American College of Cardiology

MedPAC Discusses Education, Physician Relationships

The Medicare Payment Advisory Commission (MedPAC) last week held its monthly meeting, which discussed medical education for the 21st century and physician relationships with industry. The first part of the meeting explored how undergraduate and residency programs could evolve towards outcomes-based training, utilizing HIT and core infrastructure to provide chronic care management in ambulatory settings. This would be a significant change from current hospital-focused acute care. Commissioners suggested that the Medicare program could serve as a lever to drive innovative education, linking GME payments to specific, statistically relevant measures at the institutional and physician levels. Additionally, commissioners discussed potential methods to drive workforce changes, suggesting loan repayment, subsidies or payment reform, among others ideas.

The second part of the meeting focused on four draft recommendations on physician financial relationships, which garnered protracted discussion and no clear consensus on any of the recommendations. Commissioners and staff debated whether the recommendations should be expanded to apply to additional groups, facilities, or provided services, and whether certain information, particularly provider identifiers, should remain nonpublic or available only to researchers through data use agreements. There was agreement that certain relationships did provide public value, and that any reporting system should recognize these as appropriate arrangements. Staff will redraft the financial disclosure recommendations and present them again at the November meeting. A transcript of the meeting is available on MedPAC’s Web site here.

CMS Publishes Some of Additional Medicare Edits

The Centers for Medicare and Medicaid Services (CMS) last week announced that beginning October 1 it will publish most of the 9,700 edits utilized in its Medically Unlikely Edit (MUE) program. Implemented in January 2007, the purpose of the MUE program is to reduce payment errors for Medicare Part B claims by checking the number of times a service is reported by a provider or supplier for the same patient on the same date of service. However, although the program has included quarterly updates to the edits, CMS does not publish all active MUEs because some are designed to detect and deter questionable payments rather then billing errors. According to CMS, “Publishing those MUEs would diminish their effectiveness.”

Robert Piana, M.D., F.A.C.C., chair of ACC’s Coding and Nomenclature Committee, said, "The MUEs are overdue for being publicly released and the ACC is glad to see that CMS is taking steps to release many of the existing edits. However, CMS should go further and release all edits used on physician claims. While no one should be paying for fraudulent claims, hiding the edits that result in payment denials raises concerns that these edits may not be based on the best evidence. We all benefit from a transparent system." The published edits will appear on the CMS Web site here.

CMS Eliminates Payments for ‘Reasonably Preventable’ Conditions

The Centers for Medicare and Medicaid Services (CMS) on October 1 eliminated payments to hospitals for Medicare patients for ten “reasonably preventable” conditions. These conditions include: Stage III and IV pressure ulcers; fall or trauma resulting in serious injury; vascular catheter-associated infection; catheter-associated urinary tract infection; foreign object retained after surgery; certain surgical site infections; air embolism; blood incompatibility; certain manifestations of poor blood sugar control; and certain deep vein thromboses or pulmonary embolisms. The conditions could apply to several hundred thousand hospital stays of the 12.5 million that Medicare covers annually, according to officials, the New York Times reports.

FDA News Updates

The Food and Drug Administration (FDA) and Medtronic, Inc., have notified health care professionals of the Class I Recall of several Medtronic intrathecal catheters and intrathecal catheter revision kits used with the implanted Medtornic SyncroMedII, SynchroMed EL, and Iso Med infusion pumps that store and deliver parenteral drugs to the intrathecal space. The products were recalls because of potential misconnections of the Medtronic Sutureless Connector Catheters from the catheter port on the pump. Read more about the recall on the FDA Web site.

FDA has reviewed preliminary data from the UPLIFT (Understanding the Potential Long-Term Impacts on Function with Tiotropium) trial, which evaluates the effects of the Spiriva HandiHaler in patients with chronic obstructive pulmonary disease. The preliminary results reported to the FDA indicate that there was no increased risk of stroke with tiotropium bromide compared to placebo. The complete results of the trial, expected in November 2008, will address concerns raised by two recent publications that reported an increased risk for mortality and/or cardiovascular events in patients who received tiotropium or inhaled anticholinergics. Read the complete MedWatch 2008 Safety summary here.

HRET to Implement ICU Safety Improvement Program

The Agency for Healthcare Research and Quality awarded the Health Research & Education Trust (HRET), an affiliate of the American Hospital Association, a $3 million contract to implement a three-year program to reduce central line-associated bloodstream infections in hospital intensive care units (ICU). The program, developed by researchers at the Johns Hopkins University and used in more than 100 ICUs in Michigan, designed to survey and improve an ICU’s patient safety culture. It includes tools to help health care professionals identify opportunities to reduce potential health care-associated infections and implement policies to make care safer. HRET said it hopes to implement the program at least ten hospitals in ten states for a minimum of 100 hospitals selected. Read more here.

Webinar to Address MIPPA Imaging Requirements

Registration is now open for an Oct. 14 Webinar that will discuss new imaging policies present in the “Medicare Improvements for Patients and Providers Act of 2008” (MIPPA) and how the policies will affect providers of advanced diagnostic imaging services, such as CT, MR, nuclear medicine and PET. MIPPA calls for providers of advanced diagnostic imaging services to be accredited by 2012 in order to receive payment for the technical component of those services. The law also establishes a two-year voluntary demonstration program to test the use of physician-developed appropriateness criteria. The Webinar will be held Tuesday, October 14 from 1:30 – 2:45 p.m. The ACC’s Joe Allen is among the presenters. To register, click here or call (202) 263-2967.

Pfizer to Abandon Development of Heart Drugs

Pfizer, Inc., has announced that it will abandon early stage research on cardiovascular drugs to focus on cancer, Alzheimer’s disease, and diabetes, along with inflammatory diseases, pain and schizophrenia. As part of the transition, Pfizer is to sell or share rights to at least 11 drugs in early testing stages, including treatments for heart failure, high cholesterol and obesity, which the company no longer considers profitable enough, according to Martin Mackay, head of research and development at Pfizer. Read additional coverage from Bloomberg here.