Today’s Top Story
Study: Adoption of bundled payment system linked to reduced reimbursement, but little change in quality.
A study published in the Sept. 19 issue of The Journal of the American Medical Association finds that adoption of a bundled payment system for joint arthroplasty procedures was associated with a reduction in reimbursement without a significant change in quality outcomes. The researchers reviewed data on lower extremity joint arthroplasty episodes from 176 hospitals voluntarily participating in the U.S. Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BCPI) initiative and 841 matched comparison hospitals. Among BPCI hospitals, they found that mean Medicare episode payments were $30,551 in the baseline period, declining to $27,265 in the intervention period; among comparison hospitals over the same period, payments declined from $30,057 to $27,938. The researchers state that overall, the mean Medicare episode payments declined by an estimated $1,166 more for BPCI episodes than for comparison episodes, primarily due to reduced use of institutional postacute care. They found no statistical differences between BCPI hospitals and comparison hospitals in claims-based quality measures, including 30-day unplanned readmissions, 90-day unplanned readmissions, 30-day emergency department visits, 90-day emergency department visits, 30-day post-discharge mortality, and 90-day postdischarge mortality.
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Other News

Study: Warfarin use associated with increased time to surgery, length of stay, and mortality for patients with fractured neck of the femur.
Findings published online in the journal Clinical Orthopaedics and Related Research suggest that warfarin therapy at time of injury may be linked to increased time to surgery, length of stay, and decreased survival for certain femur fracture patients. The authors reviewed data on 1,979 patients who presented with a fractured neck of the femur at a single center. Compared to patients not taking warfarin, the authors found that those taking warfarin were less likely to go to surgery by 36 hours and by 48 hours. In addition, patients taking warfarin had a longer median length of stay and increased risk of 12-month mortality.
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FDA extends UDI and GUDID compliance date for certain class II devices.
The U.S. Food and Drug Administration (FDA) has extended the compliance date for Unique Device Identifier (UDI) label and Global Unique Device Identification Database (GUDID) submission requirements for certain class II devices to Sept. 24, 2018. Included in this group is collections of two or more different class II (or class II and class I) devices packaged together in which each device in the package is not individually labeled with a UDI, and single-use devices, other than implants, all of a single version or model, provided they are distributed together in a single device package, intended to be stored in that device package until removed for use, and not intended for individual commercial distribution. The agency states that the extension does not apply to collections of devices that include one or more devices that are implantable, life-sustaining, or life-supporting.
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Read the FDA letter (PDF)…
     An article in Modern Healthcare notes that few healthcare providers are able to take full advantage of the data provided by UDIs, as many electronic health records systems are not designed to record them.
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Are readmission rates a reliable measure of quality?
An interview published in HealthLeaders Media discusses a research letter published in the September issue of The Journal of Hospital Medicine. The study team reviewed information from nearly 4,500 acute-care hospitals and found that hospitals with the highest readmission rates were more likely to show better mortality scores in patients treated for heart failure, chronic obstructive pulmonary disease, and stroke. After adjustment, the researchers found that patients treated at hospitals that had more readmitted patients had a fractionally better chance at survival than patients who were cared for at hospitals with lower readmission rates.
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Study: Use of certain broad spectrum antibiotics is on the rise.
According to a study published online in the journal JAMA Internal Medicine, use of some antibiotics, including broad spectrum agents, has increased significantly in the United States during recent years. The research team conducted a retrospective analysis of prescription information from hospitals that contributed data to the Truven Health MarketScan Hospital Drug Database from Jan. 1, 2006, to Dec. 31, 2012. Over the study period, they found that 55.1 percent of patients received at least one dose of antibiotics during their hospital visit, and that overall antibiotic use did not change significantly over time. However, the mean change for the following antibiotic classes increased significantly: third- and fourth-generation cephalosporins, macrolides, glycopeptides, β-lactam/β-lactamase inhibitor combinations, carbapenems, and tetracyclines.
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The Southwest Times Record reports that a referendum on the Arkansas ballot in November would, if enacted, amend the state constitution to require the Arkansas General Assembly to cap non-economic damages at no less than $250,000 in a civil suit against healthcare providers. In addition, the proposed amendment would limit attorneys’ contingency fees in medical-injury suits to one-third of any award or settlement, after litigation costs are deducted. Supporters of the initiative argue that higher rates of medical lawsuits increase healthcare costs overall. Critics argue that the measure contains flaws, including a failure to define terms such as “non-economic damages.”
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Call for volunteers: NQF Committee on Interoperability.
AAOS seeks to nominate members to the National Quality Forum (NQF) Committee on Interoperability. The committee will provide guidance regarding issues and barriers to interoperability of health information technology. The organization plans to develop a conceptual framework to analyze, prioritize, and make recommendations for proposed interoperability concepts to be developed into performance measures. Applicants for this position must be active fellows, candidate members, candidate members osteopathic, candidate member applicants for fellowship, or candidate member applicants for fellowship osteopathic. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a 100-word biosketch, and a letter of interest highlighting his or her expertise in the subject area. All supporting materials must be submitted to Kyle Shah by Sept. 26, 2016, at 11:59 p.m. CT, at
Learn more and submit your application…(member login required)