Today’s Top Story
Judge rules that HHS lacks authority to fund key section of ACA.
The New York Times reports that a federal District Court judge has ruled that the U.S. Department of Health and Human Services (HHS) did not have the authority to fund a key section of the Affordable Care Act (ACA). At issue is a program designed to help lower-income people pay deductibles, co-payments, and other out-of-pocket expenses under the ACA. The judge ruled that Congress never provided explicit authority for the spending, and blocked further spending under the program but suspended that order pending appeal. Supporters of the program say it could still function if the administration loses the case, although other sources of funding would have to be found or the program altered, and insurance companies could lose subsidies under the program, potentially driving up premiums.
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Other News

Study: What factors may distinguish between septic arthritis and Lyme disease in pediatric patients?
A study published in the May 4 issue of The Journal of Bone & Joint Surgery attempts to identify predictors of septic arthritis in pediatric patients. The researchers retrospectively reviewed records of 189 patients younger than 18 years of age with knee effusions who underwent arthrocentesis at a single institution. Overall, 23 patients had culture-positive septic arthritis, 26 patients had culture-negative septic arthritis, and 140 patients had Lyme disease. They found that, although septic arthritis of the knee and Lyme monoarthritis may be difficult to distinguish clinically, the presence of pain with short arc motion, C-reactive protein of >4.0 mg/L, patient-reported history of fever, and age younger than 2 years were independent predictors of septic arthritis in pediatric patients. In addition, they found that an increasing number of factors present in the patient was associated with an increased risk of septic arthritis.
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Study: Delayed showering following TKA may offer little advantage for bacterial recolonization.
Findings from a small study published online in The Journal of Arthroplasty suggest there may be little advantage to delayed showering after primary total knee arthroplasty (TKA). The authors conducted a randomized, controlled trial of 32 TKA patients, 16 of whom were allowed to shower at 2 days postoperative and 16 of whom were asked to wait until 2 weeks postoperative before showering. They found no difference between cohorts in rate of colonization or bacterial type at any time point (preoperative, just after incision closure, dressing removal, and 2 weeks postoperative). In addition, no patients in either group developed infection.
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FDA issues advisory regarding treatment with fluoroquinolone antibacterial drugs.
The U.S. Food and Drug Administration (FDA) is advising that the serious side effects associated with fluoroquinolone antibacterial drugs generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options. An agency safety review has shown that, when used systematically, fluoroquinolones are associated with disabling and potentially permanent serious side effects that can occur together. Side effects can involve the tendons, muscles, joints, nerves, and central nervous system. As a result, FDA is requiring the drug labels and medication guides for all fluoroquinolone antibacterial drugs to be updated to reflect this new safety information. The agency states that healthcare professionals should stop systemic fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.
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Read the FDA Drug Safety Communication…

AMA president encourages medical professionals to take “lead role” in fighting opioid epidemic; House approves series of opioid bills.
Writing in the Huffington Post, the president of the American Medical Association (AMA) argues that the “medical profession must play a lead role in reversing the opioid epidemic.” He states that well-intended, but flawed public policies “compelled doctors to treat pain more aggressively for the comfort of our patients. But today’s crisis plainly tells us we must be much more cautious with how we prescribe opioids.” Among his recommendations:

  • Avoid initiating opioids for new patients with chronic non-cancer pain unless the expected benefits are anticipated to outweigh the risks
  • Limit the amount of opioids prescribed for post-operative care and acutely-injured patients
  • Use state Prescription Drug Monitoring Programs
  • Reduce stigma to enable effective and compassionate care
  • Work compassionately to reduce opioid exposure in patients who are already on chronic opioid therapy when risks exceed benefits
  • Identify and assist patients with opioid use disorder in obtaining evidence-based treatment
  • Co-prescribe naloxone to patients who are at risk for overdose

“As physicians, we are on the front lines of an opioid epidemic that is crippling communities across the country,” he writes. “We must accept and embrace our professional responsibility to treat our patients’ pain without worsening the current crisis.”
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     In related news, ABC News reports that the U.S. House of Representatives has approved 18 bills to address the opioid epidemic. The U.S. Senate approved its own package in March, and lawmakers hope to send a compromise bill to the president before Congress begins its summer recess.
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Nominate a colleague for the AAOS Diversity, Humanitarian, or Tipton Leadership Award!
Friday, June 10, 2016 is the last day to submit nominations for the 2017 Diversity and Humanitarian Awards, and the William W. Tipton Jr., MD, Orthopaedic Leadership Award. These awards are presented at every AAOS Annual Meeting. The respective award recipients are recognized for their endeavors to further encourage the practice of culturally competent care and/or efforts to increase diversity in orthopaedics, participation in humanitarian activities, or leadership activities in the orthopaedic profession.
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Last call: AHRQ National Advisory Council for Healthcare Research and Quality.
AAOS seeks to nominate members to the Agency for Healthcare Research and Quality (AHRQ) National Advisory Council for Healthcare Research and Quality. The council advises the HHS secretary and AHRQ director to improve the quality, safety, efficiency, and effectiveness of health care. AHRQ is seeking individuals with a variety of backgrounds. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a 100-word biosketch, a letter of interest highlighting their expertise in the subject area, and a statement that they are able to participate in full capacity. All supporting materials must be submitted by Sunday, May 15, 2016 at 11:59 p.m. CT, to Kyle Shah at
Learn more and submit your application…(member login required)