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Published 3/1/2019

Second Look—Advocacy

CMS announces new Medicare Part D model

The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation stated that it would tackle Medicare Part D drug spending costs and increase its value-based design model nationwide. Per the new plan, Medicare Part D would take more of the financial burden from patients who max out their insurance limits. CMS estimates the changes would result in about $2 billion in savings for Medicare.

Outpatient centers on the rise

The number of outpatient facilities nearly doubled from 2005 to 2016, jumping from 26,900 to 40,600 nationwide, according to a report from commercial real estate company CBRE. Outpatient care is more affordable and convenient for patients, said Christopher Bodnar, vice chairman of CBRE Healthcare Capital Markets. For providers, this means decompressing their main campuses to allow for more specialty care.

Supreme Court considers risk of fracture with osteoporosis drug

Merck & Co. appeared in the U.S. Supreme Court in response to hundreds of lawsuits alleging the company did not properly warn patients that its osteoporosis drug alendronic acid could result in an increased risk of thigh bone fracture. Some of the court justices noted that the Food and Drug Administration had expressed uncertainty about the potential fracture risk. Two judges suggested that it was Merck’s duty to present the warning appropriately to its consumers.

$120 million hip implant lawsuit settled

Johnson & Johnson’s DePuy Orthopaedics settled a $120 million lawsuit pertaining to its metal-on-metal hip implants. According to the lawsuit, DePuy falsely advertised the lifespan of its ASR XL and Pinnacle Ultamet devices. Despite the company’s claims, many patients required revision surgery within five years. DePuy agreed to maintain records of complaints for the implants. Approximately 10,000 lawsuits have been filed related to the Pinnacle device.

In-house network contracting—To prevent patients from receiving surprise out-of-network bills, several hospital administrations require employees to contract with the same insurance carriers as the hospital. However, this could put doctors at a disadvantage because it gives insurers the upper hand in negotiations.

Record-matching EHRs—A report from the Government Accountability Office (GAO) provided recommendations for consistently matching patient electronic health records (EHRs) across multiple providers. Inaccurate, incomplete, and inconsistent data across different platforms create problems in matching patients to their EHRs, leaving room for error. GAO spoke with various stakeholders to identify challenges in this area, as well as potential solutions.

Healthcare hiring hits record high—The healthcare industry witnessed a spike in new hires in December 2018 that has not been seen since February 1990, according to a report from Modern Healthcare. The article cites a monthly report from the Bureau of Labor Statistics, which states that 50,200 healthcare jobs were added in December 2018. The industry has not added 40,000 new jobs in one month since October 2015. Total healthcare jobs in December 2018 reached 10.79 percent—an all-time high.

Bundled payments for joint replacement—A two-year evaluation of the CMS’ mandatory bundled payments for joint replacements shows modest savings, according to research published in The New England Journal of Medicine (online). The Comprehensive Care for Joint Replacement (CJR) program likely saved around 3 percent per procedure—a reduction largely driven by reduced spending on postacute care facilities. Researchers also believe there was no increase in complications.

Although this payment method has helped to lower costs, AAOS’ Office of Government Relations (OGR) is concerned about the precedence of CJR over the Bundled Payments for Care Improvement (BPCI) Advanced model. Both models need financial, additional clinical, and socioeconomic risk adjustments for complex patients. Additionally, OGR is advocating that CMS reinstate the financial methodology used in BPCI Classic for BPCI Advanced regarding the cap on physician reimbursement.

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).