Published 12/1/2007


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CMS final rule for 2008 continues PQRI
The U.S. Centers for Medicare and Medicaid Services (CMS) retained the Physician Quality Reporting Initiative (PQRI) for 2008 by including the 2007 measures and adding new measures that had been adopted or endorsed by a consensus organization. According to CMS, the AQA Alliance (formally the Ambulatory Care Quality Alliance) and the National Quality Forum meet the criteria for a consensus organization; new measures, therefore, are expected to be added for back pain. Additionally, CMS (working through Quality Insights of Pennsylvania) developed structural measures for the use of e-prescribing and the use of electronic health records. For an analysis of the 2008 PQRI, visit the
AAOS Government relations Web site

Improved outcomes with zoledronic acid after hip fracture
recent study published in the New England Journal of Medicine finds that an annual infusion of zoledronic acid after repair of a low-trauma hip fracture may be associated with improved survival and a reduction in the rate of new fractures. Researchers conducted a randomized, double-blind, placebo-controlled trial of 1,065 patients who were assigned to receive a 5 mg yearly dose of intravenous zoledronic acid, and 1,062 patients who were given placebo. With a median follow-up of 1.9 years, the rate of any new clinical fracture was 8.6 percent in the zoledronic acid group, and 13.9 percent in the placebo group—a 35 percent risk reduction for those in the experimental group. Additionally, 101 of 1,054 patients in the zoledronic acid group (9.6 percent) died, compared to 141 of 1,057 patients (13.3 percent) in the placebo group—a reduction of 28 percent in deaths from any cause in the zoledronic acid group

Knee buckling common, associated with functional limitations
study in the Annals of Internal Medicine finds that knee “buckling” is common whether a subject has knee arthritis or not, and that such buckling is often associated with a functional loss. Researchers examined 2,351 men and women age 36 to 94 years (median, 63.5 years), of whom 278 (11.8 percent) reported experiencing at least one episode of knee buckling within the past 3 months. Of those, 217 (78.1 percent) experienced more than one episode, and 35 (12.6 percent) fell during an episode. Nearly half of study participants with knee buckling said they were limited, at least to some degree, in their daily activities, yet more than half of those who reported buckling had no osteoarthritis on radiography

HHS pilot program to reimburse for quality outcomes via EHR use
The U.S. Department of Health and Human Services (HHS) has announced a
demonstration program in which 1,200 physician practices will receive financial incentives for using certified electronic health records (EHRs) and meeting certain clinical quality measures. Stating that EHRs have the potential to improve quality of care, HHS is implementing the program to help promote a value-based healthcare system in the United States. The 5-year initiative will be administered by CMS, and will provide an annual bonus based on the physician group’s score on a standardized survey that assesses the specific EHR functions the group employs. HHS is asking private insurers to consider offering similar incentives to help accelerate EHR adoption.

Medical school enrollment up, but more residencies needed
According to the
Commercial Appeal, the number of slots available in U.S. residency programs must increase if the programs are to keep pace with the record number of students currently enrolled in medical schools. Many medical schools have expanded their enrollment to help combat a nationwide shortage of physicians, but increasing the number of residency positions is seen as a more difficult move. Most residency programs rely on Medicare funding, which has remained static in recent years. In July, the Texas Legislature approved an increase in funds for residency programs to $63 million—more than double the $25 million appropriated last year.

Medical trainee errors often the result of a breakdown in teamwork
study in the Archives of Internal Medicine finds that errors made by medical trainees, including residents, interns and fellows, are often the result of teamwork breakdowns—particularly a lack of supervision by experienced staff. Researchers analyzed data from a random sample of 889 closed malpractice claims that had been reviewed by specialist physicians between 2002 and 2004. Of the claims involving both error and injury, 240 cases (27 percent) involved trainees whose role in the error was considered to be at least moderately important. Among those 240 cases, the most prevalent contributing factors were: errors in judgment (173 cases, 72 percent), teamwork breakdowns (167 cases, 70 percent), and lack of technical competence (139 cases, 58 percent)

Patients often unable to name the drugs they’re taking
A study in the Journal of General Internal Medicine finds that as many as 40 percent of patients may not be able to tell physicians what medications they are taking. Researchers studied 119 patients with high blood pressure (average age, 55 years) at three community health centers in Grand Rapids, Mich. About one third of patients with adequate health literacy (the ability to read and comprehend health-related materials) were unable to name their drugs accurately. The researchers suggest that patients bring their prescription bottles to the doctor’s office, and know the name of their pharmacy in case there is any question about what they’re taking.