This week (December 1-6, 2014), 120 people in 23 states are scheduled to receive a hip or knee replacement free of charge. These gifts of pain-free mobility come from Operation Walk USA, a coalition of 85 orthopaedic surgeons that has provided more than $13 million in services to nearly 500 patients since 2010. Patients eligible for Operation Walk USA services are US citizens and permanent residents who do not qualify for government assistance programs but cannot afford the surgery on their own.
Case in point is 50-year-old Army veteran David Chalker, who is scheduled for a bilateral hip replacement this week. Unrelenting and severe hip pain forced Chalker to leave his machinist job, which in turn led to mounting debt and an inability to afford health insurance.
New Albany, Ohio orthopaedist Dr. Adolph Lombardi, Operation Walk USA’s founder, told Reuters that finding hospitals willing to donate space is the biggest barrier to the program’s growth. But thanks to additional non-physician volunteers such as nurses, technicians, and physical therapists, pre- and post-operation services are also free for patients. And device manufacturers donate the implants.
“When will I be able to play again?” Following ACL reconstruction surgery, that’s a question physical therapists and orthopaedic surgeons invariably hear—often repeatedly—from their athletically inclined patients.
The multiple factors that go into answering this difficult question are the subject of this complimentary webinar.
Current evidence suggests that approximately 50 to 60 percent of patients post ACL-reconstruction eventually return to sports at preinjury levels. But the timing of that return—and the many variables leading to it—create a series of challenging clinical decision points. This webinars explores the most relevant surgical, rehabilitative, and patient-centered factors that contribute to sound decisions in which surgeons, physical therapists, and patients participate fully.
Moderated by Robert Marx, MD, JBJS Associate Editor for Evidence-based Orthopaedics, this webinar focuses on two articles, one from each journal.
After the articles’ primary authors present their data, two additional return-to-sports experts add their perspectives to this body of research.
Robert Marx, MD
Freddie Fu, MD and Terese Chmielewski, PT, PhD, SCS
Kevin Wilk, PT, DPT, FAPTA and Kurt Spindler, MD
This webinar is brought to you by the Journal of Orthopaedic & Sports Physical Therapy and The Journal of Bone and Joint Surgery
Kantar Media’s recent Mobile Device Usage Study evaluated 17 mobile apps. The study asked, orthopaedists which apps they used in the prior six months, time spent per usage, and how the apps they used performed on seven key performance metrics. JBJS Reviews (reviews.jbjs.org), an online review journal launched just one year ago, ranked first among orthopaedic app users in time spent as well as in the overall rating for the seven key performance indicators.
JBJS Reviews ranked #1 on delivering quality clinical content, keeping surgeons informed on the latest practices and procedures, and as being one of the top professional resources.
The survey also measured how physicians use tablets and smartphones. According to the study, physicians use smartphones primarily for managing contact information, texting colleagues, taking static images, maintaining their calendar and appointments, and emailing colleagues. The number-one for which doctors said they use tablets was viewing video, followed by receiving medical news.
The study also looked at the types of apps used on the two types of devices. The apps most frequently used on smartphones are for drug references. Tablet users use both medical journal apps and apps to access EHRs.
The JBJS Reviews App is available for iPhone, iPad, and Android devices.
According to data published in the New England Journal of Medicine in 2011, nearly 15 percent of orthopaedic surgeons are likely to face a medical liability claim each year, and the cumulative likelihood of an orthopaedic surgeon facing such a claim by the age of 45 is 88 percent. In addition to statistics like this that suggest a flawed system, the tort-based medical malpractice system has not proven to deter substandard care or improve patient safety–and neither has the tort-reform approach to improving the existing liability environment.
Alternatives to tort reform may provide a ray of hope. A recent JAMA article summarized what it calls “a welcome influx of creative initiatives that transcend traditional reforms.” The Mello et al. article evaluates nontraditional approaches that were or are being tested during demonstration projects supported by the Agency for Healthcare Research and Quality (ARHQ). The article devotes much of its space to the so-called communication-and-resolution approach pioneered by the Lexington, Kentucky VA hospital and the University of Michigan Health System. The worth-reading article also covers mandatory presuit notification and apology laws, judge-directed negotiation programs, clinical guideline-based safe-harbor laws, and administrative compensation systems.
In a recent AAOS Now article citing possible barriers to widespread implementation of these and other no-fault approaches to medical liability reform, David Sohn, MD, JD, identifies the trial lawyer lobby as probably the biggest political hurdle that needs to be overcome.
