Evidence-based Savings Opportunities Exist with TJR Devices

John Cherf, MD, MPH, MBA, Simon Kerr

Total joint replacement (TJR) surgery has been the most common hospital-based orthopaedic procedure recently. The Centers for Medicare & Medicaid Services (CMS) and most commercial payers are currently evaluating the procedures with a focus on cost. New payment models and the growing emphasis on value require rigorous analysis of costs and the impact of money spent on quality throughout the continuum of care.

Common Misconceptions Continue to Plague Implant-related Hypersensitivity Responses and Testing

Nadim James Hallab, PhD

The terms metal hypersensitivity and metal allergy have been used interchangeably to refer to metal delayed-type hypersensitivity (DTH) responses. DTH, or adaptive, immune responses differ dramatically from normal physiologic responses to metal debris. A normal physiologic response to metal implant debris may be adverse (toxic and/or immunogenic) and increase in proportion to exposure.

Is ‘Insurance Only’ Billing Advisable?

Cheyenne Brinson, MBA, CPA, Patricia S. Hofstra, JD

Surgeons instructing billing staff to bill “insurance only” is a scenario that is all too common in orthopaedic practices. In effect, the practice is waiving the patient’s copay, coinsurance, and deductible amounts and accepting whatever amount the insurance company will pay. In most circumstances, this puts the surgeon and the practice in jeopardy. Medicare pays providers the lesser of the reasonable costs or the customary charges for services furnished to Medicare beneficiaries.

The Value of Claims ‘Signal’ Data in Orthopaedic Surgery

Michael Marks, MD, MBA

In last month’s article, “Scientific Analysis for Medical Liability Claims,” Coverys’ Robert Hanscom, vice president of business analytics, and Lisa Simm, manager of risk management, presented the methodology the insurer utilizes to analyze medical professional liability (MPL) claims. This article features an analysis of Coverys’ review of 474 closed orthopaedic claims from 2013–2017.