AAOS Now, All Articles
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The Financial Impact of CMS’ Two-midnight Rule
When the Centers for Medicare & Medicaid Services removed total knee arthroplasty from the inpatient-only list, institutions had to employ the two-midnight rule to short-stay (one-midnight) inpatient hospitalizations.
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Survey Asks Orthopaedic Fellows How Medical Debt Impacts Life and Career
In a new study, researchers discovered that the massive burden of educational debt not only severely impacts orthopaedic fellows’ bank accounts and career choices, but also plays a significant role in their life decisions.
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AAOS Advocacy Efforts Address the BPCI Advanced Model
Almost a year ago, the Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payments for Care Improvement (BPCI) Advanced model as part of its ongoing bundled payment initiative through the Center for Medicare & Medicaid Innovation (CMMI). The voluntary, episode-based program ties payments to quality performance and requires that participants bear financial risk and use certified electronic health record technology.
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The Debate Continues Over Surprise Medical Billing
Editor’s note: This article is a follow-up to a September 2019 AAOS Now article titled, “Action Is Needed for the Right Solution to Surprise Billing.” This article was up to date as of mid-March. Read the online version for any updates on this issue.
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CMS’ Elimination of the IPO List Would Have Consequences
In its 2021 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (ASC) proposed rule, the Centers for Medicare & Medicaid Services (CMS) proposed eliminating the inpatient-only (IPO) list over the next three years, beginning with 266 musculoskeletal services in 2021.
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2021 MPFS: What It Means for Your THA and TKA Reimbursement
On Dec. 1, 2020, the Centers for Medicare & Medicaid Services (CMS) released the finalized 2021 Medicare Physician Fee Schedule (MPFS).
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CMS Revisits the Quality Payment Program
Over the years, the Centers for Medicare & Medicaid Services (CMS) has experimented with ways to shift reimbursement from fee-for-service models to programs that incentivize high-quality, low-cost care.
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Orthopaedic Advocacy Week Advances Three AAOS Policy Priorities
AAOS members dedicated May 24–28, 2021, to amplifying yearlong advocacy efforts during the first-ever Orthopaedic Advocacy Week.
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AAOS Responds to the IPO Elimination Reversal in 2022 CMS Outpatient Rule
On July 19, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year 2022 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.
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CMS’ Proposed Payment Policy Changes for 2022 Are Significant
In July, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated proposed rules for the calendar year (CY) 2022 Medicare Physician Fee Schedule (PFS) and the CY 2022 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC).
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A No-nonsense Explanation of the Impending Cuts to Your Medicare Reimbursements
I have been studying healthcare policy for the past 15 years. Even after all this time, I still find some of the rules and legislation that come out of Washington, D.C., to be incredibly confusing and unnecessarily complex.
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AAOS and Other Physician Groups Denounce Regulators’ Implementation of No Surprises Act
AAOS and other organizations representing more than 140,000 physicians on the front lines of healthcare delivery strongly oppose the Biden administration’s giveaway to insurance companies in its rule to define the independent dispute-resolution (IDR) process established in the No Surprises Act.
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Problematic Laws: A Stark Law Case Study
This article, the final in the Advocacy 101 series, addresses what we have casually called “problematic legislation.”
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AAOS Continues Surprise Billing Fight
The AAOS Office of Government Relations has been focused on protecting patients from surprise medical bills and ensuring a fair process for payment dispute resolution since the issue first came into the national spotlight in 2019.
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AAOS’ Advocacy Efforts Focus on Access to Quality Care
This article and the next installment will specifically address quality of care.
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Podcast Episode Addresses Uptick in Healthcare Workplace Violence and Efforts to Mitigate Risks
Workplace violence occurs in healthcare settings four times more often than in any other setting. Leaders within the orthopaedic community have taken strides to address this increase in violence.
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Gold Card Legislation Can Aid in Prior Authorization Reform
Gold card legislation is one tool that can be used to curb the overutilization of prior authorization requirements.
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Why Should Employed Surgeons Care about Advocacy Issues?
Editor’s note: This article is the final installment of the series Advocacy 201, which focused on the work of the Advocacy Council to improve the practice of orthopaedic surgery.
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Interview with Advocacy Council Chair Adam J. Bruggeman, MD, Covers Regulatory Opportunities to Address Prior Authorization
Alexandra Page, MD, FAAOS, deputy editor of AAOS Now, had the opportunity to speak with Adam J. Bruggeman, MD, FAAOS, FAOA, the new chair of the AAOS Advocacy Council.
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AAOS Comments on Proposed Medicare Payment Policy Changes for 2024
On Sept. 8, AAOS issued formal comments to the Centers for Medicare & Medicaid Services on the agency’s proposed payment policy changes in the Medicare program for calendar year 2024.
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CMS Finalized Changes for 2024 Medicare Payment Systems
Late in 2023, the Centers for Medicare & Medicaid Services finalized changes for the 2024 Inpatient Prospective Payment System, Medicare Physician Fee Schedule, and Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System.
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Dr. Glaucomflecken Inspires Advocacy through Comedy at OrthoPAC Luncheon
On Tuesday afternoon, hundreds of people flooded the annual donor appreciation luncheon of the OrthoPAC to laugh and learn from Will Flanary, MD—better known by his 4 million followers on social media as “Dr. Glaucomflecken.”
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Social Media Famous ‘Dr. Glaucomflecken’ Inspires Advocacy through Comedy at OrthoPAC Luncheon
At the annual donor appreciation luncheon of the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC), held during the AAOS 2024 Annual Meeting, hundreds of attendees convened to laugh and learn from Will Flanary, MD—better known by his 4 million followers on social media as “Dr. Glaucomflecken.”
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AAOS Leader Speaks to Congress about Cyberattack
When Change Healthcare, the nation’s largest clearinghouse for processing medical claims, was struck by a ransomware cyberattack in February, the ensuing outage exposed significant weaknesses in the U.S. healthcare infrastructure.
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Congress Seeks Input from Advocacy Council Chair Adam Bruggeman, MD, MHA, on Cost of Consolidation
On May 23, Adam Bruggeman, MD, MHA, FAAOS, FAOA, chair of the AAOS Advocacy Council, testified to the House Budget Committee on the consequences of healthcare consolidation.
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A New Era Begins: OrthoPAC’s Success Will Shape Healthcare Advocacy in 119th Congress
In this pivotal moment of change, the OrthoPAC—the only PAC dedicated exclusively to advancing orthopaedic interests—has achieved unprecedented success.
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Congress Averts Year-End Shutdown, Fails to Pass Pay-Cut Relief
On Dec. 21, 2024, President Biden signed a stopgap funding bill into law to prevent a government shutdown and keep the government operating until March 14, 2025.
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Relieving Administrative Burden: How Surgeons, Washington, and Industry Partners Are Working to Reform Prior Authorization
Recent developments in the healthcare industry’s ongoing struggle with prior authorization (PA) requirements have revealed a significant shift in the landscape.
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OrthoPAC Luncheon Dishes Advocacy Updates and Jokes
Will Flanary, MD, ophthalmologist and social media personality more commonly known as “Dr. Glaucomflecken,” made his return to the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) Donor Appreciation Luncheon on Tuesday.
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Commemorating 5 Years of Collective Action through Orthopaedic Advocacy Week
Each year, Orthopaedic Advocacy Week serves as a reminder that advocacy is strongest when collective.
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Collective bargaining may help protect physicians’ rights in a commoditized healthcare system
Unionization — specifically collective bargaining — presents a potential path to reclaim authority, protect patient care, and improve surgeon well-being.
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Adolph J. Yates Jr., MD, shares guidance on navigating new CMS reporting requirements in orthopaedic surgery
The transition to a value-based healthcare system has come with several recent changes in the way orthopaedic care is reported to the Centers for Medicare & Medicaid Services.
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Health Insurance Mergers May Fundamentally Change Market
Recently proposed mergers between the healthcare giants Anthem/Cigna and Aetna/Humana would reduce the number of national health insurance providers from five to just three, spurring questions about the potential effects of reduced competition. In response, a great deal of attention has focused on whether the U.S.
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Residents Transitioning to Practice Need to Fully Understand the Medical Liability System
Clinicians practice within a litigious environment, the nature of which varies depending on practice location and subspecialty. Residents who are transitioning from training into practice, therefore, need to be familiar with the medical liability system and how variation in tort protection laws among states may inform their choice of future practice location.
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The Cons of Alternative Payment Models for Joint Replacement
Healthcare reform has shifted payments from volume- to value-based models with a goal of lowering costs while maintaining or improving outcomes. An unintended consequence of the models, in their current form, is the threat posed to safety net hospitals that traditionally provide greater access to vulnerable populations.
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Payment Policy Changes Proposed for Musculoskeletal Care
In early August, the Centers for Medicare & Medicaid Services (CMS) released the highly anticipated calendar year (CY) 2021 Medicare Physician Fee Schedule (PFS) and the CY 2021 Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS/ASC) proposed rules. The two payment rules, which are published annually, include significant proposed changes to the landscape of musculoskeletal care.
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MICRA Will Be Tested Again in 2022
California has been a national leader in medical malpractice tort reform since the 1970s. In 1975, the Medical Injury Compensation Reform Act (MICRA) was enacted during a special session as a comprehensive plan to support physicians and limit
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Newest Podcast Addresses How AAOS Identifies and Tackles ‘Active Pursuit’ Issues
In the year since AAOS launched “The Bone Beat” podcast, episodes have focused primarily on individual healthcare policy topics affecting the orthopaedic specialty, such as disparities in healthcare, the shift of procedures to the outpatient setting, and the regulatory landscape of biologics.
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Grasstops Advocacy Is a More Targeted, Tactical Approach
Grassroots is a common concept, but people may not be as familiar with the idea of grasstops advocacy. Technically speaking, grasstops advocacy describes the situation when specific opinion leaders are tactically deployed to effect change through the politic.
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Learn More about Advocacy at the AAOS 2021 Annual Meeting
I encourage you to consider four advocacy opportunities at the Annual Meeting: the OrthoPAC booth in the Exhibit Hall, the OrthoPAC Donor Luncheon, the OrthoPAC Resident Leadership Reception, and meeting your state orthopaedic society leaders.
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Understanding Ambulatory Surgical Center Ownership Models
An ambulatory surgical center (ASC) exclusively furnishes outpatient surgical and procedural services with the expectation that patients will not need hospitalization and their stays will not exceed 24 hours.
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Year in Review: AAOS’ Advocacy Efforts Prove Successful
The AAOS Office of Government Relations (OGR) is wrapping up one of the most unusual years that lobbying organizations have experienced in American politics.
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AAOS Files Amicus Brief in Support of Lawsuit Challenging No Surprises Act Rule
The American Association of Orthopaedic Surgeons (AAOS) joined in filing an amicus brief supporting a lawsuit—led by the American Medical Association and the American Hospital Association—that challenges the federal government’s implementation of the No Surprises Act.
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Past Advocacy Podcast Episodes Are Still Timely and Relevant
It has been two years since AAOS launched its advocacy-focused podcast during the virtual 2020 Annual Meeting.
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AAOS Advocacy Podcast Spotlights Trends and Regulatory Response to Practice Consolidation in Healthcare
The AAOS Bone Beat Advocacy Podcast kicked off 2022 with a three-part series on consolidation in healthcare.
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AAOS Is Clear in Its Response to CMS about Proposed Medicare Payment Policy Changes for 2023
The American Association of Orthopaedic Surgeons issued formal comments to the Centers for Medicare & Medicaid Services on the agency’s proposed payment policy changes for calendar year 2023.
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Congress Partially Delays 2023 Medicare Cuts in New Package
Just before the holidays, Congress passed a $1.7 trillion omnibus appropriations bill to fund the federal government. Included in the package was a provision to postpone the 4 percent Pay-As-You-Go (PAYGO) Medicare pay cut slated to begin this year, but Congress fell short of preventing the full 4.5 percent reduction to Medicare Physician Fee Schedule payments. The result is an approximate 2 percent payment reduction in 2023 and at least an additional 1.25 percent in 2024.
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Update on Implementation, Challenges to Surprise Billing Law
It has been nearly three years since the No Surprises Act legislation, which aims to prevent unexpected medical bills for emergent and scheduled services, was signed into law in December 2020.
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AAOS Signs Open Letter about the Rising Risks of Caring for Patient Athletes
In an open letter published June 12, AAOS and 27 other sports medicine organizations voiced concern over the rising complexity and risk associated with providing care to patient athletes.
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Orthopaedic Advocacy Week Concludes with Ask for Members to Stay Involved
The third annual Orthopaedic Advocacy Week took place from July 24 through 28 and was a resounding success.
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A Collaborative Approach Can Improve Value-based Care
In August, AAOS submitted comments to the Center for Medicare and Medicaid Innovation in response to a request for information released in July regarding the development of episode-based payment models.
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AAOS Leaders Advocate for Legislation to Protect Patients and the Profession at Combined NOLC/Fall
As the adage goes, “If you’re not at the table, you’re probably on the menu.” In pursuit of a seat at the table, AAOS members traveled from around the country to Washington, D.C., on Sept. 17 through 21 for the third annual Combined National Orthopaedic Leadership Conference (NOLC)/Fall Meeting.
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Surgeons across the United States Advance AAOS Policy Priorities during Orthopaedic Advocacy Week
The third annual Orthopaedic Advocacy Week took place July 24 to 28, 2023, and gave all AAOS members based in the United States the opportunity to help amplify year-round advocacy efforts to advance musculoskeletal care.
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AAOS Authors White Paper on Tackling Healthcare Consolidation
AAOS authored a comprehensive white paper in April outlining consolidation trends in U.S. healthcare and providing mitigation strategies for Congress to address the issue.
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What Orthopaedic Surgeons Need to Know about 2025 CMS Payment Policy Changes
Throughout the year, AAOS has issued formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed Medicare payment policy changes for calendar year (CY) 2025.
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Adam J. Bruggeman, MD, MHA, Explains the Changing Landscape of Prior-Authorization Reform
AAOS Now Editor-in-Chief Robert M. Orfaly, MD, MBA, FAAOS, sat down with Adam J. Bruggeman, MD, MHA, FAAOS, FAOA, chair of the AAOS Advocacy Council and orthopaedic spine surgeon at Texas Spine Care Center in San Antonio, to discuss how the battle over prior authorization is evolving and gaining momentum through new partnerships and approaches.
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Building on the Success of AAOS 2025, OrthoPAC Prepares for the Next 25 Years of Excellence
The Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) had a strong presence at the AAOS 2025 Annual Meeting in San Diego.
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CMMI’s New Three-Pillar Strategic Plan Will Impact Musculoskeletal Care
Abe Sutton, director of the Center for Medicare and Medicaid Innovation (CMMI), announced the Trump administration’s new vision for the center. CMMI’s work will now center on three pillars.
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Podcast Explores Payment-Reform Challenges and How Advocacy Can Lead to Long-Term Solution
The AAOS Bone Beat Advocacy Podcast has released its latest episode, “The Real-World Cost of Payment Reform for Orthopaedic Surgeons” .
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President Trump signs reconciliation bill with 1-year Medicare payment fix
After months of negotiations, Congress passed the One Big Beautiful Bill Act (H.R. 1) in a party-line vote, and President Donald Trump signed it into law on Friday, July 4.
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Orthopaedic Surgeons Should Prepare for New Laws
The AAOS estimates that approximately 150 new state laws have been passed during the past year that affect the practice of medicine and the patient-physician relationship. This article focuses on a few of the topics the new regulations address. The hottest issues for specialty medicine have been, and will continue to be, network adequacy and balance billing.
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Adapting to a Modernizing Health IT Landscape: AAOS Revises Position Statement
The health information technology (IT) landscape has changed considerably since the early days of the “meaningful use” program.
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Federal Surprise Medical Billing Law Enacted Following Years of Influential AAOS Advocacy
On Dec. 28, 2020, President Donald J. Trump signed the No Surprises Act into law. This legislation will for the first time remove patients from the middle of out-of-network (OoN) billing disputes between healthcare professionals and insurers and create an independent dispute resolution (IDR) process to settle payment amounts.
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Legislators Discuss Prior Authorization Reform
The May episode of AAOS’ advocacy-focused podcast, “The Bone Beat,” centered on a high-priority advocacy initiative: reforming prior authorization and coverage reviews.
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AAOS Comments on Proposed Medicare Payment Policy Changes for 2022
AAOS issued formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed payment policy changes for Calendar Year (CY) 2022.
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New Podcast Episode Dives into the Economic Effects of Medicare Pay Cuts
Orthopaedic surgery is set to face as much as a 10 percent reduction in Medicare reimbursement beginning in 2022.
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New Advocacy Podcast Explores the Economic Effects of Medicare Pay Cuts
Given the policy changes included in the Centers for Medicare and Medicaid Services (CMS) recently released 2022 Medicare Physician Fee Schedule Final Rule, orthopaedic surgery was* set to face an up to 10 percent reduction in Medicare reimbursement beginning in 2022.
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Pandemic Accelerates Transition to ASCs
Editor’s note: This article continues the series on ambulatory surgical centers (ASCs). The first two articles in the series appeared in the October and December issues of AAOS Now and covered ASC ownership models and how they are impacted by Certificate of Need laws. The following article discusses how the COVID-19 pandemic may impact the future of ASCs.
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Coding Coverage and Reimbursement Committee Protects Our Ability to Care for Our Patients
In this article, Douglas W. Lundy, MD, MBA, FAAOS, chair of the AAOS Advocacy Council, examines another Advocacy Council committee: the Coding Coverage and Reimbursement Committee.
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The AAOS Medical Liability Committee
In 2006, I was an AAOS Leadership Fellow attending the National Orthopaedic Leadership Conference in Washington, D.C. David Halsey, MD, FAAOS, was chair of the AAOS Council on Advocacy at that time, and I was awed by the tremendous impact that the Council’s work had on our ability to practice our art.
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Podcast: Orthopaedic Surgeons Share Perspectives on Practice Consolidation in Healthcare
Editor’s note: This article is part two in a series on the AAOS Bone Beat Advocacy Podcast episodes regarding practice consolidation in healthcare. Part one, which spotlighted consolidation trends and regulatory response, was published in the July issue.
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Congressmen Seek to Reduce Prior Authorization Burden
Editor’s note: This article is the second installment in a new series featuring members of Congress who are supported by the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC). The series will feature legislators from different political parties who support bipartisan orthopaedic healthcare policy issues.
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Physician Representatives Introduce Bill to Adjust Medicare Payments to Inflation
This article is part of a series featuring members of Congress who are supported by the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC).
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Final Chance to Prevent 2024 Pay Cuts
As we approach the end of the year, I want to reflect on AAOS’ advocacy efforts to reform Medicare payment policy and offer some insights on the path forward into 2024.
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More about PQRS 2016: What You Need to Know
As we move through the final year of the Physician Quality Reporting System (PQRS) in 2016, some physicians may be looking forward to saying goodbye to this program forever. Those sentiments may be a bit premature. Although the PQRS program in its current form will be ending, PQRS will continue as part of the Merit-Based Incentive Payment System (MIPS). (See cover story, "CMS Releases MACRA Proposed Rule).
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Evidenced-based Advocacy: The Argument for POHs
One of the less-discussed provisions of the Affordable Care Act is the ban on the expansion of existing physician-owned hospitals (POHs) and the formation of new ones. The ban was founded on concerns about physician self-referrals and possible conflicts of interest. Similar concerns led to the passage of the Stark Act in 1989, which prevented self-referral of Medicare patients.
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New Law Repeals Antitrust Exemption for Health Insurers
In December 2020, new legislation, the Competitive Health Insurance Reform Act, was enacted to repeal the McCarran-Ferguson Act. The law now requires health insurers to follow the same free-market rules as nearly every other industry in the United States.
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Podcast: AAOS Members Can Present a United Front when Advocating in a Politically Fragmented Environment
On the August episode of the AAOS Advocacy Podcast, AAOS Advocacy Council Chair and podcast host Douglas Lundy, MD, MBA, FAAOS, sat down with former AAOS President Gerald R. Williams Jr, MD, FAAOS, to discuss unity among members amidst divisive political and social events.
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AAOS Responds to 2023 Final Rules on Medicare Payment Systems
Throughout the year, the American Association of Orthopaedic Surgeons (AAOS) has issued formal comments to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed Medicare payment policy changes for calendar year (CY) 2023.
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What Does the Federal Trade Commission Noncompete Rule Mean for Orthopaedic Practices?
On April 23, in a narrow 3-2 decision, the FTC issued a final rule on noncompete practices in the United States.
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A Unified Approach to Physician Payment Reform Will Help Bring Stability to the U.S. Healthcare System
Adam J. Bruggeman, MD, MHA, FAAOS, FAOA, chair of the AAOS Advocacy Council and orthopaedic spine surgeon at Texas Spine Care Center in San Antonio, discusses the importance of a unified approach to Medicare payment reform.
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CMS shadow bundles represent a call to action for orthopaedic surgeons in the changing healthcare landscape
Since 2010, the Centers for Medicare & Medicaid Services have actively sought to transform U.S. healthcare to a value-based model.
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Cybersecurity Is Not Just a Software and Hardware Issue
Cybersecurity is a growing threat for many industries, particularly health care. Healthcare data are richer in volume and value than financial or retail data, and medical identity fraud takes longer to detect, making the industry an attractive and easy target. Earlier this year, the Department of Health and Human Services (HHS) warned about an increase in ransomware attacks targeting healthcare organizations.
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Patients Over Paperwork Fight Continues
In June, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI), titled “Reducing Administrative Burden to Put Patients Over Paperwork.” The proposal, which CMS Administrator Seema Verma first introduced in October 2017, aims to decrease the regulatory requirements that lead to overly burdensome reporting measures for clinicians.
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Understanding APMs and MIPS
The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) not only replaced the flawed Sustainable Growth Rate model, but also offered a high-level description of a number of new initiatives to decrease cost and improve quality of care for Medicare beneficiaries. Almost a year after the passage of MACRA, implementation of the law continues to evolve with release of regulatory specifics from the Centers for Medicare & Medicaid Services (CMS).
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BPCI, CJR, and Other Emerging Payment Models in Orthopaedics
With the Comprehensive Care for Joint Replacement (CJR) program set to start on April 1, 2016, the AAOS Annual Meeting symposium "Bundled and Emerging Payment Models in Orthopaedics" provided a unique opportunity to evaluate current programs and discuss impending changes in reimbursement. AAOS immediate Past-President provided an overview of the symposium, while Kevin J.
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Out-of-Network Providers, In-Network Hospitals
Health plans with high out-of-pocket expenses and narrow insurance networks continue to grow in the Affordable Care Act (ACA) market exchanges. As a result, balance billing for out-of-network providers at in-network hospitals has become a major issue for regulators, the media, and physicians. Insurance regulators, seeking to fix the problem, have created model legislation that will be debated in nearly every state.
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Meaningful Use Update
On Dec. 28, 2015, President Obama signed the Patient Access and Medicare Protection Act into law. The Act was established to address payment adjustments under the Electronic Health Record (EHR) Incentive Program (meaningful use program) for the 2015 reporting period.
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Eliminate Adverse Events with Integrated Clinical Pathways
The current healthcare environment is forcing hospitals to face uncertain futures and chart new courses as they shift from volume- to value-based systems and business models. According to Ian Morrison, author of The Second Curve: Managing the Velocity of Change, the second curve is the future—new technologies, new consumers, and new markets—and traditional methods of change are not sufficient to enable companies, including healthcare organizations, to survive.
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COVID-19: Elective Surgery Safety Remains a Complex Issue
As hospitals and physicians continue to adapt, there are questions regarding how to proceed with elective surgery in patients who have had COVID-19.
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Enhancing Orthopaedic Surgery Education through Intraoperative Videography
Justin T. Smith, MD, an orthopaedic sports medicine surgeon at Atrium Health Musculoskeletal Institute Orthopedics & Sports Medicine in Rock Hill, S.C., delivered an informative presentation on videography in orthopaedics.
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How Will the Rising Use of GLP-1 Medications Impact Patients and Orthopaedics?
It is impossible to avoid the torrent of ads touting glucagon-like peptide-1 medications. The drugs are still relatively new, and more issues may arise with time.
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Bringing Sustainability to Orthopaedics: Greening the Individual and the Clinic
2023 was the warmest year on Earth since global records began being tracked in 1850.
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3D Printing Is a Promising Alternative for Manufacturing Orthopaedic Implants
The advent of 3D printing has resulted in multiple established uses for this technology in orthopaedic surgery.
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An Aviation Lesson for Surgeons: Why Structured Debriefing Is One Key to Mastery in Orthopaedic Surgery
In high-stakes environments, from surgical suites to the skies, there exists a shared understanding: The job is not finished until the debrief is done.
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Ancillary Services Offer Opportunity for Improved Care, Value, and Pay
"Why do we need to understand ancillary services?" asked Peter L. Althausen, MD, MBA, speaking at the annual meeting of the Orthopaedic Trauma Association. According to Dr. Althausen, providing ancillary services can help enhance the care orthopaedists provide to patients and can also offer ways for physicians to supplement their incomes. Dr.
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Bringing Sustainability to Orthopaedics: Greening the Future of Orthopaedics and Healthcare
The success of society and the orthopaedic specialty depends on how the planet’s limited resources are managed.
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Post COVID-19: Is Orthopaedic Telemedicine Here to Stay?
During the COVID-19 pandemic, the role of orthopaedic virtual visits and telemedicine developed rapidly out of necessity.
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Unequal Access to Orthopaedic Care Fuels Push for Healthcare Reform
The United States’ exorbitantly expensive healthcare system remains inaccessible to many.
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Climbing Revision Arthroplasty Rates Pose Financial Threat to Healthcare System
The aging of the baby-boomer population and advances in implant fixation, which have permitted total hip arthroplasty (THA) and total knee arthroplasty (TKA) to be performed in younger patients, have resulted in a dramatic increase in the number of these procedures.
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Improving Transfer of Information to Optimize Patient Safety
The competing demands of mastering minutiae and working expeditiously create tension for many healthcare providers. Efforts to satisfy both these goals often involve negotiating "efficiency-thoroughness trade-offs," a normal process wherein providers strike a balance between productivity and safety. This is particularly evident when providing patient information during transitions of care.
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Quality Initiative Results in Practice Changes, Cost Savings
A quality improvement project aimed at increasing the use of removable braces instead of casting to treat distal radius buckle fractures (DRBFs) at two pediatric centers changed minds and resulted in significant savings, according to a report presented at the 2017 annual meeting of the American Society for Surgery of the Hand.
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Physiatry in a Orthopaedic Practice Can Be A Win-win for Surgeons and Patients
Twenty years ago, when I was offered the opportunity to join the Peachtree Orthopedics Clinic (POC) in Atlanta, I was honored to be recruited by one of the area’s premier orthopaedic practices. The leaders of POC recognized the need for my services as a nonsurgical specialist. As it turns out, I was the group’s first full-time physiatrist. In 1998, most orthopaedic practices had surgeons who were generalists and only a smattering of subspecialists. POC was different.
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The economic impact of robotic arthroplasty systems is a hurdle to adoption, despite the technology’s promise
Robotic-assisted total hip and knee arthroplasty has gained global traction, but these platforms require substantial initial investment before they can be implemented.
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Patient Safety Experts to Participate in Summit
Despite the many technological advances in health care, surgical adverse events leading to patient harm still exist. As a leader in the patient safety movement, AAOS aims to help healthcare organizations work together to address the many issues and challenges involved in providing safe, high-quality care. Together with the American College of Surgeons, AAOS will sponsor the National Surgical Patient Safety Summit (NSPSS), Aug. 4–5, in Rosemont, Ill.
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Culture of Safety
This feature is the next installment in a series of dialogues among members of the AAOS Patient Safety Committee. This dialogue focuses on how to establish and maintain a culture of safety within an environment in which everyone is expected to err but also champions the teams and systems that catch errors before they cause harm. Dr. Ring: Let’s talk about ideas for creating a culture of safety. Dr.
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Greening the OR through Waste Reduction
Knowledge of the environmental and public health impacts associated with current waste-disposal practices is growing.
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Building the Pipeline: Where Will the Next Generation of Rural Orthopaedic Surgeons Come From?
The path for students from rural areas to become physicians, especially orthopaedic surgeons, is challenging.
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Study: Costs of Certain Orthopaedic Procedures Lower at an ASC
According to research recently published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), direct costs for select orthopaedic procedures were significantly less when these procedures were performed at an ambulatory surgical center (ASC) rather than at a university-based children's hospital (UH).
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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).
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After the Error
In the January 2017 issue of AAOS Now, my coauthor Robert J. MacArthur, MD, shared a first-person account of how a wrong-side knee procedure could occur in the era of Universal Protocol. I—David Ring, MD, PhD—also have a personal story of medical error. In 2008, I published an account of my wrong procedure—a carpal tunnel release in a patient who should have had a trigger finger release—and later spoke about my error at several meetings across the country.
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Surgeons Acknowledge Feelings of Detachment, Fatigue, and Hope about Waste
In a 2021 study in the Journal of Climate Change and Health, Hsu et al found that over 24 hours, a total of 255 kilograms of waste was produced in a community emergency department (ED).
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Matthew Deren, MD, shares how he integrated robotics in his total joint arthroplasty practice more than a decade ago
Matthew Deren, MD, director of the Adult Reconstruction Fellowship at Cleveland Clinic, has been at the forefront of integrating robotic systems into arthroplasty practice over the past decade.
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Rural Orthopaedic Surgeons Face Unique Challenges
There is a growing shortage of orthopaedic surgeons in rural areas of the United States. As the general population ages, the need for musculoskeletal care will continue to increase.
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Using Telemedicine for Orthopaedic Follow-Up
My first experience with using telemedicine for orthopaedic follow-up was in August 2014. I had performed an anterior cruciate ligament reconstruction on a 17-year-old male named Tom, who lived about 90 miles from our hospital. A week later, during a casual conversation with his father, I learned that Tom was doing well recovering at home, but was having trouble adjusting his postoperative brace. Tom's dad asked if I could "FaceTime" with Tom and show him how to adjust it.
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Advances in 3D Printing and Bioprinting May Transform Orthopaedics
In addition to the ability to construct complex or one-off orthopaedic devices, 3D printing has the potential to transform the field of orthopaedic surgery.
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Optimizing Patient Safety while Transferring Information
Patient safety relies, to a significant extent, on healthcare providers' ability to exchange critical information about patients effectively and to properly manage handoffs from one provider to another. Fortunately, a few simple rules for exchanging important patient information have been shown to dramatically increase the likelihood of success.
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Decline in HACs Associated with Cost Savings and Fewer Deaths
All too often, patients enter a hospital with one condition and acquire others during treatment. These hospital-acquired conditions (HACs), as defined by the Centers for Medicare & Medicaid Services (CMS), are common and costly medical complications that could reasonably have been prevented through the application of evidence-based guidelines.
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Advocacy Never Sleeps
The activities and education at the AAOS 2021 Annual Meeting helped set the table for our upcoming 2021 Combined National Orthopaedic Leadership Conference (NOLC)/Fall Meeting, which will be held Sept. 26–29 in Washington, D.C.
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Keeping Our Patients and Ourselves Safe
AAOS Now will cover nonclinical subjects that may be controversial but are clearly on the minds of many members. One such topic will initiate our special coverage this month, as the issue of healthcare workplace safety has been thrust into the spotlight.
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Reflection: The COVID-19 Pandemic Has Changed Orthopaedic Surgery
In the withdrawal following the throes of the pandemic, orthopaedic surgeons are searching for what comes next. The aftermath of COVID-19 on healthcare and its workforce will be long studied. The intersection of a selectively lethal infection, unprecedented social disruption, and the coincident emergence and innovations in telehealth has changed the practice of orthopaedics.
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This Is Not a Job
Distinguishing a profession from a job is riddled with subjectivity and semantics. To me, it relates to the specialization, education, and training required. Professions have ethics and standards that define their practice and are typically self-regulated.
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Global Shortages in Healthcare Professionals: How Do We Reach Human Resource Sustainability in Our Practices?
The theme of this month’s edition of AAOS Now is environmental sustainability, with several excellent articles to spur individual thought and group discussion on the environmental impact of the decisions we all make in our healthcare systems.
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Tip Your Reps: The Service Is Worth the Price
Orthopaedic implant distribution can involve complex, multi-tiered organizations, but I will focus on the person we know from direct contact in our offices and ORs: the industry representative.
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The Medicare Crisis: A Call to Action for Orthopaedic Surgeons
As orthopaedic surgeons, we dedicate our careers to improving the lives of our patients, many of whom rely on Medicare for their healthcare needs.
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From PPE to Saline: How Do We Fix the Healthcare Supply Chain?
Supply-chain disruptions and shortages now seem almost commonplace.
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Vigilante: Prior Authorization Pushes Too Far
At the writing of this column, the killing of UnitedHealthcare CEO Brian Thompson looms large in the news.
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Tariffs May Strain the Fragile Healthcare Supply Chain
It remains probable that tariffs and the uncertainty surrounding them will add to the financial stresses of our suppliers, individual physician practices, and healthcare delivery system as a whole.
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A feeling for the patient
Interpreting results and implementing new surgical techniques should be recognized as tools to enhance, not replace, assessment and treatment of our orthopaedic patients.
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Keep Recurring Meetings Virtual
A virtual-only approach should apply to many meetings—particularly recurring weekly educational meetings and administrative conferences, which are the backbone of the academic orthopaedic mission.
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Gun Violence Claims the Life of Another Orthopaedic Surgeon
Regardless of our political views, I hope we can all agree that we can no longer stand by and bear witness to the brutal murders of our colleagues in their places of work.
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Academic versus Private Practice: Weighing the Pros and Cons
Should an orthopaedic surgeon pursue academic medicine or private practice? Thirty years ago, I was completing my fellowship and pondering that question as I weighed several offers.
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Simple Steps to Connect with Patients May Prove Helpful in the Face of Future Liability
I would like to suggest to readers an additional tip for avoiding medial liability suits that has helped me tremendously during my career: Call your patients the night of their surgery.
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Soup or Syringes?
Editor’s note: The Final Cut is a recurring editorial series written by a member of the AAOS Now Editorial Board.
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Nurturing the Physician-Patient Relationship
Trust is at the heart of every physician-patient relationship. However, several factors in recent years have contributed to the erosion of the physician-patient relationship.
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Standardization Is Innovation
There is an intersection of innovation and value, where change is created that adds value.
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CMS Releases MACRA/Quality Payment Program Final Rule
On Friday, Oct. 14, the U.S. Centers for Medicare & Medicaid Services (CMS) released the final rule for the Medicare Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and replaces the sustainable growth rate formula. The Quality Payment Program has two tracks for payment: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs) (Fig. 1).
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CMS Releases MACRA Proposed Rule
On April 27, 2016, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule detailing, for the first time, the physician reimbursement framework required by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. MACRA, which replaced the flawed Sustainable Growth Rate (SGR) formula, created a new program for physician reimbursement that streamlines quality programs and addresses reporting burdens.
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Orthopaedists Respond
The Atlantic hurricane season has been unusually intense this year, spawning five major hurricanes. Hurricanes Harvey, Irma, and Maria, in particular, were especially destructive due to their intensity, duration, and sheer physical size. Although so many different geographic regions were severely impacted by devastating winds and flooding, the hurricanes did not cause high numbers of musculoskeletal injuries.
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Unsustainable Physician Reimbursement Rates
The United States has the highest per capita healthcare spending in the world. U.S. healthcare costs have outpaced inflation for several years. Over the past 20 years, the federal government has attempted to control costs—specifically Medicare costs. Cost reduction strategies often focus on specific segments of the healthcare market. These segments include hospitals, outpatient facilities, labs, drugs, physicians, rehabilitation, durable medical equipment, etc.
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Disposal of Unused Opioid Medications: Aligning Patient Needs and Provider Expectations
Through the support of a grant from AAOS to the Virginia Orthopaedic Society (VOS), Carilion Clinic Orthopaedics and the Virginia Tech Carilion School of Medicine completed an investigational study of the beliefs, perceptions, and practices regarding opioid medication disposal among orthopaedic patients and providers in southwestern Virginia, which is commonly considered the area west of Roanoke, Va.
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Las Vegas Crisis: Preparation Saves Lives
On Oct. 1, 2017, 59 people were killed and nearly 500 more were injured at a Las Vegas concert in what is classified as the deadliest mass shooting in U.S. history. The tragic event tested the resolve and capacity of the entire healthcare community in Las Vegas. Fortunately, the medical system had prepared for a chaotic, mass-casualty event, and was able to respond to the Route 91 Harvest Festival shooting with an organized, coordinated effort.
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Workshop Attendees Share Best Practices to Increase Patient Collections
After your employees, an orthopaedic surgery practice's two most valuable resources are time and money. In the United States, nearly 40 percent of insured adults are on a high-deductible health plan (HDHP). As a result, an increasing percentage of receivable (A/R) balances are the patient's responsibility. When improperly managed, these balances are difficult to collect and consume large amounts of the billing staff's time. A survey of AAOS/KarenZupko & Associates, Inc.
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AAOS Commits to Strengthening Its Practice Management Portfolio
In early 2018, the AAOS Board of Directors created a Practice Management Task Force to conduct an internal and external assessment of the AAOS practice management portfolio. The goal of the task force was to support the development of the Academy’s practice management portfolio, reinforce the education strategy, enhance member value, and drive incremental revenue.
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State and Federal Solutions to ‘Surprise Billing’
AAOS Now has covered out-of-network (OoN) billing in several previous articles, but the subject remains active in many state and federal legislative bodies. This article focuses on pending legislation and other potential solutions to address OoN billing as of May 1. (See the sidebar for a more recent legislative update.) Since the passage of the Affordable Care Act, insurers have increasingly offered products with narrow, inadequate, and nontransparent networks.
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Everything is going up but your payments
By Robert C. Fine, JD, CAE; Robert Jasak, JD; and Matthew Twetten Orthopaedists face 11+ percent Medicare payment cut Orthopaedists are facing possible across-the-board Medicare payment cuts of more than 11 percent, starting in January 2008. Physicians in other specialties are facing similar payment cuts. If these cuts take place, they will be among the largest since the “resource-based” Medicare physician payment system started in 1992.
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Code Blue: America’s emergency care system
Is the crisis in emergency care threatening our ability to deal with trauma? In October 2006, the AAOS Bulletin reported on the growing crisis in emergency care, including the challenges facing orthopaedists who take call. A year later, it seems that little has changed, except for the intensity of the problem.
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How many orthopaedists does it take to...?
Is the United States facing a shortage of orthopaedic surgeons? Or are recent calls for more surgeons another false alarm? By Mary Ann Porucznik Last year, the New York Times asked “Who’ll treat us as we get older?” This year, Investor’s Business Daily asked “Is there a doctor in the house?” and Congress Daily AM wondered “Will there be enough physicians?”
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“I’m from the government, and I’m here to help…”
“I’m so envious of the tools you use. Walking around the exhibit floor, I wanted to be an orthopaedic surgeon—and I’ll bet you wish I were one, too!”
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Is the private practice orthopaedist disappearing?
Changing practice patterns are affecting involvement Once, the image of a physician in private practice mirrored “Marcus Welby, MD,” or “Dr. Kildare.” Those days are long gone and, if a report presented at the Board of Councilors fall meeting is accurate, the independent, private-practice orthopaedic surgeon may also be disappearing. That trend could have significant implications for organizations such as the AAOS and state orthopaedic societies. In Oregon, reported Matthew C.
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CMS issues final IPPS rule
Three conditions added to HAC payment policy Under the final inpatient prospective payment system (IPPS) rule updating Medicare payments to hospitals for fiscal year 2009, the Centers for Medicare and Medicaid Services (CMS) added three new conditions to the list of hospital-acquired conditions (HAC) for which Medicare will not pay at the enhanced complication/comorbidity payment level.
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2012 MPFS presents problems for orthopaedics
The 2012 Medicare Physician Fee Schedule (MPFS) final rule, released by the Centers for Medicare & Medicaid Services (CMS) on Oct. 27, 2011, did not contain good news—especially for orthopaedists.
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Making the Case for Orthopaedic Procedures
The explosive growth in the number of costly orthopaedic procedures—including joint replacements, back surgeries, and other treatments—has attracted the attention of legislators, payers, employers, and experts in both health care and economics. Without scientific evidence to support the effectiveness of these procedures, many of these critics are beginning to ask questions.
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Court Upholds Healthcare Reform Law
Madeleine Lovette On June 28, 2012, the Supreme Court of the United States upheld the constitutionality of the Patient Protection and Affordable Care Act (PPACA). The 5–4 decision came as a shock to many, particularly since it was Chief Justice John Roberts who cast the deciding vote.
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As Medicare Costs Rise, Reimbursements Drop
In 1990, Medicare expenditures totaled $111 billion. That number has more than quintupled today. But even as Medicare costs have skyrocketed, the individual payments to physicians for services rendered have plummeted—particularly for surgical procedures.
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Study Takes Close Look at Impact of ACL Surgery
In the second of a series of studies examining the economic impact of orthopaedic procedures, researchers found that outcomes for patients who had appropriately selected anterior cruciate ligament (ACL) reconstruction were both more effective (short- to intermediate-term) and less costly than rehabilitation alone.
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CMS Releases 2015 Fee Schedule Final Rule
The Centers for Medicare and Medicaid Services (CMS) releases its Physician Fee Schedule (PFS) final rule each year, bringing with it changes to physician reimbursement and a variety of related programs. The final rule for year 2015 was released on Oct. 31, 2014, with changes to physician fees, Medicare’s Physician Quality Reporting System (PQRS), the electronic health records (EHR) Meaningful Use program, and other quality and payment initiatives.
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Foggy Forecast for Sunshine Act
During a National Provider Call sponsored by the Medicare Learning Network® in June, providers learned more about how the Centers for Medicare & Medicaid Services (CMS) plans to implement provisions of the Physician Payment Sunshine Act. But the presentations raised even more questions about how physicians can interact with what CMS is calling the “Open Payments Program” and what they will be required to do in the event of a dispute over the information.
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What’s Ahead for Orthopaedic Payments?
How are orthopaedic surgeons going to be paid in the future? What programs will affect the individual orthopaedic surgeon’s income? Will payments become a “zero-sum game” in which some orthopaedic surgeons are winners and others are losers? These and other questions were addressed during the AAOS Board of Councilors (BOC)/Board of Specialty Societies (BOS) Fall Meeting symposium on “The Changing Landscape of Payment Strategies.”
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Orthopaedic Surgeons Get Results at NOLC
The 2015 National Orthopaedic Leadership Conference (NOLC) brought approximately 400 orthopaedic surgeons from around the country to Capitol Hill to talk with legislators about issues important to the orthopaedic community.
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CMS Finalizes Mandatory Bundled Payment Model
On Nov. 16, 2015, the Centers for Medicare & Medicaid Services (CMS) finalized a plan to bundle payment and quality measures for several lower extremity joint replacement procedures. The Comprehensive Care for Joint Replacement (CJR) model was originally announced in July and would have required participation by nearly all hospitals in 75 geographic areas, beginning Jan. 1, 2016.
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Comeback in the Crescent City
Two years after Katrina, New Orleans orthopaedists are rebuilding their practices and their city When Hurricane Katrina struck the Gulf Coast—and New Orleans, in particular—in August 2005, it destroyed entire towns and displaced thousands. After living through the desperate conditions following the hurricane, when civil services came grinding to a halt and much of the city was under water, AAOS members had to put their personal and professional lives back together.
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What’s to be done about the uninsured?
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.
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AAOS responds to DOJ-required disclosures
Academy calls for appropriate disclosure, educational context On Oct. 31, 2007, to comply with settlement agreements reached with the US Attorney of New Jersey (Department of Justice or DOJ), five major orthopaedic hip and knee implant manufacturers disclosed the names and certain financial information about the physicians with whom they have consulting or other relationships.
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“I want to go off call”
Does your group have a plan for anticipated or unanticipated changes in its work profile? What would you do if a partner requested a temporary leave to pursue a master’s degree in business administration? How would you respond when a member announces one day, “I want to go off call”? Most groups must face such transitions at some point, but deciding what to do on a case-by-case basis at the time of each request can be emotionally damaging, build resentment, and set confusing precedents.
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Orthopaedists and industry: Working together—at arm’s length
One year later, uncertainty continues This time last year, the orthopaedic industry was struggling to respond to the terms of a settlement reached by the US Attorney’s office for New Jersey (Department of Justice, DOJ) with five major orthopaedic hip and knee manufacturers. The settlements appear to have permanently altered the relationships between orthopaedic surgeons and industry. They continue to have a ripple effect in education funding, research, clinical care, and humanitarian efforts.
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Getting paid for taking call
Hospital responses vary, but trend is clear The crisis in emergency care coverage isn’t going away—and neither is the need to compensate those physicians who take call. That was the consensus of the participants in a Webinar sponsored by HealthLeaders Media on June 17, 2008. But developing the right on-call compensation model is tricky and requires a collaborative effort by medical staffs and hospital administrators.
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Reimbursement formula has “outlived its usefulness”
Call for change requires greater physician involvement In an affable and fast-paced conversation, former Secretary of Health and Human Services Tommy G. Thompson and former Senator William W. Bradley discussed a wide variety of political topics during the 2009 Annual Meeting educational event sponsored by the Orthopaedic Political Action Committee (PAC). Moderated by Stuart L.
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AAOS adopts ‘off-label’ statement
Supports use in “the best interest of patients,” advises counseling and reporting The orthopaedic community faces many complex challenges in navigating and reconciling changing regulatory requirements and technological and scientific developments. One area of regulatory focus and ambiguity is the intersection of the practice of medicine and a physician’s legal use of products that may be unapproved for certain indications or “off-label” when in the best interest of the patient.
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Medicare scam alert
The Centers for Medicare & Medicaid Services (CMS) recently notified physicians of a phone/fax scam in which perpetrators attempt to obtain the physician’s account information. The perpetrators pose as the Medicare carrier or Medicare Administrative Contractor and fax the physician’s office. The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours to prevent a gap in Medicare payments.
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Industry CEOs: Relationships with surgeons are vital
Transparency is necessary and desirable, but patient outcomes depend on interaction Recently, AAOS Now sought comment from the chief executives of five major orthopaedic device manufacturers on various aspects of physician-industry relationships. We wondered what has changed and what remains the same since the agreements reached with the U.S. Attorney’s Office in New Jersey (Department of Justice/DOJ) expired earlier this year. (See “Final notes on the DOJ,” below.
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AAOS Board approves new EMR position statement
“Access to and correct usage of patient Electronic Health Records (EHRs)/Electronic Medical Records (EMRs) provide major benefits to patients and physicians alike. When properly designed and utilized, EHRs can improve patient safety, increase clinical efficiency, reduce costs, allow seamless transfer of vital patient information, and allow physicians to better use their time and expertise treating patients.”
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Medicare fraud hits home
Rising levels of identity theft have become a major issue for prosecutors and law enforcement officials, and given the quantity of identifying information requested by health plans, hospitals, and the government, physicians have become prime targets for scammers. Stolen physician identities can be used in elaborate schemes, particularly with billing for durable medical equipment (DME) for patients covered by Medicare. That’s what happened to one AAOS member, Richard J. Haynes, MD.
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Violence in healthcare settings
In 2008, three people—including a nurse, another hospital employee, and a visitor—were killed in a shooting spree at Doctors Hospital in Columbus, Ga. In February 2010, a gunman walked into the emergency department of Scotland Memorial Hospital in Laurinburg, N.C., and shot two patients before being subdued by police.
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Physicians Face Medicare Cliff
On July 1, the Centers for Medicare & Medicaid Services (CMS) issued two proposed rules for 2012 payments under Medicare. The first covered payment policies and rates for physicians and nonphysician practitioners (NPPs) for services paid under the Medicare Physician Fee Schedule (MPFS) in calendar year (CY) 2012; the second covered the 2012 Outpatient Prospective Payment System (OPPS).
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Common Sense or Unreasonable Boycotts?
The good news? Antitrust laws are designed to protect physicians as consumers. The bad news: Antitrust laws are not designed to protect physicians as sellers of professional services. That was the message delivered by Robert Canterman, staff attorney at the U.S. Federal Trade Commission (FTC), one of the two agencies charged with enforcing antitrust laws.
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AAOS Opposes MedPAC’s SGR “Fix”
On October 6, the Medicare Payment Advisory Commission (MedPAC) voted 15–2 in favor of adopting a proposal to repeal the sustainable growth rate (SGR) formula that establishes physician pay under Medicare. Under the proposal, current payment rates would remain flat for primary care physicians over the next decade and payments to specialists would be cut.
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Will You Be In My Medical Neighborhood Home?
In July 2012, the American Association of Orthopaedic Surgeons (AAOS) Health Care Systems Committee (HCSC) sponsored a one-day symposium on the “Musculoskeletal Care Coordination: The Role of the Orthopaedist in the Medical Neighborhood.” Hosted by HCSC Chair Craig A. Butler, MD, MBA, and moderated by HCSC Member William Kumler III, MD, MBA, and Jeffrey M.
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Sunshine Act Data Collection Begins
As of August 1, medical drug and device manufacturers and group purchasing organizations (GPOs) began collecting data on payments and transfers of value (TOV) made to U.S. healthcare providers. The data collection is required under the Physician Payment Sunshine Act (Sunshine Act), which establishes a publicly accessible database disclosing potential conflicts of interest between physicians and applicable medical drug and device manufacturers.
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Buyer Beware of Foreign Drugs, Devices
Perhaps more than ever before, physicians are being inundated with fax and Internet advertising by foreign pharmacies selling prescription drugs and medical devices. Often, the prices are well below those set by the physician’s usual domestic drug and device suppliers.
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Orthopaedic Practices Face Mounting Financial Pressures
Many private orthopaedic practices may find significant challenges to maintaining financial solvency in the future, according to research presented during the 2013 AAOS Annual Meeting by Alberto D. Cuellar, MD. Dr. Cuellar’s Scientific Poster, “The Economic Conundrum of Private Practice Orthopaedic Surgery,” was selected as the overall best poster by the Central Program Committee. The study analyzes more than a decade of historical financial data from a multispecialty orthopaedic group.
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Orthopaedic Surgery Helps Keep U.S. Economy Going
As healthcare reform takes shape and healthcare consumers become more cost conscious, evidence-based, cost-effective approaches to what orthopaedic surgeons do can make a big difference in both patient access to care and physician compensation. Looking at just one set of numbers—the projected increase in total knee arthroplasty (TKA) surgeries, for example—might well raise eyebrows among insurers, employers, and legislators for several reasons.
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Legislation to Delay ICD-10 Introduced
Physicians and other eligible professionals are expected to implement the International Classification of Diseases–10th edition (ICD-10) diagnostic coding system effective Oct. 1, 2015. Under ICD-10, the number of diagnostic codes would increase from the 13,000 currently in place under ICD-9 to more than 68,000 codes.
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Meet Your New Partner—Uncle Sam
During the 2015 AAOS Now Forum on “Orthopaedic Economics in 2020,” John Cherf, MD, MPH, MBA, chair of the AAOS Practice Management Committee, outlined the impact of government initiatives on orthopaedic practices, both now and in the future. Calling passage of the 1965 Social Security Act, which incorporated both Medicare and Medicaid, “the most significant health reform of the twentieth century,” Dr. Cherf also noted the passage of the Patient Protection and Affordable Care Act in 2010, as “landmark legislation” in the twenty-first century.
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Unintended Consequences of CJR
Bundled payments are not only here to stay, they are now being mandated in specific geographic regions, under the Comprehensive Care for Joint Replacement (CJR) program. Although the intent of this payment strategy is to drive value in health care, a likely unintended consequence may be to decrease access to surgical care for certain high-risk patients.
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Implant makers add consultant info
The recent settlement agreements between five orthopaedic implant manufacturers and the U.S. Attorney of New Jersey (Department of Justice) required the companies to post financial information on their relationships to orthopaedic surgeons without any explanation of why the payments were made. As of Nov. 15, three of the companies had added, in another section of their Web sites, information about individual consultants that includes a description of the services rendered.
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‘Bad eggs’ are giving surgeons a black eye
As both an orthopaedic surgeon and the chief executive officer of a medical device company that he cofounded, William Petty, MD, has a unique perspective on both the potential—and real—conflicts of interest that exist in the relationships between orthopaedic surgeons and industry. Dr. Petty, who currently serves as co-chair of the AAOS Corporate Advisory Council (CAC), recently shared his dual perspective on the issue during a CAC discussion (see related story, pg.
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DOJ settles with device makers
As this issue of AAOS Now went to press, the Department of Justice announced a settlement had been reached with five major device makers in a investigation exploring the companies’ relationships with orthopaedic surgeons. Under the settlement, four companies (Zimmer, Inc., DePuy Orthopedics, Biomet Orthopedics, and Smith & Nephew) will pay fines totaling $311 million. Stryker Orthopedics, Inc. was not fined, but will be subject to the same federal oversight and required reforms as the others.
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OIG’s Morris: An enforcer’s perspective
Relationships between physicians and the healthcare industry, including pharmaceutical and device manufacturers and suppliers, are under intense scrutiny. The popular press and professional journals are raising questions about the ability of physicians to maintain their professional integrity in an environment where lucrative physician-industry deals flourish.
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Docs on brink again
As this issue of AAOS Now went to press, physicians were once again facing a 21.2 percent cut in Medicare reimbursement rates, beginning June 1, 2010. So far this year, the cuts have been delayed three times; a measure that would have postponed application of the sustainable growth rate (SGR) formula until 2014 was facing stiff opposition in both the House and Senate. AAOS has consistently called for the repeal and replacement of the flawed SGR formula.
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No deal on deficit
As this issue of AAOS Now went to press, the Joint Select Committee on Deficit Reduction acknowledged that it failed to reach a bipartisan deficit reduction agreement. As a result, $1.2 trillion in across-the-board cuts to federal spending will go into effect on Jan. 1, 2013. These cuts include a potential 2 percent reduction in Medicare reimbursements.
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How has orthopaedics evolved?
Every 2 years, the AAOS conducts the OPUS (Orthopaedic Practice in the United States) survey. This census of AAOS members, which was last conducted in 2010, provides a comprehensive look at the practice characteristics of orthopaedists in the United States. It not only reflects the orthopaedic workforce, but also shows how the orthopaedic specialty is evolving.
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What the Sunshine Act Brings to Light
Pharmaceutical and medical device companies have long provided physicians with promotional materials, ranging from imprinted office supplies, gifts, and meals, to consulting fees and sample products. In recent years, however, questions have been raised about the impact of such materials on both prescribing and purchasing habits and patient care and safety.
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Tips for Limiting Scope of Practice Expansion
Defining the scope of practice for a healthcare provider is often challenging, particularly when nonphysician providers want to step beyond traditional roles. However, it is patients who are most at risk when physicians and nonphysician healthcare providers are allowed to administer musculoskeletal treatment outside of their areas of training and experience.
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AAOS Publishes Clinical Considerations Resource to Help Members Navigate the COVID-19 Pandemic
Unprecedented times call for unprecedented actions. At the end of April, there were more than one million confirmed cases of COVID-19 in the United States, with more than 160,000 confirmed in New York City alone. Although New York City is the epicenter of the U.S. COVID-19 pandemic, it is also a place we can turn to for guidance on navigating a path forward.
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Stay Updated on COVID-19-related Telemedicine Guidelines
With the outbreak of novel coronavirus (COVID-19), many outpatient clinics and facilities find themselves unprepared for telehealth visits. The care team’s clinical decision-making must first determine which patients are at higher risk for COVID-19 morbidity and then decide which of them still need evaluation. This process will dramatically increase patient phone calls and portal messaging in the coming weeks.
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What You Need to Know About Telemedicine Coding During the COVID-19 Pandemic
The Department of Health and Human Services Office for Civil Rights (OCR) has relaxed the guidelines regarding telemedicine services due to the COVID-19 public health emergency. OCR will not impose penalties in the event of noncompliance with requirements under the Health Insurance Portability and Accountability Act for physicians using applications such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype.
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Economics: Private Practices Fight for Survival
Spurred by the global pandemic known as COVID-19, the U.S. healthcare system has never faced so many unprecedented challenges simultaneously. When the outbreak first gained traction across the world and then in the United States, physicians across medical specialties were faced with utilizing limited resources to address an overwhelming demand for care by those infected.
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Latest AAOS COVID-19 Webinar Updates Members on Return to Elective Surgery, News from D.C., and Telemedicine Coding
In a COVID-19 webinar conducted on Thursday, April 23, AAOS’ top leaders provided updates and guidance on returning to elective surgery, the latest news on federal funding legislation, and a recap of advocacy efforts by the Academy’s Office of Government Relations (OGR) to ensure that orthopaedic practices receive fair consideration in spending programs and regulatory accommodation.
