Today’s Top Story
AHA calls on CMS to adopt more flexible approach to meaningful use.
In a letter to the acting principal deputy administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) urges the agency to do away with what it calls an “all-or-nothing approach” to meaningful use of electronic health records (EHRs). AHA notes that under the existing system, “failure to meet any one of the requirements under the Medicare and Medicaid EHR Incentive Programs has meant a provider would not receive an incentive payment,” and that current rules penalize such providers. AHA states that such a system is “unfair to providers that make good faith efforts to comply, may actually comply with a large percentage of the requirements, expend significant resources and funds in doing so, but still fall short.” CMS has responded that the agency lacks the legal authority to vary from its current approach, but the AHA letter addresses those issues and requests that CMS allow providers who attest to meeting 70 percent of the meaningful use requirements to be designated as meaningful users. Read more…
Read the AHA letter (PDF)…
     AAOS has similarly advocated for increased flexibility in the meaningful use program, urging CMS in a letter earlier this month to adopt a shortened reporting period for 2016. Read the AAOS letter (PDF)…

Other News

Study: What factors are linked to PE in trauma patients?
A study published in the April issue of the Journal of Orthopaedic Trauma (JOT) seeks to assess predictors for pulmonary embolism (PE) in trauma patients. The authors reviewed data on 38,597 trauma patients, 239 of whom had a PE. They identified seven statistically significant predictors of PE:

  • Age
  • Obesity
  • Injury from motorcycle accident
  • Arrival by helicopter
  • Emergency department admission pulse rate
  • Admission to intensive care unit
  • Injury location, including thorax, abdomen, and lower extremity

The authors note that the model was able to discriminate between predicted and actual PE events with a receiver operating characteristic area under the curve of 0.87. They state that identifying the top 25 percent of high-risk patients predicted 80 percent to 84 percent of PE cases. Read the abstract…

Study: Low risk of harmful radiation at eye level during fluoroscopy.
Findings from a study published online in JOT suggest low risk of harmful radiation at eye level to primary orthopaedic surgeons during fluoroscopic procedures. The researchers conducted a prospective, comparative study of 131 orthopaedic procedures performed by 26 surgeons. They found that radiation at eye level was detected in 31 of 131 cases. The mean radiation dose detected at the eye level of the primary surgeon was 0.02 mSv, per procedure. The researchers state that femoral nails and pelvic fixation procedures had a significantly higher mean dose received than other procedure groups. They found no significant difference in eye doses received by orthopaedic consultants and trainees. Read the abstract…

Study: ACB may be superior to FNB for preserving quadriceps strength following TKA.
Data presented at the annual meeting of the American Society of Regional Anesthesia and Pain Medicine suggest that adductor canal block (ACB) may offer improved preservation of quadriceps strength compared to femoral nerve block (FNB) for patients who undergo total knee arthroplasty (TKA). The research team conducted a randomized trial of 98 patients treated with either ACB or FNB. At 6-, 24-, and 48-hour follow-up, they found that patients in the ACB cohort demonstrated statistically significant increases in quadriceps muscle strength compared to those in the FNB cohort. The research team noted no significant difference between groups in visual analog scale pain scores, pain medications intake, duration of nerve block performance, and duration of nerve block functioning. Read more…
Read the abstract (large PDF; abstract: 1229)…

Study: Biomarkers may serve as indicators of TBI.
A study published online in the journal JAMA Neurology suggests that blood-based biomarkers may help detect the presence of traumatic brain injury (TBI). The authors conducted a prospective cohort study of 584 adult trauma patients. They found that both glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) were detectible in blood samples within 1 hour of injury. Over the course of 1 week, GFAP demonstrated a diagnostic range of areas under the curve for detecting mild to moderate TBI of 0.73 to 0.94, and UCH-L1 demonstrated a diagnostic range of 0.30 to 0.67. For detecting intracranial lesions via computed tomography (CT), the diagnostic ranges of areas under the curve were 0.80 to 0.97 for GFAP and 0.31 to 0.77 for UCH-L1. For distinguishing patients with and without a neurosurgical intervention, the range for GFAP was 0.91 to 1.00 , and the range for UCH-L1 was 0.50 to 0.92. The authors state that GFAP performed consistently in detecting mild to moderate TBI, CT lesions, and neurosurgical intervention across 7 days, while UCH-L1 performed best in the early postinjury period. Read more…
Read the abstract…

Resident Assembly Research Committee to host webinar on research during residency.
The AAOS Resident Assembly Research Committee will host a webinar, “Research During Residency: Executing Now with an Eye Towards Career Development,” on Thursday, March 31 at 7:30 p.m. CT. This webinar is the second of a two-part series, and will focus on tips for effectively completing research projects during residency. Topics to be discussed include effective time management, focusing research projects, collaborating with peers and attendings (as well as tips for effective remote collaboration), quantity versus quality, recruiting and training students as research assistants, grant applications, and how to get the most out of a research rotation or year. Register for the webinar…

Last call: Committee positions closing soon!
A number of openings on the AAOS Committee Appointment Program website are closing soon. Act now to apply for the following positions:

  • ACR Appropriateness Criteria Expert Panel on Musculoskeletal and Pediatric Imaging (one liaison opening; closes April 3)
  • Central Evaluation Committee (two members—trauma; April 1)
  • The Joint Commission Technical Advisory Panel on Fluoroscopy (one member; April 3)
  • OKU Evaluation Committee (April 3)
    • Oncology (one member)
    • Hip & knee reconstruction (one member)
    • Orthopaedic basic science (one member)

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