Today’s Top Story
CMS proposes changes to increase participation in quality and payment programs.
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule addressing alterations for the second year of the Quality Payment Program (QPP). Among other things, the proposed rule includes new flexibilities for clinician participation in either Advanced Alternative Payment Models or the Merit-based Incentive Payment System, and makes it easier for rural and small providers to participate in those programs.
The American Association of Orthopaedic Surgeons (AAOS) will provide comments to CMS by Aug. 18, 2017. Read the AAOS statement…
Read the CMS statement…
Read the rule…
View AAOS QPP resources…
View American Medical Association QPP resources…

Other News

HHS issues statement on malicious hacking group and Windows security vulnerabilities.
The U.S. Department of Health and Human Services (HHS) Office for Civil Rights is warning healthcare providers and others regarding security vulnerabilities in several Microsoft products, including the Windows operating system, and a threat by a malicious cyber group labeled by the U.S. Department of Homeland Security as “Hidden Cobra.” The agency states that the group is targeting critical infrastructure sectors in the United States. The notice comes on the heels of a recent series of ransomware attacks on healthcare organizations. Ransomware, which can be delivered via email by attachments or links within the email, restricts user access to the computer until the user pays a fee to the attackers. Read more…
Read the HHS statement (PDF)…
Read more about how to address computer security vulnerabilities (PDF)…

Study: Little difference in risk of revision following single- or double-bundle ACL reconstruction with hamstring tendon graft.
Data from a study published online in the journal Clinical Orthopaedics and Related Research suggest similar risk of revision following anterior cruciate ligament (ACL) reconstruction using a single- or double-bundle hamstring tendon technique. The authors reviewed data on 60,775 patients from three national registers in Denmark, Norway, and Sweden. They found that 994 patients were reconstructed with double-bundle hamstring tendon grafts, 51,991 with single-bundle hamstring tendon grafts, and 7,790 with single-bundle bone-patellar tendon-bone grafts. At 5-year follow-up, they found that survival was 96.0 percent for the double-bundle group, 95.4 percent for the single bundle hamstring tendon group, and 97.0 percent for the single-bundle bone-patellar tendon-bone group. Read the abstract…

AHRQ notes increase in opioid-related hospitalizations over a decade.
A report from the U.S. Agency for Healthcare Research and Quality (AHRQ) looks at trends in opioid-related hospitalizations and finds that hospitalizations involving opioid pain relievers and heroin increased about 75 percent for women and 55 percent for men between 2005 and 2014. Findings of the report include the following:

  • The age group most likely to have an opioid-related hospitalization varied substantially across states. In 13 states, including California, people 65 years old and older were the most likely to be hospitalized.
  • In all states reporting on opioid-related visits to emergency departments (EDs), the rate was highest among adults 25-44 years of age.
  • Men were more likely to make opioid-related visits to EDs in 2014, although ED visit rates increased sharply for both sexes over the term of the study.

The research team drew data from the AHRQ Fast Stats database—an online resource that includes information on opioid-related hospital stays and ED visits, as well as breakdowns by age, sex, community-level income, and urban versus rural residency. Read more…
Read the complete report (PDF)…

Study: Yoga may not be inferior to PT for treatment of nonspecific cLBP.
A study published online in the journal Annals of Internal Medicine suggests that a manualized yoga program may not be inferior to physical therapy (PT) for patients with nonspecific chronic low back pain (cLBP). The researchers conducted a 12-week, single-blind, 3-group randomized noninferiority trial with subsequent 40-week maintenance phase for 320 racially diverse adults with cLBP. Participants received either 12 weekly yoga classes, 15 PT visits, or an educational book and newsletters. At 12-week follow-up, they found that patients in the yoga and PT cohorts were 21 and 22 percentage points less likely, respectively, than education participants to use pain medication at 12 weeks. At 1-year follow-up, the researchers noted that improvements in yoga and PT groups were maintained, with no differences between maintenance strategies. In addition, frequency of adverse events did not significantly differ between yoga and PT groups. Read the abstract…

Study: Heavy use of electronic devices linked to increased likelihood of nerve and ligament symptoms.
Findings published online in the journal Muscle & Nerve suggest that overuse of electronic devices may be associated with variations of the median nerve and transverse carpal ligament. The research team surveyed 48 university students, 24 of whom were considered intensive uses of electronic devices (≥5 hours/day) and 24 of whom were determined to be nonintensive users (<5 hours/day). Compared with nonintensive users, they found that intensive users had significantly more positive results in Phalen’s and Durkan’s tests, and reported increased wrist or hand pain. In addition, intensive users also had significantly larger median nerve cross-sectional areas, flattening ratios, and perimeters, as well as greater bowing of the transverse carpal ligament compared with nonintensive users. Read the abstract…

Call for volunteers: Voting panel for pediatric developmental dysplasia of the hip AUC.
The Appropriate Use Criteria (AUC) Section seeks AAOS fellows to participate on the voting panel for the Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip (DDH) in Infants Up to Six Months of Age AUC. The voting panel will participate in two rounds of voting, during which it will rate the appropriateness of various treatments for pediatric patients who are at risk of DDH. Voting panel members will be required to attend a 1-day, in-person meeting in Rosemont, Ill. Nominees for the voting panel are required to complete the AAOS conflict of interest enhanced disclosure form online. If you are interested in participating on the voting panel for this AUC topic, please contact Mary DeMars by Friday, June 30, 2017, at: demars@aaos.org