Published 2/1/2014

Second Look—Advocacy

ED use by Medicaid beneficiaries
Data in Science (January) suggest that increasing coverage under Medicaid may significantly increase overall use of hospital emergency departments (EDs). At 18 months after the initiation of Medicaid expansion to 25,000 Oregonians, researchers found that Medicaid coverage increased overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group. The increases persisted across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.

Hospital rankings for THA, TKA
The U.S. Centers for Medicare & Medicaid Services (CMS) has published a list of 97 hospitals where patients tended to have the smoothest recoveries after total hip arthroplasty (THA) and total knee arthroplasty (TKA), as well as a list of 95 hospitals where patients were more likely to see significant setbacks after such procedures. About 95 percent of hospitals were ranked as average. Factors considered included 30-day readmissions and serious complications such as blood clots, infections, problems with the artificial joints, or death. The data was collected from July 2009 through June 2012.

Physician shortage looming?
An article on The Pew Charitable Trust’s website looks at possible healthcare provider shortages in the wake of implementation of the Affordable Care Act (ACA). Although new technologies and midlevel medical providers may improve access in the long-term, the Association of American Medical Colleges estimates a shortage of 45,000 primary care physicians and 46,000 specialists by 2020.

Could specialty practices be medical homes?
According to Modern Healthcare, current proposals under consideration in Congress to replace the Medicare Sustainable Growth Rate (SGR) formula with an alternative system include measures that would reward specialty practices for services typically associated with medical homes, such as non–face-to-face care-management services for patients with two or more chronic conditions.

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)