Today’s Top Story
Supreme Court rules in favor of subsidies in latest ACA challenge.
In a 6-3 vote yesterday, the U.S. Supreme Court upheld subsidies of health insurance for consumers who purchase health plans on the federally operated healthcare exchange. At issue was wording in the Affordable Care Act (ACA) that plaintiffs claimed would allow subsidies to insurance purchasers only in states that set up and run their own healthcare exchanges. Attorneys for the Obama administration had responded that the law was always intended to subsidize all qualified purchasers, regardless of whether the federal government or the state runs the healthcare exchange. Had the court ruled otherwise, some experts suggested that it could have created a so-called “death spiral” condition, in which healthy consumers would exit the healthcare insurance market due to rising costs, leaving a disproportionate number of higher-cost, higher-need patients in the care of insurers that were required to cover them under the ACA. Read more…

Other News

Senate bill seeks to address issues with meaningful use and ASCs.
According to Modern Healthcare, the U.S. Senate Finance Committee has passed a bill that, if enacted, would adjust meaningful-use requirements for physicians who use ambulatory surgery centers (ASCs). Currently, ASCs are excluded from qualification for incentive payments under the Medicare meaningful use of certified electronic health record (EHR) technology program. As a consequence, many EHRs used in ASCs have not been tested and certified. However, in calculating the 50 percent meaningful use requirement under current rules, physicians who actively or exclusively use ASCs for surgery would have to count patient visits at ASCs when measuring the percentage of visits, even if they occurred at an ASC without a tested or certified EHR. Under the so-called Electronic Health Fairness Act, meaningful use requirements would be adjusted and physicians at ASCs protected from possible reimbursement penalties. Read more…(registration may be required)

Are patients at low-volume hospitals at increased risk?
An article in U.S. News & World Report looks at the issue of proposed volume standards for certain surgical procedures. A recent analysis by the publication reviewed information on nearly 120,000 patients and found that those who were treated at hospitals with the lowest volumes were associated with increased risk of mortality. The findings prompted three major health systems to propose minimum volume standards for 10 procedures, including joint arthroplasty. Read more…

Study: How do wear rates compare between UHMWPE and HXLPE femoral heads in cemented THA?
A study published online in the journal Clinical Orthopaedics and Related Research compares wear rates of oxidized zirconium femoral heads to stainless steel heads for cemented total hip arthroplasty (THA). The authors conducted a blinded, randomized trial of 100 THA patients who received one of the four bearing combinations:

  • Highly crosslinked polyethylene (HXLPE) socket and oxidized zirconium head (n = 25)
  • HXLPE socket and stainless steel head (n = 25)
  • Ultrahigh-molecular-weight polyethylene (UHMWPE) socket and oxidized zirconium head (n = 25)
  • UHMWPE socket and stainless steel head (n = 25)

At minimum 4-year follow-up, 86 patients were available. The authors found that, among UHMWPE patients, the median steady-state penetration rate from 1 year onward was 0.03 mm/year in the oxidized zirconium cohort and 0.11 mm/year in the stainless steel cohort. Among HXLPE patients, the median steady-state penetration rate from 1 year onward was 0.02 mm/year in the oxidized zirconium cohort and 0.05 mm/year in the stainless steel cohort. The authors write that, apart from the HUMWE/stainless steel combination group, all other groups had a steady-state penetration rate well below the osteolysis threshold and a low difference between groups that may not be clinically important. Merle d’Aubigné outcome scores were statistically similar between all groups. Read the abstract…

Study: Orthopaedic trauma patients may be at increased risk of complication compared to general orthopaedic patients.
Data published in the July issue of the Journal of Orthopaedic Trauma suggest that orthopaedic trauma patients may be twice as likely to sustain complications compared to general orthopaedic patients. The researchers conducted a prospective, multicenter study of American College of Surgeons National Surgical Quality Improvement Program data on 146,773 orthopaedic patients. They found that the complication rate in the trauma group was 11.4 percent (n = 2,554 of 22,361) in the trauma cohort and 4.1 percent (n = 5,137 of 124,412) in the general orthopaedic cohort. After controlling for variables such as demographics, surgical variables, and patient comorbidities, they found that trauma was a risk factor for developing complications. The researchers noted that hip and pelvis patients were four times more likely than upper extremity patients to develop any perioperative complication, and overall, lower extremity patients were three times more likely to develop any complication than upper extremity patients. Read the abstract…

The Associated Press reports that the Connecticut Association of Ambulatory Surgery Centers estimates that a proposed tax on ASCs would, if enacted, force as many as 15 of the 61 ASCs in the state to close. Proponents of the new tax say that it will generate $15 million in the first year of the budget and $20 million in the second year. Critics argue that it could impact the bottom lines of some ASCs by as much as 25 percent to 30 percent. Read more…

Reminder: Submit your OKU11 SAE answer file by June 30 to be included in the next quarterly scoring.
Submit your answers to AAOS for confidential scoring after completing the continuing medical education (CME) evaluation form. Your 20 scored and recorded CME credits will be posted to your transcript.

Call for volunteers: ACS Quality of Geriatric Surgical Patient Care Improvement Program.
AAOS seeks to nominate a member to the American College of Surgeons (ACS) Quality of Geriatric Surgical Patient Care Improvement Program. The goal of the initiative is to develop a geriatric surgery standards and verification program. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic with an interest and experience in geriatric surgical quality improvement. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area and a statement that he or she is able to participate in full capacity. All supporting materials must be submitted to Kyle Shah by Tuesday, July 7, 2015, at 11:59 p.m. CT, at
Learn more and submit your application…(member login required)