Articles Posted in Orthopedics & Sports Medicine

dcscooter-300x150In the cooler, rainier autumnal weather, transportation officials may be planting the seeds of significant change for the health, safety, and way that residents and visitors get around Washington, D.C. They may allow a smaller number of private companies to double the number of scooters zipping around the nation’s capital by the new year. By the spring, the devices may quadruple in number.

This could mean the estimated 5,000 or more scooters in the district now would increase to 10,000 by January and to 20,000 by June.

District officials say they’re responding to a spike in demand from the public for convenient ways to get around and to do so with needing to use multiple clumsy and confusing smart phone apps.

ctscan-300x214As Walmart tries to work with its 1 million-plus U.S. employees in controlling health care costs, the retailing giant has not only struck a blow for quality medical treatment, it also has raised key questions about a costly and booming specialization in health care: medical imaging.

Walmart decided to shake up this diagnostic field by telling its employees to pay more themselves or to first seek CT scans and MRIs at one of 800 imaging centers that a company-retained health care consulting firm has identified as providing high-quality care. Covera Health, a New York City-based health analytics company, “uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments,” Kaiser Health News Service reported.

KHN reporter Phil Galewitz said Walmart targeted improved imaging based on the giant retailers’ experiences already in funneling workers to select facilities its research has found to offer efficient, high-quality care in specific areas, such as organ transplantation, back and knee surgeries, and heart and cancer treatment.

Bracescamarrest-238x300Federal authorities have busted up what they say is a $1.2 billion Medicare fraud that should give taxpayers and patients pause about long-distance medical consultations and the huge sums of cash washing around the medical device industry.

Two dozen people, some of them doctors, have been charged in a complex ploy to gull seniors into asking about back, shoulder, wrist, and knee braces that were promoted as free on TV and radio ads nationwide. When the older adults called to inquire about the devices, they were transferred to telemarketing centers in the Philippines and Latin America.

In the far-away boiler rooms, trained operators extracted important personal information from callers, then connected them for “telemedicine” consultations with cooperating doctors. The MDs asked cursory questions before then prescribing the devices, whether needed or not. The orders were filled by select companies, which then would send out the braces and charge them to Medicare.

footballinsurance-300x218Parents and young athletes may have wrestled with the decision whether to play contact sports, as research shows the injuries that players can suffer from blows to the head. But lesser known parties to the games may be the undoing of  professional and organized soccer, hockey, and football: Insurance companies.

The firms, which provide necessary and invaluable protections to players and organizations by spreading the financial risks of harms, have fled professional and amateur sports, declining to offer them coverages, even at high costs, Steve Fainaru and Mark Fainaru-Wada of ESPN’s Outside the Lines program reported.

Insurers are balking not only at providing liability policies but also worker compensation for pros, ESPN says. The dearth of coverage has hit hard the NFL, collegiate and Pop Warner programs, as well as football helmet makers. They’re forced to hunt far and wide for the few firms willing to assume sports risks — and they pay high and accordingly, if they can get policies.

knees-300x81With a graying nation projected to see millions of patients undergoing knee replacements each year at an annual cost to taxpayers running in the billions of dollars, it may be past time to ask if surgeons and hospitals promote and perform these popular procedures to excess.

Liz Szabo, in a story written for the nonprofit, nonpartisan Kaiser Health News Service (KHN) and published in the Washington Post, reported that knee surgeries have their “risks and limitations,” and “doctors are increasingly concerned that the procedure is overused and that its benefits have been oversold.”

As she wrote:

When doctors, hospitals, insurers, and their captive lawmakers howl about how unfair malpractice lawsuits allegedly can be for modern medicine, patients who have suffered harms while seeking medical services should require loved ones, friends, and members of their community to view Bleed Out.

This new HBO documentary details the decade-long quest by comedian Steve Burrows and his family for justice for his mother, Judie. She was an energetic, retired teacher when she fell from her bike and needed emergency hip surgery. Before she had recovered, she fell again and needed a second operation. But this time, something went wrong: She lost more than half her blood, fell into a coma, and suffered irreversible brain damage that meant that she would spend the rest of her life in institutional care in rural Wisconsin.

cdcheadsup-300x111Common sense and moderation can matter a ton in maintaining good health, as recent news reports show, particularly with kids and concussions, middle-aged adults and heart disease, and collegiate alcohol abuse.

With youngsters returning to school and so many of them participating in sports and recreation programs, it’s good that the federal Centers for Disease Control and Prevention has issued evidence-based guidance on protecting kids who suffer mild traumatic brain injury or what most of us would call concussions.

These injuries have become a growing concern for parents and young athletes. Sports leagues and sporting groups are coming to a time of reckoning with just how harmful head trauma can be.

Bundle-300x151Federal regulators may be forced to reconsider their plans to curtail a cost-containing experiment that affects some of the most commonly performed surgeries — knee and hip replacement procedures that hundreds of thousands of seniors undergo annually through their Medicare coverage at a cost to taxpayers of billions of dollars.

Under the Affordable Care Act, doctors and hospitals were pushed to adopt a new and different way to think about and to bill for these surgeries, which, by the way, aren’t risk free. Instead of patients getting flooded with bills from each provider involved — the lab, radiologist, anesthesiologist, surgeon, hospital, and so forth — Obamacare got all the parties together and told them they would get a single, “bundled payment.” Hospitals, typically, then acted as the chief point of contact, getting the providers to figure their fair share, billing patients (once), and collecting reimbursements and distributing them appropriately.

The system seemed to work: costs declined, the quality of care went up, and patients expressed relief that their mailboxes weren’t jammed with a blizzard of the usual incomprehensible medical bills. But doctors, hospitals, and insurers kept grumbling. The Trump Administration and Republicans in Congress, as part of their relentless and counter-factual assault on the ACA (more on that in a second), took aim at bundled payments and talked about changing and eliminating this approach.

ncaalogo-300x200College football has kicked off its fall season with a flourish, but the signs are increasing that concerns about players’ health and safety may slash at the game’s size, spectacle, and importance.

Just as the pro leagues were forced to answer in court for the harms that athletes suffer due to repeated blows to their heads, the National Collegiate Athletic Association (NCAA) has been hit with claims in the civil justice system, asserting wrongful deaths of players from the recent past.

Lawsuits, believed to be part of what will be a wave, were filed against the college sports conference on behalf of the survivors and estates of a onetime University of Southern California fullback and a University of California at Los Angeles running back.

mcnair-240x300In College Park, Md., new cooling tents have sprouted on the University of Maryland’s football practice field, where the training staff also is taking pains now to provide adequate cold drinks and breaks to players. Observers say the pre-season regimens, however, are not only marked by greater attentiveness to the young athletes’ needs, they’re also eerily quiet and somber.

That’s because top Terps leaders have apologized and conceded the school shares blame for the tragic and preventable heat stroke death of Jordan McNair, 19, a Maryland offensive lineman. Coaches forced the young man to run and over-exert himself during a May 29 practice. More importantly, they failed to diagnose the severity of his condition, neglecting to so much as take his pulse and blood pressure, and, in a disputed account, not noticing that he was suffering seizures, or acting fast to drop his body temperature with ice and cooling baths.

Published reports suggest he showed heatstroke signs before 5 that afternoon, though trainers did not call for emergency help and an ambulance until nearly 6, when his body temperature may have hit 106 degrees. He was admitted to a hospital, where nurses and doctors immersed him in a cooling bath and reduced his temperature to 102 degrees — 90 minutes or so after he apparently got into distress.

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