ACS Surgery News

The comments are in and shaping of the final Medicare Physician Fee Schedule for 2016 rests now in the hands of officials at the Centers for Medicare & Medicaid Services. What are the key provisions doctors need to know about to practice successfully in 2016? Experts gave their opinions in a webinar sponsored by the American Health Lawyers Association (AHLA).

Physician Quality Reporting System (PQRS)

CMS proposes to audit not only physician participants, but also vendors who submit quality measure data on behalf of doctors, under the 2016 proposed fee schedule. The agency recommends that vendors make available contact information for each eligible practitioner on behalf of whom it submits data and retain data submitted to CMS for PQRS for 7 years.

Doctors who fail to report on nine quality measures for PQRS will not automatically face trouble, according to Daniel F. Shay, a health law attorney in Philadelphia. In general, individual physicians in PQRS must report on at least nine measures covering three National Quality Strategy (NQS) domains for at least 50% of their Medicare patient base. But if fewer than nine measures are reported, physicians have the chance to explain themselves.

“In some cases, a practice may not have at least nine measures that apply to it, Mr. Shay said. “The [eligible practitioner] would then be able to report on fewer than nine measures, but would be subject to the measure application validity process, which basically means CMS audits the provider to prove they couldn’t have reported on all of the required measures.”

Also, CMS proposes extending participation in PQRS to doctors who practice in critical access hospitals, according to the 2016 proposed fee schedule. PQRS is a voluntary quality reporting program that applies adjustments to payments based on benchmarks. CMS is suggesting that physicians who practice in certain critical access hospitals now have the option to participate in the program – such doctors were previously excluded.

Incident to service

When overseeing care that is “incident to” service, CMS proposes that billing physicians also act as supervising physicians. The proposal could significantly impact group practices who do not typically use that structure, said Washington health law attorney Julie E. Kass during the AHLA webinar.

Incident to is defined as services furnished incident to a physician’s professional services over the course of a patient’s diagnosis or treatment. Medicare pays for services rendered by employees of a physician only when all “incident to” criteria are met. Those criteria include that services rendered by nonphysicians are under the direct supervision of a physician physically in the same office suite. In the proposed 2016 rule, CMS seeks to clarify that the billing physician must be the same physician who supervises the ancillary personnel. Previously, group practices may have billed under the provider who ordered the treatment, according to Ms. Kass.

“It sounds simple, but then you put it into the context of what happens in a real life practice,” she said. “I think a lot of practices, in operationalizing this rule, have generally used the ordering physician as the physician who billed for the service without paying a lot of attention to who was the actual supervising physician.”

Group practices may want to rethink how they bill for incident to services, and ensure the billing physician is the one who supervises the treatment, she advised.

The Stark Law

Proposed changes to regulations implementing the Stark Law could make it easier for physicians to hire new nonphysician providers (NPP) to provide primary care. Under the fee schedule proposal, hospitals would be allowed to assist in the recruitment of health professionals for physician practices. Currently, hospitals may not because remuneration could be considered a compensation relationship between the hospital and physician practice. The proposed change aims to promote care team collaboration and help curb primary care shortages.

The exception would permit recruitment assistance and retention payment from a hospital, rural health clinic, or federally qualified health center to a physician practice to employ an NPP. However, the NPP would have to be a bona fide employee of the physician practice and provide primary care services. CMS defines an NPP as a physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. CMS is also recommending a cap on the total remuneration and duration of assistance provided.

The limits aim to “make sure the physicians have skin in the game in bringing in the NPP,” Ms. Kass said. “It’s not all going to be the burden of hospital to provide recruiting assistance, but rather the physician has to need and want the NPP enough to be willing to bring them in as well without total support and assistance.”

Value-Based Payment Modifier Program

CMS proposes a new way to determine the extent of payment cuts and bonuses in the Value-Based Payment Modifier program. The program evaluates the performance of solo practitioners and groups on the quality and cost of care they provide to fee-for-service Medicare patients.

In 2016, the agency proposes to adjust payments based on the size of the participating group and to determine that size by reviewing claims data and its Provider Enrollment, Chain, and Ownership System (PECOS)-generated list. CMS would apply whichever number is lower in PECOS or claims data.

Now is a good time for doctors to check their PECOS data to ensure the information is accurate and up to date, Mr. Shay recommended.

As many expected, the Value-Based Payment Modifier is slowly expanding to encompass more physicians. Beginning Jan. 1, 2015, the value modifier was applied to physician payments under the fee schedule for groups of 100 or more. In January 2016, it will be applied to physician payments for doctors in groups of 10 or more. In 2017, the modifier will apply to solo practitioners and physicians in groups of two or more. (All modifiers are based on performance periods 2 years prior.)

PQRS will continue to play a central role in the Value-Based Payment Modifier system, Mr. Shay added. CMS is proposing to use the PQRS reporting period for 2016 as the basis for the 2018 value modifier. The agency will draw from the group reporting option and individual EP reporting mechanisms proposed for 2016.

“We’re seeing just more interconnection between these two systems,” Mr. Shay said.

Physician Compare

Physicians should expect to have more information about their performance reported to the Physician Compare website under the proposed 2016 fee schedule. The site already continues information on physician education, location, group affiliations, and status in quality programs. CMS now wants to include performance rates on 2015 PQRS cardiovascular disease prevention measures for doctors who report them, in support of the Million Hearts program. Additionally, CMS proposes that groups receiving a pay increase under the Value-Based Payment Modifier Program report the data to the website. Doctors also would continue reporting information about patient experiences under the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey program. The surveys are designed to capture a patient’s experience receiving care from their physician.

Mr. Shay noted that one concern with the Physician Compare website is that doctors have little recourse to challenge information on the site. Physicians have only a 30-day window to review information about themselves and correct errors.

“There is no formal appeals mechanism for the website,” Mr. Shay.

CMS is currently reviewing feedback and comments submitted about the proposed physician fee schedule before issuing the final schedule, usually in November.

agallegos@frontlinemedcom.com

On Twitter @legal_med

The comments are in and shaping of the final Medicare Physician Fee Schedule for 2016 rests now in the hands of officials at the Centers for Medicare & Medicaid Services. What are the key provisions doctors need to know about to practice successfully in 2016? Experts gave their opinions in a webinar sponsored by the American Health Lawyers Association (AHLA).

Physician Quality Reporting System (PQRS)

CMS proposes to audit not only physician participants, but also vendors who submit quality measure data on behalf of doctors, under the 2016 proposed fee schedule. The agency recommends that vendors make available contact information for each eligible practitioner on behalf of whom it submits data and retain data submitted to CMS for PQRS for 7 years.

