User login
Official Newspaper of the American College of Surgeons
Senate recesses without addressing SGR repeal bill
The Senate adjourned for a 2-week recess early on March 27, leaving without taking action on House-passed legislation to repeal the Medicare Sustainable Growth Rate formula and reauthorize the Children’s Health Insurance Program.
The Senate will not convene again until April 13, nearly 2 weeks after a temporary SGR patch expires. Doctors will see their Medicare pay cut by 21% on April 1.
As has happened in the SGR’s troubled past and for other reasons, doctors and legislators expect the Centers for Medicare & Medicaid Services to hold Medicare payments for a while until the Senate can act.
“We’ve seen CMS hold checks for 2 weeks. We know that can happen,” Rep. Michael Burgess (R-Texas), lead sponsor of H.R. 2, the Medicare Access and CHIP Reauthorization Act, told reporters. “If it doesn’t pass this week, the world wouldn’t come to an end.”
A 2-week hold generally does not impact physicians’ practices too harshly, Dr. Robert Wergin, president of the American Academy of Family Physicians, said regarding an administrative hold CMS announced in January 2015. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”
The American Medical Association called for the Senate to address H.R. 2 as soon as it returns.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Robert Wah, president of the AMA, said in a statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
On Twitter @denisefulton
The Senate adjourned for a 2-week recess early on March 27, leaving without taking action on House-passed legislation to repeal the Medicare Sustainable Growth Rate formula and reauthorize the Children’s Health Insurance Program.
The Senate will not convene again until April 13, nearly 2 weeks after a temporary SGR patch expires. Doctors will see their Medicare pay cut by 21% on April 1.
As has happened in the SGR’s troubled past and for other reasons, doctors and legislators expect the Centers for Medicare & Medicaid Services to hold Medicare payments for a while until the Senate can act.
“We’ve seen CMS hold checks for 2 weeks. We know that can happen,” Rep. Michael Burgess (R-Texas), lead sponsor of H.R. 2, the Medicare Access and CHIP Reauthorization Act, told reporters. “If it doesn’t pass this week, the world wouldn’t come to an end.”
A 2-week hold generally does not impact physicians’ practices too harshly, Dr. Robert Wergin, president of the American Academy of Family Physicians, said regarding an administrative hold CMS announced in January 2015. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”
The American Medical Association called for the Senate to address H.R. 2 as soon as it returns.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Robert Wah, president of the AMA, said in a statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
On Twitter @denisefulton
The Senate adjourned for a 2-week recess early on March 27, leaving without taking action on House-passed legislation to repeal the Medicare Sustainable Growth Rate formula and reauthorize the Children’s Health Insurance Program.
The Senate will not convene again until April 13, nearly 2 weeks after a temporary SGR patch expires. Doctors will see their Medicare pay cut by 21% on April 1.
As has happened in the SGR’s troubled past and for other reasons, doctors and legislators expect the Centers for Medicare & Medicaid Services to hold Medicare payments for a while until the Senate can act.
“We’ve seen CMS hold checks for 2 weeks. We know that can happen,” Rep. Michael Burgess (R-Texas), lead sponsor of H.R. 2, the Medicare Access and CHIP Reauthorization Act, told reporters. “If it doesn’t pass this week, the world wouldn’t come to an end.”
A 2-week hold generally does not impact physicians’ practices too harshly, Dr. Robert Wergin, president of the American Academy of Family Physicians, said regarding an administrative hold CMS announced in January 2015. “It does affect your cash flow, but it has happened in the past, particularly around the time with SGR patches.”
The American Medical Association called for the Senate to address H.R. 2 as soon as it returns.
“Physicians are always working to provide the highest quality of care for their patients and the bipartisan bill passed by the House provides a clear pathway for them to do that,” Dr. Robert Wah, president of the AMA, said in a statement. “We urge the Senate to immediately address this issue upon their return and once-and-for-all lay this destructive issue to rest by building the stable and sustainable Medicare program that our nation’s patients and physicians need and deserve.”
On Twitter @denisefulton
Doctors hail House vote to repeal, replace SGR
Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.
By a vote of 329-37, the House on March 26 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act. The legislation builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – which includes a 0.5% pay increase per year for providers over the next 5 years.
Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.
“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”
If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.
The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers
During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.
“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”
Physician associations commended passage of the bill.
“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.
Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.
“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”
By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.
“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”
Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.
“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.
President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.
“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.
The bill’s passage comes as the latest SGR patch is set to expire on March 31.
The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.
Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.
“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”
But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.
“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”
On Twitter @legal_med
Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.
By a vote of 329-37, the House on March 26 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act. The legislation builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – which includes a 0.5% pay increase per year for providers over the next 5 years.
Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.
“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”
If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.
The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers
During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.
“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”
Physician associations commended passage of the bill.
“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.
Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.
“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”
By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.
“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”
Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.
“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.
President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.
“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.
The bill’s passage comes as the latest SGR patch is set to expire on March 31.
The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.
Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.
“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”
But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.
“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”
On Twitter @legal_med
Physicians are lauding passage of legislation by the House of Representatives to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that would raise physician payments and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years.
By a vote of 329-37, the House on March 26 passed H.R. 2, the Medicare Access and CHIP Reauthorization Act. The legislation builds on H.R. 1470, the SGR Repeal and Medicare Provider Payment Modernization Act – reintroduced March 19 – which includes a 0.5% pay increase per year for providers over the next 5 years.
Physician leaders praised the vote and thanked lawmakers for finally passing what they called a critical SGR fix.
“Never before has there been such broad and bipartisan support within and outside of Congress for policies to repeal the Medicare SGR formula and to create a better payment system for physician services provided to patients enrolled in Medicare,” ACP President David A. Fleming said in a statement. “It is imperative that the Senate pass H.R. 2 before it recesses on Friday, March 27, and before a devastating 21% SGR cut is applied cut is applied to all physician services provided to Medicare enrollees.”
If enacted, H.R. 2 also would consolidate existing quality programs – including those regarding the meaningful use of electronic health records – into a single value-based performance program; incentivize physicians to use alternate payment models that focus on care coordination and preventive care; and push for more transparency of Medicare data for physicians, providers, and patients.
The bill also would reauthorize for 2 years CHIP, the Community Health Centers program, the National Health Service Corps, and the Teaching Health Centers program, all are scheduled to expire later this year. Additionally, the legislation continues a partial delay of the Medicare two-midnights ruleuntil Sept. 30.
The Congressional Budget Office estimates that enactment of H.R. 2 will increase the deficit by $141 billion over 10 years. The CBO’s score also found that the legislation would save money compared to the price of continued patches.
A total of $73 billion of the $214 billion cost of package is offset through spending reductions and revenue increases included in the bill, the CBO found. These include income-related premium adjustments for Medicare Parts B and D, Medigap reforms, an increase of levy authority on payments to Medicare providers with delinquent tax debt, adjustments to inpatient hospital payment rates, a delay of Medicaid Disproportionate Share Hospital (DSH) changes until 2018, and a 1% market basket update for postacute care providers
During House debate, Rep. Michael C. Burgess (R-Texas), the bill’s sponsor and a member of the Energy and Commerce Committee’s Health Subcommittee, said the legislation resolves an issue that many lawmakers have worked to repair their entire congressional careers.
“Everyone agrees, the Medicare Sustainable Growth Rate formula has got to go,” said Rep. Burgess, an ob.gyn. “The bill before us provides 5 years of payment transition and allows medicine to concentrate on moving to broad adoption of quality reporting and most importantly, allows congress to move past the distraction of the SGR formula and to begin to identify Medicare reforms that can further benefit our citizens.”
Physician associations commended passage of the bill.
“The American Medical Association applauds the U.S. House of Representatives for overwhelmingly passing a long overdue bill to permanently eliminate the flawed SGR formula and put in place important Medicare payment and delivery reforms that will improve the health of the nation,” AMA President Robert M. Wah said in a statement.
Long-term health security for elderly and disabled patients is closer to reality thanks to the passage of H.R. 2, according to Dr. Robert L. Wergin, president of the American Academy of Family Physicians.
