Today’s Top Story
CMS finalizes Quality Measure Development Plan for MACRA.
Healthcare IT News reports the Centers for Medicare & Medicaid Services (CMS) has released its finalized Quality Measure Development Plan (MDP), providing the foundation for implementing measures to support the Medicare Access and CHIP Reauthorization Act’s (MACRA’s) Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). According to Kate Goodrich, director, Center for Clinical Standards and Quality for CMS, the measures—which take into account feedback from 60 individuals and 150 organizations—are meaningful and applicable across payer and healthcare settings, requiring a partnership with patients, their families, frontline clinicians, and professional organizations. Among other things, the plan refines quality measures to close performance gaps in clinical care, safety, care coordination, patient and caregiver experience, population health and prevention, and affordable care. AAOS submitted comments on the MDP.
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Other News

Study: FHL and FDL transfers similarly effective for peroneal tendon tears.
A study comparing single-stage flexor hallucis longus (FHL) transfers with flexor digitorum longus (FDL) tendon transfers for treatment of concomitant peroneus longus and brevis tears found that both were “successful” options for lateral transfers. The Level IV study, appearing in the June issue of Foot & Ankle International, involved nine patients, with five undergoing FHL transfer and four undergoing the FDL procedure, with a mean follow-up of 35.7 months. All patients were satisfied with the results, and there were no statistically significant differences between the FHL and FDL transfer groups with regard to clinical examination or objective power and balance tests, although measurements of strength and balance did demonstrate significant deficits in the operative extremity, even years following the procedure.
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Pediatric study: Exercise soon after concussion may have benefit.
A study suggests that in children who have sustained a concussion, early resumption of exercise may be associated with faster recovery. The Canadian study, presented at the Pediatric Academic Societies’ annual meeting, tallied survey responses from children regarding their physical activity 7, 14, and 21 days after injury and found that of the children still experiencing concussion symptoms, 58 percent resumed exercising a week after being injured, and more than three-quarters (76 percent) were physically active 2 weeks later—both contrary to recommendations. Exercise within 7 days of injury was associated with nearly half the rate of persistent post-concussive symptoms. Principal investigator Roger Zemek, MD, FRCPC, said the findings do not support fast return to contact drills or games but may point to a benefit from light aerobic activity such as walking, swimming, or stationary cycling, and indicate need for further research.
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Study: Adherence to a Mediterranean diet may reduce hip fracture risk in postmenopausal women.
A healthy dietary pattern may play a role in maintaining bone health in postmenopausal women, according to a study published in JAMA Internal Medicine. The study analyzed longitudinal data on 90,014 women aged 50 to 79 years from 40 U.S. clinical centers included in the Women’s Health Initiative (WHI) observational study. The alternate Mediterranean Diet (aMED), Healthy Eating Index 2010 (HEI-2010), Alternate Healthy Eating Index 2010 (AHEI-2010), and the 8-component Dietary Approaches to Stop Hypertension (DASH) scores were used to assess the participants’ diet quality and adherence. Outcome measures included incident total and hip fractures. During 15.9 years median follow-up, there were 2,121 cases of hip fractures and 28,718 cases of total fractures. Women scoring in the highest quintile of the aMED index had a lower risk for hip fractures; no association between the aMED score and total fractures was observed. In addition, the AHEI-2010 score was not associated with hip or total fractures, and although higher HEI-2010 or DASH scores tended to be inversely related to hip fracture risk, the results were not significant.
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Study: How many deaths are linked to medical errors?
A study published online in the journal The BMJ suggests that medical errors may be one of the leading causes of death in the United States. The research team analyzed data from four prior studies and, based on 35,416,020 hospitalizations, extrapolated 251,454 deaths linked with medical error during 2013. If correct, the study suggests that medical error may be associated with as many as 9.5 percent of deaths in the United States each year. The research team notes that assumptions made in extrapolating study data to the broader U.S. population may limit the accuracy of its projections, and also notes that “absence of national data highlights the need for systematic measurement of the problem.”
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Massachusetts.
A math glitch at a small hospital on the resort island of Nantucket could cascade into a major loss in Medicare funding—as much a $160 million—for hospitals across the state, the Boston Globe reports. Under the somewhat arcane rules of hospital reimbursement, the 19-bed Nantucket Cottage Hospital sets the floor rate for payments statewide. Because of the high cost of living on the island, that arrangement has usually worked out favorably for other hospitals, but this year, consultants made errors that led to lower wages being reported to Medicare, which will cause a “steep and extraordinarily serious” decline in Medicare payments for the fiscal year beginning in October, according to the Massachusetts Hospital Association. Hospital representatives are enlisting help from the state’s Congressional delegation to ask CMS to accept corrected numbers and adjust the funding calculation accordingly. Previously, parties in other states have contended that the outsized role of the Nantucket hospital in setting reimbursement creates a windfall for Massachusetts facilities.
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AAOS seeks comments for Management of Periprosthetic Joint Infection of the Hip and Knee CPG.
AAOS is conducting a survey regarding an upcoming Clinical Practice Guideline (CPG) on the management of periprosthetic joint infection of the hip and knee. The purpose of the survey is to collect clinician topic suggestions for the CPG, which is in the early stages of development. Aggregated suggestions from the survey will be anonymously presented to the guideline workgroup.
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