Published 10/1/2012

Second Look-Clinical

CMS delays ICD-10 adoption
CMS has delayed implementation of the International Classification of Diseases Version 10 (ICD-10) to Oct. 1, 2014. The change in compliance date will offer healthcare providers and other covered entities more time to prepare and fully test their systems to ensure a smooth and coordinated transition.

Sentinel Event Alert
The Joint Commission has issued a Sentinel Event Alert on the safe use of opioids in hospital settings. The alert includes suggested actions regarding hospital processes, technology, education, and standardized tools that can be used to screen patients for risk factors associated with oversedation and respiratory depression.

FDA recall
The U.S. Food and Drug Administration (FDA) has initiated a Class 1 recall of Synthes Hemostatic Bone Putty manufactured between July 6, 2011, and Dec. 14, 2011. The agency states that the product may ignite if it comes into contact with electrosurgical cautery systems under certain conditions during surgery. Class I recalls are the most serious type of recall and involve situations in which there is a reasonable probability that use of these products will cause serious adverse health consequences or death. AAOS also issued a Patient Safety Member Alert on this recall.

Consensus among NFL physicians on use of Toradol
A task force developed through the NFL Team Physicians Society recommends increased caution and restraint in the use of ketorolac tromethamine (Toradol) in professional football players. The recommendations appear in the journal Sports Health: A Multidisciplinary Approach (September/October). According to the recommendations, ketorolac should be administered only under the direct supervision and order of a team physician, in the lowest effective therapeutic dose, for no more than 5 days. In addition, it should not be used prophylactically or taken concurrently with other NSAIDs.

New rule for electronic claims payments
The U.S. Department of Health and Human Services (HHS) has announced operating rules for making healthcare claims payments electronically and describing adjustments to claims payments. The new rule builds upon industry-wide healthcare electronic fund transfer standards adopted earlier this year and is projected to save between $2.7 billion and $9 billion in administrative costs over the next decade.

Court dismisses challenge to PPACA rule
According to Modern Healthcare, the U.S. Court of Appeals in Houston has dismissed an appeal from the Physician Hospitals of America and the Texas Spine & Joint Hospital challenging a restriction on expansion by physician-owned hospitals. The plaintiffs had asked the court to strike down a section of the PPACA that limits the ability of physician-owned hospitals to expand existing facilities or add new ones. The hospital was unable to complete an already-begun expansion before the PPACA cutoff date.

FTC watching impact of medical consolidation
The Federal Trade Commission (FTC) suspended for 30 days the noncompete clauses in the contracts of cardiologists in Reno, Nev., according to American Medical News (AM News). The action is seen as a sign that the agency is keeping a watchful eye on medical consolidation and may be apt to intervene when it perceives that reduced competition leads to higher prices.

Safety of resident involvement in surgery
A study published online in Archives of Surgery finds that resident involvement in surgical procedures is safe, based on data from the National Surgical Quality Improvement Program database (2005–2007). A comparison of postoperative outcomes for patients whose surgeries were performed with and without resident participation found similar mortality rates across groups and similar individual complication rates, with the exception of superficial surgical site infections (SSI), which was higher in the resident group. The increased superficial SSI rate may be related to the longer surgical times in the resident group.

CMS to penalize hospitals for high readmission rates
According to Kaiser Health News, the U.S. Centers for Medicare & Medicaid Services (CMS) plans to penalize more than 2,000 hospitals due to high readmission rates. The penalties are authorized under the Patient Protection and Affordable Care Act (PPACA) and are part of a multifaceted effort by CMS to use Medicare to implement improvements in healthcare quality. As a group, the hospitals will forfeit about $280 million in Medicare funds during 2013. Overall, 278 hospitals will lose 1 percent of their Medicare reimbursements—the maximum amount allowed by law.

Survey: 93 percent of planned ACOs “physician-driven”
Survey data released by the Commonwealth Fund find that 13 percent of 1,672 hospitals surveyed are either participating in or planning to participate in accountable care organizations (ACOs) during the next year. Of those, 93 percent were described as physician-driven—created as joint ventures between hospitals and physicians or physician-led.

Survey: Physicians burnout
According to data published online in Archives of Internal Medicine (AIM), burnout is more common among physicians than among other workers in the United States; specialty physicians at the front line of care access are at the greatest risk. The survey of 7,288 physicians found that 45 percent of respondents reported at least one symptom of burnout, with the highest rates of burnout among emergency medicine, family medicine, and general internal medicine physicians. Compared with a probability-based sample of 3,442 working adults, physicians were more likely to have symptoms of burnout and to be dissatisfied with work-life balance.

Study: Medicaid patient access falling
A study in the August Health Affairs finds that 31 percent of physicians were unwilling to accept any new Medicaid patients during 2011. Based on data from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement, physicians in smaller practices and those in metropolitan areas were less likely to accept new Medicaid patients. Researchers also found a correlation between higher state Medicaid-to-Medicare fee ratios and an increased likelihood of accepting new Medicaid patients.

Specialists as primary care providers
According to a research letter published online in AIM, 41 percent of patients with primary care needs seek care from a specialist. Based on data from the National Ambulatory Medical Care Survey (NAMCS) in 1999 and 2007, 41 percent of patients visited specialty physicians for either common symptoms and diseases or preventive examinations in 1999, and 41.2 percent of patients visited specialty physicians for primary care needs in 2007.

Impact of acquisitions on hospital costs
A Wall Street Journal article on the effects of hospitals’ acquiring private physician practices states that these acquisitions can increase prices. Physicians who become part of hospital systems may be paid for services at the systems’ rates, which are often higher than what insurers formerly paid them as independent physicians. Services such as imaging scans previously performed at independent facilities may be billed as hospital outpatient procedures, resulting in cost increases.

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).