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Latest COVID-19 Webinar from Academy Leadership Provides Updates on Advocacy, Return to Surgery, and Research
In a COVID-19 webinar presented on May 13, AAOS’ Presidential Line provided updates on advocacy, return to surgery, COVID-19 member research, patient information, and virtual education. Similar to previous webinars, a question-and-answer session shed some light on members’ top concerns about navigating the COVID-19 pandemic.
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Reporting for Duty: Redeployment Strategies Need to Address Ethical Considerations of Privacy Protection
As the numbers of COVID-19-positive patients and deaths rise in the United States, health systems are increasingly looking toward redeployment strategies to supply needed staff to overburdened hospitals. The American Medical Association Code of Medical Ethics Opinions related to physicians’ responsibilities in disaster response and preparedness specify an obligation to respond during disasters.
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COVID-19: A Personal Anecdote and Recommendations from Beijing, China
Hongyi Shao, MD, is an arthroplasty surgeon at Jishuitan Hospital in Beijing, China. He pursued a research fellowship at the Rothman Orthopaedic Institute, which is where Antonia Chen, MD, MBA, FAAOS, met him. In an interview, Dr. Chen talked with Dr. Shao about his personal experiences during the COVID-19 crisis in China.
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Sound Off: Rapid Restructuring of Large Subspecialty Pediatric Orthopaedic Department During Pandemic
The rapid acceleration of COVID-19 called for significant and rapid restructuring of many facets of care. This can be likened to rapidly rerouting a large cargo ship moving along with significant momentum—a difficult task many departments and practices are currently facing. Our goal in sharing our recent experience is to offer ideas, as different parts of the country must rapidly adapt, and to stimulate discussion of ideas.
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How to Create a Telemedicine Program for COVID-19 and Beyond
A few years ago, a study demonstrated several benefits to utilizing telemedicine, such as increased patient satisfaction, shorter wait times, and decreased costs for patients and orthopaedic departments.
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Sound Off: Another Roadblock to Elective Surgery - The Patient
The COVID-19-related disruption of the health sector has been unprecedented. Hospitals have diverted their resources toward managing the onslaught of infected patients. Elective surgeries have been suspended, and non-emergency medical care has plummeted. Health systems have asked the government for financial assistance during this time, as many profitable revenue streams have been virtually eliminated. Mayo Clinic even reported a projected $3 billion loss for the year and has considered pay cuts for almost a third of its work force—nearly 20,000 people.
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Frequently Asked Questions Regarding Telemedicine Coding in the Era of COVID-19
Editor’s note: The information contained in this article was current as of June 2; coding guidance may have since been revised. For any updates, visit cms.gov or the AAOS Member Resource Center for the latest telemedicine coding guidance during the COVID-19 pandemic.
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Personal Protective Equipment: Orthopaedic Surgeons Face Ongoing Supply Chain Crisis
Many individuals demonstrated not only altruism but also innovation to help manage a shortage of personal protective equipment (PPE) during the height of the COVID-19 crisis, a few of whom are highlighted below. PPE can include cloth masks, made of woven fabric, often of natural fibers such as cotton; medical/surgical masks with nonwoven fabric, often of manufactured fibers such as polypropylene; and respirators such as N95s and, in Europe, FFP2, which are made of even more tightly meshed polypropylene, which can exclude viral particles.
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How Did We Only Have 1 Percent of the Masks Needed to Fight COVID-19?
Spring came early in New York City this year, but you wouldn’t have known that by reading the news. Instead, you read of mounting cases of the dreaded SARS-CoV-2 and its associated illness, COVID-19.
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Telemedicine Brings the Orthopaedist to the Patient
Since the start of the COVID-19 pandemic, clinic waiting rooms around the country have emptied as patients, physicians, and policymakers quickly pivoted to telemedicine for health care to reduce patient and physician exposure. For orthopaedic surgeons, telemedicine has revolutionized the delivery of patient care, which may have a lingering impact for years to come.
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The Future of Telemedicine Is Evolving
A recent two-part series published in AAOS Now discussed the history of telemedicine (TM) and its current application (“Telemedicine in Orthopaedics: Risks Versus Benefits,” December 2019; “Liability and Billing Concerns,” January 2020). Since then, the world has been embroiled in the COVID-19 pandemic, and acceleration of the use of TM has been one byproduct. Undoubtedly, the perception, understanding, and utility of TM have evolved rapidly for patients and healthcare providers. This article presents orthopaedic aspects of federal legislative changes pertaining to TM, particularly billing and regulatory changes, as well as an overview of TM best practices.
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Tales from the Field: Managing Practice During COVID-19
During an AAOS webinar presented in August, surgeons from three different regions of the country recounted their institutions’ experiences confronting the onset of the COVID-19 pandemic.
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Small-town Orthopaedists Respond to a Big-time Pandemic
Rural hospitals are closing at an unprecedented rate, forcing patients to travel greater distances to receive emergency care and increasing healthcare disparities.
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COVID-19: Painful but Not Fatal for Orthopaedic Practices
To better understand changes caused by COVID-19, the Illinois Association of Orthopaedic Surgeons (IAOS) conducted a survey of orthopaedic surgeons in Illinois in October 2020. The findings indicate that although COVID-19 resulted in short-term pain, it will not be fatal for orthopaedic practices.
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Build a Strong Foundation for Your Practice’s COVID-19 Recovery by Focusing on Your Biggest Asset: Your People
This article describes a case study from my own practice’s experience during the first wave of COVID-19, and I hope it can provide some helpful tips, advice, and lessons learned as we battle a new wave.
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Two New CPT Codes Introduced for COVID-19
In the wake of COVID-19, physician practices and outpatient nonfacility settings have adopted extra safety precautions and protocols to safely provide in-person visits.
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A Rural Practitioner’s Experience with Providing Orthopaedic Care During the Pandemic
James Barber, MD, FAAOS, an orthopaedic surgeon at Southeastern Orthopaedics in Douglas, Ga., shared his personal experience of being a rural orthopaedic practitioner during the COVID-19 pandemic.
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Webinar Presenters Recall Effects of COVID-19 on Practices in New York, Chicago
During an AAOS webinar, surgeons from three different regions of the country recounted their institutions’ experiences confronting the onset of the COVID-19 pandemic and lessons they learned.
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Online Reputation Management: A Necessity for Orthopaedic Surgeons
Orthopaedic surgery patients use online reviews to help find trustworthy surgeons, and a single patient referral can generate thousands of dollars in new revenue, underscoring the financial importance of maintaining a positive online reputation.
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Engagement Theater Offers a Lineup of Exciting Topics
Among the many daily activities taking place in Academy Hall is the Engagement Theater.
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Value-based Healthcare in Orthopaedics: Putting Theory into Practice
Value-based healthcare continues to evolve, and sometimes it is difficult to distinguish whether changes in the care landscape represent a step forward or two steps back.
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Posters Offer Attendees Informative, Self-directed Education
The Annual Meeting’s selection of posters is one of the best examples of self-directed education the meeting offers.
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Value-based Healthcare Delivery Starts with You
Value-based healthcare continues to evolve, and sometimes it is difficult to distinguish what is a step forward or two steps back. Orthopaedic surgeons and practice managers are often tasked with determining what is best for their offices, ORs, and patients with few trusted resources available to help guide them.
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Surgeons Adept at Using Social Media Share Tips to Help Others Build Positive Digital Reputations
At Monday’s Instructional Course Lecture (ICL) “Social Media and Orthopaedics: Establishing Your Online Reputation,” panelists delved into the importance of social media and how it can help or hurt an orthopaedic surgeon’s overall reputation.
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Subject Matter Experts and Various Resources Available to Address Coding Questions
Experience Orthopaedic Code-X® with live demos Tuesday at 10 a.m. and Thursday at 12 p.m. in the Engagement Theater in Academy Hall. .
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Many Strides Yet to Go: The Imperative to Increase Diversity in Orthopaedics and Serve the Entire Patient Population
In yesterday’s symposium “Racial Disparities in Orthopaedic Surgery: Patients, Residents, and Faculty,” a panel of orthopaedic surgeons comprising mostly underrepresented minorities at various stages of their careers discussed the many factors and issues related to racial disparities in healthcare.
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Orthopaedic Surgeons Tasked with Addressing Sexism
During the President’s Forum on Ethics, Bullying, and Harassment, which took place at the AAOS 2022 Annual Meeting, presenter Casey Jo Humbyrd, MD, FAAOS, director of the program in surgical ethics at the University of Pennsylvania, began her presentation on ethics with a personal anecdote.
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Symposium Addresses DEI in Orthopaedics
At Wednesday’s symposium on “Racial Disparities in Orthopaedic Surgery,” if a single message emerged, it was that not only do the social legacies of prejudice and inequality persist in orthopaedics but they also afflict the specialty to an outsized extent.
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Supreme Court Rules on LGBTQ Job Discrimination
On June 15, the U.S. Supreme Court ruled that federal law protects workers from discrimination based on their sexual orientation or gender identity. The decision marks the first major case on transgender rights and adds new protections for LGBTQ (lesbian, gay, bisexual, transgender, or queer [or questioning]) workers.
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Webinar Addresses Diversity in Global Orthopaedics
Earlier this year, AAOS and the International Orthopaedic Diversity Alliance (IODA) cosponsored a webinar titled “Creating a Global Orthopaedic Culture in Which Everyone Can Thrive” to call attention to the need for diversity, equity, and inclusion in orthopaedics.
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Increasing Equity in Language and Communication in Healthcare Practice Can Improve Patient Outcomes
Racial and ethnic disparities affect the quality of healthcare delivery, communication, decision-making, and outcomes, including survival.
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Difficult Peer Conversations: Getting the Outcome You Want
Are you in a leadership position in your practice, ambulatory surgery center, or hospital? Have you had any formal training in dealing with conflicts among your peers? As surgeons, we occasionally have to communicate about unpleasant subjects with our patients. As individuals, we may face the same problem at home or in our other roles. But as leaders, we frequently need to address problems with our fellow physicians.
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Branding Your Orthopaedic Practice: What it Takes to Stand Out
Based on studies I have read, only about half of Americans have a preferred orthopaedic surgeon. This would seem to indicate that while some orthopaedic practices have strong branding, many do not. One might assume that those dominant practices have achieved strong brand recognition through creative advertising or spending more on marketing their practice.
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OIG Says "No Bonus Points" for Having a Compliance Plan
If your practice is targeted for a Medicare audit, the Office of the Inspector General (OIG) will no longer give you points for having a compliance plan on the shelf. Unless you've operationalized that plan into an active program, it's not going to garner any leniency with the auditors, according to Inspector General Daniel Levinson, who announced new compliance guidance at the 2016 Health Care Compliance Association conference.
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The Death and Rebirth of Gainsharing: Payment Opportunities for the Orthopaedic Surgeon
"Gainsharing" is a popular management and incentive compensation strategy that is often used in manufacturing and by companies with industrial service lines. It is used to reduce costs by paying incentives to employees who develop or participate in cost-saving strategies. The amount of the "gainshare" incentive payment is typically based on the amount of cost savings produced by the employee, as determined by a preset formula and other performance measures.
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Tips for Evaluating and Obtaining Employment
After spending 10 years in medical school, residency, and fellowship, most new orthopaedists feel appropriately trained to perform surgical procedures. However, little of that education is devoted to some of the most important aspects of the profession, including how to find a job that fits the individual, how to navigate the negotiation process, and how to develop a foundation for a strong practice.
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CJR and Orthopaedic Bundled Payments: The Future Is Now
After many years of designing, testing, and evolving, the Centers for Medicare & Medicaid Services (CMS) appears committed to transitioning from fee-for-service to bundled payments for several episodes of care. By mandating participation in the Comprehensive Care for Joint Replacement (CJR) program and proposing more mandatory programs, CMS is sending physicians a message that bundled payments are here to stay. Bundled payment models from CMS have been evolving for some time.
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Don't Be Intimidated by ICD-10-CM Changes
The 2,000 new ICD-10-CM (International Classification of Diseases, 10th edition, Clinical Modification) codes that go into effect Oct. 1, 2016, shouldn't send you into a panic. The changes, when analyzed and approached systematically, are not overwhelming. This article addresses changes in the musculoskeletal and injury chapters that affect orthopaedics. It does not cover editorial changes, additional punctuation, and codes not typically used by orthopaedic surgeons.
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Commonly Asked Coding Questions
A: Although the four –X{EPSU} modifiers were initiated by CMS, they have also been part of the Common Procedural Terminology (CPT) manual since 2015. These four modifiers—XE, XS, XP, and XU—are used in lieu of modifier 59. The modifiers are commonly called –X{EPSU} modifiers for separate Encounter, Structure, Practitioner, and Unusual non-overlapping service referenced in the EPSU acronym. The latest CMS directives about using the –X{EPSU} modifiers were issued last year (2015).
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How Might Bundled Payments Change under the New Administration?
Thomas C. Barber, MD, and Douglas W. Lundy, MD, MBA, answered questions from reporters at the AAOS Annual Meeting related to the future of bundled payments. Dr. Barber and Dr. Lundy are the outgoing and incoming chairs, respectively, of the AAOS Council on Advocacy and are experts on the changes to orthopaedics that are coming out of Washington, D.C. Specifically, Drs.
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Documentation Guidelines for Medical Decision Making
Thousands of pages of regulation have been generated since the American Medical Association (AMA) first introduced Evaluation and Management (E/M) codes to describe inpatient and outpatient visits in 1992. When originally published, the E/M code descriptors were ambiguous and unclear, resulting in the reporting of erroneous levels of service and the inability to audit or oversee the delivery of services to Medicare beneficiaries.
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Coding Best Practices Streamline Dispensing DME for Medicare
Although orthopaedic practices often provide patients with supplies or durable medical equipment (DME) as part of a treatment plan, this aspect of coding is frequently overlooked in training courses. This article addresses documentation criteria and medical necessity policies. For information on how to select appropriate codes and file claims correctly, see Part 1 (Dispensing DME in Orthopaedics for Medicare, AAOS Now, October 2017). Q.
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Strategic Planning in a Dynamic Healthcare Environment
If health care offered a stable environment in which stakeholders could clearly understand payment models, competition, and how rapidly change might occur, then the need for strategic planning might be superfluous," explained Michael J. Stahl, PhD, Professor Emeritus, who for 18 years served as the distinguished professor of management and director of the physician executive MBA program at the University of Tennessee, Knoxville. Prof.
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CPT 2017 for Foot and Toes
Every autumn, the American Medical Association's (AMA) Current Procedural Terminology (CPT) book is updated with changes for the next year. In 2016, minimal changes were made, possibly due to the implementation of the International Classification of Diseases, 10th edition (ICD-10) and a desire to not overload physician practices. In a prior article, 2017 changes for the spine area were presented. (See "2017 Spine CPT Code Changes," AAOS Now, November 2016.
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Is Your Practice Not Getting Paid?
It's easy to blame a practice's skyrocketing accounts receivable (A/R) on coding and the insurance companies. But our experience with orthopaedic practices, and the results of AAOS/KarenZupko & Associates (KZA) pre-workshop surveys on coding and reimbursement, indicate that the problem is a lot more complex. To ensure that "clean" claims go out and proper payments are received, physicians and staff must accurately code and document services.
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New Cuts to X-Ray Reimbursements
Beginning in 2018, orthopaedic practices will face a reduction in reimbursement for the use of computed radiography (CR) as an incentive to upgrade to digital radiography (DR). AAOS is opposed to these reductions, which could punish providers for using a digital technology that is often clinically advantageous to their patients.
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A Novel Approach to Group Leadership
Much has been written about effective governance within organizations, especially concerning the chief executive. A single leader must be empowered to make decisions for the organization on matters for which he or she will be held accountable. Having multiple individuals within a single office holding top leadership positions would not be functional and certainly not sustainable.
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Measuring the Impact of EHRs
According to a 2016 study on physician activities in the clinic setting, "ambulatory care in the United States has been subject to dramatic pressures in the past decade to cut costs, meet regulations, and transition to electronic health records (EHRs)." EHRs have been heralded as both time savers and space savers, eliminating the need for bulky paper records and enabling physicians and their staff to more effectively identify and follow a patient's treatment.
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What OPUS Reveals About Practice Settings and Productivity
Editor's note: This article is the final installment of a three-part series that summarizes the results of the biennial orthopaedic census. Previous articles include "Orthopaedic Practice in the United States" (AAOS Now, July 2017) and "Census Examines Orthopaedic Workforce Trends" (AAOS Now, August 2017). Since 1985, 16 surveys on Orthopaedic Practice in the United States (OPUS) have been conducted. Also known as the Census Survey, OPUS gathers demographics and practice data of U.
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Crystal Ball: Specialist Contemplates Future of Sports Medicine
, a leading sports medicine specialist based in Chicago, is the head team physician for the Chicago Bulls and co-team physician for the Chicago White Sox and DePaul University. In 2009, he was named the NBA Team Physician of the Year by the National Basketball Athletic Trainers Association. Given Dr. Cole’s dedication to sports medicine and its advancement, he offers unique perspectives on the specialty’s future.
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Telehealth at a Tipping Point
What's a service orthopaedic practices can offer that is popular with patients, reimbursed by most payers, not too expensive to implement, and deliverable in all 50 states? Telehealth: Although it's obviously not suitable for every type of patient encounter, the value telehealth confers to patients, practices, and payers has pushed adoption to the tipping point. These services also allow practices to differentiate themselves.
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Reduce the Pain of Precertification
A familiar complaint many orthopaedic surgeons hear from exasperated staff is, “I couldn’t get this MRI approved—the insurance company wants a peer-to-peer review.” The surgeon must then get on the phone with the insurance company, and after providing additional information about the case, is often successful in obtaining approval for the procedure. However, this process is not only a waste of surgeon and staff time, but it also results in delayed treatment for the patient.
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Perspectives on Out-of-network Billing
Out-of-network (OoN) billing, or “surprise billing” consisting of unexpected charges for OoN services, is an increasingly recognized issue. In the past several years, some states have enacted laws to remediate the problem. In 2015, New York enacted a surprise-billing law that prevents patients with health insurance from having to pay more than their in-network copay when receiving emergency services from an OoN provider at an in-network facility.
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Keeping Your Practice Safe: Lessons in Cybersecurity
Technology hacks and digital ransom demands have become more commonplace in the healthcare sector, and many physicians and practices may not be well equipped to ward off a future attack. During the AAOS Fall Meeting in San Antonio, Texas, Amy L. Ladd, MD, chair of the AAOS Board of Specialty Societies, moderated a panel discussion on real-world examples of healthcare hacks and tips to improve cybersecurity, titled “Cybersecurity, Hacks, and Ransom.” Samuel E.
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The Pregnant Orthopaedic Surgeon: Risks and Precautions
Gender distribution in medical education has now equalized with roughly half of medical students being women. In contrast, orthopaedic surgery residency programs have lagged behind other subspecialties in recruiting women. Only 14 percent of orthopaedic residents and 6 percent of active AAOS fellows are female. It is important to address the factors that can be modified to reduce gender disparity within the field.
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Approaching Retirement with Dignity and Foresight
Aging surgeons may face diminution of physical strength, visual acuity, and coordination that gradually impair performance. Drawing the curtain on surgery can be one of the most difficult decisions affecting an orthopaedist’s life. In this roundtable discussion, Antonia F. Chen, MD, MBA, speaks with Richard H. Rothman, MD, PhD, and Lawrence D. Dorr, MD, on maintaining skills, monitoring one’s own performance, and finding value outside the operating room. Dr.
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Staff Issuing Patients Blank ABN Forms Is Not Acceptable
For many orthopaedic offices, it is standard practice to require Medicare beneficiaries to sign a blank advance beneficiary notice (ABN) at check-in, “just in case” the physician recommends an item or service that may not be covered by Medicare. The rationale is that the team can fill in the blanks later as documentation that the patient was told he or she is responsible for payment. If this is how your team handles ABNs, it is time to reset your systems.
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Tips for Utilizing ICD-10-CM
In May 2015, most orthopaedic surgeons and their staff were highly focused on learning the new diagnostic language of ICD-10-CM (International Statistical Classification of Diseases and Related Health Problems, 10th revision, Clinical Modification). That’s because the new diagnosis codes were scheduled to replace ICD-9-CM in October 2015. Three years later, practices are still learning how to utilize the ICD-10-CM code set to support the services they perform.
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Arthroscopy Coding for Major Joint
An accurate understanding of coding rules increases likelihood of receiving appropriate payment Correctly reporting and billing for arthroscopy services is often confusing. Last month, AAOS Now reviewed the knee arthroscopy codes and outlined the appropriate use of modifiers. This month, the topic is coding for shoulder and hip arthroscopic procedures. The traditional coding rule about the shoulder is to consider the joint as one compartment.
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APMs and BPCI Advanced: What They Mean for Orthopaedists
Several new payment models have been introduced under the Medicare Access and CHIP Reauthorization Act (MACRA). The most common is the Merit-Based Incentive Payment System (MIPS), which requires providers to report directly on performance measures including outcomes, cost, and operational data. Performance on these metrics, as well as how much data the clinician reports, determine the reimbursement adjustment with a maximum of +/- 4 percent to start, increasing to +/- 9 percent in 2022.
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MACRA-compliant EHR Implementation Can Challenge Even the Best Practices
In 2016, the leadership at Resurgens Orthopaedics determined that the electronic health record (EHR) system we were using in our practice was suboptimal in engaging and complying with Medicare Access and CHIP Reauthorization Act (MACRA) requirements. We decided to undergo the exhaustive process of analyzing every EHR available to find the best product for our physicians and employees, and in 2017, we went “live” with our new platform.
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Orthopaedic Practices Must Adapt Patient-acquisition Strategies
Clinical technology for orthopaedic surgeons has progressed tremendously over the past two decades. Surgeries that once lasted several hours and required large open incisions can now be performed with arthroscopes, fluoroscopy, and less-invasive approaches. After years of clinical research and outcome reporting, many clinical technologies have become standard in orthopaedic surgery.
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Reasons Why Diagnostic Coding Matters in Value-based Care
Payers are great at collecting data. They use the information to develop payment policies, determine reimbursement rates, and, increasingly, to negotiate value-based contracts. Payers profit because they know how much it costs to take care of patients with certain illnesses and comorbidities. Payers know how to harness the power of data. Orthopaedic surgeons—not so much.
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Co-management Agreements Prove to be Viable Models for Physician Input
Value-based models of health care have evolved over the past 10 years. During that time, it has become clear that sustainable improvements in quality and reductions in the cost of care require close coordination of stakeholders. Early efforts to provide incentives to surgeons through gain-sharing cost savings were met with variable success, particularly for total joint arthroplasty.
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Don’t Let Going Out of Network Get Out of Control
Consider the following: A local hospital has three general surgeons covering trauma. Two are in network with most plans, and one is out. The out-of-network (OoN) surgeon charges whatever he wants. In most instances, insurance companies pay the entire bill, and patients are rarely balance billed for amounts not covered by the payer. Practices such as this raise costs for everyone covered by insurance.
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Evidence-based Savings Opportunities Exist with TJR Devices
Total joint replacement (TJR) surgery has been the most common hospital-based orthopaedic procedure recently. The Centers for Medicare & Medicaid Services (CMS) and most commercial payers are currently evaluating the procedures with a focus on cost. New payment models and the growing emphasis on value require rigorous analysis of costs and the impact of money spent on quality throughout the continuum of care.
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Leverage Proven Best Practices to Find Your Next Practice Administrator
Hiring an executive to oversee your business is a formidable undertaking. After spending years building a successful practice, how do you hire someone who will care for the practice as much as you do? Start by specifying your goals. Assess the current state of your business and its future. Recognize the challenges you are facing, and be prepared to discuss them with candidates during the recruitment process.
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How to Avoid Common Mistakes When Coding Hand Procedures
Billing for hand procedures is among the most complex types of orthopaedic coding. Here, we highlight eight frequently encountered errors when coding hand procedures and how to fix them. Current Procedural Terminology (CPT) includes references to specific locations in the forearm, wrist, hand, and fingers for reporting flexor and extensor tendon repair codes. Codes are selected based on the location of the repair, not the site of tendon insertion.
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Condition-based Payment Models Serve as New Options
This editorial concludes a two-part series on payment models. The first article appeared in the April issue of AAOS Now. Visit www.aaos.org/aaosnow to read more. Part one of this editorial introduced the concept of condition-based bundled payments as a middle ground between procedure-based bundles and capitation payment models. A condition-based bundled payment model encourages procedures that offer the greatest patient value and, by default, disincentivizes low-value care.
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Good or Bad: Every Organization has a Culture
Every organization has a culture. The size, scope, location, makeup, or identity of an organization makes no difference, but the larger the organization, the more likely that additional subcultures will occur among departments. Culture is created and cultivated—whether actively or unconsciously influenced and whether positively or adversely inspired. Culture can be described as “the way things are done around here,” but creating and sustaining a healthy culture is an august goal worth pursuing.
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Does Your Practice Treat Pain?
Get your payer coverage policies and E/M coding and documentation in order Interventional pain management is a growing specialty, and many orthopaedic groups have added an interventionalist to the physician team. If this is the case for your practice, make sure the interventionalist understands the reimbursement and documentation nuances essential to optimizing payment and mitigating payer takeback risk.
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Not Just for Research Anymore: The Usefulness of PROMs in Clinical Practice
The utilization of patient-reported outcome measures (PROMs) has been driven by a growing interest in understanding patients’ perceptions of their physical and psychosocial health and outcomes of treatment. Although most agree with this general direction, the institutional uptake of PROMs at the point of care is highly variable, with a range of logistical, cultural, and clinical barriers to adoption.
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How To Choose a Healthcare Consultant
This article outlines three important steps for choosing the right consultant and having a successful working relationship.
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Q&A with Expert Attorneys Covers How to Avoid Audits and Takebacks
Government and private payers use computer algorithms to identify atypical billing patterns and coding outliers. Cheryl Toth, MBA, talked with Patricia Hofstra, JD, a partner at Duane Morris LLC, and Michael J. Sacopulos, JD, president of the Medical Risk Institute, about what orthopaedic surgeons can do to reduce the risk that their billing and coding could trigger an audit or takeback.
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2020: New Year Means New Codes for Drug-delivery Implant Devices and More
Each year, the American Medical Association (AMA) provides coding and guideline changes to the Current Procedural Terminology (CPT) Manual. This article summarizes the relevant changes to the musculoskeletal section for 2020. For a full summary of the additions, deletions, and revisions, refer to Appendix B of the CPT Manual.
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Liability and Billing Concerns
Editor’s note: This article concludes a two-part series on telemedicine (TM). Part two discusses liability and compensation concerns associated with TM. Part one appeared in the December 2019 issue of AAOS Now.
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Five Coding Tips for Dealing with Third-party Billing Entities
Editor’s note: AAOS partners with KarenZupko & Associates, Inc. (KZA) on the organization’s coding education, and KZA often provides content for AAOS Now. For more information, visit www.aaos.org/membership/coding-and-reimbursement.
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Supply Chain Knowledge Is Important to Orthopaedic Physicians
In varied roles throughout my career, including my position on the Board of Directors of the Association for Health Care Resource & Materials Management (AHRMM), I have developed a vision and mission that drive me—to elevate the healthcare supply chain field and to aid in the development of collaborative activities and tools that bridge clinician to supply chain to management/administration to patient.
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Major Changes Are Coming to E/M Visits in 2021: Will You Be Ready?
The documentation guidelines set forth by the Centers for Medicare & Medicaid Services (CMS) for evaluation and management (E/M) services, established 20 years ago, do little to support patient care.
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Do Bundled Payments Impact Quality and Cost of Care?
Editor’s note: This article is the first part of a three-part series on a roundtable discussion about bundled payments. The second installment will appear in the June issue of AAOS Now. AAOS Now welcomes comments from those in private practice or other settings to share their experience on this topic.
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Do Bundled Payments Impact Patient Care or Satisfaction?
Editor’s note: This article is the second part of a three-part series on a roundtable discussion about bundled payments. The final installment will appear in the July issue of AAOS Now, and the first installment was published in the May issue. AAOS Now welcomes comments from those in private practice or other settings to share their experience on this topic.
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Five Tricky Modifier Questions Answered
Modifiers are used to explain special circumstances about a service to the payer. Typically, when a modifier is not applied, the claim is denied or reimbursement is incorrectly reduced.
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AAOS Webinar Offers Tips for Building a Practice
In an Academy webinar titled “How to Build Your Practice as a Young Surgeon,” faculty presenters Grant Garrigues, MD, FAAOS; Alexander R. Vaccaro, MD, MBA, PhD, FAAOS; and Antonia F. Chen, MD, MBA, FAAOS, shared perspectives, pointers, and strategies for success in the first 10 years of practice; how to navigate the academic track and the journey to a chairmanship; and how to combine a productive research career with a thriving clinical practice.
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Presenter: ‘Grow Your Practice and Stay Out of Jail’
In today’s competitive environment, many practices are weighing the pros and cons of selling their practice or remaining independent. Ryan Johnson, a nationally recognized healthcare lawyer from Fredrikson & Byron P.A., tackled that question in a webinar presented for the American Alliance of Orthopaedic Executives (AAOE) titled “Innovating in a Regulated Environment: Grow Your Practice and Stay Out of Jail.”
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Are You a ‘Disruptive Physician’?
In its code of medical ethics, the American Medical Association defines the behavior of disruptive physicians as “personal conduct, whether verbal or physical, that negatively affects or that potentially may affect patient care.” We’ve all been there—colleagues “losing it” and yelling at staff in the OR or saying something that clearly steps over the line in the heat of the moment.
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Do Not Forget About HIPAA When Posting on Social Media
This article reviews HIPAA and its accompanying rules, how HIPAA pertains to social media, and best practices for individuals seeking to expand their social media presence within the context of their surgical practice.
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When Is the Right Time to Step Aside?
After long and meaningful discussions with my wife of 25 years, we decided that it was best for me to resign from my role as copresident of Resurgens Orthopaedics in Atlanta, one of the largest orthopaedic practices in the country.
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Patient Safety in the Era of Telemedicine: Recognizing Red Flags
There remains a dearth of orthopaedic literature reporting on the prevalence of adverse events encountered in the setting of virtual visits. This lack of information presents a patient safety concern that must be addressed before telemedicine is considered a mainstay of everyday practice.
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The Who, What, When, Where, Why, and How of 2021 CPT E/M Coding
The year 2021 marks a historic change in the coding world for outpatient office visits, with the first major revision to the CPT evaluation and management (E/M) codes in more than 20 years taking effect.
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What Is Orthopaedic Surgery’s Environmental Impact?
Although orthopaedic surgery encompasses a significant component of healthcare spending, the environmental impact of the specialty is poorly described.
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AAOS Responds to Big Changes in the 2021 Medicare IPO List
In formal comments and meetings with CMS prior to the removal of 266 musculoskeletal procedures from the IPO list, effective Jan. 1, AAOS expressed serious concern over this complicated clinical and policy decision to remove these procedures from the IPO list.
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Coding for Patient Optimization Work in the Presurgical Period
The AAOS Coding Coverage & Reimbursement Committee in conjunction with the American Association of Hip and Knee Surgeons Health Policy Council addresses one of the most common coding questions in orthopaedic practices: How should work performed prior to surgery be reported?
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AAOS Responds to NCCI Code Edit to Distal Radial Fracture and Carpal Tunnel Release
AAOS and the American Society for Surgery of the Hand argued that although a carpal tunnel release is done infrequently in connection with a distal radial fracture.
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Navigating the National Correct Coding Initiative
For procedural coding in orthopaedic surgery, physicians, and their staff primarily rely on two information sources: Current Procedural Terminology and the AAOS publication Complete Global Service Data for Orthopaedic Surgery.
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American Medical Association’s Webinar Clarifies CPT E/M Revisions
The June AAOS Now article “‘Technical Corrections’: CPT Evaluation and Management Publishes Additional Guideline Revisions” raised several questions about how revised and retroactive guidelines made March 9 would affect providers.
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Physician-industry Relationships Impact COI, Education, and More
Concerns about conflicts of interest (COIs) and their ethical implications in the practice of medicine has increased in recent years.
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The Orthopaedic CMO Role during the Pandemic and Beyond
In the depth of the COVID-19 pandemic, hospital chief medical officers (CMOs) were faced with emergency management of overflowing hospitals, overwhelmed emergency departments, staff safety, and stoppages in elective care.
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CPT Code 73580, Knee Arthrography, Is Often Misused
The American Medical Association (AMA) Relative Value Scale Update Committee (RUC) routinely assesses the appropriate use and value of Current Procedural Terminology (CPT) codes.
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Physicians Need to Know about Upcoming Musculoskeletal Guideline Changes for 2022
The American Medical Association (AMA) provides Current Procedural Terminology (CPT®) code and guideline changes to the CPT Manual each year.
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Medical Practices Face Labor Shortages During Pandemic
Recruitment and retention of qualified personnel are notoriously challenging in healthcare, particularly in private practice.
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Medical Liability Insurance: Do Surgeons Need Tail or Nose Coverage?
This article describes insurance coverage for prior acts, also known as “tail” and “nose” malpractice insurance.
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Commonly Asked Coding Questions in 2022
In this column, KarenZupko & Associates addresses recently asked questions on coding for various orthopaedic procedures posed by orthopaedic surgeons, practice managers, and staff.
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Avoiding the Kickback Trap
The takeaway from Wednesday’s symposium “Orthopaedic Surgeons in Prison: It Could Happen to You” was all too well encapsulated by that eye-opening title.
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Adjusting Patient Length-of-stay Expectations in Total Hip Arthroplasty Care Pathways
According to Michael Tanzer, MD CM, FRCSC, adult hip and knee specialist and professor of surgery at McGill University Health Centre in Montreal, the concurrent implementation of several components of a pathway has obscured the impact of individual care modifications administered before a patient enters one.
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Confusion Continues over Reporting More than One Calcaneus Osteotomy, Code 28300, per Surgery
The March 2021 AAOS Now article titled “AAOS Facilitates Increase in NCCI MUE for Calcaneus Osteotomy Code 28300” discussed the National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) for osteotomy Current Procedural Terminology ® (CPT ®) code 28300, Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation.
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Avoid the ‘Kickback Trap’
The takeaway from the AAOS 2022 Annual Meeting symposium “Orthopaedic Surgeons in Prison: It Could Happen to You” was all too well encapsulated by that eye-opening title.
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OrthoInfo: Helping Physicians Empower Their Patients
An educated patient is an empowered patient, which is why the Academy created OrthoInfo, its website for the general public.
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Coding Update for Drug-delivery Devices
Editor’s note: This article is part one in a two-part series on updated Current Procedural Terminology ® (CPT ®) codes addressing drug-delivery devices. Part two will be published in the August issue of AAOS Now.
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Scenarios Illustrate Coding Changes for Musculoskeletal Drug-delivery Devices
Editor’s note: This article is the second in a two-part series on updated Current Procedural Terminology ® (CPT ) codes addressing drug-delivery devices. Part one was published in the July issue.
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Coding for Open Knee Procedures Poses Challenges
Coding for open knee procedures can be challenging. In some cases, the available Current Procedural Terminology ® (CPT) code definitions do not explicitly describe the techniques that physicians are using.
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Police Chief Louis M. Dekmar Offers Guidance for Improving Safety in the Healthcare Workplace
Acts of healthcare workplace violence, such as the recent passing of orthopaedic surgeon Preston Phillips, MD, FAAOS, at his workplace at the hands of a former patient, have drawn increased attention to the topic of workplace safety in healthcare settings.
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A Sneak Peek of CPT 2023: Nervous System Updates
This article will preview the relevant changes in the Nervous System section for 2023 that will affect orthopaedic surgeons.
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CPT® Changes to E/M Coding Start Jan. 1
Get ready, the Current Procedural Terminology (CPT®) guidelines for many categories of Evaluation and Management (E/M) services are scheduled to change on Jan. 1, 2023.
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A Deeper Dive into the NCCI Procedure-to-Procedure Rationales and Narrative Guidelines
This article will dive more deeply into two aspects of the National Correct Coding Initiative (NCCI) program that impact orthopaedic coding: the Procedure-to-Procedure edit rationales and narrative guidelines. Understanding how the components of NCCI work is essential for maximizing reimbursement and managing compliance risk.
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Update Details Coding for Non-face-to-face and Indirect Patient Optimization Work in the Presurgical Period
This article will discuss the appropriate CPT codes to report non-face-to-face and indirect services for preoptimization and provide an example of a relevant scenario in orthopaedics.
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OrthoInfo: Trusted Health Information for Orthopaedic Surgeons and Their Patients
It is essential that the information patient receive is reliable. That is why OrthoInfo, the Academy’s patient education website, is so valuable.
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ICL Illuminates the Cost-value Equation in Orthopaedic Care
During the Instructional Course Lecture (ICL) titled “Costing for the Clinician: How to Understand Cost in Orthopaedic Care,” moderator Brian Cunningham, MD, FAAOS, vice chair and director of inpatient orthopaedics at Methodist Hospital in Minneapolis, Minn., led a lively discussion on the factors impacting costs associated with care of musculoskeletal conditions.
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ChatGPT Is the Next Step in Artificial Intelligence
Editor’s note: This is the seventh article in a series on artificial intelligence (AI) and orthopaedics. Previous articles covered AI history, basic concepts, AI creep, how AI reads radiographs, early orthopaedic uses, bias, and medical ethics. This article is part one of a two-part introduction to the hottest and equally controversial development in AI, generative AI. The article will cover basic concepts and issues with training.
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Artificial Intelligence Is Changing Orthopaedics
The following is an output from ChatGPT when asked, “Can you help write an AAOS Now article on the impact of artificial intelligence?”
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AAOS Prioritizes Safety with New Online Toolkit Focused on Workplace Violence
The primary goal of the Workplace Violence Toolkit is to provide resources to help AAOS members improve safety from violence for both orthopaedic patients and care teams.
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Coding Potpourri: Answers to AAOS Members’ Coding Questions
Current Procedural Terminology (CPT) is always evolving.
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The Details of Denials Matter
Failure to share denial reports on a regular basis—whether monthly or quarterly—raises important concerns. The feedback loop is broken.
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Should Physicians Unionize? A Patient-centered Approach
A physician union presents one mechanism to alter the power dynamic between physicians and healthcare administrators, ultimately providing a counterforce to hospital corporatization.
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Sleep Deprivation Can Diminish Physician Performance
Sleep deprivation affects mental and physical functioning and can lead to unprofessional behavior and medical errors.
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Second-victim Syndrome Can Trigger Debilitating Psychological Responses
Orthopaedic surgeons are particularly susceptible to a phenomenon known as “second-victim syndrome.”
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Are Procedure-Based Bundled Payments Leading to the Commoditization of Elective Orthopaedic Care?
With the increasing economic burden of the healthcare system, healthcare payment reform has been a primary topic of academic and political discus-sion for the past decade, and newer models of reimbursement are steadily being implemented.
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Practice Management Course for Residents and Fellows-in-Training Offers Rich Content for Early-Career Surgeons
The Practice Management for Residents and Fellows-in-Training course is a free half-day educational offering specially developed to deliver content customized to the needs of early-career surgeons.
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Code-X Streamlines Coding and Supercharges Revenue
AAOS is unwavering in its commitment to providing members with leading-edge tools designed to maximize reimbursements.
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Surgeons Adept at Using Social Media Share Tips to Help Others Build Positive Digital Reputations
At the Instructional Course Lecture titled “Social Media and Orthopaedics: Establishing Your Online Reputation,” held during the AAOS 2024 Annual Meeting in San Francisco, panelists delved into the importance of social media and how it can help or hurt an orthopaedic surgeon’s overall reputation.
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When the Physician Is Ill: Navigating Illness and Disability as an Orthopaedic Surgeon
Mary Lloyd Ireland, MD, FAAOS, focused her talk on the perspective of the physician-as-patient and on the matters of “work, life, and leadership” that she encountered after a diagnosis of and treatment for breast cancer.
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Symposium Acknowledges Workplace Bullying, Harassment, Discrimination as a ‘Today Problem’
When AAOS launched its last Strategic Plan in 2019, it included a goal to evolve the culture and governance of AAOS’ Board of Directors and volunteer structure to become more strategic, innovative, and diverse.
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Coding Alert: Denials of HCPCS Q-Codes for Casting and Splinting
AAOS was recently made aware of widespread denials for splinting and casting supplies (Q-codes) relating to fracture care in several states across the United States.
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‘An Unrecognized Problem Cannot Be Addressed’: ICL Offers Strategies to Mitigate Workplace Violence
The threat of workplace violence has emerged as a pressing concern in healthcare, demanding collective attention and sparking discourse.
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If Surgeons Are Not Benchmarking Practice Performance, How Do They Know Whether They Need to Improve?
An orthopaedic practice generated a net patient revenue of $20 million in 2023. Is that a good number?
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OrthoInfo QR Codes: An Easy Way to Share Patient Education
Good musculoskeletal patient education is hard to find, but AAOS has it covered with OrthoInfo, which features more than 450 pieces of content across all orthopaedic subspecialties, developed and updated regularly by orthopaedic specialists.
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Recently Redesigned AAOS Toolkits Offer Key Resources for Orthopaedic Practice
AAOS is proud to unveil its newly redesigned Toolkit Portfolio, consisting of 15 comprehensive toolkits tailored to support orthopaedic surgeons and surgical teams.
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Attorney Explores Business and Intellectual Property Issues Concerning New Medical Device and Product Development
Orthopaedic surgeons who are interested in product development should carefully assess legal considerations such as intellectual property, patents, contractual obligations, restrictive covenants, conflicts of interest, and company partnerships.
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CPT Updates 2025: New and Revised Codes for Musculoskeletal and Telemedicine Services
The American Medical Association (AMA) provides code and guideline changes to the Current Procedural Terminology (CPT) Manual each year. This article will preview relevant changes to the musculoskeletal section for 2025.
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What Orthopaedic Surgeons Should Know about the Legal Aspects of Telemedicine
Telemedicine expanded during the COVID-19 pandemic, but many states have rescinded emergency waivers that allowed for interstate communication. Three specific federal laws impact telemedicine.
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Streamline Your Coding at AAOS 2025 with Code-X
Are you ready to optimize your practice’s reimbursements and simplify claim submissions?
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Government Insurance Limits Patient Access to Orthopaedic Surgeons and Physical Therapy Services
This article assesses the current literature and evidence regarding access and utilization of both physical therapy services and orthopaedic surgeons for patients with government insurance versus private insurance.
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Prior Authorization Does Not Reduce THA Costs, Leads to Delays in Patient Care
Commercial insurance companies often use prior authorization as an attempt to control costs.
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Coding for interprofessional consultations via telephone, internet, or electronic health record
Codes are available to report evaluation and management services for consultations provided to a treating physician or other qualified health profession (QHP), performed by another specialized QHP without face-to-face contact.
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Supporting patients’ emotional well-being can help foster a safer environment for surgeons and healthcare staff
In the United States, healthcare workers are five times more likely to experience workplace violence than workers in other industries.
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Liability Management 101
Today's orthopaedic practices are at a crossroads. Many face possible mergers or acquisitions and potential relationships with hospital systems and third-party payers. As the healthcare landscape shifts, so too does a practice's professional liability exposures. Recently, I spoke with David Burke, director of Smith Brothers Insurance Healthcare Division, to find out what orthopaedic surgeons can do to protect themselves and their practices. Dr.
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7 Golden Rules for Reducing Hip Arthroscopy Denials
If a constant stream of denials for hip arthroscopy procedures frustrates you, know that you are not alone. These denials are a common source of angst for physicians. The good news is, if you know how to avoid common coding pitfalls, document correctly, and follow payer medical policies, most of these denials will disappear. The key is having proper documentation, prior to submitting the claim. This minimally invasive hip surgery is still relatively new.
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How Do "Physician Compare" Websites Affect Orthopaedic Practice?
With the current focus on patient satisfaction and the consumer-driven healthcare economy, a number of independent websites enable patients to rate individual physicians whom they encounter. The impact of these websites on orthopaedic practice is continuing to be elucidated. Many for-profit websites compare and contrast individual physicians and surgeons. This article reviews some of the most well-known physician comparison websites and examines their implications for practice.
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PA and NP Billing: Are You Doing It Correctly?
The effective use of physician assistants (PAs) and nurse practitioner (NPs) in an orthopaedic practice requires an understanding of key billing rules that apply to these nonphysician providers (NPPs). Compare your practice's internal procedures to the following common questions and answers. The guidelines referenced are for Medicare claims; other payers may have different rules. The Medicare scenarios and guidelines described in this article apply the same way to both PAs and NPs.
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2017 Spine CPT Code Changes
Spine surgeons face a multitude of Current Procedural Terminology ® (CPT) code changes, effective Jan. 1, 2017. This article provides a summary of these changes so practices can get a head start on understanding their implications. A complete listing of changes can be found in the 2017 CPT manual.
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Updating the Case for POPTS
Since 2012, several studies have been published showing that physical therapy (PT) provided within a physician practice may result in lower utilization and costs than PT provided in private therapy practices. Data from these studies support the claims that physician-owned physical therapy services (POPTS) do not result in overuse or excessive costs. GAO study At the request of Congress, the U.S.
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Frequently Asked Coding Questions
Increasingly, pain management specialists—physical medicine and rehabilitation specialists or anesthesiologists—are joining orthopaedic groups that have adopted a more global approach to musculoskeletal system care. However, this presents challenges for the billing time, particularly with respect to coding procedures and transfers of care from the orthopaedists to their pain colleagues. The coding team at KarenZupko & Associates shared the following frequently asked questions.
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Census Examines Orthopaedic Workforce Trends
The Orthopaedic Practice in the United States (OPUS) Survey, also known as the orthopaedic census, gathers demographics and practice data on U.S. orthopaedic surgeons.
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What Can Benchmarking Do for Your Practice?
Are you ready for 2018? For many practices, using benchmarking data is a good way to start planning for the year ahead. Not only does the data help practices determine their performance in comparison to their peers, the information also enables them to identify their own strengths and weaknesses.
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How to Use Modifier 25 Correctly
Modifier 25 is used when a minor procedure (one with a 0- or 10-day global period) and a significant and separately identifiable evaluation and management (E/M) service are performed during the same session or day. The Office of the Inspector General (OIG) and Medicare have identified the use of modifier 25 as an area of potential overuse and misuse.
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Are You Ready for SHFFT?
In a proposed rule announced on July 25, 2016, the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) introduced three new Episode Payment Models (EPMs) for episodes of care surrounding acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment, excluding lower extremity joint arthroplasty (SHFFT).
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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).
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Medicare Sharpens Focus on the Global Surgical Package
The Centers for Medicare & Medicaid Services (CMS) has expressed concern that services with 10- and 90-day postoperative periods are not valued accurately, and follow-up visits included in the value of the global services are not consistently being performed.
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2017 Medicare Guidelines for Imaging
Effective Jan. 1, 2017, "FX" is a new Medicare modifier used to indicate that X-ray images were taken using film. The FX modifier is appended to the global radiology code or the radiology code with the modifier TC (technical component) when submitting Part B claims to Medicare and using film instead of capturing X-ray images digitally. If your images are in digital format, you do not need to change your reporting at this time.
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Orthopaedic Participation in APMs: What Are the Options?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ushered in the largest change to physician payments in more than a generation. As has been widely reported, the Quality Payment Program (QPP) replaces the sustainable growth rate formula with two payment tracks: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). Although these two tracks are presented as separate and distinct, a closer examination of the Final Rule (Nov.
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Bundled Payments: Early Lessons from NYU
The payment model for healthcare services is shifting, spurred in no small part by the federal government. In 2015, the U.S. Department of Health and Human Services set a goal of providing 30 percent of Medicare payments through an alternative payment model by the end of 2016. That goal was met by March 2016.
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Medical Imaging and HIPAA Compliance
Last month, I coauthored an article on Health Insurance Portability and Accountability Act (HIPAA) compliance that offered tips on how orthopaedic practices can keep their patients’ information safe (see “Top 10 HIPAA Mistakes to Avoid, AAOS Now, September 2017). In this article, I speak with Les Trachtman, CEO of Purview, a patient-driven healthcare technology company, about medical imaging and HIPAA compliance. Dr.
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Top 10 HIPAA Mistakes for Practices to Avoid
The Health Insurance Portability and Accountability (HIPAA) Act of 1996 continues to challenge every medical practitioner. A recent discussion on the current state of HIPAA revealed the top 10 mistakes that practices make during implementation. This year has been rough in terms of privacy. The Office of Civil Rights (OCR) has consistently levied stiff financial penalties on those who violate HIPAA rules. Hacking and ransomware attacks are more frequently in the news.
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Tips for Implementing Previsit Patient-reported Outcomes Collection
Quantifying pain intensity and magnitude of physical limitations using patient-reported outcomes measures (PROMs) can help determine whether and how well specific interventions will lead to meaningful improvements. But routine collection of PROMs is a challenge, as evidenced by the 30 percent to 80 percent response rate generated by joint registries.
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Take Your (Clinic) Life Back: Get a Scribe
A 2017 Medscape survey indicated that nearly half (49 percent) of orthopaedic surgeons feel burned out. The top three causes cited? too many bureaucratic tasks increasing computerization of practice too many hours at work If you’re looking to reduce the number of hours and tasks spent on bureaucracy and electronic data entry, as well as reclaim some quality of life at work, consider hiring a scribe. Scribes enable physicians to focus on patients and get out of the office sooner.
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Is Your Practice Optimizing Coding Resources?
Is your billing team or third-party billing service using the right resources, rules, and guidelines when assembling claims and managing denials? When substantiating coding or appealing claims, you must base your reasons on standard resources, applied in the correct order.
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Arthroscopy Coding for Major Joints
When the American Medical Association (AMA) published the first edition of Current Procedural Terminology (CPT) to standardize surgical procedure terminology and reporting, modern arthroscopy was in its infancy and no CPT code described it. As the number of arthroscopies for knee, shoulder, and hip conditions has exploded during the past few decades, CPT has attempted to address the reporting needs of these procedures.
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Have You Heard the Latest Medical Liability Risk?
On June 20, 2017, the Commonwealth of Pennsylvania Supreme Court handed down a 4–3 decision that has the potential to rock the world of medical liability. The justices ruled that surgeons, in order to obtain informed consent, have the duty to provide their patients with information about the risks, benefits, and alternatives of a particular procedure. Furthermore, surgeons must deliver that information personally. Who is responsible?
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On the Rise: What Is Driving the Cost of Medical Malpractice Insurance?
When the latest medical malpractice premium notice arrives at a physician’s office, it is not often for a small amount. Even practices that have avoided expensive lawsuits or claims are not shielded from rising premiums. Often, it seems that rising medical malpractice premiums are like death and taxes: inevitable. Medical malpractice premiums differ from one state to another and among specialties, yet they are all driven by the same factor: the cost of risk.
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Should I Sell My Practice to Private Equity?
As we all know, times change and healthcare trends re-emerge. In recent years, private equity has successfully consolidated and strengthened several specialties, including dermatology, dentistry, and ophthalmology. The focus has now turned to orthopaedics/musculoskeletal care.
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The EHR Era: Workload Reduction Strategies
The introduction of electronic health records (EHR) has imposed new workloads and workflows on physicians and orthopaedic practices. Although EHRs offer benefits including centralized and consolidated medical information, electronic prescriptions, and enhanced legibility, interoperability of these systems remains problematic. Many clinicians have found that the largely regulatory- and reimbursement-driven documentation requirements offset the advantages of EHR.
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Are Physicians Required to Return Overpayments?
When overpaid, many providers wonder if they need to return the funds. The short answer is yes. An overpayment is money that does not belong to providers and keeping it exposes them to collection and other risks. The U.S. Centers for Medicare & Medicaid Services (CMS) ruled that Medicare overpayments must be refunded within 60 days. However, some practices are passive on the issue and many do not have a policy addressing these funds.
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Medical Necessity Monopoly: How to Avoid ‘Chance’ and Advance to ‘GO’
Consider the following: A patient presents to your office complaining of symptoms that indicate a possible herniated disk. A history notes symptoms following the S1 nerve root, and your examination finds right radicular signs. You order an MRI to confirm your findings and proceed to discuss herniated disk surgery with the patient. Is it time to escort the patient to the surgery scheduler? Not yet.
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Don't Be the Next Victim of Billing Fraud and Abuse
Every physician has scenarios they seek to avoid: bad nights on call, less than optimal outcomes, and the fear of malpractice suits. What many don’t think about are coding mistakes that could result in federal investigators knocking on the office door. Audits may uncover coding errors, resulting in stiff fines and even jail time.
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The Rise of the MD/MBA
Physicians spend a considerable portion of their time in medical school, residency training, and fellowship in clinical training to become proficient in their specialties. Throughout the training process, there is little to no guidance on the business side of medicine. With the evolution of health care and a focus on fiscal management and economics, maintaining a medical practice—whether independent practice or hospital employment—is a challenge.
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Medicare’s New Documentation Rules Impact Practices
In the November 2018 Federal Register, the Centers for Medicare & Medicaid Services (CMS) released new, relaxed documentation guidelines, effective Jan. 1, which have a significant effect on office workflow. When documenting services for new and established outpatient visits, the billing provider does not need to redocument any part of the chief complaint (CC) or history in the medical record when recorded by the patient, patient’s family members, or ancillary staff.
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CPT Code Updates Surgeons and Staff Need to Know
It’s a new year, and along with it come additions, deletions, and changes to Current Procedural Terminology (CPT) codes. Here are eight essential updates that surgeons, coders, and billing staffs must understand to code accurately and get paid in 2019. Three new add-on codes are effective in 2019: 20932, 20933, and 20934. Each describes a type of structural allograft.
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Common Misconceptions Continue to Plague Implant-related Hypersensitivity Responses and Testing
The terms metal hypersensitivity and metal allergy have been used interchangeably to refer to metal delayed-type hypersensitivity (DTH) responses. DTH, or adaptive, immune responses differ dramatically from normal physiologic responses to metal debris. A normal physiologic response to metal implant debris may be adverse (toxic and/or immunogenic) and increase in proportion to exposure.
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Tips and Best Practices for Using Code-X
This concludes a two-part series on Code-X. Part one appeared in the May issue of AAOS Now. After speaking with Michael Marks, MD, MBA, and Margaret Maley, BSN, senior consultants from KarenZupko & Associates, Inc., (KZA) about the most valuable features of Code-X in part one, Cheryl Toth, MBA, spoke with Madelaine Reese, senior product manager of online learning at AAOS, about tips for getting the most out of this coding and compliance tool, which was developed by AAOS. Ms.
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Do Your Cybersecurity Policies Need a Checkup?
When was the last time you reviewed your cybersecurity policies? If you can’t recall, you’re overdue. Such policies are critical for protecting patient and other sensitive data in your network and reducing the risk of breaches that can cause reputational harm, costly recovery, and patient disclosure activities. Recently, I spoke with Michael J.
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Supporting a BPCI or CJR Program Requires a Strong Team and Leveraging New Technology
Embarking on a successful Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) program requires establishing and fostering relationships with key stakeholders. Essentially, any provider who participates in a patient’s longitudinal pathway of care should be part of the multidisciplinary team. The team may include physicians, administrators, payers, nurses, therapists, case managers, post-acute care organizations, and others.
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Ensure Lasting Career Joy by Aligning Your Work with Your Values
During the fall 2018 in-person meeting of AAOS’ Patient Safety Committee (PSC), members addressed the importance of being proactive in maintaining joy in the workplace. David C. Ring, MD, PhD, chair; committee members Todd Soung Kim, MD, Michael R. Marks, MD, MBA, Michael T. Archdeacon, MD, and Nina R. Lightdale-Miric, MD; former committee member Michael S. Pinzur, MD; and 2018 resident member Keely Boyle, MD, discussed the importance of becoming familiar with what matters most and setting up surgical practice to match those values.
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Issues Loom Over Recent CMS Decision
Total knee arthroplasty (TKA) was removed from the Centers for Medicare & Medicaid Services’ (CMS) inpatient-only (IPO) list on Jan. 1, 2018.
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Ambulatory Surgery Centers Versus Hospital-based Outpatient Departments: What’s the Difference?
When performing outpatient procedures, many orthopaedic surgeons operate in either an ambulatory surgery center (ASC) or a hospital-based outpatient department (HOPD). Although some of the workflows and services offered may appear similar between the two, the background operations are substantially different from business and regulatory perspectives.
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Therapy Billing: Be Sure Your Team Is Doing Things Right
Many orthopaedic surgeons are adding physical and occupational therapy services to their practices. These enhancements can be daunting for in-house billing teams, as they may lack experience with the new services, therapy terminology, and associated Current Procedural Terminology codes.