Doctors who fail to report on nine quality measures for PQRS will not automatically face trouble, according to Daniel F. Shay, a health law attorney in Philadelphia. In general, individual physicians in PQRS must report on at least nine measures covering three National Quality Strategy (NQS) domains for at least 50% of their Medicare patient base. But if fewer than nine measures are reported, physicians have the chance to explain themselves.

“In some cases, a practice may not have at least nine measures that apply to it, Mr. Shay said. “The [eligible practitioner] would then be able to report on fewer than nine measures, but would be subject to the measure application validity process, which basically means CMS audits the provider to prove they couldn’t have reported on all of the required measures.”

Also, CMS proposes extending participation in PQRS to doctors who practice in critical access hospitals, according to the 2016 proposed fee schedule. PQRS is a voluntary quality reporting program that applies adjustments to payments based on benchmarks. CMS is suggesting that physicians who practice in certain critical access hospitals now have the option to participate in the program – such doctors were previously excluded.

Incident to service

When overseeing care that is “incident to” service, CMS proposes that billing physicians also act as supervising physicians. The proposal could significantly impact group practices who do not typically use that structure, said Washington health law attorney Julie E. Kass during the AHLA webinar.

Incident to is defined as services furnished incident to a physician’s professional services over the course of a patient’s diagnosis or treatment. Medicare pays for services rendered by employees of a physician only when all “incident to” criteria are met. Those criteria include that services rendered by nonphysicians are under the direct supervision of a physician physically in the same office suite. In the proposed 2016 rule, CMS seeks to clarify that the billing physician must be the same physician who supervises the ancillary personnel. Previously, group practices may have billed under the provider who ordered the treatment, according to Ms. Kass.

“It sounds simple, but then you put it into the context of what happens in a real life practice,” she said. “I think a lot of practices, in operationalizing this rule, have generally used the ordering physician as the physician who billed for the service without paying a lot of attention to who was the actual supervising physician.”

Group practices may want to rethink how they bill for incident to services, and ensure the billing physician is the one who supervises the treatment, she advised.

The Stark Law

Proposed changes to regulations implementing the Stark Law could make it easier for physicians to hire new nonphysician providers (NPP) to provide primary care. Under the fee schedule proposal, hospitals would be allowed to assist in the recruitment of health professionals for physician practices. Currently, hospitals may not because remuneration could be considered a compensation relationship between the hospital and physician practice. The proposed change aims to promote care team collaboration and help curb primary care shortages.

The exception would permit recruitment assistance and retention payment from a hospital, rural health clinic, or federally qualified health center to a physician practice to employ an NPP. However, the NPP would have to be a bona fide employee of the physician practice and provide primary care services. CMS defines an NPP as a physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. CMS is also recommending a cap on the total remuneration and duration of assistance provided.

The limits aim to “make sure the physicians have skin in the game in bringing in the NPP,” Ms. Kass said. “It’s not all going to be the burden of hospital to provide recruiting assistance, but rather the physician has to need and want the NPP enough to be willing to bring them in as well without total support and assistance.”

Value-Based Payment Modifier Program

CMS proposes a new way to determine the extent of payment cuts and bonuses in the Value-Based Payment Modifier program. The program evaluates the performance of solo practitioners and groups on the quality and cost of care they provide to fee-for-service Medicare patients.

In 2016, the agency proposes to adjust payments based on the size of the participating group and to determine that size by reviewing claims data and its Provider Enrollment, Chain, and Ownership System (PECOS)-generated list. CMS would apply whichever number is lower in PECOS or claims data.

Now is a good time for doctors to check their PECOS data to ensure the information is accurate and up to date, Mr. Shay recommended.

As many expected, the Value-Based Payment Modifier is slowly expanding to encompass more physicians. Beginning Jan. 1, 2015, the value modifier was applied to physician payments under the fee schedule for groups of 100 or more. In January 2016, it will be applied to physician payments for doctors in groups of 10 or more. In 2017, the modifier will apply to solo practitioners and physicians in groups of two or more. (All modifiers are based on performance periods 2 years prior.)

PQRS will continue to play a central role in the Value-Based Payment Modifier system, Mr. Shay added. CMS is proposing to use the PQRS reporting period for 2016 as the basis for the 2018 value modifier. The agency will draw from the group reporting option and individual EP reporting mechanisms proposed for 2016.

“We’re seeing just more interconnection between these two systems,” Mr. Shay said.

Physician Compare

Physicians should expect to have more information about their performance reported to the Physician Compare website under the proposed 2016 fee schedule. The site already continues information on physician education, location, group affiliations, and status in quality programs. CMS now wants to include performance rates on 2015 PQRS cardiovascular disease prevention measures for doctors who report them, in support of the Million Hearts program. Additionally, CMS proposes that groups receiving a pay increase under the Value-Based Payment Modifier Program report the data to the website. Doctors also would continue reporting information about patient experiences under the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey program. The surveys are designed to capture a patient’s experience receiving care from their physician.

Mr. Shay noted that one concern with the Physician Compare website is that doctors have little recourse to challenge information on the site. Physicians have only a 30-day window to review information about themselves and correct errors.

“There is no formal appeals mechanism for the website,” Mr. Shay.

CMS is currently reviewing feedback and comments submitted about the proposed physician fee schedule before issuing the final schedule, usually in November.

agallegos@frontlinemedcom.com

On Twitter @legal_med

The comments are in and shaping of the final Medicare Physician Fee Schedule for 2016 rests now in the hands of officials at the Centers for Medicare & Medicaid Services. What are the key provisions doctors need to know about to practice successfully in 2016? Experts gave their opinions in a webinar sponsored by the American Health Lawyers Association (AHLA).

Physician Quality Reporting System (PQRS)

CMS proposes to audit not only physician participants, but also vendors who submit quality measure data on behalf of doctors, under the 2016 proposed fee schedule. The agency recommends that vendors make available contact information for each eligible practitioner on behalf of whom it submits data and retain data submitted to CMS for PQRS for 7 years.

Doctors who fail to report on nine quality measures for PQRS will not automatically face trouble, according to Daniel F. Shay, a health law attorney in Philadelphia. In general, individual physicians in PQRS must report on at least nine measures covering three National Quality Strategy (NQS) domains for at least 50% of their Medicare patient base. But if fewer than nine measures are reported, physicians have the chance to explain themselves.

“In some cases, a practice may not have at least nine measures that apply to it, Mr. Shay said. “The [eligible practitioner] would then be able to report on fewer than nine measures, but would be subject to the measure application validity process, which basically means CMS audits the provider to prove they couldn’t have reported on all of the required measures.”

