Today’s Top Story

Medicare may become insolvent by 2026

A report from the Medicare Board of Trustees reveals that Medicare Part D drug spending is projected to lose solvency in 2026, three years earlier than 2017 predictions. The Centers for Medicare & Medicaid Services (CMS) said this is due to higher manufacturer rebates, a decline in spending for hepatitis C drugs, and a slowdown in spending growth for diabetes medications. Total Medicare costs are expected to grow from 3.7 percent of the gross domestic product to 5.8 percent in 2038, and eventually to 6.2 percent by 2092. Lack of capital flowing into the hospital-care trust fund may be a result of this year’s tax law change. In response to the report, Treasury Secretary Steven Mnuchin said Medicare is secure and “on track to meet its obligations to beneficiaries well into the next decade.”

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Other News

Decline in hospital-acquired conditions has saved thousands of lives and billions of dollars

A report from the Agency for Healthcare Research and Quality (AHRQ) estimates that 350,000 hospital-acquired conditions (HACs) were avoided, reducing the HAC rate by 8 percent between 2014 and 2016. This may have helped prevent an estimated 8,000 deaths and save $2.9 billion during that time. CMS set a goal to reduce HACs by 20 percent between 2014 and 2019 by enforcing quality improvement assistance in more than 4,000 hospitals. If this goal is met, it is estimated there will be 1.8 million fewer HACs, 53,000 fewer deaths, and $19.1 billion saved in hospital costs between 2015 and 2019.

Read the press release from AHRQ…

CMS issues final rule on joint replacement payment model participant hospitals impacted by extreme circumstances

CMS published a final rule on extreme and uncontrollable circumstances—such as a hurricane—for Comprehensive Care for Joint Replacement Payment Model participant hospitals. The rule provides flexibility in the determination of episode spending in areas impacted by these circumstances for performance years three through five. The ruling is effective July 9.

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Study: Joint aspiration and saline injection-reaspiration may predict prosthetic infection

A study published online in The Bone & Joint Journal found that both preoperative joint aspiration and culture of saline injection-reaspiration in the event of an initial dry tap may predict prosthetic joint infection in patients undergoing hip and knee aspirations. Researchers conducted a retrospective analysis of 580 hip and knee aspirations in patients with moderate to high risk of infection who later received revision arthroplasty over a 12-year period. Normal fluid aspiration occurred in 313 cases (54 percent), and saline injection-reaspiration of an initial dry tap occurred in 267 cases (46 percent). The sensitivity and specificity were 81 percent and 90 percent, respectively, for normal fluid aspiration. Sensitivity and specificity were 87 percent and 79 percent, respectively, for the saline injection-reaspiration after dry tap, compared to 81 percent and 90 percent, respectively, for direct aspiration.

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Study: First-in-human study treats spinal cord injury with neural stem cell transplantation

Transplantation of neural stem cells could be a safe way to promote neurological improvement after a spinal cord injury (SCI), according to a first-in-human phase I study published online in Cell Stem Cell. Four trial participants with T2–T12 SCIs received treatments including removal of spinal instrumentation, durotomy, and laminectomy, followed by six midline bilateral stereotactic injections of human spinal cord-derived neural stem cells, each containing 1.2 million neural stem cells. All participants tolerated the treatment, and no adverse events were reported for 18 to 27 months after transplantation. According to International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, two subjects had one to two levels of neurological improvement following treatment. Researchers note that this trial lacks statistical power and a control group, and future studies should address NSI-566 cells in a dose-escalation design.

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Study: Foot and ankle surgical patients are overprescribed opioids

A study presented at the AAOS 2018 Annual Meeting reported that patients who undergo orthopaedic foot and ankle procedures are prescribed narcotic medication by nearly twice the amount that is actually consumed, leading to a significant surplus of narcotics available for potential diversion.

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Nominate a colleague for the 2019 Tipton Leadership Award

AAOS is accepting nominations for the 2019 William W. Tipton Jr, MD, Leadership Award, which will be presented at the AAOS 2019 Annual Meeting in Las Vegas. The honoree will receive a $5,000 donation to be used in furthering leadership in orthopaedics, as well as a commemorative plaque. The last day to submit a nomination is June 15.

Learn more and submit a nomination…

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