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Telemedicine in Orthopaedics: Risks Versus Benefits
This article is part one of a two-part series on telemedicine (TM). Part one provides a historical background and presents TM’s potential role in orthopaedics. Part two will discuss liability and compensation concerns TM providers may face and will appear in the January 2020 issue of AAOS Now.
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How Does Your Revenue Cycle Stack Up Against Your Peers?
Each year, KarenZupko & Associates, Inc., (KZA) sends a precourse survey to those who have registered for the KZA/AAOS coding and reimbursement workshops.
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What Happens When the Orthopaedist Becomes the Patient?
Orthopaedic surgeons have liabilities far beyond malpractice concerns. We prepare for surgical complications in a number of ways, including obtaining informed consent, establishing good rapport with patients, and purchasing medical malpractice insurance. But how many of us are prepared for personal illness or injury?
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Survey Assesses Compensation Trends for Physicians and Practice Administrators
The annual American Alliance of Orthopaedic Executives (AAOE) Benchmarking Survey collects data from orthopaedic practices across the country to give practice professionals the data they need to make strategic decisions.
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AAOE Survey Illustrates Evolving Overhead and Staffing Trends
Managing overhead is critical for orthopaedic practices. Overhead must be monitored regularly to make sure that staff and other practice expenses support efficient practice workflows and positive patient experiences. Benchmarking Survey trends from the American Alliance of Orthopaedic Executives suggest that orthopaedic practices are effectively managing overhead expenses, while staffing patterns and outsourced service utilization change to meet patient needs and healthcare requirements.
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The Devil Is in the Details
Beginning Jan. 1, 2021, the level of service selection for new and established patient “office or other outpatient” visits will be based only on either medical decision-making (MDM) or time. Current Procedural Terminology (CPT) is making dramatic changes to the way those services are defined and documented, impacting billions of healthcare dollars.
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Your Patients and Colleagues Are on Social Media, and You Should Be Too
The benefits of social media extend far beyond simply allowing patients to follow you on Twitter or Instagram. Social media accounts are an easy, low cost way to promote yourself and your practice.
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How One Case Hooked Me on Twitter
Having seen several cases posted on Twitter in the past, I decided to request help in identifying the implant. With permission from the patient, I turned to Twitter for assistance.
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Ransomware: The Other Viral Threat for 2020
Orthopaedic practices are not immune from this recent wave of ransomware attacks.
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Your Practice Has Been Hacked. Now What?
Ransomware has attacked members of our fellowship.
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Five Best Practices for the Social Media-inclined Orthopaedic Surgeon
This article provides five helpful tips for using social media as a part of your orthopaedic practice.
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Digital Orthopaedics Conference Features Chat with AAOS President and Past President
DOCSF kicked off in January with an event that included a “fireside chat” featuring AAOS Past President Joseph A. Bosco III, MD, FAAOS; AAOS President Daniel K. Guy, MD, FAAOS; Thomas P. (Tad) Vail, MD, FAAOS, president and chair of the UCSF Department of Orthopaedics; and Stefano Bini, MD, who moderated and participated in the discussion.
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Heightened Targets of Acquisition: How Orthopaedic Groups Can Stay Afloat
Orthopaedic groups need to understand the antitrust laws involved, how to structure joint venture deals that toe the line, and how to act when a hospital willing to violate antitrust laws to force an acquisition jeopardizes the ASC’s future.
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Coding Alert: ICD-10-CM ‘Excludes 1’ Claims Edit
The “Excludes 1” notation in the ICD-10-CM diagnosis code set indicates that the excluded code listed in the note cannot be billed with the code(s) listed above the notation.
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Perspectives on Musculoskeletal Digital Transformation Strategy
In an era when healthcare is inundated by emerging technologies, including telemedicine, remote monitoring, and longitudinal virtual care, subspeciality practices are facing increasing pressure to design and execute a comprehensive digital strategy.
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A Sneak Preview of CPT 2022
The American Medical Association provides code and guideline changes to the Current Procedural Terminology ® (CPT) Manual each year. This article previews the relevant changes to the musculoskeletal section for 2022.
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New OnDemand Webinar Focuses on RVU System and Code-X Software
The AAOS coding webinar Relative Value Unit System and Code-X Software, presented on Oct. 14 by Brian Galinat, MD, MBA, FAAOS; Peter Mangone, MD, FAAOS; and Tye Ouzounian, MD, FAAOS, is now available on the AAOS website under OnDemand.
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CMS and NCCI Restrict Surgeon Billing for Open Multi-ligament Knee Repair and Reconstruction
The National Correct Coding Initiative (NCCI), which is owned and operated by the Centers for Medicare & Medicaid Services (CMS), was developed to prevent improper payments for specific Current Procedural Terminology (CPT®) code combinations and units of service.
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Coding Alert: New CPT Modifier 93 for Audio-only Services
Effective Jan. 1, 2022, a new modifier was added to the Current Procedural Terminology (CPT) code set to describe real-time telemedicine services between a patient and a physician or other qualified healthcare professional rendered via audio only.
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Two New Coding Publications Available
The AAOS two-volume publication Complete Global Service Data for Orthopaedic Surgery was extensively reviewed and revised for 2022 by the AAOS Coding Coverage and Reimbursement Committee (CCRC) and is now available for purchase in print and as an e-book.
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CMS Updates Physician Assistant and Nurse Practitioner Billing
Editor’s note: This article is part one of a two-part series focusing on the 2022 Centers for Medicare and Medicaid Services updates to physician assistant and nurse practitioner billing.
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Physician Assistant and Nurse Practitioner Billing Questions: Are You Doing It Correctly in 2022?
Editor’s note: This article is part two of a two-part series focusing on the 2022 Centers for Medicare & Medicaid Services updates to physician assistant and nurse practitioner billing.
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OrthoInfo Content Helps Keep Kids Safe
As children prepare to go back to school and gear up for fall sports and activities, OrthoInfo, AAOS’ patient education website, is here to help teach parents and guardians how to keep their kids safe from injuries, address a wide range of musculoskeletal conditions, and reinforce bone-healthy habits.
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Specific Actions Must Be Taken in Order to Mitigate Workplace Violence in Outpatient Clinical Settings
Violence is an epidemic in America—no place more so than in the healthcare workplace.
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Panelists Explore Business and Legal Aspects of Hospital Employment for Orthopaedic Surgeons
Four orthopaedic surgeons discussed a few of the aspects that are important to understand and consider when thinking about the business side of a hospital-employed model.
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OrthoInfo Patient Education Is New and Improved
When people visit a healthcare website, they want to feel confident that they are receiving the most trustworthy and up-to-date information. With so much bad information online, however, it can be difficult to know whom to trust.
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Coding Education OnDemand Offers New Educational Resources
The recording of the AAOS coding webinar “CPT Changes to E/M Services for 2023” is now available OnDemand on the AAOS website. The webinar was presented in December 2022 by R. Dale Blasier, MD, FAAOS; Adam Levin, MD, FAAOS; and Christopher Kauffman, MD, FAAOS.
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Optimize Your Coding and Maximize Reimbursement with AAOS Orthopaedic Code-X, Now Powered by GaleAI
Through the AAOS Orthopaedic Code-X software, AAOS is devoted to providing the best coding tools available for surgeons.
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New Coding Webinars and Resources Available from AAOS
Several new resources regarding coding for orthopaedic services are now available from AAOS.
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A Test Drive of ChatGPT and Generative AI in Orthopaedics
Understanding that ChatGPT is primarily a language model, the question for AAOS members is how this system can be implemented within the patient-surgeon relationship.
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Truth in Advertising: Hospital Rankings May Create Confusion for Patients
When traveling around the country, it is not uncommon to notice billboards claiming a hospital is “the best” or in the “top 50” or “top 1 percent” in a particular region or in the country.
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What Orthopaedic Surgeons Should Know about Medicare Audits in 2023
To ensure that AAOS members have the information necessary to comply with Medicare policies and avoid overpayment requests or claims denials, here is the latest background information on current audit programs and audit targets.
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Resilience Alone Cannot Address Orthopaedic Surgeon Burnout, Moral Injury
The concept of resilience is applied widely within and outside of medicine, and the challenges of the past several years have brought to the forefront the idea of cultivating resilience.
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The Good, Bad, and Ugly of Patient Reviews
Online patient reviews of medical practitioners also have become increasingly popular, and it is now commonplace for patients to read and leave reviews of physicians before and after their clinical encounters.
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The Evolving ‘Front Door’ for MSK Patients: Is the Physician In?
The use of digital care in orthopaedic offices is becoming more common. Although these innovations have increased patient satisfaction and outcomes, they have failed to decrease the cost of care.
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Learn How OrthoInfo Can Transform Your Patient Education Program
Capital One asks, “What’s in your wallet?” AAOS asks, “What’s in your patient education library?”.
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When the Physician Is Ill: How Employers Can Support Surgeons during Serious Illness
Christopher Bono, MD, FAAOS, shared his story of illness and recovery in the context of how the employer should optimally respond when a surgeon gets sick.
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Orthopaedic Surgeon Ian Engler, MD, Shares Experience during the Lewiston, Maine, Mass Shooting
On the evening of Oct. 25, 2023, there was a mass shooting in Lewiston, Maine, with 18 people killed at two locations. Ian Engler, MD, an orthopaedic surgeon in Lewiston, was one of the many physicians and other caregivers who heard the news and rushed to the hospital to help.
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CMS Revises Split/Shared Services Definition for 2024
The purpose of this article is to clarify coding and billing for split/shared billing.
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ICD-10-CM Basics for Orthopaedics
Here are a few important reasons why diagnosis coding accuracy is crucial to orthopaedic practice:
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Coding Policy Updates AAOS Members Need to Know
AAOS members should be aware of several new coding policy updates that may impact orthopaedic practices.
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Complexity Add-On Code G2211: What Is It and How Is It Used in Orthopaedics?
On Jan. 1, the Centers for Medicare & Medicaid Services (CMS) implemented Healthcare Common Procedure Coding System (HCPCS) code G2211.
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Coding Alert: Two New Coding Resources Available to Support Appeals of Inappropriate Denials
For orthopaedic surgeons who are experiencing inappropriate denials of certain Current Procedural Terminology (CPT) codes, AAOS is working to support its members in their appeals to payers.
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CMS Provides Updates on Targeted Probe and Educate Program Regarding Hyaluronate Injections
Recent changes related to Healthcare Common Procedure Coding System coding for drug administration have led to hospital and physician audits related to joint arthroplasty procedures. This article addresses how recent Targeted Probe and Educate reviews may have recently come to light in adult reconstruction practices.
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Onboarding New Physicians to an Orthopaedic Practice: Optimizing the Transition from Training to Patient Care Is Key
Whether it be an academic, private practice, or employment model, the new surgeon arrives to his or her practice with little understanding of practice mechanics, no referral network, and often limited social connections, hoping to be successful.
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A Phased Approach Ensures Successful Onboarding of Orthopaedic Surgeons to a New Practice
Although each organization is different and has different needs, there are a few key steps that practices can take to conduct successful onboarding.
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Essential Practice Management Course for Residents and Fellows-in-Training Happening Tuesday
Designed exclusively for orthopaedic surgery trainees, the “Practice Management for Residents and Fellows-in-Training” course is a free half-day course that will provide critical knowledge to navigate your early-career challenges.
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Optimizing Orthopaedic Care: A Guide to Global-Period and Transfer-of-Care Modifiers
Maintaining continuity of care for the patient during the global period is critical to overall outcomes, and accurate documentation and coding are essential to proper reimbursement and effective coordination of patient care.
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ICL Explores How Recent CPT Coding Changes May Impact Telehealth, Fracture Care Reimbursement
Coding is a complex topic and quite often a moving target.
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Symposium provides varied practice perspectives on mandated PROMs collection
There has been talk about incorporation of patient-reported outcomes for years, but new requirements are putting collection of these data front and center for many orthopaedic surgeons.
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AAOS’ coding portfolio provides resources to optimize reimbursement, ensure compliance
From policy changes and denials to modified codes, coding for orthopaedic procedures presents numerous challenges for even the most seasoned physicians.
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Using IT in Your Practice: Now and Into the Future
Information technology (IT) has disrupted numerous sectors of our economy and society. Examples abound—from Wikipedia, iTunes, and Amazon to Expedia, Uber, and Airbnb. Even personal interactions and sharing of experiences are being transformed, as exemplified by the Millennial Generation's use of social messaging apps (Snapchat, WhatsApp, Instagram). In the future, will this innovative disruption include medical practices?
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Orthopaedic Impact Study Pays Dividends to Missouri Economy
If your state's director of economic development announced that he or she had brought an industry to the state that would generate $1.79 billion in total economic output and $28 million in state taxes while supporting 11,000 jobs, it would certainly be statewide news. Here in Missouri, the Show-Me State, that is exactly what happened.
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Multisensory Patient Education and Informed Consent
Research recently published in the Journal of Bone and Joint Surgery finds that patient education involving the use of multiple senses (sight, hearing, and touch) during a surgeon-patient informed consent discussion improves patients' understanding of anticipated care and possible outcomes. The randomized, controlled trial involved 67 consecutive patients with a new diagnosis of knee osteoarthritis and who were treated with a corticosteroid injection.
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Liability Coverage in a Changing Healthcare Environment
In the first article of this two-part series on liability management (see "Liability Management 101," AAOS Now, August 2016), I spoke with David Burke, director of Smith Brothers Insurance Healthcare Division, about what orthopaedic surgeons can do to protect themselves and their practices today and into the future. Specifically, we addressed directors & officers insurance, employment practice liability insurance, and fiduciary liability insurance.
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ACI and HIPAA Security Risk Assessment Measure Requirement
The base score for ACI equals 50 percent of the overall ACI score and is a mandatory component in order to receive any points within the ACI performance category. Therefore, a MIPS-eligible clinician must report all six base score measures to earn the full base score, and then he or she can earn additional points through the performance score. However, in 2017, the requirements have been reduced during the transition period.
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Insurer Provides Interesting Perspective on Tort Reform in the Medical Malpractice Arena
For as long as I can remember, the issue of tort reform has been front and center for every orthopaedic surgeon. Traditionally, it has been at the top of the list of "must haves" for the legislative agenda when orthopaedic surgeons visit Capitol Hill each spring. In 1975, California enacted the Medical Injury Compensation Reform Act and most tort reform efforts since then have tried to incorporate caps on noneconomic damages.
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PROs in Practice
In the first article of this two-part series on the use of patient-reported outcomes (PROs) (see "Collecting and Using Patient-Reported Outcomes in Everyday Practice," AAOS Now, January 2017), Charles A. Goldfarb, MD, from Washington University in St. Louis, shared his experiences with implementing the Patient-Reported Outcomes Measurement Information System (PROMIS®). In this article, we talk with Bradley J.
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Ransomware: A HITECH Shakedown
Imagine arriving at your office bright and early one Monday morning only to learn you are unable to access your practice's electronic health record (EHR) system. Your system has been hacked, locking you out of all your data, including patient charts, radiographs, billing, and claims. To make matters worse, you receive a notice that you must pay thousands of dollars to retrieve this information.
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Meeting the Unmet Need: Independent Medical Examinations
The Centers for Disease Control and Prevention reports 80.1 million visits per year to physician offices, hospital outpatient centers, and the emergency department for injuries. The nearly 3 million nonfatal workplace injuries and illnesses reported by private industry employers in 2014 occurred at a rate of 3.2 cases per 100 equivalent full-time workers. Many of these workplace injuries result in a lawsuit or workers' compensation claim.
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Cybersecurity and the New “Armed Robbery”
Criminal activity is on the rise. Orthopaedic practices nationwide are coming under increasing attacks from cyber pirates who, after breaching the office’s security system, are demanding ransom. It is much less risky for perpetrators—often from another country—to hack into a secure computer system than to perform an armed robbery at the reception desk. Yet the goals and rewards are the same.
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Advancing Care Coordination Through More Episodic Payment Models
On Dec. 20, 2016, the Centers for Medicare & Medicaid Services (CMS) issued the Final Rule (CMS-5519-F) for new mandatory bundled payments focused on cardiac care. The rule also expanded the mandatory Comprehensive Care For Joint Replacement (CJR) model for orthopaedic care. The new programs were originally scheduled to begin July 1, 2017; however, a recent rule has delayed the models until Oct. 1, 2017, and potentially to Jan. 1, 2018.
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Dispensing DME in Orthopaedics for Medicare
Orthopaedic practices often provide patients with supplies, such as casts and canes, integral to patients' treatment plans. This article covers the essentials of coding and claims submission. Understanding the definitions and rules for DME can help practices make more effective decisions on which supplies to offer patients as well as help them ensure that items are both accurately reported and appropriately paid. The article also focuses on Medicare policy, which applies nationally.
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Is Your Practice Primed to Launch an Orthopaedic Urgent Care Center
As patient care moves to less-acute settings, orthopaedic urgent care (OUC) is becoming more common. One of the most common reasons for emergency room care are musculoskeletal, and OUCs are a great opportunity to provide better access, better quality, and better value for their patients and communities. The move toward OUC There are many big-picture reasons to consider adding an OUC center to your practice. At a health system level, it can provide huge savings.
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Password Security: OpenSaysMe
Strong passwords are an essential, frontline defense in protecting data and systems In April 2018, the Center for Orthopaedic Specialists in California had to notify patients that some of their protected health information (PHI) may have been accessed by unauthorized individuals as the result of ransomware that had been installed on the practice’s network. The attack impacted nearly 85,000 current and former patients at the center’s three facilities.
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Scientific Analysis for Medical Liability Claims
In orthopaedics, as in much of medicine, improvements in patient care are achieved when processes are developed to analyze outcomes. Medical professional liability (MPL) claims can serve as lagging indicators or signals of serious problems in the delivery of care. Medical liability insurer Coverys thoroughly analyzes MPL cases; the resulting data then serve as a critical guide to the vulnerabilities permeating health care.
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Making the Case for Collecting PROMs
In a recent American Alliance of Orthopaedic Executives (AAOE) survey, only 35 percent of the participating practices are collecting patient-reported outcomes measures (PROMs). However, most practices indicated they are collecting patient satisfaction surveys (61 percent) and identified quality measures (71 percent) (Fig. 1). Orthopaedic practice executives, particularly those from small practices, may not be shocked by these figures.
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How Causation Is Determined in Workers’ Compensation Cases Continues to Evolve
Determining causation is a critical issue for diagnosis and treatment of medical conditions and diseases. The science of causation continues to improve with additional research; however, because the concept has different meanings and applications for various parties, its definition remains elusive. By definition, cause is something that results in an effect. In philosophy, if A causes B, then A must always be followed by B.
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Have You Heard the Latest Professional Liability Risk?
The list of liability risks for physicians continues to increase. On behalf of the Medical Liability Committee, this article presents new risks via highlights from a recent discussion with Jeannine M. Foran, BSN, JD, a Connecticut healthcare attorney who leads the Health Care Practice Advisory Group at Heidell, Pittoni, Murphy & Bach, LLP, in Bridgeport, Conn. Dr. Marks: What is the latest liability risk that physicians should be concerned about? Ms.
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7 Secrets to Increasing Leadership Impact
A major concern for senior executives is “bench strength”—the quantity and quality of up-and-coming, potential leaders who are in the pipeline. The problem is that too often these would-be leaders “hold back, shrink, and play small.” In today’s climate of unprecedented change, intense competition, and more demanding customers, leaders can’t hold back or shrink.
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Answers to Five Common Coding Questions
In this article, we discuss five concerns from surgeons and their staff that are currently “trending.” 1. Vendor advice = a flashing yellow light Question: Our orthopaedic surgeon recently performed a single-level anterior cervical diskectomy and fusion and reported Current Procedural Terminology (CPT) codes 22853 and 22845 for the intervertebral biomechanical device and anterior instrumentation.
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Four Tips for Avoiding Data Breaches
According to a new report by Radware, a provider of load balancing and cybersecurity services for data centers, the average cost of a cyberattack now exceeds $1 million. Furthermore, 37 percent of the organizations that have been attacked experienced subsequent damage to their reputation. I asked Michael J. Sacopulos, JD, founder and president of Medical Risk Institute, to provide some practical approaches for minimizing risk of breaches and costly cyber fallout.
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Communication and Resolution Programs Can Help When Something Goes Wrong and a Patient Is Harmed
In the past, patient harm often was followed by a lack of transparent communication with patients about what went awry, ultimately leading to adversarial relationships among patients, physicians, and medical centers. Long delays between the harm and any resolution, lack of investigation, and slow rectification of issues contributing to the harm were common. Apologies are now an accepted and protected part of communication and may come with settlement offers.
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Is ‘Insurance Only’ Billing Advisable?
Surgeons instructing billing staff to bill “insurance only” is a scenario that is all too common in orthopaedic practices. In effect, the practice is waiving the patient’s copay, coinsurance, and deductible amounts and accepting whatever amount the insurance company will pay. In most circumstances, this puts the surgeon and the practice in jeopardy. Medicare pays providers the lesser of the reasonable costs or the customary charges for services furnished to Medicare beneficiaries.
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Teamwork Enhances Workplace Culture
During the fall 2018 in-person meeting of AAOS’ Patient Safety Committee (PSC), members addressed methods for creating a culture of safety and enjoyment in orthopaedic surgery. David C. Ring, MD, PhD, chair; committee members Michael R. Marks, MD, MBA; Nina R. Lightdale-Miric, MD; and former PSC member How do you create a good team? What about the idea of hiring for values?
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Institutional Approach Combats Physician Burnout and Promotes Wellness
Most orthopaedic surgeons went to medical school to take care of patients and advance the science of medicine. Those altruistic goals serve as a path to personal fulfillment. However, an increasing number of physicians are frustrated with the practice of medicine, given the pressures to meet what often seem to be unrealistic expectations from patients.
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Coding Experts Weigh in on the Value of Code-X
If you are looking for an electronic tool that makes code selection easier and gives your practice powerful data for reducing denials, strengthening appeals, and validating plan payments, the Academy’s Code-X software tool is a good choice.
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Seven Common Questions in Foot and Ankle Coding
A previous article published in AAOS Now (“How to Avoid Common Mistakes When Coding Hand Procedures,” March 2019) identified common coding issues for hand procedures. This article presents seven coding conundrums and frequently asked questions pertaining to foot and ankle procedures.
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Hiring a Healthcare Consultant Can Help In Certain Situations
This article is the first of a two-part series; the second installment will appear in the October issue of AAOS Now. In today’s constantly changing and complex healthcare environment, it can seem impossible to keep up with the latest industry trends, operational efficiencies, software and security requirements, legal/compliance issues, and more. That is because it is impossible.
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How to Bill and Get Paid for Unlisted Procedures
Orthopaedic surgeons often perform procedures for which no specific Current Procedural Terminology (CPT) exists. For example, hip surgeons often are frustrated that there are no codes for periacetabular osteotomy (PAO) or labral reconstruction.
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AAOE Releases Top Trends from Its Benchmarking Survey of Orthopaedic Practices
The annual American Alliance of Orthopaedic Executives (AAOE) Benchmarking Survey collects data from orthopaedic practices across the country to give practice professionals the data they need to make strategic decisions.
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Diagnosis Coding, Risk Adjustment, and You: Today’s Documentation Is Building Tomorrow’s Payment Rates
According to orthopaedic surgeon William Mohlenbrock, MD, FACS, senior vice president, chief medical officer, and founder of Verras, Inc., “Virtually every physician believes his or her patients are the sickest.”
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Mandatory Requirements for Taking Call
Although many specialties are not required to be on emergency room (ER) call, surgical specialists are often still required to take call as a result of medical staff bylaws or employment contracts.
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Roundtable Participants Encourage Orthopaedic Involvement in the Development and Implementation of Payment Models
Alternative payment models (APMs), specifically bundled payments, are a frequent topic of discussion. As the election cycle kicks into high gear, health care will be at the forefront of the minds of politicians and voters alike. With rising healthcare costs and an ever-increasing population in need of orthopaedic care, bundled payment models, as a means to provide value-based care, are being evaluated as another alternative to a fee-for-service reimbursement model.
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Evaluation and Management Changes Are Coming Soon
Effective Jan. 1, 2021, the Current Procedural Terminology (CPT) evaluation and management (E/M) “Office and Other Outpatient Services” codes and guidelines will have significant changes. It is crucial to ensure that your electronic health records (EHRs), practice management systems (PMSs), and billing software systems are updated to reflect these considerable changes and report the correct levels of E/M services for new and established patients.
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CPT Coding Changes: What You Need to Know for 2021
The American Medical Association publishes the revised Current Procedural Terminology code set annually. This article addresses the CPT coding changes effective Jan. 1, 2021, by each section of the CPT code set.
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Is Time on Your Side in 2021?
In 2021, medical decision making (MDM) or time can be used to select the level of service for evaluation and management (E/M) codes for new or established outpatient visits.
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Watch Out for Common Social Media Pitfalls
This article contains some tips to consider as you build your social media presence in a way that is beneficial to your followers and your practice.
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New Challenges and Proven Strategies for Optimal Surgeon-patient Communication
Compared to the countless hours dedicated to surgical training, there is little direct observation of orthopaedic resident and fellow communication skills. This lack of training is demonstrated in the literature, as orthopaedic surgeons ranked last out of 28 specialties with respect to patient-reported communication skills.
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THA Example Demonstrates How to Win in Bundled Care
Once the dust settles on the difficult year that was 2020, payers and healthcare economists will return their focus to the hottest topic in the pre-COVID-19 era—how to reengineer the delivery system from one that remunerates providers for volume to one that rewards value.
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‘Technical Corrections’: CPT Evaluation and Management Publishes Additional Guideline Revisions
Since the adoption of the CPT® Evaluation and Management (E/M) Office or Other Outpatient guidelines changes by the American Medical Association (AMA) on Jan. 1, numerous questions have been raised regarding the ordering of tests and medical decision-making (MDM) credit.
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AAOS Posts New Webinar about Prior Authorization
The Prior Authorizations, Peer-to-Peer Review webinar, presented in July by Eric Stiefel, MD, FAAOS, and Christopher Kauffman, MD, FAAOS, is now available on the AAOS website in the Webinars OnDemand section.
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AAOS Announces New RVU and Code-X Webinar
On Thursday, Oct. 14, at 7:15 p.m. CT, Tye Ouzounian, MD, FAAOS; Peter Mangone, MD, FAAOS; and Brian Galinat, MD, MBA, FAAOS, will present the Relative Value Unit (RVU) System and Code-X Software webinar.
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Coding Alert Update: Telehealth Place of Service Codes
The Centers for Medicare & Medicaid Services (CMS) has published new guidance on the reporting of telehealth/telemedicine Place of Service (POS) codes.
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The EMR: Is It All It’s Cracked Up to Be?
I cut my teeth in medicine before CT, MRI, intraoperative navigation, cellphones, and of course, the electronic medical record (EMR).
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Coding Education on Demand: New Educational Resources
A recording of the AAOS coding webinar CPT & CMS 2022 Updates, presented in February by John Heiner, MD, FAAOS, and William Creevy, MD, FAAOS, is now available on the AAOS website in the Webinar OnDemand section.
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A Sneak Preview of CPT 2023: E/M and Musculoskeletal System Updates
Editor’s note: This article is part one in a two-part series on updated Current Procedural Terminology ® (CPT) codes for 2023. Part two will be published in the November issue of AAOS Now and will cover revisions to the Nervous System section of the CPT code set.
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Upcoming Webinar Addresses CPT Changes for 2023
On Wednesday, Dec. 14, the AAOS Coding Coverage and Reimbursement Committee will offer a webinar to explain the upcoming 2023 changes affecting Current Procedural Terminology ® Evaluation & Management codes, which will greatly impact reporting of services rendered and obtaining appropriate reimbursement.
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Rich Practice Management Content Is Ready for Residents and Fellows-in-training
A free, half-day educational course, “Practice Management for Residents and Fellows-in-training,” was specially developed to deliver content customized to the needs and career stages of orthopaedic surgeons in training.
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ICL Illuminates the Cost-value Equation in Orthopaedic Care
During the Instructional Course Lecture (ICL) titled “Costing for the Clinician: How to Understand Cost in Orthopaedic Care,” moderator Brian Cunningham, MD, FAAOS, led a lively discussion on the factors impacting costs associated with care of musculoskeletal conditions.
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Recent NFL Player Judgment Could Alter the Athlete-Team Physician Relationship
A verdict was recently awarded to a former NFL football player in connection with a knee injury and subsequent surgery.
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OrthoInfo: Orthopaedic Patient Education, Simplified
AAOS has made it easy for members to put OrthoInfo content in patients’ hands.
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The Employed Model of Practice: Care and Financial Considerations for Orthopaedic Surgeons
There is a trend toward more doctors being employed by hospitals and healthcare systems.
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2023 Changes to the Inpatient and Consultation E/M Codes
This year ushered in much-anticipated changes to the Evaluation and Management Current Procedural Terminology coding guidelines.
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The Digital ‘Front Door’: Is It Opening or Closing on Our Patients?
As independent tradespeople, we must provide value for those with whom we are contracted—such as patients, insurers, large employer organizations, and the federal government. Unfortunately, these two “contracts” are not always aligned.
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Coding for Magnetically Controlled Spinal-Lengthening Device Procedures
Growing rod constructs have been used for decades to treat early-onset scoliosis (EOS) without creating a definitive posterior spinal fusion that would limit growth.
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Commonly Asked Coding Questions in 2023
This column addresses recently asked Current Procedural Terminology (CPT) coding questions posed by orthopaedic surgeons, practice managers, and staff.
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Social Determinants of Health, Payment Reform, and the Role of the Orthopaedic Surgeon
Lack of access to housing, food, transportation, and employment has significant effects on both healthy patients and those managing chronic diseases.
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The Advantages and Disadvantages of Gain Sharing for Orthopaedic Surgeons Are Practice-Specific
At the AAOS 2024 Annual Meeting, experts discussed and scrutinized recent gain-sharing arrangements during a symposium titled “The Pros and Cons of Gainsharing Between Hospitals and Orthopaedic Surgeons—Is the Juice Worth the Squeeze?”
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Infertility: The Hidden Cost of Orthopaedic Training
Resident physicians, particularly those specializing in surgery, often find themselves contending with the challenging decision to postpone pregnancy during their critical childbearing years, because those years are spent primarily in medical school and postgraduate training.
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The Collaboration between the Medical Device Industry and Surgeons Continues to Drive Advancements in Patient Care
As medical technology continues to advance, the role of the medical device industry in supporting aspects of orthopaedic surgery, including patient care, research, and resident education, is expanding.
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Webinar: CPT, CMS 2025 Updates
On Thursday, Jan. 9, 2025, please join AAOS for a webinar that provides an in-depth review of the 2025 changes affecting CPT codes and CMS payment policies related to orthopaedics.
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The State of Musculoskeletal Health in Rural America
Health and healthcare in rural America are in crisis, including musculoskeletal care.
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Tips and Guidance for Starting an Independent Medical Examination Practice
An independent medical examination-based practice can be a fulfilling option for orthopaedic surgeons seeking to transition away from surgical care or enhance their current practice.
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Coding Webinar Explores Optimizing Reimbursement for Osteoporosis Counseling
Improving osteoporosis care delivery and fracture-prevention counseling is critical to musculoskeletal healthcare.
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CMS’ new Transforming Episode Accountability Model set to replace and expand on BPCI-A and CJR
The Centers for Medicare & Medicaid Services recently announced the Transforming Episode Accountability Model (TEAM), set to launch on Jan. 1, 2026.
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For early-career orthopaedic surgeons, it is never too early to focus on personal finance
The financial decisions made early in an orthopaedic surgeon’s career could have significant effects on short- and long-term financial wealth.
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Risk Evaluation and Management Strategies for Prescribing Opioids
During the AAOS Annual Meeting, experts discussed the epidemic of opioid drug use, misuse, and abuse in the United States, and focused on ways in which orthopaedic surgeons can practice safe and effective pain management for their patients. "Risk Evaluation and Management Strategies for Prescribing Opioids," a symposium moderated by began with a presentation by David H. Sohn, MD, JD, who explored the complicated legal landscape that has developed around physicians' prescribing habits.
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Upcoming Practice Management Articles in AAOS Now
Coding for Complications Comprehensive Care for Joint Replacement (CJR)—Perils of Failure December: Advancing Care Information The Medicare and CHIP Reauthorization Act (MACRA)/Quality Payment Program Ambulatory Surgical Centers/Specialty Hospitals
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Watch Annual Meeting Symposia on Demand
From anywhere in the world—and at any time—you can benefit from the outstanding educational presentations given at the AAOS 2017 Annual Meeting. These symposia bring you today's hottest topics, presented by surgeons who are shaping the future of the orthopaedic specialty. A listing of the symposia that are available as webcasts follows. They are available for free, on demand streaming through April 30 at www.aaos.
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Maximize Benefits, Minimize Risk Through Clinically Integrated Networks
Although clinically integrated networks (CINs) have been around for decades, their popularity appears to be on the rise, coinciding with the increase in alternative payment models (APMs) and value-based care initiatives. That's because CINs offer both patients and physicians—including specialists such as orthopaedic surgeons—many tangible benefits. Patients receiving care via a CIN typically have a single point of entry during which their medical history and current symptoms are recorded.
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Practice Management Added to 2017 OITE
The Orthopaedic In-Training Examination (OITE) is a standardized examination administered annually by the AAOS. The OITE is the first and longest running yearly medical specialty examination in the United States. In 1960, J. Vernon Luck Sr, MD, who was, at that time, the first vice president of the AAOS, proposed a specialty examination to document and guide the process of learning during graduate training.
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Coding for Closed Treatment of Fractures
Coding for closed treatment of fractures is nuanced and complex, which can lead to confusion. This article clarifies previously published guidelines on how to code for this form of treatment.
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How to Prepare for the American Board of Orthopaedic Surgery Exam
Taking the American Board of Orthopaedic Surgery board examination can be an intimidating experience for orthopaedic surgery residents. Recently, David Hamilton, MD, a PGY-5 resident at the University of Kentucky, spoke on behalf of AAOS Now with A. Jay Khanna, MD, of Johns Hopkins Medicine, on how to best prepare for the exam. Dr.
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The Value of Claims ‘Signal’ Data in Orthopaedic Surgery
In last month’s article, “Scientific Analysis for Medical Liability Claims,” Coverys’ Robert Hanscom, vice president of business analytics, and Lisa Simm, manager of risk management, presented the methodology the insurer utilizes to analyze medical professional liability (MPL) claims. This article features an analysis of Coverys’ review of 474 closed orthopaedic claims from 2013–2017.
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Feedback and Coaching Are Vital Elements of Workplace Culture and Success
During the fall 2018 in-person meeting of AAOS’ Patient Safety Committee (PSC), members discussed methods for creating a culture of safety and enjoyment in orthopaedic surgery. David C. Ring, MD, PhD, chair; and committee members Michael R. Marks, MD, MBA; Michael T. Archdeacon, MD; Todd Soung Kim, MD; Dwight W. Burney III, MD; and AAOS Medical Director William O.
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Tips for Selecting the Right EHR System
The process of choosing the right electronic health record (EHR) system for your practice has become increasingly important over the years. Some factors may be beyond our control when choosing an EHR.
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How to Avoid, Appeal Claims Denials
Accurate coding is essential to obtaining appropriate reimbursement for services rendered.
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Tips to Forge Successful New Intergenerational Partnerships
At the 2020 virtual Annual Meeting of the Pediatric Orthopaedic Surgeons of North America, two surgeons in a single practice—one a longtime senior partner and the other about six years out of fellowship training—shared their perspectives on the process of bringing on a new partner and joining the practice as the junior surgeon.
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AAOS Develops Landmark Resource Outlining the Value-based Care Landscape
AAOS released the first-ever provider-specific payment continuum outlining the musculoskeletal value-based care landscape. This endeavor comes in response to the unprecedented acceleration of new alternative payment models (APMs) and care delivery transformation initiatives to reduce healthcare costs and improve outcomes for patients.
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Consolidation: The Role of Private Equity in Orthopaedics
The search for growth and security is leading many practices to consider some type of consolidation. This trend has been part of the medical landscape for 20 years.
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Solutions Address PT Business Integration Challenges
This article addresses long-term business challenges specific to PT and how orthopaedic surgery practices are successfully meeting those challenges.
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OrthoInfo Content Helps Patients Navigate Hip and Knee Arthritis and Arthroplasty
Millions of people suffer from pain and loss of mobility due to hip and knee arthritis, and hundreds of thousands undergo hip and knee arthroplasty every year.
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Fictional Scenario Underscores How Non-compete Clauses Can Contribute to a Culture of Hospital Disloyalty to Physicians
Increasingly, I hear stories from all over the United States that sound much like Dr. Doe’s story in one way or another; just substitute “workspace” for block time, clinic staff, remuneration cuts, or termination.
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Happy Patients File Fewer Lawsuits: How to Avoid a Medical Liability Suit
Patients of physicians who were previously sued were more likely to rate their physicians poorly, described feeling rushed, and believed that their physicians did not adequately explain their condition or need for testing.
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Locum Tenens: Professional Preparation and Practical Tips
The following is useful information on professional preparation for a position as a locum tenens orthopaedic surgeon.
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Upcoming Webinar: CPT and CMS 2024 Updates
Register for the upcoming webinar “CPT and CMS 2024 Updates,” taking place Wednesday, Jan. 31, 2024, from 7:15 to 8:15 p.m. CT.
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Coding for Vertebral Body Tethering for Treatment of Adolescent Idiopathic Scoliosis
A vertebral segment, as defined in the CPT manual, includes the complete bony elements of a vertebra but does not include the interval disks between vertebrae. In this case, the number of vertebral segments corresponds to the number of vertebral bodies instrumented anteriorly.
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Get a Sneak Peek of CPT Coding Updates for 2024
This article previews relevant changes to the musculoskeletal section of the American Medical Association’s Current Procedural Terminology (CPT) Manual for 2024.
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Improve Self-Care by Minimizing Occupational Hazards
More attention is being paid to the overall approach and changing culture of how orthopaedic surgeons approach their own safety in the OR.
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Orthopaedic Surgeon Recounts Her Journey with Infertility
My partner, Mikey, and I wanted to start a family but weren’t sure whether we were ready yet. I was 36 years old at the time.
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Orthopaedic Surgeons and the Orthopaedic Device Industry Benefit from a Symbiotic Partnership
There has been a long and mutually beneficial partnership between orthopaedic surgeons and the orthopaedic industry.
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Community Hospital CEO Shares Perspective on Financial Challenges Facing Rural Hospitals
Edward Herrman, CEO of Hays Medical Center (HaysMed), a level 3, private, nonprofit community hospital in Hays, Kansas, discussed challenges facing his center as well as rural hospitals in general.
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From fear to safety: Thomas Brownfield, MSN, urges early action against healthcare workplace violence
AAOS’ Committee on Healthcare Safety recently hosted a webinar titled “Workplace violence in healthcare — Identifying risks and taking action.”.
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Upcoming Webinars
Oct. 17, 2016 Moderator: Nicholas Colyvas, MD CJR: Understanding the Economics and Risk Oct. 25, 2016 Moderator: John Cherf, MD, MPH, MBA Selling & Closing an Orthopaedic Practice Nov. 1, 2016 Moderator: Stephen W. Shick, MD For more information, email pracman@aaos.org
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Total Joint Coding and Documentation in Quality Programs
Both the Comprehensive Care for Joint Replacement (CJR) and Bundled Payment for Care Improvement (BPCI) programs mandate increased alignment between hospitals and physicians. Historically, coding of the patient experience during the hospitalization has affected hospital reimbursement, but not physician reimbursement. With these new initiatives, physicians now have a stake in the game.
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Care Delivery Redesign for Bundled Payments: No Risk, No Reward
There are many challenges facing the U.S. healthcare system, including fragmented care delivery and misaligned incentives. These problems show up everywhere we look and affect our daily work in a variety of ways.
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Trends in Orthopaedic Practice Acquisition by Private Equity
Private equity has demonstrated increasing interest in orthopaedic surgery in particular.
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Coding Education on Demand: Two New Educational Resources
A recording of the AAOS coding webinar titled “TKA/THA RVUs Impacted by 2021 Medicare Physician Fee Schedule Final Rule,” presented in April by John Heiner, MD, FAAOS, and Frank Voss, MD, FAAOS, is now available on the AAOS website.
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Register and Submit Questions for Upcoming Webinar on CPT Changes for 2023
On Wednesday, Dec. 14, the AAOS Coding Coverage and Reimbursement Committee will present the webinar CPT Changes to E/M Services for 2023.
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BHG Financial: New AAOS Member Advantage Program Partner Offers Discounted Products and Services
Members can take advantage of exclusive access to personal, business, and Small Business Administration (SBA) 7(a) loans from BHG Financial.
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Informed Consent Is a Key Component of Shared Decision Making with Orthopaedic Patients
Physicians have a legal and ethical responsibility to ensure that a patient’s consent is truly informed.
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Is Going Private Equity a Deal with the Devil or a Blessing in Disguise?
The trend of private equity (PE) firms investing in or acquiring orthopaedic practices seems to be increasing, but what exactly is a PE transaction?
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Coding Education OnDemand: Prior Authorization Webinar Available
The recording of the AAOS coding webinar titled “Prior Authorizations,” presented on Aug. 29 by Eric Stiefel, MD, FAAOS, and Noah Raizman, MD, FAAOS, is now available on the AAOS website.
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Webinar on Preprocedural Optimization Services Now Available
On April 9, the AAOS Coding, Coverage, & Reimbursement Committee hosted a webinar titled “Preprocedural Optimization Services.”.
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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.
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Telemedicine Is Capable and Necessary to Move Forward
The COVID-19 pandemic has impacted every facet of our lives and unexpectedly modified our practice as orthopaedic surgeons. As providers, one adjustment involves safer delivery of care through telemedicine. This is the lowest-risk medical access available to our patients.
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Homegrown Marketing for Your Orthopaedic Practice
Several months ago, a friendly debate was sparked on the American Alliance of Orthopaedic Executives’ (AAOE) members-only online community, Collaborate, when a member posed the question of whether to conduct marketing in-house or outsource it. To continue the conversation, AAOE hosted a webinar that featured members from two practices sharing their experiences.
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AAOS Facilitates Increase in NCCI MUE for Calcaneus Osteotomy Code 28300
The Centers for Medicare & Medicaid Services developed two types of code edits for claims submissions to prevent overpayment of overlapping, duplicate services reported. The two types of code edits include the National Correct Coding Initiative and Medically Unlikely Edits.
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Technical Corrections Published for 2023 E/M CPT Codes
On March 1, the American Medical Association published technical corrections and errata for the 2023 Current Procedural Terminology (CPT) code set, effective retroactively to Jan. 1.
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ICL Tackles Benefits, Safety, and Strategies for Implementing Wide-awake Hand Surgery
“Wide-awake hand surgery is growing in usage and prevalence by hand surgeons due to its versatility, convenience, safety, and economics.
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Q & A Session Sheds Light on Coding Fractures
Fracture care is a “common denominator” service within orthopaedics—used in some way by every subspecialty. Despite years of use, they remain a common topic of questions from association members and their staffs.
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Clinical Photography Is a ‘Snap’ to Implement
Currently, there are no orthopaedic-specific standards for clinical photography, and less than 50 percent of orthopaedic publications adhere to plastic surgery criteria. This article focuses on app-based clinical photo capture for providers even with no professional photographic experience.
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Concerning Error Rates Released on DME Billing
Physician practices considering an in-house durable medical equipment program should make sure all staff know the guidelines and documentation requirements for the items dispensed, as not knowing could result in costly mistakes.
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Alert: NCCI Edits Rescinded for Lumbar Arthrodesis with Laminectomy
AAOS participated in a meeting with the CMS regarding the July 1 National Correct Coding Initiative Procedure to Procedure edits between Column One spine codes 22630, 22632, 22633, and 22634 and Column Two spine codes 63052 and 63053.
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Panacea Financial Offers Financial Solutions for AAOS Members
Whether you are moving for residency, opening a practice, or refinancing student loans—Panacea Financial was built to support orthopaedic surgeons.
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Pictures add power to your presentation
How to find just the right images to make your PowerPoint presentations POP! Have you ever sat through the “PowerPoint Presentation from Hell”? Most of us have. It’s long and tedious—a dreary succession of slides filled with tiny text, presented by a lackluster speaker who doesn’t seem to notice that the audience isn’t paying attention. When it’s your turn to stand at the podium, how will you keep your audience riveted to your talk—not drifting off toward dreamland?
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Hiring better billing staff
What to look for and how to find it Picking the wrong people to fill business office positions is a very expensive mistake. Because staff salaries are the largest component of overhead in any practice, you should focus on hiring staff who have the skills and talent to add to your revenues. Conversely, hiring less skilled or trained people will have a negative impact on revenues—no matter how hard you work.
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Medicare’s rules on supervision of diagnostic imaging
Orthopaedic surgeons and their billing staff typically pay careful attention to Medicare’s incident-to-billing rules. But they often aren’t as well informed on Medicare’s rules for supervision of diagnostic testing. Some practices confuse the two sets of rules, despite the differences between them. This article focuses on supervision of diagnostic imaging most commonly done in orthopaedic practices.
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Staff training with the click of a mouse
Have you ever considered the cost to your practice when an employee leaves? There’s not only the cost of recruiting a new team member, but also the costs of lost productivity. According to human resource experts, these costs can run as high as 25 percent of the employee’s annual salary and benefits. So the cost of turnover for a medical assistant who receives $30,000 compensation and $6,000 in benefits annually would be $9,000.
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Is it time for your practice to go digital?
That’s the question Michele M. Zembo, MD, MBA; Glenn Sumner, MBA, and Ira H. Kirschenbaum, MD, hoped to help audience members answer during the Practice Management Symposium for Practicing Orthopaedic Surgeons, held on the Tuesday before the 2007 Annual Meeting. Their session, “Preparing your office for the digital world,” explored the benefits of implementing electronic medical records, digital imaging, and other technologies. Dr.
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Once bitten, twice shy: Choosing the right practice the first time
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.
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Cash controls: Better safe than sorry
You did everything right. You dictated the visit and the surgery promptly, documented perfectly, coded accurately, and yet still you aren’t paid. Why? Perhaps the systems in your practice allow receipts to be short-circuited in a variety of ways, and payments for the work you do are not being reconciled and credited to you. Here’s a step-by-step process to assess the internal cash controls in your practice.
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Negotiating your orthopaedic employment contract
Make sure you can live with the details One of the most important documents orthopaedic surgeons encounter in their professional lives is their employment contract with an orthopaedic group. The contract is just as important for surgeons entering practice as it is for surgeons switching practices midcareer. It’s no less important than a prenuptial agreement or your last will and testament.
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Reporting knee revision surgery correctly
Reporting knee revision surgery does not need to be complicated or mysterious. It does require an understanding of both the definition of revision surgery and the modifier 58. A single-stage procedure When a total knee prosthesis is removed and replaced as the definitive procedure during the same operative session, it is considered knee revision surgery.
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Place of service affects your reimbursement
Facility, nonfacility designations make a difference In 2008, the Office of Inspector General (OIG) for the department of Health and Human Services intends to focus on Place of Service errors for services submitted by physicians. According to the OIG work plan, “We will review physician coding of place of service on claims for services performed in ambulatory surgical centers (ASC) and hospital outpatient departments.
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How to hire a practice administrator
Frank discussions + due diligence make for a happy “marriage” Business is booming at your four-person orthopaedic group practice, and your partners agree it’s time to bring on an experienced practice administrator. After interviewing several candidates, you select a well-spoken, seemingly intellectual and insightful candidate who holds a senior-level job at a major state-run hospital system.
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Taking the road to PACS
Converting to computed radiography: a step-by-step process with inspiring results Southern Bone & Joint Specialists is a 20-physician orthopaedic practice with four offices in southeast Alabama. The physicians see more than 400 patients a day and order approximately 45,000 radiographs each year. The practice more than doubled in size during the past 10 years.
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Answers to your coding questions
Plus tips to help you get paid correctly Because coding questions always cover a range of topics, this issue of AAOS Now focuses on answering several recent inquiries. We’ve also included some coding suggestions designed to help you get paid correctly the first time around. Remember, new common procedural terminology (CPT) codes require you to be aware and update your reporting. Outdated code usage means denials Q: I am a new manager of an orthopaedic practice.
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2008 spine-code changes you can’t afford to miss
The American Medical Association’s (AMA’s) Common Procedural Terminology (CPT) 2008 (CPT 2008) includes a number of spine-code changes, including revisions, additions, and clarifications, that can affect the spine surgeon’s bottom line. New and revised CPT codes are designated with a triangle symbol: p. Additionally, several instructional comment changes in the Spine section of CPT are noted with sideways triangle symbols: ut.
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Tips for establishing an alliance with your practice manager
A 10-item “to do” list that will pay off for your practice Forging a strong, enduring alliance with your practice executive is neither complex nor difficult, but it is critical. If your current manager chooses to leave, finding a new manager will be both expensive and time-consuming. In addition, while you’re looking for a new person and for several months after hiring someone, your practice will be treading water.
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Be prepared before depositions
Tips for responding to questions during expert witness depositions How to Excel During Depositions: Techniques for Experts That Work (SEAK, Inc., Falmouth Mass., 1999) by Steven Babitsky, Esq., and James J. Mangraviti Jr., Esq., is one of the best resources I’ve found for orthopaedic surgeons who serve as expert witnesses and for those who are defendants in a lawsuit. Last month, I reviewed some of the authors’ tips on answering counsel’s questions.
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Frequently asked coding questions
Report codes properly to ensure payment Attendees at the AAOS coding workshops frequently have questions about various aspects of coding. This month’s column covers several questions that apply to many practices. Conscious sedation Q: Is conscious sedation reportable by the physician who administers this at the time of a closed reduction? A: Yes.
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Retirement plans: Choose one and invest regularly
When retirement plans make news, it’s usually bad—which is a primary reason for having professional assistance in setting up a retirement plan and for regularly reviewing established plans. You don’t want to approach retirement and get bad news about your retirement plan. Defined benefits, contributions Most retirement plans are “qualified plans,” meaning that they meet certain Internal Revenue Service requirements that offer tax advantages to both the employee and the employer.
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Category III code updates
Get ready to use these updated spine codes What’s a Category III code? Category III codes, also known as “emerging technology” codes, were first introduced in 2002. These codes are alpha-numeric codes (such as 1234T) and are found in a tabbed section following the Category I and II codes in the 2008 CPT Professional Edition. You can also access them online (www.ama-assn.org/categoryiiicodes.pdf). Category III codes are temporary codes.
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Preparing to close your practice
There’s lots of work to do before you retire According to the last AAOS census (2006), more than half of all orthopaedic surgeons in practice today are older than age 50. Although many of these surgeons may continue in practice for several more years, concerns about decreasing reimbursements and increasing practice and liability insurance costs may cause others to consider cutting back on their practices or retiring at an early age.
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To pay or not to pay
By Kathleen L. DeBruhl, Esq., and David D. Haynes, Jr., Esq. Structuring compensation to on-call physicians The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 in response to concerns that hospital emergency departments were improperly transferring or refusing to treat indigent patients.
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Is your practice audit ready?
The OIG 2009 Work Plan is taking a close look at coding There’s nothing secret about what the Office of the Inspector General (OIG) for the Department of Health and Human Services is planning. It’s all laid out in the OIG Work Plan for Fiscal Year 2009. The following provisions on this year’s agenda (shown in italics) have applicability to orthopaedic practices.
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Which system is right for your practice?
Considerations for moving to electronic billing and collection systems How medical practices bill and collect for services rendered has changed over the years. Virtually all payors, for example, now prefer electronic claims, which are less expensive to process and provide faster turnaround than paper claims. For example, Medicare can process an electronic claim in about 14 days, while a paper claim takes about 28 days.
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Dashboard gives you the big picture
By Jennifer A. O’Brien, MSOD Why and how to use an executive summary of practice indicators Perhaps one of the toughest transitions an orthopaedic surgeon has to make is the shift from a one-on-one care provider to the executive leader of an orthopaedic practice, particularly in a group situation. At least once a month, physicians must be able to transition from looking at specific diagnoses and treatment plans to examining the business success and well-being of their practices.
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Professional interpretation of X-rays
Our physicians understand the need to dictate a report for the professional interpretation of an X-ray, but they question whether the report must be separate from the evaluation and management (E/M) note. Can you clarify this for us? This question is asked regularly. In February 2007, AAOS Now addressed the issue in the article “Do professional interpretations of X-rays require a written report?
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CPT codes updated in 2009
Current Procedure Terminology (CPT®) 2009 contains several new and revised CPT codes and Guideline instructional changes. Last month’s column reviewed changes to fractures and “G” codes, general musculoskeletal CPT codes, anesthetic agents, and cervical disk arthroplasty code additions and revisions.
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AAOS aims to improve quality of practice life
Board workshop focuses on practice management issues Continuing his pledge to “improve the quality of practice life” for AAOS members, Joseph D. Zuckerman, MD, led a workshop on practice management issues for the AAOS Board of Directors in May. The workshop focused on the current environment for orthopaedic practices and the steps AAOS could take to support members in practice management. How are you doing?
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Making cents of computers
New systems—especially PACS—can improve the economic efficiency of a practice Since the first days of residency, orthopaedic surgeons have known and used acronyms such as AVN, OATS, and DJD. But today, new letter groupings are having a profound effect on the way that orthopaedic surgeons practice, as the following questions show: Is your EMR system CCHIT-certified? Are your PM and EMR systems integrated, and will they work with your office PACS?
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It’s all about the ancillaries
The medical practice of orthopaedic surgery is fun, intellectually stimulating, and rewarding. However, developing a financially successful practice is challenging. In today’s climate of declining reimbursement, every surgeon needs to spend time developing a practice strategy to ensure financial success in the years to come. Don’t count on reimbursements The current favored technique of containing medical costs seems focused on reducing reimbursement rates.
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Ins and outs of Modifier 58
What does it mean? When is it appropriate? Understanding the definition and applicability of modifier 58 is a key to accurate coding during the global period. Its proper use will also reduce your risk of an audit during the global period.
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Using technology to market your orthopaedic practice
Whatever your practice setting, technology can help you grow Marketing is the effort of promoting your practice to a target group, with the goal of maintaining or improving the financial health of the practice. Although some orthopaedic surgeons claim to be averse to “marketing,” it is necessary to keep a practice viable. Using e-mail to market Technology can play a significant role in effective marketing.
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Taking the pain out of injection coding
Injection coding is often confusing, and the complexity of coding and reimbursement for injections performed in the office setting is compounded by coding rules, payor rules, separate reporting of evaluation and management (E&M) services, and lack of clear documentation. Remember that common injections administered by orthopaedists from the musculoskeletal section of the American Medical Association’s 2009 Current Procedural Terminology (CPT®) are considered “surgical” injections.
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What’s your perspective on EMRs?
A roundtable discussion on electronic medical record systems Medical practices have gradually begun adopting electronic medical record (EMR) systems, and recent funding opportunities under the American Reinvestment and Recovery Act may facilitate that shift. But is it an advisable strategy for all practices? AAOS Now explored the issue with five physicians: Jon M. Maxwell, MD, a solo practitioner in Adrian, Mich.
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Operative note dictation: Tips for knee procedures
Although dictation of operative notes might seem straightforward, many surgeons fail to include enough information to enable proper coding of knee procedures not related to joint reconstruction. For example, documentation differentiating open and arthroscopic procedures is often missing; incorrect or nonspecific diagnosis codes may be used; and CPT, G codes, and modifiers may be used incorrectly.
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Implementing contract negotiations: Let the games begin
Once you know the rules, you’re positioned to win Editor’s note: This is the final article in a series devoted to examining various aspects of negotiating payor agreements. “Negotiating contracts” (June) and “Making your pitch for higher payments” (July) are the first two articles in the series. Once you’ve assembled the data you need and sent your proposal letter to payors, you’re ready to begin the negotiating process.
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Selling to a hospital? Be sure to look before you leap
Five issues to consider before signing on the dotted line Faced with shrinking reimbursement rates for their professional and ancillary services and increasing administrative, regulatory, and technological burdens, many physicians in private practice are considering selling their practices to and becoming employees of a hospital or health system.
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C P T coding updates for 2010 – Par t 2
Casting, spinal codes, and new Category III codes The 2010 Current Procedural Terminology (CPT®) Manual includes several new or revised sections pertinent to orthopaedic surgery. Each year brings with it several new orthopaedic-related CPT codes and guideline changes. Both are significant, and physicians, managers, and coding staff should pay attention to the guidelines for each section so that they are able to incorporate these instructions into daily coding practices.