Also, CMS proposes extending participation in PQRS to doctors who practice in critical access hospitals, according to the 2016 proposed fee schedule. PQRS is a voluntary quality reporting program that applies adjustments to payments based on benchmarks. CMS is suggesting that physicians who practice in certain critical access hospitals now have the option to participate in the program – such doctors were previously excluded.

Incident to service

When overseeing care that is “incident to” service, CMS proposes that billing physicians also act as supervising physicians. The proposal could significantly impact group practices who do not typically use that structure, said Washington health law attorney Julie E. Kass during the AHLA webinar.

Incident to is defined as services furnished incident to a physician’s professional services over the course of a patient’s diagnosis or treatment. Medicare pays for services rendered by employees of a physician only when all “incident to” criteria are met. Those criteria include that services rendered by nonphysicians are under the direct supervision of a physician physically in the same office suite. In the proposed 2016 rule, CMS seeks to clarify that the billing physician must be the same physician who supervises the ancillary personnel. Previously, group practices may have billed under the provider who ordered the treatment, according to Ms. Kass.

“It sounds simple, but then you put it into the context of what happens in a real life practice,” she said. “I think a lot of practices, in operationalizing this rule, have generally used the ordering physician as the physician who billed for the service without paying a lot of attention to who was the actual supervising physician.”

Group practices may want to rethink how they bill for incident to services, and ensure the billing physician is the one who supervises the treatment, she advised.

The Stark Law

Proposed changes to regulations implementing the Stark Law could make it easier for physicians to hire new nonphysician providers (NPP) to provide primary care. Under the fee schedule proposal, hospitals would be allowed to assist in the recruitment of health professionals for physician practices. Currently, hospitals may not because remuneration could be considered a compensation relationship between the hospital and physician practice. The proposed change aims to promote care team collaboration and help curb primary care shortages.

The exception would permit recruitment assistance and retention payment from a hospital, rural health clinic, or federally qualified health center to a physician practice to employ an NPP. However, the NPP would have to be a bona fide employee of the physician practice and provide primary care services. CMS defines an NPP as a physician assistant, nurse practitioner, clinical nurse specialist, or certified nurse-midwife. CMS is also recommending a cap on the total remuneration and duration of assistance provided.

The limits aim to “make sure the physicians have skin in the game in bringing in the NPP,” Ms. Kass said. “It’s not all going to be the burden of hospital to provide recruiting assistance, but rather the physician has to need and want the NPP enough to be willing to bring them in as well without total support and assistance.”

Value-Based Payment Modifier Program

CMS proposes a new way to determine the extent of payment cuts and bonuses in the Value-Based Payment Modifier program. The program evaluates the performance of solo practitioners and groups on the quality and cost of care they provide to fee-for-service Medicare patients.

In 2016, the agency proposes to adjust payments based on the size of the participating group and to determine that size by reviewing claims data and its Provider Enrollment, Chain, and Ownership System (PECOS)-generated list. CMS would apply whichever number is lower in PECOS or claims data.

Now is a good time for doctors to check their PECOS data to ensure the information is accurate and up to date, Mr. Shay recommended.

As many expected, the Value-Based Payment Modifier is slowly expanding to encompass more physicians. Beginning Jan. 1, 2015, the value modifier was applied to physician payments under the fee schedule for groups of 100 or more. In January 2016, it will be applied to physician payments for doctors in groups of 10 or more. In 2017, the modifier will apply to solo practitioners and physicians in groups of two or more. (All modifiers are based on performance periods 2 years prior.)

PQRS will continue to play a central role in the Value-Based Payment Modifier system, Mr. Shay added. CMS is proposing to use the PQRS reporting period for 2016 as the basis for the 2018 value modifier. The agency will draw from the group reporting option and individual EP reporting mechanisms proposed for 2016.

“We’re seeing just more interconnection between these two systems,” Mr. Shay said.

Physician Compare

Physicians should expect to have more information about their performance reported to the Physician Compare website under the proposed 2016 fee schedule. The site already continues information on physician education, location, group affiliations, and status in quality programs. CMS now wants to include performance rates on 2015 PQRS cardiovascular disease prevention measures for doctors who report them, in support of the Million Hearts program. Additionally, CMS proposes that groups receiving a pay increase under the Value-Based Payment Modifier Program report the data to the website. Doctors also would continue reporting information about patient experiences under the Consumer Assessment of Healthcare Providers & Systems (CAHPS) survey program. The surveys are designed to capture a patient’s experience receiving care from their physician.

Mr. Shay noted that one concern with the Physician Compare website is that doctors have little recourse to challenge information on the site. Physicians have only a 30-day window to review information about themselves and correct errors.

“There is no formal appeals mechanism for the website,” Mr. Shay.

CMS is currently reviewing feedback and comments submitted about the proposed physician fee schedule before issuing the final schedule, usually in November.

agallegos@frontlinemedcom.com

On Twitter @legal_med

What is high-value care and how can it be achieved? Overuse of clinical tests and diagnostic procedures, largely driven by concerns about missing unusual but potentially significant diagnoses, drives health care costs and can result in worrisome incidental findings.

Dr. Hyung “Harry” Cho, a hospitalist and assistant professor of medicine at the Mt. Sinai School of Medicine in New York, has launched the Overuse Clinical Case Morbidity and Mortality (OCCAM’s) Conference to attack the problem of clinical overuse from a new perspective. Dr. Cho and his colleagues have turned the traditional morbidity and mortality conference on its head by addressing overuse as a medical error and using the conference as a forum to discuss which practical steps should be taken to improve quality of care while avoiding overuse of tests.

In this video interview, Dr. Cho – along with other key members of the OCCAM’s team – discuss the initiative’s inception, the importance of workgroups in implementing quality improvement initiatives from the ground up, and how to advance the conversation to define high-value care.

dchitnis@frontlinemedcom.com

What is high-value care and how can it be achieved? Overuse of clinical tests and diagnostic procedures, largely driven by concerns about missing unusual but potentially significant diagnoses, drives health care costs and can result in worrisome incidental findings.

Dr. Hyung “Harry” Cho, a hospitalist and assistant professor of medicine at the Mt. Sinai School of Medicine in New York, has launched the Overuse Clinical Case Morbidity and Mortality (OCCAM’s) Conference to attack the problem of clinical overuse from a new perspective. Dr. Cho and his colleagues have turned the traditional morbidity and mortality conference on its head by addressing overuse as a medical error and using the conference as a forum to discuss which practical steps should be taken to improve quality of care while avoiding overuse of tests.

