What’s to be done about the uninsured?

James H. Herndon, MD; Mary Ann Porucznik

According to the latest statistics from the U.S. Census Bureau, 44.8 million Americans—approximately 15 percent of the total U.S. population—have no health insurance. And the numbers are increasing. Current predictions are that one in four Americans will be uninsured by 2013—just six years from now. For those of us who compose America’s healthcare delivery system, this statistic should be alarming.

Once bitten, twice shy: Choosing the right practice the first time

Andrew M. Wong, MD; Brian J. Hartigan, MD

Did you know that up to half of new orthopaedic surgeons will change their practice situation within the first two years? During an average career, ortho-paedists may change practices two or three times. Although changing a practice is common, it’s also costly in terms of money, marital and family stress, professional productivity, and personal satisfaction.

Reducing OR inefficiencies improves financial results

Craig R. Mahoney, MD

Process improvement can result in a better bottom line for you—and your hospital Orthopaedic surgeons frequently complain about operating room (OR) inefficiencies, specifically the turnover time between consecutive total joint arthroplasties. At a recent meeting I attended, this was the most common concern, and many audience members provided testimonials on the strategies they had used to improve turnover time in their individual hospitals.

Increasing diversity sparks demand for cultural competency

Elaine Fiedler

Have you taken a good look at your patient population recently? If so, you’ve probably noticed that it’s a lot more diverse now than it was 10 or 15 years ago. In part, the change is due to the nation’s shifting demographics. Currently, minorities make up about 32 percent of the U.S. population—up from 25 percent in 1990—and their numbers are continuing to increase. According to Census Bureau projections, minorities will comprise almost 35 percent of the U.S.

The aging surgeon: How old is too old?

Charles D. Hummer III, MD

Despite what many physicians and the public at large may believe, no chronologically based definition of physician competence exists in the U.S. According to a representative of the Federation of State Medical Boards (FSMB), advanced age is not considered a potentially disqualifying criterion for holding an unrestricted medical license in any state, although some states have established a minimum age for physician licensure.

Contingency plan does not eliminate need for NPI

Steven E. Fisher, MBA

It’s still true: Orthopaedic surgeons, as covered entities (CEs) under the Health Insurance Portability and Accountability Act (HIPAA), are required to have applied for, and received, a National Provider Identifier (NPI) by May 23, 2007. Even though the Centers for Medicare and Medicaid Services (CMS) has issued a “contingency plan,” the requirement for CEs to have and use an NPI hasn’t changed. So why have a plan?

Do the uninsured present a higher liability risk?

David E. Attarian, MD

Within the context of the current medical malpractice crisis, one approach to managing risk and reducing potential liability is to practice negative defensive medicine. In this approach, a physician would attempt to identify categories of patients and/or conditions that are perceived to present an increased risk of litigation and to avoid treating those patients.

A simple system for coding E/M services

James Davidson, MD

Editor’s Note: This information has been updated Updating office E/M coding Four tables and a point system help determine Evaluation and Management coding As a practicing orthopaedic surgeon, I am required to properly code for Evaluation and Management (E/M) of patients at every office visit. Unfortunately, the rules for E/M coding are both lengthy and very specific, and the charts designed to assist orthopaedic surgeons in properly coding E/M services are cumbersome.

Where to go for more information on the NPI

National Plan and Provider Enumeration System Web site: https://nppes.cms.hhs.gov/NPPES CMS NPI Information: www.cms.hhs.gov/NPS/ National Standard Health Care Provider data: www.hipaadvisory.com/data Federal Register, Vol. 69, No. 15, Jan. 23, 2004: www.gpoaccess.gov/.html To see the full text of the contingency plan, go to http://www.cms.hhs.gov/NPS.pdf The AAOS online Practice Management Center and the March/April issue of AAOS Now also have information on the NPI.

The ins and outs of coding for hip resurfacing

Mary LeGrand, RN, MA, CCS-P, CPC, with M. Bradford Henley, MD, MBA; Frank R. Voss, MD; Kevin J. Bozic, MD, MBA; Robert L. Barrack, MD; Thomas P. Schmalzried, MD

Coding for a total hip arthroplasty using resurfacing implants was last addressed in the October 2005 AAOS Bulletin. At that time, the AAOS Coding, Coverage, and Reimbursement Committee recommended using the hemiarthroplasty code when only the femoral side of the joint was replaced. But what code or codes should be reported when both the femoral head and acetabulum are treated with resurfacing implants?