ACS Surgery News

CHICAGO – Urgent carotid interventions were safe after thrombolysis for acute mild to moderate strokes, according to a review of 165 patients at the Ochsner Clinic in New Orleans.

“Our data support the practice of not denying a patient an urgent carotid intervention simply because of TPA [tissue plasminogen activator] administration during the acute stroke period,” said lead investigator Dr. Nicolas Zea, an Ochsner vascular surgeon.

“Urgent carotid endarterectomy [CEA] or coronary artery stenting [CAS] can be safely undertaken in minor to moderate strokes with NIH stroke scale scores less than 10; TPA itself does not appear to be a contraindication, even within 72 hours,” he added.

Urgent carotid interventions are becoming more common after ischemic strokes to prevent recurrences. The approach is most effective within 2 weeks of the index event, but there have been concerns that intracranial hemorrhages (ICH) and other complications might be more likely if patients have had TPA.

Dr. Ochsner and his colleagues conducted their review because, “as vascular surgeons, we are going to encounter a lot more of these patients in the very near future,” Dr. Zea said a meeting hosted by the Society for Vascular Surgery.

From January 2009 to January 2015, 31 patients at Ochsner had carotid interventions – 25 CEA, 6 CAS – a mean of 2.1 days after receiving TPA for transient ischemic attacks (TIA) or ischemic strokes. The patients’ mean National Institutes of Health Stroke Scale (NIHSS) score was 6.6.

Over the same period, 134 patients who had not received TPA had urgent carotid interventions – 110 CEA, 24 CAS – a mean of 2.6 days after TIA or ischemic stroke presentation. Their mean NIHSS score was 6.1.

There were no statistically significant demographic or comorbidity differences between the TPA and no-TPA groups; patients were about 70 years old, on average, and the majority were men. Most had ipsilateral carotid stenosis greater than 70%, or acute occlusions.

The 30-day overall complication rate was 12.9% in the TPA group and 6.7% in the non-TPA group, a nonsignificant difference (P = 0.35).

In the TPA group, there was one (3.2%) ICH, one (3.2%) neck hematoma, and two (6.4%) deaths. In the no-TPA group, there were two (1.5%) ICHs, two (1.5%) neck hematomas, one (0.7%) ischemic stroke, two (1.5%) myocardial infarctions, and two (1.5%) deaths.

In both groups, ICH patients had stroke scores greater than 10. Also, although the rate of death was higher in the TPA group, the deaths “were not necessarily related to thrombolysis,” Dr. Zea noted. One death was from pulmonary embolism, the second from unknown causes. Deaths were due to acute mesenteric ischemia and ICH in the no-TPA group, Dr. Zea said.

There was one (3.2%) hemorrhagic conversion in the TPA group and two (1.5%) in the no-TPA group. Similarly, one (3.2%) TPA patient and two (1.5%) no-TPA patients had complications from access site bleeding. The differences were not statistically significant.

In the TPA group, it didn’t seem to matter if intervention came within 72 hours of administration – as in about half the cases – or afterward, when TPA risks have largely passed. There was one death and one ICH in patients in the earlier group, and one death in the later group, a nonsignificant difference.

There was no outside funding for the study. Dr. Zea had no disclosures. One of the coinvestigators is a consultant for Lutonix.

aotto@frontlinemedcom.com

CHICAGO – Urgent carotid interventions were safe after thrombolysis for acute mild to moderate strokes, according to a review of 165 patients at the Ochsner Clinic in New Orleans.

“Our data support the practice of not denying a patient an urgent carotid intervention simply because of TPA [tissue plasminogen activator] administration during the acute stroke period,” said lead investigator Dr. Nicolas Zea, an Ochsner vascular surgeon.

“Urgent carotid endarterectomy [CEA] or coronary artery stenting [CAS] can be safely undertaken in minor to moderate strokes with NIH stroke scale scores less than 10; TPA itself does not appear to be a contraindication, even within 72 hours,” he added.

Urgent carotid interventions are becoming more common after ischemic strokes to prevent recurrences. The approach is most effective within 2 weeks of the index event, but there have been concerns that intracranial hemorrhages (ICH) and other complications might be more likely if patients have had TPA.

Dr. Ochsner and his colleagues conducted their review because, “as vascular surgeons, we are going to encounter a lot more of these patients in the very near future,” Dr. Zea said a meeting hosted by the Society for Vascular Surgery.

From January 2009 to January 2015, 31 patients at Ochsner had carotid interventions – 25 CEA, 6 CAS – a mean of 2.1 days after receiving TPA for transient ischemic attacks (TIA) or ischemic strokes. The patients’ mean National Institutes of Health Stroke Scale (NIHSS) score was 6.6.

Over the same period, 134 patients who had not received TPA had urgent carotid interventions – 110 CEA, 24 CAS – a mean of 2.6 days after TIA or ischemic stroke presentation. Their mean NIHSS score was 6.1.

