Published 1/1/2016

Second Look—Advocacy

Healthcare spending
Data released by the U.S. Centers for Medicare & Medicaid Services (CMS) find that per-capita spending on health care in the United States increased by 4.5 percent during 2014, while overall health spending grew by 5.3 percent. CMS notes that healthcare spending grew 1.2 percentage points faster than the overall economy in 2014, resulting in a 0.2 percentage-point increase in the health spending share of gross domestic product, from 17.3 percent to 17.5 percent. The report states that the increase in spending growth was driven primarily by an expansion of coverage under the ACA and a rise in prescription drug costs.

Deaths due to HACs
A report released by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) estimates that a reduction in hospital-acquired conditions (HACs) from 2010 to 2014 was associated with 87,000 fewer patient deaths in hospitals and a nearly $20 billion reduction in healthcare costs. Researchers analyzed the incidence of selected avoidable HACs in 2014 compared to 2010 rates, and found that hospital patients experienced 2.1 million fewer HACs—a 17 percent decline over that period.

Narrow networks
Among other things, a rule released by CMS attempts to address the effect on consumers of narrow provider networks under health plans sold on the federal Affordable Care Act (ACA) insurance exchange during 2017. Under the Proposed Notice of Benefit and Payment Parameters for 2017, insurers would be required to provide written notice to enrollees of discontinuation of a provider "30 days prior to the effective date of the change or otherwise as soon as practicable."

If the provider is terminated without cause, a second provision would require the insurer to allow an affected enrollee to continue treatment until the treatment is complete or for 90 days (whichever is shorter) at in-network cost-sharing rates. Further, CMS proposes that insurers be required to count cost sharing charged to the enrollee for certain out-of-network services (provided at an in-network facility) towards the enrollee's annual limitation on cost sharing.

Modifications to orthopaedic devices after FDA approval
Findings published online in the journal Clinical Orthopaedics and Related Research suggest that considerable device modification may occur after medical devices are brought to market after undergoing the U.S. Food and Drug Administration (FDA) premarket approval (PMA) process. The authors reviewed information on 70 PMA-approved orthopaedic devices (34 peripheral joint and 18 spinal implants or prostheses, plus 18 other devices or materials). The devices underwent a median 6.5 postmarket changes during their lifespan, or 1.0 changes per device-year. Overall, the rate of new postmarket device changes approved per active device increased from fewer than 0.5 device changes per year in 1983 to just fewer than 3.0 device changes per year in 2014. Among 765 total postmarket changes across all devices, 172 changes altered device design or components

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.