In this video interview, Dr. Cho – along with other key members of the OCCAM’s team – discuss the initiative’s inception, the importance of workgroups in implementing quality improvement initiatives from the ground up, and how to advance the conversation to define high-value care.

dchitnis@frontlinemedcom.com

What is high-value care and how can it be achieved? Overuse of clinical tests and diagnostic procedures, largely driven by concerns about missing unusual but potentially significant diagnoses, drives health care costs and can result in worrisome incidental findings.

Dr. Hyung “Harry” Cho, a hospitalist and assistant professor of medicine at the Mt. Sinai School of Medicine in New York, has launched the Overuse Clinical Case Morbidity and Mortality (OCCAM’s) Conference to attack the problem of clinical overuse from a new perspective. Dr. Cho and his colleagues have turned the traditional morbidity and mortality conference on its head by addressing overuse as a medical error and using the conference as a forum to discuss which practical steps should be taken to improve quality of care while avoiding overuse of tests.

In this video interview, Dr. Cho – along with other key members of the OCCAM’s team – discuss the initiative’s inception, the importance of workgroups in implementing quality improvement initiatives from the ground up, and how to advance the conversation to define high-value care.

dchitnis@frontlinemedcom.com

The advice from those who have already tried coding with ICD-10? Hire a certified coder if you don’t have one on staff already.

“If a physician office doesn’t have a certified coder, it should,” according to Penny Osmon Bahr, director of Avastone Health Solutions, who took part in the final International Classification of Disease, tenth revision, “end-to-end” test conducted by the Centers for Medicare & Medicaid in July. “That’s just plain and simple.”

Ms. Osmon Bahr described coding as “the pulse point of how data are really consumed,” whether via ICD-10 or part of value-based contracting, research on patient outcomes, or incentives being driven by the CMS. “It takes coders to ensure that the data that is going out truly represents your patient population and the patients that you are treating.”

©DWP/Fotolia.com

Some physician practices “haven’t invested in education for staff to become knowledgeable in coding or certified in coding. That could be a struggle as the world continues to evolve.”

Another bit of advice: Scale back on the number of patient visits you book in October. That will give extra time to learn and incorporate ICD-10 into work flows.

“One of the things that we’ve encouraged our physicians to do is they need to lighten their schedules in October to prepare for ICD-10 to make sure they are completing the documentation that’s needed and coding with the current codes,” Lori Albano, manager of EDI development and support with practice management and EHR software vendor Nextgen Healthcare of Atlanta. “So maybe the first 2 weeks they lighten [appointments] by 20%” and then set up a specific schedule to ramp back up to full capacity.

Ms. Albano also recommended a focused approach to learning new codes to help avoid being overwhelmed.

“Take the top 50-100 ICD-9 codes that you currently use and become familiar with those ICD-10 codes and the documentation required to support them,” she said. “Start documenting on that level now.”

Ms. Osmon Bahr also stressed thorough documentation.

“You always want to tell the most specific story about your patient that you can,” she said, based on the greater number and specificity of the ICD-10 code set.

Ms. Osmon Bahr and Ms. Albano both spoke positively of the experience of testing and said that CMS appears ready to make the transition. The agency announced on Aug. 28 that its final round of end-to-end testing found no new issues and that no CMS front-end issues led to claims rejections. Previous issues in prior test rounds have been resolved, the agency noted.

gtwachtman@frontlinemedcom.com

The advice from those who have already tried coding with ICD-10? Hire a certified coder if you don’t have one on staff already.

“If a physician office doesn’t have a certified coder, it should,” according to Penny Osmon Bahr, director of Avastone Health Solutions, who took part in the final International Classification of Disease, tenth revision, “end-to-end” test conducted by the Centers for Medicare & Medicaid in July. “That’s just plain and simple.”

Ms. Osmon Bahr described coding as “the pulse point of how data are really consumed,” whether via ICD-10 or part of value-based contracting, research on patient outcomes, or incentives being driven by the CMS. “It takes coders to ensure that the data that is going out truly represents your patient population and the patients that you are treating.”

©DWP/Fotolia.com

Some physician practices “haven’t invested in education for staff to become knowledgeable in coding or certified in coding. That could be a struggle as the world continues to evolve.”

Another bit of advice: Scale back on the number of patient visits you book in October. That will give extra time to learn and incorporate ICD-10 into work flows.

“One of the things that we’ve encouraged our physicians to do is they need to lighten their schedules in October to prepare for ICD-10 to make sure they are completing the documentation that’s needed and coding with the current codes,” Lori Albano, manager of EDI development and support with practice management and EHR software vendor Nextgen Healthcare of Atlanta. “So maybe the first 2 weeks they lighten [appointments] by 20%” and then set up a specific schedule to ramp back up to full capacity.

Ms. Albano also recommended a focused approach to learning new codes to help avoid being overwhelmed.

“Take the top 50-100 ICD-9 codes that you currently use and become familiar with those ICD-10 codes and the documentation required to support them,” she said. “Start documenting on that level now.”

Ms. Osmon Bahr also stressed thorough documentation.

“You always want to tell the most specific story about your patient that you can,” she said, based on the greater number and specificity of the ICD-10 code set.

Ms. Osmon Bahr and Ms. Albano both spoke positively of the experience of testing and said that CMS appears ready to make the transition. The agency announced on Aug. 28 that its final round of end-to-end testing found no new issues and that no CMS front-end issues led to claims rejections. Previous issues in prior test rounds have been resolved, the agency noted.

gtwachtman@frontlinemedcom.com

The advice from those who have already tried coding with ICD-10? Hire a certified coder if you don’t have one on staff already.

“If a physician office doesn’t have a certified coder, it should,” according to Penny Osmon Bahr, director of Avastone Health Solutions, who took part in the final International Classification of Disease, tenth revision, “end-to-end” test conducted by the Centers for Medicare & Medicaid in July. “That’s just plain and simple.”

Ms. Osmon Bahr described coding as “the pulse point of how data are really consumed,” whether via ICD-10 or part of value-based contracting, research on patient outcomes, or incentives being driven by the CMS. “It takes coders to ensure that the data that is going out truly represents your patient population and the patients that you are treating.”

©DWP/Fotolia.com

Some physician practices “haven’t invested in education for staff to become knowledgeable in coding or certified in coding. That could be a struggle as the world continues to evolve.”

Another bit of advice: Scale back on the number of patient visits you book in October. That will give extra time to learn and incorporate ICD-10 into work flows.

“One of the things that we’ve encouraged our physicians to do is they need to lighten their schedules in October to prepare for ICD-10 to make sure they are completing the documentation that’s needed and coding with the current codes,” Lori Albano, manager of EDI development and support with practice management and EHR software vendor Nextgen Healthcare of Atlanta. “So maybe the first 2 weeks they lighten [appointments] by 20%” and then set up a specific schedule to ramp back up to full capacity.