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GSD for Orthopaedic Surgery gets a facelift
By Matthew Twetten New look, updated contents Published annually by the AAOS since 1991, the GSD was conceived as a tool to help orthopaedic surgeons and their office staff code and bill providers appropriately for the services they render. The guide is edited by members of the AAOS Coding, Coverage, and Reimbursement Committee, c haired by Blair C. Filler, MD.
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Making your pitch for higher payments
Let your proposal letter make the case The first step in negotiating reimbursement rates with third-party payors is assembling the data. The second step is putting those data to work with a simple but substantive proposal letter. Addressed to the payor’s contracts manager, the proposal letter introduces the practice, requests a rate increase and, most importantly, makes the case for the proposed increase.
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Negotiating contracts
Tips for success in dealing with HMOs and PPOs Knowledge is power. The more you know about a health plan—whether it’s a health maintenance organization (HMO) or a preferred provider organization (PPO)—the more successful your negotiations will be. As with any business agreement, each of the parties (you and the health plan) hopes to gain an advantage.
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Keys to successfully selecting, negotiating, and acquiring a PACS
Once you say “yes” to PACS, what’s the next step? Selecting and acquiring a picture archiving and communication system (PACS) are not trivial matters, nor is the financial responsibility associated with acquisition of such a system one to be taken lightly. The most important aspect of PACS selection and acquisition can be summed up in one word: process.
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Shriners changes billing policy
Fundamental change in response to economic challenges Shriners Hospitals for Children, which provide health care to more than 123,000 children annually, without financial obligation to patients or their families, is implementing a fundamental policy change intended to solidify the hospital system’s financial standing.
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Therapy billing for beginners
How to bill for physical, occupational therapy Orthopaedic surgeons are increasingly incorporating physical and occupational therapy services into their practices. In-house billers, who may be inexperienced with the new services, terminology, and associated CPT codes, may be apprehensive about the move. Clarifying the services, codes, and treatment continuum will help to maximize revenue and prevent billing errors.
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Are E&M services reportable with a surgical procedure?
Examining the use of modifiers 25 and 27 Payors are becoming more prone to denying evaluation and management (E&M) services as “incidental to another service.” The appropriateness of a denial and appeal depends on whether the coding rules for both services were met. If the scenario is coded appropriately, practices should definitely appeal.
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Back to basics
The multiple procedure reduction rule and modifier 51 Occasionally, it’s important to get back to basics. This article takes a back-to-basics look at modifier 51 and the multiple procedure payment policy. When two or more medical procedures are performed during the same session by the same provider, Medicare does not reimburse all procedures at the full billed or allowable amount.
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Someone is watching you
Did you know that the Centers for Medicare & Medicaid Services (CMS) lists more than 4,000 acronyms for various programs?
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Is professional courtesy worth saving?
The last patient of the day is the son of a local pediatrician. The boy fell off his snow board and sustained a wrist fracture. You cast the fracture, check the postreduction films, and tell his mom that you want to see the boy in a week to check the alignment with another X-ray. As you fill out the charge ticket, you tell the receptionist, “No charge for today.” Easy, right? Think again.
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Reporting repeat procedures in the global period
Occasionally, a procedure may need to be repeated. Reporting the repeated service may be confusing, especially if performance of the repeated procedure takes place during the global period of the original case. This is a situation that calls for use of a modifier appended to the repeated service. The modifier 76 is used to indicate a “repeat procedure or service by same physician or other qualified health care professional.”
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2011 CPT code updates
Significant changes to orthopaedic-related codes and guidelines The orthopaedic-related Current Procedural Terminology (CPT) codes and guideline changes for 2011 are significant. Surgeons and coders should pay special attention to the new, revised, and deleted codes and introductory guideline changes, as well as the new “Coding Tips” throughout the 2011 CPT manual. This article reviews selected orthopaedic code changes for 2011.
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Selecting a new partner
Compatibility is as important as competence Selecting a new partner for a group practice is one of the most important tasks the group will undertake. Every recruitment should advance the practice toward achieving its goals, not just from a scope of practice standpoint, but also from the perspective of building a strong, cohesive, and sustainable practice. Yet groups often approach this undertaking in a haphazard and nonchalant manner.
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Changes in reporting wound débridement—2
Last month, AAOS Now reported on the changes made to the Integumentary System section of CPT 2011 in the reporting of wound care services. This month’s column reviews changes in the same section regarding skin repair (closure) and replacement. Guideline changes Specific guideline clarifications and changes were made to the complex repair and débridement services.
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Are you ready for the HIPAA 5010 conversion?
Just 6 months left to implement new electronic claim transactions standards Because nearly all Medicare Part B claims transactions are submitted electronically, orthopaedic practices must be prepared for new standard formats that go into effect on Jan. 1, 2012. These new electronic data interchange (EDI) standards—version 5010—replace the current versions of the standards (4010) for healthcare transactions. What is 5010?
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OIG’s 2011 work plan
Should you be worried? Audit risks for practices have never been higher. The Office of the Inspector General (OIG) for the Department of Health and Human Services issues an annual work plan, and the 2011 version lists a minimum of 18 projects that may have relevance to an orthopaedic practice. This article discusses some, but not all, of the major areas that are likely targets.
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Foot and ankle coding overview
Answers to your questions on foot and ankle coding Reporting services for foot and ankle procedures—especially surgery on the toes—is challenging. Payer rules related to modifiers further complicate the claims submission process and increase the challenges faced by the appeals team. Modifier usage, as well as payers’ acceptance of modifiers 50, 51, 59 and the toe modifiers discussed in this article, is based on CPT rules and Medicare’s Correct Coding Initiatives (CCI) edits.
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When it’s not your complication
How to report services provided to your partner’s patient during the postoperative period If a complication arises after surgery, prompt treatment is required. But if your partner, the orthopaedist who performed the surgery, is unavailable and you step in to provide the care, how should you report and code the service? To better appreciate how these services should be reported, you must first understand what is included in the global surgical package related to postoperative care.
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The office-based orthopaedist
A roundtable discussion Recently, John M. Purvis, MD, a member of the AAOS Now editorial board, held a roundtable discussion on the pros and cons of being an office-based orthopaedist, who no longer performs surgery. Joining Dr. Purvis were Charles E. Baker, MD, who returned to practice with the Fondren Orthopedic Group, Houston, Texas, after 9 years of retirement; Robert E. Eilert, MD, emeritus professor of pediatrics at Children’s Hospital Colorado, Denver; Frank B.
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Discounting for multiple arthroscopic procedures
By Margaret M. Maley It may take more from the bottom line than you think! It’s hardly a surprise when payers issue an explanation of benefits (EOB) with a reduction in reimbursement for multiple procedures performed during the same operative session by the same provider. Both Medicare and all payers that follow Medicare reimbursement policies use the multiple procedure reduction rule when calculating the reimbursement for the additional procedures.
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Coding and Documentation Tips for Spinal Injections
Mary LeGrand, RN, MA, CCS-P, CPC In recent years, the American Medical Association’s Current Procedure Terminology (CPT) deleted the mainstay facet joint injection codes (64475–64479) and introduced the “all-inclusive” paravertebral facet joint injection codes 64490–64495. These new codes are part of the transition from component coding to the combination codes.
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Commonly Asked Foot and Ankle Coding Questions
This month’s coding column addresses questions related to coding of foot and ankle procedures. Metatarsal fracture Q: A patient is diagnosed with a metatarsal fracture; the shaft is fractured both proximally and distally. The surgeon treats the fracture of the shaft with an open reduction and internal fixation (ORIF) and internally fixates both fractures as a single unit.
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Do You Need Disability Insurance?
As an orthopaedic surgeon, you see the impact of disabling injuries every day. Although you do your best to repair limbs mangled in motor vehicle accidents or by falls and trauma, you know that recovery can sometimes take months, even years. Consider these facts: According to the National Safety Council, a disabling injury occurs nearly every second in the United States. Nearly one in five Americans—54 million people—is classified as disabled, based on U.S.
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Don’t Drown: Ride the (Modified) Wave!
How much do you know about the way appointment scheduling really works in your practice? Many orthopaedic surgeons are simply content to have a steady stream of patients whenever they are in the office. However, failing to implement a structured appointment scheduling system can result in both dissatisfied patients and lost revenue. Many medical offices use the “wave” method to schedule appointments.
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Keeping Up with Orthopaedic Apps
The last few years have witnessed a rapid expansion in clinical information available for use in smart phones and tablets, including new ways to access medical records, read journals, and keep up with product releases. For practicing surgeons, staying abreast of the most relevant and useful software can be a challenge. The mobile computing sector is currently fragmented by various devices and operating systems.
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Commonly Asked Coding Questions
This month’s coding column addresses coding questions that have been submitted by AAOS members. Using modifier 58 in staged procedures Q: Our surgeon recently operated on a patient who had a traumatic injury to the lower extremity. The patient underwent initial excisional débridement at the first encounter on May 1, 2012. On May 3, 2012, the patient was returned to the operating room (OR) for a subsequent excisional débridement.
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Best Practices for Orthopaedic Practices
AAOE members weigh in on office technology Recently, AAOS Now asked representatives from the American Association of Orthopaedic Executives (AAOE) to participate in a roundtable discussion on technology best practices in the orthopaedic practice setting. Moderating the discussion was George D. Trantow, FACHE, of Aspen Orthopaedic Associates (Colo.), which has 10 orthopaedic surgeons and 55 full-time employees. Joining him were the following practice managers: James P. Kidd, CMPE, of St.
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Ten Steps to Minimize Office Theft
Although information regarding embezzlement that takes place specifically in orthopaedic offices is not currently available, several characteristics of orthopaedic practices may make them even more vulnerable to theft than other medical practices. Because many orthopaedic offices stock supplies such as orthoses as a courtesy to patients, and because many practices have multiple locations, establishing internal controls is more challenging—and all the more necessary.
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Coding for Knee Arthroscopy and Chondroplasty
The definition of a chondroplasty, reported with CPT code 29877 (“Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]”), did not change in 2012. What did change is the guideline instruction referring the physician and coding staff to CPT code 29880 and 29881 when a chondroplasty is performed with a meniscectomy (29880 or 29881). So, the ultimate change for 2012 is not with the chondroplasty CPT code but with the meniscectomy CPT codes.
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EHRs Deliver on Promise of ‘Increasing Revenue’
But they also triggered a coding outcry at CMS Karen Zupko and Mary LeGrand, RN, MA, CCS-P, CPC Suddenly, it seems the popular press has developed an interest in medical coding. Perhaps it has something to do with money. The details of how higher level evaluation and management (E/M) coding has cost the Centers for Medicare & Medicaid Services (CMS) “billions” hit the pages of The New York Times, Washington Post, and Wall Street Journal in September.
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Avoid Fraud in Your Practice
Medical practices lose $25 billion annually to fraud and theft, according to the Association of Certified Fraud Examiners, and are increasingly vulnerable to employee theft. In part this is due to the fact that many medical practices—particularly solo or small group practices—share the following three common characteristics: Supervision of employees is limited or lax. A limited number of staff members handles all accounting procedures.
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Commonly Asked Fracture-Related Coding Questions
This issue of AAOS Now takes a look at some commonly asked fracture-related coding questions. Using a global fracture CPT code Q. The physician saw a patient in the office for a shoulder injury sustained during football training camp activity. Following the evaluation, the physician diagnosed a nondisplaced clavicle fracture. No cast or splint was applied. Can we report a global fracture code? A.
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Planning for Retirement: What Orthopaedic Surgeons Need to Know
A recent survey of physicians, conducted by the Deloitte Center for Health Solutions, found that 60 percent of physicians—regardless of age, sex, or specialty—believe many of their colleagues will retire earlier than planned in the next 1 to 3 years. Data such as these reinforce the need for “planning for life after orthopaedics,” which was also the topic of an Instructional Course Lecture during the 2013 AAOS Annual Meeting. Cynthia K.
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Benchmarking Your Orthopaedic Practice
AAOE Benchmarking Survey provides valuable information Benchmarking is a valuable tool that enables medical practices to measure their internal processes against those of their peers. Each year, the American Association of Orthopaedic Executives (AAOE) surveys its members to establish orthopaedic practice benchmarks. Recently, AAOE members participated in a roundtable discussion on the survey’s benefits to their practices. Allan A.
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End-of-Year Tax Tips: Reducing Your Tax Liability
The end of the year is fast approaching, so now is a good time to think about actions that could potentially help to reduce your 2013 tax liability. This time of year can be very busy when it comes to preparing your finances. Several new laws were implemented in 2013 under the American Taxpayer Relief Act of 2012, including a 39.6 percent income tax bracket, a 20 percent capital gains tax, and 3.8 percent investment surtax on high-income taxpayers.
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Why Are My Receipts Down?
Orthopaedic surgeons frequently ask, “Why are my receipts down?” It’s an issue in both small and large practices, regardless of location, and applies on a monthly and/or quarterly basis. All too often, the response is overarching, oversimplified, and doesn’t really get at the root of the problem. For example, the following are typical answers: The insurance companies are simply not paying or are delaying payment. The billing company or the billing staff messed up.
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Enhancing Fracture and Osteoporosis Care
Orthopaedic surgeons and patients are becoming more aware that those who sustain a fragility fracture are at significantly higher risk of a future fracture. Although orthopaedic surgeons may not be able to prevent the first fracture, they are increasingly being seen as key in identifying patients at risk for additional fractures.
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Understanding Your Employment Contract
After 5 years of residency plus 1 year of fellowship, you uproot your family and move across the country for a promising employment opportunity. Once there, you dive full force into your practice. You perform your duties as expected, generate income for the practice, and quickly build both a patient base and a formidable reputation. One morning, without warning, you are called into a partner’s office and terminated. Blindsided, you wonder, “Can this happen?”
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Getting Ready for ICD-10
Rockford Orthopedic Associates is moving forward Although many orthopaedic practices may be crying, “Say it isn’t so!”, the Centers for Medicare and Medicaid Services (CMS) has announced that on Oct. 1, 2014, the codes used to report medical diagnoses and inpatient procedures—currently the International Classification of Diseases, 9th edition (ICD-9)—will be replaced by ICD-10 code sets. Orthopaedic practices, therefore, have approximately 15 months to make the transition.
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Establishing a Service Line Co-management Agreement
Most orthopaedic surgeons are aware of the rapidly growing trend of physicians seeking hospital employment. But many orthopaedic surgeons currently in private practice may want to increase their alignment and integration with hospitals and medical groups, without becoming hospital-employed physicians. Co-management agreements enable orthopaedic surgeons to achieve this goal.
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What’s Your Practice Worth?
The introduction of healthcare reform in the United States will make uncertainty a fact of life for physicians and hospitals over the next several years. As a result of heightened uncertainty and risk, orthopaedic surgeons may seek to sell their practices to hospitals or establish joint ventures.
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Transitioning from Fellowship to Practice
“During fellowship, orthopaedic surgeons are highly focused on learning clinical principles, surgical techniques, and the art of medicine. It’s a lot like drinking from a fire hose,” said Kenneth J. Hunt, MD, of Stanford University, Palo Alto, Calif. “As a result, we often take for granted the efficiencies that our mentors have built in to their practices and what’s involved in achieving them.” At the 2013 American Orthopaedic Foot & Ankle Society (AOFAS) annual meeting, Dr.
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Physician Compensation in Private Practice
Physician compensation models typically vary by practice type. The classic private practice model of three to seven physicians has traditionally used models that treat each provider’s clinical revenue as his or her own and divide expenses according to a method that accounts for fixed and variable overhead. This is the so-called “eat what you kill” approach.
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Making the Decision to Become Employed
Get help from the AAOS Practice Management Committee Melbourne D. Boynton, MD; David L. Cannon, MD; and Charles A. Goldfarb, MD Based on data from the AAOS member census, from 2010 to 2012, about 400 orthopaedic surgeons in the United States moved from a private practice to an employed practice model. For some orthopaedic surgeons the transition was easy; others struggled with the loss of autonomy.
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What to Expect from the Orthopaedic Surgery Group Practice Manager
Jennifer A. O’Brien, MSOD When a physician gives an order to a nurse, technician, physical therapist, or pharmacist, the standard, appropriate response, albeit unspoken most of the time, is “Yes, doctor.” With practice managers, however, it’s different. In an orthopaedic group, the purpose and success of the whole comes first. The orthopaedic surgeons who are partners in the group make the practice manager the keeper of that mission.
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ICD-10 Focus on Common Knee and Shoulder Codes
Much has been written about the explosion of diagnosis codes under the International Classification of Diseases, 10th Edition Clinical Modifications (ICD-10). The amplified granularity of the system and the addition of laterality coding will certainly have an impact on orthopaedics. The ICD-10 implementation delay until Oct. 1, 2015, gives orthopaedic practices an opportunity to take a focused look at the most commonly used codes in ICD-9 and map them to the corresponding codes in ICD-10.
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Mapping Your Way to ICD-10 Implementation Success
As orthopaedic surgeons and their practice teams ready themselves for the implementation of ICD-10, a team-based transition action plan is essential. One step in making the transition is known as “mapping.” Mapping describes the process of comparing the codes currently used in ICD-9 to those that will be used in ICD-10 for the same condition or injury. Mapping helps to illustrate the differences in documentation requirements between ICD-10 and ICD-9.
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Avoid Billing Service Nightmares
Recently, an orthopaedic surgeon remarked that he was thinking about outsourcing his billing so he could avoid learning ICD-10 and make ICD-10 “the billing service’s problem.” But hastily outsourcing billing and collections without carefully evaluating the company can lead to problems. Choosing the wrong billing service or outsourcing for the wrong reason can quickly become a nightmare of risk and lost revenue.
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ICD-10 Coding of Osteoarthritis
With just a few months left before the International Classification of Diseases, 10th Edition (ICD-10) goes into effect, it is time to begin focused, orthopaedic-specific training in earnest. Under ICD-9, most diagnosis codes used by orthopaedic surgeons were in the musculoskeletal section, and categories were numbers from 710 to 739. Injury and poisoning diagnostic categories, including traumatic fractures, were reported with codes that ranged from 800 to 999.
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AAOS Participating in ASC Quality Improvement Program
The AAOS is working with the Health Research and Educational Trust (HRET) of the American Hospital Association to undertake a special 1-year program designed to improve quality of care at ambulatory surgery centers (ASCs). The pilot program focuses on improving patient safety and reducing postoperative infections to zero. The Agency for Healthcare Research and Quality (AHRQ) is funding the program. “Participating in this program aligns with other AAOS patient safety programs.
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Matrix Management
What to expect from the orthopaedic surgery group practice manager Jennifer A. O’Brien, MSOD Matrix management means that an employee may have multiple reporting relationships. A unilateral decision by one of the managers could affect the productivity and work flow within the other units or other overall business goals such as eliminating the expense of unnecessary overtime or achieving cross training and coverage that will serve all the partners when a staff person has to be out.
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25 Tips for Passing a HIPAA Risk Assessment
Title II of the Health Insurance Portability and Affordability Act (HIPAA), known as the “Administrative Simplification Provisions,” requires medical practices to follow a set of national standards for electronic healthcare transactions and assigns national identifiers for providers, health insurance plans, and employers.
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Commonly Asked Coding Questions—and the Answers
This month’s coding column addresses commonly asked questions related to coding or reimbursement issues. Pediatric spine Q: A new pediatric spine surgeon has joined the practice. He is planning a surgical procedure in which he will be placing instrumentation, but will not be doing any additional procedures at that session. How is this case coded when the surgery is performed, because the instrumentation codes are add-on codes?
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When “7” Is Not a Lucky Number
The 7th character extension represents a major distinction between the International Classification of Diseases, Ninth Edition (ICD-9) and the International Classification of Diseases, Tenth Edition (ICD-10). A clear understanding of the 7th character is imperative due to its extensive use in orthopaedics.
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Commonly Asked Coding Questions
This month’s coding column addresses commonly asked questions related to orthopaedic coding and reimbursement issues under the American Medical Association’s (AMA) Common Procedural Terminology (CPT) rules. Interlaminar stabilization Q: Previously, we were instructed to report the work associated with the coflex® interlaminar technology as an unlisted code. We are having significant difficulties in getting paid and want to ensure we are billing the service correctly.
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A Great Way to Reduce Practice Expenses
How much does your practice spend on drug, medical, surgical, and office supplies each year? The typical orthopaedic surgeon spends about $66,000 each year, according to the Medical Group Management Association 2013 Cost Survey for Orthopaedic Practices. Every dollar your practice saves on supplies drops right to the bottom line and results in a dollar increase in income.
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Does Your Practice Measure Up?
Practice executives discuss the value of benchmarking How does your practice measure progress? Simply comparing numbers from year to year is one way, but that may not tell you the whole story. Benchmarking is another way to measure practice performance. Participating in a benchmarking survey, such as that conducted by the American Association of Orthopaedic Executives (AAOE), can show how well your practice’s numbers compare to similar practices in your region.
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Breaking the News: It’s Not the Job
What do you tell a patient who says, “My work caused my condition. What should I do?” Sometimes, the answer is easy. But other times, despite the patient’s conviction that his or her condition is work-related, science suggests a different etiology. Do you elect not to address the issue and leave the decision to the employer, the insurance carrier, or the courts? Or do you, as the orthopaedic surgeon, attempt to address the issue based on current science?
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A Systematic Approach to Expense Reduction Analysis
In today's healthcare world it is more important than ever to "manage expenses." The typical practice administrator is constantly looking for ways to cut costs. However, these tasks are usually performed on an ad hoc basis without a scientific, analytical approach. A spreadsheet that can be used to systematically review every area of a practice and to create a game plan to manage potential expense savings would certainly help.
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What You Need to Know Before Leaving a Medical Practice
Are you tired of having too much paper work, dealing with electronic medical records, and fighting with payers? Are you ready for something new? If you’ve decided it’s time to move on, proceed carefully. Unfortunately, physicians commonly underestimate the planning and work it takes to close, sell, or retire from a medical practice. Physicians transition their practices for many reasons and in many ways.
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New Orthopaedic CPT Codes for 2015
In 2015, orthopaedic coders will have to make changes based on several revisions to ICD-9 codes and guidelines as well as new orthopaedic-related CPT code information. Physicians and coders should review the entire 2015 CPT manual for guideline and code changes pertinent to their individual or group practices. This article introduces new orthopaedic-related CPT codes for 2015.
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Weighing the Pros and Cons of Hospital Affiliation
Orthopaedic groups and hospitals are under significant pressure to manage costs, maintain quality, reduce hospital readmissions, implement electronic health records systems, and meet many other challenges. According to Jeff Boomershine, CPA, “in the last few years, there has been a frenzy of hospitals and physicians trying to figure out ways to work together” to address these issues. “Everybody knows that large health systems are acquiring primary care practices,” said Mr.
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Leveling the Playing Field for Out-of-Network Providers
Leslie Howard, Esq. By definition, a “level playing field” is about fairness, a system in which all players abide by the same set of rules. This system requires transparency and consistency of the rules, their definition, and their interpretation. The rules should be outlined in a playbook that all players can access and understand. Unfortunately, for out-of-network (OON) providers in today’s medical reimbursement world, the field is sorely off balance.
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Modifier 59 Revisited
In August 2014, the Centers for Medicare & Medicaid Services (CMS) identified modifier 59 as the most widely used modifier, noting that providers can use it to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. It also introduced a subset of “X” modifiers for modifier 59, but provided few specifics on the appropriate use of these modifiers.
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Electronic Medical Records and Patient Safety
The evolution of the electronic medical record (EMR) has resulted in major changes in the healthcare environment. As early as 2009, Congress was allocating funds ($19 billion) to promote the use of EMRs, and EMRs are a major component of the Affordable Care Act. As orthopaedic surgeons, we each have individual stories and experiences with EMRs—both favorable and unfavorable. However, little emphasis has been placed on the potential effects on patient safety resulting from the use of EMRs.
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That Was Then, This Is Now: Arthroscopic Subacromial Decompression
This is the first in a series of articles updating previous AAOS Now coding articles. Since the original article was published in August 2013, the Centers for Medicare & Medicaid Services (CMS) has released specific instructions related to shoulder coding. This article addresses the implications of Medicare's coding and payment rule, as well as Medicare's National Correct Coding Initiative (NCCI) edits for Medicare Part B services and the Medicare Outpatient Code Editor (OCE).
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Practice Settings and Productivity
Think of the last course you took at the AAOS. Were your lab partners private practitioners, members of a group practice, or hospital employees? Did you talk about the dominant payers in your geographic area? Did you discuss how many procedures you performed? The AAOS member census, Orthopaedic Practice in the United States (OPUS) Survey, has answers to these and other questions that you can use to benchmark yourself and your practice.
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Orthopaedic Workforce Trends
The 2014 Orthopaedic Practice in the United States (OPUS) Survey, also known as the orthopaedic census, gathers demographics and practice data on U.S. orthopaedic surgeons. Conducted by the AAOS research and scientific affairs department, the census helps ensure that AAOS members are accurately represented, that Academy program and products evolve to reflect changes in membership, and that the AAOS continues to address the professional needs and interests of its members.
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The Role of Integrated Practice Units in the Treatment of Musculoskeletal Conditions
In today's changing healthcare climate, new terminology around value-based care is emerging. Value-based payment has quickly moved to the forefront of the discussion in response to goals set by the Centers for Medicare & Medicaid Services (CMS), which aim to transition the majority of payments away from traditional fee-for-service (FFS). Value-based payments include bundles and mandated alternative payment models such as the Comprehensive Care for Joint Replacement (CJR) program.
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Winning with Payment Reform
"What's important to us is maintaining our independence and our relevance," noted Peter A. Caprise, MD, of the Orthopaedic Center of Central Virginia (OCCV). "So when we look at payment reform, we don't see burdens that are coming down the pike, but opportunities for our practice to shore up our bottom line and ensure our independence." Dr. Caprise shared OCCV's strategy for winning with payment reform at the Fall Meeting of the AAOS Board of Councilors/Board of Specialty Societies.
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What Stage Is Your Marketing?
The recent shift from "volume" to "value" in health care also resonates in marketing your orthopaedic practice. Effective marketing depends on much more than simply ensuring patients see your practice name multiple times in a day or week. Getting the most from your marketing dollars requires ongoing measurements, improved outcomes, and enhanced efficiencies.
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Orthopaedic Telemedicine: Will It Catch On?
Telemedicine has been a part of physician-patient interaction since the 1970s. Over the years, advances in communications technologies have allowed for exponential growth in the number of applications that telemedicine can provide. For example, practices no longer have to rely on the telephone for scheduling patient appointments and making call backs. Electronic Health Record (EHR) systems and independent vendors also offer online appointment scheduling.
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Do professional interpretations of X-rays require a written report?
Coding specialists frequently receive questions about whether a written report (documentation) is needed to support claims reporting the professional interpretation of X-rays by orthopaedic surgeons. Typically, an orthopaedic surgeon in private practice owns the radiology equipment, employs the staff and interprets the X-ray. The physician reports radiology services using a global radiology code, such as CPT code 73564 “Radiologic examination, knee; complete, four or more views.”
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Orthopaedic revenues and expenses keep increasing
MGMA 2006 Cost Survey provides a benchmark for your practice Every year, the Medical Group Management Association (MGMA) conducts a survey of orthopaedic group practices. Information is collected on a wide array of subjects, including gross charges, receipts, relative value units (RVUs) per physician, expenses, patients per physician, accounts receivable, and so forth. The results are interesting in and of themselves; they are even more interesting when looked at over time.
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Treat pelvic, acetabular fractures carefully to reduce liability risk
To many orthopaedic surgeons, the mere mention of pelvic or acetabular fractures gives rise to images of severe trauma such as a motorcyclist with a badly displaced both-column acetabular fracture, or a patient in hypovolemic shock due to an open-book pelvic fracture or other traumatic injuries. Orthopaedic surgeons in private practice rarely see injuries of this magnitude, and they quickly, happily, and appropriately refer such patients to orthopaedic trauma surgeons whenever possible.
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Information equals power
Is your practice keeping pace with the competition? Does the education, training, and experience of your staff measure up to their peers across town? As an employer, are you offering your workers a competitive compensation and benefits package? If you don’t know the answers to these questions and others, isn’t it time you found out? The American Association of Orthopaedic Executives’ (AAOE) is an ideal place to start.
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20 Steps to Getting Paid Faster
Many orthopaedic practices spend far too much time fixing and resubmitting claims that were denied due to errors. Following are 20 steps you can take on a daily, weekly, and monthly basis to submit cleaner claims and get paid faster. These tips will help you reduce accounts receivable days, as well as the time and costs associated with resubmitting claims. General principles Identify one staff member to review all insurance payments for accuracy.
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CPT Resolves Coding Dilemma
The American Medical Association has recently updated its CPT® 2012 guidelines to correct a problem in the guidelines applicable to the instrumentation, intervertebral device, and bone graft codes. As add-on codes, the instrumentation, intervertebral device, and bone graft codes must have an applicable “parent” or primary procedure code. CPT® 2012 did not originally list 22633 or 22634 as an applicable parent or primary procedure code for the add-on codes.
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Tips for Dealing with Potentially Litigious Patients
"Identifying the High-Risk Patient,” in the October 2013 issue of AAOS Now attempted to separate myth from reality about patients assumed to be likely to sue. This article provides tips and techniques for dealing with litigious patients and for minimizing the risk of a lawsuit. Set realistic expectations A high-risk situation, for this review, represents an encounter that places the provider at risk for lawsuits.
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Register for ICD-10 Testing Week
Providers can submit test claims March 3–7 The International Classification of Diseases, 10th Edition (ICD-10) code set goes into effect on Oct. 1, 2014. To help providers prepare for the transition, the Centers for Medicare & Medicaid Services (CMS) will conduct national testing for current direct submitters the week of March 3–7, 2014.
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Lessons from the Literature on Litigation
The threat of being sued for malpractice hangs over the heads of physicians like the sword of Damocles. Concerns about litigation often play some role in the decision making process when treating patients. To put this in context, a frequently cited study published in 1993 found that nearly 40 percent of the U.S. membership of the American Society for Surgery of the Hand has been sued at some point, and more than one third of members had been sued more than once.
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CMS Announces ICD-10 Testing Dates
The Centers for Medicare and Medicaid Services (CMS) has announced three testing dates leading up to the Oct. 1, 2015, implementation of the International Classification of Diseases–10th Edition (ICD-10). According to CMS, the first testing week will be Nov. 17–21, 2014. Two additional testing weeks are scheduled in 2015: March 2–6 and June 1–5.
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The Benefits of Comanagement for the Orthopaedic Surgeon
James M. Daniel Jr, JD, MBA; Michelle E. Calloway, JD, CHC, CHCP; and John Cherf, MD, MPH, MBA As new payment models evolve, providers must focus on improved quality and efficiency to remain financially stable. In this environment, comanagement has emerged as a popular alignment option.
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“Clean Up” Diagnosis Coding for Staged Revisions
Assigning diagnosis codes for joint revision surgery is challenging in both ICD-9-CM and ICD-10-CM. Orthopaedic practices that carefully examine the instructions in both editions may find that they have been reporting staged revisions incorrectly for years. The following side-by-side comparison of ICD-9 and ICD-10 coding will help clean up diagnosis coding for staged revision surgeries.
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When a colleague is in trouble
What should you do if you notice a problem? Physicians, just as all human beings, may have physical and substance abuse illnesses, which may impair their ability to safely practice medicine. The lifetime prevalence of substance abuse due to drugs and/or alcohol among physicians is estimated at between 10 percent and 20 percent.
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Peer Support When We Need It Most
Physicians hurt when patients hurt S. Jay Jayasankar, MD; Sara Nadelman, MPH; and Jo Shapiro, MD “It feels like the ground has fallen from underneath your feet and your breath has been stolen—you’ve made a medical error. Is there any way to undo it?” That was the reaction of David Ring, MD, to an adverse event he experienced. As physicians, we likely will or have already experienced similar emotions at some point in our careers.
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USBJI Healthcare Programs Promote Good Bone Health
Free public education programs focus on fragility fractures, arthritis The U.S. Bone & Joint Initiative (USBJI) can help spread the word about the value of orthopaedic care with two free public education programs. Fit to a T is especially targeted to men and women in their mid-40s to late 60s, as well as seniors and others who have had or are at risk for fragility fractures. The program’s primary goal is to educate people on bone disease before they break a bone.
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Two new practice management podcasts now available
Building skills for success—in the office as well as in the operating room—is important for every orthopaedic surgeon. To help you gain insight into methods to improve the business aspects of your practice, the AAOS has developed an audio program series, Practice Management Consults. The first two programs in Series 1—Pay for Performance (P4P) and Managing Payer Agreements—were introduced last fall. Now, the last two audio programs in the series are available.
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New Tool Kit Helps Build Clinician Support Programs
When things go wrong in health care, patients and their families aren’t the only ones who suffer. In 1999, after I (Linda Kenny) experienced a near-fatal adverse event, the caregivers involved in my case—anesthesiologist, code team, and orthopaedic surgeon—openly shared with me the pain and devastation they were experiencing. At that time, support systems for patients, families, and clinicians were practically nonexistent.
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JAAOS examines pediatric pelvic fractures
For more information on treating pelvic fractures, check the March 2007 issue of the Journal of the AAOS (JAAOS), which features an article on “Pediatric Pelvic Fractures” by Candice P. Holden, MD; Joel Holman; and Martin J. Herman, MD. Pelvic fractures comprise a small percentage of pediatric fractures and usually result from high-energy trauma such as motor vehicle accidents.
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Using Modifier AS for surgical assist services
Nonphysician providers (NPPs) are becoming increasingly important in orthopaedic practices, leading to questions about how to correctly code and bill for the surgical assist services they provide. Although commercial rules for reporting surgical assist services can and do vary markedly, the Medicare rules apply across the country and are quite clear. Medicare uses modifier AS to report nonphysician assistant-at-surgery services.
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Increase reimbursements with electronic coding, billing
For the last several years, orthopaedic practices have seen professional reimbursements decline while practice expenses increase. According to AAOS census data, private pay insurance in orthopaedic practices declined from 38.7 percent of total revenues to 17.1 percent of total revenues between 1988 and 2004. For the same time period, payments from managed care programs increased from 11.6 percent to 33.8 percent of total revenues and Medicare/Medicaid payments increased from 26.4 percent to 31.
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Real world tips for a more successful practice
Symposium serves up healthy slice of business acumen Conventional wisdom once held that the three “As”—ability, affability, and availability—were enough to guarantee a successful medical practice. But with decreasing reimbursements, rising operational costs, increasing regulations, and the constant threat of litigation, three other letters—MBA (Masters in Business Administration)—may be just as important today.
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Are you spineless—and is it hurting your bottom line?
Opening a nonsurgical spine clinic can have several benefits for your practice. Spine care is big business; approximately $80 billion are spent on spine-related health care each year in the United States, and about 80 percent of adults will experience back pain during their lifetimes. Significantly, most spine care is nonsurgical and conservative.
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Physician assistant “FAQs”
“Partnering” with other health care providers can benefit your orthopaedic practice in several ways. With more than 3,000 physician assistants (PAs) currently working in orthopaedics, many practices already benefit from the enhanced efficiency and continuity of care that PAs provide. In 2005, PAs working in orthopaedic practices conducted more than 15 million patient visits, an average of 75 a week per PA. Q. What is a physician assistant (PA)? A.
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Choosing the right EMR system for you
The AAOS Practice Management Committee’s EMR Primer includes an introduction to electronic medical records as well as a list of questions to ask EMR vendors and a sample evaluation form. AAOS members can download the primer for free from the online Practice Management Center, but here is a sampling of the type of questions you should be asking during demonstrations or when you request a proposal. System functionality How do I locate a patient’s record in the system?
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Reducing OR inefficiencies improves financial results
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.
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‘We was robbed!’
Protect your practice from occupational fraud At the Odd Couple Orthopaedic Group, I.M. Neat, MD, was reviewing accounts. He’d been handling them himself since the practice’s bookkeeper eloped three months earlier, and he was puzzled at how the bottom line had changed. He and his partner, U.R. Knott, MD, were seeing the same number and mix of patients. But for the past three months, their cash flow had been substantially higher. “We’ve been robbed,” he realized.
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Medical liability in cyberspace
The use of computers and the Internet in health care has exploded over the past decade, producing efficiencies and improvements in communication, patient education, medical records, billing, resource allocation, and access to subspecialty care. Concomitantly, the physician employing these tools in professional practice has been exposed to novel medical-legal risks and liability that did not exist a generation ago.
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Risk management Web site could lower your liability premiums
In today’s world, orthopaedic surgeons are frequently the targets of medical liability lawsuits. Realizing this, many medical liability insurance carriers now offer a premium discount to those physicians who make an effort to limit their exposure by following simple risk management guidelines or by becoming familiar with basic preventive measures.
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The quality initiative alphabet soup
From AQA to P4P—developing quality measures Pay-for-performance (P4P) programs are being implemented by many payors, including the Centers for Medicare and Medicaid Services. Although P4P programs are changing and may completely disappear, the quality initiative they represent isn’t going away. From now on, physicians will be collecting and reporting quality data—and that can only improve the quality of care that patients receive.
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Coding for pediatric spine deformity procedures
By Mary LeGrand, RN, MA, CCS-P, CPC Coding for pediatric spine deformity procedures follows similar coding principles to adult spine cases. The major difference is the use of the spinal deformity codes and osteotomy codes in cases of severe scoliosis or congenital kyphosis. Laminectomy/discectomy are typically performed in conjunction with either the insertion of implants or osteotomy procedures and should not be included as a separate code.
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FAQs about the 2009 Practice Management Symposium
Everything you need to know to get the most out of the course Hundreds of AAOS members have taken—and benefited from—the Practice Management Symposium for Practicing Orthopaedic Surgeons, held the day before the Annual Meeting. If you haven’t yet decided to attend, the answers to these frequently asked questions will most likely convince you. Why should I attend? The bottom line: it’s about your livelihood.
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Know where you want to go—and you’ll get there
Fundamentals for successfully marketing the orthopaedic practice Marketing—a word that was once associated primarily with business courses and retail industries—is now a necessary function of any innovative orthopaedic practice seeking to grow or maintain its presence in today’s competitive healthcare marketplace. Although some practices have marketing plans and initiatives, others may be unsure of how best to develop a plan that works.
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Bringing someone in: A succession planning primer
Recruiting can be rewarding, if all parties are on the same page Bringing a new partner into a practice can be an exciting yet difficult time, according to Michael J. McCaslin, CPA, of Somerset CPAs (Indianapolis). “What is succession planning? Ensuring that new physicians are in the pipelines to keep the practice going,” he says.
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Coding for closed treatments of fractures
Coding for closed treatment of fractures is controversial; this article provides suggestions on how to code for this form of treatment. Closed treatments are either with or without manipulation.
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Risk management—It’s not all about medical malpractice
In the narrow world of our day-to-day practice, orthopaedic surgeons often think of risk management strictly in terms of avoiding exposure to medical liability lawsuits. But in Insurance and Risk Management Strategies for Physicians and Advisors, author, physician, and healthcare economist David E. Marcinko, MD, has assembled a cadre of experts who address the broader issue of risk management.
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Integrating PAs into your practice
Physician extenders benefit you and your patients Many orthopaedic surgeons are using physician extenders, such as physician assistants (PAs) or nurse practitioners, in their offices. These relationships can be very beneficial to patients, physicians, and the general public in responding to the ever-increasing number of people who need orthopaedic care.
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Are you missing out on the news?
Did you know that you could be missing important messages from the AAOS—including patient safety member alerts and Headline News Now? AAOS frequently sends messages to members on the behalf of the Board, committees, and various other organizational entities. Due to the algorithms involved in detecting junk mail, such broadcast e-mails from the AAOS may be labeled as spam. To ensure that you receive the messages from AAOS that are vital to you and your practice, make sure that the aaos.
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Schwarzkopf on leadership
Battlefield lessons work in the office “The truth of the matter,” said Gen. Norman Schwarzkopf Jr., “is that you always know the right thing to do. The hard part is doing it.” Have clear goals People need to know what success looks like. The more clearly you can describe success, the more likely it is that your employees will meet your goals. Think about the goals you have for your practice. Can you state them in a manner that is easily understood by all?
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Cornerstones of effective governance: Values and ethics
Basing decisions on ethical values is good business The word “governance” became a common business buzz word following the headline-making corporate scandals of companies such as Enron and WorldCom. The Sarbanes-Oxley Act of 2002 aimed to prevent the recurrence of such white-collar crimes through strict corporate governance guidelines that hold management, boards, and accounting firms accountable for the reporting of financial information.
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Managing the call schedule
Challenge is to balance the needs of patients, physicians Throughout the nation, patients are finding it difficult and sometimes impossible to obtain emergency care services in a timely manner. At the same time, physician practices are finding it difficult—and sometimes impossible—to provide the depth of emergency care services that are required.
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Personal health records: The patient’s EMR
Consumers are keeping track of their own medical records When you hear the words “Microsoft” or “Google,” you may think of Bill Gates, personal computers, and Web search engines—not health care. But now these companies are joining health insurers such as Blue Cross Blue Shield, Humana, and WellPoint in offering personal health records (PHRs) to consumers and beneficiaries.
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Rise of the Machines: It’s VHS vs. Betamax again
Traditional orthopaedic practice is changing. One area of focus, on both local and national levels, is the move toward an electronic format for medical record keeping.
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Plan to attend the 2010 Practice Management Symposium
Key management concepts—from personnel to finances—to improve your practice If there’s one thing that medical school, residency, and a fellowship didn’t prepare you for, it’s running a small business. And that’s just what your orthopaedic practice is—a small business that’s faced with a plethora of regulatory requirements, management issues, financial questions, and service improvement challenges. Looking for ways to improve your income?
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Small groups have big advantages
Setting offers autonomy, flexibility, but has downsides as well Recently, AAOS Now explored why some orthopaedists are leaving private practice to become full-time employees of a multi-specialty group, hospital, or health maintenance organization (See “Is the private practice orthopaedist disappearing?”).
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Contracting: Beyond the basics
Knowing terms can lead to successful negotiations Executing acceptable physician contracts with insurance carriers has become an increasingly important and difficult task for private practice managers and physicians. Although negotiating changes in a carrier’s routine contract is not easy, it can be done. When presented with an unacceptable contract, you have three choices—to decline it, to change it, or to create an addendum.
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Offsetting the other expenses of a medical liability case
A new type of insurance helps replace lost revenue and other costs Dealing with a medical liability claim is a financial burden, if not a nightmare for physicians, regardless of the outcome. Insurance certainly helps financially, but currently it only pays the lawyers and the plaintiffs. Responding to a medical liability claim, however, can have several other financial consequences. You can’t treat patients when you’re giving a deposition or sitting in the courtroom.
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Temporary reprieve on “Red Flag Rules” enforcement
FTC delays enforcement until Aug. 1, 2009 The U.S. Federal Trade Commission (FTC) has extended the compliance deadline for the Identity Theft Red Flag Rules from May 1, 2009, until Aug. 1, 2009, to give business entities more time to develop and implement written identity theft prevention programs. The rule requires creditors and financial institutions to implement programs to identify, detect, and respond to patterns, practices, or specific activities that could indicate identity theft.
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E-prescribing: The clock is ticking
The sooner you start, the more you can earn If you don’t already use an e-prescribing system, now is the perfect time to start. The sooner you begin participating in the 2009 e-Prescribing Incentive Program, the greater your potential incentive payment will be. Physicians who e-prescribe and participate in Physician Quality Reporting Initiative (PQRI) for 2009 could see up to 4 percent in incentive payments next year.
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Seven skill sets for your practice executive
Management and communication abilities are key In the operating room, orthopaedic surgeons concentrate on surgery, but they must also know enough about the roles of others to ensure they are properly performing their duties. Similarly, in their practices, orthopaedists may not need to be involved in daily management, but they do need to understand what must be accomplished and be able to determine if the practice executive is doing the job efficiently and effectively.
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Managing overhead in the orthopaedic practice
Controlling costs is key component of practice’s long-term success Although labor costs are a practice’s largest overhead expense, controlling other aspects of overhead should not be overlooked. Practices need to effectively manage—not simply reduce—these costs to maintain their present viability and ensure future success. Controlling fixed costs Occupancy costs include rents/mortgage, property taxes and insurance, utilities, housekeeping, and maintenance.
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Orthopaedic groups find strength in numbers
Large practices have size on their side, but also face challenges Solo and small group orthopaedic practices have their benefits. They can provide more autonomy than larger groups, and politics and bureaucracy may be less of an issue. But many orthopaedists, such as Frank A. Pettrone, MD, feel that the advantages of large group practices far outweigh those available in smaller practices. One of 35 partners at Commonwealth Orthopaedics, an orthopaedic practice in northern Virginia, Dr.
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Going it alone
Solo practitioners driven by entrepreneurial spirit As the former football free safety for the University of Florida Gators, Michael D. Gilmore, MD, knows the challenges of going it alone—and thrives on them. “Being a solo practitioner is much more difficult than trying to cover a receiver one-on-one in front of 100,000 people,” he says. “It’s much more challenging than that.” As a successful solo practitioner in Florida’s panhandle (Marianna), Dr. Gilmore enjoys being his own boss.
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Who owns the data?
Electronic medical records are protected health information One of the most important aspects of an electronic medical record (EMR) is the data it houses. The physical location of that data becomes an important issue for consideration when orthopaedic surgeons contract with a vendor for an EMR system. Physicians have two basic options when choosing an EMR system, and each offers a different data storage model.
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Joint injections and CCI edits
Follow CPT rules for proper payments Recently, a coder for a sports medicine group submitted the following question regarding the administration of a joint injection for pain management at the end of the case: “A joint injection (20610) is listed as a component code of a meniscectomy procedure (29881) but the Correct Coding Initiative (CCI) edits indicate that the edit may be overridden with the use of the 1 modifier when appropriate.
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Managing patient data security
From HIPAA to managing a breach The Health Information Technology for Economic and Clinical Health (HITECH) Act was created to fund and support a paperless national health information network through the adoption of electronic health records (EHR).
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Medicare participation options for physicians
Physicians have until March 17 to decide On Dec. 19, 2009, President Obama signed into law legislation postponing the scheduled 21.2 percent cut in the Medicare physician payment conversion factor. Without further action by Congress, however, the cut will go into effect on March 1. All other changes promulgated in the 2010 final physician fee schedule rule went into effect Jan. 1.
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CPT coding updates for 2010—Part 1
Focus on tumor codes Each year brings with it several new orthopaedic-related CPT codes and guideline changes. Both are significant and physicians, managers, and coding staff should pay attention to the guidelines for each section so that they are able to incorporate these instructions into daily coding practices. The 2010 Current Procedural Terminology (CPT®) Manual includes several new or revised sections pertinent to orthopaedic surgery.
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Updating office E/M coding
Updated guidelines and tables for 2010 In May 2007, AAOS Now published “A simple system for coding E/M services,” a series of guidelines and tables for correct coding of evaluation and management (E/M) services. But the rules have changed since then, so this article updates that information. Orthopaedists and practices may use these guidelines to assist in internal compliance. New rules such as “no consults for Medicare” and emphasis of current red flags for audits are included.
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Easing the burden of on-call coverage
Survey finds increased compensation may offset other limiting factors Maintaining appropriate levels of on-call coverage, especially specialist coverage, in the emergency department (ED) can be a balancing act for hospitals. Similarly, a surgeon’s decision to participate in ED call may take multiple factors into consideration. As a result, many facilities are re-evaluating their on-call schedules and procedures. What does this mean for orthopaedic surgeons?
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Code surgical treatment of pelvis correctly
Medicare decision to treat pelvis as unilateral structure creates confusion Have you received a denial from Medicare, stating that Category I Current Procedure Terminology (CPT) codes 27215–27218 are invalid? If so, you’re not alone. In 2009, the American Medical Association (AMA) made changes to the CPT descriptors for those codes and to its coding guidelines to clarify that each of the surgical procedures was for the treatment of a unilateral pelvic injury.
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Coding arthroscopic knee procedures
Although coding arthroscopic knee procedures should be pretty straightforward, confusion persists around coding and reimbursement for chondroplasty and removal of loose or foreign bodies. This tends to result from a lack of understanding of the Current Procedural Terminology (CPT) coding rules and payor reimbursement rules.
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The changing face of orthopaedic employment
By Jennifer M. Anderson; Mark S. Thomas; and Leslie R. Jebson Factors driving the hospital and physician connection Each generation of physicians has different motivators, drivers, and expectations. Many younger physicians—including orthopaedic surgeons—want to work fewer hours and expect greater flexibility in employment opportunities to match their personal priorities. This new generation of physicians may account for the large number of orthopaedic surgeons seeking hospital employment.
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The solo practice: Strategies for success
Keeping an orthopaedic practice—particularly a solo practice—profitable is challenging. Solo practitioners are usually the only revenue generators for the practice. To be successful, they must also assume the roles of office manager, administrator, and accountant. In my experience, the solo practitioner must take a very active managerial role in the practice, even though he or she will likely have little formal business training.
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EMR Primer: The next generation
Free primer helps you adopt the latest technology According to the National Center for Health Statistics, just 6 percent of U.S. office-based physicians were using a fully functioning electronic medical records (EMR) system in 2009. Even if the adoption rate among orthopaedists is three times greater than the physician population as a whole, approximately 80 percent of AAOS members are not using a fully functioning EMR system. New technology purchases are always difficult.
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Add muscle to your revenue management
New member benefit can reduce rejections, help speed payments What are your top three concerns about your practice? If you’re like most physicians and practice executives, financial performance will probably rank among them. For most practices, pressures on reimbursement and increasing costs—particularly in the area of collections—are constantly straining their ability to cover practice expenses.
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Commonly asked hand coding questions
Previous question-and-answer columns have addressed commonly asked questions about joint injections, foot and ankle services, and other issues. This issue focuses on questions about hand coding. Collagenase injections Q. How should we report services for initial and subsequent collagenase injections? A. The answer depends on whether your Medicare carrier or private payer has a specific policy related to this procedure. Check their websites for medical policies or coding instructions.
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Orthopaedic surgeons and PAs: Best practices
By Ann Davis, PA-C, and Tricia Marriott, PA-C, MPAS Teamwork benefits patients, practices, and physicians During the last decade, the number of physician assistants (PAs) in the United States has nearly doubled. Today, more than 83,000 PAs work in a variety of medical practices, including orthopaedics. More than 10 percent of all PAs report working in orthopaedic surgery, proof that orthopaedic surgeons are taking advantage of the multiple ways that PAs add value to a practice.
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How useful is the 22-modifier?
Current Procedure Terminology (CPT) codes can be modified to “…report or indicate that a service or procedure which has been performed has been altered by some specific circumstance but not changed in its definition or code,” according to the American Medical Association (AMA), which developed the system. (See “A short history of CPT coding.”) The 22-modifier documents work required to provide a service that is substantially greater than the work typically required.
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AAOS Physician Narrative Exchange Program: Coming to the 2011 Annual Meeting
Program is designed to help practices streamline EMR documentation If your orthopaedic practice has not yet adopted an electronic medical record (EMR) system, such a purchase is probably in your future. Federal government incentive programs to promote adoption and use of EMR systems will prompt most orthopaedic practices to implement an EMR system within the next 5 years.
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Running a business that cares for patients
Book Review This discussion about the business of running a medical practice, combined with the author’s personal philosophy of service excellence in patient care, could easily be titled “Business 101 & My Practice Model.” The author—Michael Harris, MD—is a colorectal surgeon at Mt. Sinai School of Medicine and physician manager of a “45-surgeon faculty practice.”
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Changes in reporting wound débridement
This year, CPT 2011 introduced multiple changes in the reporting of wound care services associated with fractures, as well as wound care not associated with an open fracture and/or dislocation. The online version of this article includes a summary chart (PDF), showing the code changes, that can serve as an easy reference for accurate reporting of wound care services. Highlights and key changes in the Integumentary System Section of 2011 CPT are covered in this article.
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How do patients see your practice?
Speaking at the Practice Management Symposium for Practicing Orthopaedic Surgeons at the 2011 AAOS Annual Meeting, Thomas J. Grogan, MD, emphasized that successful practices must take into account the public face of their offices. “What I have found is that my receptionist drives more work to my practice than anybody else…probably including me,” he explained.
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Don’t take your physical facility for granted
Eleven ideas to consider in 2011 and beyond Orthopaedic practices vary greatly in how they operate on a day-to-day basis. But they all have the following overhead outlays: staff salaries, occupancy, employee benefits, drugs and medical/surgical supplies, and professional liability insurance. These five expenses account for more than 75 percent of total overhead.
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10 tips to implementing an EMR system
By Richard Dell, MD; Charles Rhoades, MD; and Howard Mevis How you make the shift makes the difference You’ve invested countless hours evaluating electronic medical record (EMR) programs and the companies behind these programs. You’ve selected a system, completed the purchase, and installed the new software and hardware. You’ve ensured that everyone in the office—physicians and staff—has successfully completed training on the new system and is ready for the “go live” date.
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How likely are you to be sued?
It’s not a question of whether, but when…and how to reduce your risk Did you know that the cumulative likelihood of a physician in the highest risk specialties (neurosurgery, cardiothoracic surgery, general surgery, orthopaedic surgery, and plastic surgery) having a medical liability claim is 88 percent by age 45 and 99 percent by age 65?
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Lecture series prepares residents for systems-based practice
Now in its third year, the AAOS Resident Practice Management Lecture Series (RPMLS) helps orthopaedic residency programs fulfill the Accreditation Council for Graduate Medical Education requirement for systems-based practice, while increasing residents’ understanding of the many outside influences that have an impact on practice management. The RPMLS currently includes 18 audio–slide lectures presented by orthopaedic surgeons, practice management consultants, and Academy staff.
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Avoiding Employee Claims of Wage and Hour Violations
As small business owners, orthopaedic surgeons are well aware of the many state and federal laws governing business practices. Although the Fair Labor Standards Act (FLSA) is often overlooked, small and large businesses can find that violations of this act can result in substantial expenditures of time, energy, and money. Since 2004, the number of FLSA lawsuits tied to wage-and-hour disputes has increased 77 percent, according to the National Employment Lawyers’ Association.
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Improving the Primary Care/Specialist Referral Process
Both the ease and the speed of the specialist referral process are major concerns for patients and their primary care providers. Factors that slow the process decrease the efficiency of care delivery and make future referrals less likely. Any medical specialty office should strive to coordinate referrals seamlessly, providing optimal and timely care to the patient.
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Unlock the Hidden Profits in Your Orthopaedic Practice
Can you increase your practice’s profitability without increasing your hours worked? You don’t have to see more patients, perform more surgeries, or add ancillary services to generate more income. You can reduce expenses, such as your costs for practice supplies. Every dollar you save on purchasing supplies and equipment goes directly to your bottom line as profit.
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Catch the Thief in Your Office
What would you do if you were told there was a 100 percent chance that you as an orthopaedic surgeon would be the victim of fraud or embezzlement at some point? What would you do if you were told that your chances were “only” three out of four? In fact, no one really knows the extent of the problem because most incidences of embezzlement are never uncovered. Further, many incidences of embezzlement that are uncovered are never reported to the authorities or prosecuted.
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Engaging Your Patients in Pricing Discussions
If a patient called your practice for a personalized cost estimate, would you be able to provide one? The need for increased cost transparency is becoming a higher priority for several reasons. The average health plan deductible has increased by about 65 percent over the past 5 years, prompting patients to ask how much they will personally owe for a procedure or service.
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What You Need to Know About Employment Agreements
Consider these important issues before signing Todd A. Rodriguez, JD Whether you are joining a group practice or entering an employment relationship with a hospital, you should consider several significant legal and financial issues when negotiating your employment agreement. Before signing any agreement, you should review—with legal counsel as appropriate—and fully understand all the terms of the agreement. The following are among the most critical provisions to consider.
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5010 – Ready or Not It’s Here!
Recently, the Centers for Medicare & Medicaid Services (CMS) announced it would not take enforcement measures against Health Insurance Portability and Accountability Act (HIPAA)-covered organizations that were not 5010 compliant until June 30, 2012. This is not an extended deadline for compliance, simply a grace period before the agency begins taking enforcement actions. However, providers may already be experiencing an increase in claim rejections.
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Expect Fundamental Changes in Reimbursement
Our piece of the pie is getting smaller,” announced John Cherf, MD, MPH, MBA, during the Practice Management Symposium for Practicing Orthopaedic Surgeons at the AAOS 2012 Annual Meeting. “In 2009, about $2.5 trillion was spent on health care in the United States,” he continued. “If you look at the pie chart (Fig. 1), two pieces stand out pretty clearly: 31 percent of the money goes to hospitals and 21 percent to physicians.
