Published 8/1/2012

Second Look- Advocacy

Compensation for on-call coverage
Hospitals are changing how they pay physicians for on-call coverage, according to data from the Medical Group Management Association’s “Medical Directorship and On-Call Compensation Survey: 2012 Report Based on 2011 Data.” Data indicate that although a daily stipend is the most frequent payment form, the proportion of physicians who receive it dropped from 33 percent in 2009 to 29.1 percent in 2011. The annual stipend also became less common, dropping from 14 percent in 2009 to 10 percent in 2011. The percentage of physicians receiving payments based on work resource value units (RVUs) grew from 0 percent in 2009 to 2.6 percent in 2011, and 7.5 percent of physicians receive per-shift payments.

Study: Patients overestimate physician reimbursements
A study in the May Journal of Arthroplasty finds that many patients overestimate physician reimbursement for total hip arthroplasty (THA) and total knee arthroplasty (TKA). A survey of 812 people (279 THA patients, 348 TKA patients, and 185 patients who were being evaluated for hip or knee arthritis) found that respondents estimated Medicare payments to physicians at $8,212 for THA (actual average = $1,375) and at $7,196 for TKA (actual average = $1,450).

FDA panel on MoM hip devices
Members of the U.S. Food and Drug Administration (FDA) Orthopaedic and Rehabilitative Devices Panel offered recommendations for follow-up care for patients with metal-on-metal (MoM) hip devices. Panelists heard from FDA presenters, physicians (including AAOS members), and representatives from industry. FDA presenters argued that patients complaining of pain and other symptoms should undergo regular radiographic evaluation and blood testing for metal levels. However, panelists pointed out that blood tests are often inaccurate and interpreting the results can be difficult. Panelists agreed that annual radiographs should be sufficient for patients who are not experiencing pain.

CMS projects jump in healthcare spending
A report released by the Office of the Actuary at the U.S. Centers for Medicare & Medicaid Services (CMS) estimates that U.S. health spending will grow an average of 4.0 percent annually from 2011 through 2013. In 2014, health spending growth is expected to increase to 7.4 percent, as major coverage expansions from the Patient Protection and Affordable Care Act (PPACA) go into effect. Overall, the office predicts that, from 2011 through 2021, national health spending will grow at an average rate of 5.7 percent annually. The data appeared online in Health Affairs.

CMMI adds more testing for ACO model
The U.S. Center for Medicare and Medicaid Innovation (CMMI) has announced an additional round of testing of the Advance Payment Accountable Care Organization (ACO) Model. The Advance Payment ACO Model is designed to test whether physician-owned or rural providers participating in the Medicare Shared Savings Program would benefit from additional start-up resources to build necessary infrastructure. Selected participants will receive upfront and monthly payments, which they can use to make important investments in their care coordination infrastructures. CMMI has added an additional program start date of Jan. 1, 2013.

States won’t participate in Medicaid expansion
Officials in several states want to abandon an expansion of Medicaid in the wake of the U.S. Supreme Court ruling on the PPACA. The Court ruled that Congress did not have the authority to require states to expand their Medicaid programs to include adults who are only slightly above the poverty line, or risk losing federal funding. Under PPACA, the federal government will cover the cost of the Medicaid expansion when it begins in 2014, but over time the states will pay a gradually increasing share, to a maximum of 10 percent.

Study: ED crowding is on the rise
A study published online in the Annals of Emergency Medicine found that emergency department (ED) crowding is getting worse. Based on data from the annual National Hospital Ambulatory Medical Care Surveys (2001 to 2008), ED visits increased 1.9 percent per year. In addition, mean occupancy increased 27 percent during the 8 study years.

These items originally appeared in AAOS Headline News Now, a thrice-weekly enewsletter that keeps AAOS members up to date on clinical, socioeconomic, and political issues, with links to more detailed information. Subscribe at www.aaos.org/news/news.asp (member login required)