Ms. Albano also recommended a focused approach to learning new codes to help avoid being overwhelmed.

“Take the top 50-100 ICD-9 codes that you currently use and become familiar with those ICD-10 codes and the documentation required to support them,” she said. “Start documenting on that level now.”

Ms. Osmon Bahr also stressed thorough documentation.

“You always want to tell the most specific story about your patient that you can,” she said, based on the greater number and specificity of the ICD-10 code set.

Ms. Osmon Bahr and Ms. Albano both spoke positively of the experience of testing and said that CMS appears ready to make the transition. The agency announced on Aug. 28 that its final round of end-to-end testing found no new issues and that no CMS front-end issues led to claims rejections. Previous issues in prior test rounds have been resolved, the agency noted.

gtwachtman@frontlinemedcom.com

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

NEW YORK – Displaying a low-tech, low-cost white board in the operating room during the “time out” before surgery can significantly improve memory retention among members of the surgical team, a new study suggests.

“We found that providing a white board that you can buy at any office supply store gives a visual stimulus on top of the verbal stimulus [that] improves retention of important information,” Dr. Aryan Meknat, the study author, said at the annual Minimally Invasive Surgery Week.

A surgical pause or “time out” performed before any operative procedure is a major component of the Joint Commission’s Universal Protocol to prevent wrong site, wrong procedure, and wrong person surgery. Retention of information presented during the surgical pause is essential, at the beginning of the case and for the duration of the procedure, he said.

During the study, surgical teams were randomly divided into two groups: in the first group, 30 team members were given information verbally during the surgical pause; while a second group of 29 team members was provided with verbal information that was read from the white board. The white board was displayed in the operating room throughout the surgical procedure for the second group.

After the conclusion of the procedure, the white board was removed and both groups were given a short written questionnaire. Each team was tested only once in order to keep the study blinded. Also, participants had no prior knowledge that they would be tested after the procedure.

Study participants were asked to recall several facts about the patient, including the patient’s first and last name, age, sex, weight, site of IV placement, allergies, medications, relation of accompanying guardian, and the signature on the consent form.

Team members in the first study group answered a total of 300 questions, and 200 questions (66.7%) were correctly answered. Participants in the second group – which used the white board – answered 290 questions, and 239 (82.4%) were correctly answered. The white board group had a 23.6% overall increase in correctly answered questions. The difference between retention in the two groups was statistically significant (P less than .05) in every category tested.

“These findings apply to operating rooms everywhere, especially in cases where there may be long delays before starting the procedure, changes in anesthesia midcase, situations where two procedures are scheduled in one patient, or in intraoperative emergency situations. We need to be sure that the surgical team retains information, as well as [listens] to verbal instructions,” said Dr. Meknat of MobiSurg, a mobile surgical unit based in Laguna Hills, Calif.

Dr. Meknat reported having no financial disclosures.

Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.

The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.

©Jupiterimages/thinkstockphotos.com

To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.

To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.

It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.

“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”

Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.

In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.

agallegos@frontlinemedcom.com

On Twitter @legal_med

Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.

The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.

©Jupiterimages/thinkstockphotos.com

To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.

To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.

It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.

“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”

Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.

In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.

agallegos@frontlinemedcom.com

On Twitter @legal_med

Assessments are complete, and the Centers for Medicare & Medicaid Services has determined which physician practices will face a pay cut – officially, a “downward payment adjustment” – for failing to comply with the Physician Quality Reporting System (PQRS). Doctors have just 2 months to challenge findings that they believe were made in error to spare themselves a cut in 2016.

The pay cut will apply to individual eligible practitioners and PQRS group practices that did not satisfactorily report data on quality measures in 2014. The 2% cut will be applied to all Part B covered services, according to a Sept. 9 CMS announcement.

©Jupiterimages/thinkstockphotos.com

To learn whether they are subject to the cut, physicians can review their 2014 PQRS feedback reports, which became available Sept. 8. The reports apply to doctors who submitted quality data in calendar year 2014. Feedback reports for 2015 will be available approximately this time next year.

To challenge PQRS determinations, physicians can submit an informal review between Sept. 9 and Nov. 9 and request that the CMS reevaluate incentive eligibility and adjustment determinations. Those requests can be made through the quality reporting portal. Physicians who request a review will be contacted via email of a final decision by the CMS within 90 days of their request. All decisions will be final and there will be no further review or appeal, according to the CMS.

It should not be surprising that physicians who did not satisfactorily comply with PQRS will see a 2% pay cut next year, said David Harlow, a health law and policy attorney based in Newton, Mass. What’s unusual, however, is that the informal review process does not include an avenue for an independent evaluation, Mr. Harlow said.

“It’s CMS reviewing a CMS decision,” he said in an interview. “From a provider perspective, there might be some skepticism about the independence of that review. CMS says this is not something that is subject to further administrative or judicial review. So there’s not an appeal.”

Mr. Harlow said that he would not be surprised if physician organizations advocate for further judicial relief in the process. CMS has previously provided avenues for administrative or judicial appeals of its decisions in other programs, he noted.

In its announcement, the agency outlined the ways in which physicians could have avoided the coming pay cut. This included reporting nine measures across three domains for 50% of Medicare patients, completing the GPRO Web Interface, or reporting at least one registry measures group for 20 patients, at least 11 of whom were Medicare Part B patients. Additionally, doctors could have reported three measures across one domain for 50% of Medicare patients, or satisfactorily participated in a qualified clinical data registry.

agallegos@frontlinemedcom.com

On Twitter @legal_med

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

NEW YORK – Virtual learning of laparoscopic surgical skills is now possible and appears to be as successful as direct mentoring through an in-person teaching course, according to a pilot study of 16 medical students and residents naive to laparoscopy.

Suturing skills were equivalent in the group mentored directly, compared with those who learned how to suture in a virtual course using a telementoring program called Top Gun Surgeon. Suturing was evaluated based on time, skill, and errors.

“Our preliminary data suggest there is no difference between in-person transferring of suturing skills versus telementoring. Top Gun Surgeon is a new, cost-effective telementoring program, using telecommunications to guide surgeons and teach them skills from afar. It is a great extender, expanding access to available mentors, and increasing access to surgical training,” said Dr. James C. Rosser Jr., a surgeon at Celebration Hospital in Florida and developer of the original Top Gun Surgeon training program, which recently added a telementoring component.

Future studies are planned with a group of 75 surgeons to validate telementoring as an effective method of teaching laparoscopic surgical skills. Participants will go through a series of drills based on the Top Gun Surgeons to increase their speed and competence.

Improving skills such as suturing is critical for the field, according to Dr. Rosser.