“For the first time in 12 years, true Medicare reform is feasible,” Dr. Wergin said in a statement. “H.R. 2 repeals the disruptive SGR and restructures physician payment to help expand access, encourage quality improvements and spur innovation. The SGR has plagued Medicare patients for far too long. It’s destabilized their access to care and threatened the financial viability of their physicians’ practices for more than a decade.”
By reauthorizing CHIP, the bill will also help ensure millions of children, adolescents, and pregnant women have access to the care that they need, according to a joint statement by the American Academy of Pediatrics, the AMA, and the American Congress of Obstetricians and Gynecologists.
“CHIP is a bipartisan program that works,” the organizations said. “Since its beginning 17 years ago, the program has worked together with Medicaid to cut the child uninsurance rate in half, offering timely access to high-quality, affordable health insurance.”
Enactment of H.R. 2 will allow physicians to focus more fully on patient care rather than face the threat of dramatic cuts that could make caring for Medicare patients unsustainable, according to Dr. Kim Allan Williams Sr., president of the American College of Cardiology.
“Instead of kicking the can down the road one more time, Speaker [John] Boehner and Leader [Nancy] Pelosi demonstrated strong bipartisan leadership to address this problem at last. We urge the Senate to follow suit and quickly take up and pass the provisions of the House measure,” Dr. Williams said in a statement.
President Obama has indicated that he will sign the bill, calling the replacement model a system that offers predictability and accelerates participation in alternative payment models that encourage quality and efficiency.
“The proposal would advance the administration’s goal of moving the nation’s health care delivery system toward one that achieves better care, smarter spending, and healthier people through the expansion of new health care payment models, which could contribute to slowing long-term health care cost growth,” Mr. Obama said in a March 25 statement.
The bill’s passage comes as the latest SGR patch is set to expire on March 31.
The Senate could take up the bill as early as March 27; however, it also could wait until mid-April after a 2-week recess. Without a permanent or temporary SGR fix, doctors can expect a 21% Medicare pay cut come April 1.
Democrats on the Senate Finance Committee have criticized H.R. 2, saying that it unfairly penalizes patients and does not reauthorize CHIP for long enough.
“Any legislation of this magnitude sent to the Senate must be balanced,” according to a joint statement signed by all 12 Democrats who serve on the Finance Committee. “Our current understanding of what the House is negotiating does not sufficiently pass that test....While our concerns vary, we are united by the necessity of extending CHIP funding for 4 years.”
But Finance Committee Chair Sen. Orrin Hatch (R-Utah) has called for swift passage of the bill.
“The time to act is now,” Sen. Hatch said in a March 25 speech on the Senate floor. “I can’t imagine another bipartisan opportunity like this coming around again anytime soon.”
On Twitter @legal_med
Indocyanine green technique detects sentinel nodes in breast cancers
Indocyanine green dye caused no major side effects and was almost 99% concordant with radioisotope technetium for sentinel lymph node detection in early-stage breast cancer, according to researchers.
The results extend promising findings from an earlier meta-analysis of the tracer in a variety of tumor types, said Dr. Domenico Samorani of Santarcangelo di Romagna Hospital, Rimini, Italy.
“The method seems reproducible, safe, eliminates exposure to ionizing radiation, and is potentially cost-saving, despite requiring specialist training. [Also,] it could be an option for breast cancer centers with no nuclear medicine supply,” wrote Dr. Samorani and colleagues.
Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for staging breast cancer, as it causes much less morbidity and is associated with similar rates of survival and locoregional recurrence. Vital blue dyes and radioisotope technetium (99mTc) are the most commonly used enhancers, but the blue dyes can cause allergic reactions and skin necrosis, and 99mTc is costly and requires special logistics and handling because of its radioactivity, the investigators noted. For these reasons, there has been renewed interest in indocyanine green dye (ICG) as an alternative, they said (Eur. J. Surg. Oncol. 2015;41:64-70).
For the study, the investigators evaluated 589 lymph nodes from 301 patients with clinically node-negative, invasive or microinvasive early breast cancer confirmed by core biopsy. All patients underwent 99mTc-guided sentinel node detection, which served as the gold standard for comparison. To perform ICG-guided detection, the researchers diluted 25 mg of ICG PULSION with 5 mL distilled water and then injected empirical doses of 0.4 to 1.2 mL of the solution subcutaneously above the tumor site for unicentric cancers, or around the areola for multicentric disease. Then the researchers used an infrared-emitting camera (Photodynamic Eye, Hamamatsu Photonics, Hamamatsu, Japan) to visualize the lymphatic drainage pathway and localize sentinel nodes for removal.
Overall, 98.7% of sentinel nodes that were 99mTc positive also were ICG positive (95% confidence interval, 97.1%-99.5%), a high degree of concordance that reflected past study results, the investigators said. Notably, the ICG-guided technique identified at least one sentinel node for 297 patients (98.7%), compared with 287 patients (95.4%) for the 99mTc method (P < .05). Thus, the use of ICG prevented removal of the entire axilla for 10 patients, the researchers wrote.
For six patients, the ICG method identified a metastatic node that 99mTc failed to identify. Therefore, ICG provided an advantage for 16 cases (5.3%). No patients experienced allergic reactions, 3.2% developed seromas, and 2.5% developed paresthesia, the researchers added.
Use of ICG instead of 99mTc for sentinel lymph node detection has several advantages: It does not require involving a nuclear medicine department, uses less radioactive material, minimizes issues around waste disposal, and can be performed in the operating room immediately after the induction of general anesthesia, said the researchers. And if combined with radio-guided occult lesion localization (ROLL), it avoids placing two radioactive tracings at the injection site, thereby facilitating tumor detection, the researchers noted.
Clinicians who are implementing ICG-guided sentinel node detection should consider combining it with 99mTc to avoid missing nodes during the learning process, the researchers emphasized.
They reported no funding sources and no conflicts of interest.
Indocyanine green dye caused no major side effects and was almost 99% concordant with radioisotope technetium for sentinel lymph node detection in early-stage breast cancer, according to researchers.
The results extend promising findings from an earlier meta-analysis of the tracer in a variety of tumor types, said Dr. Domenico Samorani of Santarcangelo di Romagna Hospital, Rimini, Italy.
“The method seems reproducible, safe, eliminates exposure to ionizing radiation, and is potentially cost-saving, despite requiring specialist training. [Also,] it could be an option for breast cancer centers with no nuclear medicine supply,” wrote Dr. Samorani and colleagues.
Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for staging breast cancer, as it causes much less morbidity and is associated with similar rates of survival and locoregional recurrence. Vital blue dyes and radioisotope technetium (99mTc) are the most commonly used enhancers, but the blue dyes can cause allergic reactions and skin necrosis, and 99mTc is costly and requires special logistics and handling because of its radioactivity, the investigators noted. For these reasons, there has been renewed interest in indocyanine green dye (ICG) as an alternative, they said (Eur. J. Surg. Oncol. 2015;41:64-70).
For the study, the investigators evaluated 589 lymph nodes from 301 patients with clinically node-negative, invasive or microinvasive early breast cancer confirmed by core biopsy. All patients underwent 99mTc-guided sentinel node detection, which served as the gold standard for comparison. To perform ICG-guided detection, the researchers diluted 25 mg of ICG PULSION with 5 mL distilled water and then injected empirical doses of 0.4 to 1.2 mL of the solution subcutaneously above the tumor site for unicentric cancers, or around the areola for multicentric disease. Then the researchers used an infrared-emitting camera (Photodynamic Eye, Hamamatsu Photonics, Hamamatsu, Japan) to visualize the lymphatic drainage pathway and localize sentinel nodes for removal.
Overall, 98.7% of sentinel nodes that were 99mTc positive also were ICG positive (95% confidence interval, 97.1%-99.5%), a high degree of concordance that reflected past study results, the investigators said. Notably, the ICG-guided technique identified at least one sentinel node for 297 patients (98.7%), compared with 287 patients (95.4%) for the 99mTc method (P < .05). Thus, the use of ICG prevented removal of the entire axilla for 10 patients, the researchers wrote.
For six patients, the ICG method identified a metastatic node that 99mTc failed to identify. Therefore, ICG provided an advantage for 16 cases (5.3%). No patients experienced allergic reactions, 3.2% developed seromas, and 2.5% developed paresthesia, the researchers added.
