Today’s Top Story

Study: How has Medicare reimbursement for orthopaedics shifted over time?

A study published online in the journal Orthopedics examines trends in Medicare reimbursement for orthopaedic procedures. The researchers reviewed the Medicare Physician Fee Schedule for Current Procedural Terminology code values for common orthopaedic and nonorthopaedic procedures from 2000 to 2016, and adjusted all prices to 2016-dollar values. They found that over the course of the study period, annual reimbursements decreased for all orthopaedic procedures examined except orthopaedic implant removal. Orthopaedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee arthroplasty, and total hip arthroplasty. Orthopaedic procedures with the least annual reimbursement decreases were carpal tunnel release and ankle fracture repair. In addition, the researchers found that the rate of change in Medicare procedure reimbursement varied between orthopaedic specialties, with trauma seeing the smallest decrease in annual change compared with spine, sports, and hand. Finally, they note that annual reimbursement decreased at a significantly greater rate for adult reconstruction than for any other orthopaedic specialty.

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Other News

Study: Casting or surgery may offer similar outcomes for unstable ankle fracture in older patients

A research letter from a study conducted in the United Kingdom and published in the March 27, 2018, issue of The Journal of the American Medical Association suggests that close contact casting or surgical treatment of unstable ankle fracture may offer equivalent ankle function for older adults. The authors conducted a randomized clinical trial of 428 patients older than 60 years, 206 of whom were treated with casting and 222 of whom were treated with surgery. At median three-year follow-up, they found no significant difference across cohorts in Olerud and Molander Ankle Score, quality of life, or pain. Overall, 17 patients in the casting cohort (8 percent) and 22 patients in the surgical cohort (10 percent) underwent surgery after six months. Five patients in the casting group underwent internal fixation for nonunion after six months. In post hoc analysis, the authors found that the mean total operating room procedures per participant (per protocol) were 1.3 in the casting group and 1.2 in the surgery group, while mean total surgical procedures per participant were 0.3 in the casting group and 1.2 in the surgery group.

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Study: ACS rare among younger patients with SCH fracture, but some at increased risk

According to a study published online in the Journal of Pediatric Orthopaedics, certain patients with pediatric supracondylar humerus (SCH) fracture may be at increased risk for acute compartment syndrome (ACS). Members of the research team reviewed data on 839 patients with SCH fracture from a single institution and 31,234 SCH fractures from the National Trauma Data Bank. Overall, 67 patients had documented ACS. In a regression analysis, the researchers found that older age, male sex, floating elbow fracture pattern, and neurovascular injury were risk factors for developing ACS in pediatric patients.

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Could Medicare opioid restrictions unintentionally harm some patients?

An article in The New York Times profiles concerns among some providers that restrictions on opioid prescribing may negatively affect some patients. A Medicare rule that is likely to be approved next month will restrict the prescribing of long-term, high-dose opioids. Supporters say the regulation will provide a barrier to opioid addiction. Critics argue that the rule interferes with the physician-patient relationship, and could force patients who lose access to the drugs into withdrawal or encourage them to seek illegal replacements.

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OIG report suggests that many outpatient PT claims do not comply with Medicare requirements

A report from the U.S. Department of Health and Human Services Office of Inspector General (OIG) projects that 61 percent of Medicare claims for outpatient physical therapy (PT) services may not comply with Medicare medical necessity, coding, or documentation. Members of the research team reviewed a stratified, random sample of 300 Medicare claims for PT services from July 1, 2013, to Dec. 31, 2013. Among the 300 claims, they found that therapists claimed $12,741 in Medicare reimbursement on 184 non-compliant claims. Based on the sample results, the researchers estimate that during the audit period, Medicare paid $367 million for outpatient PT services that did not comply with Medicare requirements.

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Study: Antibiotic resistant infections may cost $2.2 billion per year in the U.S.

Information published online in the journal Health Affairs suggests that resistant infections may cost the United States $2.2 billion annually. The authors reviewed data from the Medical Expenditure Panel Survey and estimated the incremental healthcare costs of treating a resistant infection, as well as the total national costs of treating such infections. They estimate that antibiotic resistance was associated with an addition $1,383 in cost per patient with a bacterial infection “The need for innovative new infection prevention programs, antibiotics, and vaccines to prevent and treat antibiotic-resistant infections is an international priority,” the authors write.

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Call for volunteers: Shoulder & Elbow Evaluation Committee

April 13 is the last day to apply for chair of the Shoulder & Elbow Evaluation Committee. Members of the Evaluation Committees write questions for the orthopaedic self-assessment examinations. Applicants for this position must be active or emeritus fellows with extensive knowledge and experience in shoulder and elbow.

Learn more and submit your application…  (member login required)