Today’s Top Story
Senate releases updated version of ACA replacement legislation.
The U.S. Senate introduced its own version of the American Health Care Act (AHCA), titled the Better Care Reconciliation Act (BCRA). The Senate version of the bill is similar to the AHCA, which was passed earlier this year by the U.S. House of Representatives as a replacement for the Affordable Care Act (ACA). Key differences include:

  • Both bills end funding for Medicaid expansion, but the AHCA cuts it entirely in 2020 while the BCRA proposes to phase it out over 3 years, beginning in 2021.
  • Both bills convert Medicaid funding to block grants for states, but the BCRA proposes a lower rate of growth after 2024 compared to the AHCA.
  • AHCA bases premium subsidies for healthcare exchange plans solely on age; BCRA bases them on age and income, similar to the ACA.
  • Unlike the AHCA, the BCRA authorizes cost-sharing subsidies through 2019 for low-income families covered through healthcare exchange plans.

Medscape notes that the BCRA is currently labeled a discussion draft, suggesting that lawmakers expect it to be amended prior to a full Senate vote Under reconciliation rules, 51 votes are required to ensure passage. Read more…

An article from the Associated Press further compares the ACA, the AHCA, and the BCRA. Read more…
Read the bill (PDF)…

Other News

FDA announces recalls of Alvogen Clindamycin Injection USP ADD-Vantage Vials; certain Advanced Pharma/Avella products.
The U.S. Food and Drug Administration (FDA) announced a voluntary manufacturer recall of seven lots of Alvogen Clindamycin Injection USP ADD-Vantage Vials due to microbial growth detected during a routine simulation of the manufacturing process. The agency requests that anyone with existing inventory stop use and further distribution of the impacted lots as well as immediately quarantine the product. Alvogen is notifying its distributors and customers via an Urgent Drug Recall Notice and is arranging for the return of all recalled products. Read more…
     In an unrelated issue, Advanced Pharma, Inc. d/b/a Avella of Houston is conducting a limited, voluntary recall of specific lots of Potassium Phosphate and Succinylcholine Chloride. This effort is a secondary recall based on a recent recall of certain products manufactured by Hospira, Inc. The lots were repackaged and/or compounded at a facility using recalled Hospira products. Read more…

MedPAC report highlights issues with CMS Open Payments reporting by some PODs.
An article in Bloomberg BNA notes that the recently released U.S. Medicare Payment Advisory Commission (MedPAC) June 2017 Report to the Congress: Medicare and the Health Care Delivery System argues for increased scrutiny of physician-owned distributorships (PODs). The authors state that most PODs are subject to Open Payments reporting requirements as group purchasing organizations (GPOs). “However, PODs that purchase devices for resale to a single hospital rather than a group of hospitals do not meet CMS’ definition of a GPO and are therefore excluded from reporting.” The authors further note that the U.S. Senate Finance Committee has determined “that many PODs do not report their physician ownership interests to Open Payments, and some PODs have changed how they compensate physicians to circumvent the reporting requirements.” The agency recommends that CMS increase efforts to report physician ownership information and assess penalties on non-compliant PODs. Read more…
Read the complete report (PDF)…

Study: Long-term satisfaction noted for FAI patients treated with either arthroscopic débridement or labral repair
A study published in the June 21 issue of The Journal of Bone & Joint Surgery examines 10-year outcomes for patients who have undergone hip arthroscopy for femoroacetabular impingement (FAI). The authors reviewed prospectively collected data on 79 patients who underwent arthroscopic labral repair and 75 who underwent arthroscopic débridement, 94 percent of whom (n = 145) were followed for ≥10years. Overall, 50 patients (34 percent) underwent total hip arthroplasty (THA) within 10 years following the arthroscopy. Factors that were significantly associated with increased likelihood of THA included older age, hips with >2 mm of joint space preoperatively, and acetabular microfracture. However, the authors found no significant difference in postoperative outcome scores across cohorts, based on Hip Outcome Score—activities of daily living scale, Hip Outcome Score—sport scale, modified Harris hip score, and Short Form-12 physical component summary. In addition, median patient satisfaction score was 10 (very satisfied) in both groups. Read the abstract…

Study: “Boarded” surgical ICU patients may receive less attention.
According to a study published online in The American Journal of Surgery, patients who “board” in surgical intensive care units (ICUs), rather than the designated home unit, may receive less attention from providers, with corresponding negative effects on outcomes. The researchers observed surgical ICU rounds at a single academic quaternary medical center and found that boarded patients were often seen at the end of rounds and for less time. Non-boarders were generally older, observed on a later post-ICU admission day, and were more likely to be mechanically ventilated. The researchers state that not being a boarder, age, Acute Physiology and Chronic Health Evaluation II score on admission, vasopressor use, and positive pressure ventilation all predicted increased rounding time. Read more…
Read the abstract…

Study: What treatment approaches are recommended for diabetic patients with osteoporosis?
A study published online in The Journal of Clinical Endocrinology & Metabolism examines treatment options for patients with both type 2 diabetes and osteoporosis. The research team analyzed data from multiple human studies and recommended that metformin, sulfonylureas, DPP-4i, and GLP1-RA are preferred for the treatment of type 2 diabetes among osteoporotic patients. The investigators stated that insulin should be used with caution and with careful measures to avoid hypoglycemia, while thiazolidinediones and canagliflozin should be avoided. “Insulin therapy is the preferred method for achieving glycemic control in hospitalized patients with [type 2 diabetes] and fracture(s),” they wrote. “The treatment and monitoring of osteoporosis should be continued without important amendments because of the presence of [type 2 diabetes].” Read more…
Read the abstract…

Call for volunteers: Committee on Evidence-Based Quality and Value.
July 14 is the last day to submit applications for a position on the Committee on Evidence-Based Quality and Value (one member opening). This committee directs and evaluates evidence-based initiatives such as Clinical Practice Guidelines (CPGs) and Appropriate Use Criteria (AUC) and oversees related educational and implementation products to the AAOS members and leadership. Applicants for this position must be active fellows, emeritus fellows, candidate members, or candidate member applicants for fellowship. Learn more and submit your application…(member login required)