Today’s Top Story
CMS issues ACO rule with increased flexibility.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released a final rule that updates the Medicare Shared Savings Program to provide additional flexibility and enhance a focus on primary care. Among other things, the final rule:

  • Creates a new Track 3 that includes higher rates of shared savings, prospective assignment of beneficiaries, and the opportunity to use new care coordination tools
  • Streamlines data sharing between CMS and accountable care organizations (ACOs)
  • Refines the policies for resetting ACO benchmarks to provide strong incentives for ACOs to improve patient care and generate cost savings
  • Announces the agency’s intent to propose further improvements to the benchmarking methodology later in 2015

An independent evaluation report released by CMS earlier this month found that the Pioneer ACO Model generated more than $384 million in savings to the Medicare system over its first 2 years. Read more…(registration may be required)
Read the CMS statement…

Other News

Study: Computer-assisted TKA may reduce embolic load compared to conventional approach.
Findings from a study published in the June 3 issue of The Journal of Bone & Joint Surgery (JBJS) suggest that the use of computer-assisted surgery may be associated with reduced embolic load compared to conventional surgery for total knee arthroplasty (TKA). The researchers conducted a prospective, randomized study of 57 patients who underwent either computer-assisted (n = 29) or conventional (n = 28) TKA. They found that the mean embolic score was 5.48 points for the computer-assisted surgery cohort, and 6.21 points for the conventional technique group. After tourniquet deflation, they observed fat emboli in the blood of one patient in the computer-assisted surgery group and five patients in the conventional surgery group. The researchers note, however, that among patients with an uncompromised cardiopulmonary system, the embolic load difference between the techniques did not appear to be clinically relevant. Read the abstract…

Study: TAA may reduce pain and disability for obese as well as non-obese patients.
Total ankle arthroplasty (TAA) may be linked to reduced pain and disability for both obese and non-obese patients, with no significant difference in likelihood of complication, according to a study published in the June 3 issue of JBJS. The research team conducted a retrospective cohort study of 39 obese (body mass index [BMI] ≥ 30 kg/m2) and 48 non-obese TAA patients. Although patients in the obese group had significantly worse preoperative SF-36 Physical Component Summary scores compared to the non-obese group, at mean 3.92-year follow-up, researchers found that both obese and non-obese patients demonstrated significant improvements in AOS pain, AOS disability, and SF-36 Physical Component Summary scores, and changes in those scores were similar for both groups. The research team noted no significant difference in the proportion of complications or revisions between cohorts. Read the abstract…

Study: Human factors linked to avoidable medical errors.
According to a study published online in the journal Surgery, human factors may be a leading contributor to avoidable medical errors. The authors identified 69 avoidable errors among 1.5 million procedures. They prospectively analyzed events leading up to the errors using the validated Human Factors Analysis and Classification System. They found that a total of 628 human factors–primarily action-based errors (n = 260) and preconditions to actions (n = 296)—contributed to the 69 errors. The most common action factors were confirmation bias (n = 36) and failure to understand (n = 36); the most common precondition factors were channeled attention on a single issue (n = 33) and inadequate communication (n = 30). Read more…
Read the abstract…

Study: Withholding resumption of ARBs after surgery may increase risk of 30-day mortality.
Data from a study published online in the journal Anesthesiology suggest that withholding resumption of angiotensin receptor blockers (ARBs) after surgery may be associated with increased risk of 30-day mortality. The research team conducted a retrospective cohort study of 30,173 inpatient noncardiac surgical admissions from the Veterans Affairs Healthcare system. They found that approximately 10,205 patients (33.8 percent) did not resume ARB by day 2. Patients who resumed ARB had a 30-day mortality rate of 1.3 percent (260 of 19,968), compared to a 30-day mortality rate of 3.2 percent (323 of 10,205) for those who did not resume ARB medication within 2 days of surgery. Overall, the research team notes that withholding ARB in younger patients increased mortality risk compared with older patients. Read more…
Read the abstract…

Anti-fraud initiative will require “high risk” Medicaid providers to undergo background checks.
Modern Healthcare reports that CMS will soon require states to stratify all Medicaid and Children’s Health Insurance Program (CHIP) providers based on their likelihood of defrauding the programs. Providers who are deemed by states to be high risk will be required to undergo criminal background checks, including fingerprinting. State Medicaid agencies will terminate or deny enrollment to providers who are required to submit fingerprints if they meet any of the following criteria:

  • Fail to submit fingerprints within 30 days of the Medicaid agency’s request
  • Fail to submit fingerprints in the form and manner requested by the Medicaid agency
  • Have been convicted of a criminal offense related to that person’s involvement with the Medicare, Medicaid, or CHIP program during the last 10 years

State Medicaid agencies will not be required to perform a background and fingerprint check on any provider who recently went through the process for Medicare or another state’s Medicaid agency. Read more…(registration may be required)
Read the letter from CMS (PDF)…

Read the June issue of AAOS Now on your tablet!
The June edition of AAOS Now magazine is now available for electronic devices capable of reading files in ePub format, including the iPhone and iPad, Android devices, and desktop computers. (Unfortunately, Amazon Kindle does not currently accept ePub files.) To download and view the ePub version of AAOS Now, visit the link below and log in using your AAOS username and password. If you have comments or questions about the ePub version of AAOS Now, please email Peter Pollack, electronic content specialist, at ppollack@aaos.org.
Download and read AAOS Now in ePub format…

Call for volunteers: AHRQ National Advisory Council for Healthcare Research and Quality.
AAOS seeks to nominate members to the Agency for Healthcare Research and Quality (AHRQ) National Advisory Council for Healthcare Research and Quality. The council advises the secretary of the U.S. Department of Health and Human Services and the director of AHRQ on improving the quality, safety, efficiency, and effectiveness of health care. 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. 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 their expertise in the subject area and a statement that they are able to participate in full capacity. All supporting materials must be submitted to Kyle Shah by Sunday, June 21, 2015 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…