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Take Steps to Improve Practice Efficiency
How efficient is your orthopaedic practice? Practice efficiency is a way to improve personal satisfaction, patient care, and financial success. An efficient, well-organized practice helps reduce your down time and allocates resources to help maximize your productivity. Orthopaedic surgeons generally see more patients per clinic hour than other specialty providers.
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Give Your Practice a Competitive Advantage
Make sure your practice executive, key staff are AAOE members Francis “Sam” Santschi, JD Measuring the return on investment (ROI) for staff education and professional development is difficult. But when it comes to membership in the American Association of Orthopaedic Executives (AAOE), your ROI will be easy to determine. Once your practice executives start taking advantage of AAOE member benefits, you’ll see a change.
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Six Steps for Managing Your Online Reputation
Thanks to the Internet, unhappy patients can now express their discontent for all the world to see. If you or your practice have not yet been the target of a negative online review, chances are reasonably good that you will be in the future. The proliferation of online physician rating websites is making it easy for disgruntled patients to vent their frustrations.
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What to Consider When Closing Your Medical Practice
Orthopaedic surgeons may decide to close their medical practices for many reasons. Some may elect to sell their practices to hospitals and become hospital employees. Others may have experienced a disability or the unexpected death of a key partner in the practice. Still others may decide that the current regulatory and economic landscape is becoming too burdensome, and some will simply wish to retire.
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Frequently Asked Coding Questions
This month’s column addresses recent questions related to correct coding under the American Medical Association’s (AMA) Common Procedural Terminology (CPT) rules and the AAOS Global Service Data Guide (GSDG). Shoulder Surgery Q. My coder says that, effective Jan. 1, 2013, only one surgical CPT code can be submitted, even when two or more procedures are performed in the same shoulder.
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2013 4th Quarter Tax Saving Tips
What to do now to save on 2013 taxes Carole C. Foos, CPA, and David B. Mandell, JD, MBA As the 4th quarter of the year approaches, most orthopaedic surgeons have a fairly good idea of what their taxable income will be for 2013. If you are wondering whether you can do anything now to save taxes on April 15, the answer is very likely “yes.” The following ideas could help reduce your 2013 income tax bill, depending on your facts and circumstances.
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Are You Ready for ICD-10?
“Whether you like it or not,” said John McGraw, MD, “in less than a year, ICD-10 is going to be here.” Dr. McGraw, chair-elect for the AAOS Board of Councilors (BOC), was addressing members of the BOC and the Board of Specialty Society (BOS) during their Fall Meeting. The panel of experts he introduced echoed his call for readiness. Why make the switch? “Don’t shoot the messengers; it’s not our fault,” began M.
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3 Key Financial Controls for Your Practice
In the current economic climate, the healthcare field is filled with uncertainty and insecurity. To survive, independent orthopaedic practices will need to implement financial controls and focus on effective management. Commercial businesses already know the importance of implementing financial controls and safeguards, which should become just as prevalent in physician practices.
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Coding Knee Arthroscopies
Coding knee arthroscopies can be challenging for both physicians and coders—especially when the surgeon performs multiple procedures, one of which is documented as a synovectomy. Although the rules may seem straightforward, they are not as clear as they appear. Synovectomy procedures in the knee Synovium is the smooth lining of the joint that produces synovial fluid to lubricate the joint.
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Frequently Asked Coding Questions
This column addresses recently asked questions on coding orthopaedic procedures. Remember, you can direct specific coding questions to the AAOS for review by the Coding, Coverage, and Reimbursement Committee and AAOS staff. Visit www.aaos.org/coding for more coding information. Injections with ultrasound guidance Q: Can the ultrasound guidance CPT code—76942—be reported when the physician performs a major joint injection (CPT code 20610) using ultrasound guidance?
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The Differences Between Modifiers 51 and 59
One of the most frequently asked question about modifiers is “When do I use modifier 51 and when do I use modifier 59?” This article differentiates the use of these modifiers when two or more procedures are performed on the same day. About modifier 51 Modifier 51 (multiple procedures) is used to inform payers that two or more procedures are being reported on the same day.
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Surgical Modifier Application during the Global Period
The first step in understanding how to use modifiers during the postoperative global surgical period is to review the definitions for the global surgical package. There are differences in the way the global surgical package is defined under the American Medical Association’s Current Procedural Terminology (CPT) rules and under Medicare. CPT and Medicare vary on what services may be reported during the global period and when those services may be reported.
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Financial Strategies for Young Physicians
You’ve finally completed your medical education (medical school, residency, and fellowship) and are ready to embark on an orthopaedic career. But how are you going to deal with the debt that you’ve accrued? According to the American Medical School Association, 86 percent of medical school graduates have educational debts totaling between $119,000 and $150,000. As a young orthopaedist, your debt may be even higher.
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Super Groups: Are They the Future of Private Practice?
Orthopaedic group practices—whether single specialty or multispecialty—have been around for a long time. But in recent years, a new type of group practice—the “super group”—has emerged, not only in orthopaedics, but in many other medical specialties. Super groups may range from 15 to several hundred physicians and may have multiple locations in a market area.
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Identifying the High-Risk Patient
The high-risk patient is not easily defined. Physicians often make their own determinations based on personal experience. Although the high-risk patient is often assumed to be uninsured or poorly insured, elderly, demanding, mentally challenged, previously injured, sick, or litigious, not all of these characteristics are accurate descriptors. This article attempts to separate myth from reality in defining the high-risk patient.
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Is Your E&M Documentation an Audit Risk?
The Work Plan for the Centers for Medicare & Medicaid Services’ Office of the Inspector General (OIG) regularly targets potentially inappropriate evaluation and management (E&M) service payments. This year, OIG has focused on disproportionately high frequency utilization of the same level of E&M service by the same provider. The impetus for this close scrutiny is that Medicare contractors noticed an increased frequency of medical records with identical documentation across services.
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Counting Down to ICD–10
ICD-10 implementation is just 6 months away. By now, orthopaedic practices should have accomplished the following actions: Completed the education of physicians, nurses, physician assistants, and coding staff. Finalized all software testing. Completed a review of business associates agreements. Identified the most common or frequently used ICD-9 codes and translated this information to ICD-10.
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Data-Supported Outcomes and Quality Improvement
With implementation of the Affordable Care Act, change has become the byword for the U.S. healthcare system. The way physicians deliver and get paid for healthcare services is changing, and many physicians have shifted from private practice to hospital employment. These changes—as well as the expectation of additional changes—concern many practicing orthopaedic surgeons. They also create the need for us to lead and manage our practices in new ways.
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Five Frequently Asked Questions About ICD-10
During the AAOS-sponsored ICD-10 education courses presented this year by KarenZupko & Associates, orthopaedic surgeons, practice managers, and staff had plenty of questions about ICD-10. Here are five that were frequently asked. If we’ve been using unspecified codes before, why can’t we use them now? For orthopaedics, a key feature of ICD-10 is its expansion to include greater detail about the injuries and conditions treated.
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Frequently Asked Coding Questions
The following coding questions have been raised during the past several months. Removal of spinal interbody device Q. In the operative note, the surgeon documented removal of an interbody device from L4-5. The surgeon states that a peer told him to report this procedure using CPT code 22850—removal of posterior nonsegmental instrumentation (eg, Harrington rod). The coding team does not agree. Is this work reportable and, if so, is CPT code 22850 the correct code? A.
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Enhancing the Patient Experience
Improving the delivery of care goes beyond patient satisfaction Patient experience has gained importance with the passage of the Affordable Care Act. Defined as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care,” patient experience goes beyond satisfactory outcomes and “making patients happy.”
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Is Your Documentation Up to Par?
It may be hard to imagine that payers really read the operative notes to make sure the documentation supports the work performed, but the reality is that when services reported don’t match the codes submitted, payers pay attention. A recent case filed in a United States District Court is just one example.
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Reducing the Tax Bite on Retirement Wealth
Tax diversification is the key Carole C. Foos, CPA, and David B. Mandell, JD, MBA Nearly all orthopaedic surgeons are focused on reducing their income taxes. This is understandable, because income taxes are generally the highest-rate tax AAOS members will pay during their lifetimes. Compared to other taxes, the raw amount of income tax paid is also typically the largest, and income taxes must be paid annually.
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ICD-10: The Documentation Is in the Details
The format and structure of ICD-9 and ICD-10 codes (Fig. 1) are so completely different that it is difficult to believe that in just a few months they will be used for the same purpose. When educating AAOS members about the transition to ICD-10, I and others have found that is it best to start with something familiar. Then and now In ICD-9, many orthopaedic codes began with the number 7 or 8.
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Care Transitions and Meaningful Use Criteria
The goal of electronic health records (EHR) is to enhance interaction with disconnected data sources. Every day, for example, various forms of information technology within an orthopaedic practice—including picture archiving and communications systems, billing and coding systems, and practice management systems—feed data into or use data from an EHR. Thus, it is key that information technology systems within a practice be coordinated.
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Bar Raised for Stage 2 Meaningful Use
Orthopaedic surgeons may well consider Sept. 4, 2014, as a “date that will live in infamy.” On that date, the Centers for Medicare & Medicaid Services (CMS) Office of the National Coordinator for HIT (ONC) published final regulations for meeting Stage 2 meaningful use criteria for electronic medical records (EMRs).
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Balanced Scorecard for the Medical Practice
What is a Balanced Scorecard (BSC)? Can your practice benefit from implementing the concept? At our 14-surgeon orthopaedic practice, implementing a BSC resulted in a more systematic focus on key performance metrics that impact the patient experience and monitor the effectiveness of a range of internal processes. The BSC is a reporting and strategy tool that has been used since the 1990s in a range of industries outside of healthcare.
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Medical Necessity ≠ Medical Decision Making
When coding evaluation and management (E&M) services, coders—including physicians—may experience some confusion related to the terms “medical necessity” and “medical decision making.” The two terms are not synonymous for the purpose of selecting E&M codes, and failure to understand the difference between them can lead to incorrect coding of E&M services, as well as cause problems in physician education and billing audit services.
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ICD-10 Implementation: Final Countdown!
The ICD-10 implementation deadline is less than 6 months away; is your practice ready to make the switch? Evaluating where you are in the implementation process is crucial to the success of your practice. To ensure that claim denials are kept to a minimum, you will be required to test and update software and train staff on the correct application of ICD-10 codes no later than Sept. 30, 2015.
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Maintaining Practice Profitability: No Easy Feat
The economics of an orthopaedic practice are rapidly changing, according to Michael J. McCaslin, CPA, and current revenue sources are likely to shift in importance going forward. Mr. McCaslin shared his thoughts on “Maintaining Practice Profitability in 2020” during the 2015 AAOS Now Forum on Orthopaedic Economics. “Professional services revenues for private practices are likely to be flat to declining,” said Mr. McCaslin, “as the shift from fee-for-service to value-based payments continues.
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That Was Then, This is Now
Over time, coding recommendations or payer rules, including Medicare payer rules, change or are clarified. This article addresses a coding issue originally covered in the February 2014 issue of AAOS Now. Modifier 59 denials' Q. The local Medicare carrier has recently denied multiple claims with the same Current Procedural Terminology (CPT) code reported more than once, using modifier 59 to indicate that the second procedure was performed at a different location.
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How to Manage Conflict in Your Practice
Dealing with difficult personalities and managing conflicts within an orthopaedic practice can be a sensitive issue that is often unavoidable. These situations are not limited to internal staffing issues but may also arise from interactions between staff and patients. The following five tips can be helpful in managing conflicts. Speak in a calm and respectful tone. Take notice of when a situation begins to escalate and conflict arises. Remember to speak slowly and with confidence.
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Implementing Shared Decision Making in the Orthopaedic Practice
The process of shared decision making (SDM) should be a patient-centered experience, fostered by collaboration between the patient and physician. Although barriers exist to implementing SDM in an orthopaedic practice, doing so also presents orthopaedists with opportunities (Table 1). Barriers Orthopaedics is uniquely suited for SDM but the practice has not been widely adopted.
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Are Medical Scribes Right for Your Practice?
An increasing number of hospitals and private practices are turning to medical scribes to increase productivity and profitability, as well as to enhance patient care and satisfaction. Medical students, medical assistants (MAs), and other professionals who serve as medical scribes are at the physician’s side during patient examinations, documenting the visits in real time.
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What to Do When the EHR Goes Down
When you were considering the purchase of your electronic health record system (EHR), the company’s sales representative probably pointed proudly to the system’s reliability and minimal “downtime.” This is the amount of time when the system fails for any reason. Most companies describe their EHR reliability as 99.99 percent. So what do you do when the 1/100 of a percent occurs and the EHR goes down—whether in the middle of the day or at 2:00 a.m.?
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New AAOS Member Offering
Identity Theft and Cyber-Security Protection from MetLife Defender An identity is stolen every 3 seconds in the United States. Every time you go online to pay bills, shop, or connect with friends and family, you may be putting your personal data at risk. The American Association of Orthopaedic Surgeons (AAOS) is pleased to offer members MetLife DefenderSM, a proactive, comprehensive service to protect against a range of identity theft and other cyber risks.
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“X” Subset Modifiers and Orthopaedic Clinical Examples
Confusion about modifier 59 and the “X” subset modifiers is evident in the responses from orthopaedic practices to a recent survey conducted by Karen Zupko & Associates, Inc. Modifier 59 is used to indicate that a procedure or service was distinct or independent from other non-evaluation and management services performed on the same day. The “X” subset modifiers were introduced in 2013 to define specific subsets of the -59 modifier.
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Meeting the Needs of the Contemporary Patient
Given the complexity of payment realities, the burden of quality initiatives, and the uncertain nature of future regulations, it may be a slight overstatement to say, "The future is bright for orthopaedic surgeons." However, orthopaedics has a silver lining. Demand for services will increase over the next decade due to an aging and obese patient population and improvements in technology.
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Tips for Managing Patient Collections in the New Reimbursement Landscape
According to the Kaiser Family Foundation’s 2014 Employer Health Benefits Survey, 80 percent of U.S. workers with health insurance must meet an annual deductible (average $1,100) before benefits become payable under the plan. Most health plans include extensive cost-sharing features, such as copayments, coinsurance deductibles, and narrow networks. As financial accountability for health care shifts from payers to patients, managing patient collections becomes more important than ever.
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Calculating Overhead: What It Really Costs to See a Patient
The conventional definition of overhead is simply the cost of doing business. In an orthopaedic practice, overhead is the money spent to provide goods and services to patients. Managing overhead is a challenge for any orthopaedic practice, but being able to accurately calculate and control overhead is critical for orthopaedic surgeons to control their practice finances. The first key to controlling overhead is being able to measure it.
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Discharging a Disruptive Patient
In the course of practicing medicine, many providers have to deal with patients who do not comply with instructions or who become upset because they can't have requested testing or treatment on demand. Although these patients may be frustrating to deal with at times, the best approach is always to focus on improved communication and education. These patients usually come to an understanding about the proposed recommendations or seek opinions elsewhere.
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Is Your Team More than a Group of Individuals?
The difference between teams and groups of individuals is relevant to every orthopaedic surgeon because it is through teams that patient care is delivered. This is not a new concept, but it reflects a paradigm shift for surgeons indoctrinated to regard the "team" as a mere support system for individual accomplishments. As surgeons, we share an inclination to tightly control processes and to view our teams as vehicles for our individual efforts.
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Five Tips to Enhance Practice Revenues
In the past, development of a financially successful practice hinged primarily on a physician's clinical expertise, which alone served to attract patients and generate revenue. Nowadays the economic climate is very different. Orthopaedic surgeons must develop new ways to generate revenue while meeting the healthcare needs of their patients. To be successful, practices must generate revenue from multiple sources.
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Arbitration: A Better Way of Settling Medical Disputes
Although arbitration agreements are widely used in many different contract situations, they are not common in healthcare situations. These agreements help ensure that disputes are managed by an arbitrator, rather than in a courtroom. Physicians may consider using arbitration agreements to address the risk of malpractice lawsuits. Most states have laws governing arbitration agreements between physicians and patients.
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Take off your white coat and put on your blue suit
Think about what you can do differently to generate more revenue Over the last decade or so, the rapid rise of fiscal challenges has rivaled the technological progress in the practice of orthopaedic surgery. And with that shift has come a need for orthopaedic surgeons to take off their white coats and put on their blue suits—to understand economies of scale and scope as well as they understand the complexities of the musculoskeletal system.
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Are your collection agency accounts collecting dust?
Do you know how much money your collection agency recovered last year? If you don’t, how can you evaluate their effectiveness…or your return? Although patient balances forwarded to a collection agency are often considered “lost causes,” there would be little point in using such services if that were always the case. Some patients simply do not respond to practice statements or internal collection letters.
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Group purchasing program celebrates first anniversary
Results continue to exceed expectations A year ago, the American Association of Orthopaedic Surgeons (AAOS) signed an agreement with Esurg Corporation for a new member benefit—a group purchasing program. Since then, the program has consistently exceeded expectations. In fact, Esurg recently noted that the AAOS had accomplished more during the first 6 months of the program than other affiliates had accomplished in 18 months.
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Easing the strain of a busy practice
Here’s how one orthopaedic office uses physician assistants to improve patient—and physician—satisfaction Like most orthopaedic surgeons, Matthew J. Jimenez, MD, is a busy man. In addition to taking care of patients at the Illinois Bone & Joint Institute (IBJI) in Morton Grove, Ill., Dr.
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Physician assistants: Scope of practice
What exactly can PAs do? And who decides? The boundaries of a PA’s scope of practice are defined by the following four factors: State law Education and experience Facility policy Physician delegation State law Since the inception of the profession, dramatic changes have occurred in the way states deal with PA practice. The first state laws for PAs, passed in the 1970s, allowed broad delegatory authority by the supervising physician.
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AAOS Group Purchasing Program takes off
The AAOS Group Purchasing Program, powered by Esurg Corporation, rolled out at the 2007 Annual Meeting in February. Since then, orthopaedic surgeons from across the country have been taking advantage of the free savings analysis—and finding out just how much they could save with the program. In most cases, the analysis showed they could save 20 percent or more.
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Increasing diversity sparks demand for cultural competency
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.
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Better communication skills pay off
“Grateful” workshop participant appreciates downstream benefits Engagement. Empathy. Education. Enlistment. Academy members who participate in the AAOS Communication Skills Mentoring Program (CSMP) learn to implement these “four E’s” of communication, along with many other effective tools and techniques for improving patient-physician interactions. Through the leadership of CSMP Chair John R.
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Preparing for an expert witness deposition
If you are called upon, follow the Boy Scout motto and “be prepared.” Although most medical liability lawsuits are settled before they reach trial, settlements are often reached after expert witnesses are deposed by opposing counsel. A deposition is often viewed as the proving ground for lawsuits. Whether you are providing expert witness testimony in defense of another physician or on behalf of a plaintiff, being prepared is your best defense.
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Pearls and pitfalls in the treatment of tibial plateau fractures
Tibial plateau fractures are common injuries that affect the articular surface of the proximal tibia. They range from minimally displaced lateral depression fractures to severe bicondylar fractures that may be associated with knee dislocations, compartment syndromes, or vascular injuries. The options available to stabilize these fractures have multiplied during the past few years and include smaller screw diameters, locking plates, and improved osteobiologic implants.
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Healthcare, medical liability, and reform alternatives
The 2008 presidential campaign is drawing attention to healthcare reform, a focus that is likely to continue in coming months. It’s no secret why: Americans express deep dissatisfaction with the healthcare system. In a recent Gallup poll, for example, nearly three-quarters of respondents said that the healthcare system is in crisis or has major problems. Cost and access top Americans’ healthcare concerns in recent polls. Quality is also cited as a problem.
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Avoid these team-busting practices
What NOT to do if you want a strong office team Building an alliance with your practice executive is key to ensuring that your practice runs smoothly, efficiently, and profitably. Last month, we looked at 10 tips for establishing an alliance with your manager. But sometimes, what you don’t do is as important as what you should do. Here are 10 “don’ts” that will help keep your team intact and functioning well. DON’T undermine authority DO NOT permit violations to the “chain of command.”
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How far does your obligation go?
Can prescribing physicians be liable for their patients’ actions? Driving while under the influence of narcotic pain relievers, sedatives, and psychotropic drugs is a recipe for disaster. And that’s just what happened in Massachusetts, when David Sacca—a 75-year-old man with metastatic lung cancer, chronic obstructive pulmonary disease, asbestosis, and hypertension—lost consciousness while driving and killed a 10-year-old child.
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Moving into the digital age
Knowing your costs can help you decide Orthopaedic practices face a number of challenges today. Reimbursements continue to decline at the same time that new technology is becoming available to help deliver state-of-the-art care to our patients. As a solo practitioner, I face the ongoing challenge of balancing the adoption of new and exciting technologies with not going broke. In deciding whether to digitalize our X-ray system, I found that knowing my costs was key to making the decision.
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Do you get the picture?
Get the most from digital radiographs and PACS Today’s sophisticated technologies are changing the way radiographs are treated and stored. Nearly all hospital systems across the United States now use picture archiving and communication systems (PACS). A recent audit in our practice found that 95 percent of outside referrals to the practice were accompanied by digital radiographs, often placed on a CD-ROM.
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Ending back pain through posture and movement
“8 Steps to a Pain-Free Back” is a step in the right direction A personal experience with back pain and surgery was the genesis for Esther Gokhale’s 8 Steps to a Pain-Free Back. She describes the root cause of back pain as a posture drift (improperly tucked pelvis, slouched shoulders, and protruding neck) away from the naturally intended alignment.
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Accommodating obese patients in an orthopaedic practice
By Adolph J. “Chick” Yates Jr., MD Careful planning, frank discussions best serve a difficult patient population An increasing number of Americans are overweight; many meet the definition of obesity (body mass index of 30 or more). While the lay press trumpets an “obesity epidemic,” the orthopaedic literature is also increasingly reporting on the higher rates of perioperative complications associated with the overweight patient.
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How to use physician extenders
Four ways to integrate PAs into your practice Integrating a physician extender into your office isn’t a matter of “one-size-fits-all.”
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What is an “OPA-C,” anyway?
Are you bewildered by the “alphabet soup” of credentials used to designate certification or licensure of allied health providers and physician extenders? Let’s clear up one of those titles right now: The “OPA” or “OPA-C.” The certified orthopaedic physician’s assistant (OPA-C) is a professional, mid-level physician extender who works strictly in the field of orthopaedic medicine under the supervision of an orthopaedic surgeon.
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The ins and outs of a practice operational assessment
What you should know—and why you should do one Spend a few moments and take the simple quiz below. If you respond “I don’t know” to any of these questions, your practice is a prime candidate for an operational assessment, and you should keep reading. Operational Assessment Quiz (PDF) What is an operational assessment? An operational assessment is a review of selected aspects—frequently all aspects—of a medical practice.
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Metrics, benchmarks add value to your practice
Your practice can become a “Better Performing Practice” For nearly a decade, the Medical Group Management Association (MGMA) has designated “Better Performing Practices,” based on a series of benchmarks and metrics. Capital Region Orthopaedics, where I serve as the chief executive officer, has earned the “Better Performing Practice” distinction from the MGMA in each of the last 6 years. Significant effort is required to earn this distinction.
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Clinical competence and the aging surgeon
Patient safety, ethical considerations must be respected When is a surgeon too old to operate or a physician too old to practice medicine? We could pose the same query about any profession. The question is difficult to answer because it involves a person’s sense of self-worth, society’s needs and expectations, and many complex legal issues. Some surgeons have successfully practiced medicine and surgery into their 80s and beyond.
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How to avoid a “staff infection”
7 steps to better morale Low morale spreads quickly and is highly contagious. No one is immune. Left unchecked, poor morale can poison an entire practice, leading to a “staff infection.” Low morale is destructive to a physician office because it leads to an entire set of issues hazardous to quality patient care. For example, a byproduct of low morale is that attention to detail slips.
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Managing across the generations
Adapt your style to engage your staff, partners Have you or your staff ever had difficulties communicating? Do you feel that you are unable to reach younger workers? Do you feel that your older managers do not relate well to you? If you answered “yes” to any or all of these questions, you may be having trouble working across the generational divide. As discussed in a previous article (“Are you an ‘old coot’ or a ‘young whippersnapper’?”
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Orthopaedic surgeon wins scope of practice lawsuit in Kentucky
Ruling supports provision, billing of physical therapy services A recent Kentucky Supreme Court decision upheld the right of healthcare providers such as orthopaedic surgeons to provide and bill for in-office physical therapy services. Ronald S. Dubin, MD, who has been in private practice in Corbin, Ky., for more than 20 years, took the case to the state Supreme Court, which ruled in his favor. Background According to Dr.
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No such thing as minor adjustments
By Jennifer A. O’Brien, MSOD Tips to improve your net collections ratio “We have a net collections ratio of 99 percent!” the physician partner declared confidently during a recent revenue cycle consultation. “No, you don’t,” I responded sadly. “Your staff has been writing off everything the payors don’t allow to ‘contractual adjustments.’ Your real net collections ratio is much lower; the calculation is flawed by these inaccurate adjustments.”
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Economic survival in the 21st century
Economies of scale, scope will help you survive Many factors are driving up the cost of providing health care in the 21st century. Understanding these trends can help orthopaedic surgeons position themselves for success. Traditionally, AAOS membership included four groups, in roughly equal proportions: solo practitioners, partnerships or small groups, large groups, and academics. But this is changing.
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Marketing your practice via the Internet
How Internet marketing can help your practice—and what it can’t do Despite the Internet’s ubiquitous presence in our lives, opportunities for marketing medical services on the Internet are actually quite limited. In a practice-related context, Internet marketing is the strategic use of Web sites to accomplish specific goals, such as educating patients, advertising your practice, selling specific services, or advancing the careers of certain surgeons in a group.
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Hammering out coding challenges
Four steps to accurate coding for hammer toes and bunion procedures More than 100 procedures have been described for treating hammer toes in conjunction with bunion procedures (Fig. 1). Coding is challenging due to the complexity, methods of treatment, and reimbursement policies for each payor. But the following four steps can help ensure accurate coding and reimbursement for these procedures.
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Answers to your coding questions
Frequently asked questions and answers Q: We read the article on coding for pediatric spine fusion (AAOS Now, August 2008) with interest. We are not sure we have been counting segments the way it was described in the article. A: Many questions were submitted about this article, which was verified for accuracy by representatives from the AAOS, the North American Spine Society, and American Association of Neurological Surgeons.
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Protect your inventions and intellectual property
By Brenna Legaard, JD, and Robert N. Lyman, JD A general understanding of patent law is key Surgeons are prolific inventors. They are smart, understand how things work, and are focused on solving problems. In our practice as patent attorneys with many surgeon-clients, we have found that surgeon/inventors frequently test their devices before consulting a patent attorney. They want to know if their inventions work and whether the substantial cost of getting a patent will be worth it.
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Tips for dealing with the difficult patient
Communicate, set boundaries, and extricate yourself carefully When it comes to dealing with difficult patients, you’re not alone. Every office has them. You dread seeing their names on your schedule. Your staff puts off returning their calls. Clearly, something needs to be done to improve relationships with these patients, but what? Difficult patients are dependent, clingy, and entitled at best; they may also be manipulative, self-destructive, noncompliant, litigious, and even hostile.
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Sailing through the economic storm
How to keep your practice afloat during uncertain times Until recently, running your practice may have been smooth sailing. But then the recession struck like a gale-force wind. Now you, your partners, and your practice administrator are grappling with its repercussions on practice revenues, retirement plans, new equipment purchases, staffing levels, vacations, and more. In sailing, a plan directs your course.
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Leverage your buying power to control costs
AAOS Group Purchasing Plan provides cost and time savings Is your practice feeling the pinch of the nation’s economic downturn? The AAOS Group Purchasing Program just may be the silver lining in an otherwise dark cloud. Established in February 2007, the AAOS Group Purchasing Program, powered by eSurg Corp., can save your practice time and money on the supplies you use most. AAOS members have immediate access to nationally negotiated contract prices on quality brand-name supplies.
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HHS initiates liability demonstration projects
In September 2009, President Barack Obama issued a memorandum to Kathleen Sebelius, the Secretary of the Department of Health and Human Services that read, in part, as follows: “We should explore medical liability reform as one way to improve the quality of care and patient-safety practices and to reduce defensive medicine….to begin funding projects that can test a variety of medical liability models and determine which reforms work….
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Updating guidelines and tables for office E/M coding
Editor’s note: This is the second article updating information first provided in the May 2007 edition of AAOS Now. This article covers components of the orthopaedic evaluation, while the previous article covered the issues of new and established patients and consultations. The orthopaedic evaluation is made up of three key components: the history, the physical examination, and medical decision-making.
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Getting back into the game
A professional career does not have to end with retirement Do you want to return to orthopaedic practice after an off-season away from patient care? Are you considering a return into a robust practice from either a low-volume or narrowly focused practice environment? Although your circumstances may introduce some individualized considerations, the following basic strategies can help you “get back into the game.”
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E-prescribing: What’s new for 2010
CMS Finalizes Incentive Program The Centers for Medicare & Medicaid Services (CMS) has finalized provisions affecting the 2010 E-prescribing Incentive Program. As in 2009, eligible professionals who adopt a qualified e-prescribing system and successfully report the e-prescribing measure will earn a bonus of 2 percent of the total estimated Medicare Part B Physician Fee Schedule (PFS)-allowed charges for all covered professional services furnished during the 2010 reporting period.
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“Loss of chance” doctrine in medical liability
In two landmark decisions in 2008, the Supreme Judicial Court (SJC) of Massachusetts ruled that state law permits recovery for a “loss of chance” in medical malpractice cases. As a result, Massachusetts plaintiffs may now receive compensation for a reduction, resulting from a doctor’s negligence, in their “chance” for a more favorable outcome, even if that chance is less than 50 percent.
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Is your EMR fueling risky record keeping?
Not all timesavers are helpful Simply implementing an electronic medical record (EMR) system won’t necessarily reduce your risk of an audit. On the contrary, if you don’t use the system’s documentation features properly, EMRs may actually increase your risk of an audit. Bubble sheets Bubble sheets—preprinted response sheets similar to those used in academic testing or research surveys—are used in some EMR systems for patients to report their family and medical history.
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Understanding reinsurance
Protection for the companies that protect you Everyone understands the basic principle behind insurance. Individuals or groups reduce their financial risk by pooling their money with others who have a similar risk. When a loss occurs, a large fund is available to offset it. Similarly, insurance companies are faced with the problem of how to make the law of large numbers work to their advantage.
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The 7 Cs of certification
Are you competent, capable, communicative, concerned, caring, committed, and compassionate? In the patient’s mind, being board-certified (competent and capable) is not nearly as important as being patient-certified (communicative, concerned, caring, committed, and compassionate). These are the 7 Cs. Physicians who rate highly in all these parameters may satisfy patients more fully, are likely able to deal better with unanticipated events, and rarely get sued (based on our experience).
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Are you ready for emerging technologies?
Put high tech to work in your practice Orthopaedic surgeons have frequently been identified as “high-tech,” that label more appropriately applies to the tools used in the operating suite rather than to the way many orthopaedic practices are run. In many cases, orthopaedic practices still rely on paper records, film radiographs, and snail mail rather than electronic medical records (EMRs), picture archiving and communications (PACs) systems, and Web-based patient portals.
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Tips for cutting office expenses
Using discounts and rewards to reduce front office costs Efficient acquisition and distribution of office supplies is a good way to control overhead. In most practices, the front office uses most of the office supplies. Postage, paper, and printer supplies quickly can add up to high monthly expenses if not monitored closely. Although these expenses are usually attributable to the cost of doing business, there’s no reason they can’t be controlled.
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Promoting a culture of safety
Joint Commission initiatives aimed at enhancing patient safety When some orthopaedists think of The Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations), they may envision an organization focused on issuing requirements to physicians and healthcare organizations. But enhancing patient safety, rather than dictating rules and regulations, is at the heart of the organization’s mission, according to Robert A.
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Managing implant distribution and costs
Two solutions that put surgeons and hospitals in the driver’s seat For several years, there’s been a disconnect between payments to orthopaedic surgeons who perform joint replacements and the cost of the procedure itself. While reimbursement for a hip replacement fell nearly 26 percent from 1997 to 2007, for example, the “average selling price” of a total joint implant increased more than 130 percent.
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Enhance your practice revenues with AAOS primer
Primer provides “pearls” of wisdom; “pitfalls” to avoid In the past, development of a financially successful practice hinged primarily on a physician’s clinical expertise, which served to attract patients and generate revenue. But today, the economic climate is very different. It used to be relatively easy for orthopaedic surgeons to maintain their net incomes by seeing more patients and doing more surgeries.
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Navigating a changing healthcare environment
Expect transformational change and financial compression On March 23, 2010, President Obama signed into law one of the most comprehensive healthcare reform bills ever enacted, The Patient Protection and Affordable Care Act. This legislation was followed by the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010).
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The ABCs of an effective deposition
Regardless of the reason for the lawsuit, as the defendant physician you will need to thoroughly prepare for your deposition. The plaintiff’s attorney has wide latitude to ask questions. Your attorney will make objections and give you counsel as necessary. Your testimony becomes a part of the record, and any inconsistencies between your deposition and trial testimony may be used to undermine your credibility. The following tips will help you give an effective deposition.
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Technology issues for 2011
By Howard Mevis A productive, busy orthopaedic practice relies heavily on digital technology in the provision of patient care. In implementing an electronic medical record (EMR) system, orthopaedic surgeons need to be mindful not only of data security and data storage/infrastructure issues, but also of the system’s impact on patient communications, its ability to interact with other systems, and its limitations.
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Tech issues in 2011: Data storage and security
By Howard Mevis Digital technology is reaching into every aspect of an orthopaedic surgeon’s practice. Recent regulations—particularly those on data storage and security—will have an increasingly significant impact on orthopaedic practices in 2011. Data security Data security is the number one technology issue for 2011.
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Benchmarking physical therapy programs
Use benchmarking to gauge and improve provider productivity and program profitability A successful physical therapy (PT) program requires effective management of multiple functions, including maintaining an appropriate level of provider productivity, minimizing patient cancellations and no shows, capturing all appropriate charges, effectively using support staff, and consistently collecting all payments due.
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Managing office expenses by using corporate credit cards
Credit cards can facilitate purchases and control utilization The practice expense account is a highly regarded benefit of partnership. A physician’s expense account can have a substantial impact on operating expenses if not carefully managed, because this corporate ‘perk’ can be overutilized. Practice executives must constantly scrutinize purchases and debit partners accordingly to keep cash and operations flowing.
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Surgeons and teamwork
Creating predictable improvements in safety, quality, and patient satisfaction While performing a procedure to repair a disk herniation and remove an extruded fragment, Dr. Smith did the unthinkable (in his mind anyway); he made a mistake leading to a wrong surgery. During his 30 years as a board-certified surgeon, Dr.
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Back from the brink?
Lessons orthopaedists need to learn—now! “The Death of an Orthopaedic Group” (AAOS Now, April 2011) was both disturbing and timely. I believe that all orthopaedists are, to some degree, at risk for extinction as the economic conditions of orthopaedic practice become increasingly unfavorable. Because my partners and I have recently struggled to bring our group back from the edge of economic oblivion, I believe that Dr.
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Take control of your digital footprint
Engaging patients online gives you the opportunity to manage your own reputation “Patients search for information about their conditions, their medications, and, of course, their physicians,” noted Howard J. Luks, MD, who has spoken frequently on the topic of physician online engagement. “That poses a risk to doctors, particularly orthopaedists, who are elective specialists and frequently depend on referrals from patients and other physicians.
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Avoiding a lawsuit: Lessons from the never-sued
An orthopaedic career without a single lawsuit is possible In orthopaedics, the average physician is named in a lawsuit once every 7 years. So can a practicing orthopaedist have a 40-year career without being sued? In my position as CEO and Chairman of COPIC, a medical liability company, I have been privileged to know several surgeons who have had long careers without a lawsuit.
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Including business education in residency training programs
Many orthopaedic surgeons would agree, at least on an intuitive level, that we, as physicians, should understand the business of our chosen profession, and as a community, we seem to want to understand this perspective. But when does this realization occur? Based on the results of a short survey of Chicago-area residents, residents are already thinking about these issues. (See “Residency training programs need to add business education,” AAOS Now, August 2011.
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Using Benchmarking for Decision Making
In today’s uncertain business climate, managing a medical practice involves much more than simply caring for patients. Although that will always be important, to be successful orthopaedic surgeons and their practice managers must also make informed business decisions. That requires a method to gauge pertinent statistics: benchmarking.
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Improving Patient Flow Yields Big Dividends
Improving patient flow can have an impact on many aspects of a practice’s success, including shortening wait times and increasing patient satisfaction. Depending on how the process is revised, it can also boost employee morale by using critical knowledge from within the organization. Just ask Julie Meurer, health services manager at Panorama Orthopedics & Spine Center in Denver. Ms.
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Big Tax Law Changes Could Be Coming Soon
At the end of 2012, the “Bush tax cuts” are set to expire—and it’s not just the top 1 percent who will be affected. Without new legislation, tax rates will increase for all taxpayers and certain deductions will be curtailed for some taxpayers. What follows is a summary of the most common changes scheduled to take effect this year and in 2013.
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CPT Coding Update 2012—Part 2
This is the second in a series of articles providing a high-level overview of code changes for 2012. It is not meant to be an all-inclusive introduction to either the code changes or the guideline changes being introduced in 2012.
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Preserving Independence Through a Practice Merger
Although healthcare reform, reimbursement changes, and continuing economic pressures are making hospital employment an attractive option, most surgeons still desire the autonomy of private practice. One option is to merge with other independent practices to create an organization with the scale and resources to thrive in today’s healthcare environment.
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Building a Business Strategy
For several years, the AAOS has offered a variety of symposia on practice management, including two during the Annual Meeting—one directed to orthopaedic residents and the other to practicing orthopaedic surgeons. I’ve been to most of them, and in my opinion, the best one is the AAOS Practice Forward: Managing Your Practice in an Era of Health Care Transformation, which I attended last year.
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10 Steps to Getting Paid Faster
Your orthopaedic practice faces an ever-changing landscape of policies and mandates that can force you to adapt your processes for revenue management. The recent 5010 transition and upcoming ICD-10 requirements, declining Medicare reimbursements, and growing patient responsibility for payments are just a few of the issues you face. Your practice needs systems and support you can count on to manage your revenue cycle more efficiently.
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Does Patient Responsibility Still Exist?
E. Burke Giblin, Esq., and Christina M. Scarpa, Esq. A common theory of negligence raised against physicians, especially against orthopaedic surgeons, is a claim of negligence in failing to track and monitor the follow-up care required by the patient, resulting in a delay in diagnosis or treatment and injury to the patient. For years, plaintiff’s attorneys have creatively argued that a patient’s failure to follow-up for additional treatment is the physician’s responsibility.
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Build Referrals with Nine Milestones in Patient Care
Patient growth in an orthopaedic practice is influenced by several variables including, but not limited to, competitors, payer networks, and health system arrangements. Although these external forces are influential, critical choices in personnel, management, physician commitment, and adaptability determine whether or not the practice effectively communicates leadership, brand superiority, and market preference. Patients and referral sources rarely need more choices. They need help choosing.
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The Truth Behind APTA’S Campaign Against POPTS
The American Physical Therapy Association (APTA) has waged a decades’ long campaign to bar orthopaedic and other physician groups from providing physical therapy (PT) services. APTA and its state chapters actively discourage their members and other physical therapists from working for physician groups and have led legislative efforts that would, if successful, result in job losses for physical therapists affiliated with physician groups.
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Improving Your Online Success
Your current and potential patients are asking a lot of the Internet in general and of healthcare practice websites in particular. Gone are the days when websites only provided patients with a way to locate a practice. Potential patients want more information before deciding to contact the referral from their primary doctor or friend. Today, patients want a comprehensive online experience with your practice before they pick up the phone or schedule a consultation.
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Five Easy Ways to Get Started with Online Video for Your Practice
Just how popular is online video? Consider the following statistics: 84 percent of Internet users in America watch videos online. In January 2012, Americans watched 40 billion videos. One trillion people visited YouTube—the dominant producer of Internet video—in 2011. It’s not just folks sitting at their home computers who are watching video.
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Do You Need a New EMR System?
Before you decide, consider these issues Howard Mevis Although many orthopaedic practices have not yet fully adopted an electronic medical records (EMR) system, some early adopters have realized that their very expensive investment is not working out. A recent report from KLAS Research found that more than half of the medical practices polled indicated that they were giving some consideration to replacing their EMR system.
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Run Your Medical Practice Like a Business
Although physicians may not realize it, their medical practices are big businesses and need to be run as such, according to Ron Howrigon, president of Fulcrum Strategies, a contract negotiation and healthcare marketing firm that works with physician groups of all sizes and specialties across the United States. “When you look at the millions of dollars of revenue that flow through physician practices—even small practices—you realize that they really are big businesses.
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Coding Changes Will Hit Twice in 2014
Next year brings two sets of coding changes that orthopaedic surgeons and their staffs will have to know and incorporate into practice. The first change occurs with the traditional Current Procedural Terminology (CPT) code updates for new, revised, and deleted codes in January; the second change will be the introduction of the International Classification of Diseases, 10th edition, clinical modifications (ICD-10-CM) on Oct. 1, 2014.
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Survival Skills For Independent Practices
The Affordable Care Act charged healthcare providers to seek ways to integrate the delivery of health care for a patient. Several innovative ways to accomplish this goal were introduced that require hospitals, physicians, and other healthcare providers to work together. As in the 1990s, hospitals responded by buying physician practices, employing physicians, and creating clinically and financially integrated organizations with the medical staff or community physicians.
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How to Deal with the “Problem Physician”
“Problem physicians” are easily recognizable, but often difficult to address. At the 2012 AAOS Fall Meeting of the Board of Councilors and Board of Specialty Societies, five speakers discussed physician behaviors that undermine patient safety and outlined ways that physician colleagues could support changes in those behaviors. Moderator Frank B.
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A Tax-Advantaged Way to Protect Your Assets
Erica Smith You have spent your entire life building your savings. You deserve to be able to enjoy them! But what if you require long-term care at some point? Today, the annual cost of many nursing homes exceeds $100,000, and has been steadily increasing. If you required long-term care, would these costs deplete your savings? What is long-term care insurance?
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The Key to Meaningful Use
How one orthopaedic practice earned $342,000 in Medicare incentive payments Because the meaningful use program was defined with primary-care physicians in mind, participation by specialists has been challenging. But more than 9,000 orthopaedists have successfully attested and earned incentive payments.
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How Much Life Insurance Do You Need?
Understanding why you need life insurance isn’t difficult, especially if you have a family. Life insurance helps protect the financial future of your family should something happen to you. If you don’t have a family, life insurance can help protect the future of your business or provide a meaningful legacy for a cause in which you believe. Determining how much life insurance you need, however, may be a little harder.
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A Potpourri of Coding Questions
This column addresses recently asked questions on coding orthopaedic procedures. Remember, you can direct specific coding questions to the AAOS for review by the Coding, Coverage, and Reimbursement Committee and AAOS staff. Visit www.aaos.org/coding for more coding information. Postoperative period services Q: We are a new practice and our coders are new to orthopaedic surgery coding.
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Improving “Performance in Practice” with MOC
Orthopaedic surgeons understand the importance of continuously measuring, assessing, and improving the quality of care they provide to patients. One way to ensure that this ongoing performance improvement occurs is by satisfying the requirements of the American Board of Orthopaedic Surgery’s (ABOS) Maintenance of Certification (MOC) Part IV: “Performance in Practice.”
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Turn Transmittals into Training Tools
Payer transmittals—the electronic or mail-out disclosures sent by insurance companies when they’ve identified an error or problem or when an update is needed—are a dime a dozen. Your billing team receives them regularly and typically sets them aside after reading them—especially when the message is like this recent example from a Medicare Administrative Contractor (MAC): We have identified claim issues for dates of service 1/1/2013 through 1/11/2013.
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Are You Monitoring Your Investment Accounts Daily?
Are you checking your investment accounts on a daily basis? If so, the only thing you will likely accomplish is to drive yourself crazy, especially in today’s whipsaw economy. Instead of taking a short-term, day-trader mentality, a better idea is to make solid, well-researched decisions for long-term growth and monitor the results regularly—such as each month or quarter—but not on a daily basis.
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Avoid Billing Service Nightmares
Issues to consider before partnering with independent and hospital-based billing services Jennifer A. O’Brien, MSOD In addition to the compliance and security issues highlighted in part 1 of this series (“Avoid Billing Service Nightmares,” AAOS Now, February 2014), an evaluation of operations, experience, and costs is essential to selecting the right partner for the provision of billing services.
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Getting a Handle on Denials and Underpayments
Five steps to improving your billing performance A.J. Johnson In the average physician office, there can be a wide gap between expected and actual claim reimbursement. In fact, payers make inaccurate payments on one out of every 14 healthcare claims (7.1 percent), according to the 2013 American Medical Association (AMA) National Health Insurer Report Card. This missing revenue isn’t easy to see when it’s hidden.
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Coming Soon: Random Audits for HIPAA Omnibus Rule
The Health Insurance Portability and Accountability Act (HIPAA) Omnibus rule went into effect in September 2013. As 2015 approaches, orthopaedic practices can expect the Office of Civil Rights (OCR) in the Department of Health and Human Services to increase its random audit program. The 2013 rule expanded the penalties for privacy and security breaches identified during audits.
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How NOT to Promote Your Practice
The ability to attract new patients is vital to a practice’s success. To do so effectively and efficiently, partners in an orthopaedic practice need to have a shared vision and to align the practice’s objectives with that vision and the needs of the market.
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Liability under “Good Samaritan” Laws
Physicians treating patients are under a duty to provide care that meets certain standards of care. This is due to the fact that physicians have a fiduciary relationship to their patients. But what about physicians who are treating people with whom they have no relationship at all? For example, a physician pulls over at the scene of an accident and, through a sense of civic responsibility, delivers health care. Can that physician then be sued if the injured persons do not survive?
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Four Steps to Improve Your Bottom Line
Sometimes, taking simple steps can result in big payoffs—particularly when it comes to the bottom line. The following tips can help improve cash flow, reduce expenses, and keep your practice Health Insurance Portability and Accountability Act (HIPAA)-compliant. Know what you’re owed. Patients’ out-of-pocket costs are increasing. Your staff should know each patient’s payment responsibilities before the patient checks in. Collect copayments at the time of service.
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Journal Club Topics
Looking for articles on which to base a journal club session—particularly one on advocacy or practice management topics? Look no farther than AAOS Now. In the past year, AAOS Now has published a number of articles that would make good fodder for a journal club discussion.
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How Much Do Orthopaedists Spend?
Given the increased scrutiny of medical costs by payers and government, researchers at the Vanderbilt Orthopaedic Institute Center for Health Policy attempted to identify spending patterns for orthopaedic surgeons across the United States. Their study—“Patterns of Costs and Spending Among Orthopedic Surgeons Across the United States: A National Survey”—was published online in The American Journal of Orthopedics.
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Measuring Up: What an Orthopaedic Group Should Expect in a Practice Manager/CEO
Jennifer A. O’Brien, MSOD On any given issue within a group practice—whether operational or organizational—it may be difficult for an individual physician partner to see the issue from any perspective other than his or her own. Older physicians sometimes don’t understand the younger physicians’ points of view and vice versa. Longtime practice competitors or rivalries may loom larger in some partners’ minds than in others.
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Five Financial Concepts to Understand
Tips from an AAOS Practice Management Primer Finance isn’t a required course for medical school or residency. But understanding financial concepts is important for orthopaedic surgeons to succeed in private practice. Even orthopaedic surgeons who practice in academic medical centers, hospitals, or groups large enough to hire financial managers need to understand some basic financial concepts so they can make informed decisions.
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Jack of Orthopaedic Surgery, Master of Business
I know a physician with four degrees who says that the physician with only two degrees is an impaired physician. Although this may not be an accurate assessment, it does raise the question: “How useful are advanced degrees outside of medicine to orthopaedic surgeons in their daily practices?” In my opinion, having an advanced degree in business is very valuable.
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How Much Do Your Employees Cost?
An employee benefits analysis can be beneficial Barbara Sack, MHSA, CMPE, and Debra L. Mitchell, RN, BSN, MBA Knowing and understanding the total cost of an employee to the practice is vitally important both to the practice executive and to the physician owners. Just as important is ensuring that employees understand the value of their full compensation package. Many employees simply assume that their cost to the practice equals their gross paycheck.
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Don’t Let Sprain and Strain Drain Your Brain
Sprains and strains are common injuries in orthopaedic patients. Knowing how to describe these injuries with the correct ICD-10-CM code will be very important when October 2015 rolls around. In ICD-9, sprain and strain codes are found in the same category range (840–848).
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Ignoring Potential HIPAA Violations Is Risky Business
When was the last time your practice performed a security and risk assessment (SRA)? If you don’t know, ask your practice executive. If your practice executive doesn’t know, chances are you need to conduct one—and soon. An estimated one third of solo and group medical practices have not conducted an SRA, which puts them at risk for substantial fines. You don’t want to be among them.
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Understanding the Implications of MACRA
On April 28, 2015, a piece of legislation often referred to as the "SGR repeal law" was signed. This bill, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently eliminated the Sustainable Growth Rate (SGR) formula. More importantly, the law made significant changes to the way Medicare will pay physicians and accelerates a shift to value-base payments. These changes will have a lasting impact on all healthcare providers, including orthopaedic surgeons.
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The Intersection Between Telemedicine and the Corporate Practice of Medicine Doctrine
Advances in technology have led to increased access to health care, as well as differing approaches and new questions concerning medical licensure requirements across state lines. The impact can be seen in areas such as the provision of remote healthcare services to patients located outside of a physician’s home state.
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Making the Most of PAs and NPs
Physician assistants and nurse practitioners add value, quality The number of physician assistants (PAs) and nurse practitioners (NPs) working in medical practices has grown substantially. According to a recent survey conducted by Jackson Healthcare, a healthcare staffing firm, nearly one-third of physician respondents say they have increased their use of advanced practice professionals, including PAs.
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Ethical Issues in Domestic Medical Tourism
The evolution of medical care and the philosophy underlying physician reimbursements have brought new ideas and forces to bear on the delivery of health care in 2015. As healthcare insurers and payers search for alternatives to the traditional fee-for-service model and pursue the goal of “value” in health care, they take into consideration various models of care.
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Apply Now for the LFP
The Leadership Fellows Program (LFP) offers an exciting opportunity available to all AAOS Fellows who are age 45 and younger by January 31, 2016. The LFP is a 1-year program that begins at the AAOS Annual Meeting. The program’s goal is to facilitate the development of future AAOS leaders from younger members who have previous volunteer or leadership experience. The LFP combines didactic and experiential leadership training with an ongoing mentoring program.
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Not Yet Ready for Stage 2 Meaningful Use?
No one said that achieving meaningful use of electronic health records (EHR) would be easy. But few believed it would be as difficult and complicated as it’s become. Recognizing this, the Centers for Medicare & Medicaid Services (CMS) has established a hardship exception. It’s not an “out,” but it does allow providers more time to meet the meaningful use requirements. Payment adjustments to Medicare-eligible professionals (EPs) began on January 1, 2015.
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Which Credit Cards Should Your Practice Accept?
New AAOS member benefit gives you added flexibility Jerry Winkelmann Four major payment card brands currently dominate the U.S. market: Visa, MasterCard, Discover, and American Express. Is it necessary for your practice to accept all four? If you want to help ensure patient satisfaction, payment assurance, and practice efficiency, the answer is yes. The rationale is simple. Patients want to be able to pay for your services their way.
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Pearls and Nuggets for ICD-10
The following bits and pieces of useful information for coders and physicians deserve discussion and definition. "Specificity" in diagnosis coding is the ultimate goal. To achieve the highest specificity, particularly as it pertains to acute injuries, thorough and complete documentation is absolutely necessary. Do not use"Unspecified Codes" or"NOS (Not Otherwise Specified)" simply because they are not"specific."
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How Meaningful Is Meaningful Use?
The successful adoption and implementation of electronic health records (EHRs) has, since 2011, been measured by the attainment of “meaningful use (MU),” a series of staged requirements established by the Centers for Medicare and Medicaid Services (CMS). During the first 4 years of the program, more than 350,000 eligible providers registered, and more than $7 billion in bonus payments has been paid out. Beginning in 2016, penalties will be assessed.
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Commonly Asked Coding Questions
Physician members and staff attending AAOS-sponsored coding workshops frequently have questions that cannot be addressed in a course, or that surface after they return to the office. This month’s coding column addresses several questions that have been received after a coding workshop. In most cases, the question involves differences between the way Medicare and private payers use the American Medical Association’s (AMA) Current Procedural Terminology (CPT) codes.
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ICD-10 Coding for Nontraumatic (Acquired) Spine Diagnoses
Since the introduction of the International Classification of Diseases, 10th Edition (ICD-10), several questions have been asked about coding for diagnoses as related to acquired (atraumatic) disorders of the spine. This article covers a few of the most common scenarios. Documentation specificity Q: I understand that many spinal conditions have greater anatomic differentiation under ICD-10. Do I really need to use this increased specificity in documentation and diagnosis coding?
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Is a Practice Merger in Your Future?
Statistics show dramatic trends in the acquisition of medical practices by hospitals, the creation of large practice organizations, and the disappearance of the individual practitioner. For example, in 2014, only 35 percent of physicians described themselves as independent practice owners, according to a study by the Physicians Foundation. Just 6 years earlier, 62 percent of physicians identified themselves as independent practice owners.
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Decreasing Variation in Clinical Practice
The current "cost crisis" in health care has resulted in greater emphasis on increasing value in healthcare delivery, particularly in orthopaedics. As orthopaedic practitioners, we are best positioned to streamline musculoskeletal care and to guide changes in practice. Among the many tools that can be used to increase the value of orthopaedic care are Standardized Clinical Assessment and Management Plans (SCAMPs).
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Going After Orthopaedic Aftercare
The provision of orthopaedic aftercare falls into two categories, which are addressed differently under the International Classification of Diseases, 10th revision (ICD-10). One category of aftercare uses codes beginning with the letter "Z"; the other category of aftercare uses the 7th character extension.
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Save with new group purchasing arrangement
In today’s economy, the most effective way for an orthopaedic surgeon to increase profits is to trim costs. Large groups may be able to negotiate supplier arrangements that provide them with reduced costs, but smaller practices and solo practitioners may find it difficult to achieve such economies of scale.
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P4P: Participation now may pay off later
Meeting quality indicators may eventually affect your financial success How do you feel about pay-for-performance (P4P)? Regardless of your answer, it’s very important that you realize the growing influence of P4P and understand what P4P may require of you in the future. A panel of experts discussed these and other issues at the 2007 BONES Society Annual Conference.
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AAOS updates coding resources for 2008
Coding requirements continue to change and AAOS is keeping pace. All AAOS coding products have been completely updated for 2008 to help you stay current and maximize your reimbursements. Hundreds of code and cross-reference changes for 2008 are covered. CTP Coding Guide The Orthopaedic CPT Coding Guide explains the five levels of evaluation and management (E&M) codes, and includes practical coding scenarios to help you understand coding changes and code to the highest specificity.
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Opting out of Medicare: Is it for you?
Reimbursement isn’t the only issue to consider when making the decision to opt out. With an anticipated 10 percent reduction in Medicare physician payments next year, many orthopaedic surgeons may wonder if this will be their last year of participation in the Medicare program. Speaking at the 38th Annual Conference of the BONES Society, Jayme R.
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Hiring a PA? Here’s how to get paid
Primer on third-party reimbursement for medical services provided by Pas Medicare coverage for PAs The first Medicare coverage for physician assistant services was authorized by the Rural Health Clinic Services Act in 1977. Over the next 20 years, Congress incrementally expanded Medicare Part B payment for PA services by authorizing coverage in hospitals, nursing facilities, and rural health professional shortage areas, and for first assisting at surgery.
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Staffing certifications: What they mean and why they are important
Are you a DO or an MD? An FACS, an FAAOS, or both? And what difference does it make? You know that the letters after your name add a particular cachet to your professionalism, particularly now when consumers are being encouraged to ask questions about fellowship training and board certification when selecting a physician. But did you realize that the same holds true for your office staff? Clinical staff credentials apply to physician assistants and nurses.
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The aging surgeon: How old is too old?
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.
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Support builds ‘bridge over troubled waters’ during lawsuits
Two orthopaedic surgeons who have navigated their own rugged seas offer help to others “I can distinctly remember the sheriff’s deputy walking into my office and serving me with papers. I had no idea what it meant at the time,” says Glen Shapiro, MD. “I had nearly 10 years in practice and I had never been sued before. It was a huge shock.”
