Today’s Top Story
Study: Without risk adjustment, bundled payment programs could penalize hospitals that treat more complex cases.
Findings from a study published in the September issue of the journal Health Affairs suggest that, to avoid unfairly penalizing certain hospitals, the U.S. Centers for Medicare & Medicaid Services (CMS) should include risk adjustment in bundled payment initiatives such as the Comprehensive Care for Joint Replacement (CJR) program. The research team applied payment models analogous to the CJR to Medicare claims for patients who underwent lower extremity joint replacement in Michigan from 2011 to 2013, and calculated the net difference in reconciliation payments with and without risk adjustment. They found that reconciliation payments were reduced by $827 per episode for each standard-deviation increase in a hospital’s patient complexity, and estimated that risk adjustment could increase reconciliation payments to some hospitals by as much as $114,184 annually. Read more…
Read the abstract…

Other News

House passes bill to protect traveling team physicians.
USA Today reports that the U.S. House of Representatives has passed the Sports Medicine Licensure Clarity Act. If enacted, the Act would clarify medical liability rules to ensure team physicians and athletic trainers are properly covered by their professional liability insurance while traveling with athletic teams in another state. The bill now proceeds to the U.S. Senate for consideration.
In a statement, the American Association of Orthopaedic Surgeons (AAOS) thanked legislators for their support of the bipartisan bill. Read more…
Read the AAOS statement…
Learn more about the bill…

CMS: Medicare readmission rates fell 8 percent from 2010 to 2015.
Data released by CMS suggest that national Medicare readmission rates fell 8 percent from 2010 to 2015. In addition, the agency notes the following:

  • Medicare 30-day readmission rates went down in 49 states and the District of Columbia.
  • In 43 states, readmission rates dropped by more than 5 percent.
  • In 11 states, readmission rates fell by more than 10 percent.

CMS states that across states, Medicare beneficiaries avoided approximately 100,000 readmissions in 2015 alone, compared to 2010 levels. Read more…

Study: Improved surgeon-sonographer interaction linked to improved diagnostic utility of ultrasound for RCTs.
Data from a study published in the September issue of the Journal of Shoulder and Elbow Surgery suggest that improved interaction between surgeon and sonographer may improve the diagnostic utility of ultrasound diagnosis of rotator cuff tears (RCTs). The authors conducted a temporal cohort analysis of 775 patients. The surgeon-sonographer interaction consisted of the following three components:

  • The shoulder clinic has both an ultrasound machine and an ultrasonographer.
  • The ultrasonographer attended at shoulder operations.
  • The ultrasonographer reviewed patients both pre- and postoperatively.

At the start of the study, the diagnostic utility for detection of rotator cuff tears by ultrasonography was 93 percent sensitive and 68 percent specific. At the end of the study, 4.5 years later, the diagnostic utility was 99 percent sensitive and 93 percent specific. Read the abstract…

Study: Surgery performed at lower-quality hospitals may cost more over time.
A study published in the September issue of Health Affairs suggests that surgery performed at lower-quality hospitals may cost more over time compared to procedures performed at high-quality institutions. The researchers reviewed data on hospital quality and information on Medicare fee-for-service claims for five surgical procedures, including hip arthroplasty, and evaluated the relationships between 30- and 90-day episode-based spending, patient satisfaction, and surgical mortality. They found that the difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in 30-day episode spending, and readmissions, which accounted for 19.9 percent. The researchers write that the “findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care.” Read more…
Read the abstract…

Are resident work hour studies unethical?
The Baltimore Sun reports that Public Citizen and the American Medical Student Association have asked several hospitals to end their participation in studies to determine the effect of resident work hours on patient care, calling them unethical. The advocacy groups say that patients are not made aware they are part of the research and have not consented to participating in studies such as the iCOMPARE (Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education) and the FIRST (Flexibility in Duty Hour Requirements for Surgical Trainees ) trials. A poll conducted by the organizations finds that 84 percent of respondents would wish to be informed if they were admitted to an experimental hospital where first-year residents were allowed to work 28 or more consecutive hours without sleep. Read more…
Read the statement from Public Citizen…

Call for abstracts: 2017 EWI research symposium.
AAOS seeks abstracts for combat casualty and trauma-related research for poster presentations at the 2017 Extremity War Injuries (EWI) XII: Homeland Defense as a Translation of War Lessons Learned, to be held Jan. 30-Feb. 1, 2017, in Washington, D.C. Overall, 24 abstracts will be selected for poster presentations, and of those, 12 will be selected for podium presentations. Research should focus on one of the following themes:

  • Tactical medicine / intentional violence / disaster preparedness
  • Disaster preparedness and natural disasters
  • Disease and non-battle injury

The $600 EWI registration fee will be waived for poster presenters. Presenters are responsible for their own hotel and travel costs associated with attending the EWI symposium. Presenters will be responsible for hotel and travel costs associated with attending the EWI symposium. CME (up to 15.5 hours) will be available for EWI XII attendees and participants. Abstract submissions, along with current curriculum vitae, must be submitted by Oct. 10, 2016, to Erin Ransford, manager, research advocacy, at: ransford@aaos.org.
Learn more and obtain an abstract submission form…

Clarification: An item in the Sept. 12 issue of Headline News Now reported that hyaluronic acid (HA) injections continue to be used to treat knee osteoarthritis (OA), despite questions regarding the efficacy of the treatment. It should be noted that the study specifically reviewed information on patients with end-stage OA. According to the researchers, “despite the controversy surrounding the efficacy of HA injections, they continue to constitute a substantial portion of payments in the treatment of end-stage knee osteoarthritis and are more costly than all other currently utilized treatment modalities. … A decrease in the use of HA injections in end-stage knee osteoarthritis could reduce the overall health-care cost burden, potentially without causing an adverse effect on outcomes.”