There were no statistically significant demographic or comorbidity differences between the TPA and no-TPA groups; patients were about 70 years old, on average, and the majority were men. Most had ipsilateral carotid stenosis greater than 70%, or acute occlusions.

The 30-day overall complication rate was 12.9% in the TPA group and 6.7% in the non-TPA group, a nonsignificant difference (P = 0.35).

In the TPA group, there was one (3.2%) ICH, one (3.2%) neck hematoma, and two (6.4%) deaths. In the no-TPA group, there were two (1.5%) ICHs, two (1.5%) neck hematomas, one (0.7%) ischemic stroke, two (1.5%) myocardial infarctions, and two (1.5%) deaths.

In both groups, ICH patients had stroke scores greater than 10. Also, although the rate of death was higher in the TPA group, the deaths “were not necessarily related to thrombolysis,” Dr. Zea noted. One death was from pulmonary embolism, the second from unknown causes. Deaths were due to acute mesenteric ischemia and ICH in the no-TPA group, Dr. Zea said.

There was one (3.2%) hemorrhagic conversion in the TPA group and two (1.5%) in the no-TPA group. Similarly, one (3.2%) TPA patient and two (1.5%) no-TPA patients had complications from access site bleeding. The differences were not statistically significant.

In the TPA group, it didn’t seem to matter if intervention came within 72 hours of administration – as in about half the cases – or afterward, when TPA risks have largely passed. There was one death and one ICH in patients in the earlier group, and one death in the later group, a nonsignificant difference.

There was no outside funding for the study. Dr. Zea had no disclosures. One of the coinvestigators is a consultant for Lutonix.

aotto@frontlinemedcom.com

CHICAGO – Urgent carotid interventions were safe after thrombolysis for acute mild to moderate strokes, according to a review of 165 patients at the Ochsner Clinic in New Orleans.

“Our data support the practice of not denying a patient an urgent carotid intervention simply because of TPA [tissue plasminogen activator] administration during the acute stroke period,” said lead investigator Dr. Nicolas Zea, an Ochsner vascular surgeon.

“Urgent carotid endarterectomy [CEA] or coronary artery stenting [CAS] can be safely undertaken in minor to moderate strokes with NIH stroke scale scores less than 10; TPA itself does not appear to be a contraindication, even within 72 hours,” he added.

Urgent carotid interventions are becoming more common after ischemic strokes to prevent recurrences. The approach is most effective within 2 weeks of the index event, but there have been concerns that intracranial hemorrhages (ICH) and other complications might be more likely if patients have had TPA.

Dr. Ochsner and his colleagues conducted their review because, “as vascular surgeons, we are going to encounter a lot more of these patients in the very near future,” Dr. Zea said a meeting hosted by the Society for Vascular Surgery.

From January 2009 to January 2015, 31 patients at Ochsner had carotid interventions – 25 CEA, 6 CAS – a mean of 2.1 days after receiving TPA for transient ischemic attacks (TIA) or ischemic strokes. The patients’ mean National Institutes of Health Stroke Scale (NIHSS) score was 6.6.

Over the same period, 134 patients who had not received TPA had urgent carotid interventions – 110 CEA, 24 CAS – a mean of 2.6 days after TIA or ischemic stroke presentation. Their mean NIHSS score was 6.1.

There were no statistically significant demographic or comorbidity differences between the TPA and no-TPA groups; patients were about 70 years old, on average, and the majority were men. Most had ipsilateral carotid stenosis greater than 70%, or acute occlusions.

The 30-day overall complication rate was 12.9% in the TPA group and 6.7% in the non-TPA group, a nonsignificant difference (P = 0.35).

In the TPA group, there was one (3.2%) ICH, one (3.2%) neck hematoma, and two (6.4%) deaths. In the no-TPA group, there were two (1.5%) ICHs, two (1.5%) neck hematomas, one (0.7%) ischemic stroke, two (1.5%) myocardial infarctions, and two (1.5%) deaths.

In both groups, ICH patients had stroke scores greater than 10. Also, although the rate of death was higher in the TPA group, the deaths “were not necessarily related to thrombolysis,” Dr. Zea noted. One death was from pulmonary embolism, the second from unknown causes. Deaths were due to acute mesenteric ischemia and ICH in the no-TPA group, Dr. Zea said.

There was one (3.2%) hemorrhagic conversion in the TPA group and two (1.5%) in the no-TPA group. Similarly, one (3.2%) TPA patient and two (1.5%) no-TPA patients had complications from access site bleeding. The differences were not statistically significant.

In the TPA group, it didn’t seem to matter if intervention came within 72 hours of administration – as in about half the cases – or afterward, when TPA risks have largely passed. There was one death and one ICH in patients in the earlier group, and one death in the later group, a nonsignificant difference.

