AAOS Now, July 2017
New Habits Can Better Serve Patients
During a recent meeting of the Patient Safety Committee, Chair David Ring, MD, PhD, facilitated a discussion on how physicians can deal with the conflict between evidence and experience. Participating committee members Dwight Burney, MD; Michael Pinzur, MD; Alan Reznik, MD; Andrew Grose, MD; and Michael Marks, MD, shared strategies. Dr Ring: As physicians, we all have ways of dealing with the limits of modern medicine—habits we fall back on when we face difficult situations.
Patient-Reported Outcome Measures for Research, Reimbursement, and Point of Care
Patient-reported outcome measures (PROMs) have become more common over the past 30 years. Providers have been exposed to PROMs through the reporting of performance measures for the Physician Quality Reporting System and payment reform efforts such as the Merit-based Incentive Payment System track in the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA).
Abnormal Elbow Findings Identified in Little League Throwers
A study of Little League baseball players before and after a season of play found that arm pain and MRI abnormalities of the medial elbow were common even in players who complied with the Little League throwing guidelines, especially those who played year round. Study data also support the conclusion that pain and injury are more closely related to the cumulative number of throws and not necessarily the number of pitches in a given game.
Addressing the Opioid Epidemic
Although many patients may benefit from opioid medications, abuse of prescription opioids is a serious problem responsible for nearly 50 deaths a day and thousands of emergency department visits a year. For example, the number of emergencies related to nonmedical use of opioids increased 183 percent between 2004 and 2011. In response, state governments passed nearly 60 laws in 2015 aimed at curbing the opioid epidemic.
Transforming Clinical Practice Initiatives and MIPS
Under the Medicare Access and CHIP Reauthorization Act, The Quality Payment Program (QPP) replaces the sustainable growth rate formula in determining physician reimbursement by Medicare. The QPP replaces three previous programs—the physician quality reporting system, the value-based modifier, and meaningful use. In their stead is one budget-neutral program, the Merit-based Incentive Payment System (MIPS).
Staying out of Trouble Prescribing Controlled Substances
Physician and public awareness of issues related to opioid use has skyrocketed over the past several years. Prescription drug abusers outnumber those who use all other "street" drugs except marijuana, and twice as many deaths are caused by prescription opioids than heroin. Every state except Missouri now has a Prescription Drug Monitoring Program (PDMP) that tabulates and distributes data about federally controlled substances that are prescribed and dispensed.
Rethinking Recovery after Orthopaedic Injury
Although acute pain is a normal part of recovery after musculoskeletal injury, it is less clear why some patients fully recover while others continue to experience pain and disability months and years after the initial event. A growing body of evidence demonstrates that psychosocial factors explain at least some of the transition from acute pain to chronic pain and disability.
Orthopaedic Practice in the United States
Every 2 years, the AAOS research, quality, & scientific affairs department gathers demographic and practice data on orthopaedic surgeons through the Orthopaedic Practice in the United States (OPUS) Survey, also known as the Census Survey. The most recent data comes from the 2016 Census Survey, which had a response rate of 26 percent.