JHS Journal Club

Created in 2018, the JHS Journal Club is a Twitter-based journal club that allows you to interact with other Journal of Hand Surgery readers and discuss interesting articles in JHS. You’ll participate in live meetings via Twitter, sharing thoughts with readers from around the world.

How to Participate

Step 1. Sign up for Twitter if you haven’t already. If you’re unfamiliar with Twitter, check out Twitter Guide: Getting Started.

Step 2. Join the conversation

Using the actual Twitter website or app is not the best option for participating, as you will be required to continually refresh your feed to follow the conversation. Try one of these easy alternatives:

  • Option 1 (highly recommended): Visit tchat.io and enter the hashtag #JHSJC to follow the conversation in real-time. The site will automatically add the #JHSJC hashtag to each of your tweets and make it easier for you to participate. An alternative to tchat.io is tweetchat.com. Be sure to allow access your Twitter account.
  • Option 2: Follow the #JHSJC hashtag as a saved search in a Twitter client such as Tweetbot (download for Mac, iPhone or iPad), which has the ability to continually stream when you are connected.

Step 3. Participate

Speak your mind!

  • If you’re following options 1 or 2 above, the #JHSJC hashtag will automatically be added to your tweets, so there’s nothing else you need to do.
  • If you’re using the Twitter website or app, be sure to include @JHandSurg and #JHSJC to your Tweets.

Questions? Contact us at jhs@assh.org.

June #JHSJC

June’s #JHSJC will take place on:

Date: June 11, 2019
Time: 9:00 p.m. EDT

Article #1

An In-Depth Review of Physician Reimbursement for Digit and Thumb Replantation
By Rachel C. Hooper, MD, Jennifer M. Sterbenz, BS, Lin Zhong, MPH, MD, and Kevin C. Chung, MD, MS

June 2019: Volume 44, Issue 6, Pages 443–453
Full article here: https://www.jhandsurg.org/article/S0363-5023(18)30858-X/fulltext
Free podcast available here: https://www.jhandsurg.org/pb/assets/raw/Health%20Advance/journals/yjhsu/June_2019.mp3

Summary

The authors used the Truven MarketScan data for years 2009-2016 to identify a sample of patients who had undergone revision replantation and who had undergone a replantation. They collected data on mean physician and hospital reimbursement and also calculated the work Relative Value Unit (wRVU) associated with both procedures. This was compared with the wRVU for common hand surgery procedures. Physician reimbursement varied from around $3300 to $7753. Hospital reimbursement varied to a much greater extent than did physician reimbursement leading the authors to conclude that factors related to payment for these two groups were independent from one another. When the reimbursement/wRVU was calculated, replantation was found to be reimbursed at a rate lower than any of the other procedures examined including revision amputation, carpal tunnel release, cubital tunnel release, trigger finger release, open reduction and internal fixation of distal radius fractures, digital nerve repair, flexor tendon repair and extensor tendon repair.

Points for discussion

  • Over 41,000 patients were excluded (from a starting number of 51,716), mostly because of what was thought to be miscoding: they were listed as “replantation” but treated as outpatients. In the end, there were just over 200 replantations and 6200 revision amputations analyzed. Should this sample be considered representative and the findings generalizable?
  • It might be argued by payers, that the reimbursement for replantation is appropriate and that the other procedures are overvalued. Could this data be used to realign how the wRVU’s are calculated in a way that would address the inequity by lowering the wRVU for the elective procedures?
  • Obviously, one of the reasons the wRVU for replantation is so much lower than that for the routine elective procedures, is the length of time it takes to perform a replantation. How should that be remedied? In other words, how should this information be used to change the status quo, especially given that it is unlikely that a large amount of new money will enter the pool for physician reimbursement in the future, value-based payment schemes?

Article #2

The Feasibility and Usability of a Ranking Tool to Elicit Patient Preferences for the Treatment of Trigger Finger
By Lauren M. Shapiro, MD, Sara L. Eppler, MPH, and Robin N. Kamal, MD

June 2019: Volume 44, Issue 6, Pages 480–486.e1
Full text here: https://www.jhandsurg.org/article/S0363-5023(18)30534-3/fulltext 

 Summary

The authors created a tool for ranking patient preferences for three trigger finger treatments: splinting/therapy, injection and surgery. The literature was used to describe the attributes of each treatment choice in terms of rate of success, complications, immobilization time, pain associated with treatment, anesthesia required and cost. Patients were asked to rank the importance of each attribute and then this information was used to guide a discussion regarding treatment choice. Thirty patients participated in the study. Using a scale to measure feasibility, the tool was thought to be easily implemented in the clinic and the authors noted that most patients found it satisfactory.

