Published 12/1/2013

Second Look—Advocacy

SGR repeal draft released
The Senate Finance and the House Ways and Means Committees have released draft legislation that would repeal Medicare’s sustainable growth rate (SGR) formula, freeze physician payment levels through 2023, and create a performance-based incentive program in 2017.

The incentive program would assess eligible professionals’ performance in quality, resource use, clinical practice improvement activities, and electronic health records’ meaningful use. Doctors who receive a significant portion of their revenue from some alternative payment model (such as an accountable care organization or bundled payment model) would be exempt from the program and instead receive a bonus payment starting in 2016.

The draft would also require providers to consult appropriate use criteria for advanced imaging and electrocardiogram services. The American Association of Orthopaedic Surgeons has submitted comments.

Choosing orthopaedics as a specialty
Findings from a study in The Journal of Bone & Joint Surgery (Oct. 2) suggest that increased exposure to orthopaedic content during medical school and increased female mentorship may help recruit more women into careers in orthopaedic surgery. The survey of 529 orthopaedic residents (114 female) regarding their choice of specialty found sex-associated differences in timing and positive influences linked to residents’ decisions to choose orthopaedics as a specialty. Significantly more women than men believed that acceptance by senior faculty in the field was a barrier to women entering orthopaedic surgery compared with general surgery.

Cost, benefits of physical therapy mandates
Physical therapy mandates by Medicare administrative contractors (MACs) may be ineffective and costly, according to data from a study in The Journal of Arthroplasty (October). Some contractors mandate 3 months of physical therapy prior to arthroplasty even though evidence-based studies documenting the efficacy of physical therapy in treating advanced arthritis are lacking. Researchers argue that medical necessity documentation should be driven proactively by orthopaedists, not retroactively by MACs.

Improving clinical COI standards
Although U.S. medical schools have made significant progress to strengthen their management of clinical conflicts of interest (COIs), most schools still lag behind national standards, according to a study in Academic Medicine (October). The comparison study of clinical COI policies (2008 and 2011) found that nearly two thirds of medical schools still lacked policies to limit ties to industry in at least one area explored, including gifts, meals, drug samples, and payments for travel, consulting, and speaking. No school met all the standards.

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)