Published 6/1/2017

Second Look – Advocacy

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)

Surgical checklists
Data published in the Annals of Surgery (online) suggest that implementation of a checklist-based surgical quality improvement program may reduce mortality following inpatient surgery. The authors drew information from a state-wide all-payer discharge claims database to compare 30-day postoperative mortality rates after inpatient surgery. Overall, 14 hospitals completed participation in a voluntary checklist-based quality program. The authors found that the risk-adjusted 30-day mortality among completers was 3.38 percent in 2010 and 2.84 percent in 2013, compared to other hospitals (n = 44) in which 30-day mortality was 3.50 percent in 2010 and 3.71 percent in 2013.

MIPS participation
The U.S. Centers for Medicare & Medicaid Services (CMS) has issued a reminder for groups participating in the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program. The agency states that groups are not required to register unless they wish to use the CMS web interface and/or Consumer Assessment of Healthcare Providers & Systems for MIPS Survey. If they plan to use the web interface or the survey, they must register by June 30, 2017. For 2017, only groups of 25 or more eligible clinicians that have registered can report via the CMS web interface. In addition, groups that participate in MIPS through qualified registry, qualified clinical data registry, or electronic health record data submission mechanisms do not need to register.

Medicare Administrative Contractors will soon send letters to physician practices that describe the status of each clinician's participation. CMS states that clinicians should participate in MIPS for the 2017 transition year if they bill more than $30,000 in Medicare Part B allowed charges a year and provide care for more than 100 Part B-enrolled Medicare beneficiaries each year.

EHR Incentive Programs and QPP
In a letter to the secretary of the U.S. Department of Health and Human Services (HHS), the Healthcare Information and Management Systems Society (HIMSS) has recommended delaying by 6 months—to July 1, 2018—the start date for using the 2015 Edition Health IT Certification Criteria under the Electronic Health Record (EHR) Incentive Programs and Quality Payment Program (QPP). The organization states that doing so would increase the likelihood that providers, vendors, and consultants have the necessary time to fully test and implement the criteria to ensure their safe, effective, and efficient implementation.

Physician compensation
Medscape has released its Physician Compensation Report 2017, in which orthopaedics again tops the list of highest-paid specialties. The report states that average annual pay for self-employed specialist physicians is $368,000, compared to $278,000 for employed specialists. In addition, it finds a 37 percent pay gap between male and female specialists overall, but notes that some of that trend may be explained by a smaller percentage of women among higher-reimbursed specialties. Overall, 68 percent of emergency medicine physicians and 48 percent of orthopaedists described themselves as fairly compensated. The report also notes a strong upward trend in physicians who participate in accountable care organizations, from 3 percent in 2012 to 36 percent in 2017.

Female physician pay gap
STAT reports on a survey conducted by Doximity, which finds that male physicians make more money than female physicians across every specialty and in every metropolitan area surveyed. After adjustment, the survey of more than 36,000 physicians notes an average pay gap of about 26.5 percent nationally. Mississippi and Arkansas displayed the largest pay gap of 47 percent; Hawaii had the smallest at 18 percent.

Trauma center access
A report from the U.S. Government Accountability Office (GAO) finds that only 57 percent of 73.7 million children in the United States during the period 2011-2015 lived within 30 miles of a pediatric trauma center. The proportion of children who lived within 30 miles of a pediatric trauma center varied widely among the states. The writers say that some studies have found that children treated at pediatric trauma centers have a lower mortality risk compared to those treated at adult trauma centers and other facilities, although other studies found no difference in mortality. The GAO states that, as overall mortality is low among severely injured children, additional information on outcomes other than mortality may be required to fully assess the effect of a lack of access to pediatric trauma centers.

A study of primary care published in JAMA Internal Medicine (online) suggests that hospital employment of physicians may be associated with increased use of low-value imaging and increased specialty referrals. The research team reviewed data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey on 31,162 patient visits for upper respiratory tract infection, back pain, and headache. Compared with visits to community-based physicians, they found that hospital-based visits were associated with higher likelihood of orders for computed tomography and magnetic resonance imaging, radiographs, and specialty referrals. With the exception of specialty referrals, which were more frequent in hospital-owned community-based practices, the research team found that practice patterns were similar across hospital-owned and physician-owned community-based practices.

A study published in Medical Care (March) finds little association between The Leapfrog Group's voluntary Safe Practices Score (SPS) and compulsory Medicare outcomes and penalties. The researchers compared 2013 data from Leapfrog Hospital Safety Scores against central line-associated bloodstream infection and catheter-associated urinary tract infection standardized infection ratios (SIRs), and Hospital Readmission and Hospital-Acquired Condition (HAC) Reduction Program penalties incorporating 2013 performance. They found that no SPS measures were associated with SIRs, and only one SPS (feedback) was associated with reduced likelihood of HAC penalization. "With increasing compulsory reporting," the researchers write, "Leapfrog SPS seems limited for comparing hospital performance."

Medicare payment policies
CMS has issued a proposed rule to update 2018 Medicare payment and policies pertaining to when patients are admitted into hospitals. The proposed rule is designed to relieve regulatory burdens for providers and promote transparency, flexibility, and innovation in delivery of care. Among other things, the proposed rule includes the following:

  • changes to the FY 2017 and FY 2018 reporting periods for Clinical Quality Measures (CQMs)
  • alignment of specific CQMs available to eligible professionals participating in the Medicaid EHR Incentive Program with those available to professionals participating in MIPS
  • no payment adjustments to eligible professionals who furnish "substantially all" of their services in an ambulatory surgical center (ASC)

The agency will accept comments on the proposed rule until June 13, 2017.

Facility inspection findings
An article produced by NPR and ProPublica states that CMS is considering requiring private healthcare accreditors to publicly identify issues noted during medical facility inspections, as well as steps being taken to address them. A CMS report issued last year found that accrediting organizations often missed serious deficiencies found soon after by state inspectors. The writer notes that government inspection reports generally offer a detailed description of issues noted during inspections, but many private accrediting organizations do not, leading to a "patchwork" situation in which some inspections are public and others are not. The writer states that nearly nine in 10 hospitals are directly overseen by private accreditors.

Off-label promotion
The Arizona Republic reports that the state of Arizona has enacted a law that allows manufacturers to promote off-label uses of drugs and medical devices. The measure will allow company representatives to share information with medical practitioners as long as it is "not misleading, not contrary to fact and consistent with generally accepted scientific principles." Critics of the move argue that off-label promotion could lead to improper prescribing, wasteful spending, and inappropriate treatment for patients. Despite the new law, some observers note that manufacturers may be hesitant to change current promotional practices, as they must answer to the U.S. Food and Drug Administration under federal law.