News in 10

The 10 items below are the most significant elements of recent editions of Headline News Now-the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons. Check this page regularly for updates.
Updated on September 8th, 2015

1. Study: Meniscal transplant improves function in short- to mid-term, but procedure may not be curative in the long-term.
According to findings published in the Aug. 5 issue of The Journal of Bone & Joint Surgery (JBJS), patients who undergo meniscal transplantation demonstrate good outcomes in the short- to mid-term, but additional surgery may be required in the long-term. The researchers conducted a prospective study of 40 consecutive medial and lateral bone-meniscus-bone transplants using cryopreserved menisci in 38 patients. At mean 11-year follow-up, they found that the estimated probabilities of transplant survival were 88 percent at 5 years, 63 percent at 10 years, and 40 percent at 15 years. The researchers noted that overall mean time to failure was 8.2 years for medial transplants and 7.6 years for lateral transplants. They write that patients who undergo meniscal transplantation "should be advised that the procedure is not curative in the long term and additional surgery will most likely be required."
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2. Action needed to prevent increase in drug-resistant infections.
A report from the U.S. Centers for Disease Control and Prevention (CDC) projects an increase in the number of drug-resistant infections unless immediate action is taken. Among other things, the report recommends that hospital owners and healthcare facility administrators:

  • Implement systems to alert receiving facilities when transferring patients who have drug-resistant germs.
  • Review and perfect infection control actions in each facility.
  • Make leadership commitments to join area healthcare-associated infection/antibiotic resistance prevention activities.
  • Connect with public health departments to share data about antibiotic resistance and other hospital-acquired infections.
  • Provide clinical staff access to prompt and accurate laboratory testing for antibiotic-resistant germs.
  • CDC recently announced awards of nearly $110 million to help states and communities strengthen their capacity to track and respond to infectious diseases.
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    Read more on the CDC funding initiative…

    Read the complete report…

3. Study: Nutritional screening may help predict complications for patients with fracture or dislocation.
Data from a study published in the August issue of the Journal of Orthopaedic Trauma suggest that nutritional screening may serve as a predictor for the development of complications and hospital readmission for fracture or dislocation patients. The research team conducted a retrospective review of 796 patients, 459 (57.7 percent) of whom were of normal nutritional status and 337 (42.3 percent) of whom exhibited at least one sign of malnutrition based on the Malnutrition Universal Screening Tool. Among patients with normal nutrition, 2.8 percent developed at least one specified complication (infection, venous thromboembolism, respiratory failure, ulceration, or readmission), for a complication-to-patient ratio of 0.033. Among patients with signs of malnutrition, 8.0 percent developed at least one complication, for a complication-to-patient ratio of 0.101. A multivariate regression analysis found that each additional point in a patient's nutrition score corresponded to a 49.5 percent increase in the likelihood of a complication developing.
Read the abstract…

4. CMS releases guide to assist orthopaedists with ICD-10 transition.
The U.S. Centers for Medicare & Medicaid Services (CMS) has released ICD-10: Clinical Concepts for Orthopedics-part of a series of guides that include common ICD-10 codes, clinical documentation tips, and a series of example clinical scenarios to familiarize providers with coding under ICD-10. Other guides in the series cover areas such as pediatrics, family practice, and internal medicine.
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Read the guide (PDF)…

Find more resources from the AAOS…

5. How old is too old to practice?
An article on the KPBS Public Broadcasting website looks at the issue of aging physicians, noting that one in four currently practicing physicians in the United States is estimated to be 65 years or older. The writer states that the American Medical Association House of Delegates recently advocated the development of "guidelines and methods of screening and assessment to assure that senior/late career physicians remain able to provide safe and effective care for patients," and some hospitals have implemented screening programs for older physicians who wish to retain their staff privileges. Supporters of such moves state that they are necessary to maintain patient safety. However, some critics argue that blanket screening would place "a lot of burden on everybody to weed out a few."
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6. Expedited licensure process now approved in 11 states.
Lexology
reports that 11 states have now enacted the Interstate Medical Licensure Compact Act-an initiative designed to streamline the licensure process for physicians who seek to practice in multiple states. The legislation does not permit physicians to practice across state lines, but instead offers a simplified process to physicians who practice in states that have approved the Act to apply for licensure in other such states. At least eight additional states have introduced legislation to adopt the Act.
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Learn more about the Interstate Medical Licensure Compact Act…

7. Does value-based payment equal lower revenues?
An article in the July/August 2015 issue of HealthLeaders magazine argues that a move toward value-based reimbursement need not negatively affect revenue. The writer profiles two health systems that have are undergoing successful transitions, including one that began a shift to value-based pay in 1995, and another that has seen revenue hold steady even though value-based reimbursement now accounts for 22 percent of the system's revenues.
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8. Report looks at physician payment systems.
A report from the American Medical Association examines trends in physician payment, based on surveys of post-residency physicians. The researchers state that, during 2014, about 51 percent of respondents said they were paid by multiple methods. Additionally, the report notes the following:

  • Salary and productivity-based payments were the most common payment methods.
  • About one-half of physicians' total compensation was earned from salary.
  • Nearly a quarter (23 percent) of employed physicians didn't receive salaried payments at all.
  • Salary was more likely to be a key factor for physicians working outside of a group practice than for those inside a practice.
  • Physician payment methods varied widely across specialties.
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9. Study: Late-night medical care performed by surgeon may not increase patient risk the next day.
According to a study conducted in Canada and published in the Aug. 27 issue of The New England Journal of Medicine, a surgeon's provision of medical services the previous night may not significantly alter the risk of adverse outcome for patients who undergo elective surgery the next day. The researchers conducted a population-based, retrospective, matched-cohort study of 38,978 patients undergoing elective procedures and found no significant difference in primary outcome (death, readmission, or complication) between patients who underwent a daytime procedure performed by a physician who had provided patient care after midnight and those who underwent a procedure performed by a physician who had not treated patients after midnight.
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Read the abstract…

10. Is "observation" the new "readmission?"
An article published on the blog of the journal Health Affairs questions whether a recent drop in hospital readmissions among Medicare patients corresponds to an increase in patient safety. The writers note that hospitals have seen an increase in the number of patients designated for "observation," which they argue simply relabels readmissions while harming patients financially. "Between 2006 and 2013," they write, "observation stays increased by 96 percent, accounting for more than half of the apparent decline in total Medicare admissions during that seven-year period." They note that observation patients often receive care in a regular inpatient unit, but from the point of view of Medicare, observation is considered outpatient care, leaving patients responsible for a greater share of costs, yet ineligible for Medicare-paid rehabilitation or skilled nursing care.
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