“Adoption of advanced laparoscopic procedures has been abysmal in the U.S.,” he said at the annual Minimally Invasive Surgery Week. “Surgeons need to adopt advanced skills required for minimally invasive surgery, starting with suturing.”

“Our data show that only 18% of self-proclaimed advanced laparoscopy surgeons can tie a knot in 10 minutes. You can take the Top Gun course and learn how to do this in 12 hours with telementoring, or teach yourself in 350 hours,” he said in an interview.

The standard setup for telementoring involves a downloadable iBook, two webcams, two tripods, a headset, and a USB extender. This platform costs about $322 to acquire, according to Dr. Rosser.

“A robot costs $100,000,” he said. “It’s not feasible to buy a robot for every training station.”

The suturing training course is $1,500 per physician and can be ordered through stealthlearningcompany.com.

The potential advantages of telementoring include expanded access to available mentors, increased access to surgical training, multiplication of the workforce, and improved novice performance, according to Dr. Rosser. Another potential benefit is the cost effectiveness of the program, provided the transfer of skills is proven to be equally effective to in-person training in larger studies. With the virtual program, a single mentor can monitor multiple positions.

More than 7,500 surgeons have gone through the Top Gun Surgeon training program since its launch in 1992. The telementoring component is new.

“This is the first time we have done a study at a high academic level where skills are transferred virtually by telementoring. We saw equivalent transfer of skills using the direct mentoring method and telementoring,” Dr. Rosser said. “We believe that this technology can be transferred to other industries. It’s groundbreaking to learn new skills without traveling.”

Dr. Paul Wetter, chairman of the Society of Laparoendoscopic Surgeons, said the virtual course has a lot of appeal.

“In this era of time constraints for the medical profession, being able to take a course and practice on a simulator where you are, instead of having to travel to meetings, and the opportunity to learn at your own pace and go back to review specifics you may be unsure of, will allow laparoscopic surgeons to ‘warm up’ their skill set,” Dr. Wetter said. “Many studies show improved surgical outcomes with ‘warming up.’ ”

The Society of Laparoendoscopic Surgeons – in collaboration with Dr. Rosser – developed the new iBook teaching platform. The Society is currently developing a CME course for accreditation using the new platform.

“This program will help solve the difficulties related to time and logistics and improve laparoscopic surgery skill sets, which is linked to patient safety and outcomes,” Dr. Wetter said.

The pilot study was sponsored by Karl Storz, a medical device manufacturer.

Mesenchymal stem cell transplants appeared to regenerate cartilage and improve clinical outcomes after 2 years in patients with knee osteoarthritis in a small South Korean study.

There were 24 treated knees among the 11 men and 9 women in the study, whose average age was 58 years and mean body mass index was 26.6 kg/m².

©decade3d/Thinkstock.com

At baseline, 21 lesions (87.5%) were grade 2 or 3 on the MRI Osteoarthritis Knee Score scale for size of cartilage-loss area, and 23 lesions (95.9%) were grade 2 or 3 for percentage of full-thickness cartilage loss. A grade of 2-3 indicates moderate to severe disease.

At MRI follow-up 2 years after transplant, only five lesions (20.8%) were grade 2 or 3 for cartilage-loss area and five were grade 2 or 3 for full-thickness cartilage loss, reported Dr. Yong Sang Kim of the Yonsei Sarang Hospital in Seoul and his associates (Osteoarthritis Cartilage. 2015. doi: 10.1016/j.joca.2015.08.009).

There were clinical improvements, too. At baseline, the mean International Knee Documentation Committee score improved from 38.7 at baseline to 67.3 at follow-up and the mean Tegner activity scale score improved from 2.5 at baseline to 3.9 at follow-up. The results were all statistically significant and independent of age, sex, body mass index, and size and location of the cartilage lesions.

“This study showed encouraging clinical outcomes of [mesenchymal stem cell] implantation with fibrin glue as a scaffold in OA knees,” and it adds to the growing body of literature supporting mesenchymal stem cells (MSCs) in osteoarthritis. “MSC implantation with fibrin glue as a scaffold seems to be effective for repairing cartilage lesions in OA knees,” the investigators wrote.

The cells were derived from fat liposuctioned from the subjects’ buttocks and delivered to their damaged knees in a fibrinogen-thrombin gel under arthroscopic guidance. The cartilage lesions, which were most often on the medial femoral condyle, were debrided beforehand. Patients’ knees were immobilized for 2 weeks after transplant. Weight bearing was allowed at 4 weeks, and sports at 3 months.

It’s not fully known why MSCs help knee OA. Perhaps they release factors that stimulate cartilage formation by resident chondrocytes or other cells in the joint, and inhibit joint inflammation. The investigators derived their cells from fat – instead of bone marrow – because stem cells from fat are easier to get, easy to purify, and may be more chondrogenic. Fat is also richer in stem cells than marrow.

The next step is to identify predictors of good outcomes. “Patient characteristics or cartilage lesion variables may serve as important selection criteria for stem cell–based repair strategies,” Dr. Kim and his associates said.

The researchers had no disclosures.

aotto@frontlinemedcom.com

Mesenchymal stem cell transplants appeared to regenerate cartilage and improve clinical outcomes after 2 years in patients with knee osteoarthritis in a small South Korean study.

There were 24 treated knees among the 11 men and 9 women in the study, whose average age was 58 years and mean body mass index was 26.6 kg/m².

©decade3d/Thinkstock.com

At baseline, 21 lesions (87.5%) were grade 2 or 3 on the MRI Osteoarthritis Knee Score scale for size of cartilage-loss area, and 23 lesions (95.9%) were grade 2 or 3 for percentage of full-thickness cartilage loss. A grade of 2-3 indicates moderate to severe disease.

At MRI follow-up 2 years after transplant, only five lesions (20.8%) were grade 2 or 3 for cartilage-loss area and five were grade 2 or 3 for full-thickness cartilage loss, reported Dr. Yong Sang Kim of the Yonsei Sarang Hospital in Seoul and his associates (Osteoarthritis Cartilage. 2015. doi: 10.1016/j.joca.2015.08.009).

There were clinical improvements, too. At baseline, the mean International Knee Documentation Committee score improved from 38.7 at baseline to 67.3 at follow-up and the mean Tegner activity scale score improved from 2.5 at baseline to 3.9 at follow-up. The results were all statistically significant and independent of age, sex, body mass index, and size and location of the cartilage lesions.

“This study showed encouraging clinical outcomes of [mesenchymal stem cell] implantation with fibrin glue as a scaffold in OA knees,” and it adds to the growing body of literature supporting mesenchymal stem cells (MSCs) in osteoarthritis. “MSC implantation with fibrin glue as a scaffold seems to be effective for repairing cartilage lesions in OA knees,” the investigators wrote.

