Published 4/1/2011

Second Look—Advocacy

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.

Physician-owned hospitals
A U.S. District Court judge has denied a motion by the federal government to dismiss a lawsuit that challenges Patient Protection and Affordable Care Act (PPACA) restrictions on expansion of physician-owned hospitals. The plaintiffs argued that the restrictions are unconstitutional; the government argued that the plaintiffs had not satisfied a requirement that administrative remedies “be pursued fully” before taking legal action. The judge ruled that the so-called “exhaustion requirement” did not apply, because it would have placed the hospital at undue risk of forfeiting reimbursement for all future Medicare self-referrals.

Resident work limits
Many surgical residents don’t comply with work-hour limits, according to data published in the February Archives of Surgery. An anonymous survey of 141 surgical residents from across the United States between Nov. 1, 2007, and March 1, 2008, found that 64.6 percent of respondents did not comply with work-hour limits, even though most respondents were aware of and favored limits. The most problematic areas of compliance were “at least 10 hours of rest between duty hours,” “24-hour limit of continuous care plus 6 additional hours for continuity of care and educational objectives,” and “80-hour work limit over 4 weeks.” The main reasons cited for noncompliance were education and continuity in patient care. Noncompliance was highest among trauma and vascular surgery residents.

FDA: NPWT system safety
The U.S. Food and Drug Administration (FDA) has updated its safety communication regarding serious complications associated with negative pressure wound therapy (NPWT) systems. Since 2007, the agency has received reports of 12 deaths and 174 injuries. Most wound infections were related to the retention of dressing pieces in the wounds. Bleeding continues to be the cause of the most serious adverse events, having been reported in 12 patients.

Elective surgery numbers
The Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making find wide regional variations in elective surgery for Medicare patients with similar conditions. Rates for inpatient hip replacement ranged from 0.9 per 1,000 enrollees in Honolulu to 5.8 per 1,000 enrollees in Sioux City, Iowa, while rates for inpatient back surgeries ranged from 1.8 per 1,000 enrollees in Honolulu to 8.8 per 1,000 enrollees in Boise, Idaho.

Insurance waiver rules
The U.S. Department of Health and Human Services has released rules regarding State Innovation Waivers, which allow states to opt out of the PPACA beginning in 2017, provided they:

  • Included coverage that is at least as comprehensive as the coverage offered through PPACA health insurance exchanges
  • Make coverage at least as affordable as it would be through the exchanges
  • Cover at least as many residents as otherwise would be covered under PPACA
  • Do not increase the federal deficit

Because most PPACA health insurance provisions go into effect in 2014, Congress is considering several bills that would move the PPACA waivers date forward.

A permanent SGR fix?
The American Association of Orthopaedic Surgeons (AAOS) and 130 other medical organizations are urging Congress to enact legislation to eliminate Medicare’s sustainable growth rate (SGR) formula and lay the groundwork for broader physician payment and delivery reforms. The formula will require a 29.5 percent cut to physician reimbursements beginning Jan. 1, 2012.