Dear NVOS Members,
The articles contained in this e-newsletter are excerpted from AAOS newsletters and other media sources to help our members stay current on national issues.
The NVOS Staff |
Top Story On Medical Fee Schedules
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The Nevada Division of Industrial Relations recently held a hearing on proposed regulatory changes to the Medical Fee Schedule (not to be confused with the annual revisions to the fee schedule that took effect on Feb. 1). Many members were concerned about three issues in the report: 1) the switch from RVP to RBRVS; 2) the assumption that reimbursement rate should be adjusted downward based on commercial reimbursement data; and 3) the possible decrease in access to care that such rate decreases might precipitate. The NVOS response letter is viewable by clicking here. In case you have not seen it, here is a link where you can access the Milliman report:
http://dirweb.state.nv.us/WCS/wcs-ProposedRegs.htm
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Manufacturer To Pay $80 Million After Marketing Unapproved Orthopaedic Cutting Guide
|  The U.S. Department of Justice (DOJ) and OtisMed have reached a settlement agreement regarding the use of the OtisKnee-a cutting guide designed to assist surgeons performing total knee arthroplasty procedures. The manufacturer initially did not seek clearance from the U.S. Food and Drug Administration (FDA) for marketing the product before it started selling them. Under terms of an acquisition deal, the manufacturer later filed for FDA clearance to market the device, and FDA stated that the manufacturer had not demonstrated that the guides were safe and effective. The DOJ claims that the company sold 18,000 of these devices from 2006 to 2009 without FDA clearance. The manufacturer's chief executive officer directed employees to continue shipping the device even after the company's board of directors voted unanimously to halt shipments. This action was reported by a whistle blower, an employee of the company that ultimately acquired OtisMed. In settling the case with the DOJ, the manufacturer paid $80 million in criminal and civil fines, and the executive is to be sentenced on March 18; he faces up to 3 years in prison and $300,000 in fines. The acquiring company was not charged with wrongdoing and has agreed to audit its other devices to ensure that they have proper FDA clearances.
Read the FDA statement...
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Study: Many Patients Have Expectations For Physician Attire, But Attire May Not Influence Perceptions Of Care
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According to findings published online in the journal BMJ Open, many patients have specific expectations for physician dress, and patient perceptions of attire may be influenced by age, locale, setting, and context of care. The research team reviewed data from 30 studies covering 11,533 patients across 14 countries. They found that preferences or positive influence of physician attire on patient perceptions were reported in 21 studies (70 percent). Overall, 18 studies (60 percent) noted that patients preferred formal attire and white coats, although other attire was not specified. Preference for formal attire and white coats was more prevalent among older patients and in studies conducted in Europe and Asia. In addition, four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs, while four of five studies in intensive care and emergency settings also found no attire preference. Only three of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions.
Read more...
Read the complete study...
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Study: CMS Standards For Coverage Determinations Increased Over 13 Years
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According to a study published in the February issue of the journal Health Affairs, over a 13-year span, the U.S. Centers for Medicare & Medicaid Services (CMS) has raised the evidentiary bar for coverage of expensive medical items, services, treatment procedures, and technologies. The research team examined Medicare national coverage determinations and found that, after adjustment for strength of evidence and other factors known to influence the determinations, CMS was about 20 times more likely to deny coverage in recent years compared to earlier in the study period. In addition, coverage during the study period was increasingly and positively associated both with the degree of consistency of favorable findings in CMS-reviewed clinical evidence and with recommendations made in clinical guidelines. The research team writes that the rising evidence standards raise questions about patient access to new technologies.
Read more...
Read the abstract...
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CMS Moves To Address Provider Concerns Regarding EHR Incentive Programs
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The U.S. Centers for Medicare & Medicaid Services (CMS) states that it plans to update the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to reduce the reporting burden on providers, while supporting the long-term goals of the program. The new rule, expected early this year, will address provider concerns about software implementation, information exchange readiness, and related issues. Among other things, CMS is considering proposals to:
- Realign hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 edition software into their workflows and to better align with other CMS quality programs.
- Modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers' reporting burdens.
- Shorten the EHR reporting period in 2015 to 90 days to accommodate these changes.
The announcement is separate from a forthcoming proposed rule for stage 3 of meaningful use that is expected to be released in early March.
Read more...
Read the CMS statement...
Read the response from the American Association of Orthopaedic Surgeons (AAOS)...
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ONC Offers Roadmap To Improve Interoperability Of EHRs
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A report released by the Office of the National Coordinator for Health Information Technology (ONC) offers a road map for individuals and providers "to send, receive, find and use a common set of electronic clinical information at the nationwide level by the end of 2017." The report notes that many successful electronic health information-sharing arrangements currently exist in communities across the nation, but such arrangements often form around specific geographies, and barriers inhibit nationwide interoperability. Such barriers include the following:
- Electronic health information is not in any standardized format.
- Lack of financial motives, misinterpretation of existing laws governing health information sharing, and variations in regulation and policies often inhibit sharing of electronic health information.
- No reliable and systematic method exists to establish and scale trust across disparate networks nationwide according to individual preferences.
The following actions are among the recommendations in the roadmap to improve interoperability:
- Establishment of a coordinated governance framework and process for nationwide health information interoperability
- Improved technical standards and implementation guidance
- Clarification of privacy and security requirements
Read the report (PDF)...
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Third-Party Proposal Suggests Paying For SGR Repeal Through Savings From Alternative Payment Models
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The non-profit Center for Healthcare Quality and Payment Reform (CHQPR) has released a report that outlines a proposal to pay for a long-term fix for the Medicare Sustainable Growth Rate (SGR) formula through the use of alternative payment models. On April 1, 2015, physicians are scheduled to see an estimated 21 percent cut called for under the SGR. Although repeal of the SGR has bipartisan support, legislators have been unable to agree on an approach to offset the cost of the repeal. The CHQPR report calls on the U.S. Centers for Medicare & Medicaid Services to rapidly deploy three accountable payment models that have demonstrated effectiveness: bundled payments, warrantied payments, and condition payments. The authors argue that Medicare spending could be safely reduced "by giving physicians the tools they need to keep patients healthy, avoid unnecessary tests and procedures, reduce avoidable hospitalizations, and prevent infections and complications. Savings from better care could be used to pay for repealing the SGR and for making reasonable annual updates to physician payments."
Read more...
Read the report (PDF)...
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2014-2015 Board of Directors
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