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Improve your practice income with audio consults
From maximizing income and minimizing expenses to selecting an EMR or digital radiograph system, Practice Management Consults help you with “the business side of medicine.” Most medical schools don’t cover the business side of medicine. But to succeed in today’s economic environment, orthopaedic surgeons must know more than just the proper approach to a surgical technique. That’s why the AAOS introduced the Practice Management Consults series last year.
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Three perspectives on expert witness testimony
Physician, defendant’s attorney, and plaintiff’s attorney offer advice It could have been your mother up on the stage, admonishing you to “dress neatly, be polite and respectful, and don’t lose your temper.” Instead, J. Kent Mathewson, JD, Christopher T. Hurley, JD, and Charles Carroll IV, MD, were providing the advice during Instructional Course Lecture 105 at the 2008 Annual Meeting.
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Thoughts on shedding light on the dark side
Progressive hospitals are now developing orthopaedic subspecialty service lines as “destination centers of superior performance.” These subspecialty service lines may focus on total joint replacement, spine, or trauma, and are led by physicians. In 1995, I became a service line leader (part-time position) in joints, spine, and the operating room. As usual in many hospitals, tensions and issues of trust existed between administration and physicians.
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Improved communications reduce litigation
LEADing the way to more effective communication skills Can improved communications with your patients reduce the prospect of a medical liability lawsuit? The simple answer is “yes.” The difficulty lies in putting effective communication skills to use. This article discusses the LEAD (Listen, Empower, Advise, and Define) technique to more effective communication. Each step serves as a building block to more effective communication.
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Mcare debate keeps physicians in limbo
Uncertainty over program could threaten patient access to care More than 900 orthopaedic surgeons in Pennsylvania may have to wait until spring to learn what their total medical liability insurance bill will be for 2008. Gov. Edward G. Rendell and the Pennsylvania General Assembly are trying to work out differences on whether or not the state Mcare Fund, which assists doctors with medical liability insurance bills, should also help patients without healthcare insurance.
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4 years, 2 vendors, 1 success story
Implementing PACS at the Iowa Orthopaedic Center The Iowa Orthopaedic Center (IOC), a geographically diverse orthopaedic practice of 24 physicians with seven locations throughout central Iowa, first acquired a picture archiving and communication system (PACS) in 2003. Although only a few vendors offered the technology at the time, we believed that a PACS could save physician and staff time, while reducing overhead through higher efficiency and less handling of films.
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It’s time to digitize your archives
Control costs, increase profits by eliminating paper records The practice of orthopaedic surgery is far more complex today than when I finished my residency. I work in a private practice setting with a group of other solo practitioners, and we have a cost-sharing arrangement. When I joined the practice, many established practices were just beginning to understand how computer technology could help them become more cost efficient and profitable.
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Additional modifier changes for 2008
Last month, we reviewed the changes for modifiers 22, 25, and 76 that went into effect in 2008. This month, we’ll examine the changes for modifiers 51, 58, 59, and 78. Modifiers are used to indicate that a service or procedure has been altered by some specific circumstance, but has not changed in its definition or code, or to indicate a special circumstance when reporting a service.
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Take advantage of practice management primers
Has your practice made the switch to electronic medical records (EMR) yet? Are you investigating picture archiving and communication systems (PACS)? Before you make any decisions, check out the free online primers, prepared by the AAOS Practice Management Committee. EMR Primer The EMR Primer debuted at the 2007 Annual Meeting.
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Modifier changes for 2008
A modifier is a 2-digit code appended to a Current Procedural Terminology (CPT) code to indicate that a service or procedure has been altered by some specific circumstance, but has not changed in its definition or code. Exceptions to the 2-digit code are the anesthesia modifiers and the use of Healthcare Common Procedure Coding System (HCPCS) modifiers for toes and fingers. In 2008, some modifiers were changed. This column will cover the changes for modifiers 22, 25, and 76.
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You can’t afford to miss this opportunity
Why attend the Practice Management Symposium for Practicing Orthopaedic Surgeons? I have been in solo practice for more than 20 years. I spent years learning, developing, and honing the skills necessary to provide outstanding orthopaedic care to my patients. Like every other AAOS fellow, I am under constant attack by a third-party “army” of insurers, adjusters, and the U.S. government (Medicare/Medicaid), whose sole mission seems to be finding ways to pay me less for the work I do.
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Physician extenders: PAs, NPs, and…athletic trainers?
Athletic trainers moving from the sidelines to the doctor’s office These days, you’re just as likely to find an athletic trainer (AT) in an orthopaedic exam room—taking a patient’s history or applying a cast—as in a sweaty locker room. With a growing number of orthopaedic surgeons seeking to enhance their practices through physician extenders, certified athletic trainers are stepping up to the plate.
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What can I do about my medical liability insurance?
Five steps to reducing your current premiums Even if you haven’t considered alternatives to your current medical liability policy, hundreds of other physicians have moved well beyond the consideration stage. According to a 2005 article in The Wall Street Journal (“Doctors’ Creed: Insure Thyself,” Aug. 17, 2005), the size of the alternative medical liability market is between $9 billion and $18 billion—out of a total market of $30 billion in premiums.
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“Red Flag” enforcement begins May 1
Will your practice be in compliance? Last fall, the Federal Trade Commission (FTC) delayed enforcement of the “Identity Theft Red Flag Rule” (the Rule) from November 1, 2008, until May 1, 2009, to give industries and professionals—such as physicians and other healthcare providers—who were unaware of their responsibilities time to comply. That deadline is just days away, and compliance is mandatory.
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Are you an E&M outlier?
Benchmarking yourself can show variations in practice patterns No orthopaedic practice wants to become the subject of a billing audit by the Office of the Inspector General (OIG) or a Medicare Recovery Audit Contractor (RAC).
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Tips for holding effective practice meetings
Is your orthopaedic group spending more time at meetings and accomplishing less? These six tips can shift the balance. Schedule carefully The larger the group, the more important it is to schedule meetings far in advance. Hold meetings on different days or times so that no one doctor is regularly inconvenienced (or unable to attend) due to office, surgery, or call schedules.
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Contracting: Beyond the basics—II
More contract terms you should know In today’s economic climate, an awareness of the options available to physicians—as well as a willingness to negotiate—is key in executing acceptable physician contracts with insurance carriers. Last month, I reviewed several contract terms and provisions that practice managers and physicians should know as they review insurance carrier physician contracts.
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The business of orthopaedics takes center stage
AAOS Board focuses on practice management AAOS First Vice-President Joseph D. Zuckerman, MD, opened the December 2008 Board workshop on practice management by saying, “Education is the Academy’s primary mission, but that mission has to be integrated with member needs. And members realize that practice management is an important—and often overlooked—aspect of their education.” Orthopaedic surgeons “in the trenches” Panelists Thomas J. Grogan, MD (solo); Charles E.
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How long must we wait?
By Kevin G. Shea, MD; Kevin Scanlan, JD; and Charles Mehlman, DO, MPH The impact of interstate variability of the statute of limitations for medical liability Medical liability continues to be a major issue for patients, physicians, and healthcare providers in the United States. Any attempt at healthcare reform should consider the impact that medical liability has upon healthcare access and costs.
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How to conduct an operational assessment
An operational assessment is a detailed review of all or selected aspects of a medical practice (Table 1). Whether your practices uses an outside consultant or conducts its own internal assessment, whether you are planning a comprehensive assessment or a more focused one, you’ll need to collect data, conduct analyses, and prepare reports. The following information should help guide you through the process.
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Tort reform and the Collateral Source Rule
In the legal world, it’s said that “the fastest way to a mistrial is to mention the word ‘insurance’ in front of the jury.” The saying references the Collateral Source Rule, a central part of American personal injury law since the Civil War. Originally, the Collateral Source Rule was created to prevent a defendant from benefitting from the plaintiff’s receipt of money from other sources, which was triggered by the defendant’s wrongdoing or tort.
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E-prescribing: An easy way to earn bonus payments
Bonus payments, no penalties make learning easier Beginning this year, AAOS members who e-prescribe can potentially earn a 2 percent bonus payment from the Centers for Medicare & Medicaid Services (CMS), in addition to any Physician Quality Reporting Initiative (PQRI) bonus. The e-prescribing bonus drops to 1 percent in 2011 and 2012, and to 0.5 percent in 2013. After that, the penalties kick in.
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Key trends for orthopaedic medical liability claims
One third of claims are settled with payment According to the Physician Insurers Association of America (PIAA), the average indemnity payment in medical liability lawsuits involving orthopaedic surgeons rose by 13 percent from 2003 to 2008, from approximately $233,000 to $270,000. Of the 28 specialties tracked by the PIAA, orthopaedic surgery has the seventh highest average indemnity (Fig. 1). Of the 2,284 paid claims reported to PIAA in 2008, 195 (8.
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Don’t simply reduce overhead…manage it!
Labor costs are key in managing overhead You’ve no doubt heard that “If you increase your medical revenue by $1.00, you make $0.50 after overhead. If you reduce your expenses by $1.00, you get $1.00.” The logic is appealing, but misleading. The adage would be true if your practice only existed for a single moment. The $1.00 you save is saved once. The $0.50 you earn is earned over and over again. For this reason overhead should be managed, not necessarily reduced.
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The physician as employee: Pros and cons
Are the scales tipping in favor of salaried providers? These are troubling times for medical professionals. With wholesale changes in the U.S. healthcare system almost inevitable, it seems that providers—the true buyers of healthcare services and the largest beneficiary group in the current system—will eventually be targeted in any effort to control costs. The eventual dismantling of a system that rewards physicians for ordering more tests and doing more surgery seems unavoidable.
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Changing practice trends require flexibility
Preparation and clear thinking are keys to survival The next few years are likely to see major changes in the practice of orthopaedic surgery, and physicians who are unprepared may find themselves on the back side of unfavorable trends, according to panelists at the 2010 Practice Management Symposium for Practicing Orthopaedic Surgeons. Moderated by Michael Q. Freehill, MD, the panel brought together surgeons from a variety of practice settings.
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Anatomy of an EMR contract
Make sure these areas are covered to your satisfaction “I’m in the business of shifting risk,” attorney Steven M. Harris, Esq., told attendees at the recent AAOS Electronic Medical Records (EMR) and Other Technologies: Revolutionary Change in Orthopaedic Practice course. “The contract apportions risk between party one and party two.” Mr. Harris advised his audience to involve professionals—such as EMR consultants, technology advisors, and legal advisors—early on.
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Risk purchasing groups: Not so fast
Recently, AAOS Now featured the concept of risk purchasing groups (RPGs) as a potential member benefit for state orthopaedic societies. Both the New Jersey and Florida state orthopaedic societies have formed RPGs, and other orthopaedic societies are following their lead. I participated in an RPG for 6 years, dually as an insured physician and as the chairman and chief executive officer of COPIC, which insured the RPG. I thought it might be valuable to share my experiences.
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CBO revises assessment on impact of tort reform
Reform could reduce budget deficit by $54 billion over 10 years It seems that orthopaedic surgeons have found another friend in Congress—or at least in the Congressional Budget Office (CBO). Douglas W. Elmendorf, the director of the CBO, recently wrote to Rep. Bruce Braley (D-Iowa), explaining why the CBO revised its assessment of the effect that the medical liability crisis has on the economy.
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Informed consent: More than just a signature
Take advantage of the opportunity to build a relationship When asked to define informed consent, many orthopaedic surgeons may instead reply, “I’ll know it when I see it.” Despite the many articles on the issue, widespread misunderstanding of what constitutes informed consent and how to provide it still exists.
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Taking lessons from barbarians
The best-selling book Barbarians at the Gate: The Fall of RJR Nabisco, by Bryan Burrough and John Helyar, chronicles the ascent and demise of F. Ross Johnson, CEO of RJR Nabisco. It’s a fascinating read about the depths of human greed, with a most appropriate title. Orthopaedic surgeons in private practice are facing tumultuous times and are under siege, much like the citizens of Rome were. We struggle to balance declining reimbursements in the face of ever-increasing overhead costs.
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Is your EMR fueling risky record keeping?
By Cheryl L. Toth Customize templates to ensure accurate documentation If you’re evaluating electronic medical record (EMR) systems, or have recently implemented one, don’t be fooled into thinking that the risk of an audit disappears after going digital. In fact, EMRs may actually increase your risk of an audit—unless you use the system’s documentation features properly. Recent audits of orthopaedic practices reveal inaccurate descriptions of patients’ reports or physicians’ actions.
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Physicians as targets
By Michael J. Schoppmann, Esq. Insights, hard realities, and how to risk manage them Today, every physician must come to accept certain key insights and recognize certain hard realities. Consider the case of Dr. B, who was seeking privileges at a local hospital. First, he obtained and completed the medical staff credentialing application. One of the questions, standard to all credentialing applications, asked if he had ever been sued for medical malpractice. Dr.
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Patient safety and risk management
Kim, aged 3 years, lays asleep, waiting for a miracle. Outside her room, the nurses on the night shift pad softly through the half-lighted corridors, stopping to count breaths, take pulses, or check the intravenous pumps. In the morning, Kim will have her heart fixed.
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Workplace bad apples
A rotten attitude can undermine teamwork Does one bad apple spoil the whole barrel? Many times, yes, especially in a work environment where success relies upon interdependent activities among staff. So how do you identify a bad apple on your staff? Bad apples come in an assortment of varieties; following are descriptions of the most common. The crab apple The crab apple is always putting others down to raise her own status.
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Translational etiquette
Carry your golf-course manners to the office All golfers, whether beginners or experts, follow basic rules of etiquette on the golf course. This same code of conduct can be transferred to the physician’s office to maintain a productive and respectful work environment. The following tips will keep your office running smoothly. Replace your divots If you take the last of the supplies, inform the appropriate person what supply replacement needs to be ordered.
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A simple way to cut office expenses
The AAOS Group Purchasing Program, Powered by eSurg, can help According to the 2008 Orthopaedic Practice Benchmarking Survey conducted by the American Association of Orthopaedic Executives, the average orthopaedic surgeon spends nearly $34,000 for medical supplies. Supply expenses equal nearly 3 percent of an average office’s total collections.
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Divisional mergers
Consider this option for keeping your practice viable If you are an individual orthopaedist or in a small orthopaedic practice, you may be feeling that the professional and financial returns you are seeking are becoming more difficult to attain. Thus you may be thinking about how to grow your existing practice or whether to integrate your practice into a hospital-based organization or a multispecialty practice.
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Don’t let your EMR system put you at risk
Most medical practices are making the transition from paper to electronic records. Although electronic medical record (EMR) systems have many benefits, in some ways an EMR may actually increase the practice’s liability risk. Privacy, security, documentation, medication prescribing, and tracking test results are all potential problem areas. The following tips may help reduce these risks.
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You have been sued—Part 2
Tips for defendant doctors Negligence cases are won and lost on expert witness testimony. It gives the jury the scientific and factual basis for the “standard of care” and provides them with the information needed to determine whether that standard has been violated by an act of omission (something should have been done but wasn’t) or an act of commission (something should not have been done but was).
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EMRs: Confronting the challenge
By Menachem M. Meller, MD, PhD From note pads to I-pads—and back again Mention electronic medical records (EMR) at a medical staff meeting and the responses range from a smug sense of accomplishment to apprehension. Computerizing medical documents is no different in principle than computerizing grocery items. Some might ask, in a system as complex as health care, what took so long?
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AAOS Group Purchasing Program suspended
For 4 years, the AAOS has sponsored a group purchasing program for medical and surgical supplies, with nearly 1,000 practices participating in the program. On Nov. 29, 2010, however, the AAOS received word from eSurg Corporation, the entity that has had operational responsibility for the program, that the AAOS Group Purchasing Program is being discontinued. The AAOS agreement with eSurg expires on Dec. 31, 2010, and the program will cease operation at that time.
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Adding physical therapy to your practice
Physical therapy (PT) and occupational therapy (OT) are crucial to successful outcomes for patients with musculoskeletal problems, and many excellent reasons exist to develop in-house PT/OT. However, the success of physician-owned physical therapy services (POPTS) is not a foregone conclusion. There is an array of operational, financial and political pitfalls.
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About my error
No matter what happens, take accountability for your actions It feels like the ground has fallen from underneath your feet and your breath has been stolen—you’ve made a medical error. Is there any way to undo it? Turn back the clock, make amends, make it right? Did it really happen? In my case, it did—I released a carpal tunnel instead of a trigger finger. I’m not supposed to make a mistake.
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Death of an orthopaedic group
By Robert Garroway, MD, MBA How could a busy, six-surgeon orthopaedic practice that had been in business for more than 45 years simply fall apart over a 2-year period? Could the problems that undermined this practice have a similar impact on your practice?
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Taking care of ourselves to better care for our patients
Heeding the adage,“Physician, heal thyself,” is no mean task It seems that physicians are more frequently expressing the sentiment that their joy in the practice of medicine is vanishing. The pressures of practice, liability concerns, and increasing requirements and regulations are some contributory factors. How do we as physicians cope? How can we provide the best care for patients if we do not care for ourselves? We physicians are often reluctant to seek help.
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Get acquainted with social media
Before you jump into social media, first define your goals and determine how much time you’re willing to devote to keeping up your presence on the Web. Although many different types of social media are available, the most commonly used social media networks are Facebook, LinkedIn, and Twitter. Here is a brief introduction to them. Facebook With more than 750 million users, Facebook (www.facebook.com) is the most popular of all the social networking sites.
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You’ve been sued: Tips for defendant doctors
A lawsuit won’t go away—but here’s how you can deal with it You were out in the garage packing implants for a medical mission trip to Kenya when the deputy drove up to serve you with the complaint. (This actually happened.) Immediately, your entire world turned upside-down. The normal homeostasis of your life shattered. You can’t think, your mouth is dry, your palms are sweaty, and closing your eyes doesn’t make it any better.
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Worldwide trends in medical liability
By Thomas B. Fleeter, MD What can the United States learn from other countries? Defensive medicine and legal costs are believed to play a significant role in our country’s rising healthcare costs. Moreover, the current U.S. tort system is both cumbersome and expensive, while providing relief to relatively few patients who sustain injuries as the result of a medical error.
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Meaningful Use Incentives: The Money Is on the Table
Thomas C. Barber, MD A recent report indicated that more than 800 orthopaedic surgeons have successfully implemented a certified electronic medical record (EMR) program and obtained Stage 1 meaningful use incentive payments from the federal government. With more than 22,000 orthopaedic surgeons in the AAOS who could potentially qualify for those payments, that’s disappointing, but not surprising. If you have begun using an EMR, are you working to obtain Stage 1 incentive payments?
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Physician Stress and Burnout: Prevalence, Cause, and Effect
A nationwide, multispecialty survey of more than 2,000 physicians conducted by Physician Wellness Services and Cejka Search in late 2011 found that almost 87 percent of respondents felt moderately to severely stressed and burned out on an average day, and almost 63 percent admitted feeling more stressed and burned out now than they did 3 years ago.
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Six Steps to a Successful Group Practice Interview
After years of clinical training, many orthopaedic residents and fellows face an equally daunting task—finding the right job. Because job seekers may be focused on issues such as salary and location, they often give little thought to the interview itself. Fortunately, one of the easiest ways to help ensure success is for candidates to picture themselves on the other side of the table, according to Douglas W. Lundy, MD, vice president of Resurgens Orthopaedics, Atlanta.
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Tips for 5010 implementation
Under the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers are required to follow certain standards for electronic transactions, including claims submission, remittance advice, eligibility, claims status, and referral authorizations. On Jan. 1, 2012, these standards were upgraded to the 5010 version. To help AAOS members with the transition, Gateway EDI—our partner in the AAOS Revenue Management Program—has a “5010 FAQ & Tips” page on its website.
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CPT Code Update 2012—Part 1
This article provides a high-level overview of code changes for 2012. It is not meant to be an all-inclusive introduction to either the code changes or the guideline changes being introduced in 2012. The new CPT codes are indicated in the CPT book with a ; revised codes have a and guideline changes are found between sidelying triangles . A list of all additions, deletions, and revisions is found in the CPT codebook Appendix B.
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EHR Implementation: Meaningful Use Stage 2
The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 provided funds to reimburse physicians for the purchase and meaningful use of an electronic health record (EHR) system. Once the regulations were put in place, physicians and hospitals around the country began to purchase certified systems and make the transition from paper to electronic patient files.
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New Coding & Reimbursement Webpage
The AAOS has a new webpage dedicated to coding policy and reimbursement. Now you can browse through coding frequently asked questions, review previously published articles on coding issues, find information on various payment policies, and check for upcoming AAOS-sponsored coding courses. In conjunction with the new coding webpage, the AAOS is introducing a new coding inquiry service.
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Physicians, Patients Share Responsibility for Treatment
Years ago, a patient in his 50s walked into my office without a prior appointment. He complained of neck and arm pain that had resulted from a fall a few days earlier. It was obvious from observation that he had a neurologic impairment. My concern was the most consequential differential diagnosis of an unstable cervical spine and cord/root injury. I applied a soft collar and requested that the patient be transported by stretcher to the hospital next door.
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Is Your Practice Prepared for a Disaster?
Disasters, naturally occurring or otherwise, are things most of us don’t like to think about. However, when a medical practice is not adequately prepared, disasters can cause catastrophic damage resulting in a substantial loss of revenue. Physicians and practice administrators should develop a comprehensive response plan before a disaster occurs—because it’s the last thing that you’ll want to deal with during or after the event has taken place.
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AAOS Now Journal Clubs Underway
In the July issue of AAOS Now, Editor-in-Chief S. Terry Canale, MD, reported on the success of three trial programs using AAOS Now practice management articles in a journal club format. He also announced that the AAOS Now Editorial Board had received a $5,000 sponsorship from HCA (Healthcare Corporation of America) to help fund the first 10 residency programs that apply to conduct a journal club on practice management ($500 each).
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PAs and OPAs: What’s the Difference?
Many orthopaedic surgeons are unaware that, despite their similar-sounding names, physician assistants (PAs) and orthopaedic physician assistants (OPAs) are two distinct professions. Understanding the distinctions between PAs and OPAs, however, is important. PAs have broad medical training at accredited programs and work in all specialties, including orthopaedics. PAs are licensed in all states and are recognized by Medicare, Medicaid, and most commercial payers.
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Physician Stress and Burnout: Taking Care of Yourself
The August issue of AAOS Now included a report on the results of the Physician Stress and Burnout Survey conducted by Physician Wellness Services/Cejka Search. The findings are a wake-up call for both organizations and physicians on the importance of seriously addressing stress and burnout.
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Evaluate Employment Situations Carefully
During the 2013 Practice Management Symposium for Practicing Orthopaedic Surgeons, the question of hospital-employment of orthopaedic surgeons was a hot topic. In today’s healthcare market, many hospitals are seeking to employ orthopaedic surgeons, and many orthopaedic practices are facing financial challenges. But is making the switch worth it? According to faculty members Louis F. McIntyre, MD, Westchester Orthopaedics in White Plains, N.Y., and Ian J.
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Are You Prepared For the Future?
As orthopaedic surgeons, we are facing ever-increasing challenges to practicing medicine and managing our practices. We must learn to deal with many new problems, ranging from the establishment of new delivery systems to the introduction of new payment models. These changes can have a significant impact on how we practice orthopaedics as well as on our practice revenues.
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Bits and Tidbits
RAC prepayment reviews Current procedural terminology (CPT) codes 99205 and 99215 have been identified as among the top 15 codes for improper payment rates. National Government Services, a Medicare recovery audit contractor (RAC), plans to conduct service-specific prepayment reviews of CPT codes 99205 and 99215 for claims submitted to Jurisdiction 6 Part B for Illinois, Minnesota, and Wisconsin.
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OPAs and PAs: Past and Present Realities
Orthopaedic physician assistants (OPAs) and physician assistants (PAs) are two different professions despite having similar titles. To understand the use of the common title requires a brief review of the history of the professions. In 1967, the AAOS developed a board to review and accredit orthopaedic assistant programs in training individuals who could assist orthopaedic surgeons in managing patient care and assisting with fracture immobilization and surgery.
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Meaningful Use Stage 2—Don’t Stop Now!
Even though the federal government has delayed the implementation of Stage 2 meaningful use criteria until 2014, AAOS members should not relax efforts to incorporate electronic medical records (EMR) into their practices. It is important to continue pursuing the goals of the government’s electronic health records incentive program—namely, better, safer health care at lower costs. “Don’t stop now,” says Richard M. Dell, MD, a member of the AAOS Electronic Health Records Project Team.
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What You Need to Know about the HIPAA Omnibus Rule
On Jan. 25, 2013, the Department of Health and Human Services (HHS) published the “HIPAA Omnibus Rule,” a set of final regulations modifying the Health Insurance Portability and Accountability Act (HIPAA) Privacy, Security, and Enforcement Rules to implement various provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act.
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Asset Protection for Orthopaedic Surgeons
I frequently counsel physicians and other high net worth individuals who are facing substantial legal claims.
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Building an Organizational Culture
In “The Importance of Organizational Culture” (AAOS Now, February 2013), we discussed the results of a survey, conducted by Physician Wellness Services and Cejka Search, that focused on cultural attributes important to physicians’ overall satisfaction. A companion survey of hospital administrators helped to identify the gaps between these attributes and the physicians’ satisfaction with their organization’s focus on them.
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Informed Consent: A “New” Form of Medical Liability?
The notion of informed consent is actually quite old, dating back to medieval times. Italian, French, and Middle Eastern archives from as early as the 14th century describe pro corpore mortuoto, or “hold harmless documents,” aimed at absolving doctors from responsibility for untoward events in the course of treatment. This concept has evolved to the modern day concept of informed consent, in which physicians discuss the risks of procedures with patients and obtain signed consent forms.
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Help in Meeting New HIPAA Requirements
The AAOS Practice Management Committee has posted two new documents to help orthopaedic practices meet the new privacy and security regulations under the Health Insurance Portability and Accountability Act (HIPAA) that went into effect on Sept. 23, 2013. These final rules require all healthcare practitioners to change their notices of privacy practices and to implement new business agreements with business associates.
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Connecting With Patients Through Portals
Portals improve communication, care processes Howard Mevis Time—it’s your most valuable resource. One step you can take to increase efficiency and improve productivity is to establish a patient portal. Not only will a patient portal facilitate your ability to meet the goals established under Stage 2 Meaningful Use objectives, it will also save time, enhance productivity, and improve communications.
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How Data Sharing Can Influence Behavior in the OR
Ambulatory surgery centers (ASCs) have led the way toward an increased understanding of the true costs of surgical procedures and advanced efforts to minimize such costs. In the ASC environment, surgeons act on the data to decrease costs and increase revenue for the surgery center and its investors. Large hospitals and academic centers have been unable to match either the specificity of the data collection or the cost awareness among surgeons.
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Transitioning Out of Residency
Congratulations. You are a final-year orthopaedic resident and only a short time away from completing your residency and making “real money.” Not so fast, the real work is about to begin. Your job search is a job in and of itself. Are you prepared? According to Ryan Dopirak, MD, residents should ask potential employers lots of questions so they can critically evaluate orthopaedic practice opportunities.
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Groups Must Register for 2014 PQRS
Eligible professionals (EPs) who wish to participate in the 2014 Physician Quality Reporting System (PQRS) program as a group practice can now register for the group practice reporting option (GPRO) at https://portal.cms.gov The registration system is open until Sept. 30 for the 2014 PQRS program. Additional information about the 2014 GPRO registration is available on the CMS website.
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What You Should Know About Audits
The Centers for Medicare & Medicaid Services (CMS) has intensified its Medicare audit programs in various jurisdictions across the country. Three types of audits can occur: Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Zone Program Integrity Contractors (ZPIC) audits. Here are some key facts orthopaedic practices should understand about Medicare audits. Not all audits are the same Each of the three types of audits is looking at something different.
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Doing Too Much As a Leader Doesn’t Work
Being a leader can be extremely demanding, especially in a 24/7 culture that is increasingly on the go. Leaders, like most people, naturally react to increased demands by doing more. In fact, leaders do far too much. It turns out that leaders would be much more effective if they did less. Although doing nothing seems counterintuitive, it can, in the end, be remarkably effective, for several reasons.
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Hope for a National Good Samaritan Law?
In deciding whether or not to provide care in an emergency—such as those discussed in the article “On Call at 30,000 Feet” (AAOS Now, September 2013)—physicians will inevitably take into account concerns about potential liability. Although the Aviation Medical Assistance Act “and other Good Samaritan laws” (including those covered in this issue’s article on “Liability and Good Samaritan Laws,” page 34) provide some protection, the U.S.
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Recent Trends in State Medical Liability Reform
Currently, 31 states have legislation that places caps on noneconomic damages in medical liability lawsuits. Of these, six have caps on both economic and noneconomic damages. However, achieving tort reform on a state-by-state basis is both difficult and unpredictable. For example, although noneconomic damage caps have been upheld in 16 states, they have been overturned as unconstitutional in 12 states.
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The Growth Prescription
Twenty years ago, reimbursement changes and the introduction of managed care and capitated plans fostered fear and uncertainty among orthopaedic surgeons. However, once they were able to get past their fears of the unknown, many made decisions that had a significant impact on their future success. Orthopaedic surgeons became smarter and began to view their practices as professional services firms that provided clinical services instead of as medical clinics.
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The Ins and Outs of Tail Coverage
Most medical liability insurance policies are claims-made policies. This means that a physician is afforded coverage for claims made and reported while the policy is in force. In addition, the alleged act, error, or omission upon which the claim is based had to occur after the policy’s retroactive date, usually the inception date of the first claims-made policy purchased, as long as there has not been a gap in coverage. Tail coverage protects the physician going forward.
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HIPAA Highlights: What Orthopaedists Need to Know
Kathleen L. DeBruhl, JD, and Gilbert F. Ganucheau Jr, JD Most physician practices are familiar with their obligation to protect a patient’s protected health information (PHI) under the privacy and security standards of the Health Insurance Portability and Accountability Act (HIPAA). Recently adopted new rules have changed some of the old understandings and require the identification and modification of certain policies.
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Meaningful Use: Preparing for an Audit
CMS provides tips for practices Any provider who receives an electronic health record (EHR) incentive payment under either the Medicare or Medicaid EHR Incentive Program may be subject to a meaningful use audit. Medicare eligible professionals and dual-eligible hospitals will be audited both before and after incentive payments have been made. The following tips from the Centers for Medicare and Medicaid Services (CMS) can help orthopaedic practices prepare for a meaningful use audit.
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Solo Practice: Not Dead Yet
A roundtable discussion with orthopaedists who “go it alone” The future of the orthopaedic solo practitioner concerns Stuart J. Fischer, MD, a member of the AAOS Now editorial board who is himself in private practice in Summit, N.J. Recently, Dr. Fischer convened a virtual roundtable of the following private practitioners to discuss the issue: James W. Barber, MD, who is in private practice at Southeastern Orthopaedics in Douglas, Ga. Basil R.
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What Your Practice Says About You
Marketing can be defined as the business activities involved in moving goods from the producer to the consumer, which goes beyond selling, advertising, and promotion. When applied to medicine, marketing is a system of coordinated activities centered on the interchange between patients and a medical practice. If the practice is organized to ensure that the level of services delivered meet the expectations of patients’ needs and desires, the likelihood of success dramatically increases.
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Asset Protection 101: More Than Malpractice
Everyone understands the reason for frequent school fire and tornado drills as well as the importance of conducting a life boat drill before the ship even leaves port. Planning ahead for what to do in the event of an emergency can save lives as well as property. When it comes to asset protection, however, many physicians make only one plan—medical liability coverage—even though other circumstances are more likely to result in significant financial losses.
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FACS: What’s in It for Me?
The other day, I counted up how many dues-paying medical organizations I belong to and I came up with 12! That made me think about what I actually “get” from belonging to each of these organizations. I started to measure the value of my memberships. I think every orthopaedic surgeon would agree that AAOS membership is an excellent value, based on the education, advocacy, and quality efforts it undertakes on behalf of our profession.
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Medical Malpractice: Myth vs. Fact
The fear of medical malpractice lawsuits can have a negative impact on the delivery of health care in America. Physicians who fear being sued may avoid treating those they see as high-risk patients, which affects access to care. Or, they may engage in defensive medicine, which is the practice of ordering extra tests to avoid lawsuits.
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Practice Management in the Exhibit Hall
The AAOS Annual Meeting is a great place to improve your practice management skills and to learn how to make your practice more efficient and profitable. But did you know that in addition to the courses and symposia focused on practice management you could pick up practical skills from your peers on the Technical Exhibits floor?
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Unconventional Warfare: Fighting the New Tort Reform Battles
As health care changes, so does the perceived liability associated with its delivery. With these changes, plaintiff attorneys are adopting new strategies to obtain compensation for patients. The fight for caps on noneconomic damages and other traditional tort reform measures should not eclipse the need to adapt to the times.
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Meeting Meaningful Use: One Practice’s Experiences
Meeting the criteria required for Stage 2 of Meaningful Use (MU) isn’t easy—as our experience at Resurgens Orthopaedics, a multispecialty orthopaedic practice with 21 locations and more than 100 physicians, proves. Although Resurgens was an early adopter of electronic health record (EHR) technology and successfully attested for MU Stage 1, Stage 2 has been a significant challenge. (See “Meeting the Challenges of Meaningful Use Stage 2.”
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Domestic Medical Tourism: Coming to a Center Near You
Although medical “tourism” and itinerant surgery have been part of the medical profession since its inception, Domestic Medical Tourism (DMT) is becoming an increasingly common phenomenon. As a result, physicians and surgeons are faced with both practical and ethical considerations not previously encountered. In this two-part series, members of the AAOS Ethics Committee will outline some of these considerations, in the hope that they will be included in discussions on the topic.
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Don’t Count on ICD-10 Delay
Based on the results of a recent report by the Government Accounting Office (GAO) and a hearing by the House Energy and Commerce subcommittee on Health, physicians should not expect another delay in the requirement to implement the ICD-10 diagnostic coding system on Oct. 1, 2015.
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Digital Engagement for Physician Recruiting
With the explosive growth of digital media, an age-old tool for recruiting has been taken to a whole new level. Networking in today’s digital world offers a medical practice exponential reach beyond just its personal group of alumni and peers. It also enables the practice to build a strong employer brand and gain a competitive edge in the “war for talent” for a fraction of the cost.
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What You Should Know About the HIPAA Privacy Rule
Headlines about data breaches draw attention to the Health Insurance Portability and Accountability Act's (HIPAA) Security Rule. However, its companion—the HIPAA Privacy Rule—is just as important. Although the two rules work hand-in-hand, they are based on different concepts. The Security Rule oversees the mechanisms used to protect the privacy of electronic patient health information (ePHI), while the Privacy Rule focuses on the use and disclosure of that information.
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Hospital Dollars and ICD-10 Documentation
An increasing number of orthopaedic surgeons are employed by hospitals or academic institutions. If you are among them, understanding the connection between your hospital paycheck and the detail of your clinical documentation is critical. In fact, your future income may depend on it. Follow the (ICD-10) money Most hospital-employed physician income is based on work relative value units (wRVUs) multiplied by a conversion factor.
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Two Ways to Achieve Hospital-Physician Alignment
One of the aims of the Affordable Care Act was to increase alignment between doctors and hospitals. Alignment strategies such as accountable care organizations (ACOs), clinically integrated networks (CINs), medical homes, or bundled payment programs all encourage collaboration between doctors and hospitals, enabling more efficient and effective care.
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Taking the Pulse of Orthopaedic Medical Liability
On a regular basis, the American Association of Orthopaedic Surgeons' (AAOS) Medical Liability Committee surveys AAOS members on their medical liability insurance and their exposure to potential lawsuits. The 2015 Medical Liability Survey was conducted during October and November 2015. The 17-question survey was designed by the committee with the help of the AAOS department of research and scientific affairs. A total of 540 surveys were returned, for a response rate of nearly 20 percent.
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The Impact of ICD-10 Implementation
On Oct. 1, 2015, the 10th revision of the International Classification of Diseases (ICD) code set was implemented in the United States. This was the largest and most far-reaching change since the adoption of ICD-9 in 1979, and was anticipated to have a profound impact on medical practices. Two months after implementation (December 2015), KarenZupko & Associates, Inc. (KZA) conducted a survey to measure that impact.
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Category 1 CPT Coding Update 2016: Imaging Services
Changes made in the radiology section of Current Procedure Terminology (CPT) coding in 2016 may have an impact on orthopaedic practices, particularly with respect to the possibility of audits. Orthopaedists who submit billing and reporting for imaging services must meet the same standards as radiologists, including a comprehensive report. Twelve new CPT codes were added and several other changes were made to the radiology section (Table 1).
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Time to get moving on strategic planning
Like most orthopaedic surgeons, you probably take a hands-on approach to problems. You don’t mind getting into the thick of things and tackling difficult issues. But when it comes to strategic planning, you hesitate. After all, your revenues are acceptable and your practice is running smoothly. So why bother? The obvious answer is that developing a strategic plan is good for your bottom line and should be part of your practice’s governance framework.
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Are you saving with the AAOS Group Purchasing Program yet?
Collective buying power could save you 20 percent or more on supplies Ever since the American Association of Orthopaedic Surgeons (AAOS) Group Purchasing program, powered by Esurg Corporation, was rolled out at the 2007 Annual Meeting, AAOS members have been signing up and saving 20 percent or more on their medical/surgical, office, and pharmaceutical product needs.
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Punch up your presentations with graphics
Choosing the right visuals will ensure that audiences pay attention and remember your presentation. All graphics are not created equal—especially when it comes to your PowerPoint presentation. When used correctly, visual graphics can be extremely powerful—driving your point home better than any 20-minute lecture. But when they’re misused, graphics can create clutter in your presentation and distract the audience from your message. So how do you know if your visual is “good” or “bad?”
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Managing modifiers for surgical assistant services
Orthopaedic practices commonly question how to correctly code and bill for surgical assistant services for both physicians and nonphysician providers (NPPs). Although commercial rules for reporting surgical assistant services can and do vary markedly, the Medicare rules apply across the country and are quite clear. In addition, Current Procedural Terminology® (CPT) clearly defines relevant modifiers and their use.
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Organizations offering staff certification
National Commission on Certification of Physician Assistants—www.nccpa.net American Academy of Physician Assistants—www.aapa.org American Health Information Management Association—www.ahima.org American Academy of Professional Coders—www.aapc.com American College of Medical Practice Executives and Medical Group Management Association—www.mgma.com Professional Association of Healthcare Office Managers—www.pahcom.
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Contingency plan does not eliminate need for NPI
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?
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Pearls and pitfalls with proximal third tibial fractures
Seven suggestions for avoiding potential complications Last month (AAOS Now, September 2007), we discussed pearls and pitfalls in the treatment of tibial plateau fractures. This month, the focus is on proximal third tibial fractures, such as the one depicted in Figure 1. This fracture of the proximal tibial metadiaphysis had been nailed 6 months previously. The patient had obvious angulation of the leg, a limb-length discrepancy, and significant pain with ambulation.
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Informed consent: A process, not a piece of paper
Today, every surgeon has at least some familiarity with the concept of informed consent, and malpractice lawsuits based solely on lack of informed consent are relatively rare. Aspects of informed consent, however, may still cause confusion, so it is worthwhile revisiting this topic. Part of the problem is the term “consent,” which makes it sound like surgeons go out, drag people into their offices, and ask them for permission to perform surgery on them, to which they agree.
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AAOS/AMA to conduct Practice Information Study
For the first time in nearly a decade, the AAOS, the American Medical Association (AMA), and more than 70 other healthcare professional organizations have worked together to coordinate a comprehensive multispecialty survey of America’s physician practices.
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Read your medical liability insurance contract
By J. Michael Maxwell, MD, and Mark A. Tisdel You may end up with more questions than you had at the start I’ve often asked myself, “What can I do about my medical liability insurance?” I seem to have the same conversation with my office manager, my certified public accountant (CPA), and my attorney every year. At year-end, my medical liability insurance premium stands out like a basketball player at a women’s gymnastics meet.
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Identity theft: Could it happen in your office?
Under new regulations, medical practices must take steps to prevent identity theft The Federal Trade Commission (FTC) Red Flag Rules, which went into effect on November 1, 2008, are part of the government’s continuing efforts to curtail the rise in identity theft. The Red Flag Rules apply to “creditors”—including physicians—and provide guidance for establishing protocols to detect, prevent, and mitigate identity theft.
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Pick up your free PACS Primer
If you are thinking about moving to a picture archiving and communication system (PACS), be sure to stop by the Practice Management booth in Academy Row during the 2008 Annual Meeting and pick up your FREE copy of the PACS Primer, prepared by the AAOS Practice Management Committee and staff in the practice management group. If you cannot attend the Annual Meeting, you can download an electronic version of the Primer from the online Practice Management Center (www.aaos.org/pracman).
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Survey reveals extent, impact of medical liability problem
Orthopaedists paid premiums averaging $42,200 in 2006 In 2007, the AAOS Medical Liability Committee, along with the AAOS department of research and scientific affairs, surveyed a sample of the AAOS fellowship regarding a broad range of issues related to medical liability. We hoped to compare the results of this survey with those of previous surveys on this topic (conducted in 2002 and 2004), as well as to compare the medical liability situation for orthopaedic surgeons in various states.
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Arbitration: A promising method of alternative dispute resolution
Utah physicians have positive experiences Many Utah physicians are testing arbitration as an alternative method of resolving medical liability claims. Arbitration is a common method of dispute resolution used to mitigate the expense and time of wading through a court supervised liability suit. Most people readily, and sometimes unknowingly, consent to arbitration when signing contracts for rental cars, bank accounts, insurance policies, and loans.
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Invest wisely for a secure retirement
Understanding basic investment concepts and vehicles is helpful Recent news stories have focused on the failure of various investment vehicles, reinforcing the importance of having a personal understanding of risk and a trusted advisor. The most important investment concept is to “get started!” The earlier you begin to invest, the longer your money is working for you. Compound interest and dollar cost averaging can help increase the value of your retirement fund.
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Pearls and pitfalls: Fractures of the distal radius
Dealing successfully with difficult fractures Radius fractures are among the most common and most commonly treated fractures. Although Abraham Colles stated that after a radius fracture, full freedom of movement and function are restored—and that statement may be true for fractures in the very young or very old—fractures in the younger adult population can certainly be problematic. Distal radius fractures are often the result of high-energy impacts and falls and can be difficult to treat.
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What’s up with practice management?
According to Joseph D. Zuckerman, MD, AAOS first vice president, practice management support from the AAOS will be the “next best thing” and the focus of his term in office. He’s already taking steps to meet that goal. Practice management support from the AAOS is good and getting better. Online support The online Practice Management Center (www.aaos.org/pracman) now contains more than 150 articles and white papers on practice management–related topics.
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Settle or go to trial? Assessing a medical liability claim
A perspective from an insurance claims executive A medical liability lawsuit is a concern every practicing orthopaedic surgeon considers at one point or another. Whether the claim is warranted or not, the experience is universally distressing and takes precious time away from treating patients. Surprisingly, it is not necessarily just the facts surrounding the medical care that will ultimately determine whether a case is settled or defended through trial.
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Are you spending too much on supplies?
By Steven E. Fisher, MBA AAOS Group Purchasing Program announces new price reductions How much is your practice currently spending on medical, pharmaceutical, and office supplies? What if you could get those same supplies—but for even lower prices than you’re currently paying? Wouldn’t that be a boost for your bottom line?
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Coping with Medicare Advantage fee-for-service plans
By Steve Gillies and Sarah Gretch From enrollment to reimbursement: Tips you can use Medicare Advantage (MA) plans are second-generation “Medicare + Choice” plans, which were created under the Balanced Budget Act of 1997. This act gave Medicare beneficiaries the option to receive their Medicare benefits through private health insurance plans (Part C), instead of through the original Medicare plan (Parts A and B).
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It’s all about your livelihood
Practice management symposium focuses on the bottom line “The AAOS aims to have a positive impact on the quality of practice life,” said Joseph D. Zuckerman, MD, in his opening remarks at the Practice Management Symposium for Practicing Orthopaedists, held the day before the 2009 Annual Meeting. “No other effort could have a greater impact on more members.”
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Managing revenues—during a recession and after
How to improve your cash collections The recent economic downturn has several implications for orthopaedic surgeons. Generally, the health professions, including orthopaedic surgery, have been somewhat immune to variations in the business cycle. Recent information, however, points to a decreased rate of elective surgery. According to a report from the American Hospital Association (November 2008), one third of hospitals have seen a moderate to significant decrease in elective procedures.
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The anatomy of a lawsuit
A case study of the toll it takes The case involved a patient who, despite having 10 successful prior surgeries with no clotting, had massive clotting throughout his body following uncomplicated total knee replacement. Medical facts The patient, a 52-year-old man of normal stature and habitus, had a history of constant and increasing left knee pain that caused difficulty with walking, stair climbing, rising from a seated position, and sleeping.
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Planning a practice retreat
Retreats can be helpful—if planned properly A period of tremendous change is frequently the impetus to plan a practice retreat. It certainly was in the case of my practice, Orthopaedic Surgery Associates of Marquette (Mich.), PC. During the past few years, we had built a new office, replaced our chief operational officer of more than 30 years, hired two new partners, and attempted several joint ventures with hospitals.
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How does your practice measure up?
AAOE can help you “benchmark” against others Your six-physician orthopaedic group isn’t in serious financial trouble, but income has remained flat for a number of years. With declining reimbursements and soaring overhead costs, you’re really not surprised. Before you shrug your shoulders and return to the operating room, ask yourself: How does your practice performance match up with other practices in the region?
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Are you an “old coot” or a “young whippersnapper”?
Generational differences have workforce implications Clashes amongst different generations is nothing new. Parents and children fight the battles daily in households everywhere. It’s a part of growing up. As children grow into adulthood and find jobs, the battles may begin anew—not at home, but in the workplace. In an orthopaedic practice, the generational differences may be apparent not only among the physicians, but also between physician and staff members.
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Don’t trust your future to a coin flip
Online tool helps you find the right practice Are you just starting out in practice? Are you looking for a new professional challenge and practice? Or are you and the significant others in your life contemplating relocating for personal reasons? Whatever your reasons for looking for a new practice, the challenge will be finding one that meets your specific needs, meshes with your goals, and provides you with the benefits and challenges you want.
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Peer oversight of expert testimony
In many medical liability lawsuits, expert testimony is essential for jurors to understand the applicable standards of care. Historically, doctors who testified in court for or against the conduct of a peer alleged to have committed medical malpractice were given enormous deference by the U.S. legal system.
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Bullies, bad attitudes, and misbehaviors
Acting out is risky behavior for physicians and patients In 2006, a neurosurgeon in Oakland, Calif., allegedly became belligerent—verbally and physically abusive—when told that instruments brought in from another hospital needed to be sterilized before he could operate on a trauma patient. It took three deputies to restrain and arrest him. The patient was subsequently treated safely by another surgeon.
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Medical liability reform: Back on the table
President Obama, AAOS take steps in the right direction In his speech to Congress on health care on Sept. 9, 2009, President Barack Obama recognized that medical liability issues were leading to increasing healthcare costs. In this public forum, the president stated, “I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs.
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Save on resources, references for your practice
Looking for ideas on how to reduce patient cycle times? Planning to update your practice’s job descriptions? A new resource from the AAOS could help. The AAOS Practice Management Committee (PMC) is charged with helping members manage the business aspects of their practices.
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Reporting complications does not need to be complicated
Treating surgical complications can be difficult, but reporting them can be straightforward—particularly if you have a thorough understanding of modifier 78. The definition of modifier 78 is an “unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period.” The following example can provide a better understanding of how to use modifier 78. A dislocated THA Dr.
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New AAOS primer: Hospital employment
Has your local hospital asked you about full-time employment? Are you considering trading the hassles of an independent practice for the security of a hospital position? Before you make any decision, you’ll want to check out the new primer from the AAOS Health Care Systems Committee (HCSC), with input from the Practice Management Committee.
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Never say “never events”
Can we reframe them to support patient safety? Confusion persists about the conditions commonly referred to as “never events” and those deemed as “nonreimbursable serious hospital-acquired conditions” (HACs) by the Centers for Medicare & Medicaid Services (CMS).
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Medical liability insurance 101
Key criteria for selecting medical liability coverage Since 2002, COPIC—a physician-directed provider of medical liability insurance—has provided intensive, week-long risk management rotations for resident physicians. The purpose of these sessions is to give residents an appreciation for the “disease” of malpractice and an ability to recognize its causes and prevent its symptoms. More than 700 residents have taken the rotations to date.
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Punitive damages against physicians in the healthcare reform era
In the context of claims against healthcare providers, most states generally allow punitive damages only in cases involving gross misconduct, an egregious violation of the standard of care, or utter indifference to the well-being of the patient. The line between “mere negligence” and “malicious misconduct,” however, is often blurry. What are punitive damages?
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Electronic medical records: Liability is lurking
The two sides to using electronic medical records With more than 75,000 medical liability lawsuits filed annually, does the electronic medical record (EMR) provide physicians with some security against an action? It certainly can. But with new rules and regulations on protecting patient information, can an EMR put physicians at risk for additional liability? Almost certainly, yes. According to Douglas W.
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Get CME and a medical liability premium discount
ProMutual joins NORCAL in offering discounts The AAOS has long been involved in efforts to help lower medical liability premiums for members—from campaigns to institute tort reforms to studies designed to identify and reduce risk. Now, the AAOS is partnering with medical liability insurance companies to enable members to obtain rate reductions based on risk management and communication education.
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CMS approves three imaging accreditors
Medicare requirement takes effect in 2012 Orthopaedic surgeons have options for complying with upcoming accreditation requirements for advanced imaging after the Centers for Medicare and Medicaid Services (CMS) named three organizations, one of which has ties to the AAOS, as designated accrediting bodies.
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The apology dynamic
Meeting the needs of the offended party is key in making an apology During the past 15 years, public and private apologies have increased, as has the body of literature on the application of apologies in various aspects of life.
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The surgeon’s role in assisting defense counsel
By B. Sonny Bal, MD, JD, MBA, and Randy R. Cowherd, JD Odds are that you, an orthopaedic surgeon, will be served with a medical liability lawsuit at some time in your career. The legal proceedings begin when the patient files a complaint with the local court, making you the ‘defendant’ and an unwilling participant in an unfamiliar and possibly intimidating process. Shortly thereafter, your medical liability insurance carrier will identify a lawyer as your defense counsel.
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Giving back to your community
Orthopaedic charitable foundations can offer great benefits The formation of a 501(c)(3) tax-exempt private foundation is an interesting addition to an orthopaedic practice that can add value in several ways. For many orthopaedic surgeons, part of finding satisfaction in practice lies in giving back to the local community. Forming a foundation is a relatively simple and inexpensive process that can bring great benefits to orthopaedic practices.
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Saying sorry
Michigan project’s response when medical procedures go awry Rick Boothman still thinks about a malpractice case he won 30 years ago. Fresh out of law school, he represented a surgeon who had been sued by a former patient. “As the jury was filing out, the lady who sued my client leaned around the podium and I learned this was the first time she’d talked to him in three or four years,” he recalls. “She said, ‘If I’d known everything you said in the courtroom, I never would have sued you.
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Patient safety means patients first
Adverse events are more than just complications Although medical errors, adverse events, and complications have always been around, I, like most orthopaedic surgeons, had lumped them all into the category of complications—until I read Michael L. Millenson’s Demanding Medical Excellence: Doctors and Accountability in the Information Age.
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Manage risk by managing patient expectations
By Susan Keane Baker Creating reasonable expectations results in trust and confidence Managing expectations is a process of helping patients know how to be right and when to be satisfied. Managing expectations is creating structure and process with the outcome of patient trust and confidence in you and your team. Patients expect two types of value from their physicians: rational value and emotional value.
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Medical liability reform: Is alternative dispute resolution the answer?
The AAOS Position Statement on Medical Liability Reform outlines the challenges of the current medical liability system, and sets forth principles for reform, introducing them by stating, “The AAOS believes that broad reforms are necessary to compensate negligently injured patients promptly and equitably, enhance patient–physician communication, facilitate improvement of patient safety and quality of care, reduce defensive medicine and wasteful spending, decrease liability costs, and improve pat
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Compliance liability may be a greater risk than medical malpractice
Most orthopaedic surgeons are well aware of the risks of medical malpractice. But many of those same physicians view compliance regulations as more of a nuisance or hassle than a real concern. They may view hospital compliance officers as trying to make a demanding profession even more onerous and will put off taking mandatory online training modules.
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What risks? Whither management?
Risk management—in any field—attempts to identify and control hazards to prevent or minimize risks. Ideally, managing risk becomes part of an organization’s culture, with an emphasis on human factors and behavior. Secondary prevention Traditional risk management in medical tort liability has focused on defending claims. (See “The surgeon’s role in assisting defense counsel” and “Tips and pointers for depositions,” AAOS Now, November 2010.
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Four principles of “never events”
Phrase coined by The Leapfrog Group must become a reality Lewis Blackman, an energetic and promising 15-year-old from South Carolina, underwent surgery to correct a common congenital deformity in his chest. The surgery was successful, but during his postoperative care, Lewis experienced an adverse reaction to an anti-inflammatory drug. Despite pleadings from his mother and obvious signs of deterioration, Lewis’ caregivers did not change his medication.
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In-office pharmaceutical dispensing
Orthopaedic practice shares lessons learned A few years ago, our orthopaedic practice established an in-office pharmaceutical dispensing program for the convenience of our workers compensation patients. We had two goals: to improve medication compliance among patients, and to provide the practice with an additional ancillary revenue stream. With the help of an outside partner, we developed a program that allowed us to own and dispense the medication.
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Is a hospital alliance in your future?
According to AAOS census data, hospital employment of orthopaedic surgeons grew approximately 70 percent from 2004 to 2008. During the 2011 AAOS Annual Meeting, a symposium on hospital-based employment of orthopaedic surgeons, moderated by Kevin J. Bozic, MD, MBA, focused on this trend and its significance. In answering the question, “Is hospital-physician alignment here to stay or simply a passing fad?
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Communication matters
From reducing litigation to improving patient care, communication is key One of the two premises of the Communications Skills Mentoring Program (CSMP), a 4-hour seminar developed by the Academy under the guidance of John R. Tongue, MD, and S. Terry Canale, MD, is that communication matters. The other premise is that communication techniques can be learned. Why does communication matter?
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More victims than meet the eye
Patients are not the only victims in medical errors In November 1999 (the same month the Institute of Medicine released its famous report, To Err Is Human: Building a Safer Health System), at the age of 37, I was scheduled for a total ankle replacement surgery at a major medical facility in Boston.
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Health courts? Let’s think again
By George D. Dikeou, Esq. Although widely touted, health courts may not be the right answer The current method of resolving incidents of medical injury in the United States is widely recognized as flawed. A system of “fault finding” as a requirement for claims resolution does not advance quality improvement or patient safety.
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Your Most Difficult Patient: The One with Nothing Wrong
Patient A.B. has “never been the same” since her auto accident 9 years ago. While stopped at a red light, her SUV was hit from behind by a slow-moving small car. Although the SUV was equipped with high seat backs, Ms. A.B. was wearing her seat belt, and neither vehicle sustained significant damage, she has suffered from neck and thoracic spine pain ever since the accident. The constant pain, she said, is exacerbated by movement and prolonged sitting. Ms. A.B.
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Healthcare Texting in a HIPAA-Compliant Environment
Texting speeds communication but could put you at risk Andrew A. Brooks, MD I’m often amazed at how little healthcare communication has changed in the nearly 25 years since I was a medical student. The last great innovation was the introduction of the pager. In most hospitals, the communication process among physicians is arcane, inefficient, and potentially dangerous as it relates to patient care.
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2013 Orthopaedic-Related CPT Code Updates
The 2013 CPT Manual includes few new orthopaedic surgical CPT code changes, but many guideline changes. One clarification throughout the manual, especially in the E&M and Modifier sections, relates to the term “physician.” Not only medical doctors can use these codes and report these services; “other qualified healthcare professionals” such as physician assistants and nurse practitioners use the same codes. This article addresses key orthopaedic-related changes.
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Trends in Medical Liability Coverage for Orthopaedic Surgeons
Fellowship survey finds 92 percent of trial cases decided for defendant Douglas W. Lundy, MD, FACS The AAOS Medical Liability Committee recently fulfilled one of its charges by conducting the 2011 Professional Liability Insurance Survey. The committee regularly surveys the fellowship to ensure that the needs and perceptions of the membership are addressed. The last such survey was performed in 2006.