The cells were derived from fat liposuctioned from the subjects’ buttocks and delivered to their damaged knees in a fibrinogen-thrombin gel under arthroscopic guidance. The cartilage lesions, which were most often on the medial femoral condyle, were debrided beforehand. Patients’ knees were immobilized for 2 weeks after transplant. Weight bearing was allowed at 4 weeks, and sports at 3 months.

It’s not fully known why MSCs help knee OA. Perhaps they release factors that stimulate cartilage formation by resident chondrocytes or other cells in the joint, and inhibit joint inflammation. The investigators derived their cells from fat – instead of bone marrow – because stem cells from fat are easier to get, easy to purify, and may be more chondrogenic. Fat is also richer in stem cells than marrow.

The next step is to identify predictors of good outcomes. “Patient characteristics or cartilage lesion variables may serve as important selection criteria for stem cell–based repair strategies,” Dr. Kim and his associates said.

The researchers had no disclosures.

aotto@frontlinemedcom.com

Mesenchymal stem cell transplants appeared to regenerate cartilage and improve clinical outcomes after 2 years in patients with knee osteoarthritis in a small South Korean study.

There were 24 treated knees among the 11 men and 9 women in the study, whose average age was 58 years and mean body mass index was 26.6 kg/m².

©decade3d/Thinkstock.com

At baseline, 21 lesions (87.5%) were grade 2 or 3 on the MRI Osteoarthritis Knee Score scale for size of cartilage-loss area, and 23 lesions (95.9%) were grade 2 or 3 for percentage of full-thickness cartilage loss. A grade of 2-3 indicates moderate to severe disease.

At MRI follow-up 2 years after transplant, only five lesions (20.8%) were grade 2 or 3 for cartilage-loss area and five were grade 2 or 3 for full-thickness cartilage loss, reported Dr. Yong Sang Kim of the Yonsei Sarang Hospital in Seoul and his associates (Osteoarthritis Cartilage. 2015. doi: 10.1016/j.joca.2015.08.009).

There were clinical improvements, too. At baseline, the mean International Knee Documentation Committee score improved from 38.7 at baseline to 67.3 at follow-up and the mean Tegner activity scale score improved from 2.5 at baseline to 3.9 at follow-up. The results were all statistically significant and independent of age, sex, body mass index, and size and location of the cartilage lesions.

“This study showed encouraging clinical outcomes of [mesenchymal stem cell] implantation with fibrin glue as a scaffold in OA knees,” and it adds to the growing body of literature supporting mesenchymal stem cells (MSCs) in osteoarthritis. “MSC implantation with fibrin glue as a scaffold seems to be effective for repairing cartilage lesions in OA knees,” the investigators wrote.

The cells were derived from fat liposuctioned from the subjects’ buttocks and delivered to their damaged knees in a fibrinogen-thrombin gel under arthroscopic guidance. The cartilage lesions, which were most often on the medial femoral condyle, were debrided beforehand. Patients’ knees were immobilized for 2 weeks after transplant. Weight bearing was allowed at 4 weeks, and sports at 3 months.

It’s not fully known why MSCs help knee OA. Perhaps they release factors that stimulate cartilage formation by resident chondrocytes or other cells in the joint, and inhibit joint inflammation. The investigators derived their cells from fat – instead of bone marrow – because stem cells from fat are easier to get, easy to purify, and may be more chondrogenic. Fat is also richer in stem cells than marrow.

The next step is to identify predictors of good outcomes. “Patient characteristics or cartilage lesion variables may serve as important selection criteria for stem cell–based repair strategies,” Dr. Kim and his associates said.

The researchers had no disclosures.

aotto@frontlinemedcom.com

The 10-year incidence of serious complications after mesh-sling surgery for stress urinary incontinence is a relatively low 3.29, but patients treated by surgeons who perform a low volume of the procedures have a 37% higher relative risk of requiring further surgery for complications, compared with patients of experienced surgeons, according to a report published online Sept. 9 in JAMA Surgery.

“These findings support the regulatory statements that suggest that patients should be counseled regarding serious complications that can occur with mesh-based procedures for SUI and that surgeons should achieve expertise in their chosen procedure,” wrote Dr. Blayne Welk of the department of surgery and the department of epidemiology and biostatistics at Western University and St. Joseph’s Health Care, London (Ont.) and his associates.

The investigators performed a population-based retrospective cohort study to determine the incidence of surgical removal or revision after a mesh-sling procedure for SUI and to examine whether there are specific risk factors for mesh-related complications. They analyzed data for 59,887 women who underwent the procedure across Ontario during a 10-year period. Median follow-up was 4.4 years.

The procedures were performed by 1,068 surgeons: 293 urologists, 625 gynecologists, and 150 unspecified clinicians. Cases were classified according to whether the surgeon performed a high or low volume of mesh-sling procedures specifically for SUI. High volume was defined as a number at or above the 75th percentile for yearly volume in the province, or more than 16 procedures per year.

Overall, 1,307 women (2.2%) required mesh removal or revision a median of 1 year after the initial surgery. The cumulative incidence of the composite outcome of removal/revision of vaginal or urethral mesh, removal of a foreign body, endoscopic treatment of a urethral foreign body or mesh encrustation, uretrolysis, or repair of a urethrovaginal fistula was 3.29 at 10 years, Dr. Welk and his associates reported. Surgical specialty had no significant effect on complication risk.

This incidence is consistent with previous report from HMOs in the United States and a meta-analysis of clinical trial results, the investigators noted (JAMA Surg. 2015 Sept. 9. doi: 10.1001/jamasurg.2015.2590). Patients of low-volume surgeons had a 37% higher relative risk of complications requiring reoperation than did patients of high-volume surgeons. In a further analysis of the data, patients of low-volume surgeons were significantly more likely to experience the composite outcome than were patients of high-volume surgeons (hazard ratio, 1.37), and, again, the difference between surgical specialties was nonsignificant.

Urologists and gynecologists have very different surgical training and day-to-day practices, the researchers noted, and as a result they hypothesized that complication rates might differ between the two groups of clinicians. But that was not proven in the findings.

“This suggests that procedure-specific knowledge and experience is important for surgery to treat SUI, rather than general operative training,” Dr. Welk and his associates wrote.

Women who underwent multiple mesh-based procedures for SUI were at highest risk for the composite endpoint. Their absolute risk for later mesh removal or revision was 4.87%.

“This novel finding should temper the enthusiasm of case series that suggest that the use of multiple synthetic slings is safe and efficacious,” the researchers wrote.