Use of ICG instead of 99mTc for sentinel lymph node detection has several advantages: It does not require involving a nuclear medicine department, uses less radioactive material, minimizes issues around waste disposal, and can be performed in the operating room immediately after the induction of general anesthesia, said the researchers. And if combined with radio-guided occult lesion localization (ROLL), it avoids placing two radioactive tracings at the injection site, thereby facilitating tumor detection, the researchers noted.
Clinicians who are implementing ICG-guided sentinel node detection should consider combining it with 99mTc to avoid missing nodes during the learning process, the researchers emphasized.
They reported no funding sources and no conflicts of interest.
Indocyanine green dye caused no major side effects and was almost 99% concordant with radioisotope technetium for sentinel lymph node detection in early-stage breast cancer, according to researchers.
The results extend promising findings from an earlier meta-analysis of the tracer in a variety of tumor types, said Dr. Domenico Samorani of Santarcangelo di Romagna Hospital, Rimini, Italy.
“The method seems reproducible, safe, eliminates exposure to ionizing radiation, and is potentially cost-saving, despite requiring specialist training. [Also,] it could be an option for breast cancer centers with no nuclear medicine supply,” wrote Dr. Samorani and colleagues.
Sentinel lymph node biopsy has largely replaced axillary lymph node dissection for staging breast cancer, as it causes much less morbidity and is associated with similar rates of survival and locoregional recurrence. Vital blue dyes and radioisotope technetium (99mTc) are the most commonly used enhancers, but the blue dyes can cause allergic reactions and skin necrosis, and 99mTc is costly and requires special logistics and handling because of its radioactivity, the investigators noted. For these reasons, there has been renewed interest in indocyanine green dye (ICG) as an alternative, they said (Eur. J. Surg. Oncol. 2015;41:64-70).
For the study, the investigators evaluated 589 lymph nodes from 301 patients with clinically node-negative, invasive or microinvasive early breast cancer confirmed by core biopsy. All patients underwent 99mTc-guided sentinel node detection, which served as the gold standard for comparison. To perform ICG-guided detection, the researchers diluted 25 mg of ICG PULSION with 5 mL distilled water and then injected empirical doses of 0.4 to 1.2 mL of the solution subcutaneously above the tumor site for unicentric cancers, or around the areola for multicentric disease. Then the researchers used an infrared-emitting camera (Photodynamic Eye, Hamamatsu Photonics, Hamamatsu, Japan) to visualize the lymphatic drainage pathway and localize sentinel nodes for removal.
Overall, 98.7% of sentinel nodes that were 99mTc positive also were ICG positive (95% confidence interval, 97.1%-99.5%), a high degree of concordance that reflected past study results, the investigators said. Notably, the ICG-guided technique identified at least one sentinel node for 297 patients (98.7%), compared with 287 patients (95.4%) for the 99mTc method (P < .05). Thus, the use of ICG prevented removal of the entire axilla for 10 patients, the researchers wrote.
For six patients, the ICG method identified a metastatic node that 99mTc failed to identify. Therefore, ICG provided an advantage for 16 cases (5.3%). No patients experienced allergic reactions, 3.2% developed seromas, and 2.5% developed paresthesia, the researchers added.
Use of ICG instead of 99mTc for sentinel lymph node detection has several advantages: It does not require involving a nuclear medicine department, uses less radioactive material, minimizes issues around waste disposal, and can be performed in the operating room immediately after the induction of general anesthesia, said the researchers. And if combined with radio-guided occult lesion localization (ROLL), it avoids placing two radioactive tracings at the injection site, thereby facilitating tumor detection, the researchers noted.
Clinicians who are implementing ICG-guided sentinel node detection should consider combining it with 99mTc to avoid missing nodes during the learning process, the researchers emphasized.
They reported no funding sources and no conflicts of interest.
FROM THE EUROPEAN JOURNAL OF SURGICAL ONCOLOGY
Key clinical point: The fluorescent dye indocyanine green tracer showed promise in detecting sentinel lymph nodes in early-stage breast cancer.
Major finding: The dye caused no major side effects and was almost 99% concordant with radioisotope technetium.
Data source: Prospective validation trial evaluating 589 lymph nodes from 301 patients with clinically node-negative, invasive early breast cancer.
Disclosures: The investigators reported no funding sources and no conflicts of interest.
Four-port laparoscopic cholecystectomy linked to less fatigue
Single-port and four-port laparoscopic cholecystectomy were associated with similar self-reported pain scores and physiologic measures of recovery, according to a double-blinded, randomized trial published online in the Journal of the American College of Surgery.
But patients in the four-port arm reported significantly less fatigue (P = .009), and 40% needed postoperative narcotics, compared with 60% of patients who underwent single-port laparoscopy (P = .056), reported Dr. Juliane Bingener and her associates at Mayo Clinic, Rochester, N.Y.
“The data from this study may assist patients and surgeons in the discussion on how to choose a procedure,” said the researchers. “If fast postoperative recovery is the most important goal, four-port cholecystectomy may be more advantageous than single-port laparoscopic cholecystectomy. If cosmesis is the most important factor, single-port entry may be chosen” (J. Am. Coll. Surg. 2015 March 2 [doi:10.1016/j.jamcollsurg.2015.02.022]).
The study comprised 110 patients, of whom half underwent single-port and half underwent four-port laparoscopic cholecystectomy, all performed by the same surgeon. The primary outcome was patient-reported pain 7 days after the procedure, as measured by the visual analog scale (VAS). In all, 81% of patients were female, and median age was 47.5 years, the researchers reported.
Postoperative VAS pain scores rose significantly for both groups, compared with baseline, but did not significantly differ between the groups, said the investigators (single-port: 4.2 ± 2.4; four-port: 4.2 ± 2.2; P = .83). Cytokine levels and variations in heart rate also were similar between the groups.
However, measures of fatigue on the linear analog self-assessment were better with four-port entry, compared with the single-port approach (3.1 ± 2.1, versus 4.2 ± 2.2, respectively; P = .009), the investigators reported. And 49% of patients in the single-port group reported severe fatigue (a score greater than 5), compared with only 22% of the four-port group (P = .005).
“While this could be due to alpha-error, the fact that the group with the higher fatigue levels (single port) also seemed to be taking more oral narcotic pain medication before discharge … while maintaining similar pain scores in the postoperative period and otherwise having a similar distribution of factors affecting postoperative pain … suggests that the narcotic pain medication may have indeed had an influence on the fatigue scores,” the investigators said.
The National Institutes of Health and the National Center for Advancing Translational Sciences funded the research. The authors declared no conflicts of interest.
Single-port and four-port laparoscopic cholecystectomy were associated with similar self-reported pain scores and physiologic measures of recovery, according to a double-blinded, randomized trial published online in the Journal of the American College of Surgery.
But patients in the four-port arm reported significantly less fatigue (P = .009), and 40% needed postoperative narcotics, compared with 60% of patients who underwent single-port laparoscopy (P = .056), reported Dr. Juliane Bingener and her associates at Mayo Clinic, Rochester, N.Y.
“The data from this study may assist patients and surgeons in the discussion on how to choose a procedure,” said the researchers. “If fast postoperative recovery is the most important goal, four-port cholecystectomy may be more advantageous than single-port laparoscopic cholecystectomy. If cosmesis is the most important factor, single-port entry may be chosen” (J. Am. Coll. Surg. 2015 March 2 [doi:10.1016/j.jamcollsurg.2015.02.022]).
The study comprised 110 patients, of whom half underwent single-port and half underwent four-port laparoscopic cholecystectomy, all performed by the same surgeon. The primary outcome was patient-reported pain 7 days after the procedure, as measured by the visual analog scale (VAS). In all, 81% of patients were female, and median age was 47.5 years, the researchers reported.
Postoperative VAS pain scores rose significantly for both groups, compared with baseline, but did not significantly differ between the groups, said the investigators (single-port: 4.2 ± 2.4; four-port: 4.2 ± 2.2; P = .83). Cytokine levels and variations in heart rate also were similar between the groups.
However, measures of fatigue on the linear analog self-assessment were better with four-port entry, compared with the single-port approach (3.1 ± 2.1, versus 4.2 ± 2.2, respectively; P = .009), the investigators reported. And 49% of patients in the single-port group reported severe fatigue (a score greater than 5), compared with only 22% of the four-port group (P = .005).