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You Be the Judge
Medical liability cases are based on state tort law. To prevail, a plaintiff must prove the following four elements: duty, breach of duty, causation, and damages. The questions of how and when “duty” is created may be problematic at times, as the illustrative court cases in this article indicate. When a physician agrees to become the treating doctor for a patient, a fiduciary duty is created between the physician and patient.
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EMR Compliance Depends on Good Practices
Authorship and accuracy are two keys to being compliant with electronic medical record (EMR) requirements according to Ranjan Sachdev, MD, MBA, CHC, an orthopaedic surgeon in private practice in Bethlehem, Pa., who is certified in Health Care Compliance. Speaking at the Practice Management Symposium for Practicing Orthopaedic Surgeons during the 2012 AAOS Annual Meeting, Dr. Sachdev outlined areas of compliance risk when using EMRs.
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The Benefits of Using Medical Scribes
Scribes have been used to document and record events for thousands of years. In modern medicine, the scribe’s function is to accompany the physician during a patient examination and document the visit in the patient’s medical chart. In orthopaedics, a scribe is ideally either a physician’s assistant, nurse, or a certified athletic trainer who already understands the specialty.
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AAOS Group Purchasing Program Returns
The AAOS is proud to announce the return of a Group Purchasing Program, designed to reduce your practice costs and improve inventory management. The new and improved Group Purchasing Program by MedAssets was introduced at the 2012 AAOS Annual Meeting and is already making a difference for several practices. Leverage the buying power of more than 90,000 physicians and other medical professionals already taking advantage of this program.
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Considering ICD-10 in Light of RAC Audits
Rachel V. Rose, JD, MBA, and Michael R. Linkins, MBA, CPC, CMPE The implementation of both the International Classification of Diseases, 10th Revision (ICD-10) coding and Recovery Audit Contractor (RAC) overpayment identification presents significant challenges for providers. Both initiatives rely on complete and accurate clinical documentation and can have a significant impact on the revenue cycle. The transition to ICD-10 Until recently, Oct. 1, 2013, was the date set for the U.S.
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When a Patient Leaves Against Medical Advice
The patient with a comminuted impacted distal radius fracture arrived at the emergency department (ED) inebriated, hostile, and angry. The ED physician hastily splints the wrist and sends the patient for radiographs. As the on-call orthopaedic surgeon, you are in the operating room, and it’s more than an hour before you can see the wrist-fracture patient. Despite your apology about the delay, the patient becomes more upset.
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A First Look At Meaningful Use Stage 2
On August 27, 2012, the Centers for Medicare & Medicaid Services (CMS) published the 672-page Final Rule that specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.
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Avoiding Complications in Arthroscopic Surgery
Not all medical complications result in litigation. According to an AAOS member survey, postoperative complications that resulted in litigation included deep vein thrombosis (DVT), infection, or persistent pain following knee arthroscopy. Technical errors, including implant failures and nerve injury, were also common causes of litigation.
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The Orthopaedic Surgicalist: A New Paradigm
In the early 1990s, physicians had no experience with the term “hospitalist.” Now, more than 20 years later, it is a familiar title for physicians who provide in-hospital acute care. Before the hospitalist model, primary care physicians would perform that function when their patients were admitted to a hospital. But this was often problematic.
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Aligning Physician and Hospital Goals through Gainsharing
As health systems and providers adapt to evolving regulations and post-reform challenges, opportunities to develop greater alignment have become a major driver in the healthcare industry—providing better patient outcomes, improving system-wide efficiency, and reducing the cost of care.
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Watch What You Say About Others
A recent malpractice case highlighted an increasingly common mistake that physicians are making: badmouthing other physicians. In this case, a knee replacement patient, who had had several previous knee surgeries, experienced postoperative stiffness. Prior to consenting for manipulation under anesthesia, the patient visited another orthopaedic surgeon for a second opinion.
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Planning Your Life—And Your Life Insurance
Life insurance helps protect the financial future of your family should something happen to you. But how do you decide when it’s the right time to purchase life insurance, and what factors should you consider when planning for coverage? This article reviews some of the life events that may trigger a need for life insurance or simply serve as a good time to evaluate your life insurance needs.
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An Orthopaedic Hospital Becomes Refuge in Hurricane
Hospitals pride themselves on being prepared for all sorts of emergencies. But not even the best-laid plans can ready an institution and its staff for an unprecedented event. That’s what Tisch Hospital at NYU Langone Medical Center faced when Hurricane Sandy forced unplanned evacuations after the facility lost power. “I’m not a dramatic guy,” said Joseph D. Zuckerman, MD, professor and chair of the department of orthopaedic surgery at NYU Langone.
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Good Governance and the Private Physician Group
Private group practices are at a crossroads due to the rapidly changing healthcare environment. Issues such as payment reform, capital investment, and technology are causing many private practice physicians to reevaluate their futures. For some, the future is in hospital employment and they will consider selling their practices. Those who choose to remain independent will face both obstacles and opportunities.
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The Average Return on “Marketing” Is Negative
Why does a profession that relies on research and data to correctly diagnose, treat, and manage patients so rarely use research and data to plan, execute, and grow the practice? Consider the following studies. The first study looked at market research for 137 orthopaedic practices over a 12-month period. Practices had from 3 to 38 doctors, in all practice settings from all regions of the country.
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How Helpful are Mobile Healthcare Apps?
The use of mobile technology to assist physicians and patients, recently dubbed “mHealth,” has firmly established its presence in hospitals and training programs nationwide. One of the most visible aspects of mHealth includes the use of mobile smartphones and tablets that run applications (apps) that can function as clinical examination tools, reference databases, technique guides, or medical calculators. The use of mobile apps for the treatment of disease is not without concern.
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Patient Confidentiality in the Age of Instant Communications
As physicians, we have both a legal and an ethical responsibility to protect the privacy of patient information. This covenant of confidentiality is necessary for our patients to feel comfortable in sharing the full range of their medical information. If we, as physicians, do not have access to the full range of our patients’ medical information, our ability to diagnose and treat would be compromised. Federal law prohibits unauthorized access to confidential medical data.
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Counting Down to ICD–10
The implementation date for shifting to the International Classification of Diseases, 10th edition (ICD–10) is less than a year away! If you have not begun planning for your office to make the switch on Oct. 1, 2014, you need to quickly establish and adhere to an accelerated timeline. Adopting the following schedule will help ensure that your office is ready to implement ICD–10 next year. Dec. 31, 2013—Complete your review of all practice systems that currently use ICD–9 coding.
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Asset Protection Planning for the Surgeon
Asset protection has emerged as a fundamental in financial planning for individuals with high net worth. Estate planning attorneys who fail to address this aspect do their clients a disservice. Even the most elegant estate planning documents are rendered meaningless if a surgeon has been sued and lost all of his or her estate assets prior to death.
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Get Ready for ICD-10
You have just over a year to get your practice ready to implement the International Classification of Diseases–10th edition (ICD-10) coding system. The change in the coding system affects your practice and all your interactions with those who require coding information. If you haven’t already, sign up today for the AAOS ICD-10 webinar series presented by the AAOS Practice Management and Coding, Coverage, and Reimbursement Committees.
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5 Simple Steps to Get Your ICD-10 Plan Started
It’s less than 8 months until the ICD-10 deadline on Oct. 1, 2014, but many providers are finding it difficult to get started with their planning to make the switch. Others have started their efforts, but may be overwhelmed by a transition of this magnitude and unsure of what their next steps should be. Whether you’re stuck in the middle of planning or still trying to get started, the following five steps can help make your ICD-10 plan more manageable.
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The Value of Physician Comanagement Agreements
A roundtable discussion on what comanagement means to orthopaedic surgeons New payment models and an increased emphasis on aligning hospitals and physicians have fostered growing interest in physician comanagement agreements. Under these agreements, which are usually between a hospital and a physician group, the focus is on a specific service line, as well as on improving quality and efficiency. Recently, two members of the AAOS Practice Management Committee—Nicholas V.
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How AAOE Can Help You Thrive
The American Association of Orthopaedic Executives (AAOE) is an organization of practice managers and administrators for orthopaedic surgeons and their affiliated services. Today’s members include independent physicians, group practices that went to one or a few hospitals to provide patient care, large multispecialty practices, and practices owned or service lines managed by health systems or hospitals. The adept practice administrator requires the latest in knowledge and skills.
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Navigating the Perfect Storm
The healthcare industry is undergoing significant transformation. The federal government and commercial payers are focused on reducing costs by shifting to a “value-based” reimbursement system in which the highest quality outcomes delivered at the lowest possible cost is the standard. As a result of the Affordable Care Act, patients will be changing their healthcare usage patterns based upon new insurance models being introduced.
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The Orthopaedic Surgeon and Care Coordination
Why should orthopaedists care about coordination of medical care? It is about teamwork which provides efficient and quality care for patients. It can keep referral sources happy and patients coming through the door. Care coordination can optimize patient outcomes with fewer return calls, office visits, or readmissions. For some specialized practices, the cost vs.
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Using Life Insurance for Estate Planning
Wanting the people we love to be taken care of—even if we aren’t physically there to do so—is a natural emotion. But achieving that goal requires planning ahead and evaluating all aspects of the situation. Life insurance may be one way to provide the necessary funds. But this requires taking taxes into consideration so that our loved ones can benefit from every dollar of the life insurance plan.
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Hit by an Alligator or Crushed by a Crocodile
External cause codes in the International Classification of Diseases, 10th Edition (ICD-10) have been the source of much hilarity—and considerable concern. After all, who would ever consider the need for a code to report the following incidents?
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Buy/Sell Agreements for Medical Practices
Nearly one in five AAOS members is in solo practice, according to the 2012 Orthopaedic Surgeon Census. More than half of AAOS members are part of a private group practice. And the average age of AAOS members is 55 years. Based on these statistics, many members may be wondering what will happen to the practice when a partner retires, becomes disabled, or dies? Some practices may already have strategies for acquiring a partner’s share and redistributing it or transferring it to a new partner.
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New Certification Program for Geriatric Fracture Care
Founded in 2012, the International Geriatric Fracture Society (IGFS) is a nonprofit, 501(c)6-designated organization whose mission is to be recognized as the foremost international authority for collaboration on the delivery of evidence-based, patient-centered care for the treatment of geriatric or fragility fractures.
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Easing the Transition From Residency into Practice
Eleven things you need to know Gail S. Chorney, MD, and Charles A. Goldfarb, MD Residency and fellowship training primarily focus on orthopaedic education. But to succeed, residents and fellows need to learn other aspects of running a practice (such as billing, coding, or compliance issues). The following 11 “need-to-know” items cover both general tips on running an effective practice and specific tips on coding and billing.
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Is It Professional Courtesy or Fraud?
In the past, it was common for physicians to give “courtesy discounts” to colleagues and others. But passage of the Health Insurance Portability and Accountability Act, HIPAA, in 1996 made these discounts potentially illegal, with significant civil monetary and criminal penalties. Not collecting deductible or coinsurance payments may have serious repercussions for a practice.
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The Impact of the ACA on Orthopaedic Practices
Since passage of the Affordable Care Act (ACA), many orthopaedic surgeons have expressed concern about its potential negative impact on their practices. One area that could affect orthopaedic practices is the mandate for large employers to provide health insurance coverage for their employees or risk being subject to significant tax penalties.
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Steps to Improve Front Desk Collections
Many patients today have increased deductibles and copayment amounts, which means that orthopaedic practices should pay more attention to front-desk collections procedures. If the front desk staff does not collect from the patient while the patient is still at the practice, the results will be less revenue, weaker cash flow, and more work. The key to improved front-desk collections is preparation. The following steps will help maximize results. 1.
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Orthopaedic Practice in the United States
What’s the most popular orthopaedic specialty? Is there a potential shortage of orthopaedic surgeons? How many orthopaedic surgeons are women? How fast is hospital employment of orthopaedic surgeons growing? These are the types of questions that reporters, researchers, and regulators ask. And the answers can be found in the Orthopaedic Practice in the United States (OPUS) Survey, also known as the AAOS Census Survey.
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Three Questions to Consider Before You Recruit a Surgeon
In private practice, the most important questions related to a new physician hire are often those posed before you ever meet a candidate. Too often medical groups overlook the pre-work required for a prudent and efficient physician recruiting process. To avoid this pitfall, thoroughly consider the answers to the following questions prior to beginning a physician search. Can your practice support an additional partner?
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Show Me the Money
Gail S. Chorney, MD Although not every orthopaedic surgeon needs to be an expert on the revenue cycle, it certainly helps to know a few basic concepts. The word “cycle” implies that the billing process may be just an endless circle with no payment in sight. However, if physicians and staff adhere to a few basic principles, it can be a straight line to the money. Where it all begins The revenue cycle begins when the patient calls the office to make an appointment.
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Maintaining a Successful Orthopaedic Practice in a Post-ACA World
As a group, orthopaedic surgeons repeatedly demonstrate a strong, focused, and independent (entrepreneurial) spirit. As a clinical discipline, orthopaedics historically has been one of the most profitable services for hospitals and health systems. With the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, however, the rules for maintaining a successful orthopaedic practice changed virtually overnight.
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Take the TEAM Approach to ICD-10 Implementation
CD-10 goes into effect on Oct. 1, 2015. To ensure that your practice is ready for the transition, take the TEAM approach! Test Contact software vendors and clearinghouses to make sure that they are ready for the transition. Inquire about testing and steps your practice needs to take to ensure successful claims submissions. This will help avoid any delays in reimbursement. Educate It is not too early to begin educating staff on ICD-10 coding.
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Improving Surgical Safety: Developing a Safety Culture and Checklist Usage
Despite multiple nationwide and global patient safety initiatives (Table 1), surgical and patient safety errors are still common and adverse event rates for surgical conditions remain unacceptably high. Some studies have shown that about one-half of hospital adverse events are associated with surgical procedures conducted in the operating room (OR).
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Physicians on Record—Without their Knowledge
Are your patients secretly recording their conversations with you? Today, nearly two thirds of Americans own smartphones that, with one touch, can easily and secretly record any conversation—including discussions between physicians and patients. It is unclear how often physician/patient interactions are being recorded—with or without the consent of the physician.
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A Look at Contemporary On-Call Compensation Arrangements
The prevalence of compensating physicians for on-call services has increased over the past several years. It is estimated that as many as 35 percent of all physicians receive some type of compensation for call-related activities and that three-quarters of physicians who provide on-call coverage receive some type of compensation. On-call pay ensures that hospital emergency departments have access to physicians who provide coverage.
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Mitigating Against Lawsuit Loss
As orthopaedic surgeons, we are likely to be sued at some point in our careers. Some of us have been sued already. Whatever our status, each of us as individuals—as well as our group practices—should have a proactive approach toward risk mitigation. We should also have appropriate strategies in place to handle patient problems that have the potential for becoming lawsuits.
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The Healthcare Value Equation
Orthopaedic surgeons are facing a multitude of challenges. Government mandates affecting payment structure, coding classification, and performance evaluation have changed the focus of practicing medicine.
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Dealing with Unexpected Medical Outcomes
The unexpected medical outcome is an issue that all physicians—regardless of specialty—will have to deal with at some point. When that circumstance arises, physicians must deal with it ethically. However, the medical liability laws that apply in the state of practice (or state where the incident occurred) may add to the stress of the situation and the difficulty of the communication.
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AAOS launches EMR educational initiative
How much do you—or your practice manager—know about electronic medical records (EMRs)? How comfortable would you feel interviewing an EMR vendor? Would you know what questions to ask? Which EMR system would be best for your practice…and could you afford it? To help you understand and make decisions about implementing EMRs in your practice, the AAOS Practice Management Committee has developed a major educational initiative on EMRs for 2007.
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Get ready now for National Action Week
Celebrate the Bone & Joint Decade, Oct. 12-20, with programs and materials from the AAOS and the USBJD “Starting out as an orthopaedic surgeon, I never thought of myself as a public speaker. But I have found myself in front of groups of 300 people talking about preventing and treating musculoskeletal conditions. I think this volunteer work is very important,” says Kimberly J. Templeton, MD, who chairs both the U.S.
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Five ways to put PSAs to work for you
If all you’ve ever done has been admire the AAOS public service announcements in airports, you’re missing out on a valuable resource. No doubt you’ve seen the large airport posters featuring public service announcements (PSAs) from the AAOS. The striking images—an elderly woman on a tightrope, a smashed all-terrain vehicle (ATV) in an emergency department, a woman with three knees—are hard to miss.
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Vicarious liability: “Let the master answer”
By Edward D. Shoulkin, JD, and Tamara J. Smith, JD Hospitals, medical practice groups, and other healthcare entities often find themselves named as defendants alongside physicians in lawsuits alleging physician malpractice. In many cases, the plaintiff patient claims that the physician was an “agent, servant, or employee” of the hospital or practice group, and the healthcare entity, therefore, should be held vicariously liable for the physician’s acts or omissions.
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Have you gotten your number yet?
National Provider Identifier is mandatory as of May 23, 2007 If you have not applied for your National Provider Identifier (NPI) yet, time is running out! As of May 23, 2007, healthcare providers who are defined as “covered entities” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) are required to use the NPI for all electronic healthcare-related “standard” transactions.
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Do the uninsured present a higher liability risk?
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.
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The emotional effects of medical errors on physicians
Physicians—particularly surgeons—hold themselves to high standards of excellence, reports the August 2007 issue of The Joint Commission Journal on Quality and Patient Safety. As a result, medical errors produce high levels of stress, anxiety, and sleep loss in most doctors, according to the results of a survey of more than 3,000 physicians in the United States and Canada.
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From the cockpit to the OR
Crew resource management: A model for orthopaedics? Human beings make mistakes, but systems play a role as well. Poorly designed systems frequently lead people to make errors or—at minimum—fail to prevent them. That was one of the conclusions of the 1999 Institute of Medicine report, To Err is Human: Building a Safer Health System, which raised awareness of the significant consequences of medical errors.
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Research Awards: Call for Papers
The AAOS is soliciting manuscripts for the 2009 Kappa Delta Awards and the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award: Up to three $20,000 Kappa Delta awards, one of which is designated for “Young Investigators,” and one $20,000 OREF award will be bestowed. Manuscripts should be original and written specifically for these awards.
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Legal trends in the evolution of medical risk
The adoption of EMRs and best practices is changing the scene Medical “risk” generally takes two related forms. The first is the physical risk to patients that medical treatment, therapy, surgery, or drugs will harm them or leave them in a worse position than when they started. This risk is referenced in the goal of any physician to “do no harm.” The second form of risk is financial and legal, and belongs to the healthcare provider. A patient who has been harmed may file a lawsuit.
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Introducing the 2009 CPT code updates
Reading the new Current Procedure Terminology (CPT®) 2009 can be a daunting challenge, but is necessary to ensure that you and your staff are aware of new and revised CPT codes and Guideline instructional changes. This article focuses on new CPT and HCPCS codes applicable to orthopaedics (exclusive of changes to the evaluation and management codes); you should review the entire CPT 2009 for changes that may affect your individual practice.
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Pearls and pitfalls: Arthroscopic rotator cuff repair
The goal of any arthroscopic surgical procedure is to reproduce what is done with its corresponding open procedure. Sometimes this simple tenet can be forgotten as we try to perform procedures in a minimally invasive manner. If the patient’s anatomy has not been adequately restored, however, the goal has not been attained, no matter how small the incision.
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Protecting your assets: Why medical liability insurance isn’t enough
Medical liability is a ubiquitous concern for orthopaedic surgeons. The prospect of a lawsuit brings well-justified fears of a prolonged, unpleasant, and costly judicial process that could result not only in professional stigma but also in financial ruin.1 Laws capping tort damages have been effective in some states, but in many states, political forces make the adoption of such limits unlikely.
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Orthopaedic liability: The plaintiff’s perspective
An Interview with a Personal Injury Lawyer Editor’s Note: One aspect of medical liability that frequently is not fully explored is the perspective of the plaintiff’s attorney. In the interests of closing the gap between the orthopaedic surgeon and the plaintiff, Paul Manner, MD, a member of the AAOS Medical Liability Committee, asked Elliot Budashewitz, a personal injury attorney, to comment on and respond to several questions and concerns.
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What is a preventable adverse event?
Current trends forecast double jeopardy for physicians and hospitals During the past decade, both the press and the government have increased scrutiny of imperfections in the healthcare system. In response, hospitals and physicians have implemented new systems and updated standards to reduce adverse events and/or medical errors.
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Avoid healthcare fraud by playing by the rules
Know what’s involved—and what you should avoid doing Federal and state governments are stepping up the pace and cracking down on healthcare fraud. Even more significantly, private citizens are joining in on the action—taking a percentage of the money judgments collected by state and federal governments. If accused, physicians may face hefty fines, the loss of their practice, public embarrassment, criminal indictments, and possibly a jail sentence.
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Nuts and bolts of e-prescribing
Government initiatives are encouraging adoption of eRX solutions Outside of surgical intervention, the physician’s most frequently used, efficacious, and potentially dangerous therapeutic tool is a prescription for medication. In 2007 alone, more than 4.5 billion prescriptions were written—literally.
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Coding for pediatric spine deformity procedures
By Mary LeGrand, RN, MA, CCS-P, CPC Coding for pediatric spine deformity procedures requires a clearly dictated operative note defining the components of the procedure as well as the roles of the co-surgeon or assistant surgeon. This can best be seen by applying key coding concepts to several pediatric surgical case scenarios. Note: In all cases, the 2008 relative value units (RVUs) shown are calculated without Geographic Practice Cost Index or Budget Neutrality adjustments.
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Unity showing dividends in Florida
Last spring, the Florida Orthopaedic Society (FOS) and the Bones Society of Florida (BSOF) embarked on an ambitious plan to create one of the largest risk purchasing groups for medical liability insurance in the nation. Today, the purchasing group is operational and has drastically altered the medical liability marketplace in the state. Risk purchasing groups (RPGs) are recognized on both the state and federal level.
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Two heads are better than one
Practice management course puts physicians, managers “on the same page” During the current economic downturn, it’s more important than ever that physicians understand the business aspects of practice management. And because the Economic Stimulus Act of 2009 includes incentives for physicians to adopt electronic medical records (EMRs), it’s also important that orthopaedic practices know how to tap into those funds.
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OKO helps bridge the education gap
The clock is ticking on fulfilling year-end CME requirements Are you scrambling to satisfy year-end continuing medical education (CME) credit requirements? Orthopaedic Knowledge Online (OKO) can help by providing access to more than 80 peer-reviewed activities and 165 CME credits directly from your computer. Recognized as the go-to source for online orthopaedic CME, OKO is the convenient way to earn credits from the comfort of your home or office.
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The more you use EMR, the more you benefit
After implementation, it just gets better! Many essays, conferences, and instructional course lectures have been given on selecting and implementing an electronic medical record (EMR) system for your orthopaedic office. By now, many practices are using fully integrated EMRs; the next wave of learning is the continued refinement of EMR use in years 2 through 5 after implementation. E-prescribing When EMRs were first introduced, e-prescribing was considered an advanced use.
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Can’t we put an end to wrong-site surgeries?
Patient safety processes require your commitment to work “Dr. Washington,” a prominent Denver orthopaedic surgeon, recently performed an anterior cruciate ligament (ACL) repair on the right knee of a University of Denver football player. Initially, however, he opened the patient’s left knee. He quickly realized his error, closed the incision, and proceeded to perform a successful ACL repair on the correct (right) knee. After a difficult discussion with the player’s family, Dr.
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Psst! Have I got a deal for you!
Physician-owned medical device companies are enforcement nightmares The current financial crisis reminds us that investment opportunities that seem too good to be true inevitably end badly. The proliferation of physician-owned companies (POCs) as intermediaries in the medical device supply chain seems destined to teach that same hard lesson.
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The faintest ink beats the strongest memory
Document the medical record appropriately—for your own and your patient’s benefit An old Chinese proverb says that “the faintest ink is more powerful than the strongest memory.” This adage has great applicability when discussing the best ways to document medical care. Liability experts estimate that 35 percent to 40 percent of suits alleging malpractice are indefensible because of problems with medical records.
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Patient expectations: How do they matter?
By S. Jay Jayasankar, MD Unrealistic expectations are preventable triggers for claims A patient’s disappointment with an unexpected turn of events or outcome is a key driver for medical liability claims, even though only a small fraction of claims involve a compensable injury or are decided in the plaintiff’s favor.
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Purchasing alliance pays off in New Jersey
Program helps orthopaedic surgeons reduce medical liability insurance costs In September 2008, after 5 months of negotiation and legal preparation, the New Jersey Orthopaedic Society/Orthopaedic Surgeons of New Jersey (NJOS/OSNJ) launched a medical liability insurance risk purchasing group. As a result, New Jersey orthopaedic surgeons who are members of the purchasing alliance received discounts of 7.5 percent (spine surgeons) to 12.5 percent (nonspine surgeons).
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Teaching residents system-based practices
Now it is easier than ever for orthopaedic residency programs to fulfill the Accreditation Council for Graduate Medical Education (ACGME) requirement for systems-based practice (SBP), while residents learn important practice management concepts and skills. The Resident Practice Management Lecture Series (RPMLS) includes eight audio-slide lectures presented by orthopaedic surgeons, practice management consultants, and Academy staff experts in orthopaedic practice management.
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The legal terminator
Life without Lawyers: Liberating Americans from too much law By Philip K. Howard W.W. Norton & Co., New York, N.Y When I picked up Life Without Lawyers: Liberating Americans from too much law by Philip K. Howard, my first thought was, “What about Neal and Walter?” Neal is our practice group’s corporate counsel, and Walter is my first cousin, a merger-acquisition attorney.
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Is your office ‘completely connected’?
Transition may be challenging but moving forward is imperative According to Thomas J. Grogan, MD, there’s more to running a successful orthopaedic practice than following sound business principles and providing cost-effective care. Using technology to modernize the practice is another key piece of the puzzle. Transitioning to EMRs Every day, said Dr.
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What went wrong here?
By Jeff Varnell, MD, FACS Analyzing a medical liability claim Editor’s Note: Articles labeled Orthopaedic Risk Manager are presented by the Medical Liability Committee under the direction of contributing editor S. Jay Jayasankar, MD. Articles are provided for general information and are not legal advice; for legal advice, consult a qualified professional. E-mail your comments to feedback-orm@aaos.org or contact this issue’s contributors directly.
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You be the jury
The judge overturned the jury verdict—would you? Imagine going through a 5-year long medical liability lawsuit and trial. The jury finds in your favor, but the plaintiff asks for a new trial. Six months later, the judge grants the request and sets aside the previous verdict. Members of the AAOS Medical Liability Committee want to know what you would do. The online version of this article includes voting buttons and an opportunity for your comments.
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Building the case for checklists
Remaking the “to do” list for patient safety The Checklist Manifesto: How to get things right by Atul Gawande, MD. Metropolitan Books, Henry Holt and Company, LLC, New York, 2009, 209 pages. ISBN: 978-0-8050-9174-8 Many surgeons have noted a recent change in protocol at their hospitals from the relatively simple preoperative “time out” to the seemingly more burdensome World Health Organization (WHO) Surgical Safety Checklist.
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Show staff you care
Inexpensive “thanks” provide a big return A recent post to the American Association of Orthopaedic Executives’ list serve reads: “I have a physician who has a difficult time showing staff appreciation and doesn’t want to spend money to do it. He believes that if you tell someone they’re valuable, they’ll ask for more money. This philosophy is affecting morale.”
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Liability issues with physician extenders
Don’t let a valuable asset turn into a liability Efficient orthopaedic practices make use of the skills of physician extenders (PEs). Most commonly, these mid-level providers include physician assistants (PAs) and nurse practitioners (NPs). Although these skilled providers can effectively allow you to better serve patients, it is important to recognize that you, as the physician, are ultimately responsible for the care provided in your name.
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Tribunal system works in Massachusetts
An effective approach to decreasing frivolous lawsuits The Massachusetts Medical Malpractice Tribunal (MMT) system attempts to screen out nonmeritorious lawsuits and reduce the number of frivolous medical malpractice cases.
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Tips and pointers for depositions
By B. Sonny Bal, MD, JD, MBA, and Randy R. Cowherd, JD As the defendant physician in a medical malpractice litigation, you should know that your deposition is critical in planning and executing a successful defense. Jurors are often shown a videotape of your deposition before you make your in-person testimony. This article offers some practical tips and pointers to help you prepare for deposition.
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MOC: Improving quality and safety
Maintenance of Certification (MOC) is a process that assures the public of physician expertise and ongoing competence in medical specialties by establishing standards for physician education, testing, and performance. The MOC Program, established by the American Board of Medical Specialties (ABMS) seeks to amplify the benefits of recertification in promoting physician performance improvement and educational update.
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In Memoriam
Edwin K. Fennell, MD June 9, 2010 Columbia, S.C. Herbert A. Haupt, MD April 2010 Saint Louis Harris H. Kanel, MD June 3, 2010 San Mateo, Calif. William J. Medlicott, MD Dec. 21, 2008 Port Townsend, Wash. A. J. Schoepflin, MD 2007 Ada, Okla. Paul S. Shurnas, MD July 4, 2010 Columbia, Mo.
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The law and the “disruptive physician”
By: Michael J. Schoppmann, Esq. The American Medical Association (AMA), through its Council on Ethical and Judicial Affairs, supports the designation of “disruptive physician” as a potential disciplinary mechanism. It has defined two distinct forms of physician behaviors (inappropriate and disruptive) upon which such actions can be based.
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Addressing the medical liability crisis
AHRQ grants provide for liability alternatives Despite the efforts of the American Association of Orthopaedic Surgeons (AAOS) and many other medical specialty societies, the healthcare reform bill of 2010 does not directly address medical liability tort reform. During debates prior to the passage of the bill, President Obama admitted that defensive medicine may contribute to unnecessary costs.
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Evolving standards of professionalism
From “expert witness” to “expert opinion and testimony” Effective May 12, 2010, a revised set of AAOS Standards of Professionalism (SOP) apply to all expert opinions provided by AAOS fellows and members. The amended and renamed SOP for Orthopaedic Expert Opinion and Testimony replaces and amplifies the original SOP for Orthopaedic Expert Witness Testimony and requires all AAOS fellows and members who serve as expert witnesses to comply with these minimum standards of acceptable conduct.
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Update on “never events”
Recent legal proceedings relieve fears of “strict liability” with never events When the Centers for Medicare & Medicaid Services (CMS) initiated its project on “never events,” few imagined that it would lead to increased risk exposure for physicians.
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What to say when things go wrong
Despite our best intentions, medical care does not always deliver the results that we anticipate. Unanticipated outcomes may result from potential complications, such as postoperative deep vein thrombosis or infection. Explicit errors, such as use of a wrong-size joint implant or a wrong-side surgery, also result in adverse outcomes.
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What does it take to make our practices safe?
Invisible elements include personal awareness, leadership, and decision-making skills As orthopaedic surgeons, we are constantly honing our professional knowledge and skills; we, our practice staff, and our hospital teams are increasingly patient safety conscious. How, then, does patient safety elude us? Mindfulness These foundational ‘safety blocks’ need to be held together by practice skills that make up the ‘invisible mortar.’ A seminal element of this mortar is our mindfulness.
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Owning up to medical error
It was the end-of-the month morbidity and mortality (M&M) conference. The resident had just finished presenting his case: a 31-year-old male admitted to the emergency department (ED) in diabetic ketoacidosis (DKA). Because no intensive care unit (ICU) bed was available, and the ED was overflowing, the team titrated down the insulin drip quickly so they could get a floor bed for the patient.
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Hiring the right people
Recruiting and hiring administrative and clinical employees for a medical practice is not easy; there are never any guarantees that a person hired for a job will work out in the long term. All too frequently, though, employees in orthopaedic offices who are responsible for hiring staff fail to follow a protocol. Following a protocol reduces the likelihood of a bad hire and improves the likelihood of a good one.
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When Patients Refuse Treatment
Is it negligence if the patient elects not to “follow doctor’s orders”? E. Burke Giblin, Esq., and Christina M. Scarpa, Esq. A common theory of negligence raised against physicians, including orthopaedic surgeons, is the doctrine of informed consent. That a doctor has a duty to explain, in terms understandable to the patient, what he or she intends to do before a patient begins a course of treatment is well known.
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Favoring the Injured Limb: Perspectives on Workers’ Compensation
According to the AAOS 2010 report on Orthopaedic Practice in the United States, most orthopaedic surgeons in private practice have four major sources of income—private payers, Medicare, self pay, and workers’ compensation. For the practitioners who responded to the survey, workers’ compensation accounted for between 11 percent and 15 percent of their total compensation.
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Medical Liability and Orthopaedic Residents
A civil suit seeking monetary compensation for medical negligence is based on the four elements of duty, breach of duty, causation, and damages. Failure to prove any of these will lead to dismissal of a case. But what happens when a patient is treated by a resident physician and never actually sees the attending physician supervising the resident? Does the attending physician have a duty toward the patient whom he or she has never met?
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Be Mindful of the Autopilot
As a pilot as well as an orthopaedic surgeon, I am familiar with the parallels frequently drawn between the two professions. A recent string of airline crashes attributed to the pilot’s loss of control raised concerns that pilots have, to some extent, lost experience in manual piloting and become less able to cope effectively if the autopilot disengages. The use of the autopilot is so universal in commercial airliners that the pilot flies the plane manually for just a few minutes of each flight.
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How Safe Is Your Office?
When you consider “office safety,” what comes to mind? Do you think only of clean walkways and locked drug cabinets? Do you believe that simply meeting the defined safety requirements under the Health Insurance Portability and Accountability Act (HIPAA) or the Occupational Safety and Health Act (OSHA) is sufficient? If so, perhaps you need to broaden your thinking a bit.
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More Steps to Improve Practice Efficiency
Last month, I reviewed several ways to improve practice efficiency in the areas of facilities, equipment, and information technology. This article will deal with efficiencies in the areas of staffing, processes, and physician work habits. Staffing Costs related to employee salaries and benefits are usually the largest ongoing, nonprovider cost in an orthopaedic clinic.
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10 Tips for Effective Appointment Scheduling
A structured appointment scheduling system can go a long way toward improving revenue and increasing patient satisfaction in a medical practice. The article, “Don’t Drown: Ride the (Modified) Wave!” in last month’s issue of AAOS Now explained the modified wave approach to scheduling patients as an alternative to the steady stream and the pure wave methods.
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FDA Regulatory Status and Informed Consent
The doctrine of informed consent is familiar to orthopaedic surgeons who invoke the underlying principles to counsel patients prior to surgery. The basic requirement that a patient must consent to a procedure was established in 1914, in the case of Schloendorff v. Society of New York Hospital. The New York Court of Appeals ruled that absent consent, a surgeon who performs an operation is liable for a medical battery.
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No-Fault Compensation Systems
Most patients injured in medicine are not eligible for compensation, a fact often lost in discussions of medical liability tort reform. Only patients whose injuries were caused by negligence on the part of the physician or other healthcare provider can seek compensation. Most injuries in medicine, however, are due to either system errors or nonnegligent reasons.
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The Hidden Cost of “Tail” Insurance
Thomas B. Fleeter, MD Medical liability insurance policies come in two forms—claims-made and occurrence coverage. Understanding the difference between them is critical to ensuring that you have adequate protection in the event of a medical liability lawsuit. A claims-made insurance policy covers costs related to a lawsuit, provided that both the incident and the filing of the claim occur while you are insured under the policy.
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Can I Have a Refill on My Percocet?
Most orthopaedic surgeons dread this type of request, particularly from patients who are beyond the normal timeframe for significant postoperative pain medications. They are concerned not only about engendering dependency when prescribing pain medication, but also with the medical and legal ramifications of prescribing opioid medications. Orthopaedic surgeons may wonder, “Can I be sued for not giving enough pain meds? Can I be prosecuted for giving too many pain meds?
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ICD-10-CM: It Is NOT All That Bad
The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)—You’ve heard of it and, so far, what you’ve heard has you scared. Thousands of new codes, some of them sounding absolutely absurd. But believe me, ICD-10-CM is not the beast that some writers and publications make it out to be. It is manageable, and you can rest assured that you will NEVER use all those codes.
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What to Do When Your Claim’s Denied
Private payers are increasingly denying payment for CPT code 29826—arthroscopic subacromial decompression—when it is reported with open shoulder procedures.
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In Memoriam
Frederick L. Behling, MD July 10, 2013 Portola Vally, Calif. Mordecai E. Berkowitz, MD July 7, 2013 Gloucester, Mass. Kenneth R. Duff, MD Jan. 28, 2010 New Braunfels, Texas Arnold M. Illman, MD Sept. 20, 2013 Massapequa, N.Y. Perry D. Inhofe, MD Nov. 10, 2013 Tulsa, Okla. Thomas A. Koenig, MD Aug. 23, 2013 Northport, N.Y. J. Howard Ritchie, MD July 2013 Lethbridge, Alberta, Canada Harold F. Shuster, MD 2004 Bozman, Md. E.
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The Importance of Organizational Culture
Physician engagement is critical to effectively address the changes in health care, and organizational culture is central to physicians’ sense of engagement and overall satisfaction. For employed physicians—especially those who previously worked in smaller medical groups or solo practices—organizational culture becomes even more significant due to the differences in areas such as accountability, autonomy, work environment, and modes of communication.
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The Future of Liability Reform
Last October, the American College of Surgeons (ACS) held its first Medical Liability Reform Summit to evaluate the future of medical liability in the United States. The consensus was that future medical liability reforms need to focus on improving patient safety to reduce malpractice claims and their associated costs. Although increases in medical liability rates have slowed, the future of these rates is uncertain.
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Is a Clinical Comanagement Agreement Right for Your Practice?
The main reason that orthopaedic surgeons are turning to hospital and health system employment is uncertainty about healthcare reform, according to John Fink, senior manager at ECG Management Consultants.
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Solving Conflicts without Litigation
Alternative dispute resolution (ADR) refers to a collection of nonlitigation means of resolving conflicts. Interest in ADR for medical liability has been fueled by the enormous cost and inefficiency of litigation as the primary means of resolving disputes. According to estimates from the U.S. Department of Health and Human Services, between $76 billion and $122 billion is spent per year on medical liability litigation, and yet plaintiffs receive less than 1 percent of this amount.
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The “Persistent” Locality Rule
The concept of standard of care is familiar to physicians who have been participants in medical negligence cases as defendants or expert witnesses. Trial testimony relating to deviation from, and compliance with, the applicable standard of care is often key in determining whether medical negligence occurred.
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Do You Know About the AAOS Member Insurance Program?
According to the American Medical Association’s 2013 Report on U.S. Physician’s Financial Preparedness, nearly half of the physicians surveyed were “somewhat” or “very” concerned about the amount of life insurance they own. Nearly 6 out of 10 physicians were “somewhat” or “very” concerned about the amount of disability insurance they own. And nearly 70 percent don’t have long-term care insurance.
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Private Practices Still Going Strong
AMA survey shows 60 percent of physicians in physician-owned practices Although recent reports give the impression that hospital employment of physicians may soon result in the disappearance of the private-practice model, a 2012 survey by the American Medical Association (AMA) seems to indicate otherwise. Nearly 15,000 physicians were asked to participate in the survey, and 3,466 (28 percent) completed it.
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Are You Ready for the New HIPAA Regulations?
New regulations under the Health Insurance Portability and Accountability Act (HIPAA) go into effect on Sept. 23. This final set of rules requires all healthcare practitioners to change their notice of privacy privileges, policies and procedures, and business associates agreements. Notice of privacy practices Under the new regulations, patients must be able to opt out of fundraising communications.
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New Models of Healthcare Delivery in a Private Practice Model
Maintaining and improving current revenue levels is one of the most important issues facing orthopaedic surgeons. During the Practice Management Symposium for Practicing Orthopaedic Surgeons held in New Orleans last month, Craig R. Mahoney, MD, of Iowa Ortho, presented several concepts for privately owned practices to consider when working within the new healthcare payment models. According to Dr.
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Could Your Practice Pass a HIPAA Audit?
The Health Insurance Portability and Accountability Act (HIPAA) requires hospitals, physician practices, and other healthcare entities to safeguard the privacy of patient health information (PHI). The Office of Civil Rights (OCR) in the Department of Health and Human Services audits HIPAA compliance and is expected to begin a permanent random HIPAA audit program in late 2014 or 2015.
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Making the Case for Guidelines in Workers’ Compensation
The push for evidence-based guidelines in workers’ compensation is understandable. Workers’ compensation is one of the few areas of medicine in which healthcare protocols are not well scripted in advance of patient encounters. In addition, patients have no responsibility for payments such as deductibles and copayments. That leaves employers liable for 100 percent of all reasonable and required medical care. But who decides what treatment is reasonable and required?
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Bringing Cost of Care to the Forefront
One of the biggest challenges to healthcare, now and in the future, will be monitoring and controlling costs. This provides a unique challenge for practitioners, because historically, physicians have not placed adequate emphasis on overall patient cost of care. The reasons for this lack of cost consideration are multifactorial and include social, political, ethical, and legal considerations.
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Caring for the Professional Athlete
Team physicians representing professional sports organizations face a complex set of challenges relating to medical liability, litigation, and external pressures. Their patient population includes high-profile athletes performing for big business. Every patient comes with a coach, teammates, management, and fans—and each has an agenda. Every medical decision could potentially end up at the center of media scrutiny.
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Rethink Your ICD-10 Implementation Strategy
On March 31, 2014, Congress passed H.R. 4302, the “Protecting Access to Medicare Act of 2014.” In addition to establishing a 1-year patch under the sustainable growth rate Medicare physician payment, the bill also delayed the implementation date for converting to the International Classification of Diseases, 10th edition (ICD-10) for 1 year, to Oct. 1, 2015.
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Last Chance to Get Ready for ICD-10
Orthopaedic surgeons have less than 6 months to ready their practices for the change from using the International Classification of Diseases, 9th edition (ICD-9) to ICD-10. The federal government may have delayed implementation of many parts of the Affordable Care Act, but it is not going to delay implementation of ICD-10. Beginning Oct. 1, 2014, orthopaedic practices will be required to use ICD-10 diagnosis coding.
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How Well Do You Compare?
Each year, Medscape, a part of the WebMD Health Professional Network, conducts a compensation study using a third-party online survey collection site. During the period Dec. 11, 2013, through Jan. 24, 2014, more than 24,000 physicians—including 722 orthopaedists—responded to questions about their compensation, number of hours worked, practice changes resulting from healthcare reform, and adaptations to the new healthcare environment.
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Managing Your Online Reputation
“Online reputation management is becoming more important in our lives as orthopaedic surgeons,” Basil R. Besh, MD, told attendees at the Board of Councilors Board of Specialty Societies Fall Meeting. “My online reputation is vital to the success and the future of my practice.” Dr. Besh, a hand surgeon in private practice in Fremont, Calif., explained that an online presence is potentially unsettling.
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Benchmarking PT Programs
Benchmarking is a process that enables businesses, including medical practices, to measure their products and services against their peers. Benchmarks can help an orthopaedic practice determine whether its physical therapy (PT) program is operating at an optimal level, what functions need to be improved, and how to approach improvement efforts.
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Predicting the Fate of Solo, Small Practices
As solo and small orthopaedic practices face an increasing number of challenges, many physicians are being forced to reevaluate their careers. According to a recent survey, young physicians are more than 30 times likely to choose hospital employment over solo practice. Only 1 percent of medical residents in their final year say they want their own solo practices. This does not bode well for the future of solo and small orthopaedic practices.
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Labor Management—A Balancing Act
Busy orthopaedic surgeons depend on their support staff. The trust and loyalty between a surgeon and staff member that develop over time are integral to the success or failure of the practice. Physician/staff partnerships can span decades and are often characterized by an extraordinary level of mutual loyalty and respect. As a result of these strong working partnerships, however, some medical assistants or surgical secretaries may feel superior to their peers.
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Understanding Your Employment Contract
By definition, contracts are agreements between two or more parties that describe, in writing, the agreement of certain business terms. When physicians negotiate employment contracts, they usually focus on certain items like compensation, bonuses, or on-call arrangements. But even when verbal agreements have been reached on these issues, a physician may be surprised when these terms—and multiple others never discussed—appear in the written contract.
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Bundled Payment Models Facilitate Specialist Independence
The Medicare Bundled Payment for Care Improvement (BPCI) program creates unique opportunities for specialists to reduce both government and patient costs while potentially increasing surgeon revenue per inpatient Medicare case.
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Talking With Patients After an Adverse Event
Knowing what to say and how to say it is crucial Poor communication between the physician and the patient is a root cause leading to filing a medical liability lawsuit. Recently, Thomas Fleeter, MD, and Robert Slater, MD, of the AAOS Medical Liability Committee, spoke with Lee McMullin, CPHRM, about how to talk to patients after an adverse event. Mr.
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Orthopaedic Coding Q & A
It’s time to test your knowledge! Before you read the answers to the following questions, ask yourself what you would do. Then check your response against the answer. Excision of osteophytes with revision TKR Q. The new joint reconstructive surgeon performed his first revision total knee replacement (TKR). He dictated that he removed several osteophytes and he wondered what Current Procedural Terminology (CPT) code to use to report this work.
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Employment Contracts for Orthopaedic Surgeons
John Gramer With rising hospital employment of physicians, unfolding reform policies, and tightening reimbursement, medical practices need actionable data that practice managers and surgeons can use to help find, create, and promote more beneficial practice opportunities. A survey conducted by Cejka Search reflects how orthopaedic surgeons feel about hospital employment, including their expectations of benefits, incentives, and contract terms.
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Medical Assistants from a Medicolegal Perspective
The economic pressures of modern medical practice often make it desirable to employ various physician “extenders” who can assist physicians in dealing with their many patients. However, along with the economic and logistical upsides can come significant liability risks that must be managed. Medical assistants (MAs) pose a particular risk because although they are frequently the “link” between patient and physician, they have the least medical training and knowledge.
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How Do Practices Split Expenses for Overhead?
AAOE survey findings Recently, the American Association of Orthopaedic Executives (AAOE) surveyed members about how offices split overhead and revenue. According to Jerald T. Forrester, MBA, FACMPE, president and CEO of Steindler Orthopedic Clinic, in Iowa City, the results were “not surprising.” In his summary of the results, Mr. Forrester noted that the one-day online survey drew 101 respondents, primarily from groups with 10 or fewer physicians.
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“Fit to a T” program promotes bone health
Do you have an hour to help community members understand the importance of being “Fit to a T”? Not only is the United States Bone and Joint Decade’s (USBJD) National Action Week (Oct. 12-20) just around the corner, but National Osteoporosis Day is Oct. 20. The “Fit to a T” program is a great way to educate your patients and neighbors about bone health. “Fit to a T” is designed to promote bone health and educate participants about osteoporosis prevention.
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Bringing new staff up to speed
Don’t forget these issues in new employee orientation Whether you are a solo practitioner or a member of a large orthopaedic group, your support staff is a critical component of your practice. Although you may not need to recruit and orient new staff frequently, it pays to have specific protocols in place. To bring new staff members up to speed quickly, consider the following guidelines.
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Putting the “power” in PowerPoint
Whether you’re speaking to a local community group, in a lecture hall or before hundreds of your peers at the AAOS Annual Meeting, it pays to have a dynamic presentation. Learning the basics of effective public speaking with PowerPoint is easy when you know “the rules.” “We are trained to be doctors—not to be public speakers. So why are we surprised when our members do a lousy job as presenters?” asks orthopaedic surgeon David L. Nelson, MD. And who gets hurt by this lack of training?
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How to get your NPI
Applying for your NPI is simple and free. With the May 23, 2007, compliance deadline rapidly approaching, you should complete the online application at: http://nppes.cms.govWelcome According to the NPPES Web site, completing the application takes approximately 20 minutes. The site also contains tips on how to expedite your application processing. Where to go for more information on the NPI CMS NPI Information: www.cms.hhs.gov/NPS National Health Care Provider data: www.hipaadvisory.
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A simple system for coding E/M services
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.
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Tips for marketing your orthopaedic practice
Whether you are in an academic setting, a group practice, or a solo practitioner, setting goals and developing realistic strategies will help your practice grow Marketing is the ability to promote your skills as an orthopaedic surgeon to a target group, aimed at improving the financial health of your practice.
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Paperless office: A must, a maybe, or a mistake?
In Poor Richard’s Almanac, Ben Franklin stated the paradox that best describes the current state of information technology in medicine: “A penny saved is a penny earned.” Although information technology may, in the long run, save thousands of dollars for a medical practice, this leap of faith does not easily and immediately exceed the technology’s acquisition costs.
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Retirement: An orthopaedic surgeon’s perspective
Plan your retirement as you plan your surgeries—ahead of time According to recent AAOS member surveys, throughout their careers, orthopaedic surgeons tend to push back the age at which they plan to retire. Orthopaedic surgeons in their 40s generally expect to retire by around age 65. Those in their 50s expect to retire at around age 67. Perhaps most surprising, even orthopaedic surgeons in their 70s don’t expect to retire until age 76.
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Enroll now in upcoming practice management course
Would you like to manage your practice more effectively? Are you looking for ways to position it for greater growth? Make the 3rd Annual AAOS Orthopaedic Practice Management Course: Building Essential Skills a key component of your business plan. The course, directed by Kevin J. Bozic, MD, MBA, and David A.
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This survey really counts
The Physician Practice Information Survey helps determine physician payments The AAOS, the American Medical Association (AMA) and more than 70 other organizations are currently conducting a comprehensive multispecialty survey of America’s physician practices. This survey is a vital tool to determining practice patterns and will have a major impact on orthopaedic practices for years to come.
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The liability implications of medical tourism
What happens if something goes wrong? Medical tourism is a relatively new, rapidly developing industry. Medical tourists are patients who travel overseas to undergo surgical procedures or other treatments that are either unavailable or too expensive in the United States. Many medical tourists are uninsured or underinsured individuals. Others are seeking treatment options available abroad that are currently unavailable in the United States.
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It’s not your typical test experience
Practice management exam is also a learning opportunity Want help in generating additional revenue and decreasing your professional liability risk? Do you need to know more about Stark and antikickback regulations? Would you like to improve your CPT coding techniques, reduce the high expense of staff turnover, and identify inefficiencies in your practice? If you answered yes to any of these questions, the new 2007 Self-Scored Practice Management Examination is for you.
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Know what to expect in litigation
“Be prepared” is good advice Legal matters and the process of medical negligence lawsuits aren’t covered in medical school. But knowing what to expect in the event of a lawsuit can be extremely valuable, enabling the physician to prepare for the suit itself, and decreasing the anxiety and emotional trauma that such an ordeal is likely to cause. When Good Doctors Get Sued: A Practical Guide for Defendant Physicians Involved in Malpractice Lawsuits by Angela M. Dodge, PhD, and Steven F.
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When you’re on the “hot seat”
Tips in answering questions during expert witness depositions From my first encounter with the tort system, I have been concerned about the lack of formal education that we as physicians have about medical liability litigation. As an orthopaedic traumatologist, I have been deposed as a treating physician on multiple occasions. I am frequently concerned about how my testimony will be interpreted and used, in part because I am unfamiliar with the rules and processes of the legal system.
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The cost of defensive medicine
Tort reform could lower costs, improve patient care At the recent “America’s Health Care at Risk: Finding a Cure” conference, both Republicans and Democrats agreed that bipartisan cooperation and compromise are necessary to solve America’s healthcare problems. In the past, Congress has not addressed the fundamental issues that make the current healthcare system unsustainable.
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Red flag regulations effective Nov. 1
On Nov. 1, 2008, new rules and guidelines intended to detect, prevent, and mitigate identity theft go into effect. These “red flag rules” focus on implementing technologic and procedural frameworks to support fraud detection and prevention. The financial arrangements inherent in the physician/patient relationship would classify medical practices as creditors and subject to the rules.
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Enroll now in upcoming practice management course
Would you like to manage your practice more effectively? Are you looking for ways to position it for greater growth? Make the 3rd Annual AAOS Orthopaedic Practice Management Course: Building Essential Skills a key component of your business plan. The course, directed by Kevin J. Bozic, MD, MBA, and David A.
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Charting a course to safety
Documentation is key to a medical liability defense How a physician documents in the medical record is critically important in defending a medical malpractice lawsuit. Juries place great weight on what information is and is not in the medical record and when that information was entered. This article addresses the importance of good charting practices, the critical times to chart, mistakes to avoid, charting in the electronic medical record, and tips to improve documentation.
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Call for 2008 OSAE recorded answers
The next scoring of the Academy’s 2008 Orthopaedic Self-Assessment Examination (OSAE) scored and recorded exam is scheduled for Dec. 31, 2009. Submit your OSAE answers to the AAOS Scoring Center and complete the Continuing Medical Education (CME) evaluation form to receive CME credit. This one exam completely fulfills the American Board of Orthopaedic Surgery’s 20-credit self-assessment examination requirement from a scored and recorded source for Maintenance of Certification™ (MOC).
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Ad damnum: The plaintiff’s hope
If it seems that plaintiffs are seeking more and more in damages in medical liability lawsuits, they probably are. The big dollar damage figures contained in the plaintiff’s initial court paperwork are called the “ad damnum” clause, from the Latin meaning literally “to the damage.” These sometimes shocking figures on the last pages of a complaint are the plaintiff’s notification to the defendant of the damages being claimed.
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Setting yourself free with a “captive”
Alternatives to standard medical liability insurance companies Five years ago in Virginia, orthopaedic surgeons and other high-risk specialists were in the midst of a medical liability insurance crisis. The Virginia legislature had raised the medical liability insurance cap from $1 million/$3 million to $2 million/$6 million. One major malpractice insurer was in bankruptcy and another had withdrawn from the state.
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Alternative dispute resolution in medical liability cases
Avoiding a trial through arbitration or mediation Alternative dispute resolution (ADR) involves alternatives to jury trials as a means of resolving legal disputes arising out of allegations of medical professional negligence. The two primary alternatives to jury trials in the medical liability arena are mediation and arbitration. Why use ADR?
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Test your HR knowledge
Take a moment to answer the following questions. Do written position descriptions protect your employees more than they do you? How frequently should you evaluate your staff’s performance? If a staff person is “exempt,” does this mean he or she is exempt from certain federal regulations relating to discrimination in the workplace? Is it a good idea to enter into investment relationships with your senior-level staff?
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The forgotten part of informed consent
Be sure to discuss what a good outcome looks like Three months after his total knee replacement, Mr. Patient returns to see his orthopaedic surgeon. Dr. Surgeon examines him and finds much to be happy about. Surgeon: “Wonderful! Mr. Patient, this looks great. The knee is no longer red or warm or swollen. You are no longer in constant pain. You’re walking 8 blocks a day, when before you couldn’t walk a block.
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Are you ready for HITECH?
By William J. Mallon, MD Tips on making the transition to EMRs According to a national survey of physicians in 2008, only 4 percent of practices had a “fully functioning” electronic medical record (EMR) system, and 13 percent had a “basic system.” But that’s about to change. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, medical practices must make the transition to using an EMR system under a timeline that begins in 2011 and concludes in 2015.
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Vision loss following surgery
Impact of ION can be far-reaching Ischemic optic neuropathy (ION) is a rare postoperative complication that can result in partial or complete loss of vision. ION results from an interruption of the blood supply to the optic nerve heads, which are supplied by the short posterior ciliary arteries, branches of the ophthalmic artery.
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Physicians under stress
By Alan H. Rosenstein, MD, MBA Life in the fast lane affects behavior and performance Most physicians entered the medical field believing that hard work and dedication would provide them with the necessary knowledge and skills to provide best-practice care for their patients. Physicians had unique skill sets and were happy to make the necessary sacrifices in the name of patient care. All seemed to be going well until the mid 1980s.
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Avoidability: An alternative standard for medical liability
Will adopting a different standard help? Medical liability systems aim to compensate the injured, deter and/or prevent recurrence of the error, and deliver corrective justice. Negligence, the U.S. standard for liability, is established through an adversarial litigation system that is costly and emotionally demanding to all, takes an average of 5 years for resolution, and achieves these aims poorly. Tort reform—especially limits on noneconomic damages—controls costs.
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Supporting your practice administrator
AAOE is a resource to consider Orthopaedic surgeons frequently have long days that are often complicated and filled with the unexpected. A day in the life of an orthopaedic practice administrator may also be long, complicated, and filled with the unexpected. Consider this scenario: The day starts with a negotiation meeting with a large healthcare organization. When the practice administrator arrives at the clinic, a stack of messages await.
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Disability insurance for orthopaedists
Shopping for coverage? These tips can help… In the financial services business, the more things change, the more they stay the same—even when it comes to disability insurance. Although the disability insurance market has changed over the years, basic principles apply when shopping for individual coverage. This article will serve as a primer to help you find the policy or policies to best suit your individual needs in today’s marketplace.