There was no outside funding for the study. Dr. Zea had no disclosures. One of the coinvestigators is a consultant for Lutonix.

aotto@frontlinemedcom.com

Sepsis-related hospital readmission costs in California adults were more than double those for congestive heart failure (CHF) and more than triple those for acute myocardial infarction (AMI) between 2009 and 2011, a retrospective cohort analysis showed.

The all-cause, 30-day readmission rates among 240,198 sepsis patients, 193,153 CHF patients, and 105,684 AMI patients were 20.4%, 23.6%, and 17.7%, respectively, and the estimated annual costs of those readmissions were $500 million, $229 million, and $142 million, respectively, Dr. Dong W. Chang of Harbor-UCLA Medical Center, Torrance, Calif. and colleagues reported online in Critical Care Medicine (June 30, 2015 [doi:10.1097/CCM.0000000000001159]).

Patient-level factors associated with greater likelihood of 30-day readmission after sepsis included younger age (odds ratio, 1.34 for youngest vs. oldest age categories), black race (odds ratio, 1.29 vs. white race), Native American race (odds ratio, 2.39 vs. white race), and lower income (odds ratio, 1.13 for lowest vs. highest income quartiles). Male gender, residence in metropolitan areas, and greater burden of medical comorbidities were also associated with readmission after sepsis.

Hospital-level factors associated with greater likelihood of readmission included health care delivery to the highest vs. lowest quintile of minorities (odds ratio, 1.28), for-profit status (odds ratio, 1.34), and university vs. nonuniversity hospital setting (odds ratio, 1.35), the investigators found.

The findings, derived from the Healthcare Cost and Utilization Project State Inpatient Database maintained by the Agency for Healthcare Research and Quality, show that sepsis is a leading contributor to excess health care costs related to hospital readmissions.

A better understanding of the causative events leading to sepsis readmissions is needed, the investigators noted, and if studies and policies seeking to reduce hospital readmissions are to be effective, they will need to focus on the problem of sepsis-related readmissions – on a level that is at least comparable to CHF and AMI.

Dr. Chang received research support from the National Institutes of Health.

sworcester@frontlinemedcom.com

Sepsis-related hospital readmission costs in California adults were more than double those for congestive heart failure (CHF) and more than triple those for acute myocardial infarction (AMI) between 2009 and 2011, a retrospective cohort analysis showed.

The all-cause, 30-day readmission rates among 240,198 sepsis patients, 193,153 CHF patients, and 105,684 AMI patients were 20.4%, 23.6%, and 17.7%, respectively, and the estimated annual costs of those readmissions were $500 million, $229 million, and $142 million, respectively, Dr. Dong W. Chang of Harbor-UCLA Medical Center, Torrance, Calif. and colleagues reported online in Critical Care Medicine (June 30, 2015 [doi:10.1097/CCM.0000000000001159]).

Patient-level factors associated with greater likelihood of 30-day readmission after sepsis included younger age (odds ratio, 1.34 for youngest vs. oldest age categories), black race (odds ratio, 1.29 vs. white race), Native American race (odds ratio, 2.39 vs. white race), and lower income (odds ratio, 1.13 for lowest vs. highest income quartiles). Male gender, residence in metropolitan areas, and greater burden of medical comorbidities were also associated with readmission after sepsis.

Hospital-level factors associated with greater likelihood of readmission included health care delivery to the highest vs. lowest quintile of minorities (odds ratio, 1.28), for-profit status (odds ratio, 1.34), and university vs. nonuniversity hospital setting (odds ratio, 1.35), the investigators found.

The findings, derived from the Healthcare Cost and Utilization Project State Inpatient Database maintained by the Agency for Healthcare Research and Quality, show that sepsis is a leading contributor to excess health care costs related to hospital readmissions.

A better understanding of the causative events leading to sepsis readmissions is needed, the investigators noted, and if studies and policies seeking to reduce hospital readmissions are to be effective, they will need to focus on the problem of sepsis-related readmissions – on a level that is at least comparable to CHF and AMI.

Dr. Chang received research support from the National Institutes of Health.

sworcester@frontlinemedcom.com

Sepsis-related hospital readmission costs in California adults were more than double those for congestive heart failure (CHF) and more than triple those for acute myocardial infarction (AMI) between 2009 and 2011, a retrospective cohort analysis showed.

The all-cause, 30-day readmission rates among 240,198 sepsis patients, 193,153 CHF patients, and 105,684 AMI patients were 20.4%, 23.6%, and 17.7%, respectively, and the estimated annual costs of those readmissions were $500 million, $229 million, and $142 million, respectively, Dr. Dong W. Chang of Harbor-UCLA Medical Center, Torrance, Calif. and colleagues reported online in Critical Care Medicine (June 30, 2015 [doi:10.1097/CCM.0000000000001159]).

