Readmission Following Total Knee Arthroplasty
Venous Thromboembolism as a 'Never Event' is a Counterproductive Misnomer
The Orthopaedic Research and Education Foundation (OREF) congratulates James A. Keeney, MD, recipient of the Winter 2013 OREF/Current Concepts in Joint Replacement (CCJR) Clinical Practice Award.
The award recognizes Dr. Keeney’s investigation of venous thromboembolism (VTE) as a “never-event.” Never-events are defined by the U.S. Centers for Medicare and Medicaid Services (CMS) as hospital-acquired conditions considered to be reasonably preventable. To cut down on health care costs, the CMS has proposed reduction or elimination of reimbursements for such conditions.
Dr. Keeney and his research team found that wound complications, infection and bleeding caused readmission of TKA patients more often than VTE. They also found that these conditions are more costly than VTE. In addition, Dr. Keeney observed that the VTE cases occurred despite patients being treated with recommended prophylaxis after TKA, leading him and his team to conclude that it is not always preventable and therefore should not be considered a never-event. According to Dr. Keeney, to reduce health care costs the CMS should shift focus from VTE and instead concentrate on preventing more frequent causes for readmission after TKA.
Dr. Keeney earned his bachelor’s degree in biology in 1989 from the United States Air Force Academy where he was a distinguished graduate, second in his class of nearly 1,000. He received his medical degree in 1993 from Washington University School of Medicine (WUSM), St. Louis. After completing his internship and residency at Barnes-Jewish Hospital at WUSM between 1993 and 1998, Dr. Keeney served in the military in a number of roles between 1998 and 2010. These included: staff orthopaedic surgeon; orthopaedic surgery clinic chief; chief, adult reconstructive service; orthopaedic surgery consultant to the USAF surgeon general; and deputy chairman of orthopaedic surgery. During this time he was deployed to Kuwait, Armed Forces, Kuwait City; Operation Enduring Freedom, Seeb Air Base, Oman; and Operation Iraqi Freedom, Balad Air Base, Iraq. He also completed a fellowship in adult reconstructive surgery at WUSM.
In addition to his current positions as assistant professor of Orthopaedic Surgery at WUSM and chief of service for the Department of Veterans Affairs Medical Center, Dr. Keeney serves on the board of directors of the Society of Military Orthopaedic Surgeons and the American Academy of Orthopaedic Surgeons Anatomy Imaging Committee.
OREF/CCJR Clinical Practice Award
The OREF/CCJR award recognizes scientific achievement and clinical relevance through investigations that focus on health care policy, clinical outcomes, or translational research that have immediate clinical impact in the diagnosis and treatment of patients. Recipients receive a $2,000 honorarium and are reimbursed travel expenses associated with presenting their papers at an upcoming CCJR meeting.