“While this could be due to alpha-error, the fact that the group with the higher fatigue levels (single port) also seemed to be taking more oral narcotic pain medication before discharge … while maintaining similar pain scores in the postoperative period and otherwise having a similar distribution of factors affecting postoperative pain … suggests that the narcotic pain medication may have indeed had an influence on the fatigue scores,” the investigators said.
The National Institutes of Health and the National Center for Advancing Translational Sciences funded the research. The authors declared no conflicts of interest.
Single-port and four-port laparoscopic cholecystectomy were associated with similar self-reported pain scores and physiologic measures of recovery, according to a double-blinded, randomized trial published online in the Journal of the American College of Surgery.
But patients in the four-port arm reported significantly less fatigue (P = .009), and 40% needed postoperative narcotics, compared with 60% of patients who underwent single-port laparoscopy (P = .056), reported Dr. Juliane Bingener and her associates at Mayo Clinic, Rochester, N.Y.
“The data from this study may assist patients and surgeons in the discussion on how to choose a procedure,” said the researchers. “If fast postoperative recovery is the most important goal, four-port cholecystectomy may be more advantageous than single-port laparoscopic cholecystectomy. If cosmesis is the most important factor, single-port entry may be chosen” (J. Am. Coll. Surg. 2015 March 2 [doi:10.1016/j.jamcollsurg.2015.02.022]).
The study comprised 110 patients, of whom half underwent single-port and half underwent four-port laparoscopic cholecystectomy, all performed by the same surgeon. The primary outcome was patient-reported pain 7 days after the procedure, as measured by the visual analog scale (VAS). In all, 81% of patients were female, and median age was 47.5 years, the researchers reported.
Postoperative VAS pain scores rose significantly for both groups, compared with baseline, but did not significantly differ between the groups, said the investigators (single-port: 4.2 ± 2.4; four-port: 4.2 ± 2.2; P = .83). Cytokine levels and variations in heart rate also were similar between the groups.
However, measures of fatigue on the linear analog self-assessment were better with four-port entry, compared with the single-port approach (3.1 ± 2.1, versus 4.2 ± 2.2, respectively; P = .009), the investigators reported. And 49% of patients in the single-port group reported severe fatigue (a score greater than 5), compared with only 22% of the four-port group (P = .005).
“While this could be due to alpha-error, the fact that the group with the higher fatigue levels (single port) also seemed to be taking more oral narcotic pain medication before discharge … while maintaining similar pain scores in the postoperative period and otherwise having a similar distribution of factors affecting postoperative pain … suggests that the narcotic pain medication may have indeed had an influence on the fatigue scores,” the investigators said.
The National Institutes of Health and the National Center for Advancing Translational Sciences funded the research. The authors declared no conflicts of interest.
FROM JOURNAL OF THE AMERICAN COLLEGE OF SURGERY
Key clinical point: Four-port laparoscopic cholecystectomy was associated with less fatigue than was single-port laparoscopic cholecystectomy.
Major finding: Seven days after surgery, self-reported fatigue was lower for the four-port entry group compared with the single-port group (P = .009).
Data source: Double-blinded, randomized controlled trial of 110 patients who underwent single-port or four-port laparoscopic cholecystectomy.
Disclosures: The National Institutes of Health and the National Center for Advancing Translational Sciences funded the research. The authors declared no conflicts of interest.
House votes to repeal SGR, reauthorize CHIP
After years of failed attempts and temporary fixes, the House of Representatives on March 26 passed H.R. 2, a bill to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that temporarily would raise Medicare physician pay and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years, as well as other provisions.
Check back for detailed analysis and next steps for the legislation later on March 26.
After years of failed attempts and temporary fixes, the House of Representatives on March 26 passed H.R. 2, a bill to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that temporarily would raise Medicare physician pay and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years, as well as other provisions.
Check back for detailed analysis and next steps for the legislation later on March 26.
After years of failed attempts and temporary fixes, the House of Representatives on March 26 passed H.R. 2, a bill to repeal the Medicare Sustainable Growth Rate formula (SGR) and replace it with an alternative system that temporarily would raise Medicare physician pay and focus on value-based performance. The bill also reauthorizes the Children’s Health Insurance Program (CHIP) for 2 years, as well as other provisions.
Check back for detailed analysis and next steps for the legislation later on March 26.
Mesh system promising in controlling refractory fecal incontinence
ORLANDO – A proprietary self-fixating polypropylene mesh system implanted with minimally invasive surgery provides a high rate of success against refractory fecal incontinence, according to data from a multicenter prospective trial.
Whether measured at 3, 6, or 12 months, approximately 65% of patients achieved treatment success, defined as at least a 50% reduction in episodes of fecal incontinence, Dr. Dee E. Fenner reported at the annual scientific meeting of the Society of Gynecologic Surgeons.
The mesh system, which remains in clinical development, is called TOPAS. It was evaluated in 152 patients enrolled at 14 centers in the United States. All patients had failed at least two conservative treatments, such as pelvic floor exercises with or without biofeedback. The average duration of fecal incontinence was 110 months.
From a baseline of nine episodes per week, the median number of episodes of fecal incontinence fell to 2.5 times per week after surgery. This did not change when evaluated at 3, 6, or 12 months. The median number of episodes with urgency decreased from two at baseline to zero. In 19% of patients, fecal incontinence remained completely resolved over the 12 months of follow-up, according to Dr. Fenner, the study’s lead investigator and director of gynecology at the University of Michigan, Ann Arbor.
The mean procedure time for the minimally invasive surgery required to create the tunnel adjacent to the anus in which the mesh system is placed was 33 minutes. The average length of stay in the hospital was 11 hours.
Of the 104 adverse events recorded in the study, 98 were not considered serious. These included pelvic pain that resolved without treatment and infections treated with antibiotics. The two serious adverse events with the greatest potential to be treatment related were a deep venous thrombosis (DVT) and a case of worsening prolapse. There were no revisions, extrusions, or treatment-related deaths, Dr. Fenner said.
Quality of life analyses measured with standardized questionnaires demonstrated significant improvements in domains for lifestyle, coping, depression, and embarrassment, Dr. Fenner reported at the meeting, which was jointly sponsored by the American College of Surgeons.
In a critique invited by the SGS, Dr. Holly E. Richter, director of the division of urogynecology and pelvic reconstructive surgery at the University of Alabama at Birmingham, called the evidence of benefit after 12 months of follow-up “credible.” She agreed with Dr. Fenner’s conclusion that this a promising surgical therapy for refractory patients.
“These results are very good for a difficult population, but I think it is important to first demonstrate that patients cannot achieve an adequate reduction in symptoms with nonsurgical approaches before this approach is considered,” Dr. Richter said in an interview.
The study had no control arm because there were no proven treatments for patients with refractory incontinence at the time of its design, according to Dr. Fenner. Several options, including sacral nerve stimulation, have since become available, she said.
The TOPASsystem is currently under review by the Food and Drug Administration. Dr. Fenner said that approval, if granted, might still be a year away.
Dr. Fenner reported receiving research support from American Medical Systems, which manufactures the TOPAS system.
ORLANDO – A proprietary self-fixating polypropylene mesh system implanted with minimally invasive surgery provides a high rate of success against refractory fecal incontinence, according to data from a multicenter prospective trial.
Whether measured at 3, 6, or 12 months, approximately 65% of patients achieved treatment success, defined as at least a 50% reduction in episodes of fecal incontinence, Dr. Dee E. Fenner reported at the annual scientific meeting of the Society of Gynecologic Surgeons.
The mesh system, which remains in clinical development, is called TOPAS. It was evaluated in 152 patients enrolled at 14 centers in the United States. All patients had failed at least two conservative treatments, such as pelvic floor exercises with or without biofeedback. The average duration of fecal incontinence was 110 months.
From a baseline of nine episodes per week, the median number of episodes of fecal incontinence fell to 2.5 times per week after surgery. This did not change when evaluated at 3, 6, or 12 months. The median number of episodes with urgency decreased from two at baseline to zero. In 19% of patients, fecal incontinence remained completely resolved over the 12 months of follow-up, according to Dr. Fenner, the study’s lead investigator and director of gynecology at the University of Michigan, Ann Arbor.
