Orthopedics
Effectiveness of drug-free interventions to reduce pain, opioids after total knee
Editor's Note In this meta-analysis of the effectiveness of nonpharmacological interventions for pain after total knee arthroplasty, electrotherapy and acupuncture were associated with reduced and delayed opioid consumption, but there was low or very low certainty that they improved pain. Continuous passive motion and preoperative exercise did not improve pain…
Orthopedic PSH a prime model for value-based care--Part 2
Organizations that have adopted the perioperative surgical home (PSH) model of patient care have reaped the benefits of improved outcomes and a healthier bottom line. In particular, the PSH has a proven track record for colorectal surgery and orthopedic surgery. In part 1 of this two-part series (OR Manager, August…
CMS proposes canceling two bundled payment models, scaling back a third
Editor's Note The Centers for Medicare & Medicaid Services (CMS) on August 15 announced a proposed rule that would cancel two bundled-payment models and reduce the number of providers required to participate in a third. The proposed rule would cancel the Episode Payment Models and the Cardiac Rehabilitation incentive payment…
Hospitals partnering with ASCs to perform outpatient total joints
Editor's Note With the growth of ambulatory surgeries and the shift to Medicare reimbursement for outpatient hip and knee replacements, hospitals are acquiring and forming joint ventures with ambulatory surgery centers (ASCs), the August 5 Modern Healthcare reports. This allows hospitals to keep part of the revenue and better aligns…
Trends in treating total joint patients with OSA
Editor's Note This population-based analysis finds that implementation of obstructive sleep apnea (OSA) interventions in total joint patients is limited, with some current trends virtually in contrast to practice guidelines. Of more than 1 million patients analyzed, anesthetic techniques did not differ by OSA status, and overall, less than 25%…
CMS proposes paying for outpatient total joints
Editor's Note The Centers for Medicare & Medicaid Services on July 13 issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System. Among the proposals are that Medicare pay for knee replacement procedures performed in outpatient…
AHRQ: Review of VTE prophylaxis in orthopedic surgery
Editor's Note A new report from the Agency for Healthcare Research and Quality (AHRQ) compares the effectiveness of strategies to prevent venous thromboembolism (VTE) in patients having total hip replacement (THR), total knee replacement (TKR), or hip fracture surgery. The study directly compares different types of blood thinners and mechanical…
Orthopedic PSH a prime model for value-based care--Part 1
Uncertainties pepper the healthcare landscape, but the shift to value-based care is expected to continue, even though momentum may slow under the current administration. That means perioperative services leaders must continue to explore new care delivery options such as the perioperative surgical home (sidebar, p 17). “The demand for value…
Joint Commission: Four new performance measures for total joint certification
Editor's Note Four new performance measures are available for the Joint Commission’s Total Hip and Total Knee Replacement (THKR) advanced certification program, the Joint Commission announced on July 5. They are: THKR-1 Regional anesthesia THKR-2 Postoperative ambulation on the day of surgery THKR-3 Discharged to home THKR-4 Preoperative functional/health status…
Study characterizes ED visits after total joint procedures
Editor's Note Emergency department (ED) visits after total joint procedures were numerous and mostly for pain-related diagnoses, and Medicaid patients had almost double the risk of an ED or pain-related ED visit, this study finds. Of 152,783 patients analyzed, 3.42% returned to the inpatient setting and 5.81% visited the ED…
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