Patient-level factors associated with greater likelihood of 30-day readmission after sepsis included younger age (odds ratio, 1.34 for youngest vs. oldest age categories), black race (odds ratio, 1.29 vs. white race), Native American race (odds ratio, 2.39 vs. white race), and lower income (odds ratio, 1.13 for lowest vs. highest income quartiles). Male gender, residence in metropolitan areas, and greater burden of medical comorbidities were also associated with readmission after sepsis.

Hospital-level factors associated with greater likelihood of readmission included health care delivery to the highest vs. lowest quintile of minorities (odds ratio, 1.28), for-profit status (odds ratio, 1.34), and university vs. nonuniversity hospital setting (odds ratio, 1.35), the investigators found.

The findings, derived from the Healthcare Cost and Utilization Project State Inpatient Database maintained by the Agency for Healthcare Research and Quality, show that sepsis is a leading contributor to excess health care costs related to hospital readmissions.

A better understanding of the causative events leading to sepsis readmissions is needed, the investigators noted, and if studies and policies seeking to reduce hospital readmissions are to be effective, they will need to focus on the problem of sepsis-related readmissions – on a level that is at least comparable to CHF and AMI.

Dr. Chang received research support from the National Institutes of Health.

sworcester@frontlinemedcom.com

The House has overwhemingly passed the 21st Century Cures Act, H.R. 6, a broad piece of legislation aimed at streamlining the approval process for medical drugs and devices.

The bill, passed by a 344-77 vote on July 10, also aims to spur innovation in biomedical research and to boost funding to the National Institutes of Health.

Changes made prior to the bill’s introduction to the House floor raised the ire of some legislators and included a reduction in NIH funding and the inclusion of Hyde Amendment language that prohibits the use of federal funds for abortions except in the case of rape, incest, or to save the life of the mother. The bill as it stands is not expected to be picked up in the Senate, which is expected to craft its own legislation.

Alicia Ault/Frontline Medical News

“I am concerned that the very goal of this legislation set out to achieve, to encourage biomedical innovation and the development of new treatment and cures is undermined somewhat by the reduction in funding for NIH from $10 billion to $8.75 billion,” House Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., said during the floor debate on July 9.

Despite the concerns over the changes to the bill, support for the bill was overwhelmingly voiced throughout the debate.

“It is time now that we as a nation got serious about curing the major diseases – not treating the diseases, but curing the major diseases – that are affecting this country and affecting us personally,” said House Republican Doctors’ Caucus Chairman Phil Roe, R-Tenn. “I am more passionate about this bill and excited about passing the 21st Century Cures bill than anything I have voted on since I have been in the Congress.”

gtwachtman@frontlinemedcom.com

The House has overwhemingly passed the 21st Century Cures Act, H.R. 6, a broad piece of legislation aimed at streamlining the approval process for medical drugs and devices.

The bill, passed by a 344-77 vote on July 10, also aims to spur innovation in biomedical research and to boost funding to the National Institutes of Health.

Changes made prior to the bill’s introduction to the House floor raised the ire of some legislators and included a reduction in NIH funding and the inclusion of Hyde Amendment language that prohibits the use of federal funds for abortions except in the case of rape, incest, or to save the life of the mother. The bill as it stands is not expected to be picked up in the Senate, which is expected to craft its own legislation.

Alicia Ault/Frontline Medical News

“I am concerned that the very goal of this legislation set out to achieve, to encourage biomedical innovation and the development of new treatment and cures is undermined somewhat by the reduction in funding for NIH from $10 billion to $8.75 billion,” House Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., said during the floor debate on July 9.

Despite the concerns over the changes to the bill, support for the bill was overwhelmingly voiced throughout the debate.

“It is time now that we as a nation got serious about curing the major diseases – not treating the diseases, but curing the major diseases – that are affecting this country and affecting us personally,” said House Republican Doctors’ Caucus Chairman Phil Roe, R-Tenn. “I am more passionate about this bill and excited about passing the 21st Century Cures bill than anything I have voted on since I have been in the Congress.”

gtwachtman@frontlinemedcom.com

The House has overwhemingly passed the 21st Century Cures Act, H.R. 6, a broad piece of legislation aimed at streamlining the approval process for medical drugs and devices.

The bill, passed by a 344-77 vote on July 10, also aims to spur innovation in biomedical research and to boost funding to the National Institutes of Health.

Changes made prior to the bill’s introduction to the House floor raised the ire of some legislators and included a reduction in NIH funding and the inclusion of Hyde Amendment language that prohibits the use of federal funds for abortions except in the case of rape, incest, or to save the life of the mother. The bill as it stands is not expected to be picked up in the Senate, which is expected to craft its own legislation.

Alicia Ault/Frontline Medical News

“I am concerned that the very goal of this legislation set out to achieve, to encourage biomedical innovation and the development of new treatment and cures is undermined somewhat by the reduction in funding for NIH from $10 billion to $8.75 billion,” House Energy and Commerce Committee Ranking Member Frank Pallone, D-N.J., said during the floor debate on July 9.