The mean procedure time for the minimally invasive surgery required to create the tunnel adjacent to the anus in which the mesh system is placed was 33 minutes. The average length of stay in the hospital was 11 hours.
Of the 104 adverse events recorded in the study, 98 were not considered serious. These included pelvic pain that resolved without treatment and infections treated with antibiotics. The two serious adverse events with the greatest potential to be treatment related were a deep venous thrombosis (DVT) and a case of worsening prolapse. There were no revisions, extrusions, or treatment-related deaths, Dr. Fenner said.
Quality of life analyses measured with standardized questionnaires demonstrated significant improvements in domains for lifestyle, coping, depression, and embarrassment, Dr. Fenner reported at the meeting, which was jointly sponsored by the American College of Surgeons.
In a critique invited by the SGS, Dr. Holly E. Richter, director of the division of urogynecology and pelvic reconstructive surgery at the University of Alabama at Birmingham, called the evidence of benefit after 12 months of follow-up “credible.” She agreed with Dr. Fenner’s conclusion that this a promising surgical therapy for refractory patients.
“These results are very good for a difficult population, but I think it is important to first demonstrate that patients cannot achieve an adequate reduction in symptoms with nonsurgical approaches before this approach is considered,” Dr. Richter said in an interview.
The study had no control arm because there were no proven treatments for patients with refractory incontinence at the time of its design, according to Dr. Fenner. Several options, including sacral nerve stimulation, have since become available, she said.
The TOPASsystem is currently under review by the Food and Drug Administration. Dr. Fenner said that approval, if granted, might still be a year away.
Dr. Fenner reported receiving research support from American Medical Systems, which manufactures the TOPAS system.
ORLANDO – A proprietary self-fixating polypropylene mesh system implanted with minimally invasive surgery provides a high rate of success against refractory fecal incontinence, according to data from a multicenter prospective trial.
Whether measured at 3, 6, or 12 months, approximately 65% of patients achieved treatment success, defined as at least a 50% reduction in episodes of fecal incontinence, Dr. Dee E. Fenner reported at the annual scientific meeting of the Society of Gynecologic Surgeons.
The mesh system, which remains in clinical development, is called TOPAS. It was evaluated in 152 patients enrolled at 14 centers in the United States. All patients had failed at least two conservative treatments, such as pelvic floor exercises with or without biofeedback. The average duration of fecal incontinence was 110 months.
From a baseline of nine episodes per week, the median number of episodes of fecal incontinence fell to 2.5 times per week after surgery. This did not change when evaluated at 3, 6, or 12 months. The median number of episodes with urgency decreased from two at baseline to zero. In 19% of patients, fecal incontinence remained completely resolved over the 12 months of follow-up, according to Dr. Fenner, the study’s lead investigator and director of gynecology at the University of Michigan, Ann Arbor.
The mean procedure time for the minimally invasive surgery required to create the tunnel adjacent to the anus in which the mesh system is placed was 33 minutes. The average length of stay in the hospital was 11 hours.
Of the 104 adverse events recorded in the study, 98 were not considered serious. These included pelvic pain that resolved without treatment and infections treated with antibiotics. The two serious adverse events with the greatest potential to be treatment related were a deep venous thrombosis (DVT) and a case of worsening prolapse. There were no revisions, extrusions, or treatment-related deaths, Dr. Fenner said.
Quality of life analyses measured with standardized questionnaires demonstrated significant improvements in domains for lifestyle, coping, depression, and embarrassment, Dr. Fenner reported at the meeting, which was jointly sponsored by the American College of Surgeons.
In a critique invited by the SGS, Dr. Holly E. Richter, director of the division of urogynecology and pelvic reconstructive surgery at the University of Alabama at Birmingham, called the evidence of benefit after 12 months of follow-up “credible.” She agreed with Dr. Fenner’s conclusion that this a promising surgical therapy for refractory patients.
“These results are very good for a difficult population, but I think it is important to first demonstrate that patients cannot achieve an adequate reduction in symptoms with nonsurgical approaches before this approach is considered,” Dr. Richter said in an interview.
The study had no control arm because there were no proven treatments for patients with refractory incontinence at the time of its design, according to Dr. Fenner. Several options, including sacral nerve stimulation, have since become available, she said.
The TOPASsystem is currently under review by the Food and Drug Administration. Dr. Fenner said that approval, if granted, might still be a year away.
Dr. Fenner reported receiving research support from American Medical Systems, which manufactures the TOPAS system.
AT SGS 2015
Key clinical point: A minimally invasive proprietary mesh implantation system provided a large reduction in symptoms of fecal incontinence.
Major finding: Among 152 patients with fecal incontinence refractory to conservative therapies, two-thirds met the definition of treatment success and 19% reported no episodes of incontinence 12 months after surgery.
Data source: Prospective, multicenter study with a single treatment arm.
Disclosures: Dr. Fenner reported receiving research support from American Medical Systems.
CMS: Stage 3 meaningful use by 2018
All physicians and hospitals would need to meet stage 3 meaningful use beginning in 2018, according to a recent proposal by the Centers for Medicare & Medicaid Services.
In the agency’s Stage 3 proposed rule, there would be no transition period from earlier stages for those just starting or those who were in an earlier stage. CMS said that this is “expected to be the final stage” and will incorporate elements of the previous two stages.
That change comes along with the proposal beginning in 2017 to permanently make the attestation period a full year, with a few exceptions. A full-year attestation period was supposed to go into effect for 2015 with Stage 2, but CMS announced that it would reduce attestation to a 90-day period because of low participation.
The final year in which participants in the EHR Incentive Programs can receive bonus payments for meeting meaningful use criteria is 2017; penalties for failing to meet criteria have already begun.
The American College of Cardiology said in a statement that it is “concerned” by the proposal that even new physicians and practices will have to jump immediately to stage 3 in 2018 without a transition period.
“Implementing an EHR system in a physician or a hospital is not as simple as flipping a switch; it takes time, financial investment, careful consideration and planning, as well as education for all staff. The program must take this learning curve into consideration,” Dr. Kim Allan Williams Sr., ACC president, said in a statement.
The proposed rule also contains a number of more stringent requirements. On the patient engagement front, the proposed rule calls for 25% of patients to access their data, although it also allows for third-party providers to access a patient’s account as a means of satisfying the requirement. Patient-generated data also are highlighted, with a proposed requirement that physicians collect information via mobile devices or apps from 15% of their patients.Under the proposed Stage 3 of meaningful use, physicians and eligible hospitals must meet two of three criteria: that more than 50% of referrals or transitions of care involve the passing of information by the referring provider; that more than 40% of transitions or referrals received by a provider seeing a patient for the first time include information imported into that new provider’s EHR; or that for more than 80% of those new patients seen in transition or by referral for the first time, a clinical reconciliation be done on the information received during the health information exchange, including a review of current medications, medication allergies, and current and active diagnoses.
The proposed rule is scheduled to be published in the Federal Register on March 30; comments will be accepted at www.regulations.gov until May 29.
All physicians and hospitals would need to meet stage 3 meaningful use beginning in 2018, according to a recent proposal by the Centers for Medicare & Medicaid Services.
In the agency’s Stage 3 proposed rule, there would be no transition period from earlier stages for those just starting or those who were in an earlier stage. CMS said that this is “expected to be the final stage” and will incorporate elements of the previous two stages.
That change comes along with the proposal beginning in 2017 to permanently make the attestation period a full year, with a few exceptions. A full-year attestation period was supposed to go into effect for 2015 with Stage 2, but CMS announced that it would reduce attestation to a 90-day period because of low participation.
The final year in which participants in the EHR Incentive Programs can receive bonus payments for meeting meaningful use criteria is 2017; penalties for failing to meet criteria have already begun.
The American College of Cardiology said in a statement that it is “concerned” by the proposal that even new physicians and practices will have to jump immediately to stage 3 in 2018 without a transition period.
“Implementing an EHR system in a physician or a hospital is not as simple as flipping a switch; it takes time, financial investment, careful consideration and planning, as well as education for all staff. The program must take this learning curve into consideration,” Dr. Kim Allan Williams Sr., ACC president, said in a statement.
