How to prevent pulmonary function deterioration has been a focus in the management of boys with Duchenne muscular dystrophy (DMD) for many years. Since the 1980s it has been thought that an increasing scoliosis is associated with declining pulmonary function at a rate even greater than that from the effects of muscle weakness. As a result, it is common for surgery to be recommended for patients with DMD once a scoliosis of greater than 20 degrees is noted, a much lower threshold than is used for surgical treatment of idiopathic scoliosis. This practice assumes that surgical correction reduces the worsening of pulmonary function, but solid data to support that view has been absent.
The article “Functional Outcomes in Duchenne Muscular Dystrophy Scoliosis” in the March 5, 2014 JBJS confirms that surgical treatment of scoliosis in DMD does lead to better vital capacity, compared with no surgical treatment. However, before deciding that all DMD patients will need spine surgery to slow down pulmonary function worsening, surgeons should keep in mind the current efficacy of early treatment with corticosteroids to prevent scoliosis in this patient group. Not only does corticosteroid treatment prevent scoliosis development in the majority of kids, but the deterioration in pulmonary function is also slowed compared to those without this treatment.
With the information on pulmonary function provided in this article, we now have concrete data for use in discussions with parents on whether to select early treatment with corticosteroids to prevent scoliosis or to wait for surgical correction later. Surgery has risks associated with cardiac and pulmonary compromise inherent in DMD, and corticosteroids carry the risk of stunted growth and the development of cataracts in many patients. This article contributes useful hard data to enhance the process of shared decision making for the spinal care of children with DMD.
The medical landscape is always changing. With the Affordable Care Act, implementation of ICD-10, and penalties for not participating in the Physician Quality Reporting System (PQRS), practices have a lot of challenges ahead.
To help meet those challenges, orthopaedic surgeon Thomas C. Barber, chair of the AAOS Council on Advocacy, recommends that practices consider expanding ancillary services such as MRI or physical therapy. He also advises that practices should bill for all services rendered and use marketing and enhanced relationships with referring physicians to solidify their business. Finally, astutely observe the trends in your local health care community, such as ACO formation and changes in surgeon/hospital relationships. Barber says that understanding your practice’s economics and local environment will help you see opportunities for merging or collaborating with other practices.
According to orthopaedic surgeon Dr. Howard Luks, there is a big difference between a “digital” doctor and a “social” doctor even though many use the words interchangeably. In a recent blog, Luks said the real opportunity is when a doctor uses digital technology to improve communication between clinician and patient. He says that doctors typically use social media for interaction with other doctors. His sentiments concur with the results of the recent JBJS survey mentioned above, where VuMedi was ranked above all other social media sites by orthopaedic surgeons. Dr. Luks concluded that “being a social doctor means you are interested in collaborating, sharing information and lending your expertise.”
Oct. 1, 2014 is the deadline for ICD-10 conversion. However, according to a survey from the Workgroup for electronic data interchange, 8 out of 10 practices have not begun testing and only half have begun the initial steps of impact assessment. Some attribute these delays to their IT vendors not being ready; 40% of vendors said their products won’t be ready before 2014. There has been discussion about The Centers for Medicare and Medicaid Services (CMS) possibly delaying the deadline again or an “enforcement-free” period of 6 months, but CMS has resisted that idea.
On a more positive ICD-10 note, Sutter Health of California is planning on going live this May, a result of its 3-year planning efforts. The May launch will give Sutter doctors a five-month test period before the deadline. Danielle Reno, Sutter’s ICD-10 program director said, “We won’t be submitting claims to payers in ICD-10, but we will turn it on, and physicians will be able to use it.” Another company testing its ICD-10 plans is North Carolina Healthcare Information & Communications Alliance (NCHICA). Holt Anderson, executive director at NCHICA, ran a test pilot with some of the best coders, and there were still significant concerns about accuracy. Using “dual coders” who coded in both ICD-9 and ICD-10, only 55% of the transition scenarios were accurate in the first wave of testing.
Concierge medical practices are a growing segment of the healthcare industry. In a concierge practice, patients pay a retainer fee to the practice to assure that they can see their doctor when needed, whether that is the same day or next day. Patients in concierge practices have more time with their physician, and they receive prompt call backs and much more attention — even house-calls. But for a physician considering transition to this type of practice, one of the first things to consider is downsizing the number of patients.
According to Dr. Thomas LaGrelius, a family physician who transitioned from a traditional practice to a concierge practice, “If you’re going to do a comprehensive wellness exam on everyone once a year, it takes an hour or two.” He continues, “That limits you to a membership base of about 600 patients — maybe 800 if they’re younger, healthier people.” Some physicians balk at the idea of downsizing their patient panels, but for Dr. LaGrelius, doing so gave him more time to focus on each patient. But before going concierge, Dr. LaGrelius met with key thought leaders and consultants to help make the transition. The transition to a concierge practice can be most challenging for physicians who don’t have a loyal patient-base.
Ankle & Foot Pro III is one of the highest-rated apps for orthopaedic surgeons, according to TopOrthoApps, a mobile app review site. This app receives outstanding ratings in functionality, coolness, and overall features. Ankle & Foot Pro III gives a visual look at anatomy with high-level, 3-D views into muscles, tendons, nerves, vessels, ligaments and bones. The app features easily manipulated views, a “pen” feature for drawing on the screen, “pins” that identify structures of different layers, and videos demonstrating surgical procedures.
This year’s Medscape’s 2014 Lifestyle Report dives deeply into the lives of physicians outside their practices. The 2014 report, which covers 25 specialties and includes close to 32,000 responses, examines physician health (both physical and spiritual), political beliefs, marital status, and happiness both at work and outside of the office. The report shows that orthopaedists are the most financially stable physicians among the 25 specialties. Family physicians and internists are at the opposite end of the spectrum, with less than 6 out of 10 feeling they have adequate or more than adequate savings. On the happiness scale (login required), 67% of orthopaedists said they are very or extremely happy at home, while 42% of them report being extremely/very happy at work. The least happy physicians at work are family and emergency medicine physicians; only 36% of respondents in those specialties said they were happy at work, with internists and radiologists following closely at their heels.
Although nearly 30% of group orthopaedic practices are now owned by hospitals, the 2013 JBJS Role of the Orthopaedic Surgeon study finds that orthopaedic surgeons still exercise powerful voices when it comes to which products and devices get purchased. The percentage of orthopaedic surgeons claiming influence over purchases has been remarkably stable at greater than 90% for the past two years, and surgeons’ influence continues to extend through most stages of procurement processes. Even surgeons in practices owned by hospitals remain actively involved in procurement, except for supplier price and contract negotiations.
Much controversy exists over mobile app usage. According to a recent survey from Netbiscuits, a mobile software firm, almost 80% of respondents said they would prefer using a mobilized website rather than downloading an app. Only 27% of consumers say they frequently download an app when prompted to do so. Three-fourths said they will not use a brand’s website on a mobile device if it is not optimized for mobile. With 25% of consumers spending about six hours a day on the web through their mobile device, “mobilizing” your website could pay off handsomely. Read more.
Although 74% of doctors are using smartphones for work, app usage isn’t growing very quickly, according to a March 2013 study by Kantar Media. The most common type of app used by doctors on a smartphone (72%) is for diagnostic and clinical-reference purposes, up from 70% in March 2012. Drug and coding reference app usage is also up slightly from 2012 from 61% to 64%. EMR apps are used on smartphones by less than 15% of doctors. Among tablet users, the apps most often used are for medical journals/ newspapers/magazines (73%) followed by diagnostic tools/clinical references (61%), and EMR (49%). Read more here.