Published 7/1/2012

Second Look- Advocacy

CMS delays “Sunshine Act” implementation
Modern Physician
reported that the U.S. Centers for Medicare & Medicaid Services (CMS) has extended the deadline for implementation of the Physician Payments Sunshine Act until at least Jan. 1, 2013. The initiative is called for under the Patient Protection and Affordable Care Act (PPACA), and requires drug and device manufacturers to report gifts and payments to physicians and teaching hospitals.

Study: Drivers of cost increases
Findings from a study in Health Affairs (May) suggest that certain hospitals have used increased market clout to negotiate payment gains from insurers, at the expense of consumers and smaller institutions. Based on data from the Community Tracking Study, the authors found nuanced factors for increased negotiating leverage, including consolidation and the fact that certain institutions are categorized by insurers as “must-have” providers to attract employers and consumers. Because insurers can pass along increased costs to employers and their workers, a range of approaches should be examined to address the consequences of growing provider market clout.

Study: Last decade saw reduced patient access to health care
A study in Health Affairs (May) found that access to health care and use of health services for adults aged 19 to 64 years deteriorated between 2000 and 2010, particularly among the uninsured. Over the same period, access for children—many of whom qualify for public coverage through Medicaid and the Children’s Health Insurance Program—was generally maintained or improved. During the study period, enrollment in Medicaid substantially increased.

SGR repeal bill introduced in House
Medscape Today
reports that a bipartisan bill introduced in the U.S. House of Representatives would, if enacted, repeal the Medicare sustainable growth rate (SGR) formula. Among other things, the bill proposes freezing 2013 reimbursement rates at 2012 levels, followed by a 3-year period in which primary care reimbursements would increase more rapidly than payments for specialty care. The bill would also implement a new payment model in 2018 that would reward “high quality, high value care” instead of volume of services. To cover the cost of repealing the SGR (estimated at $316 billion over the next decade), the bill would use future savings from the military pull-outs from Iraq and Afghanistan.

Trends in liability claims
A study in Archives of Internal Medicine looks at trends in medical liability cases. Of 10,056 closed claims that involved some cost to the defense, 55.2 percent resulted in litigation and 54.1 percent of litigated cases were dismissed by the court. Overall, 4.5 percent of suits concluded in a trial verdict, with 79.6 percent of such cases decided in favor of the physician. The mean time required to close a medical liability claim was 19.0 months.

FDA: Assess patients on bisphosphonates at 3 to 5 years
A perspective piece in the New England Journal of Medicine (May 9) recommends caution in switching between bisphosphonates and other potent antiresorptive medications. A review of available data by the U.S. Food and Drug Administration (FDA) found that three bisphosphonates (alendronate, zoledronic acid, and risendronate) were similar in terms of mean treatment-related increases in bone mineral density through 5 years. However, the agency found inconsistent benefit in terms of fracture protection from continued bisphosphonate therapy. Further investigation into benefits and risks of long-term bisphosphonate therapy, as well as surveillance of fracture risk after discontinuation of bisphosphonate therapy, are needed. FDA states that patients at low risk for fracture may be good candidates for discontinuation of bisphosphonate therapy after 3 to 5 years, whereas patients at increased risk for fracture may benefit further from continued bisphosphonate therapy.

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)