Today’s Top Story
CMS finalizes updated payment rates and policy changes for ASC payments and OPPS.
The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized payment rates and policy changes for 2017 under the Ambulatory Surgical Center (ASC) Payment System and the Hospital Outpatient Prospective Payment System (OPPS). The agency estimates that the updates will increase ASC rates by 1.9 percent and OPPS payments by 1.7 percent during 2017. The rule also finalizes the removal of the pain management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey to eliminate any financial pressure clinicians may feel to overprescribe medications. CMS will continue to develop and field test alternative questions related to provider communications and pain, and plans to solicit comments on those alternatives in future rulemaking. Further, CMS in the rule finalized 90-day meaningful use reporting to increase flexibility for eligible professionals who participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. CMS is also finalizing policies to implement section 603 of the Bipartisan Budget Act of 2015, which requires that certain items and services furnished by certain off-campus hospital outpatient departments will no longer be paid under the OPPS beginning Jan.1, 2017.
In comments on the proposed rule, the American Association of Orthopaedic Surgeons (AAOS) supported the meaningful use, HCAHPS survey, and site of service changes. Read more…
Read the rule…
Read the AAOS comments (PDF)…

Other News

Study: Bundled payments may be a “viable” model for TJA.
Findings published in the December issue of the journal Clinical Orthopaedics and Related Research suggest that bundled payments may be a viable reimbursement model for revision total joint arthroplasty (TJA). The researchers reviewed data on 217 patients who underwent revision total hip arthroplasty (THA) or total knee arthroplasty (TKA) at a single health system that transitioned to the CMS Bundled Payment for Care Improvement (BPCI) initiative during the study term. Overall, 50 revision TKAs and 41 revision THAs were performed under the BPCI initiative, while 70 revision TKAs and 56 revision THAs were not. The researchers found that payment under the BPCI was associated with shorter length of stay and a reduction in reimbursement for the index hospitalization. In addition, they found no significant difference in total episode-of-care CMS costs between revision THA and revision knee TKA. “Owing to the unpredictable nature of the surgical procedures,” the researchers write, “inherent high risks of complications, and varying degrees of surgical complexity, future studies are needed to determine whether bundling patients having revision TJA will result in improved care and decreased costs.” Read the abstract…

Study: Early menopause linked to increased risk of fracture.
According to a study published online in the journal Menopause, younger women with menopause may be at increased risk of fracture compared to women who experience menopause at a later age. The research team reviewed data on 21,711 healthy, postmenopausal women who were treated with either hormone therapy (HT), calcium/vitamin D (Ca/D) supplementation, or both. They found that women under the age of 40 with menopause were at increased risk of fracture compared to women aged 40-49 years or older than 50 years, regardless of treatment intervention. Read more…
Read the abstract…

Study: Treatment with hydrocortisone may not reduce risk of septic shock for adults with severe sepsis.
A study conducted in Germany and published in the Nov. 1 issue of The Journal of the American Medical Association suggests that treatment with hydrocortisone may not reduce the risk of septic shock compared to placebo for adults with severe sepsis. The authors conducted a double-blind, randomized trial of patients with severe sepsis who were treated with either 200 mg of hydrocortisone for 5 days followed by dose tapering until day 11, or placebo. They found that septic shock occurred in 21.2 percent of patients (36 of 170) in the hydrocortisone group and 22.9 percent of patients (39 of 170) in the placebo group. The authors noted no significant differences between hydrocortisone and placebo groups for time until septic shock, mortality in the intensive care unit or hospital, or mortality at 28, 90, or 180 days. In addition, patients in the hydrocortisone cohort were at increased risk of secondary infection, muscle weakness, and hyperglycemia compared to those in the placebo cohort. Read the abstract…

Study: Use of WHO Trauma Care Checklist may improve patient care in a wide range of settings.
Data from a multinational study published online in the World Journal of Surgery suggest that implementation of the World Health Organization (WHO) Trauma Care Checklist may be associated with substantial improvements in patient care in a variety of settings. The researchers assessed the effects of checklist implementation in 11 hospitals across nine countries with diverse economic and geographic contexts. They found adoption of the checklist was linked to improvement in 18 of 19 process measures. Read more…
Read the abstract…

California.
Information released by the California Health Care Foundation suggests a reduction in the number of physicians in California who accept patients under the state’s Medi-Cal program, despite a rise in the number of patients covered by the system. The research team evaluated physician participation in Medi-Cal between 2013 and 2015, and among other things, found that:

  • 40 percent of California physicians provide 80 percent of Medi-Cal visits
  • The percentage of California physicians with any Medi-Cal patients decreased from 2013 to 2015
  • Physicians in the state are less likely to accept new patients with Medi-Cal than new patients with Medicare or private health insurance
  • The most frequent reasons cited by physicians for limiting Medi-Cal patients in their practices concern payment rates and program administration

Read more…
Read the report (PDF)…

Submit your entries now! MORE Awards honor excellence in orthopaedic journalism.
The Media Orthopaedic Reporting Excellence (MORE) Awards recognize and honor journalistic efforts that further the public’s understanding of musculoskeletal health issues and encourage healthy behaviors in the care of bones and joints. AAOS is asking members to submit stories from broadcast, radio, print, or websites that accurately and compassionately highlight orthopaedic procedures, treatments, and preventive care and practices. Stories must have been published or broadcast between Oct. 1, 2015, and Oct. 1, 2016. Winners will be recognized at the 2017 MORE Awards ceremony and dinner during the National Orthopaedic Leadership Conference in Washington, D.C., on April 27, 2017. For more information, please contact Kelly King Johnson at 847-384-4033. To enter a submission, please email the story link to: media@aaos.org
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