The proposed rule also contains a number of more stringent requirements. On the patient engagement front, the proposed rule calls for 25% of patients to access their data, although it also allows for third-party providers to access a patient’s account as a means of satisfying the requirement. Patient-generated data also are highlighted, with a proposed requirement that physicians collect information via mobile devices or apps from 15% of their patients.Under the proposed Stage 3 of meaningful use, physicians and eligible hospitals must meet two of three criteria: that more than 50% of referrals or transitions of care involve the passing of information by the referring provider; that more than 40% of transitions or referrals received by a provider seeing a patient for the first time include information imported into that new provider’s EHR; or that for more than 80% of those new patients seen in transition or by referral for the first time, a clinical reconciliation be done on the information received during the health information exchange, including a review of current medications, medication allergies, and current and active diagnoses.
The proposed rule is scheduled to be published in the Federal Register on March 30; comments will be accepted at www.regulations.gov until May 29.
All physicians and hospitals would need to meet stage 3 meaningful use beginning in 2018, according to a recent proposal by the Centers for Medicare & Medicaid Services.
In the agency’s Stage 3 proposed rule, there would be no transition period from earlier stages for those just starting or those who were in an earlier stage. CMS said that this is “expected to be the final stage” and will incorporate elements of the previous two stages.
That change comes along with the proposal beginning in 2017 to permanently make the attestation period a full year, with a few exceptions. A full-year attestation period was supposed to go into effect for 2015 with Stage 2, but CMS announced that it would reduce attestation to a 90-day period because of low participation.
The final year in which participants in the EHR Incentive Programs can receive bonus payments for meeting meaningful use criteria is 2017; penalties for failing to meet criteria have already begun.
The American College of Cardiology said in a statement that it is “concerned” by the proposal that even new physicians and practices will have to jump immediately to stage 3 in 2018 without a transition period.
“Implementing an EHR system in a physician or a hospital is not as simple as flipping a switch; it takes time, financial investment, careful consideration and planning, as well as education for all staff. The program must take this learning curve into consideration,” Dr. Kim Allan Williams Sr., ACC president, said in a statement.
The proposed rule also contains a number of more stringent requirements. On the patient engagement front, the proposed rule calls for 25% of patients to access their data, although it also allows for third-party providers to access a patient’s account as a means of satisfying the requirement. Patient-generated data also are highlighted, with a proposed requirement that physicians collect information via mobile devices or apps from 15% of their patients.Under the proposed Stage 3 of meaningful use, physicians and eligible hospitals must meet two of three criteria: that more than 50% of referrals or transitions of care involve the passing of information by the referring provider; that more than 40% of transitions or referrals received by a provider seeing a patient for the first time include information imported into that new provider’s EHR; or that for more than 80% of those new patients seen in transition or by referral for the first time, a clinical reconciliation be done on the information received during the health information exchange, including a review of current medications, medication allergies, and current and active diagnoses.
The proposed rule is scheduled to be published in the Federal Register on March 30; comments will be accepted at www.regulations.gov until May 29.
For high-risk SVT patients, anticoagulants may be effective option
Anticoagulation may be an effective option for patients with superficial venous thrombosis and are at high risk of venous thromboembolism (VTE), according to an evidence-based review by Dr. Joseph Raffetto and Dr. Robert Eberhardt.
In particular, they reviewed the results of three clinical trials with a total of nearly 1400 patients: STENOX, STEFLUX, and CALISTO.
Based on their assessment, Dr. Raffetto and Dr. Eberhardt, summarized that surgery and anticoagulants were both acceptable treatments for SVT patients at high risk of VTE, who had severe symptoms, who presented with close proximity to the saphenofemoral junction, or who had recurrence. Anticoagulants seemed to have fewer complications and a lower VTE rate than did surgery. However, treating all SVT patients with anticoagulants is not recommended because of cost concerns.
While anticoagulants do appear to be an effective treatment for SVT, “it is not known if SVT is causative of or an epiphenomenon for VTE. The optimal treatment of SVT is unknown with respect to selection of patient and vein, preferred therapy, and timing and duration of therapy,” the authors cautioned.
Find the full report in the Journal of Vascular Surgery: Venous and Lymphatic Disorders (doi: 10.1016/j.jvsv.2014.11.005).
Anticoagulation may be an effective option for patients with superficial venous thrombosis and are at high risk of venous thromboembolism (VTE), according to an evidence-based review by Dr. Joseph Raffetto and Dr. Robert Eberhardt.
In particular, they reviewed the results of three clinical trials with a total of nearly 1400 patients: STENOX, STEFLUX, and CALISTO.
Based on their assessment, Dr. Raffetto and Dr. Eberhardt, summarized that surgery and anticoagulants were both acceptable treatments for SVT patients at high risk of VTE, who had severe symptoms, who presented with close proximity to the saphenofemoral junction, or who had recurrence. Anticoagulants seemed to have fewer complications and a lower VTE rate than did surgery. However, treating all SVT patients with anticoagulants is not recommended because of cost concerns.
While anticoagulants do appear to be an effective treatment for SVT, “it is not known if SVT is causative of or an epiphenomenon for VTE. The optimal treatment of SVT is unknown with respect to selection of patient and vein, preferred therapy, and timing and duration of therapy,” the authors cautioned.
Find the full report in the Journal of Vascular Surgery: Venous and Lymphatic Disorders (doi: 10.1016/j.jvsv.2014.11.005).
Anticoagulation may be an effective option for patients with superficial venous thrombosis and are at high risk of venous thromboembolism (VTE), according to an evidence-based review by Dr. Joseph Raffetto and Dr. Robert Eberhardt.
In particular, they reviewed the results of three clinical trials with a total of nearly 1400 patients: STENOX, STEFLUX, and CALISTO.
Based on their assessment, Dr. Raffetto and Dr. Eberhardt, summarized that surgery and anticoagulants were both acceptable treatments for SVT patients at high risk of VTE, who had severe symptoms, who presented with close proximity to the saphenofemoral junction, or who had recurrence. Anticoagulants seemed to have fewer complications and a lower VTE rate than did surgery. However, treating all SVT patients with anticoagulants is not recommended because of cost concerns.
While anticoagulants do appear to be an effective treatment for SVT, “it is not known if SVT is causative of or an epiphenomenon for VTE. The optimal treatment of SVT is unknown with respect to selection of patient and vein, preferred therapy, and timing and duration of therapy,” the authors cautioned.
Find the full report in the Journal of Vascular Surgery: Venous and Lymphatic Disorders (doi: 10.1016/j.jvsv.2014.11.005).
Mesenteric stenting: an evolving therapy
CHICAGO – Mesenteric stenting has replaced open surgery as first-line treatment for chronic mesenteric ischemia, but it is still a therapy in flux.
Controversy exists over single- versus multivessel revascularization when both the celiac artery (CA) and superior mesenteric artery (SMA) are diseased and symptoms are consistent with chronic mesenteric ischemia (CMI), Dr. Jean Panneton said at a symposium on vascular surgery sponsored by Northwestern University.
Some vascular specialists argue that complete revascularization provides better protection when one vessel occludes, while those favoring single-vessel revascularization contend that bypassing only the most problematic vessel avoids a longer, more complex operation in these typically fragile patients.
The data on single- versus multivessel mesenteric bypass is mixed, he said. Some studies have found that two-vessel bypass results in less symptom recurrence, improved patency, and fewer reinterventions than single-vessel bypass. Other studies, however, have found no difference in 1-year patency or freedom from symptom recurrence between the two treatments.
Regardless of the number of vessels treated, no consensus exists as to which artery responds best to stenting, Dr. Panneton, from Eastern Virginia Medical School in Norfolk, said. In their own review of 121 consecutive patients over a 7-year period, there was a major discrepancy between SMA and CA stenting in 1-year primary patency (55% vs. 18%) and 6-month clinical patency (86% vs. 67%).
“In our experience, celiac stenting had much worse ISR [in-stent restenosis] and clinical patency rates than SMA stenting, which questions its utility,” he said.
In the celiac group, stents with a diameter < 6 mm were significantly more likely than larger-caliber stents to lose primary patency, defined as peak systolic velocity < 350 cm/sec.
