Today’s Top Story
CMS to evaluate new ways of reimbursing physicians for administering certain prescription medications.
Last week, the Centers for Medicare & Medicaid Services (CMS) announced plans for testing new ways of reimbursing physicians for administering drugs to patients in their offices and hospital outpatient clinics. As reported by Kaiser Health News, the two-part proposal is aimed at reducing financial incentives for physicians to use higher-cost drugs, even in cases where less expensive drugs may be equally or more effective. The drugs targeted in the proposal—such as intravenous medications and injectable drugs (including some antibiotics) administered at a medical facility—are paid for under Medicare Part B, which currently pays the average sales price of the drug plus 6 percent. Under the proposal that would begin later this year, physicians and hospital outpatient centers would receive the average price plus 2.5 percent, accompanied by a flat fee of $16.80 per drug, per day. In 2017, Medicare would test methods such as eliminating patient copayments for some drugs considered high-value medications. Read more…
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Other News
GAO: CMS must take steps to tighten ACA enrollment control and reduce fraud.
By failing to fully utilize its data hub to verify information provided by those attempting to enroll for coverage or income-based subsidies under the Affordable Care Act (ACA), CMS is missing out on opportunities to detect fraud and to improve overall management of the Health Insurance Marketplace, the U.S. Government Accountability Office (GAO) declared in a report. The GAO also said that CMS lacked an effective process for resolving inconsistencies in individual applications—such as those involving Social Security numbers or incarceration history. In undercover testing conducted by the GAO for 2014, the federal Marketplace approved subsidized coverage for 11 of 12 fictitious applications submitted online or by phone; applicants were able to maintain subsidized coverage throughout the year even though the GAO had sent fictitious documents or none at all to resolve application inconsistencies. The GAO concluded that until CMS performs a comprehensive fraud risk assessment of the ACA enrollment and eligibility process, the agency “is unlikely to know whether existing control activities are suitably designed and implemented to reduce fraud risk to an acceptable level.” Read more…
Read the full report (PDF)…
Court orders Johnson & Johnson to pay $502 million in damages for defective hip implants.
A federal district court in Texas has ordered Johnson & Johnson to pay $502 million in damages to five plaintiffs for injuries caused by Pinnacle Ultamet metal-on-metal hip implants, Modern Healthcare reports. The device is made by Johnson & Johnson’s DePuy Orthopaedics. The consolidated lawsuits allege that the Pinnacle spread metal debris into the patients’ bloodstreams and caused major injuries that, in some cases, led to further surgeries. After more than a month of testimony, the jury found that the device were defective and that the company failed to notify the public about their dangers. Although DePuy stopped selling the metal-on-metal versions of the Pinnacle in 2013, it has denied that the devices are defective and said it will appeal the verdict. Read more…(registration may be required)
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Study: NSAIDs most effective for osteoarthritis pain; “no role” for acetaminophen.
Authors of a Swiss study appearing in The Lancet comparing the effectiveness of NSAIDs with that of acetaminophen for pain in knee and hip osteoarthritis patients concluded that there is “no role for single-agent paracetamol [acetaminophen] for the treatment of patients with osteoarthritis irrespective of dose.” The meta-analysis, which surveyed 74 randomized trials with a total of 58,556 patients, compared results involving dosages of seven different NSAIDs and acetaminophen. The study found that among maximally approved daily doses, diclofenac 150 mg/day and etoricoxib 60 mg/day had the highest probability to be the best intervention, with both having 100 percent probability to reach the minimum clinically important difference. The authors wrote, “We provided sound evidence that diclofenac 150 mg/day is the most effective NSAID available at present, in terms of improving both pain and function.” Read more…
Vermont
Study data indicate that the use of telemedicine to treat patients at a Vermont Veterans Affairs hospital resulted in an average savings of 145 miles and 142 minutes per visit between 2005 and 2013, which translates to an average travel payment savings of $18,555 per year, Healthcare IT reports. The study, published in the journal Telemedicine and e-Health, also found that the volume of telemedicine services grew significantly over the study period—so much so that the travel savings increased to $63,804 by the final year. The authors note that the number of mental health telemedicine visits increased during the study period, but remained small relative to the number of face-to-face visits, and that a higher proportion of telemedicine visits involved new patients. Read more…
Read the abstract…
AAOS Board approves Orthopaedic Preferred Measure Set.
At the 2016 AAOS Annual Meeting, the AAOS Board of Directors approved the 2016 Physician Quality Reporting System (PQRS) Orthopaedic Preferred Performance Measure Set (OPS). The measure set provides a concise list of available 2016 PQRS measures most relevant to orthopaedic surgeons, and is designed to assist them in selecting measures applicable to orthopaedic practice. View the complete OPS set (PDF)…
Learn more about PQRS…
AAOS announces strategic investment in Orthobullets.
The AAOS recently approved a strategic investment in Lineage Medical LLC, parent company of Orthobullets.com. Orthobullets.com is a technology platform for online orthopaedic education developed and designed by orthopaedic surgeons. The AAOS investment is part of a continuing effort to provide members with access to high-quality products and programs that best meet lifelong learning needs. “The Academy has long been the primary source for unbiased, peer-reviewed musculoskeletal education,” said AAOS immediate past President David D. Teuscher, MD. “This new strategic relationship with Orthobullets will allow us to build on that strength, and better serve our resident members as well as the entire global membership of the Academy, by being a part of the development and delivery of a new generation of products accessible via new technology and platforms.”
Call for volunteers: ACR appropriateness criteria expert panels on musculoskeletal and pediatric imaging.
AAOS seeks to nominate members to the American College of Radiology (ACR) Appropriateness Criteria Expert Panels on Musculoskeletal and Pediatric Imaging. Appropriateness criteria are evidence-based guidelines designed to assist referring physicians and other providers in making the most appropriate imaging decision for a specific clinical condition. Applicants for this position must be active fellows, candidate members, candidate member applicants for fellowship, candidate member applicants for fellowship osteopathic, or candidate members osteopathic. In addition, each applicant 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. All supporting materials must be submitted to Kyle Shah by April 3, 2016, at 11:59 p.m. CT, at: shah@aaos.org
Learn more and submit your application…(member login required)
