Published 8/1/2009

Second Look

If you missed these Headline News Now items the first time around, AAOS Now gives you a second chance to review them. Headline News Now—the AAOS thrice-weekly, online update of news of interest to orthopaedic surgeons—brings you the latest on clinical, socioeconomic, and political issues, as well as important announcements from AAOS.

CMS issues 2010 proposed Medicare FFS rates
According to the Wall Street Journal
, the U.S. Centers for Medicare & Medicaid Services (CMS) plans to balance increases in fee-for-service (FFS) reimbursement for primary care physicians by cutting Medicare payments for specialists and imaging services. Under the proposal, Medicare would put specialists’ payments for evaluating and managing illnesses on par with those of primary-care physicians beginning in January 2010. Combined with other changes, such a move would allow the CMS to boost payments to internists, family physicians, general practitioners, and geriatric specialists by as much as 8 percent.

CMS estimates the overall impact of changes in the 2010 proposed rule to be approximately a 3 percent increase in total relative value units (RVUs) for orthopaedic surgery. For example, CPT code 27447 (total knee arthroplasty) is anticipated to see a total RVU increase of 3.9 percent and CPT code 27130 (total hip arthroplasty) is anticipated to see a total RVU increase of 4.2 percent. Orthopaedic surgeons who own equipment imaging modalities such as magnetic resonance imagers and computed tomography scanners can expect to see some impact if the proposed changes are implemented. The proposal is open for public comment until Aug. 31, 2009.

Senate HELP committee approves reform proposal
Washington Post reports that, one day after a group of key committees in the U.S. House of Representatives released their healthcare reform plan, the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) has approved legislation that would expand health insurance coverage and tighten restrictions on the way the healthcare industry operates. If passed, the “Quality, Affordable Health Coverage for All Americans” bill would create a government-sponsored health insurance program that would compete with the private sector, and require every American to carry health insurance. Most employers would be required to offer insurance to workers or pay a $750 annual fee per full-time employee; companies with fewer than 25 employees would be exempt from the requirement. Additionally, millions more Americans would be eligible for Medicaid.

AMA: Don’t reduce specialist pay
According to American Medical News
, the American Medical Association (AMA) House of Delegates (HOD) approved language stating that increased Medicare pay to physicians for operating a medical home should not be balanced by a reduction to the pay of specialist physicians. The action came during the annual meeting of the HOD in June. The HOD also approved recommendations that CMS and private plans develop one standard for a medical home, that specialty practices as well as primary care practices be able to serve as that home, and that AMA support the medical home model as a way to enhance care, but “without restricting access to specialty care.”

Medicare self-referral rules
American Medical News
that a federal trial court has turned down a challenge to a recent change in federal self-referral rules. In general, the so-called Stark law prohibits physicians from referring patients to entities in which they have a financial stake. Under current rules, CMS interprets an entity to include only the party that directly bills Medicare for designated health services, but beginning Oct. 1, the agency will broaden the scope to include those providing the services billed to Medicare. Because Medicare rules require parties first to pursue an administrative appeal, the U.S. District Court for the District of Columbia said it does not have authority to rule on the action.

Hospitals commit to save $155 billion
Three hospital associations have officially committed to save $155 billion over the next decade as part of healthcare reform efforts,
reports Modern Healthcare. About $103 billion of the total would come from a reduction in market basket updates and productivity adjustments. The deal also ensures that any public healthcare plan would reimburse more like a private payor rather than a government programand would ban physician referrals to clinics or hospitals in which they have an ownership stake.

FDA looks at acetaminophen
Boston Globe reports that the U.S. Food and Drug Administration (FDA) has convened a meeting to discuss what steps can be taken to reduce the number of accidental overdoses of acetaminophen pain medications. According to FDA statistics, acetaminophen overdoses send an estimated 56,000 people to emergency departments each year. The current 4 gram-per-day maximum dose is just below levels that can cause potentially fatal liver injury.

Model for device development process?
The Journal of Medical Devices (June 2009)
includes a comprehensive model for the medical device development process, designed to increase understanding of the process and help companies execute it more effectively. The linear model has five major phases and four decision gates, and describes a process applicable to a broad range of medical technologies and innovation settings.

New rules on propoxyphene
Due to
recent data linking propoxyphene to fatal overdoses, FDA is requiring manufacturers of propoxyphene-containing products to strengthen the label—including the boxed warning—to emphasize the potential for overdose when using those products. Manufacturers must submit the requested safety labeling changes to FDA within 30 days or provide a reason why they do not believe such changes are necessary. The agency is also requiring manufacturers to provide a medication guide to patients stressing the importance of using the drugs as directed, as well as requiring a new safety study to assess unanswered questions about the effects of propoxyphene on the heart at higher than recommended doses.

Physician groups oppose MedPAC authority plan
According to CongressDaily, a group of 10 specialty physician groups has written to leading members of the U.S. Congress opposing a Senate Finance Committee proposal to expand influence of the Medicare Payment Advisory Commission (MedPAC) over Medicare payment policies. Members of the Alliance of Specialty Medicine have asked legislators to allow Congress to “continue to exert strong oversight over these critical programs and not inappropriately relegate these critical duties to MedPAC.”

DoJ rounds up 53 in Medicare fraud
The U.S. Department of Justice (DoJ) has
arrested and indicted 53 people, including physicians, medical assistants, patients, company owners, and executives, for attempting to submit more than $50 million in false Medicare claims. In many cases, indictments allege that beneficiaries accepted cash kickbacks. The individuals were arrested in Detroit, Miami, and Denver as a result of operations conducted by the Medicare Fraud Strike Force, a multi-agency team of investigators who combat Medicare fraud by using Medicare data analysis techniques and focusing on community policing.

Whistle blower suits allege off-label marketing
According to the Pioneer Press
, a federal judge has unsealed so-called “whistle blower” lawsuits against seven manufacturers of surgical ablation devices, alleging that the companies used kickbacks and other illegal means to promote use of the devices for off-label purposes. The defendants are alleged to have promoted their products to hospitals by highlighting greater Medicare reimbursement for procedures performed with the defendants’ products and the relatively low cost of those procedures.