Published 6/1/2009

Second Look – Reimbursement & Regulation

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.

Medicare fund insolvent by 2017
According to an
annual report released by the U.S. Department of Health and Human Services and the Social Security and Medicare Boards of Trustees, the Medicare trust fund will be exhausted in 2017—2 years earlier than previously estimated. Total Medicare expenditures in 2008 were $468 billion and are expected to rise at a greater rate than workers’ earnings or the economy overall. Costs for Medicare during 2008 were 3.2 percent of the U.S. gross domestic product.

Medical boards disciplining fewer physicians
report released by the not-for-profit advocacy group Public Citizen finds that the rate of discipline for physicians in 2008 was 21.5 percent lower than in 2004. In 2008, there were 2.92 serious disciplinary actions per 1,000 physicians, compared with 3.72 actions per 1,000 physicians in 2004. The following states had the largest reductions in physician discipline since the 2001–2003 report: California, Alabama, Georgia, Mississippi, and New Hampshire.

Language issues can cloud physician/patient communication
article in the Washington Post (April 20, 2009) looks at the issue of language barriers between physicians and patients. According to the article, such difficulties may discourage people from seeking care or result in diagnostic or treatment errors. Under civil rights legislation, physicians and hospitals that accept federal funds must offer language services.

Stipends for on-call coverage more common
According to the
Medical Group Management Association’s Medical Directorship/On Call Compensation Survey: 2009 Report Based on 2008 Data, more than half (62 percent) of all on-call providers receive some sort of additional compensation. A daily stipend is the most commonly used compensation method. In addition, less than 11 percent of surgery specialist providers do not receive any additional compensation; more than half of surgical specialist providers (50.23 percent) receive a daily stipend for their additional on-call coverage.

Drug maker reimbursing insurer for fractures
Procter & Gamble Co. (P&G) has agreed to reimburse Health Alliance Medical Plans Inc. (Urbana, Ill.) for medical care provided to patients who sustain an osteoporotic fracture while taking P&G’s osteoporosis drug Actonel. According to an
article in The New York Times (Apr. 23, 2009), the arrangement covers hip and wrist fractures, but not spinal fractures.

IOM issues report on provider/industry interaction
report released by the U.S. Institute of Medicine (IOM) calls for new voluntary and regulatory measures to strengthen protections against financial conflicts of interest in medicine. The report includes the following recommendations:

Academic medical centers, journals, professional societies, and others engaged in health research, education, clinical care, and development of practice guidelines should establish or strengthen conflict-of-interest policies.

Physicians and researchers should disclose to employers and other medical organizations their financial ties to pharmaceutical, biotechnology, and medical device firms.

Congress should require pharmaceutical, biotechnology, and device firms to publicly report payments they make to physicians, researchers, academic health centers, professional societies, patient advocacy groups, and others involved in medicine.

Greater transparency and accountability should be implemented in the development of clinical practice guidelines.

Medical device pre-emption being considered
bill under consideration in the U.S. House Energy and Commerce Health Subcommittee would allow consumers to sue medical device manufacturers in state courts. The Medical Device Safety Act of 2009 was drafted in response to a Supreme Court ruling that medical devices with U.S. Food and Drug Administration premarketing approval can be pre-empted from lawsuits under state law.

AAOS observed the hearing on the bill and will continue to meet with members of Congress on this issue.

Costs of Medicare Advantage plans
analysis of private Medicare Advantage (MA) plans finds that such plans will be paid $11.4 billion more in 2009 than what the same beneficiaries would have cost in the traditional Medicare fee-for-service program. The Commonwealth Fund report estimates that since MA was enacted in 2004, $43 billion in extra payments have been made.

20 percent of Americans postponing health care
survey of 12,000 Americans conducted by Thomson Reuters Healthcare (New York) during February/March 2009 found that 20 percent of those surveyed have delayed or postponed medical care, and of those, 24 percent said that cost was the primary reason. More than half of those who skipped care missed a physician’s visit, while 8 percent said they delayed or skipped medical imaging of some sort. One in five respondents overall are expecting to have difficulty paying for either health insurance or healthcare services during the next 3 months.

40-day wait to see a surgeon
A Merritt Hawkins & Associates (Irving, Texas)
survey of 1,162 medical offices tracked the average time needed to schedule a physician appointment in five different medical specialties, including orthopaedics. The longest wait times overall were found in Boston, with an average of 70 days to see an obstetrician/ gynecologist and an average of 40 days to see an orthopaedic surgeon. The survey also tracked the number of medical offices that accept Medicaid as a form of payment. Minneapolis was found to have the highest rate of Medicaid acceptance at 82 percent, Dallas the lowest at 39 percent. The overall Medicaid acceptance rate for all metro markets was 55 percent.