Today’s Top Story
AAOS submits comments on CCJR model.
The American Association of Orthopaedic Surgeons (AAOS) has submitted comments to the U.S. Centers for Medicare and Medicaid Services (CMS) regarding a proposed rule that would establish the first mandatory Medicare episode payment program promulgated under the agency’s Center for Medicare & Medicaid Innovation authority. The Comprehensive Care for Joint Replacement (CCJR) model would test bundled payment and quality measures for an episode of care associated with hip and knee replacements in 75 geographic areas, and would affect surgeries on more than 100,000 Medicare patients annually.
In addition to the submitted comments, AAOS leadership is meeting with members of Congress this week to discuss changes to the joint replacement model as well as related concerns with the CMS meaningful use program. “AAOS supports efforts by CMS to make appropriately structured alternative payment models available to physicians and other providers,” stated AAOS President David D. Teuscher, MD. “In fact, many AAOS members have been leaders in developing, implementing, and evaluating episode-of-care payments. However, infrastructural support is incomplete, Stage 2 meaningful use attestation is below 20 percent, and electronic health records vendors have plagued practices with a lack of interoperability and errors. Until these glitches are addressed and highly reliable systems are in place, no further mandates—including the bundled payment model and meaningful use Stage 3—should be initiated.” Read the AAOS comments (PDF)…
    On Thursday, Sept. 10, 2015, Thomas C. Barber, MD, chair of the AAOS Council on Advocacy, and Alexandra E. Page, MD, chair of the AAOS Health Care Systems Committee, will discuss the recent AAOS comments and answer related questions. The @AAOSAdvocacy Twitter account will post updates and a link to a live video feed of the event. Read more…
Visit @AAOSAdvocacy on Twitter…

Other News

Judge rules ACA lawsuit can proceed.
Modern Healthcare reports that a judge in the U.S. District Court of the District of Columbia judge has allowed a lawsuit filed by legislators in the U.S. House of Representatives to contest certain parts of the Affordable Care Act (ACA) to proceed. The judge ruled that the legislators have standing to sue over allegations that the White House is illegally spending money that Congress never appropriated for ACA cost-sharing provisions, including reduced deductibles, copays, and coinsurance for certain beneficiaries. However, the judge also determined that members of the House do not have standing to sue over a separate allegation regarding the ACA employer mandate, which requires companies with 50 or more employees to provide health insurance coverage. Read more…(registration may be required)

AMA: Proposed insurance company mergers would diminish competition and exceed federal antitrust guidelines.
Analyses of commercial health insurance markets conducted by the American Medical Association suggest that two proposed mergers among four of the largest health insurance companies in the United States “would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states.” Additionally, the report states that if completed, the two mergers would diminish competition in up to 154 metropolitan areas within 23 states. The research is based on 2013 data captured from commercial enrollment in fully and self-insured plans, and includes participation in consumer-driven health plans. Read more…
Read the AMA press release…

Study: What factors are linked to early revision in THA?
A study conducted in France and published online in the journal JAMA Surgery examines factors that may be linked to early revision after total hip arthroplasty (THA). The researchers reviewed data on 100,191 patients aged 40 years or older who underwent arthritis-related THA under the general scheme of the French national health insurance system. At median 33-month follow-up, 3,142 individuals had undergone prosthetic revision. The researchers found that antibiotic-impregnated cemented THA impants had a better prognosis than uncemented THAs. There were no significant differences in revision rates between ceramic-on-ceramic, ceramic-on-polyethylene, and metal-on-polyethylene THAs, but metal-on-metal was associated with a slightly shorter survivorship. Read more…
Read the abstract…

Study: Surgery for VCF linked to lower risk of morbidity and mortality than conservative treatment.
Data from a study published in the Aug. 1 issue of the journal Spine suggest that patients who are treated surgically for vertebral compression fracture (VCF) may be at reduced risk of mortality and morbidity than patients who undergo conservative treatment. The research team reviewed data on 1,038,956 VCF patients, of whom 141,343 were treated with balloon kyphoplasty (BKP), and 75,364 with vertebroplasty (VP). They found that conservative treatment was associated with a 55 percent increased adjusted risk of mortality compared to patients treated with BKP, and a 25 percent increased adjusted risk of mortality compared to patients treated with VP. The research team writes that, compared to the BPK cohort, non-surgically treated patients had significantly higher adjusted risks of pneumonia, myocardial infarction or cardiac complications, deep venous thrombosis (DVT), and urinary tract infection, but lower adjusted risks of subsequent augmentation or fusion, subsequent augmentation, and pulmonary and respiratory complications. In addition, patients in the BKP cohort had significantly decreased risks of morbidity compared to the VP cohort, except for DVT, infection, and myocardial infarction or cardiac complications, which were similar across both cohorts. Read more…
Read the abstract…

CMS to offer “informal review” process for providers who believe they have been incorrectly assessed 2016 PQRS penalty.
CMS states that healthcare providers and provider organizations that believe they have been incorrectly assessed the 2016 Physician Quality Reporting System (PQRS) negative payment adjustment have until Nov. 9, 2015 to request an informal review of their incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. The agency states that all decisions will be final and there will be no further review or appeal. During 2016, CMS will apply a negative payment adjustment to individual eligible professionals, Comprehensive Primary Cares practice sites, and group practices participating in the PQRS group practice reporting option that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment. Read more…

Study: Exercise may help reduce bone fragility linked to certain diabetes medications.
Findings published in the August issue of the journal Endocrinology suggest that exercise may mitigate the impact of certain diabetes medications on bone and marrow health. The authors note that peroxisome proliferator-activated receptor (PPAR)? agonists have been associated with increased fractures and increased marrow adipose tissue (MAT) in diabetic patients. They compared 8-week-old female C57BL/6 mice that were treated with 20-mg/kg·d rosiglitazone against a group of control animals. At 6-week follow-up, they found that rosiglitazone was associated with 40 percent higher femur MAT volume compared with controls. However, exercise was associated with suppressed MAT volume by half in control mice and by 19 percent in rosiglitazone mice. Read more…
Read the abstract…

Surgeon General issues call to promote walking and other physical activity.

The U.S. Surgeon General has issued a call to action to promote walking and the benefits of physical activity. The initiative includes five strategic goals to promote walking and walkable communities in the United States:

  • Make walking a national priority
  • Design communities that make it safe and easy to walk for people of all ages and abilities
  • Promote programs and policies to support walking where people live, learn, work and play
  • Provide information to encourage walking and improve walkability
  • Fill surveillance, research, and evaluation gaps related to walking and walkability

The office notes that healthcare professionals can participate by assessing patients’ physical activity levels and educating them about the importance of physical activity, pointing out that “counseling may be especially important for adults who are at higher risk of chronic disease, such as those who are overweight or obese and have additional risk factors for cardiovascular disease.” Read more…

Last call: CME Courses Committee.
Sept. 15 is the last day to submit your application for a position on the CME Courses Committee. This committee plans and organizes the AAOS calendar of continuing medical education (CME) courses and webinars. The following positions are available:

  • Pediatric Orthopaedics (one member)
  • Shoulder and Elbow (one member)

Applicants for these positions must be active fellows with experience in planning, organizing, presenting, and evaluating CME courses, and a practice emphasis in the relevant topic. Learn more and submit your application…(member login required)