Today’s Top Story
Study: Oral steroids not significantly more effective than placebo in reducing pain in acute sciatica patients.
Recent research finds that patients with acute sciatica due to herniated lumbar disks had only modestly improved function—and no significant improvement in pain—after a short course of oral steroids, compared with sciatica patients who received a placebo, according to research published online in the Journal of the American Medical Association. The randomized, double-blind, placebo-controlled clinical trial was conducted from 2008 to 2013 at a large, integrated healthcare delivery system in northern California. The study involved 269 adults who met the following criteria: radicular pain for 3 months or less, a herniated disk confirmed by magnetic resonance imaging, and an Oswestry Disability Index (ODI) score of at least 30. Investigators randomly assigned participants in a 2:1 ratio to be treated with a tapering 15-day course of oral prednisone (5 days each of 60 mg, 40 mg, and 20 mg; total cumulative dose of 600 mg; n = 181) or matching placebo (n = 88). Mean ODI scores at baseline and 3-weeks were 51.2 and 32.2 for the prednisone group, and 51.1 and 37.5 for the placebo group. The prednisone group had an adjusted mean 0.3-point greater reduction in pain at 3 weeks and a mean 0.6-point greater reduction at 52 weeks. Read more…
Read the study…

Other News

Lawmakers mull easing limits on physician-owned hospitals.
Some Republicans members of the U.S. House of Representatives are seeking to undo provisions of the Affordable Care Act (ACA) that restrict expansion of physician-owned hospitals that receive Medicare reimbursement and effectively prohibit the opening of new ones, reports Modern Healthcare. During a hearing of the House Ways and Means Committee’s subcommittee on health, Rep. Kevin Brady (R-Texas), chair, asked, “What are the impacts—pro and con—of this discrimination against one model of acute care, and is the current ban based on quality of service or a desire to restrain competition?” Advocates of restrictions, most prominently the American Hospital Association, say physician-owned hospitals present inherent conflicts of interest and drive up costs to the government through anticompetitive practices and cherry-picking of patients. Proponents of physician-owned hospitals, represented by the group Physician Hospitals of America, counter that the specialization and narrow procedural focus of the hospitals result in improved efficiency, lower costs, and better outcomes. Democrats, in turn, cite a Congressional Budget Office estimate of $500 million in savings over 10 years stemming from the restrictions. Read more…(registration may be required)
Read Rep. Brady’s opening remarks…
Read testimony delivered during the hearing…

Specially trained paramedics make “house calls” to reduce avoidable ED visits.
Kaiser Health News reports that paramedics in Reno, Nevada, are participating in a new plan to cut costs and improve patient care. Paramedics with extra training in preventive and primary care are making home visits to patients, many of whom are repeat emergency department (ED) users. Paramedics may take certain patients to mental health clinics or urgent care facilities, as appropriate, rather than to the ED. The articles states that “the changes are driven by the 2010 health law, which aimed to cut spending, expand patient access, and improve quality of care.” Based on preliminary data from 2013 and 2014, the projects saved $5.5 million and helped avoid 3,483 emergency department visits, 674 ambulance transports, and 59 hospital re-admissions. The Nevada project is one of several being funded by the federal government. Read more…

Study: Osteoporosis screening underused in high-risk women; overused in low-risk women.
New research from UC Davis Health System indicate that dual-energy x-ray absorptiometry (DXA) screening for osteoporosis is underutilized in women most at risk for fracture, while more frequently performed for women at low risk for fracture. The results are published online in the Journal of General Internal Medicine. The researchers examined the incidences of DXA screening in 50,995 women aged 40 to 85 years with no prior osteoporosis screening, diagnosis, or treatment. Over a 7-year period, more than 42 percent of women between the ages of 65 and 74 years did not undergo DXA screening, and approximately 57 percent of those older than 75 years were also not screened. However, approximately 46 percent of low-risk women aged 50–59 years were screened, and 59 percent of women aged 60–64 years without risk factors were also screened. Read more…
Read the abstract…

Hospital performance ratings on high-volume procedures show room for improvement.
Data released by U.S. News and World Report indicate that only about 10 percent of 4,600 hospitals rated on five common care procedures were high-performing; another 10 percent were statistically below average, Modern Healthcare reports. The new “Common Care” rating system evaluates how well hospitals perform common elective surgeries and treat chronic diseases. The five areas of focus are heart bypass surgery, hip replacement, knee replacement, chronic obstructive pulmonary disease, and heart failure.
“This analysis has broad relevance in terms of addressing the types of patients hospitals see every day,” said Ben Harder, chief of health analysis for U.S News. “We are now on the cusp of being able to provide consumers with concrete, hospital-level, very specific information about volumes and performance.” Read more…(registration may be required)

Deadline to volunteer to be an ICD-10 tester is Friday.
Providers wanting to participate in end-to-end testing of ICD-10 codes in July prior to the October 1 implementation have until May 22 to submit application forms to the Centers for Medicare & Medicaid Services. Approximately 850 volunteer submitters will be selected to participate in the July testing. “This nationwide sample will yield meaningful results, since CMS intends to select volunteers representing a broad cross-section of provider, claim, and submitter types, including claims clearinghouses that submit claims for large numbers of providers,” CMS said in a statement.

Testers who are selected must be able to:

  • Submit future-dated claims
  • Provide valid National Provider Identifiers (NPIs), Provider Transaction Access Numbers (PTANs), and beneficiary Health Insurance Claim Numbers (HICNs) that will be used for test claims. This information will be needed by the provider’s medical administrative contractor (MAC) for set-up purposes by the deadline indicated on the acceptance notice; testers will be dropped if information is not provided by the deadline.

Forms for volunteering are available from the website of the physician’s designated MAC. Testers who participated in January and April may also participate in July without submitting a new application. Visit the ICD-10 website (pdf)…
Find your MAC…

Apply now to take part in the AAOS Leadership Fellows Program.
The AAOS Leadership Fellows Program (LFP) offers an exciting opportunity to all AAOS fellows age 45 and younger as of Jan. 31, 2016. The LFP is a 1-year program that starts at the AAOS Annual Meeting and is designed to facilitate the development of future AAOS leaders among younger members who have previous volunteer or leadership experience. The LFP combines didactic and experiential leadership training with an ongoing mentoring program. Fellows are matched with an established leader within the AAOS fellowship who serves as a mentor throughout the program. The program has the following goals:

  • Introduce fellows to the AAOS Governance structure
  • Observe AAOS leadership at work
  • Participate in interactive leadership development programs
  • Engage in opportunities for peer to peer interactions and learning
  • Experience service on an AAOS committee

Applications are now available online. This is a year-long commitment with 6 mandatory meetings. Please review the LFP schedule prior to completing the application to ensure you will be able to attend all meetings. The deadline for applications is July 31, 2015. Learn more and submit your application…(member login required)
For more information, contact Kristen Erickson at 847-384-4343, or via email at

Call for volunteers: Central Evaluation Committee.
July 15 is the last day to submit your application for a position on the Central Evaluation Committee. Members of this committee write questions for the Orthopaedic In-Training Examination. Currently, two openings are available:

  • Hand (one member opening)
  • Spine (one member opening)

Applicants for these positions must be active or emeritus fellows with a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)