Today’s Top Story
CMS announces flexibility on MACRA requirements.
The U.S. Centers for Medicare & Medicaid Services (CMS) has announced new flexibility in the implementation of Medicare’s Quality Payment Program, which is called for under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In a blog post, CMS Acting Administrator Andy Slavitt outlines four options for reporting data under the Quality Payment Program, including options that enable physicians to submit “some data” and avoid a negative payment adjustment. The announcement comes after intense pressure from numerous physician groups, including the American Association of Orthopaedic Surgeons (AAOS), which urged greater flexibility in the implementation timeline. In a comment letter to CMS regarding the proposed rule, AAOS argued that it would be “burdensome, if not impossible, for physicians to get ready for the first performance year of 2017,” and that “physicians who find this time frame too difficult to comply with may not participate in the MIPS [Merit-based Incentive Payment System] program at all.” The final rule is expected to be released by Nov. 1, 2016.
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Read the AAOS comment letter (PDF)…
Other News
Study: What factors are linked to fracture nonunion?
A study published online in the journal JAMA Surgery examines the relationships among fracture characteristics, patient-related risk factors, and risk of fracture nonunion. The authors reviewed data from a large payer database on 309,330 fractures across 18 bones. They found that the overall nonunion rate was 4.9 percent. Increased risk of nonunion was associated with severe fracture (eg, open fracture, multiple fractures), high body mass index, smoking, and alcoholism. Overall, women experienced more fractures, but men were more prone to nonunion. Scaphoid, tibia?plus?fibula, and femur fractures were most likely to experience nonunion. Additional risk factors for nonunion included use of nonsteroidal anti-inflammatory drugs plus opioids, surgical treatment, anticoagulant use, osteoarthritis with rheumatoid arthritis, anticonvulsant use with or without benzodiazepines, opioid use, diabetes or insulin use, osteoporosis with or without medication use, antibiotic use, vitamin D deficiency, diuretic use, and renal insufficiency.
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Study: Pre-referral MRI may not contribute to clinical decision making for joint pain.
A research article published in the Journal of the AAOS suggests that many pre-referral magnetic resonance imaging (MRI) scans may not contribute to clinical decision making when evaluating knee pain for older patients. The research team reviewed data on 599 new patients aged 40 years or older with knee pain, of whom 130 (22 percent) underwent MRI prior to orthopaedic referral. Overall, 17 percent of patients had weight-bearing radiographs that demonstrated >50 percent loss of joint space, and among that group of patients, MRI was considered unnecessary in 95 percent of cases. The research team writes that 48 percent of pre-referral MRIs did not contribute to treatment recommendations.
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Study: Many patients see improvement after hip arthroscopy.
A study published online in The American Journal of Sports Medicine examines survival and clinical outcomes for patients who undergo hip arthroscopy. The authors prospectively collected data on 931 primary hip arthroscopy procedures and 107 revision hip arthroscopy procedures at a single center. At 2-year follow-up, they found significant improvement in outcome scores (modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport-Specific Subscale, and visual analog scale) for patients in both cohorts. Overall, patient-reported outcome scores were higher at all time points for the primary group compared with the revision group, and mean satisfaction was 7.7 in the primary cohort and 7.2 in the revision cohort. Of 931 primary arthroscopic procedures, 52 (5.6 percent) were converted to total hip arthroplasty (THA) or hip resurfacing (HR), and the relative risk of THA/HR was 2.0 after revision procedures compared with primary procedures. The researchers write that the overall complication rate was 4.3 percent.
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Study: Physician employment by hospitals continues to rise.
According to information released by the nonprofit Physicians Advocacy Institute, the number of physician practices owned by healthcare systems increased 86 percent from 2012 to 2015, and by mid-2015, 38 percent of U.S. physicians were employed by hospitals and health systems. The researchers reviewed information from a database developed from bi-annual phone surveys of a wide range of physician practices. They found that, from 2012 to 2015, hospital employment of physicians rose approximately 59 percent in the South, 58 percent in the Northeast, 49 percent in Alaska and Hawaii, 44 percent in the Midwest, and 33 percent in the West. Over that same period, hospital ownership of practices rose approximately 118 percent in Alaska and Hawaii, 106 percent in the Northeast, 98 percent in the South, 82 percent in the West, and 72 percent in the Midwest.
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Read the complete study (PDF)…
Wisconsin.
Modern Healthcare reports that an appeals court has ruled that a health system and its employees cannot be sued over inappropriate access to patient medical records under Wisconsin state law. At issue was a lawsuit that accused a healthcare system and two employees of violating a Wisconsin law that prohibits unauthorized release of patient healthcare records. However, the court ruled that the statute does not apply to internal access of such records.
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Call for volunteers: CMS Technical Expert Panel on MACRA Quality Measure Development Plan.
AAOS seeks to nominate members to a Technical Expert Panel in support of the CMS Quality Measure Development Plan (MDP) project. The MDP is mandated under MACRA, which also requires the preparation of an annual report on the development of measures for the CMS Quality Payment Program. Applicants for this position must be active fellows. In addition, all applicants must provide the following: an online AAOS CAP application, a current curriculum vitae, a biosketch, and a nomination form (available from the email below). All materials must be submitted to Kyle Shah by Sept. 13, 2016 at 11:59 p.m. CT, at shah@aaos.org.
Learn more and submit your application…(member login required)
