Today’s Top Story
Study: Physician-owned hospitals do not appear to seek more profitable patients.
Findings from a study published online in the journal The BMJ suggest that physician-owned hospitals (POHs) in the United States do not systematically select more profitable patients or provide lower value care. The researchers conducted an observational study of 2,186 acute care hospitals, 219 of which were physician-owned. Compared against patients from non-POHs, they found that patients at POHs tended to be slightly younger and less likely to be admitted via emergency department. However, POH patients and non-POH patients were equally likely to be black or use Medicaid, and had similar numbers of chronic diseases and predicted mortality scores. Overall, POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30-day mortality, 30-day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Read more…
Read the complete study…

Other News

HHS proposes changes to the “Common Rule.”
The U.S. Department of Health and Human Services (HHS) has announced proposed changes to the “Common Rule,” regulations that govern research on research participants. Current regulations, which have been in place since 1991 and are followed by 18 federal agencies, were developed when research generally occurred at a single site, primarily medical institutions, colleges, and universities. Factors such as the expansion of research into new scientific disciplines and the increase in multisite studies were the catalyst for HHS to issue an Advance Notice of Proposed Rulemaking in July 2011 to solicit the public’s input on modernizing the Common Rule. The Notice of Proposed Rulemaking (NPRM), issued on Sept. 2, reflects the public’s input. HHS will take public comment on the NPRM for 90 days, beginning Sept. 8. The following changes are proposed in the NPRM:

  • Enhanced informed consent provisions to provide individuals with a better understanding of the study’s scope, its risks and benefits, and alternatives to taking part in the study
  • Requirements for IRB or administrative review that would increase efficiency by better aligning with risks of the proposed study
  • New information protection and data security standards aimed at reducing the potential for confidentiality and privacy violations
  • Written consent requirements for use of a study participant’s biological samples for research, with the option to consent to use of those samples in the future for unspecified research
  • Requirement for use of a single institutional review board for multisite research, in most cases

All clinical trials—regardless of funding source—would be required to adhere to the proposed rule if performed in a U.S. institution that receives funding from a Common Rule agency for studies with human participants. Read more…
Read the proposed rule (PDF)…

Study: Approximately 7 million Americans are living with THA, TKA.
Research recently published in The Journal of Bone & Joint Surgery (JBJS) finds that around 7 million Americans are living with total hip or knee arthroplasty (THA, TKA), with most of them consequently being mobile, despite advanced arthritis. The investigators estimated the prevalence of living patients who have undergone these procedures by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010, with mortality counts and general population census. The researchers accounted for relative differences in mortality rates between the general population and those who have undergone THA or TKA. They found 2.5 million THA patients (1.4 million women and 1.1 million men) and 4.7 million TKA patients (3.0 million women and 1.7 million men) in 2010. They also found a substantial rise in prevalence over time and a shift toward patients of younger ages. Read the study…

HHS proposed rule would ban discrimination based on race, color, national origin, sex, gender identity, age, or disability.
HHS has issued a proposed rule with the goal of reducing discrimination in health care. The proposed rule establishes that an existing prohibition on sex discrimination includes discrimination based on gender identity and includes requirements for effective communication for individuals with disabilities and enhanced language assistance for people with limited English proficiency. The rule applies to Health Insurance Marketplaces, any health program administered by HHS, and any health program or activity that receives any funding from HHS. Finally, the proposed rule extends nondiscrimination protections to individuals enrolled in plans offered by issuers participating in the Health Insurance Marketplaces, and explicitly bars any marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, age, or disability. HHS will accept public comments on the proposed rule though Nov. 6, 2015. Read more…
Read the rule (PDF)…
Learn more about Section 1557 of the Affordable Care Act…

Study: Fewer complications seen with motorized nail versus circular external fixation in pediatric limb lengthening.
A study of outcomes for two methods of limb-lengthening in pediatric patients with congenital femoral deficiency found that a decreased number of complications was noted with use of a motorized intramedullary nail compared with circular external fixation. The level III study, published in the Sept. 2 issue of The Journal of Bone & Joint Surgery, involved 14 skeletally mature patients who underwent 14 lengthening sessions using circular fixation and 13 patients who underwent 15 sessions using the motorized nail. The amount lengthened in the two groups was similar (mean of 4.8 cm in the circular fixation group and 4.4 cm in the motorized nail group). Complications occurred in all lengthening sessions of the patients managed with circular external fixation and in 73 percent of the 15 sessions of those managed with the motorized nail. Read more…

Study: CRPP is a viable alternative for treatment of pediatric lateral condyle fractures.
Study data indicate that closed reduction and percutaneous pinning (CRPP) is associated with decreased surgical times and does not significantly increase the incidence of complications when used as an alternative to open reduction and internal fixation (ORIF) for pediatric lateral condyle fractures (LCFs) of the humerus. In the cohort study, published in the Journal of Pediatric Orthopaedics, researchers followed 191 pediatric LCF patients who had been treated with either ORIF (n = 163) or CRPP (n= 28) for 12 weeks. CRPP was associated with significantly shorter surgical times (mean: 25.4 min), compared to ORIF (mean: 52.6 min.). A nearly anatomic reduction was obtained in all fractures, no intraoperative or immediate postoperative complications were observed, and patients in both groups recovered similar range of motion at latest follow-up. The overall complication rate was 6.3 percent for ORIF and 3.6 percent for CCRP (P =0.5). Read the abstract…

Enhance the reception area experience with a free copy of AAOS TV DVD.
AAOS TV is a patient-focused DVD featuring educational and inspiring bone and joint health content. The looping DVD, which is designed to be played in reception areas, includes 30 segments on injury prevention, advocacy-related calls to action, orthopaedic health messages, and public awareness campaigns. Run-time is approximately 1 hour and 20 minutes. AAOS TV is available at no charge to all Academy members. Please consider playing the DVD for patients in the reception area and sharing the news about this new patient engagement resource with your colleagues. To order the free DVD, please contact the AAOS public relations department at: media@aaos.org

Last call: Orthoinfo—spine section editor.
Sept. 11 is the last day to submit your application for the position of spine section editor on the AAOS Orthoinfo website. OrthoInfo provides AAOS members, patients, and the general public with authoritative information on a wide range of musculoskeletal problems and treatments. The section editor must be an active or emeritus fellow, and will be engaged by the Academy as an independent contractor on an annual basis, subject to renewal. Applicants for this position must submit a curriculum vitae and cover letter detailing their interest and qualifications, along with two references and an AAOS CAP application. Learn more and submit your application…(member login required)

The AAOS offices will be closed and AAOS Headline News Now will not be published on Labor Day, Monday, Sept. 7. Publication will resume on Sept. 9.