Interestingly, a subset analysis of patients undergoing two-vessel stenting of the CA and SMA revealed no significant differences in ISR rates or survival free from symptom recurrence, compared with single SMA stenting (J. Vasc. Surg. 2013;57:1062-6).
Surveillance after mesenteric stenting is another area in flux. Duplex ultrasound (DUS) has been validated as an accurate modality for determining native mesenteric artery stenosis, but no firm DUS criteria exist for diagnosing ISR, Dr. Panneton said. Several studies have reported that DUS velocity criteria for native mesenteric stenosis overestimates the percentage of stenosis of stented arteries.
A receiver operator curve (ROC) analysis by Dr. Panneton and his colleagues demonstrated that an SMA peak systolic velocity (PSV) of 445 cm/sec had the highest sensitivity (96%), but only 43% specificity for predicting ISR.
Further prospective validation is needed, although a similar ROC analysis reported 100% sensitivity and 95% sensitivity using a PSV of 412 cm/sec to identify SMA > 70% ISR (J. Vasc. Surg. 2012;55:730-8), he noted.
Intravascular ultrasound (IVUS) is useful as an adjunct to DUS and angiography for the detection of ISR of mesenteric arteries, but isn’t practical for routine surveillance. There is also a dearth of data on outcomes when IVUS is used with other imaging modalities, Dr. Panneton added.
What is clear is that a paradigm shift has occurred in the treatment of CMI, reflected in a threefold increase in the number of mesenteric revascularizations performed in the U.S. during the last 10 years. Still, 5-year survival rates are nearly identical between open surgery and mesenteric stenting, despite primary, secondary, and clinical patency rates seeming to favor open mesenteric bypass.
“Future technology will address the higher ISR and reintervention rates associated with mesenteric stenting and likely improve outcomes,” Dr. Panneton said.
Mesenteric stenting can still be useful, even after bypass, he said, highlighting a 78-year-old woman with a history of aortobifemoral bypass who required endovascular rescue of an SMA graft thrombosis after presenting with acute mesenteric ischemia.
“We were able with a guidewire, to get through the reversed C-loop graft that came from the iliac to the SMA and get into the distal SMA vessel,” he said. “We also used pharmacomechanical thrombectomy to really declot the graft and place a stent at the proximal anastomosis of the iliac-SMA Dacron graft.”
The team has also done mesenteric stenting using a retrograde open mesenteric stenting technique.
“It’s quite useful in acute mesenteric ischemia, but we’ve also used it more recently even in chronic mesenteric ischemia for patients who did not tolerate aortic cross-clamping or did not have any good aorta,” he said. “An example of that would be a porcelain aorta where we don’t want to clamp anything.”
Dr. Panneton is a consultant and serves on the speaker’s bureau for Medtronic.
CHICAGO – Mesenteric stenting has replaced open surgery as first-line treatment for chronic mesenteric ischemia, but it is still a therapy in flux.
Controversy exists over single- versus multivessel revascularization when both the celiac artery (CA) and superior mesenteric artery (SMA) are diseased and symptoms are consistent with chronic mesenteric ischemia (CMI), Dr. Jean Panneton said at a symposium on vascular surgery sponsored by Northwestern University.
Some vascular specialists argue that complete revascularization provides better protection when one vessel occludes, while those favoring single-vessel revascularization contend that bypassing only the most problematic vessel avoids a longer, more complex operation in these typically fragile patients.
The data on single- versus multivessel mesenteric bypass is mixed, he said. Some studies have found that two-vessel bypass results in less symptom recurrence, improved patency, and fewer reinterventions than single-vessel bypass. Other studies, however, have found no difference in 1-year patency or freedom from symptom recurrence between the two treatments.
Regardless of the number of vessels treated, no consensus exists as to which artery responds best to stenting, Dr. Panneton, from Eastern Virginia Medical School in Norfolk, said. In their own review of 121 consecutive patients over a 7-year period, there was a major discrepancy between SMA and CA stenting in 1-year primary patency (55% vs. 18%) and 6-month clinical patency (86% vs. 67%).
“In our experience, celiac stenting had much worse ISR [in-stent restenosis] and clinical patency rates than SMA stenting, which questions its utility,” he said.
In the celiac group, stents with a diameter < 6 mm were significantly more likely than larger-caliber stents to lose primary patency, defined as peak systolic velocity < 350 cm/sec.
Interestingly, a subset analysis of patients undergoing two-vessel stenting of the CA and SMA revealed no significant differences in ISR rates or survival free from symptom recurrence, compared with single SMA stenting (J. Vasc. Surg. 2013;57:1062-6).
Surveillance after mesenteric stenting is another area in flux. Duplex ultrasound (DUS) has been validated as an accurate modality for determining native mesenteric artery stenosis, but no firm DUS criteria exist for diagnosing ISR, Dr. Panneton said. Several studies have reported that DUS velocity criteria for native mesenteric stenosis overestimates the percentage of stenosis of stented arteries.
A receiver operator curve (ROC) analysis by Dr. Panneton and his colleagues demonstrated that an SMA peak systolic velocity (PSV) of 445 cm/sec had the highest sensitivity (96%), but only 43% specificity for predicting ISR.
Further prospective validation is needed, although a similar ROC analysis reported 100% sensitivity and 95% sensitivity using a PSV of 412 cm/sec to identify SMA > 70% ISR (J. Vasc. Surg. 2012;55:730-8), he noted.
Intravascular ultrasound (IVUS) is useful as an adjunct to DUS and angiography for the detection of ISR of mesenteric arteries, but isn’t practical for routine surveillance. There is also a dearth of data on outcomes when IVUS is used with other imaging modalities, Dr. Panneton added.
What is clear is that a paradigm shift has occurred in the treatment of CMI, reflected in a threefold increase in the number of mesenteric revascularizations performed in the U.S. during the last 10 years. Still, 5-year survival rates are nearly identical between open surgery and mesenteric stenting, despite primary, secondary, and clinical patency rates seeming to favor open mesenteric bypass.
“Future technology will address the higher ISR and reintervention rates associated with mesenteric stenting and likely improve outcomes,” Dr. Panneton said.
Mesenteric stenting can still be useful, even after bypass, he said, highlighting a 78-year-old woman with a history of aortobifemoral bypass who required endovascular rescue of an SMA graft thrombosis after presenting with acute mesenteric ischemia.
“We were able with a guidewire, to get through the reversed C-loop graft that came from the iliac to the SMA and get into the distal SMA vessel,” he said. “We also used pharmacomechanical thrombectomy to really declot the graft and place a stent at the proximal anastomosis of the iliac-SMA Dacron graft.”
The team has also done mesenteric stenting using a retrograde open mesenteric stenting technique.
“It’s quite useful in acute mesenteric ischemia, but we’ve also used it more recently even in chronic mesenteric ischemia for patients who did not tolerate aortic cross-clamping or did not have any good aorta,” he said. “An example of that would be a porcelain aorta where we don’t want to clamp anything.”
Dr. Panneton is a consultant and serves on the speaker’s bureau for Medtronic.
CHICAGO – Mesenteric stenting has replaced open surgery as first-line treatment for chronic mesenteric ischemia, but it is still a therapy in flux.
Controversy exists over single- versus multivessel revascularization when both the celiac artery (CA) and superior mesenteric artery (SMA) are diseased and symptoms are consistent with chronic mesenteric ischemia (CMI), Dr. Jean Panneton said at a symposium on vascular surgery sponsored by Northwestern University.
Some vascular specialists argue that complete revascularization provides better protection when one vessel occludes, while those favoring single-vessel revascularization contend that bypassing only the most problematic vessel avoids a longer, more complex operation in these typically fragile patients.
The data on single- versus multivessel mesenteric bypass is mixed, he said. Some studies have found that two-vessel bypass results in less symptom recurrence, improved patency, and fewer reinterventions than single-vessel bypass. Other studies, however, have found no difference in 1-year patency or freedom from symptom recurrence between the two treatments.
Regardless of the number of vessels treated, no consensus exists as to which artery responds best to stenting, Dr. Panneton, from Eastern Virginia Medical School in Norfolk, said. In their own review of 121 consecutive patients over a 7-year period, there was a major discrepancy between SMA and CA stenting in 1-year primary patency (55% vs. 18%) and 6-month clinical patency (86% vs. 67%).
