Published 9/1/2009

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.

Apology initiative successful

According to the Associated Press, an initiative in place at the University of Michigan Health System has reduced medical liability claims against the system from 121 in 2001 to 61 in 2006. Under the initiative, the system learns of possible medical errors from physicians themselves, patients, or patients’ lawyers. When an error is reported, the university conducts a peer review to determine if there was an error, and if changes are needed to prevent a recurrence. Health system physicians and officials also offer to meet with patients and their families, sometimes to explain that treatment was appropriate and sometimes to admit a mistake.

Focus on quality saves lives

An analysis by Thompson Reuters of 252 healthcare systems in the United States finds that hospital systems that focus on quality care are able to reduce death rates and have healthier patients overall. According to the data, the best-performing 20 percent of hospitals had 25 percent fewer deaths, 19 percent fewer complications, and 13 percent fewer patient mishaps than the 20 percent worst performers.

Group practices respond to recession

A Medical Group Management Association survey of 2,077 group medical practices finds that 36.6 percent of such practices have postponed capital expenditures during the recession, 34.7 percent have seen an increase in the number of uninsured patients, and 33.9 percent have reduced their operating budgets. The survey was conducted online via invitation, Feb. 2-26, 2009.

HHS: Nearly one-fifth of ED visits are uninsured

Data released by the U.S. Department of Health and Human Services (HHS) show that uninsured persons accounted for nearly one-fifth of the 120 million hospital-based emergency department (ED) visits during 2006. The data was based on the Nationwide Emergency Department Sample, which contains 26 million records from emergency department visits from approximately 1,000 community hospitals in the United States, representing 20 percent of all U.S. hospital EDs. The database provides weighted calculations for national estimates.

Rise in number of elderly could strain world economy

According to a report released by the U.S. Census Bureau, the number of people worldwide aged 65 years or older is estimated to reach 1.3 billion by 2040, or 14 percent of the total global population. The report states that, in many countries, people aged 80 and older are the fastest growing portion of the total population, and this group is projected to increase in size by 233 percent between 2008 and 2040. Some experts say that the increase will likely push up pension and healthcare costs, forcing major increases in public spending that could slow economic growth.

Women surgeons happy with career choice

According to a
report in Archives of Surgery (July 2009), most women surgeons would choose their same career again, although some would prefer more options regarding part-time or alternative work schedules. Of 895 respondents (25.5 percent) to a mailed questionnaire, 178 (20.3 percent) were women and 698 (79.7 percent) were men. Overall, 82.5 percent of women and 77.5 percent of men said they would choose surgery as a profession again.

AMA insurer report finds more work needed

The American Medical Association (AMA) 2009 National Health Insurer Report Card finds the following:

Wide variations exist in how often health insurers deny claims and stated reasons for denials.

Five of eight insurers showed slight improvements over last year in reducing the time necessary to respond to claims.

Insurers have made progress in eliminating unnecessary reporting discrepancies from the payment process.

Almost every insurer provides physicians with at least some access to payment policies, with the exception of policies related to prior-authorization of services.

P4P improves performance in short-term at the expense of other factors

The results of an English study on the effects of pay-for-performance (P4P) published in the New England Journal of Medicine show that, although P4P accelerated improvements in quality for two of three chronic conditions in the short term, long-term effects were less pronounced, and quality of care declined for conditions not linked to incentives. An analysis of quality of care in 42 representative family practices, with data collected both before and after implementation of P4P in 2004, found that, between 2003 and 2005, the rate of improvement in quality of care increased for asthma and diabetes (P<0.001) but not for heart disease. by 2007, the rate of improvement had slowed for all three conditions (p><0.001), and the quality of those aspects of care that were not associated with an incentive had declined for patients with asthma or heart disease. compared to the period before p4p, the improvement rate after 2005 was unchanged for asthma or diabetes and was reduced for heart disease (p="0.02).">

HHS to fund state reviews of ASCs

The U.S. Department of Health and Human Services (HHS) has allocated up to $1 million in funding to conduct onsite reviews of ambulatory surgical centers (ASCs) in 12 states (Maine, New Jersey, Maryland, Florida, North Carolina, Indiana, Michigan, Arkansas, Oregon, Utah, Wyoming and Kansas), as part of a nationwide effort to reduce healthcare associated infections in stand-alone surgery centers. The reviews are designed to ensure that the facilities are following Medicare’s health and safety standards. An additional $9 million will be available in October to expand the initiative to all other states.

Amendment would limit use of comparative research

Reuters reports that an amendment to healthcare reform legislation would prohibit the federal government from “denying or rationing” medical care based on studies comparing the effectiveness of various drugs and medical devices. A House reform bill sets up a federal center for comparative effectiveness research. Supporters say that government-funded studies are important because manufacturers have little incentive to compare their products with those of competitors. Critics, including manufacturers, have argued that such studies could be used to favor less-expensive treatments.

Consumers spend $34 billion on CAM

According to the U.S. National Center for Complimentary and Alternative Medicine, Americans spent $33.9 billion out-of-pocket on complementary and alternative medicine (CAM) during 2007, accounting for about 1.5 percent of total healthcare expenditures and 11.2 percent of total out-of-pocket expenditures in the United States. Of the $33.9 billion, an estimated $22.0 billion was spent on self-care items, mostly on the purchase of non-vitamin, non-mineral, natural products ($14.8 billion) such as fish oil, glucosamine and Echinacea. U.S. adults also spent approximately $11.9 billion on an estimated 354.2 million visits to CAM practitioners such as acupuncturists, chiropractors, and massage therapists.

Bills would let hospitals hire physicians

American Medical News reports that medical associations in California and Texas are fighting legislation that would allow rural hospitals to directly hire physicians—a move that some physicians argue may undermine their independent medical judgment and hinder patient care. Supporters of the legislation say that the changes are necessary to recruit physicians in underserved areas. Critics argue that reducing medical student debt and increasing the number of residency slots are better ways to address shortages without risking medical independence.