Many orthopaedic surgeons still believe that physical therapy (PT) services simply add to the total cost of care without improving patient outcomes. During my orthopaedic education, several knowledgeable attending surgeons said patients can be shown exercises in the orthopaedic clinic and do them on their own to avoid the increased expense of PT services. This belief extended to preoperative PT (“prehab”) to prepare patients for joint-replacement procedures. Until now, the impact of prehab on the total cost of care had not been rigorously evaluated.
In a well-designed study in the October 1, 2014 edition of The Journal, Snow et al. investigated whether preoperative PT affected total episode-of-care cost for hip- and knee-replacement procedures. They used CMS (Centers for Medicare & Medicaid Services) data from 169 urban and rural hospitals in Ohio and gleaned 4733 complete records to answer the question. The outcome measures of interest were utilization of post-acute care in the first 90 days after the procedure and total episode-of-care costs. The study defined post-acute care as admission to a skilled nursing facility, use of inpatient rehabilitation services, or use of home health services.
Nearly 80% of patients who did not receive preoperative PT services utilized post-acute care services, compared with 54% of patients who did receive prehab services. This resulted in a mean cost reduction of $871 per episode (after adjusting for age and comorbidities), with much of the savings accruing from decreased use of skilled nursing facilities. In their discussion, the authors note that prehab in this study generally consisted of only one or two sessions, and they therefore suggest that “the value of preoperative physical therapy was primarily due to patient training on postoperative assistive walking devices, planning for recovery, and managing patient expectations, and not from multiple, intensive training sessions to develop strength and range of motion.”
So it seems that prehab can reduce the overall cost of care in the setting of joint replacement. Further investigations using commercial insurance datasets to supplement this CMS data will be useful in developing treatment protocols and policies in this age of global payments for episodes of care.
Marc Swiontkowski. MD, Editor-in-Chief, JBJS
The Impact Factor uses a simple calculation – number of citations to scholarly articles published in a two-year period divided by the number of those articles. The resulting number allows various constituencies to compare the purported intellectual impact of a particular journal against other comparable journals and to trend impact over time.
For years, The Journal of Bone & Joint Surgery has focused on giving surgeons at the interface of clinical practice and academic research the best information possible, making the Impact Factor a number we didn’t focus on much. Our measurements of reader feedback and engagement have been much more important, and will continue to be.
Still, imagine our pleasant surprise when this year our Impact Factor rose dramatically, increasing 33% from 3.234 to 4.309. In addition, measurements such as what Thomson Reuters calls the “Article Influence Score” roughly doubled for JBJS.
There are many reasons for increases like this, but excellent editorial content is clearly the leading candidate for praise. As you know, Vern Tolo, MD, recently transitioned out of the role of Editor-in-Chief for The Journal. He clearly deserves much of the credit for these numbers, which occurred under his careful editorial stewardship. The Journal’s superb Deputy Editors, methodology and statistical consultants, and editorial staff also deserve praise for consistently pushing the standards of The Journal higher.
Best of all, our Impact Factor rose while our engagement with readers also increased. Recent readership surveys show that our readers are reading us in print as much as ever, online more than ever, and engaging with our social media outlets more and more every day..
We’re proud that JBJS has increasing impact as an orthoapedic journal. Our goal remains the same, however – to have a positive impact on surgical expertise, patient care, and outcomes.
According to a recent JBJS readership study among more than 1,000 orthopaedic surgeons, print readership of JBJS remained fairly consistent from 2012 to 2014; 91% accessed the JBJS print edition frequently/occasionally in 2012, and 87% did so in 2014. The percentage of respondents accessing JBJS online access jumped significantly from 58% in 2012 to 74% in 2014. Roughly 30% cited reading all/most of their issue in both the 2012 and 2014 studies.
Additionally, the survey revealed a slight increase in relevancy of JBJS to clinical practice/research compared to 5 years ago. In 2012, 33% stated JBJS was more relevant compared to the past 5 years; in 2014 36% rated JBJS more clinically relevant that it was 5 years prior.
With medical costs under constant scrutiny, the Vanderbilt Orthopaedic Institute Center for Health Policy conducted a study titled “Patterns of Costs and Spending Among Orthopaedic Surgeons Across the US.” The authors sought to determine orthopaedic surgeon contributions to total health care expenditures, and the results were recently published online in the American Journal of Orthopaedics. With 1,214 people responding to the survey (a 61% response rate), results showed that the average monthly expenditure per US orthopaedic surgeon is $33,436, or a little more than $400,000 a year. That means that the 20,400 orthopaedic surgeons spend about $8.2 billion a year. The results showed some differences in spending by type of practice and geographic location, with private practices in the Northeast tending to spend the most. The findings may help orthopaedic surgeons analyze their spending to lower costs without sacrificing quality.