Points for discussion

  • The authors didn’t report on the attributes of the study sample in terms of insurance coverage, socioeconomic status or education. Are those factors that could influence the success of this strategy or should it be assumed that the findings are likely to be generalizable?
  • It easy to assume, even without a study, that patient preferences should play a substantial role in choosing treatment especially for conditions where there is evidence that a spectrum of treatments can considered. The condition chosen, trigger finger, is one for which the attributes can be easily contrasted because the condition itself is relatively minor. What are some of the challenges to using this strategy for the discussion of a more complex problem like distal radius fracture?
  • Decision aids that incorporate patient preferences are very likely to appear prominently in electronic documentation systems of the near future. How likely is it that they can accurately capture an individual patient’s ideas in a way that can be operationalized to fit such a system – one that is likely to be favored by payers emphasizing a value-based reimbursement approach? What challenges lie ahead from the point of view of care providers?

Previous #JHSJC Discussion Articles

May 2019
Article 1: Sonographic Findings Associated With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31113-9/fulltext)
Article 2: Correlations Among Objectively Measured Impairment, Outcome Classification Systems, and Subjectively Perceived Disability After Flexor Tendon Repair (https://www.jhandsurg.org/article/S0363-5023(18)30794-9/fulltext)

April 2019
Article 1: Evaluation of Version 2.0 of the PROMIS Upper Extremity Computer Adaptive Test in Nonshoulder Upper Extremity Patients (https://www.jhandsurg.org/article/S0363-5023(18)30376-9/fulltext)
Article 2: Defining Quality in Hand Surgery From the Patient’s Perspective: A Qualitative Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30789-5/fulltext)

March 2019
Article 1: False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30599-9/fulltext)
Article 2: Effect of Radial Nerve Release on Lateral Epicondylitis Outcomes: A Prospective, Randomized Double-Blinded Trial (https://www.jhandsurg.org/article/S0363-5023(18)30793-7/fulltext)

February 2019
Article 1: Opioid Prescriber Education and Guidelines for Ambulatory Upper-Extremity Surgery: Evaluation of an Institutional Protocol (https://www.jhandsurg.org/article/S0363-5023(17)31857-9/fulltext)
Article 2: Variation in Nonsurgical Services for Carpal Tunnel Syndrome Across a Large Integrated Health Care System (https://www.jhandsurg.org/article/S0363-5023(17)32092-0/fulltext)

January 2019
Article 1: Intermediate-Term Outcome After Distal Radius Fracture in Patients With Poor Outcome at 1 Year: A Register Study With a 2- to 12-Year Follow-Up (https://www.jhandsurg.org/article/S0363-5023(18)30248-X/fulltext)
Article 2: External Fixation Versus Volar Locking Plate for Unstable Dorsally Displaced Distal Radius Fractures—A 3-Year Follow-Up of a Randomized Controlled Study (https://www.jhandsurg.org/article/S0363-5023(18)30023-6/fulltext)

December 2018
Article 1: Predicting Clinical Outcome After Surgical Treatment in Patients With Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(18)30650-6/fulltext)
Article 2: Cost-Effective Management of Stenosing Tenosynovitis (https://www.jhandsurg.org/article/S0363-5023(17)30874-2/fulltext)

November 2018
Article 1: Outcome of a Hand Orthosis and Hand Therapy for Carpometacarpal Osteoarthritis in Daily Practice: A Prospective Cohort Study (https://www.jhandsurg.org/article/S0363-5023(17)30684-6/fulltext)
Article 2: Cost Implications of Varying the Surgical Technique, Surgical Setting, and Anesthesia Type for Carpal Tunnel Release Surgery (https://www.jhandsurg.org/article/S0363-5023(17)31145-0/fulltext)

October 2018
Article 1: The Effectiveness of Mini–C-Arm Fluoroscopy for the Closed Reduction of Distal Radius Fractures in Adults: A Randomized Controlled Trial (https://www.jhandsurg.org/article/S0363-5023(17)30746-3/fulltext)
Article 2: Pain Management After Carpal Tunnel Release Surgery: A Prospective Randomized Double-Blinded Trial Comparing Acetaminophen, Ibuprofen, and Oxycodone (https://www.jhandsurg.org/article/S0363-5023(18)30652-X/fulltext)

September 2018
Article 1: A Prospective Comparison of Diagnostic Tools for the Diagnosis of Carpal Tunnel Syndrome (https://www.jhandsurg.org/article/S0363-5023(17)31445-4/fulltext)
Article 2: Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties (https://www.jhandsurg.org/article/S0363-5023(16)30694-3/fulltext)

August 2018
Article 1: Association Between Radiological and Patient-Reported Outcome in Adults With a Displaced Distal Radius Fracture: A Systematic Review and Meta-Analysis (https://www.jhandsurg.org/article/S0363-5023(18)30613-0/fulltext)
Article 2: Cost of Surgical Treatment for Distal Radius Fractures and the Implications of Episode-Based Bundled Payments (https://www.jhandsurg.org/article/S0363-5023(18)30629-4/fulltext)

July 2018
Article 1: Immediate Versus Overnight-Delayed Digital Replantation: A Comparative Retrospective Cohort Study of Survival Outcomes (https://www.jhandsurg.org/article/S0363-5023(18)30459-3/fulltext)
Article 2: Arthroscopic Diagnosis of the Triangular Fibrocartilage Complex Foveal Tear: A Cadaver Assessment (https://www.jhandsurg.org/article/S0363-5023(17)30956-5/fulltext)