Today’s Top Story
CMS announces proposed rule to improve Medicare Part B prescribing and payment.
The U.S. Centers for Medicare & Medicaid Services (CMS) has announced a proposed rule to test new models to improve how Medicare Part B pays for prescription drugs and supports physicians in delivering higher quality care. The proposed rule is designed to test different physician and patient incentives to do two things: drive prescribing of the most effective drugs, and test new payment approaches to reward positive patient outcomes. CMS seeks comments on testing six alternative approaches for Part B drugs, including:

  • Incentives for best clinical care
  • Discounting or eliminating patient cost-sharing
  • Feedback on prescribing patterns and online decision support tools
  • Indications-based pricing
  • Reference pricing
  • Risk-sharing agreements based on outcomes

CMS will accept comment on the proposed rule through May 9, 2016. Read more…
Read the CMS fact sheet…
Read the complete rule…

Other News

Study: Quality reporting costs physicians thousands of dollars per year.
A study published in the March 2016 issue of the journal Health Affairs examines physician payment systems in the United States. Researchers surveyed 394 physician practices and found that physicians and staff averaged 15.1 hours per physician per week processing quality metrics—an equivalent of 785.2 hours per physician per year—at an average cost of $40,069 per physician per year. However, they noted that time and money spent reporting was lower for specialists compared to primary care physicians; primary care physicians averaged 3.9 hours per week dealing with quality measures, compared with 1.1 hours for orthopaedists. The researchers agree that much is to be gained from quality measurement, but write that “the current system is unnecessarily costly, and greater effort is needed to standardize measures and make them easier to report.” Read more…
Read the abstract…

FDA settlement could impact off-label drug marketing.
The New York Times reports that the U.S. Food and Drug Administration (FDA) has settled a lawsuit that some experts say could have implications for the marketing of drugs for off-label use. At issue is a case in which a pharmaceutical manufacturer sued FDA for the right to promote a product to a broader range of patients. Last year, a federal district judge ruled that the agency could not prohibit the company from using truthful information to promote its drug—even for unapproved uses—as doing so would violate the company’s right to free speech. A spokesperson for FDA states that the settlement applies only to one specific case, and that the agency’s position on off-label marketing remains unchanged. However, observers note that the settlement could encourage other companies to seek similar arrangements. Read more…

Study: Is DB technique superior to SB for ACL reconstruction?
Findings from a study published online in The American Journal of Sports Medicine (AJSM) suggest that anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may not be superior to anatomic single-bundle (SB) ACL reconstruction. The authors conducted a randomized, controlled trial of 105 patients aged 18 to 52 years who underwent ACL reconstruction using the DB (n = 53) or SB (n = 52) technique. Preoperatively, no differences were found between cohorts, apart from preinjury Tegner activity level, which was lower in the DB group. At 5-year follow-up of 87 patients, the authors found no statistical differences between cohorts in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, single-legged-hop test, square-hop test, range of motion, Lysholm knee scoring scale, Tegner activity scale, or Knee injury and Osteoarthritis Outcome Score. However, they noted a significant increase of osteoarthritis within the DB group at 5-year follow-up. Read the abstract…

Study: Treatment with vitamin D3 may not reduce pain or increase tibial cartilage volume for patients with knee OA.
According to a study conducted in Australia and published in the March 8 issue of The Journal of the American Medical Association (JAMA), treatment with oral vitamin D3 may not significantly affect tibial cartilage volume or reduce pain for patients with knee osteoarthritis (OA). The researchers conducted a multicenter, randomized, double-blind, placebo-controlled clinical trial of 413 patients who received monthly treatment with either 50,000 IU oral vitamin D3 (n = 209) or placebo (n = 204). At 2-year follow-up of 340 patients, they found no significant differences between cohorts in annual change of tibial cartilage volume or WOMAC pain score. In addition, they noted no significant differences between groups in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions. Read more…
Read the abstract…

Study: Increasing UCL reconstruction suggests improved education may be needed to prevent overuse throwing injuries.
A study published in the March issue of AJSM suggests increasing use of ulnar collateral ligament (UCL) reconstruction over a 10-year period. The authors used the New York Statewide Planning and Research Cooperative System database to identify all UCL reconstructions in New York State from 2002 to 2011. They found that the volume of UCL reconstructions increased by 193 percent over the study period, and the rate per 100,000 population tripled from 0.15 to 0.45. The mean patient age was 21.6 years, and the authors noted a significant increasing trend for UCL reconstruction in patients aged 17 to 18 and 19 to 20 years. In addition, they found a 400 percent increase in concomitant ulnar nerve release/transposition performed across the study period, representing a significant increase in the frequency of ulnar nerve procedures at the time of UCL reconstruction. The authors argue for an increased educational emphasis on the risks of overuse throwing injuries and the importance of adhering to preventative guidelines. Read more…
Read the abstract…

Study: Clinical risk score may help stratify pediatric head trauma patients at risk for PPCS.
Data from a study conducted in Canada and published in the March 8 issue of JAMA suggest that use of a clinical risk score may help stratify children with head trauma who may be at risk for persistent postconcussion symptoms (PPCS). The research team conducted a prospective, multicenter cohort study of 3,063 patients aged 5 to 17 years who presented to the emergency department (ED) within 48 hours of an acute head injury. Patients were divided into derivation (n = 2,006) and validation (n = 1,057) cohorts. Overall, PPCS were present in 801 patients in the derivation cohort and 291 patients in the validation cohort. The research team used a 12-point PPCS risk score model that included the variables of female sex, age 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and four or more errors on the Balance Error Scoring System tandem stance. They found that the area under the curve was 0.71 for the derivation cohort and 0.68 for the validation cohort. The research team states that further validation research is necessary before the score is adopted in clinical practice. Read the complete study…

Call for volunteers: Central Evaluation Committee.
April 1 is the last day to submit your application for a position on the Central Evaluation Committee (one member opening—trauma). Members of the Central Evaluation Committee write questions for the Orthopaedic In-Training Examination. Applicants for this position must be active or emeritus fellows with a practice emphasis in trauma. Learn more and submit your application…(member login required)