Today’s Top Story
Medical organizations offer comments on physician reimbursement under MACRA.
Modern Healthcare reports that the American Hospital Association (AHA), the American Medical Association (AMA), and other medical organizations have offered comments on how the U.S. Centers for Medicare & Medicaid Services (CMS) should structure payment policy under the Medicare Access and CHIP Reauthorization Act (MACRA). Among other things, AHA has asked the agency “to adopt a system that measures providers fairly, minimizes unnecessary data collection and reporting burden, focuses on important quality issues, and promotes collaboration across the silos of the healthcare delivery system.” In addition, AMA has offered a list of 10 principles it would like CMS to consider, including payment flexibility to cover a variety of patient populations and organizational structures. Read more…
     The American Association of Orthopaedic Surgeons (AAOS) submitted its own comments on MACRA. Read the AAOS letter (PDF)…

Other News

Study: No significant difference in complication rates for children undergoing SFP with rhBMP.
A study published in the November issue of the journal Spine looks at use of recombinant human bone morphogenetic protein (rhBMP) in pediatric spinal fusion procedures (SFP). The authors conducted a retrospective study of 72,898 patients aged younger than 18 years who underwent SFP. Overall, 7.1 percent had insertion of rhBMP. Complication rates were 15.2 percent in the rhBMP cohort and 14.3 percent in the no-rhBMP cohort. The authors noted no significant difference between cohorts in overall complication nor among 14 different complications. However, children treated with rhBMP appeared to be at increased risk for “other infections” compared to those not treated with rhBMP. The authors suggest that future studies be conducted to examine the long-term impact of rhBMP in children with SFP. Read the abstract…

AMA calls for ban on DTC advertising of prescription drugs.
Physicians attending the interim meeting of the AMA have voted to support a ban on direct-to-consumer (DTC) advertising of prescription pharmaceutical products. The new policy also calls for a physician task force and an advocacy campaign, as well as increased transparency in prescription drug prices and costs. The association states that the initiative is driven in part by anticompetitive behavior in the pharmaceutical marketplace, and plans to encourage action by federal regulators “to limit anticompetitive behavior by pharmaceutical companies attempting to reduce competition from generic manufacturers through manipulation of patent protections and abuse of regulatory exclusivity incentives.” Read more…
Read the AAOS position statement on Pharmaceutical and Device Company Direct to Consumer Advertising…

Opioid report offers suggestions to address prescribing “epidemic.”
A report from the Johns Hopkins Bloomberg School of Public Health examines the issue of overprescribing of opioids. In addition to prescription drug monitoring programs and prescribing guidelines, the writers offer a series of suggestions, including the following:

  • Repeal of existing permissive and lax prescription laws and rules
  • Requiring oversight of pain treatment
  • Physician training in pain management and opioid prescribing and a residency in pain medicine for medical school graduates

“Used appropriately, prescription opioids can provide relief to patients,” the writers note. “However, these therapies are often being prescribed in quantities and for conditions that are excessive, and in many cases, beyond the evidence base. Such practices, and the lack of attention to safe use, storage and disposal of these drugs, contribute to the misuse, abuse, addiction and overdose increases that have occurred over the past decade.” Read more…
Read the complete report (PDF)…
Read the AAOS information statement on Opioid Use, Misuse, and Abuse in Orthopaedic Practice…

U.K. group releases guidelines for control of Gram-negative bacteria.
The United Kingdom National Institute for Health and Care Excellence has published a set of guidelines for the prevention and control of multi-drug-resistant Gram-negative bacteria. The guidelines are based on the recommendations of a working group made up of medical microbiologists and scientists, infectious disease physicians, infection control practitioners, epidemiologists, and patient representatives. The report describes measures that have been demonstrated to be clinically effective for preventing transmission when used by healthcare workers in acute and primary healthcare premises, and offers recommendations in the following areas: screening, diagnosis and infection control precautions including hand hygiene, single-room accommodation, environmental screening, and cleaning. When appropriate, recommendations are given for specific organisms as well. The guidelines are published online in The Journal of Hospital Infection. Read more…
Read the complete guidelines…
     The U.S. Centers for Disease Control and Prevention has declared the week of Nov. 16 to 22 to be “Get Smart about Antibiotics Week”—an annual one-week observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. Read more…

ACP releases position paper on concierge medicine.
A position paper released by the American College of Physicians (ACP) addresses the issue of so-called “concierge medicine,” in which patients pay a monthly or yearly fee for improved access to healthcare providers. Supporters say that the concierge model allows them to improve care because they can spend more time with patients. Critics are concerned that such an approach may drive up costs for individuals. The ACP position paper assesses the impact of direct patient contracting on access, cost, and quality, discusses ethical principles, and offers recommendations to mitigate adverse effects on underserved patients. Read more…
Read the complete position paper…

New Jersey.
NJ.com reports that a bill under consideration in the New Jersey legislature would, if enacted, require physicians and hospitals to disclose before treatment if their services are not covered by a patient’s medical insurance. The bill is designed to address the issue of balance billing, in which healthcare providers bill patients for costs not covered by insurance. Under the proposal, providers or administrators would be legally obligated to explain up front who is covered and not covered, and how much more a person would pay for an out-of-network provider. Read more…

Call for abstracts: AAOS/ORS Tackling Joint Disease by Understanding Crosstalk between Cartilage and Bone Research symposium.
Dec. 1, 2015, is the last day to submit abstracts for the AAOS/Orthopaedic Research Society (ORS) Tackling Joint Disease by Understanding Crosstalk between Cartilage and Bone Research Symposium. AAOS and ORS seek abstracts in the areas of bone and cartilage biology, biomechanics, mechanobiology, the microbiome, exosomes, genomics and other relevant areas as they relate to crosstalk between bone and cartilage. Abstracts should concisely communicate the significance, hypothesis, methods, results, and conclusions of the study. In addition, 15 Young Investigator travel awards are available for abstracts of high quality research. The symposium will be held April 28-30, 2016, in Rosemont, Ill. For more information, contact Erin Ransford, AAOS manager, research advocacy, at: ransford@aaos.org
Learn more about the symposium…

Note: An item in the Nov. 16 AAOS Headline News Now cited a study that found uninterrupted continuation of perioperative warfarin for hand and wrist surgery resulted in transient increases in hematoma formation and local ecchymosis compared to patients not taking warfarin. Because discontinuing the drug may result in potentially catastrophic thromboembolic complications, the authors concluded that continuing warfarin without interruption for patients undergoing hand and wrist surgery is appropriate.