CMS, EDS, and ABOS

Chuck and Chris have a potpourri of topics including CMS proposed changes for 2027 (not good for hand surgery), cases, and two listener submitted topics: board preparation and caring for patients with ligamentous laxity/ Ehlers Danlos.

Chuck references Christian Pean's Substack called 'Techy Surgeon' as a great resource for value based care and all things tech including AI insights.

See www.practicelink.com/theupperhand for more information from our partner on job search and career opportunities.

The Upper Hand Podcast is sponsored by Checkpoint Surgical, a provider of innovative solutions for peripheral serve surgery. To learn more, visit https://checkpointsurgical.com/.

As always, thanks to @iampetermartin for the amazing introduction and concluding music.

For additional links, the catalog.  Please see https://www.ortho.wustl.edu/content/Podcast-Listings/8280/The-Upper-Hand-Podcast.aspx

Transcript

CMS Reimbursement Changes Discussion

Charles and Christopher discussed upcoming CMS reimbursement changes affecting various medical specialties, with orthopedics projected to decrease by 7%, plastics by 3%, and hand surgery by 5%. They explained that the new fee schedule includes a proposal affecting modifier 25 codes, which would reduce reimbursement for procedures like injections when performed on the same day as other services. While many surgical specialties are facing decreases, non-surgical specialties are seeing increases, and mentioned the American Medical Association's Hand Society is actively working on government affairs to address these changes.

P1 Phalanx Fracture Treatment Challenges

Christopher and Charles discussed challenges in treating P1 phalanx fractures with rotational deformities, agreeing that evaluation and careful reduction techniques are crucial but not always straightforward. They also addressed the limited utility of CT scans for distal radius fractures, preferring traditional X-rays and clinical assessment for surgical planning. The conversation concluded with a discussion about preparing for board certification, particularly the importance of collecting and formatting case data for Part 2 of the exam.

Orthopedic Surgery Board Preparation

Charles and Christopher discussed board preparation for orthopedic surgery, emphasizing the importance of thorough patient documentation, collecting the right data, and justifying clinical decisions with current literature. 

Hypermobility Discussion (Ehlers Danlos Syndrome)

They addressed treating patients with hypermobility, noting higher surgical failure risks and recommending bony procedures when possible, while advising careful counseling about potential complications. 

The conversation concluded with plans for future podcast episodes focusing on tips for new fellows and hand surgery spotlights.