Today’s Top Story
AAOS and other organizations urge repeal of IPAB.
In a letter to legislators in the U.S. Congress, the American Association of Orthopaedic Surgeons (AAOS) and approximately 500 other medical organizations have urged repeal of the Independent Payment Advisory Board (IPAB)—a federal panel created under the Affordable Care Act and charged with reducing Medicare spending if that spending grows beyond a predetermined rate. Supporters of IPAB argue that the board will help control costs and spur healthcare delivery reforms. However, critics note that the law requires IPAB to achieve scoreable savings within a 1-year time period, pressuring it to consider short-term savings in the form of payment cuts for healthcare providers, as opposed to long-term reforms. In addition, they point out that “an unelected board without adequate oversight or accountability would be taking actions historically reserved for the public’s elected representatives in the U.S. House and Senate.” Read more…
Read the letter (PDF)…
     IPAB repeal was one of the advocacy topics during the AAOS 2015 National Orthopaedic Leadership Conference. Read more…

Other News

Study: ED opioid prescriptions often small; immediate release.
A study published online in the journal Annals of Emergency Medicine suggests that opioid pain relievers prescribed through emergency departments (EDs) in the United States often consist of low pill counts and immediate-release formulations. The researchers conducted an observational, multicenter, retrospective, cohort study of 27,516 patient visits across 19 EDs during a single week in October 2012. Overall, they found that 19,321 patients were discharged and 3,284 received an opioid pain reliever prescription. Of those, the mean age was 41 years and the mean initial pain score was 7.7. The most common diagnoses associated with opioid pain reliever prescribing were back pain (10.2 percent), abdominal pain (10.1 percent), extremity fracture (7.1 percent), and sprain (6.5 percent). The most common opioid pain relievers prescribed were oxycodone (52.3 percent), hydrocodone (40.9 percent), and codeine (4.8 percent). The researchers note that more than 99 percent of pain relievers prescribed were immediate release and 90.0 percent were combination preparations, and the mean and median number of pills was 16.6 and 15, respectively. Read more…
Read the abstract…

Study: Football practice may be major source of concussions.
Findings from a study published online in the journal JAMA Pediatrics suggest that football practice may be a major source of concussions. The authors reviewed injury data on about 20,000 players, collected by athletic trainers at youth, high school, and collegiate football practices and games during the 2012 and 2013 football seasons. They found that the game concussion rate was higher than the practice concussion rate across all three competitive levels. However, due to the increased time spent in practice compared to games, the authors note that more than 57 percent of concussed high school and college players were injured at practice, not games. “Although it is more difficult to change the intensity or conditions of a game,” the authors write, “many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors.” Read more…
Read the abstract…

Study: Small changes in meniscus may hinder function.
A study published online in the Journal of Biomechanics suggests that even small changes in the meniscus may hinder its ability to function. The researchers used computational models to explore the relationship between the extent of meniscal extrusion and biomechanical function, by altering the laxity of the meniscal horn attachments during walking for two healthy females. They found that extrusion distance increased as laxity increased, and the amount of contact force transferred through the menisci during gait decreased rapidly as the meniscal attachments became more lax. The researchers noted that horn attachment lengths that were 20 percent longer than magnetic resonance imaging attachment lengths were associated with a nearly complete loss of force transfer through the menisci during the gait cycle. Read more…
Read the abstract…

Study: Pioneer ACO model saved money; CMS plans to scale up program.
According to data published in the May 5 issue of The Journal of the American Medical Association (JAMA), beneficiaries aligned with Pioneer accountable care organization (ACOs) exhibited smaller increases in total Medicare expenditures compared to general Medicare fee-for-service (FFS) beneficiaries. The research team compared Medicare claims data on FFS Medicare beneficiaries aligned with 32 ACOs during 2012 and 2013 against a comparison group of alignment-eligible beneficiaries in the same markets. They found that total spending for beneficiaries aligned with Pioneer ACOs in 2012 or 2013 increased to a lesser degree relative to comparison populations. Overall, inpatient spending displayed the largest differential change of any spending category. Further, compared with other Medicare beneficiaries, ACO-aligned beneficiaries reported higher mean scores for timely care and for clinician communication. Read more…
     On a related note, HealthLeaders Media reports that the U.S. Centers for Medicare & Medicaid Services (CMS) has stated that it is now ready to scale up the Pioneer ACO initiative. The agency had not previously expected to make a decision on the scalability of the Pioneer model until the fifth year of the program. Read more…