Despite the concerns over the changes to the bill, support for the bill was overwhelmingly voiced throughout the debate.

“It is time now that we as a nation got serious about curing the major diseases – not treating the diseases, but curing the major diseases – that are affecting this country and affecting us personally,” said House Republican Doctors’ Caucus Chairman Phil Roe, R-Tenn. “I am more passionate about this bill and excited about passing the 21st Century Cures bill than anything I have voted on since I have been in the Congress.”

gtwachtman@frontlinemedcom.com

The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

mrajaraman@frontlinemedcom.com

The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

mrajaraman@frontlinemedcom.com

The Centers for Medicare & Medicaid Services has proposed a Comprehensive Care for Joint Replacement payment model to improve patient outcomes from hip and knee replacement surgery, the agency announced July 9.

Under the proposed rule, the hospital in which the surgery takes place would be responsible for cost and quality of care from the time of surgery through 90 days after the procedure, or an “episode” of care. Then, based on cost performance and the quality of care delivered, the facility would either receive a financial reward or be required to repay Medicare for a portion of the costs, CMS said in a statement.

“This payment would give hospitals an incentive to work with physicians, home health agencies, and nursing facilities to make sure beneficiaries receive the coordinated care they need with the goal of reducing avoidable hospitalizations and complications,” the agency said.

The new model is an effort to improve the lack of coordinated care that may lead to postsurgery complications and high readmission rates in Medicare beneficiaries who receive these procedures.

“Joint replacements are the most commonly performed Medicare inpatient surgery and their utilization is predicted to continue to grow,” CMS said. “They can require long recoveries that may include extensive rehabilitation or other post-acute care, which provides many opportunities to reward providers that improve patient outcomes.”

Read the proposed rule here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-17190.pdf

mrajaraman@frontlinemedcom.com

Physicians are praising a new proposal by the Centers for Medicare & Medicaid Services to pay for end-of-life counseling as part of a sweeping draft of updates to its 2016 physician payment schedule.

The proposed fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes modifications to reimbursement policies, changes to misvalued codes, and updates to quality performance metrics for physicians who participate in the Physician Quality Reporting System (PQRS).

©sripphoto/Thinkstock

As part of the proposal, released on July 8, two new advance care planning codes would be created to pay physicians for time discussing patient options for advance directives. The first code would cover an initial 30 minutes of the doctors’ time, and the second would cover additional 30-minute blocks as necessary.

Dr. Andrew W. Gurman, president-elect of the American Medical Association, said the proposed rule affirms the need to support conversations between doctors and patients about end-of-life wishes before critical medical events occur. The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) created the new CPT codes and recommended the associated payments for calendar year 2015.

“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Dr. Gurman said in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”

The American College of Physicians (ACP) applauded inclusion of the advance care planning codes, calling it an important step to improve care for Medicare patients with serious illnesses.

“The nation’s physicians believe that conversations among physicians, patients, and loved ones is the standard of care,” ACP President Dr. Wayne J. Riley said in a statement. “The College is pleased that CMS has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”

CMS’ proposal also includes updates to the PQRS, the federal program that provides incentive payments to eligible professionals and group practices that report data on quality measures for covered services and/or participate in a qualified clinical data registry (QCDR). The proposal would establish criteria for satisfactory reporting similar to that of previous years, including the general reporting of nine measures covering three National Quality Strategy domains.

Eligible professionals and practices who do not report on PQRS standards in 2016 will see their 2018 Medicare pay cut by 2%. The proposed fee schedule also would eliminate measures that are topped out, duplicative, or are being replaced with more robust measures. If the proposal is finalized, 300 total measures in the PQRS program are slated for 2016.

The proposed fee schedule also would modify the the Medicare Shared Savings Program (MSSP) by:

• Allowing participants to add or delete a measure if it no longer aligns with updated clinical practice or causes patient harm.

• Clarifying how PQRS-eligible professionals participating within an ACO can meet PQRS requirements when their ACO satisfactorily reports quality measures.

• Amending the definition of primary care services to include claims submitted by certain teaching hospitals and excluding those submitted by skilled nursing facilities.

The proposed fee schedule also addresses telemedicine services. CMS says it will pay for telemedicine if the treatment is on the list of approved Medicare telehealth services, and if:

• the service is furnished via an interactive telecommunications system.

• The service is furnished by a physician or authorized practitioner.

• The service is furnished to an eligible telehealth patient.

• The patient receiving the service must be located in a telehealth originating site.

If these conditions are met, Medicare will pay a facility fee to the originating site and make separates payment to the distant site health provider furnishing the service.