“In our experience, celiac stenting had much worse ISR [in-stent restenosis] and clinical patency rates than SMA stenting, which questions its utility,” he said.
In the celiac group, stents with a diameter < 6 mm were significantly more likely than larger-caliber stents to lose primary patency, defined as peak systolic velocity < 350 cm/sec.
Interestingly, a subset analysis of patients undergoing two-vessel stenting of the CA and SMA revealed no significant differences in ISR rates or survival free from symptom recurrence, compared with single SMA stenting (J. Vasc. Surg. 2013;57:1062-6).
Surveillance after mesenteric stenting is another area in flux. Duplex ultrasound (DUS) has been validated as an accurate modality for determining native mesenteric artery stenosis, but no firm DUS criteria exist for diagnosing ISR, Dr. Panneton said. Several studies have reported that DUS velocity criteria for native mesenteric stenosis overestimates the percentage of stenosis of stented arteries.
A receiver operator curve (ROC) analysis by Dr. Panneton and his colleagues demonstrated that an SMA peak systolic velocity (PSV) of 445 cm/sec had the highest sensitivity (96%), but only 43% specificity for predicting ISR.
Further prospective validation is needed, although a similar ROC analysis reported 100% sensitivity and 95% sensitivity using a PSV of 412 cm/sec to identify SMA > 70% ISR (J. Vasc. Surg. 2012;55:730-8), he noted.
Intravascular ultrasound (IVUS) is useful as an adjunct to DUS and angiography for the detection of ISR of mesenteric arteries, but isn’t practical for routine surveillance. There is also a dearth of data on outcomes when IVUS is used with other imaging modalities, Dr. Panneton added.
What is clear is that a paradigm shift has occurred in the treatment of CMI, reflected in a threefold increase in the number of mesenteric revascularizations performed in the U.S. during the last 10 years. Still, 5-year survival rates are nearly identical between open surgery and mesenteric stenting, despite primary, secondary, and clinical patency rates seeming to favor open mesenteric bypass.
“Future technology will address the higher ISR and reintervention rates associated with mesenteric stenting and likely improve outcomes,” Dr. Panneton said.
Mesenteric stenting can still be useful, even after bypass, he said, highlighting a 78-year-old woman with a history of aortobifemoral bypass who required endovascular rescue of an SMA graft thrombosis after presenting with acute mesenteric ischemia.
“We were able with a guidewire, to get through the reversed C-loop graft that came from the iliac to the SMA and get into the distal SMA vessel,” he said. “We also used pharmacomechanical thrombectomy to really declot the graft and place a stent at the proximal anastomosis of the iliac-SMA Dacron graft.”
The team has also done mesenteric stenting using a retrograde open mesenteric stenting technique.
“It’s quite useful in acute mesenteric ischemia, but we’ve also used it more recently even in chronic mesenteric ischemia for patients who did not tolerate aortic cross-clamping or did not have any good aorta,” he said. “An example of that would be a porcelain aorta where we don’t want to clamp anything.”
Dr. Panneton is a consultant and serves on the speaker’s bureau for Medtronic.
EXPERT ANALYSIS FROM THE NORTHWESTERN VASCULAR SYMPOSIUM
Value-based medicine gets boost from launch of information-sharing network
The federal government has launched the Health Care Payment Learning and Action Network as a way to help physicians and other players in the health care system transition to value-based medical care. The network was announced March 25 at a White House event.
“Health reform is really hard,” President Obama said at the event. “Everyone in the trenches knows that.”
In January, Sylvia M. Burwell, secretary of the Department of Health & Human Services, announced what the administration portrays as the next step in heath reform. Building on the cost-saving efforts of the health reform law’s accountable care organizations, HHS plans to shift at least a third of all Medicare payments away from fee-for-service to value-based payment models by 2016. By 2018, half of all Medicare payments are to be value based.
The Health Care Payment Learning and Action Network is intended to support those goals and give everyone a say in the process’s success, Secretary Burwell said at the briefing.
Specifically, the network will facilitate new care delivery models and the collection, analysis, and leverage of data from them; break down obstacles to care; create evidence-based quality metrics that do not create record-keeping burdens; and foster transparency in the health care system, according to the Centers for Medicare & Medicaid Services.
Over 2,800 partners have registered with the network, including physician organizations, insurers, accountable care organizations, hospitals and health systems, and patient advocacy groups, according to CMS.
At the briefing, Bruce Broussard, CEO of network partner Humana, said that the ACA’s focus on quality has “wrapped the focus around the journey of someone’s health. It’s really changing the system from a treatment-oriented one to a health-oriented one.”
Dr. Robert Wah, president of the American Medical Association, said that his organization joined the network because of the access to decision makers that participation is expected to give.
“It is critical that physicians take a proactive role in defining the details of new payment models, and this network will help facilitate that,” Dr. Wah said in an interview.
On Twitter @whitneymcknight
The federal government has launched the Health Care Payment Learning and Action Network as a way to help physicians and other players in the health care system transition to value-based medical care. The network was announced March 25 at a White House event.
“Health reform is really hard,” President Obama said at the event. “Everyone in the trenches knows that.”
In January, Sylvia M. Burwell, secretary of the Department of Health & Human Services, announced what the administration portrays as the next step in heath reform. Building on the cost-saving efforts of the health reform law’s accountable care organizations, HHS plans to shift at least a third of all Medicare payments away from fee-for-service to value-based payment models by 2016. By 2018, half of all Medicare payments are to be value based.
The Health Care Payment Learning and Action Network is intended to support those goals and give everyone a say in the process’s success, Secretary Burwell said at the briefing.
Specifically, the network will facilitate new care delivery models and the collection, analysis, and leverage of data from them; break down obstacles to care; create evidence-based quality metrics that do not create record-keeping burdens; and foster transparency in the health care system, according to the Centers for Medicare & Medicaid Services.
Over 2,800 partners have registered with the network, including physician organizations, insurers, accountable care organizations, hospitals and health systems, and patient advocacy groups, according to CMS.
At the briefing, Bruce Broussard, CEO of network partner Humana, said that the ACA’s focus on quality has “wrapped the focus around the journey of someone’s health. It’s really changing the system from a treatment-oriented one to a health-oriented one.”
Dr. Robert Wah, president of the American Medical Association, said that his organization joined the network because of the access to decision makers that participation is expected to give.
“It is critical that physicians take a proactive role in defining the details of new payment models, and this network will help facilitate that,” Dr. Wah said in an interview.
On Twitter @whitneymcknight
The federal government has launched the Health Care Payment Learning and Action Network as a way to help physicians and other players in the health care system transition to value-based medical care. The network was announced March 25 at a White House event.
“Health reform is really hard,” President Obama said at the event. “Everyone in the trenches knows that.”
In January, Sylvia M. Burwell, secretary of the Department of Health & Human Services, announced what the administration portrays as the next step in heath reform. Building on the cost-saving efforts of the health reform law’s accountable care organizations, HHS plans to shift at least a third of all Medicare payments away from fee-for-service to value-based payment models by 2016. By 2018, half of all Medicare payments are to be value based.
The Health Care Payment Learning and Action Network is intended to support those goals and give everyone a say in the process’s success, Secretary Burwell said at the briefing.
Specifically, the network will facilitate new care delivery models and the collection, analysis, and leverage of data from them; break down obstacles to care; create evidence-based quality metrics that do not create record-keeping burdens; and foster transparency in the health care system, according to the Centers for Medicare & Medicaid Services.
Over 2,800 partners have registered with the network, including physician organizations, insurers, accountable care organizations, hospitals and health systems, and patient advocacy groups, according to CMS.
At the briefing, Bruce Broussard, CEO of network partner Humana, said that the ACA’s focus on quality has “wrapped the focus around the journey of someone’s health. It’s really changing the system from a treatment-oriented one to a health-oriented one.”
Dr. Robert Wah, president of the American Medical Association, said that his organization joined the network because of the access to decision makers that participation is expected to give.
“It is critical that physicians take a proactive role in defining the details of new payment models, and this network will help facilitate that,” Dr. Wah said in an interview.
On Twitter @whitneymcknight
FROM A WHITE HOUSE PRESS BRIEFING