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Physician maintenance of licensure
In April 2010, the House of Delegates of the Federation of State Medical Boards (FSMB)—which represents all of the nation’s state medical and osteopathic boards—overwhelmingly supported the adoption of a framework by which licensed physicians would be required to periodically demonstrate ongoing clinical competence as a requirement for licensure renewal.
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Litigation alternative: COPIC’s 3Rs program
Disclosure and early reimbursement can deter medical liability lawsuits On April 15, 2010, the New England Journal of Medicine published “Malpractice Reform: Opportunities for Leadership by Health Care Institutions and Liability Insurers.” The article referenced “disclosure and reimbursement programs” and “disclosure and early offer programs.” COPIC Insurance Company’s 3Rs Program is perhaps the best known active disclosure and reimbursement program.
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Pearls from an arthroplasty pro
Lessons learned during 35 years of arthroplasty surgery Throughout our medical careers, each of us learns lessons about patient care and adopts techniques that are routinely used during patient encounters. The following techniques have been helpful to me, and I hope they will be useful to others as well.
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Taking the tiger by the tail
When a practitioner switches practices, who pays for tail coverage? Medical liability policies come in two basic forms—occurrence and claims-made. An occurrence policy covers the insured for events that occurred during the policy dates, regardless of when the claim is filed. Under a claims-made policy, however, both the event and the claim must be reported while the policy is in effect.
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Standard of care: A trap for the unwary?
By Brian G. McConaty, Esq. When physicians use or adopt the term “standard of care” in the context of a medical negligence case, they unwittingly play into the hands of the plaintiff’s attorney and undermine the defense. Unfortunately, the singular grammatical nature of “standard of care” implies that only one way to approach a medical problem exists, which is usually not the case.
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Practical communication tips
It’s been said that it doesn’t matter what you know if you can’t communicate it. Although that may be less true for orthopaedic surgeons than for a lot of other professionals, communication is nonetheless an essential skill. Here are six practical communication techniques for your communication tune-up. 1. Assess the likelihood of follow-through.
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New NLRB deadline
Under the National Labor Relations Act, private-sector employers—including medical practices—with income or expenses of $250,000 must display a formal notice advising employees of their rights and the obligations of employers by Jan. 31, 2012. The original Nov. 14, 2011, deadline was extended to allow for enhanced education and outreach to employers. The notice informs employees about their rights to organize a union, negotiate as a group, and strike.
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Joint and Several Liability Reform
Tort reform has been widely advocated as a means to help control healthcare expenditures by reducing the practice of defensive medicine. Much attention has been focused on capping noneconomic damages, mostly due to the real-world savings seen when caps were implemented in California and Texas. However, the influence of trial lawyers at the federal level makes implementation of these caps on a national level unlikely, which has raised interest in noncap reforms.
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Managing Relations with Industry
Medicine is a business, and healthcare is a robust part of the U.S. economy. The healthcare sector employed 10.5 percent of the American workforce in 2008 and represented 17.3 percent of the U.S. gross domestic product in 2009. Most physicians, however, entered medicine based more on their desire to help than on their craving for profit.
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Join the Social Media Conversation
Although many physicians keep up with technology trends, few orthopaedic practices are actually using social media to improve patient communications or boost their bottom line. Those that do use social media understand the benefits as more than simply a way to share general health information. Social media can help orthopaedic surgeons communicate with their patients one-on-one, market their practices, and improve communications with colleagues.
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Preparing Residents for the Challenges of Orthopaedic Practice
For years, orthopaedic training programs have done an excellent job of educating residents on how to diagnose and treat musculoskeletal problems. Graduates of orthopaedic training programs are skilled in surgical procedures of the musculoskeletal system. First-time pass rates on part 1 of the ABOS Certification examination are among the highest of any specialty. But in this increasingly complex world of medical practice, are we truly preparing our residents for practice?
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Taking Control of Your Email
The first thing you do when you wake up is check email on your smart phone. When you arrive at work, you log in to your computer and start working on the emails that you received overnight and during the drive to the office. While addressing those, you stop to read incoming messages, some of which may require immediate attention. All this before you’ve eaten breakfast or started planning your day. If this scenario sounds familiar, email may have too much control over your life.
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Health Courts: A Potential Answer for Tort Reform
Stephen A. Chen, JD, and David H. Sohn, JD, MD Medical liability tort reform is often discussed as a part of healthcare reform, yet the means of achieving significant reform have been strongly contested. Caps on payments for noneconomic damages, although effective, may not be politically feasible, leading to increased interest in alternative measures of dispute resolution and health courts.
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What You Need to Know about MOC’s “Peer Review”
There’s no getting around it—earning continuing medical education (CME) credits is a big part of the American Board of Orthopaedic Surgery’s (ABOS) Maintenance of Certification (MOC) process. By obtaining 120 AMA PRA Category 1 CME Credits™—including at least 20 credits from scored and recorded self-assessment examinations (SAE)—in two 3-year cycles, and submitting proof to the ABOS, you satisfy a key aspect of MOC. But there’s more to MOC than CME.
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Preventing Positioning Injuries: An Anesthesiologist’s Perspectives
Every member of the operating room team faces both individual and group challenges when caring for patients. A common concern is proper positioning of patients to prevent injury. Patient injuries due to surgical positioning can take many forms, from end organ damage due to hypoxia or hypotension to direct nerve injury due to compression or traction.
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Don’t Be Late for a Very Important Date
The transition to coding with the International Classification of Diseases, 10th edition—otherwise known as ICD-10—begins on Oct. 1, 2014, less than 15 months away. Unfortunately, a recent AAOS survey of orthopaedic practices found that just 1.5 percent of respondents have trained all relevant staff and are preparing for ICD-10, while 37.5 percent of respondents indicated that some staff have received some training and are preparing for ICD-10.
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Ferocious Fracture Documentation for ICD–10
With less than 1 year to go before implementation of the International Classification of Diseases, 10th revision (ICD–10), the American Health Information Management Association (AHIMA) suggests that practitioners focus on their documentation to identify gaps that need filling before the “go live” date of Oct. 1, 2014. This article drills down on deficiencies that could prove problematic when reporting the diagnoses for traumatic fractures using ICD–10.
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EHRs and Medical Liability
As electronic health records (EHRs) become a fact of life in a modern medical practice, concerns increase about new risks for medical liability related to their use. Although payers, the federal government, and healthcare systems tout the value of EHRs, many physicians remain skeptical about the value and time savings that supposedly accompany EHRs.
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AAOS Member Insurance Program Introduces Higher Limits on Disability Coverage
As an orthopaedic surgeon, you realize the impact an accident or injury can have on a person’s life. And though you spend your professional life working to improve the lives of those affected by tragedy, how much thought have you given to the impact an accident could have on your own life—and the lives of those you love?
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ICD–10 Countdown
It’s February 2014, and orthopaedic practices must implement the International Classification of Diseases, 10th edition (ICD–10) on Oct. 1—just 8 months away.
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Wanted: ASCs for Education, Quality Improvement Initiative
The AAOS and the Health Research and Educational Trust of the American Hospital Association are seeking Ambulatory Surgery Centers (ASCs) to participate in a new educational and quality improvement program. Between 9 and 12 ASCs will be selected to take part in the year-long program, which involves an educational component focused on improving teamwork, communication, infection prevention, and safety, along with data collection and monitoring.
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How Do You Spell ICD-10 Success?
New West Sports Medicine & Orthopaedic Surgery, Kearney, Neb., is a seven-surgeon practice with seven physician assistants (PAs) and four athletic trainers (ATs). It’s also ready to face the challenges presented by the transition to the International Classification of Diseases, 10th edition (ICD-10) in October. Their success is based on one word: TEAMWORK. Their ICD-10 transition team is a tour de force for leading and motivating the entire practice.
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Surgeon Substance Abuse: A Real and Present Danger
The issue of alcohol and substance abuse and dependence in the United States has a significant impact on orthopaedic surgeons. Many of us have spent late nights in the emergency department (ED) treating traumatic injuries resulting from accidents involving alcohol or drugs. What we are less likely to acknowledge, however, is that healthcare professionals may also abuse and be dependent on drugs and alcohol.
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AAOS Enhances Group Purchasing Program
The value and cost savings gained by participating in the AAOS Group Purchasing Program (GPP) can be substantial (see “A Great Way to Reduce Practice Expenses,” AAOS Now, September 2014). That’s because the AAOS GPP, powered by MedAssets, provides unparalleled access to orthopaedic supplies and equipment at competitive prices. Participants pay no enrollment or upfront fees, and no purchase commitment is required.
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On Trial: What to Expect When You Are Sued
Nothing in my training had prepared me for being a defendant on trial for a malpractice action. I had to quickly learn about the legal process and how to handle myself in this very unique environment. I hope that sharing my experience will help others prepare and survive a medical liability lawsuit. It begins when you receive a summons.
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P Is for POWER
As an orthopaedic practice executive, I recognize the importance of raising the visibility of our orthopaedic practice—Bone and Joint Specialists in Merrillville, Ind. I would like to share three ways that remembering “P is for power” can help. Practice managers may outsource certain services—such as transcription or billing—to decrease overhead. One area that many orthopaedic practices outsource is lobbying local, state, and national legislators.
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Billing Essentials for Using a PA or NP in Orthopaedics
In last month’s AAOS Now roundtable, “Making the Most of PAs and NPs,” Thomas F. Murray Jr, MD; Gail S. Chorney, MD; Anthony V. Petrosini, MD, and Kemuel Carey, MHS, PA-C, ATC, shared valuable insights on how to effectively use physician assistants (PA) and nurse practitioners (NP). This article covers essential billing research steps for groups who are new to using these providers, collectively described as nonphysician providers (NPPs).
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How to Build a Successful Orthopaedic Practice
The practice of medicine has changed notably in the Internet Age. Although crucial patient management skills that were applicable years ago are still important, new skills are now necessary to build a successful practice. As orthopaedic surgeons, we all seek to provide the highest level of care to our patients. However, outstanding care may not be enough. Patients expect compassionate, patient-centered care with short wait times, an excellent bedside manner, and a high level of service.
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The True Cost of Self-Funding Long-Term Care
According to the U.S. Department of Health and Human Services, about 70 percent of individuals older than age 65 will require long-term care (LTC) at some point in their lives. As people grow older, they may become more aware of their frailties, which seem to sneak up and burst out. Simple motions such as walking or standing can cause sudden flares of pain. Memory doesn’t work as quickly and accurately as it once did. Seemingly normal functions require more time and effort.
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Do you believe orthopaedic advertising claims?
False or misleading claims violate the new SOPs on Advertising by Orthopaedic Surgeons…and could result in sanctions against the surgeon who makes them. Have you ever seen an advertisement for an orthopaedic surgeon “board-certified in sports medicine”? How about an ad for an orthopaedic surgeon who performs bloodless, painless total knee replacement surgery and gets all of his patients back on their feet the day after the procedure? Is there anything wrong with these statements?
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Will you be my partner?
In a competitive environment, recruiting a surgeon for your practice always requires honesty—and sometimes a helping hand. The orthopaedic recruiting environment in 2007 continues to be tight, with orthopaedics ranking as one of the five most competitive specialties. If you are planning to recruit a new surgeon for your practice this year, here are some practical tips that may make the process easier.
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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.
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Make documentation problems history
An easy guide to documenting the history of present illness Unfortunately, few orthopaedic surgeons enjoy learning how to code evaluation and management (E&M) services. A significant portion of practice revenues, however, can be attributed to E&M services. Neglecting the proper documentation and coding of these encounters is a common and costly mistake. Each patient encounter (e.g.
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For practice management assistance, turn to AAOS
Members benefit from education, products, services, one-on-one counseling Whether you want to reduce expenses, improve your business management skills, or find out how others have addressed a problem, the AAOS is ready to support your efforts through its Practice Management Group (PMG). Under the direction of the new Practice Management Committee, the PMG provides education, products and services, and one-on-one member assistance.
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The orthopaedist and the workers’ compensation patient
A cautionary tale of patient care and professional liability Orthopaedic surgeons are commonly asked to care for patients who have been injured in the course of their employment. Some of these injuries are employment-specific, such as a mangled hand from a punch-press injury; others are similar to those encountered in everyday practice, such as an ankle fracture from a “slip-and-fall” at work, acute or chronic back pain, or carpal tunnel syndrome.
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Lessons for lowering your liability exposure
Atul Gawande’s latest book is well worth reading Better: A Surgeon’s Notes on Performance by Atul Gawande. Metropolitan Books, Henry Holt and Company, LLC, New York, 2007, 273 pages. ISBN-13: 978-0-8050-8211-1 Atul Gawande, MD, a general surgeon at the Brigham and Women’s Hospital in Boston, examines several current medical topics of interest in his latest book, Better: A Surgeon’s Notes on Performance, a follow-up to his Complications: A Surgeon’s Notes on an Imperfect Science.
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The power of the patient complaint
By Judith Feinberg, Esq. Paying attention to four key areas can help reduce complaints Imagine yourself in this situation: As a board-certified orthopaedic surgeon for 17 years, you serve a wide range of patients, including those with sports injuries and hip and knee replacements. You also perform a small number of independent medical exams (IMEs) for a local insurance company. One of those IMEs is on “John Q.
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Protecting your assets
Common asset protection techniques Part I of this series (AAOS Now, January 2008) described problems with the medical malpractice tort system that make sole reliance on malpractice insurance an imperfect solution to protecting a physician’s assets. “Asset protection” techniques are used to limit the risk of involuntary loss of property from adverse judgments or other unforeseen events.
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Medicare project focuses on EHR
A new national Medicare demonstration program is aiming to show healthcare professionals the on-the-ground advantages of connecting to the information age. Medicare is looking for 12 communities across the country that can bring together a broad cross-section of community leadership, leverage resources, and recruit small and medium-sized primary care physician practices willing to provide the evidence that electronic health records (EHR) can improve the quality of patient care.
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Medical liability in the developing world
Increasingly, the specter of medical liability threatens humanitarian missions Humanitarian missions to developing nations are both personally and professionally rewarding. Whether through secular or faith-based organizations, physicians perform a noble service in caring for the poor in countries with few doctors and scarce resources.
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Know when to fold them
Legal rights and responsibilities in settling malpractice claims Most orthopaedic surgeons face the unfortunate reality of becoming involved in one or more medical liability lawsuits during their careers. Although most medical liability claims are either successfully defended or dismissed with no payment to the plaintiff, some cases, for a variety of reasons, should be settled.
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Setting yourself free with a “captive”—II
The story of a successful captive company When the medical liability situation in Virginia reached crisis proportions 5 years ago—steadily rising premiums with no legislative relief in site—our seven-physician group sought new avenues for insurance. Joining forces with other “high-risk” and high premium physicians, we formed our own captive insurance company. In doing so, we used captive insurance companies located in Arizona and California that had good track records as models.
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Nuts and bolts of e-prescribing
How and why you should participate in the 2009 eRX program On Oct. 30, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a final rule implementing the new e-prescribing (eRX) incentive program that began on Jan. 1, 2009. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate incentive program for eligible professionals who are successful e-prescribers as defined by MIPPA.
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Check your schedule for an audit time bomb
Correctly code postoperative visits outside the global period Did you know that the way your practice schedules postoperative visits (CPT 99024) can represent an audit risk? CPT code 99024 is described as “Postoperative follow-up visit, normally included in the surgical package, to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) related to the original procedure.”
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Sample EMR implementation survey
How much do you know about electronic medical record (EMR) systems? a. Almost nothing b. Somewhat c. A few things d. A great deal Comment: Sometimes less is better. Having preconceived notions about EMR systems can create false expectations. What are your expectations of the new EMR system? a. The EMR system will improve productivity and office efficiency starting on day one. b.
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Just for residents…
New topics highlight 2010 Practice Management Symposium Want to learn how to build a strong base of referrals in your community? Curious about how to negotiate a contract? Need help in deciding which practice offer is right for you? If you’re a resident asking any of these questions, the 10th Annual Practice Management Symposium for Orthopaedic Residents is made for you.
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Managing your practice ahead of the curve
Strategize now to maintain your independence The reality of healthcare reform is challenging orthopaedic physicians and their practices to prepare for change. Although the real changes (bundled payments, the establishment of Accountable Care Organizations) are expected to take effect between 2012 and 2014, groups must begin to prepare now to meet the additional emphasis on accountability, quality, outcomes, and consequences for performance.
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Transforming the medical liability system
D&EO programs can lead to a culture of safety and transparency Conventional tort reform, such as caps on noneconomic damages, can help hold down physician premiums for medical liability insurance as evidenced in California and Texas. Liability reform, however, must do more than just reduce physician premiums.
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How medical errors affect physicians emotionally
By Dennis J. Boyle, MD Understanding the impact can help improve patient safety Errors are all too frequent in medicine. The 1999 Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System estimated that as many as 98,000 deaths occur in U.S. hospitals each year as a result of iatrogenic error or injury. The IOM report strongly suggested that physicians recognize, prevent, and properly disclose clinical errors.
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Responding Effectively to Adverse Events
Sharing bad news is never easy. And although most physicians understand that it’s the right thing to do, disclosing an adverse medical event to a patient can be especially difficult. However, when an adverse event occurs, patients want to understand what happened and why, and they expect open communication, honesty, and empathy from their providers. For patients, professional competence in health care isn’t just about clinical skill, it’s also about integrity and caring.
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Managing Medical Liability with Risk Retention Groups
Six years ago, rapid increases in malpractice premiums and the diminishing availability of malpractice insurers in Virginia forced our group practice to look for alternatives to traditional insurance. At that time, premiums were rising 15 percent to 20 percent each year and the number of insurance companies offering insurance was shrinking.
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Recruiting Physical and Occupational Therapists
Orthopaedic groups face many challenges in providing in-office physical and occupational therapy (PT/OT) to their patients—but attracting highly skilled, motivated therapists shouldn’t be one of them. Therapists employed by orthopaedic groups have an extremely high retention rate, and the vast majority report high levels of professional and personal satisfaction. The following recruiting DOs and DON’Ts should help you attract, hire, and retain excellent therapists.
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Pearls and Pitfalls in Medical Liability Lawsuits
During the 2012 AAOS Annual Meeting, the AAOS Medical Liability Committee hosted an instructional course lecture designed to help orthopaedic surgeons understand what’s involved in constructing a medical liability case and how to avoid being the target of a malpractice lawsuit. “Anatomy of a Medical Liability Lawsuit: Practical Issues in Malpractice Avoidance,” included, among others, Byron Mitchell, JD, a defense attorney from Virginia, and Joseph L.
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Call for Nominations
The 2014 Nominating Committee is actively soliciting suggestions for individuals who might serve in the following positions: Second Vice President Treasurer-Elect Member-at-Large [Age 45 or Older] Member-at-Large [Under Age 45] (younger than age 45 on March 13, 2014) National Membership Committee Member Nominations should be sent to John J. Callaghan, MD, Chair, 2014 Nominating Committee, c/o AAOS Office of General Counsel, 6300 N.
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Meeting the Challenge of ICD-10
On Oct. 1, 2014, the International Classification of Diseases (ICD)-10 coding system will replace the current ICD-9 coding system—and if your practice isn’t ready to make the transition, practice revenues and your income will be jeopardized. With more than 141,000 diagnosis codes in ICD-10, you need to begin today to learn about and prepare your practice for the conversion.
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Pain Meds Present Problems
Widespread use of narcotic pain medication in orthopaedic surgery is risky—not only to patients, but to prescribing physicians as well—according to a group of experts assembled for the AAOS webinar on “Risk Evaluation and Management Strategies For Prescribing Opioids.” The webinar focused on the increasing risks and regulations surrounding the prescription of narcotic pain medication in orthopaedic surgery. Moderated by Thomas B.
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What You Need to Know About EHRs and Fraud
Fueled by Medicare incentives and the threat of noncompliance penalties, healthcare practices are increasingly adopting electronic health records (EHRs). By facilitating the exchange of patient data across the healthcare system, EHRs are designed to increase patient safety, minimize errors, and reduce costs. Despite their purported benefits, however, EHRs have come under increased government scrutiny, according to attorney Limo T. Cherian with the law firm of Hogan Marren, Ltd. “The U.S.
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Electronic Health Records: The Unintended Consequences
Patrick M. Palmer, MD The electronic health record (EHR) market is huge and is here to stay, having been embraced by most physicians, insurers, government agencies, and hospital systems. The EHR industry generated $24 billion in global revenues in 2013 and has an anticipated growth rate of 10 percent per year through 2015.
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Bringing a Camera Into the OR
It’s a digital world. As more surgeons transition to electronic medical records (EMR), digital images are taking a greater place in patients’ “charts.” Surgeons who write or publish are accustomed to taking clinical pictures as well as snapshots of radiographs to include in articles. Modern digital technology has made it easier to take good quality pictures. But bringing a camera into the operating room (OR) can be a challenge.
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Improving Outcomes for Worker’s Comp Patients
Appropriate return to work can help workers who are injured on the job, their employers, and society at large.
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MOC Deadline Reminder: May 1, 2014
Diplomates of the American Board of Orthopaedic Surgery (ABOS) who wish to take the Maintenance of Certification (MOC) recertification exam in March or April 2015 must apply for the exam by May 1, 2014. The application is available on the ABOS website at www.abos.org Those who miss the May 1, 2014, deadline have until May 15, 2014, to submit their applications; a $350 late fee will be assessed.
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Lease or Buy?
Looking to update or expand your practice? If so, you may also be weighing whether to lease or buy equipment. The decision is not always an easy one to make because the two acquisition options have both advantages and disadvantages. For example, leasing generally requires a minimal down payment (or none); it may protect the practice against obsolescence; and payment may be spread over a longer period of time. So, upfront costs are lower, which frees money to be invested elsewhere.
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Breaking Bad News: How to Disclose an Adverse Event
Talking with patients after an adverse event is never easy. In the July issue of AAOS Now, AAOS Medical Liability Committee members Thomas Fleeter, MD, and Robert Slater, MD, started a conversation with Lee McMullin, CPHRM, senior risk management and patient safety specialist for Cooperative of American Physicians, a physician-owned and governed, California-based medical malpractice liability cooperative. The conversation continued in an AAOS Now podcast (downloadable from www.aaosnow.
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How to Create an Efficient Flow Process
Clinical workflow is an established process describing a series of tasks, how they are accomplished, who completes them, in which sequence, and at what priority. An efficient workflow is necessary to keep a practice running smoothly.
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Demystifying Trauma Center Levels
Just as sports medicine physicians tend to distinguish themselves by the notoriety of the athletic team that they cover, trauma surgeons tend to do the same by the level of trauma center that they cover. However, what a center is required to have to achieve a specific level and how the process actually occurs tends to be a mystery to many.
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How many ways does this ad violate the SOPs on Advertising?
When Jasper Smith, world-champion bull rider, needed hip replacement surgery, he turned to the world-famous Odd Couple Orthopaedic Practice. Drs. I.M. Neat and U.R. Knott, both board certified in sports medicine and pioneers in minimally invasive hip arthroplasty, got the rodeo star back on his feet—and back in the ring. Just three days after surgery, Smith rode “Bone Crusher” to the championship!
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10 questions to ask potential recruiters
What’s your success rate? The higher the rate, the better the recruiter Will you give me a list of your last 10 consecutive clients? You want to know about both successes and failures. Then follow up with those clients. Ask them if the recruiter communicated with them honestly and in a timely fashion. Do you plan on making a site visit? The recruiter should understand your situation, including location and requirements.
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The ins and outs of coding for hip resurfacing
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?
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AAOS, AMA conducting physician practice information survey
The AAOS, the American Medical Association (AMA), and more than 70 other medical specialty societies are working on a comprehensive multispecialty survey of America’s physician practices. The Gallup Organization will conduct the Physician Practice Information survey among a representative sample of practices in each of the participating specialties.
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Coping with malpractice stress
How to come back from a crisis in confidence Even the best and most innocent orthopaedic surgeons have been the targets of medical liability litigation that can result in anguish, a loss of self-esteem, a fear of treating future patients, and a shift to seeing each patient as a potential litigant. Coping with these feelings isn’t easy, but it is possible. My personal story may provide an example and roadmap for others.
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I’m getting sued for WHAT?
By Paul E. Weathington, Esq., and Patricia B. Freije, Esq. Medical battery is an emerging trend in medical liability litigation My client’s eyes were wide with disbelief. Although the judge had dismissed the plaintiff’s medical liability claims, the patient was allowed to recast and proceed with a different allegation—medical battery. “Battery? Can’t you go to jail for that?” he exclaimed.
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Lessons from a fire
Recently, the people of San Diego experienced the unfortunate intrusion of a major fire disaster. My family and I were among the 500,000 individuals evacuated from our homes. Although the specter of natural disaster—specifically earthquakes—has always loomed over us, when confronted with the reality of departing our home, I was struck by my lack of preparedness. My family was much more fortunate than others because we had time to gather our things and load our cars.
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Medical peer review and risk management
Risk management aims to lessen the likelihood of harm materializing from hazards. The goal of medical peer review is to improve quality and patient safety by learning from past performance, errors, and near misses. Thus, medical peer review is a risk management tool. In a 2006 survey, however, nearly a quarter of the responding Massachusetts physicians said that they would be afraid to refer a colleague for peer review, and a third admitted to fearing referral for peer review.
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Establishing standards of care: Locality rules or national standards
A trial lawyer provides his perspective on the issue A commentary in the Journal of the American Medical Association (June 20, 2007) discussed the merits of a national standard of care versus a locality standard of care. The authors advocated eliminating locality standards in favor of a national standard of care.
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The challenges of country living
Rural orthopaedists have a measurable impact “I spent 20 years in a city environment, and I just love being in a small town with relatively low crime and no traffic,” says James W. Barber, MD, describing some of the benefits of being an orthopaedic surgeon in a rural area. “I’m close to work, and I really like being in a wide-open, rural area.” Dr. Barber runs a small, solo orthopaedic practice in Douglas, Ga.—a town of about 16,000 people in the southern half of the state.
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PRP gets CPT Category III code
On July 1, 2010, the American Medical Association (AMA) Current Procedural Terminology (CPT) introduced a new category III (new technology) code for the performance of platelet rich plasma (PRP) injection procedures. The specific wording of the code follows: “0232T—Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed (Do not report 0232T in conjunction with 20550, 20551, 20600-20610, 20926, 76942, 77002, 77012, 77021, 86965.
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Reducing dictation expenses
Dictation is an obligatory part of medical practice. Comprehensive office notes are an essential part of the medical record that detail treatment history and are vital protection in a medical liability event. The detail in your notes directly affects your ability to bill appropriately for the evaluation and management of each patient and thus affects reimbursement.
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Potential Liability Risks of Electronic Health Records
Due to federal incentive payments, electronic health records (EHR) are rapidly becoming a part of the U.S. healthcare landscape. Although EHRs may offer opportunities to improve health care, electronic record keeping may also result in unforeseen liability exposure for physicians. For example, consider the following scenario: In the preoperative holding area, a nurse enters the patient’s relevant health history into the hospital’s EHR.
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Upcoming MOC deadlines
Certificate expiration Exam date Deadline date Requirement 2013, 2014, 2015 2013 5/1/2012 Application deadline for computer and oral exams 2013, 2014, 2015 2013 5/31/2012 Late application deadline for computer and oral exams; late fee applies 2013, 2014, 2015 2013 12/15/2012 Exam fee due for those taking the computer and oral examination pathways 2013, 2014, 2015 2013 12/15/2012 6-consecutive-months case list of surgical cases perf
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ICD-10 is Coming—Are You Ready?
The transition to 5010 may be settling down for your practice, but don’t get too comfortable! The next major transition—to the new International Classification of Diseases (ICD)-10 coding system—is coming, and it is going to be bigger than 5010. Despite the fact that the U.S. Department of Health and Human Services recently proposed delaying ICD-10 compliance to Oct. 1, 2014, orthopaedic practices should continue to move forward with their ICD-10 preparations.
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New Device and New Procedure Liability
The practice of medicine is constantly changing. To provide optimum care orthopaedic surgeons must be willing to change and advance as well. Innovative procedures and devices, combined with continuing medical education, are the basis for improving medical care in orthopaedic surgery. The implementation and use of innovative devices and procedures, however, carry potential liabilities that orthopaedic surgeons should understand and be ready to address. FDA approval status The U.S.
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Lateral and Prone Positioning Risks in Orthopaedic Surgery
Proper positioning of orthopaedic patients on the operating table is important to prevent injury. However, despite their unique symptoms, medical problems, and physical characteristics, these patients are typically positioned using standard surgical positions. Each position can expose various nerves to potential for injury, and it is important to be aware of them while positioning the patient.
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“The Dirty Dozen” Healthcare IT Issues
Information technology (IT) systems—including hardware, software, and related systems—are far from foolproof, and dependency on them is frequently rewarded with an ill-timed outage. Even large organizations such as airlines, the stock exchange, and the federal government experience occasional computer issues. In the course of working in healthcare IT for well over a decade, I have seen my share of IT problems.
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In Search of the Perfect Surgical Timeout
Orthopaedic surgeons who consider surgical checklist timeouts a boon to surgery probably don’t need to read any further. Those who view them as a boondoggle, however, should read on. Surgical checklist timeouts have long been compared to seatbelts. Both can save lives, but when not used correctly, neither one works very well. The main difference between the two is that seatbelts are a lot easier to use properly and a bell sounds if the seatbelt is not used correctly.
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EHR Incentive Program
Hardship exception applications due July 1 Medicare providers who were unable to successfully demonstrate meaningful use for 2013 due to circumstances beyond their control can apply for a hardship exception. The Centers for Medicare & Medicaid Services (CMS) is accepting applications for hardship exceptions to avoid the upcoming Medicare payment adjustment for the 2013 reporting year. Payment adjustments for the Medicare Electronic Health Record (EHR) Incentive Program will begin on Jan.
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Using Peer Review in Risk Management
Here at Panorama Orthopedics & Spine Center in Denver, potential medical liability cases are everyone’s concern. That is due to the process we have developed for handling “risk management cases.” Our 34-physician group supports a culture of mutual accountability and respect. About a year ago, as part of our risk management efforts, we implemented a process of “peer review” of cases that posed a potential liability risk.
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Talking Your Way Out of a Lawsuit
The common conception is that malpractice lawsuits arise from greedy patients and aggressive lawyers. However, actual analysis of the root cause of medical liability lawsuits shows that skilled surgeons can be frequently sued while doctors who are mistake-prone may never get sued. In his best-seller Blink, Malcolm Gladwell explains this conundrum: “The overwhelming number of people who suffer an injury due to negligence from a physician never file a malpractice suit at all.
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Meeting the Challenges of Meaningful Use Stage 2
Do you have unanswered questions or concerns about meeting Stage 2 Meaningful Use (MU) requirements? If so, read on for key information on attestation for MU in 2014 and achieving Stage 2 requirements in 2015.
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Responsible AI that Makes YOU Better
That's what real, powerful artificial intelligence (AI) should do. It should free up providers' time to provide direct patient care.
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Considering an In-office MRI? We Are in Your Corner.
See the video of the successful MRI Project for our physician clients in Steamboat Springs, Co. MRIConsultingGroup.com. Call or text (970) 946-7474.
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Is It Necessary to Use a Fresh Knife Blade After Incision to Reduce Infection Risk?
The practice of switching to a fresh knife blade after the incision is made remains a subject of debate, as data are conflicting as to whether the practice reduces contamination. A study that was presented as part of the Annual Meeting Virtual Experience found that contamination rates did not differ regardless of whether the knife blade was switched following incision.
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The Impact of Alternative Payment Models on Quality and Safety of Orthopaedic Care
In response to the rise in healthcare spending, the Centers for Medicare & Medicaid Services (CMS) began exploring alternative payment models (APMs) in 2011.
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Clinical Quality and the Pathway to Payment
On Tuesday, March 1, 2016, George F. Muschler, MD, vice chair of the Performance Measures Committee (PMC), moderated the symposium "Clinical Quality and the Pathway to Payment" at the 2016 AAOS Annual Meeting. Dr.
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The Crisis in Orthopaedic Technology Puts Evidence-based Medicine at Risk
Improvements in orthopaedic patient care are typically connected to improvements in orthopaedic technology. However, the supply of new implants and procedures is not guaranteed. The successful commercialization of truly novel orthopaedic technology currently faces stiff headwinds, including regulatory risk, payer risk, and market risk. This may reduce interest in financing novel technologies within the venture community and among major device manufacturers.
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Effective Leadership Is Needed to Ensure Quality and Safety in the Workplace
This is the last in a series of roundtable discussions from a September 2017 meeting of the AAOS Patient Safety Committee. In this article, David C. Ring, MD, PhD, chair; and committee members Michael S. Pinzur, MD; Michael R. Marks, MD, MBA; Dwight W. Burney III, MD; Andrew W. Grose, MD; and Alan M. Reznik, MD, MBA, address the importance of leadership in establishing a culture of safety. What is the role of leadership, and how does leadership advance quality and safety?
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Low-cost Mobile Applications Improve Patient Satisfaction and Compliance with High-demand TJA
Patients undergoing total joint arthroplasty (TJA) of the hip or knee reported higher satisfaction and better compliance with both pre- and postoperative protocols with the use of mobile applications, compared to standard care, according to a systematic review and meta-analysis, to be presented today.
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The Presence or Lack of Psychological Safety in Surgery Directly Impacts Team Member Morale and Patient Care
Orthopaedic surgeons can improve psychological safety in their practices by cultivating skills in three focus areas: communication, conflict, and culture.
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Pregnancy and Orthopaedic Surgery Practice: Experts Discuss Challenges and Solutions
During the AAOS 2023 Annual Meeting in Las Vegas, a panel of female orthopaedic surgeons led a discussion on the challenges associated with pregnancy in the orthopaedic profession.
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Study Identifies Specific Barriers to Osteoarthritis Care for Hispanic and Black Patients
Early diagnosis and treatment for osteoarthritis (OA) can improve symptoms, slow disease progression, and delay the need for joint replacement.
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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.
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FDA Guidances on Physician-Directed Use
The U.S. Food and Drug Administration (FDA) has issued several guidances—documents that outline the agency's current thinking about regulatory policy—concerning physician-directed use of medical devices. Before a guidance is finalized, the agency releases a draft guidance to solicit feedback from stakeholders. In January 2017, the FDA issued two new draft guidances, using a question/answer format.
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Complying with the Quality Component of MIPS in 2017
The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation, passed in April 2015.
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Clinical Trials for Cervical Disk Replacement
Each of the seven cervical total disk replacements (cTDR) currently available in the United States has undergone a clinical trial providing evidence of safety and efficacy that supports U.S. Food and Drug Administration (FDA) premarket approval.
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A Watchful Eye Can Prevent Future Harm to Young Patients
Nonaccidental trauma is one of the leading causes of injury and death for children in the United States, with musculoskeletal injuries as one of the most common manifestations of child abuse. As orthopaedic surgeons, we are well-positioned to recognize and diagnose nonaccidental trauma in our smallest, youngest, and most vulnerable patients. However, the diagnosis of nonaccidental trauma requires proper screening. In 2010, the U.S.
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Use Detailed Operational Benchmarking Data to Drive Increases in Ancillary Revenues
Durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) play an important role in musculoskeletal care. Such tools are often used to provide physical support to patients who have undergone surgery. Other types of DME may assist with correcting musculoskeletal deformities, such as scoliosis.
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Study Demonstrates How THA Care Pathways Can Lower Length of Stay for Patients
Care pathways in hip arthroplasty programs have effectively lowered the length of stay (LOS) after primary total hip arthroplasty (THA).
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Generative AI Could Transform Healthcare
The symposium, titled “Generative Artificial Intelligence—A Technology Set to Transform Musculoskeletal Care?” was an exploration of generative AI and its risks, challenges, and opportunities in the healthcare arena. It included insights from several experts to help attendees navigate these topics.
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CMS and Performance Measure Implementation: Understanding the Impact of the "2-Year Look Back" and "Capping Out"
As health care changes, performance measures are playing an increasing role in the care provided, how that care is perceived, and how orthopaedic surgeons get reimbursed. The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) did away with the Sustainable Growth Rate formula and the Physician Quality Reporting System (PQRS), but replaced the latter with the Merit-Based Incentive Payment System (MIPS).
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Orthopaedic Surgeons Play Key Role in Device Recalls
Orthopaedic surgeons are in a unique position to discover possible issues with orthopaedic devices. Accordingly, the surgeon’s role in ensuring the quality of those devices cannot be overstated. This responsibility requires surgeons to report device failures to the U.S. Food and Drug Administration (FDA) and to understand the hospital’s role in reporting as well. Recent innovations in arthroplasty have resulted in many positive advances for patients.
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Patient Safety Committee Discusses How Professionalism Can Limit Psychological Harm
The AAOS Patient Safety Committee supports the development, validation, and dissemination of culture and processes that improve orthopaedic surgical safety and inform Academy policy regarding these issues. If you have questions related to the content presented in this roundtable discussion or patient safety in general, please email patientsafety@aaos.org. Many medical errors and harms can be traced to ineffective communication and poor team dynamics, which are issues of professionalism.
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Higher Facility Costs Do Not Improve THA and TKA Outcomes
Costs associated with total hip arthroplasty (THA) and total knee arthroplasty (TKA) vary significantly at different facilities. A study presented as part of the Annual Meeting Virtual Experience compared short-term outcomes of THAs and TKAs performed at higher- versus lower-cost facilities and observed no significant differences.
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High Rates of Occupational Physical, Mental Injuries among Orthopaedic Surgeons
A large study of orthopaedic surgeons, investigated incidence of occupational physical and mental injuries according to subspecialty and other surgeon factors.
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Telemedicine Presentation: Panelists Offer Strategies for Effective Deployment of Virtual Visits
The COVID-19 pandemic had a transformational effect across medicine.
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AAOS to Host Second Annual Biologics Symposium
This year, AAOS will host its second annual biologics symposium, titled “The Next Generation of Biologics: Use of Real-world Evidence,” in Washington, D.C. It is designed to convene experts in science and medicine, industry, as well as regulatory agencies to examine current real-world evidence as it pertains to musculoskeletal medicine.
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Best Practices Help with Managing Failed Implants
The first article in this series explored several of the potential liability aspects of failed implants. Although an implant failure in a patient is not malpractice per se, the duty for patient safety continues before, during, and after plaintiff attorneys advertise class action suits.
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Failed or Recalled Implants: Is There Surgeon Liability?
In recent years, catastrophic failures have been associated with several orthopaedic implants. Issues with biologics, such as bone morphogenic protein, also have been reported. This article explores several of the potential liability aspects of failed implants.
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ICL Elucidates Regulatory Guidelines on Orthobiologics
Scott Bruder, MD, PhD, founder and CEO of Bruder Consulting & Venture Group, was the first presenter in the Instructional Course Lecture (ICL) titled “Orthobiologics Use and Marketing: U.S. Food and Drug Administration, Federal Trade Commission, and Ethical Compliance,” which discussed the complex regulations surrounding the use of orthobiologics.
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Study Finds Greater Complications after Elective Orthopaedic Procedures in Older Patients Treated during the COVID-19 Pandemic
The authors of a study presented at the AAOS 2023 Annual Meeting in Las Vegas sought to identify whether delays, cancellations, and changes to elective orthopaedic procedures during the height of the pandemic increased the incidence of postoperative complications in older patients.
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Performance Measures Update: Orthopaedic Preferred Measure Set
The Physician Quality Reporting System (PQRS) began in 2007 as the Physician Quality Reporting Initiative, a voluntary, incentive-based program for practitioners that was designed to better ensure high-quality healthcare services for Medicare beneficiaries. The program as it is known today will sunset on Dec. 31, 2016, as required under the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015 (MACRA).
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Recovery Care Centers Expand the Benefits of Ambulatory Surgery Centers
Prior to 1970, all surgeries were performed in hospitals and were associated with long lengths of stay and high costs. Improved surgical techniques, along with the desire to reduce the costs of simple surgeries in hospitals, have led to the development of ambulatory surgery centers (ASCs). Several surgical cases that were once considered to be inpatient only have migrated to ASCs, with well-documented high rates of patient satisfaction, good outcomes, and cost savings.
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Pros and Cons of Emerging Payment Models
This is part one in a series about payment models. Part two will appear in the May issue of AAOS Now and will focus on the application of condition-based payment models to the management of musculoskeletal disorders. At the core of the surgeon patient relationship is a shared goal of relieving pain, restoring function, and improving health in the most appropriate, convenient, and efficient way possible for the patient’s condition.
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High Rates of Occupational Physical, Mental Injuries among Orthopaedic Surgeons
A large study investigated incidence of occupational physical and mental injuries in orthopaedic surgeons according to subspecialty and other surgeon factors.
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Dedicated Orthopaedic Trauma Room Improves Surgery Efficiency, Confers Cost Benefits
A dedicated orthopaedic trauma room (DOTR) increased surgical efficiency and resulted in marked cost benefits for centers, according to findings from a Canadian study.
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Ambulatory Surgery Centers Are More Cost-Effective than Hospitals for Hand and Upper-Extremity Surgeries
A study presented at the AAOS 2024 Annual Meeting reported that ambulatory surgery centers (ASCs) exhibited cost-effectiveness across various hand and upper-extremity procedures, from total expenses to Medicare reimbursements, when compared with hospital outpatient departments (HOPDs).
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Physician-Led Orthopaedic Hospitals Score Higher on Quality Rankings
An analysis of the top 200 orthopaedic hospitals in the United States found that physician-led orthopaedic hospitals performed better than hospitals without physician leadership.
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The ‘Weekend Effect’: Are There Worse Outcomes for THAs Performed on Saturdays and Sundays?
A retrospective study presented during the AAOS 2024 Annual Meeting investigated whether there were any differences in postoperative outcomes and healthcare costs associated with total hip arthroplasty (THA) procedures performed on weekdays and weekends.
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AAOS releases new resources promoting physician-led care teams
AAOS is excited to announce the release of a new patient education initiative: Supporting Collaborative, Physician-Led Healthcare Teams.
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The "PROs" of Using AJRR to Meet CJR Requirements
The Centers for Medicare & Medicaid Services (CMS) Comprehensive Care for Joint Replacement (CJR) model, which first went into effect on April 1, 2016, requires hospitals within 67 geographic regions (known as metropolitan statistical areas, or MSAs) to bundle payments for lower extremity joint replacement (LEJR) procedures. Because data must be submitted from July 1 to Aug. 31, 2016, the 794 hospitals in areas designated as MSAs should be conscious of the steps they will take to qualify.
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Hip Fractures: Medicare ‘Paid Less for Doing More’
A study that evaluated actual Medicare reimbursement to hospitals for care of hip fracture patients utilizing the three hip fracture admission types from 2011 to 2016 found that the mean episodic Medicare reimbursement to hospitals decreased by nearly 10 percent and more than $2,000 per episode for hip fracture patients with major medical comorbidities.
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Outpatient TJAs Performed at ASCs Are Associated with Lower Costs, Admission Rates Than Those Performed at HOPDs
The type of facility where an outpatient total joint arthroplasty (TJA) is performed significantly impacts outcomes, complications, and costs associated with the procedure, according to an analysis that appeared to favor performing TJAs at ambulatory surgical centers (ASCs) over hospital outpatient departments (HOPDs).
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Edward M. Wojtys, MD, and James A. Ashton-Miller, PhD, Receive Kappa Delta Lanier Award
As a former linebacker for the University of Michigan football team, Edward M. Wojtys, MD, was drawn to the challenge of understanding and preventing knee injuries. For work spanning three decades of research into the neuromuscular function of the knee, mechanisms of ACL injury, and in vivo efforts to develop a cell-engineered anterior cruciate ligament (ACL) replacement, Dr. Wojtys and James A. Ashton-Miller, PhD, are the recipients of the 2016 Kappa Delta Elizabeth Winston Lanier Award.
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Is Telemedicine Living Up to Its Potential to Resolve Health Disparities?
Telemedicine has the ability to mitigate geographic and physical barriers to care, but amid a greater use of telemedicine during the COVID-19 pandemic, new barriers to access have been identified that may ironically widen disparities in healthcare outcomes.
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Virtual Is the New Reality: Incorporating Telemedicine into Post-pandemic Orthopaedic Practice
Historically, U.S. orthopaedic practices have not widely utilized telemedicine for the delivery of orthopaedic care.
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Study Ranks Medical Schools with the Greatest Number of Black Graduates Matched into Orthopaedic Surgery Residencies
The historically Black colleges and universities Howard University and Meharry Medical College have produced the highest number of Black medical students who successfully matched into orthopaedic residency programs, according to an analysis of an academic database.
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Unmasking the "Two Faces" of Osteoprogenitor Cells
Drugs currently used to prevent bone loss—such as bisphosphonates and denosumab—are costly and may cause serious complications, raising socioeconomic and clinical questions about their long-term use, according to the Robert E. Carroll and Jane Chace Carroll Laboratories Professor at Columbia University. Through Dr.
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Direct-to-consumer Advertising of Stem Cell Therapy Is Subpar
More healthcare practices are offering stem cell therapy (SCT) as part of their services for musculoskeletal treatments.
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Value of Bundled TJR: A Perspectives Analysis
A study that was presented as part of the Annual Meeting Virtual Experience assessed how the value of bundled total joint replacement (TJR) differs among patients, payers/employers, and hospitals/providers.
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Healthcare Performance Measures Increase in Importance
Some say the performance measurement train has left the station. There is no doubt that there is widespread concern from physicians about the financial consequences and regulatory complexity of the Physician Quality Reporting System (PQRS), Meaningful Use, Electronic Health Records (EHR) Incentive Program, and Value Based Modifier.
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Preparing Our Future Workforce: Residents Offer Perspective on Sustainability in Orthopaedic Surgery
Discussions surrounding climate change and the importance of creating a sustainable future to preserve the health of our patients and communities are becoming commonplace.
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Relationships with Industry Partners Can Enhance Orthopaedic Resident Education
The presence of orthopaedic industry in clinical and educational settings elicits differing opinions from orthopaedic surgeons.
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Residents Can Use Their Voices to Advocate for Orthopaedics by Attending Combined NOLC/Fall Meeting
For orthopaedic residents, the opportunity to attend the Combined National Orthopaedic Leadership Conference (NOLC)/Fall Meeting is not one to miss.
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Rich Practice Management Content Is Available for Residents and Fellows-in-training
Residents and Fellows-in-training can attend Practice Management for Residents and Fellows-in-training, a free half-day educational course specially developed to deliver content customized to their needs and career stages.
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Breaking Down Barriers: Promoting Paternity Leave in Residency
Paternity leave has historically been overlooked as an option during residency and often is associated with a negative stigma.
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Tales from the Hurricane Front
It's not that the healthcare system in Houston wasn't prepared for Hurricane Harvey. Having seen the devastation in New Orleans after Hurricane Katrina in 2005 and, before that, tropical storm Allison, which inundated Houston in 2001, the city's hospitals and medical network were ready as Harvey bore down on the Texas coast. As ready as anyone can be for a once-in-five-lifetimes storm.
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On Duty
It was the water of Hurricane Harvey, not the wind, that caused most of the billions of dollars in destruction, and the experiences reported by orthopaedic and other medical personnel speak to that fact. At the Memorial Hermann trauma center at Texas Medical Center—one of two Level 1 facilities in the region—the days of the storm were mostly quiet, even uneventful for what by some measures is described as the nation's busiest trauma center.
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In the Firehouse
Amy Cockerham is a nurse practitioner who works in orthopaedic trauma with Joshua Gary, MD, at Memorial Hermann's Level 1 trauma center in Houston and lives in Friendswood, a bedroom community south of the city. With the rising waters paralyzing transportation around her, Ms. Cockerham stayed in Friendswood to serve as a medical coordinator at an emergency operations center established at the fire station.
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Post-Hurricane Maria: Many Ask, 'How Can I help?'
On Sept. 28, 2017, Hurricane Maria unleashed its Category 4 strength on Puerto Rico and unbridled devastation ensued, leaving much of the island in ruin. Now, a widescale humanitarian effort is managing the aftermath of the storm. As a U.S. territory, Puerto Rico is similar yet unique when compared to the states. Nearly 3.5 million U.S. citizens live in Puerto Rico. As U.S. citizens, Puerto Ricans can travel without a passport to and from the continental United States.
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ASCs and Hospitals Yield Similar Outcomes for Treatment of Supracondylar Humerus Fractures
A study of pediatric patients treated surgically for supracondylar humerus (SCH) fractures found that those who were treated in an ambulatory surgical center (ASC) received care that was as safe, faster, and more cost-effective than those treated in a children’s hospital. The study, presented at the AAOS 2018 Annual Meeting by Carson Mills Rider, MD, identified 316 patients who underwent closed reduction and percutaneous pinning (CRPP) of Gartland extension type II SCH fractures.
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Medical Community Unifies in Response to Shooting
When a gunman perched on the 32nd floor of the Mandalay Bay hotel in Las Vegas rained gunfire on the crowd attending a Sunday night country music concert, the scores of wounded began flooding the city's emergency departments. Orthopaedic surgeons stepped up to provide care for the injured. Amid the chaos and the carnage, the patients arrived at area hospital, sometimes five to a vehicle, in ambulances, limousines, and pickup trucks pressed into service, many driven by valiant civilians.
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What to Do When—Not If—You Must Care for Patients Following a Mass Casualty or Disaster Event
During the President’s Symposium at the AAOS 2019 Annual Meeting, former AAOS President David A. Halsey, MD, hosted a session that provided education on best preparedness practices in the face of a mass casualty or disaster event. “Nearly every day it seems, some place in our country and around the world [is] affected by incidents resulting in mass casualties,” Dr. Halsey said. “We can’t choose the best time and ideal place for such events.
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Take Charge of Your Professional Online Reputation
The tools doctors use in practice are changing with the times, as are the ways patients choose their clinicians. During a career development session at the AAOS 2019 Annual Meeting, Christian Veillette, MD, MSc, FRCSC, assistant professor at the University of Toronto, discussed how orthopaedic surgeons can manage their online reputations. “Online reputation” encompasses an entire online presence, including results from a Google search.
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AAOS 2021 Luncheon Offers OrthoPAC Update and Analysis of Polarization in America
During the annual Donor Appreciation Luncheon at the 2021 Annual Meeting, members of the Orthopaedic Political Action Committee (OrthoPAC) received an update on the PAC’s standing and activities in 2021, as well as a political analysis from journalist and two-time Pulitzer Prize finalist Ron Brownstein.
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Is Age Just a Number? Considerations for Tapering or Stopping Practice
What happens to a surgeon with age? During a career development session at the AAOS 2019 Annual Meeting, R. Dale Blasier, MD, FRCS(C), MBA, of the Arkansas Children’s Hospital in Little Rock, Ark., discussed how aging wears on a surgeon and provided guidance on when—and whether—to retire from practice. “The effects of aging affect how we work,” he said. Beyond physiological changes that come with age (e.g.
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Study Explores the Dynamics of Surgeons Leaving Academic Orthopaedics
A study presented by Alice Chu, MD, FAAOS, associate professor and chief of the Division of Pediatric Orthopaedics at Rutgers New Jersey Medical School, sought to better understand recent trends in academic orthopaedics by examining the retention of academic orthopaedic surgeons from 2016 to 2022.
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A Snapshot of U.S. Orthopaedic Surgeons: Results from the 2018 OPUS Survey
The Orthopaedic Practice in the United States (OPUS) Survey, also known as the orthopaedic Census Survey, gathers demographics and practice data on U.S. orthopaedic surgeons. This article features changes that have occurred in the orthopaedic workforce over a 10-year period between 2008 and 2018.
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What the OPUS Reveals About Practice Settings and Productivity
This article is the third of a four-part series that discusses results from the 2018 AAOS Census Survey and examines orthopaedic surgeon practice setting and productivity in the United States.
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PAC Luncheon Thanks Donors, Offers Analysis of Polarization in America
Members of the Orthopaedic Political Action Committee (OrthoPAC) attended the Donor Appreciation Luncheon yesterday and were provided an update on the PAC’s standing and activities in 2021, as well as a political analysis from journalist and two-time Pulitzer Prize finalist Ronald (Ron) Brownstein.
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Orthopaedic Practice and Research Are Team Efforts
Richard F. Kyle, MD, FAAOS, is a past president of AAOS and past president of the Orthopaedic Research and Education Foundation (OREF), shared his perspectives on how the orthopaedic community has worked together to advance knowledge and apply the best treatment for every patient.
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Acronyms 101: Sifting Through Alphabet Soup, Part 4
In this our final article on healthcare policy acronyms, we address the acronyms and abbreviations seen in bundled payments and various practice-related terms. We understand that more could certainly be written on acronyms, but we believe that our four-part series has covered the most commonly used terms. As the MACRA legislation continues to unfold, there will undoubtedly be further proliferation of acronyms in the healthcare policy conversation.
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Drawing the Line on Sexual Harassment
Labor law expert challenges orthopaedic leaders to ‘model appropriate behavior’ The outcry over allegations of egregious conduct toward women by high-profile figures in media and entertainment, including Harvey Weinstein and Matt Lauer, has led to a tipping point in terms of how even famous and powerful men are called to account for their behavior.
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Learn How to Safely Use Humor to Improve Your Practice
We all like to laugh. Whether breaking up a long meeting or brightening a lunchtime discussion, a well-timed joke or witty comment makes us feel good. It temporarily suspends our mundane thoughts or worries and may even be followed by a moment of increased clarity. In the office setting, a patient encounter enhanced by a shared laugh brings warmth and authenticity to the patient-doctor relationship. For centuries, philosophers and social scientists have tried to understand what makes us laugh.
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AAOE Survey Supplements OPUS with Financial Benchmarking Data
This is the fourth and final article in a series discussing the results from the 20th American Alliance of Orthopaedic Executives Benchmarking Survey for orthopaedic practices. This article examines orthopaedic financial data in the United States.
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AAOS Partners with CareCredit to Improve Financial Experience for Orthopaedic Surgeons and Patients
AAOS has entered a new partnership with CareCredit, a leading health, wellness, and personal care credit card business.
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A New Medical Image-sharing Option Available for Free via the AAOS Member Advantage Program
Through the AAOS Member Advantage Program, members can be assured that the partners, programs, and products selected have been vetted by AAOS as practical, money-saving solutions for your professional and personal use.
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Exciting Benefits: The AAOS Member Advantage Program Provides Members with Special Discounts and Savings
The AAOS Member Advantage Program provides members with practical, money-saving solutions for personal and professional stability.
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Are You Ready to Change Your Practice?
Are you thinking about tapering back your surgical practice or retiring from surgery altogether? Are you tired of the electronic medical records (EMRs), insurance denials, and constant administrative changes? Do you worry about malpractice exposure, despite practicing a good standard of medicine? Does the adrenaline no longer surge when you are performing emergency cases?
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AAOS Practice Management Resources Can Strengthen Your Business
The Academy offers meaningful resources to keep your practice operating efficiently and your career on the right track. Visit the AAOS Practice Management Center at aaos.org/pracman to access a wealth of information and support, including the following items.
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Encouraging Professionalism in the Workplace Through Education
Increasing demands and changes in the healthcare system can both positively and negatively impact professional behavior. In light of the #MeToo movement, the focus on workplace behavior has intensified. As a follow-up to a session presented at the National Orthopaedic Leadership Conference in June, a symposium at the AAOS Fall Meeting in San Antonio, Texas, titled “Professional Behavior 2.
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Building and Managing Your Online Presence
According to a recent survey, 72 percent of Americans have used the Internet to search for health information within the past year. In addition, current statistics show that more than 2.3 billion people worldwide use social networks, and 78 percent of the U.S. population have a social network profile.
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Why Workers' Comp Matters
The current workers' compensation system is a medical driven legal compromise, commonly described as the "grand bargain" between employers and labor. The impact of the workers' compensation system was clearly stated as long ago as 1982, by Florida District Court of Appeals Judge E.R. Mills, in the case of Singletary v. Mangham Construction (418 So.2d 1138). According to Judge Mills, "Workers' Compensation is a very important field of law, if not the most important.
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A Remembrance: One Year since Tragic Killing of Preston J. Phillips, MD
On June 1, 2022, Preston J. Phillips, MD, FAAOS, died at the hands of one of his spine-surgery patients at the Warren Clinic Orthopaedic Surgery and Sports Medicine at Saint Francis Hospital in Tulsa, Okla.
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AAOS Member Slain in Exam Room
Orthopaedic surgeon Benjamin M. Mauck, MD, FAAOS, was shot and killed Tuesday inside a Campbell Clinic facility in Collierville, Tenn., reportedly by a patient.