CMS is also proposing payment changes for certain specialty services based on codes determined to be misvalued. Specifically, physicians who practice radiation therapy, radiation oncology, and gastroenterology would experience significant decreases to payments for services that they frequently furnish as a result of widespread revisions to the Relative Value Unit (RVU) structure used to establish such codes. Other specialties, such as pathology, would experience significant increases to payments for similar reasons, CMS states. The modifications are a result of an initiative to review misvalued codes and establish new and revised codes.

Meanwhile, CMS is seeking feedback on several components of MACRA, including the definition of clinical practice improvement activities and input on how to define a physician-focused payment model. The agency is also asking for feedback on whether to expand the Comprehensive Primary Care Initiative, a 4-year multipayer pilot that aims to strengthen primary care by offering population-based care management fees and shared savings opportunities to participating health providers.

The proposed rule will be published in the Federal Register on July 15; comments will be accepted through Sept. 8.

agallegos@frontlinemedcom.com

On Twitter @legal_med

Physicians are praising a new proposal by the Centers for Medicare & Medicaid Services to pay for end-of-life counseling as part of a sweeping draft of updates to its 2016 physician payment schedule.

The proposed fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes modifications to reimbursement policies, changes to misvalued codes, and updates to quality performance metrics for physicians who participate in the Physician Quality Reporting System (PQRS).

©sripphoto/Thinkstock

As part of the proposal, released on July 8, two new advance care planning codes would be created to pay physicians for time discussing patient options for advance directives. The first code would cover an initial 30 minutes of the doctors’ time, and the second would cover additional 30-minute blocks as necessary.

Dr. Andrew W. Gurman, president-elect of the American Medical Association, said the proposed rule affirms the need to support conversations between doctors and patients about end-of-life wishes before critical medical events occur. The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) created the new CPT codes and recommended the associated payments for calendar year 2015.

“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Dr. Gurman said in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”

The American College of Physicians (ACP) applauded inclusion of the advance care planning codes, calling it an important step to improve care for Medicare patients with serious illnesses.

“The nation’s physicians believe that conversations among physicians, patients, and loved ones is the standard of care,” ACP President Dr. Wayne J. Riley said in a statement. “The College is pleased that CMS has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”

CMS’ proposal also includes updates to the PQRS, the federal program that provides incentive payments to eligible professionals and group practices that report data on quality measures for covered services and/or participate in a qualified clinical data registry (QCDR). The proposal would establish criteria for satisfactory reporting similar to that of previous years, including the general reporting of nine measures covering three National Quality Strategy domains.

Eligible professionals and practices who do not report on PQRS standards in 2016 will see their 2018 Medicare pay cut by 2%. The proposed fee schedule also would eliminate measures that are topped out, duplicative, or are being replaced with more robust measures. If the proposal is finalized, 300 total measures in the PQRS program are slated for 2016.

The proposed fee schedule also would modify the the Medicare Shared Savings Program (MSSP) by:

• Allowing participants to add or delete a measure if it no longer aligns with updated clinical practice or causes patient harm.

• Clarifying how PQRS-eligible professionals participating within an ACO can meet PQRS requirements when their ACO satisfactorily reports quality measures.

• Amending the definition of primary care services to include claims submitted by certain teaching hospitals and excluding those submitted by skilled nursing facilities.

The proposed fee schedule also addresses telemedicine services. CMS says it will pay for telemedicine if the treatment is on the list of approved Medicare telehealth services, and if:

• the service is furnished via an interactive telecommunications system.

• The service is furnished by a physician or authorized practitioner.

• The service is furnished to an eligible telehealth patient.

• The patient receiving the service must be located in a telehealth originating site.

If these conditions are met, Medicare will pay a facility fee to the originating site and make separates payment to the distant site health provider furnishing the service.

CMS is also proposing payment changes for certain specialty services based on codes determined to be misvalued. Specifically, physicians who practice radiation therapy, radiation oncology, and gastroenterology would experience significant decreases to payments for services that they frequently furnish as a result of widespread revisions to the Relative Value Unit (RVU) structure used to establish such codes. Other specialties, such as pathology, would experience significant increases to payments for similar reasons, CMS states. The modifications are a result of an initiative to review misvalued codes and establish new and revised codes.

Meanwhile, CMS is seeking feedback on several components of MACRA, including the definition of clinical practice improvement activities and input on how to define a physician-focused payment model. The agency is also asking for feedback on whether to expand the Comprehensive Primary Care Initiative, a 4-year multipayer pilot that aims to strengthen primary care by offering population-based care management fees and shared savings opportunities to participating health providers.

The proposed rule will be published in the Federal Register on July 15; comments will be accepted through Sept. 8.

agallegos@frontlinemedcom.com

On Twitter @legal_med

Physicians are praising a new proposal by the Centers for Medicare & Medicaid Services to pay for end-of-life counseling as part of a sweeping draft of updates to its 2016 physician payment schedule.

