Published 8/1/2011

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.

Physicians under increasing scrutiny
Regulators are increasing their efforts to identify and prosecute physicians who accept kickbacks from commercial companies. Settlements with companies accused of issuing kickbacks now stipulate that the firms work with the government to prosecute physicians who sought payment, according to Lewis Morris, general counsel to the U.S. Department of Health and Human Services (HHS) inspector general, who spoke at the Physician-Legal Issues Conference in Chicago on June 16.

Senators probe device maker, researcher ties
Sens. Max Baucus (D-Mont.) and Charles Grassley (R-Iowa) have written to Medtronic requesting that the device maker provide documents and data relating to any adverse postoperative events or complications associated with the use of the bone-generation product Infuse, including information regarding surgeons paid as consultants. The company was asked to produce payment records and internal correspondence with physicians who have published research related to the product.

PPACA funding for providers
HHS has announced that up to $500 million in Partnership for Patients funding, made available under the Patient Protection and Affordable Care Act (PPACA), will be awarded to hospitals, healthcare provider organizations, and others to help improve care and stop millions of preventable injuries and complications related to healthcare-acquired conditions and unnecessary hospital readmissions. The Centers for Medicare & Medicaid Services (CMS) Innovation Center will award the funding through solicitation and other procurements for federal contracts.

HHS issues proposed regulations for exchanges
On July 11, HHS issued two Notices of Proposed Rulemaking (NPRMs). The Exchange NPRM is aimed at enabling states to build Affordable Insurance Exchanges—state-based competitive marketplaces created under the PPACA. The proposed Exchange NPRM provides standards for states that elect to establish and operate an Exchange, health insurance plans to participate in an Exchange, enrollment in health plans through Exchanges, and employers who opt to participate in the Small Business Health Options Program.

The other NPRM focuses on standards related to reinsurance, risk corridors, and risk adjustment to ensure stability in these newly established markets.

CMS likely to delay data reporting requirement
As part of the proposed rule for the 2012 Physician Fee Schedule, CMS has, among other things, proposed a delay of at least 1 year in the requirement for the electronic reporting of physician quality data as part of the meaningful use requirements under the American Recovery and Reinvestment Act of 2009. The agency had originally planned to require providers to begin electronically reporting clinical quality measures by no later than Jan. 1, 2012. The proposed rule, however, would allow providers to simply provide an attestation form for their quality measure submissions, which is the same standard used in 2011. Public comments on the proposed rule will be accepted through Aug. 30, 2011.

CDC releases outpatient safety checklist
The U.S. Centers for Disease Control and Prevention (CDC) has released an infection prevention checklist for outpatient settings. The checklist is designed to ensure that facilities have appropriate infection prevention policies, procedures, and supplies to allow healthcare personnel to provide safe care and to systematically assess personnel adherence to correct infection prevention practices. The checklist addresses several areas such as disease reporting, hand hygiene, environmental cleaning, and instrument reprocessing.

CMS to use predictive modeling technology
On July 1, 2011, CMS began using predictive modeling technology to fight Medicare fraud. Predictive modeling seeks to identify potentially fraudulent Medicare claims on a nationwide basis to prevent them from being paid. The initiative builds on the new anti-fraud tools and resources provided by the PPACA and gives CMS the ability to use real-time data to spot suspect claims and providers and to stop fraudulent payments before they are issued.

Hospitals headed by physicians perform better
Many top-performing hospitals are run by physicians rather than by nonphysician managers, according to a study in Social Science and Medicine. Data were compiled on 300 of the most prominent hospitals in the United States, and the professional background and personal history of each hospital’s leaders were analyzed. A strong positive association was found between the ranked quality of a hospital (based on performance related to care associated with cancer, digestive disorders, and heart surgery) and whether the chief executive officer is a physician.

Orthopaedists highest paid specialty
A survey by the Medical Group Management Association finds that among surveyed specialties, orthopaedic surgeons have the highest median compensation in the United States. The “Physician Compensation and Production Survey: 2011 Report Based on 2010 Data” finds that the median income for orthopaedic surgeons is $514,659 per year—an increase of 3.71 percent over the previous year.