April 2000 Bulletin


Documentation still a problem, says IG in FY 1999 audit

Medicare documentation errors by providers increased to $5.5 billion in fiscal year 1999 from $2.1 billion in FY 1998, according to an audit of 5,223 claims by the Inspector General of the Department of Health and Human Services. Of the $5.5 billion, $4.4 billion was due to insufficient documentation and $1 billion to no documentation. Physicians’ claims were responsible for $1.7 billion of the documentation errors. Errors due to lack of medical necessity amounted to $4.4 billion. Incorrect coding represented $2.1 billion in improper claims. Physicians accounted for $1.5 billion of these errors. The IG estimates that improper Medicare payments totaled $13.5 billion in FY 1999 or almost 8 percent of the $169.5 billion processed fee-for-service payments.

Plan international societies forum to focus on patients

Planning for the formation of the World Orthopaedic Forum is expected to begin this fall. The forum is being developed to allow representatives of international orthopaedic societies to meet and address shared concerns and advance the organization and practice of orthopaedics throughout the world. The main focus will be on the patient and improved orthopaedic care. The first formal meeting of the forum is expected to be held at the AAOS Annual Meeting in February 2001 in San Francisco. Presidents of international orthopaedic societies discussed the formation of the forum during the Annual Meeting in Orlando, Fla. last month.

Data on 70 million records to give new insights

How many spinal surgeries are performed in Boston; Milwaukee; and in Ft. Myers Fla.? What are the outcomes in each area? Are there more joint replacement surgeries in academic or nonacademic communities? What is the distribution of workforce across the United States? The data providing the answers are being assembled for the Dartmouth Atlas of Musculoskeletal Health Care, which is expected to be published this summer by the American Hospital Association. James N. Weinstein, DO, principal investigator and editor, says information is being drawn from the Medicare data on 35 million patients over a two-year period, or 70 million records. The publication will give a comprehensive look at musculoskeletal health care nationally and in geographic areas. Data will reveal trends and geographic variations in the physician work force and specific areas of musculoskeletal health care, including the spine, total joint replacement and fractures. Data will include the rates of surgery over time and allow comparisons with work force trends. In addition to examining the distribution of the physician workforce across the nation, "we’ll try to suggest benchmarks such as what is the potential for orthopaedic surgeons in geographic area and projections for the future supply (of orthopaedists)," Dr. Weinstein said.

Musculoskeletal problems big factor in lost workdays

The Bureau of Labor Statistics (BLS) estimates that in 1997 there were 1.8 million injuries and illnesses that required time off from work. Of these, more than one-half involved musculoskeletal injuries. The BLS says there were 799,000 incidents of sprains and strains; 119,500, fractures; 29,200, carpal tunnel syndrome; 18,000, tendonitis, and 10,900 amputations.

Listen, learn put patient first: Dr. Canale

Although orthopaedic surgeons have been forced to focus on managed care issues in recent years, it’s time to turn attention back to their patients, S. Terry Canale, MD, AAOS president told members at the Business Meeting during the Annual Meeting in Orlando, Fla., last month. "We have been forced to sacrifice quality of care for quantity of care," Dr. Canale said in his first vice president’s speech. He urged members to reeducate themselves on listening to and communicating with their patients. And, he urged members to rededicate themselves to continuing medical education and learn the very best treatment options.

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