The proposed fee schedule – the first since repeal of the Sustainable Growth Rate (SGR) formula and enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – includes modifications to reimbursement policies, changes to misvalued codes, and updates to quality performance metrics for physicians who participate in the Physician Quality Reporting System (PQRS).

©sripphoto/Thinkstock

As part of the proposal, released on July 8, two new advance care planning codes would be created to pay physicians for time discussing patient options for advance directives. The first code would cover an initial 30 minutes of the doctors’ time, and the second would cover additional 30-minute blocks as necessary.

Dr. Andrew W. Gurman, president-elect of the American Medical Association, said the proposed rule affirms the need to support conversations between doctors and patients about end-of-life wishes before critical medical events occur. The AMA Current Procedural Terminology (CPT) Editorial Panel and the AMA Relative Value Update Committee (RUC) created the new CPT codes and recommended the associated payments for calendar year 2015.

“This is a patient-centered policy intended to support a careful planning process that is assisted by a physician or other qualified health care professional,” Dr. Gurman said in a statement. “This issue has been mischaracterized in the past and it is time to facilitate patient choices about advance care planning decisions.”

The American College of Physicians (ACP) applauded inclusion of the advance care planning codes, calling it an important step to improve care for Medicare patients with serious illnesses.

“The nation’s physicians believe that conversations among physicians, patients, and loved ones is the standard of care,” ACP President Dr. Wayne J. Riley said in a statement. “The College is pleased that CMS has recognized what the medical community is doing to address the needs and requests made by patients and their loved ones.”

CMS’ proposal also includes updates to the PQRS, the federal program that provides incentive payments to eligible professionals and group practices that report data on quality measures for covered services and/or participate in a qualified clinical data registry (QCDR). The proposal would establish criteria for satisfactory reporting similar to that of previous years, including the general reporting of nine measures covering three National Quality Strategy domains.

Eligible professionals and practices who do not report on PQRS standards in 2016 will see their 2018 Medicare pay cut by 2%. The proposed fee schedule also would eliminate measures that are topped out, duplicative, or are being replaced with more robust measures. If the proposal is finalized, 300 total measures in the PQRS program are slated for 2016.

The proposed fee schedule also would modify the the Medicare Shared Savings Program (MSSP) by:

• Allowing participants to add or delete a measure if it no longer aligns with updated clinical practice or causes patient harm.

• Clarifying how PQRS-eligible professionals participating within an ACO can meet PQRS requirements when their ACO satisfactorily reports quality measures.

• Amending the definition of primary care services to include claims submitted by certain teaching hospitals and excluding those submitted by skilled nursing facilities.

The proposed fee schedule also addresses telemedicine services. CMS says it will pay for telemedicine if the treatment is on the list of approved Medicare telehealth services, and if:

• the service is furnished via an interactive telecommunications system.

• The service is furnished by a physician or authorized practitioner.

• The service is furnished to an eligible telehealth patient.

• The patient receiving the service must be located in a telehealth originating site.

If these conditions are met, Medicare will pay a facility fee to the originating site and make separates payment to the distant site health provider furnishing the service.

CMS is also proposing payment changes for certain specialty services based on codes determined to be misvalued. Specifically, physicians who practice radiation therapy, radiation oncology, and gastroenterology would experience significant decreases to payments for services that they frequently furnish as a result of widespread revisions to the Relative Value Unit (RVU) structure used to establish such codes. Other specialties, such as pathology, would experience significant increases to payments for similar reasons, CMS states. The modifications are a result of an initiative to review misvalued codes and establish new and revised codes.

Meanwhile, CMS is seeking feedback on several components of MACRA, including the definition of clinical practice improvement activities and input on how to define a physician-focused payment model. The agency is also asking for feedback on whether to expand the Comprehensive Primary Care Initiative, a 4-year multipayer pilot that aims to strengthen primary care by offering population-based care management fees and shared savings opportunities to participating health providers.

The proposed rule will be published in the Federal Register on July 15; comments will be accepted through Sept. 8.

agallegos@frontlinemedcom.com

On Twitter @legal_med

ACS Surgery News, the official newspaper of the American College of Surgeons, has a new look. The July issue will have a fresh design, new colors, and an increased focus on visual accessibility for readers. The updated format is easier to read and has more graphic elements for quicker access to data. Future issues with the new design will feature opinion columns, updates on critical practice economics issues, and news coverage of cutting-edge surgical technology.

ACS Surgery News readership has surged over the past 2 years. The growing popularity of ACS Surgery News is based on quality content: lively commentary by thought leaders of the surgical profession, timely coverage of surgery meetings, and in-depth features on those issues most important to surgeons.

In addition, the publication website has a fresh look: better layout; easier access to the digital, interactive version of the publication; and more graphic elements.

The next issue of ACS Surgery News mails on July 17. This publication has thrived on commentary, critique, and contributions from readers. Take a look at the new design and let the editorial team know what you think.

