study conducted in Japan and published in March 2005. The study found combined treatment with folate and vitamin B12 to be safe and effective in reducing the risk of hip fracture in elderly patients who had sustained a stroke and who had a high baseline fracture risk. The journal states that the article “has been retracted due to acknowledgment of scientific misconduct resulting in concerns regarding data integrity and inappropriate assignment of authorship.”
Read more…

Act now to nominate future AAOS leadership!
The 2017 Nominating Committee is actively soliciting your suggestions for individuals to serve in the following positions:

  • Second Vice President
  • Member-at-Large [No Age Designation]
  • Member-at-Large [Under Age 45] (younger than age 45 on March 16, 2017)
  • National Membership Committee Member

Nominations close Friday, Aug. 12, 2016. Nominations may be submitted by mail to Joshua J. Jacobs, MD, chair, 2017 Nominating Committee, c/o AAOS Office of General Counsel, 9400 West Higgins Road, Rosemont, Ill. 60018, or (preferred) electronically. Descriptions of the responsibilities, desired experience, and time commitments associated with the positions are available online.
Learn more about the positions and access the nomination form…

Last call: ACS Board of Governors.
AAOS seeks to nominate two individuals to the American College of Surgeons (ACS) Board of Governors. Applicants for these 3-year positions should be ACS fellows and should be active in surgical practice. Special consideration of women and other underrepresented minorities is strongly encouraged. All applicants must provide the following: an online AAOS CAP application; current curriculum vitae; a short biography (maximum 100 words) highlighting relevant experience/knowledge; and letter of interest highlighting their expertise. All supporting materials must be submitted to Kyle Shah by June 20, 2016, at 11:59 p.m. (CT), at
Learn more and submit your application…(member login required)