Published 6/1/2007

Second Look

In case you missed these news items the first time around, AAOS Now gives you a second chance to review them.

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Federal probe into device makers nears conclusion.
According to the New Jersey Star-Ledger, a federal probe investigating improper payments and gifts from several manufacturers of artificial joints to prominent surgeons could wrap up this summer, with a settlement in the hundreds of millions of dollars.

Investigators contend that the companies hired physicians to steer business toward their products, in violation of federal anti-kickback laws that govern healthcare providers who participate in Medicare. Although no allegations have arisen that patients were harmed or jeopardized, prosecutors have stated that many physicians failed to reveal any conflict of interest to their patients. For more information, go to www.nj.com/starledger/news11.

Study: Physician/drug company ties still strong
A study published in the April 26 New England Journal of Medicine examining the ties between physicians and the pharmaceutical industry finds that, although a number of initiatives have arisen to separate the two groups, very little has changed in recent years.

Researchers conducted a national survey of 3,167 physicians in six specialties during late 2003 and early 2004 and received a response rate of 52 percent. Of respondents, 94 percent reported some type of relationship with drug companies. The most common relationships involved being given food in the workplace (83 percent) and receiving product samples (78 percent.) Respondents also reported receiving reimbursement for meeting and education costs (35 percent), and consulting, giving lectures, or enrolling patients in trials (28 percent). The complete study can be viewed at http://content.nejm.org/356.

CMS issues guidance on hospital emergency services
The Centers for Medicare and Medicaid Services (CMS) has issued guidance clarifying the responsibility of hospitals that participate in Medicare to provide emergency services. Nearly all hospitals, including specialty hospitals and those without emergency departments, must be able to appraise an emergency situation, provide initial treatment, and refer or transfer individuals when appropriate.

The guidance also implements an element of the CMS Strategic and Implementing Plan for Specialty Hospitals—a plan generated in accordance with the Deficit Reduction Act of 2005. Additional aspects of the plan include, but are not limited to, continuing to make improvements in the inpatient hospital and ambulatory surgical center payment systems to address the perception that specialty hospitals select more profitable diagnoses and patients and developing changes to the Medicare provider enrollment application form that would clearly identify specialty hospitals as a separate category of hospitals. For more information, go to http://tinyurl.com/2dr8rv

Blues settle claims with physicians
According to the Miami Herald, 23 Blue Cross and Blue Shield organizations have reached a $128 million settlement in a four-year-old class-action lawsuit brought on behalf of about 900,000 physicians. The settlement, which addressed slow or nonpayment of claims, covers more than 90 percent of Blues plans in the United States and includes an agreement for the insurers to adjust their business practices to streamline claims communication with physicians.

Study: CT better than radiographs for lumbar spine fractures
According to Medical News Today, a study released on May 7 at the annual meeting of the American Roentgen Ray Society finds that routine computerized axial tomography (CT) may be more effective in detecting lumbar spine fractures in trauma patients than simple radiographs.

Researchers examined the cases of 932 patients who underwent both radiograph and abdomen and pelvis CT within three days of an injury. A total of 180 patients were diagnosed with a fracture of the lumbar spine. CT was positive for fracture in 165 (91.7 percent) cases, and radiographs were positive in 101 (56.4 percent). CT scanning missed 15 (8.3 percent) of the fractures, and of those, 11 were compression deformities of indeterminate age, three were possible transverse process fractures, and one was a superior end plate fracture. For more information, go to www.medicalnewstoday.com.

Physicians join in support of ethical advertising
A number of physicians’ groups, including AAOS and the American Medical Association, have joined together to support the Health Care Truth and Transparency Act—a bipartisan initiative that would make it unlawful for healthcare providers to misrepresent their qualifications to patients. Supporters of the bill state that the legislation would protect patients by increasing the Federal Trade Commission’s authority to challenge misleading marketing. For more information, go to

Survey: Concerns remain about high performance health networks
A survey published by the Center for Studying Health System Change (HSC) examines early experiences with the creation of so-called high performance networks. Insurers attempt to use high performance networks to increase quality of care; steering enrollees toward providers with higher ratings is thought to increase pressure on other providers to improve.

The study finds that employers are slow to adopt high performance networks. Physicians tend to be skeptical of the methods used to determine performance, and nearly all respondents agreed that both cost and quality are important factors, as high performance health care can be delivered inefficiently. View the complete survey online at www.hschange.org.

Survey examines trends in obtaining compensation
Physicians Practice and athenahealth, Inc. have released the results of their second annual PayerView survey, which reviews how easy or difficult it was for healthcare providers to obtain compensation from various insurers during 2006.

The survey incorporates claims performance data from athenahealth’s practice management system and covers more than 8,500 healthcare providers in 33 states. Payor performance was graded in three financial categories, three administrative categories, and one policy complexity category.

The survey finds that overall, the insurance industry improved with respect to speed of payment compared to 2005, and compliance with national coding standards improved by 25 percent. For more information, go to www.athenahealth.com. View the survey results at www.athenapayerview.com