ACS Surgery News, the official newspaper of the American College of Surgeons, has a new look. The July issue will have a fresh design, new colors, and an increased focus on visual accessibility for readers. The updated format is easier to read and has more graphic elements for quicker access to data. Future issues with the new design will feature opinion columns, updates on critical practice economics issues, and news coverage of cutting-edge surgical technology.

ACS Surgery News readership has surged over the past 2 years. The growing popularity of ACS Surgery News is based on quality content: lively commentary by thought leaders of the surgical profession, timely coverage of surgery meetings, and in-depth features on those issues most important to surgeons.

In addition, the publication website has a fresh look: better layout; easier access to the digital, interactive version of the publication; and more graphic elements.

The next issue of ACS Surgery News mails on July 17. This publication has thrived on commentary, critique, and contributions from readers. Take a look at the new design and let the editorial team know what you think.

ACS Surgery News, the official newspaper of the American College of Surgeons, has a new look. The July issue will have a fresh design, new colors, and an increased focus on visual accessibility for readers. The updated format is easier to read and has more graphic elements for quicker access to data. Future issues with the new design will feature opinion columns, updates on critical practice economics issues, and news coverage of cutting-edge surgical technology.

ACS Surgery News readership has surged over the past 2 years. The growing popularity of ACS Surgery News is based on quality content: lively commentary by thought leaders of the surgical profession, timely coverage of surgery meetings, and in-depth features on those issues most important to surgeons.

In addition, the publication website has a fresh look: better layout; easier access to the digital, interactive version of the publication; and more graphic elements.

The next issue of ACS Surgery News mails on July 17. This publication has thrived on commentary, critique, and contributions from readers. Take a look at the new design and let the editorial team know what you think.

Everything may be bigger in Texas, but New York is the biggest in at least one area: large medical malpractice payments. New York had more than three times as many $1 million–plus malpractice awards as any other state in 2014, according to data from the National Practitioner Data Bank.

New York physicians had 210 malpractice payments of $1 million or more reported to the NPDB last year, compared with 61 for Illinois, the next-highest state. Rounding out the top five were Massachusetts with 49, followed by California with 43 and New Jersey with 41, the NPDB data show.

After taking population into account, New York was still the leader with 10.66 large awards per million residents. Next in this category was the New England trio of Rhode Island, which had 9.42 such payments per 1 million population; Massachusetts (7.26); and Connecticut (6.39).

In 2014, there were four states that had no malpractice payments of at least $1 million reported to the NPDB: Alaska, Kansas, North Dakota, and Nebraska, with Kansas having the largest population. In states with at least one $1 million–plus malpractice payment, Texas physicians had the lowest rate per million population, 0.22 – just 6 awards from a population of 27 million.

rfranki@frontlinemedcom.com

Everything may be bigger in Texas, but New York is the biggest in at least one area: large medical malpractice payments. New York had more than three times as many $1 million–plus malpractice awards as any other state in 2014, according to data from the National Practitioner Data Bank.

New York physicians had 210 malpractice payments of $1 million or more reported to the NPDB last year, compared with 61 for Illinois, the next-highest state. Rounding out the top five were Massachusetts with 49, followed by California with 43 and New Jersey with 41, the NPDB data show.

After taking population into account, New York was still the leader with 10.66 large awards per million residents. Next in this category was the New England trio of Rhode Island, which had 9.42 such payments per 1 million population; Massachusetts (7.26); and Connecticut (6.39).

In 2014, there were four states that had no malpractice payments of at least $1 million reported to the NPDB: Alaska, Kansas, North Dakota, and Nebraska, with Kansas having the largest population. In states with at least one $1 million–plus malpractice payment, Texas physicians had the lowest rate per million population, 0.22 – just 6 awards from a population of 27 million.

rfranki@frontlinemedcom.com

Everything may be bigger in Texas, but New York is the biggest in at least one area: large medical malpractice payments. New York had more than three times as many $1 million–plus malpractice awards as any other state in 2014, according to data from the National Practitioner Data Bank.

New York physicians had 210 malpractice payments of $1 million or more reported to the NPDB last year, compared with 61 for Illinois, the next-highest state. Rounding out the top five were Massachusetts with 49, followed by California with 43 and New Jersey with 41, the NPDB data show.

After taking population into account, New York was still the leader with 10.66 large awards per million residents. Next in this category was the New England trio of Rhode Island, which had 9.42 such payments per 1 million population; Massachusetts (7.26); and Connecticut (6.39).

In 2014, there were four states that had no malpractice payments of at least $1 million reported to the NPDB: Alaska, Kansas, North Dakota, and Nebraska, with Kansas having the largest population. In states with at least one $1 million–plus malpractice payment, Texas physicians had the lowest rate per million population, 0.22 – just 6 awards from a population of 27 million.

rfranki@frontlinemedcom.com