This finding is also important in light of the fact that 1,307 of the study participants underwent more than one mesh implant procedure, presumably for recurrent SUI.

This study was supported by the Ontario Ministry of Health and Long-term Care and the Academic Medical Organization of Southwestern Ontario. Dr. Welk reported receiving grant funding from Astellas Canada.

The 10-year incidence of serious complications after mesh-sling surgery for stress urinary incontinence is a relatively low 3.29, but patients treated by surgeons who perform a low volume of the procedures have a 37% higher relative risk of requiring further surgery for complications, compared with patients of experienced surgeons, according to a report published online Sept. 9 in JAMA Surgery.

“These findings support the regulatory statements that suggest that patients should be counseled regarding serious complications that can occur with mesh-based procedures for SUI and that surgeons should achieve expertise in their chosen procedure,” wrote Dr. Blayne Welk of the department of surgery and the department of epidemiology and biostatistics at Western University and St. Joseph’s Health Care, London (Ont.) and his associates.

The investigators performed a population-based retrospective cohort study to determine the incidence of surgical removal or revision after a mesh-sling procedure for SUI and to examine whether there are specific risk factors for mesh-related complications. They analyzed data for 59,887 women who underwent the procedure across Ontario during a 10-year period. Median follow-up was 4.4 years.

The procedures were performed by 1,068 surgeons: 293 urologists, 625 gynecologists, and 150 unspecified clinicians. Cases were classified according to whether the surgeon performed a high or low volume of mesh-sling procedures specifically for SUI. High volume was defined as a number at or above the 75th percentile for yearly volume in the province, or more than 16 procedures per year.

Overall, 1,307 women (2.2%) required mesh removal or revision a median of 1 year after the initial surgery. The cumulative incidence of the composite outcome of removal/revision of vaginal or urethral mesh, removal of a foreign body, endoscopic treatment of a urethral foreign body or mesh encrustation, uretrolysis, or repair of a urethrovaginal fistula was 3.29 at 10 years, Dr. Welk and his associates reported. Surgical specialty had no significant effect on complication risk.

This incidence is consistent with previous report from HMOs in the United States and a meta-analysis of clinical trial results, the investigators noted (JAMA Surg. 2015 Sept. 9. doi: 10.1001/jamasurg.2015.2590). Patients of low-volume surgeons had a 37% higher relative risk of complications requiring reoperation than did patients of high-volume surgeons. In a further analysis of the data, patients of low-volume surgeons were significantly more likely to experience the composite outcome than were patients of high-volume surgeons (hazard ratio, 1.37), and, again, the difference between surgical specialties was nonsignificant.

Urologists and gynecologists have very different surgical training and day-to-day practices, the researchers noted, and as a result they hypothesized that complication rates might differ between the two groups of clinicians. But that was not proven in the findings.

“This suggests that procedure-specific knowledge and experience is important for surgery to treat SUI, rather than general operative training,” Dr. Welk and his associates wrote.

Women who underwent multiple mesh-based procedures for SUI were at highest risk for the composite endpoint. Their absolute risk for later mesh removal or revision was 4.87%.

“This novel finding should temper the enthusiasm of case series that suggest that the use of multiple synthetic slings is safe and efficacious,” the researchers wrote.

This finding is also important in light of the fact that 1,307 of the study participants underwent more than one mesh implant procedure, presumably for recurrent SUI.

This study was supported by the Ontario Ministry of Health and Long-term Care and the Academic Medical Organization of Southwestern Ontario. Dr. Welk reported receiving grant funding from Astellas Canada.

The 10-year incidence of serious complications after mesh-sling surgery for stress urinary incontinence is a relatively low 3.29, but patients treated by surgeons who perform a low volume of the procedures have a 37% higher relative risk of requiring further surgery for complications, compared with patients of experienced surgeons, according to a report published online Sept. 9 in JAMA Surgery.

“These findings support the regulatory statements that suggest that patients should be counseled regarding serious complications that can occur with mesh-based procedures for SUI and that surgeons should achieve expertise in their chosen procedure,” wrote Dr. Blayne Welk of the department of surgery and the department of epidemiology and biostatistics at Western University and St. Joseph’s Health Care, London (Ont.) and his associates.

The investigators performed a population-based retrospective cohort study to determine the incidence of surgical removal or revision after a mesh-sling procedure for SUI and to examine whether there are specific risk factors for mesh-related complications. They analyzed data for 59,887 women who underwent the procedure across Ontario during a 10-year period. Median follow-up was 4.4 years.

The procedures were performed by 1,068 surgeons: 293 urologists, 625 gynecologists, and 150 unspecified clinicians. Cases were classified according to whether the surgeon performed a high or low volume of mesh-sling procedures specifically for SUI. High volume was defined as a number at or above the 75th percentile for yearly volume in the province, or more than 16 procedures per year.

Overall, 1,307 women (2.2%) required mesh removal or revision a median of 1 year after the initial surgery. The cumulative incidence of the composite outcome of removal/revision of vaginal or urethral mesh, removal of a foreign body, endoscopic treatment of a urethral foreign body or mesh encrustation, uretrolysis, or repair of a urethrovaginal fistula was 3.29 at 10 years, Dr. Welk and his associates reported. Surgical specialty had no significant effect on complication risk.

This incidence is consistent with previous report from HMOs in the United States and a meta-analysis of clinical trial results, the investigators noted (JAMA Surg. 2015 Sept. 9. doi: 10.1001/jamasurg.2015.2590). Patients of low-volume surgeons had a 37% higher relative risk of complications requiring reoperation than did patients of high-volume surgeons. In a further analysis of the data, patients of low-volume surgeons were significantly more likely to experience the composite outcome than were patients of high-volume surgeons (hazard ratio, 1.37), and, again, the difference between surgical specialties was nonsignificant.

Urologists and gynecologists have very different surgical training and day-to-day practices, the researchers noted, and as a result they hypothesized that complication rates might differ between the two groups of clinicians. But that was not proven in the findings.

“This suggests that procedure-specific knowledge and experience is important for surgery to treat SUI, rather than general operative training,” Dr. Welk and his associates wrote.

Women who underwent multiple mesh-based procedures for SUI were at highest risk for the composite endpoint. Their absolute risk for later mesh removal or revision was 4.87%.

“This novel finding should temper the enthusiasm of case series that suggest that the use of multiple synthetic slings is safe and efficacious,” the researchers wrote.

This finding is also important in light of the fact that 1,307 of the study participants underwent more than one mesh implant procedure, presumably for recurrent SUI.

This study was supported by the Ontario Ministry of Health and Long-term Care and the Academic Medical Organization of Southwestern Ontario. Dr. Welk reported receiving grant funding from Astellas Canada.