AAOS Now

Published 11/1/2008

Second Look – Reimbursement and Regulation

GAO letter examines relationship between HAIs and medical devices
In a
letter to members of the U.S. Congress, the healthcare director of the Government Accountability Office (GAO) stated that examination and treatment practices are among the most significant factors affecting the occurrence of hospital-acquired infections (HAIs), particularly where medical devices are concerned. Experts cited factors such as certain in-hospital sterilization processes and improper handling of sterilized devices as potential causes of HAIs. Additionally, 8 of 11 experts interviewed identified the intrinsic risk of using medical devices—including the inability to completely disinfect the area where a device is inserted—as a factor as well. This report was mandated by the Food and Drug Administration (FDA) Amendments Act of 2007. None of the data sources the GAO identified could provide a national estimate on the number of HAIs in hospitals associated with medical devices.

OIG reports on Medicare imaging payments
A
report issued by the U.S. Department of Health and Human Services Office of Inspector General examines the relationship between utilization levels of magnetic resonance imaging (MRI) services paid under the Medicare Physician Fee Schedule and how such services are provided. Because various parties can perform and bill for such services, the report notes that the transparency of such transactions is reduced. Overall, four specialties—internal medicine, orthopaedic surgery, family practice, and neurology—accounted for two-thirds of MRI orders, and 85 percent of services were performed by the entity that was paid by Medicare. Furthermore, three provider arrangements—independent diagnostic testing facility, multispecialty group, and diagnostic radiology—comprised 88 percent of performers and payees.

Some hospitals skip medical error reports
According to article in the Philadelphia Inquirer, some hospitals in Pennsylvania and New Jersey have apparently failed to report medical errors and serious complications to state agencies, despite state laws requiring that they do so. Under Pennsylvania’s 2002 mandatory reporting law, hospitals must report near misses as well as events that result in death or an “unanticipated” harm. Similarly, a 2004 New Jersey law requires hospitals to report serious incidents based on a list of 28 problems, including wrong site surgery, serious injury from incompatible blood transfusions, and death or serious injury due to a medication error. Yet a handful of hospitals across both states did not report a single preventable error during 2007. A spokesperson for the Institute for Healthcare Improvement states that even the best hospitals tend to report about 20 medical errors per year.

High cost of osteoporotic fractures
A
retrospective analysis of more than 30,000 female Medicare patients aged 65 years and older and identified from a medical and pharmaceutical claims database finds that osteoporosis fractures may result in fracture-related medical expenses of $15,522 per person over 3 years. The researchers found that 64 percent of patients were not treated for osteoporosis during the 3 years following their fracture, despite being at high risk for sustaining another fracture. Overall, 14 percent of patients experienced another fracture during the 3-year follow-up period, and the additional fracture accounted for an additional $16,872 per patient in Medicare medical expenses. The authors presented their findings at the annual meeting of the American Society for Bone and Mineral Research.