Published 11/1/2011

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.

Medical identity theft cost $28 billion in 2010
According to a PricewaterhouseCoopers survey of 600 healthcare executives, nearly four out of ten providers surveyed have caught a patient trying to use someone else’s identity to obtain healthcare services. The most commonly reported breach in health information security was improper use of patient data by a person with permission to access that data, followed by patients seeking medical services under someone else’s name. According to the report, medical identity theft is the fastest-growing form of identity theft, affecting 1.42 million Americans and costing more than $28 billion during 2010.

Fewer orthopaedists treating pediatric fractures
A study reported online in the Journal of Pediatrics finds that orthopaedic surgeons are less likely to schedule appointments with children who have fractures than they were a decade ago. Investigators called 45 orthopaedic practices in the Los Angeles area pretending to be the parents of a 10-year-old boy who needed treatment for a fractured arm. More than half of practices refused to schedule appointments for a child covered by private insurance, and almost all refused to see a child covered by Medicaid. A decade ago, most practices refused to see children on Medicaid, but nearly all scheduled appointments for those with private insurance.

No public access to NPDB?
Modern Physician
reports that the U.S. Health Resources and Services Administration (HRSA) has removed public access to the National Practitioner Data Bank (NPDB), which lists medical liability payments and physician sanctions, but doesn’t publicly list physicians’ names. HRSA found that some third-party sources combined information from NPDB with other publicly accessible data sources to identify physicians. The database will remain unavailable for at least 6 months, while officials review options for making it more difficult to ascertain the identities of physicians in the reports.

Fracture risk education sheet for osteoporosis
Data from a Canadian study presented at the annual meeting of the American Society for Bone and Mineral Research suggests that educating primary care physicians on fracture risk increases the likelihood that patients with vertebral fractures detected incidentally on chest radiographs will receive treatment for osteoporosis. Patients (n = 240) who had an incidentally identified vertebral fracture were randomized to either usual care or a physician intervention group, in which primary care physicians were given a one-page overview of fracture risk. At 3 months, 44 percent of patients in the intervention group had undergone bone mineral density (BMD) testing and 17 percent had begun treatment, compared with 4 percent and 2 percent, respectively, for those in the usual-care group.

IOM workshop report
A workshop report released by the Institute of Medicine (IOM) explores how patients and their families can become more effective partners in their care. The report considers how improving patient engagement may reduce costs, improve the quality of care, and promote continuous learning and improvement in health care. Successful strategies, including new ways to talk with patients about complex health information and new tools and strategies that involve patients in making decisions about treatments and their care, were highlighted.

Knee arthroscopy and ACL reconstruction
Knee arthroscopy and knee anterior cruciate ligament (ACL) reconstruction are cost-effective procedures, according to a study published in Arthroscopy (October). The retrospective analysis of prospectively collected data from a single-surgeon outcomes registry covering two cohorts—surgically treated knee arthroscopy and ACL reconstruction—found that, at mean follow-up of 2.1 years, the cost per quality adjusted life-year was $5,783 for arthroscopy and $10,326 for ACL reconstruction.

CMS releases ACO final rule
The U.S. Centers for Medicare & Medicaid Services (CMS) has released its final rule regarding the implementation of shared savings programs, commonly referred to as accountable care organizations (ACOs). ACOs are arrangements among healthcare providers designed to reduce healthcare expenses through improved care coordination and higher-quality care, and are called for under the Patient Protection and Affordable Care Act. Under the ACO rule, providers that achieve certain quality and cost goals will be eligible for bonuses based on savings. Notable points in the final rule include:

  • Greater flexibility allowed in board and governance structures
  • Modifications to methods for assigning beneficiaries to allow for preliminary prospective assignment followed by retrospective reconciliation
  • Enhanced data sharing with participants
  • Increase in financial incentives to participate
  • Reduction in number of quality measures that ACOs will have to meet to qualify for performance from 65 to 33
  • Elimination of requirement for 50 percent of primary care physicians to be meaningful users of electronic medical records
  • An advanced-payment program for small physician-owned and rural hospitals that lack capital to start an ACO
  • Elimination of mandatory antitrust review and expansion of waivers under provisions of the physician self-referral law, the federal anti-kickback statute, and penalties law will not apply to ACO providers

More physician employment by hospitals expected
A report released by HealthLeaders Media finds that, during the 12 to 36 months leading up to the survey, 67 percent of responding hospitals and healthcare systems had received an increase in requests from independent physician groups regarding employment, and 70 percent of respondents expressed plans to employ a greater percentage of physicians in the next 12 to 36 months. Among institutions that plan to employ a greater number of physicians, 39 percent expect to hire more orthopaedists, and 71 percent expect to hire primary care physicians.