Study seeks optimum dosing schedule for nontoxigenic C. difficile strain M3 for prevention of recurrent CDI.
Research published in the May 5 issue of JAMA attempts to determine the optimal dosing schedule of nontoxigenic Clostridium difficile strain M3 (NTCD-M3) for prevention of recurrent C. difficile infection (CDI). The authors conducted a randomized, double-blind, placebo-controlled, dose-ranging study of 157 patients aged 18 years or older who were diagnosed as having CDI and who had successfully completed treatment with metronidazole, oral vancomycin, or both. Patients were treated with either oral liquid formulation of NTCD-M3 (104 spores/dose for 7 days, 107 spores/dose for 7 days, or 107 spores/dose for 14 days) or placebo for 14 days. The authors found that serious treatment-emergent adverse events were reported in 7 percent of patients receiving placebo and 3 percent of all patients who received NTCD-M3. In addition, fecal colonization occurred in 69 percent of NTCD-M3 patients: 71 percent of those who received 107 spores/dose and 63 percent of those who received 104 spores/dose. Overall, recurrence of CDI occurred in 30 percent of placebo patients and 11 percent of NTCD-M3 patients. The lowest recurrence was in patients who received 107 spores/dose for 7 days (5 percent). Read the complete study…

Submit papers now for Kappa Delta and OREF Clinical Research Awards.
July 1, 2015 is the deadline for receipt of manuscripts submitted for the 2016 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award. Up to two $20,000 Kappa Delta awards (Elizabeth Winston Lanier Award and Ann Doner Vaughan Award), one $20,000 Kappa Delta Young Investigator award, and one $20,000 OREF award will be bestowed, provided manuscripts of requisite quality are submitted. Manuscripts should represent a large body of cohesive scientific work, generally reflecting years of investigation. If the submission reflects a single project, it should be of high significance and impact. Manuscripts must be submitted by members (or candidate members) of the AAOS, Orthopaedic Research Society, Canadian Orthopaedic Association, or Canadian Orthopaedic Research Society. Please note that submissions for the 2016 Kappa Delta and OREF Clinical Research Awards will be accepted in electronic format only. A PDF of the entire submission must be emailed no later than 11:59 p.m. CT on July 1, 2015. Late submissions will not be considered. Read more…
     Please submit your manuscript to: kappadelta@aaos.org

Call for volunteers: OKU Evaluation Committee.
July 31 is the last day to apply for a position on the newly formed Orthopaedic Knowledge Update (OKU) Evaluation Committee. Members of this committee develop and review the OKU self-assessment examination—a 200-question examination produced triennially. The following openings are available:

  • Chair
  • Foot & Ankle Item Writer (two member openings)
  • Hand & Wrist Item Writer (two members)
  • Hip & Knee Reconstruction Item Writer (two members)
  • Trauma Item Writer (two members)
  • Orthopaedic Diseases Item Writer (two members)
  • Musculoskeletal Tumors & Basic Science Item Writer (one member)
  • Pediatric Orthopaedics Item Writer (two members)
  • Orthopaedic Rehabilitation Item Writer (one member)
  • Shoulder & Elbow Item Writer (two members)
  • Spine Item Writer (two members)
  • Sports Medicine Item Writer (two members)

Applicants for the chair position must be active fellows, candidate members, or emeritus fellows who have served at least one term on the Central Evaluation Committee or one of the Evaluation Committees. Applicants for member positions must be active fellows, candidate members, or emeritus fellows with broad orthopaedic practice experience in the relevant topic. Learn more and submit your application…(member login required)