October 25, 2017| Today’s News

AMA report finds high commercial insurer market concentration across United States

The American Medical Association (AMA) has released its annual report on competition in health insurance. The report presents 2016 data on commercial enrollment in health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service (POS) plans, consumer-driven health plans, and public health exchanges and examines market concentration across all 50 states, the District of Columbia, and 389 metropolitan statistical areas (MSAs). According to the report, 69 percent of all commercial health insurance markets in the United States are highly concentrated, and 43 percent of MSAs had one insurer with a market share of 50 percent or greater Reduced competition among commercial health plans is generally associated with higher premiums for consumers and lower payment for physician services.

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Study: Minimal incision THA may offer little or no long-term benefit compared to standard incision THA

Data from a study published in the Oct. 18 issue of The Journal of Bone & Joint Surgery suggest that minimal incision total hip arthroplasty (THA) performed by a high-volume surgeon may offer little long-term benefit over a standard incision approach. The authors reviewed outcome scores (n = 152) and radiographs (n = 126) at 10-year follow-up for patients who participated in a prospective, randomized, controlled trial that compared standard incision THA against minimal incision THA. They found no significant difference in functional status or radiographic outcome across cohorts. The authors note that 10-year implant survival rate was 99.1 percent in the standard incision group and 97.9 percent in the minimal incision group.

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Use of a perioperative surgical home (PSH) model of care may help improve outcomes for older patients who undergo surgical repair for hip fracture, according to information presented at the annual meeting of the American Society of Anesthesiologists (ASA). The researchers compared outcomes for 222 patients treated prior to implementation of a PSH model and 118 patients treated after, and found that 3.2 percent of non-PSH patients died within 30 days of discharge, compared to zero PSH patients. After 90 days, 6.3 percent of non-PSH patients had died, compared to 2.5 percent of PSH patients. In addition, the researchers found that PSH patients were less likely than non-PSH patients to return to the emergency department within 90 days (14.4 percent vs. 23.4 percent), less likely to be readmitted within 90 days (17.8 percent vs. 23.9 percent), and more likely to be discharged to home instead of a nursing facility (40.7 percent vs. 16.2 percent).

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Findings from a study presented at the annual meeting of the ASA suggest that patients often overestimate the amount of pain they will experience following surgery. Members of the research team surveyed 223 patients scheduled for orthopaedic, neurosurgical, or general surgery procedures regarding their pain expectations. Overall, 96 patients received regional anesthesia, 16 of whom were given general anesthesia with a peripheral nerve block before or after surgery. The remaining 127 patients received only general anesthesia. Overall, on a 0-10 scale, patients’ average expected pain rating immediately following surgery was 4.66, compared to an actual pain rating of 2.56, and their average expected pain rating on the first day after surgery was 5.45, compared to an actual pain rating of 4.30.

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An analysis published in the journal Health Affairs assesses the impact of the Choosing Wisely campaign and argues that, despite including more than 500 specialty society recommendations, adoption has been slow and further efforts may be needed to reduce continued use of low-value care. The authors suggest that initiatives to reduce the use of unnecessary procedures be paired with efforts to change the culture surrounding their use among clinicians and patients. They offer several recommendations for improving adoption of Choosing Wisely recommendations, including the following:

• Incentivizing professional societies to work together to consolidate recommendations for common conditions, populations, and indications.
• Requiring that studies incorporate design and evaluation principles that take into account multiphasic drivers of overuse of services.
• Encouraging states and community health alliances to work with payers, patients, health systems, and academic partners to test innovative approaches for reducing overuse and changing the culture of overconsumption.

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Read the report…

Read the AAOS Choosing Wisely recommendations…

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An article in The New York Times looks at the impact hurricane damage in Puerto Rico may have on hospitals. In comments to the U.S. House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations, U.S. Food and Drug Administration commissioner Scott Gottlieb, MD, noted that the U.S. territory is home to a substantial base of pharmaceutical and medical device manufacturing. Overall, about 8 percent (based on dollar value) of drugs consumed by Americans are manufactured in Puerto Rico, and the island is home to about 50 medical device manufacturing facilities.

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Read Dr. Gottlieb’s testimony (PDF)…

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Call for volunteers: Program Committees

Jan. 12, 2018, is the last day to submit your application for a position on a Program Committee Members of Program Committees grade symposia in May and abstracts in June and July, and may serve as moderators for paper sessions at the AAOS Annual Meeting. The following openings are available:

• Adult Reconstruction Knee (one member)
• Hand & Wrist (one member)
• Shoulder & Elbow (one member)

Applicants for these positions must be active or international fellows with a practice emphasis in the relevant topic.

Learn more and submit your application… (member login required)

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