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FDA Approves First Pre-Surgical Breast Cancer-Fighting Drug

The US Food and Drug Administration (FDA) approved a biotech drug from Roche, offering an earlier approach to treat breast cancer before surgery. Perjeta, approved by the European Union in 2012, is now available to patients in the US.

A New First Step

Typically the first step to fight most forms of cancer is surgery to remove tumors. Perjeta can be prescribed as part of a cancer treatment program prior to surgery to help prevent cancer from spreading and decrease tumor size. Perjeta is an inhibitor of HER-2, a protein overproduced in about 20 percent of breast cancer patients with tumors. This overproduction of the HER-2 protein rapidly increases tumor growth.

Perjeta is intended for “patients with HER2-positive, locally advanced, inflammatory or early stage breast cancer (tumor greater than 2 cm in diameter or with positive lymph nodes) who are at high risk of having their cancer return or spread (metastasize) or of dying from the disease,” according to an FDA press release. The drug is approved under the FDA’s accelerated approval program, making it available to patients while clinical trials to confirm the results and determine the long term effects will be ongoing. Results are anticipated by 2016.

The 417-women study showed patient’s cancer reaching undetectable levels increases 18 percent when using the new drug in conjunction with chemotherapy and Herceptin (trastuzumab), compared to the results of using chemotherapy and Herceptin alone.

Not Quite the Solution

Surgery is still required as part of the treatment program with the new drug. However, in some cases, the patient only needs a lumpectomy instead of a mastectomy. While Perjeta doesn’t eliminate surgery altogether, it can provide a dramatic improvement in the invasiveness of the surgery required. This new drug lays claim to first in the industry, helping to improve the treatment breast cancer.

Anesthesia Documentation Lagging

A survey taken by the Academic Health Sciences Centre of Canada and published in the U.S. National Library of Medicine found wide-ranging inconsistencies between recorded anesthetic data. To conduct the survey, the research team provided questionnaires to four different adult McGill University hospitals. Anesthesiologists were asked to rank operational variables on a scale of 1 to 5. There were 23 preoperative variables and another 33 intraoperative variables to rank according to importance.

Roughly 90% of the surveys sent by the Academic Health Sciences Centre research team were completed and returned. The research team only studied the results turned in by the McGill hospitals’ staff anesthesiologists.

Most Important Anesthetic Variables

In preoperative documentation, anesthesiologists reported two critical pieces of medical data to record. Anesthesiologists cited the patient’s allergy status as one of these two primary pieces of information. The other critical preoperative data to be recorded was the examination of the patient’s airway.

In intraoperative documentation, anesthesiologists cited the patient’s vital signs as the single most important variable to be recorded.

Recorded Anesthetic Data

After receiving the completed surveys regarding the most important anesthetic variables, the Academic Health Sciences Centre research team found that the only variable to be recorded on every patient’s medical records during anesthesia was the anesthesiologist’s name.

The patient’s allergy status was the most recorded preoperative variable, appearing on roughly 84% of medical charts. Intraoperative documentation showed a wide range of recorded data. Some anesthesiologists recorded items such as start times of the anesthesia, while other anesthesiologists recorded nothing more than the patient’s estimated blood loss.

Why is Anesthetic Documentation Important?

In terms of medical accuracy, there is a large need to improve anesthetic documentation. Inconsistencies during anesthetic documentation inhibit the medical community’s ability, as a whole, to distribute, analyze, and improve upon anesthetic data correlating with surgical performance. With more consistent anesthetic records, patients may benefit from a better communication of anesthesia-related medical information.

In terms of medical billing and coding, it is increasingly critical to maintain thorough, accurate, and consistent medical records across all areas of practice for the following reasons:

  • Precise clinical anesthetic documentation describes the correct combination of diagnostic and/or treatment code for the medical biller and coder to implement.
  • When medical billers and coders are able to depict the most accurate version of the surgical procedure, the medical practice is able to maximize reimbursement and minimize the need for resubmission of insurance claims.
  • By maximizing the medical practice’s reimbursements and minimize the need to resubmit insurance claims, patients are happier. The practice functions in a more efficient manner. In turn, the medical practice is able to maximize revenue and profits while earning an effective reputation for easily managing health insurance claims.

Oregon Reduces Number of Frequent ER Patients

America faces a physician shortage that is only set to intensify when the Affordable Care Act takes full effect in January of 2014. A number of ongoing efforts are being made to streamline the care process for patients without compromising their level of care. In July of 2012, hospitals in Oregon began a program aimed at limiting the number of “frequent flier” visits to their ERs. Although the new initiative will take place over the course of five years, it shows early signs of success.

Oregon’s New ER Program

Approximately 80 percent of all healthcare expenditures in the United States are used to service only 20 percent of the population. Visits to the emergency room can be notoriously expensive. Officials in Oregon have taken these two factors into consideration and designed a new program aimed at lowering ER visits, especially by “frequent flyers.” Frequent flyers are defined by the program as patients who visit the ER ten times or more each year. Some of the patients who fall into this group annually visit the ER at a rate of once a week.

Oregon’s program is federally funded; as of 2012, the state began receiving almost $2 billion in federal funds to be spread out over the course of five years. The goal of the program is to reduce the medical inflation rate in Oregon by two percent over the course of this period. Promising early numbers suggest that this goal is reasonable to expect. In the first year, emergency room attendance rates by documented frequent flyers have dropped in many Oregon hospitals – in the case of at least one hospital, at a rate of 48 percent.

The Methods of the New Program

The main technique used in this new program is to isolate patient issues which do not directly demand a visit to the emergency room. Many patients end up in the emergency room with complaints that do not necessitate immediate care, and this number is especially high among frequent flyers. Additionally, frequent flyers may end up in the emergency room due to complications from relatively benign health issues.

Patients in Oregon are being walked through the care process by Coordinated Care Organizations, or CCOs. Employees in these organizations help patients navigate the medical system and encourage frequent flyers to make regular appointments with a primary care doctor instead of visiting the emergency room whenever a perceived problem arises. Additionally, these CCOs may provide basic shelter and hygiene support for individuals who run into emergency-level health issues on a regular basis as a result of their lifestyle. On a case-by-case and hospital-by-hospital basis, the numbers coming out of Oregon may help to set the precedent for more nuanced ER practices and less cluttered ERs moving forward.

New Action Set Reduces Hospital Readmissions

A new set of protocols has been found to be effective in reducing the number of patient readmissions following their initial discharge.

The Re-engineered Discharge Toolkit

Researchers at the Boston University Medical Center have established the Re-engineered Discharge Toolkit, or “RED.” The researchers amended and expanded on a list of proactive steps aimed at limiting patient readmissions.

While researching and writing the steps included in RED, enhanced emphasis was placed on cross-cultural differences. The researchers examined the ways in which healthcare is viewed differently depending on the cultural background of patients. Much of the re-engineering aspect of their work came in the form of increased focus on communication prior to patient discharge. Specifically, they focused on the issues that can arise in the event of a language barrier.

Following discharge, a patient must take greater responsibility for their own care. In order to do this, they must be well-versed on the appropriate care-related behavior that is expected from them by the healthcare professionals who are approving their discharge.

The RED steps outline the procedures for making sure patients understand proper behavior following discharge, including how and where to obtain necessary medications, as well as how and when to take them. Furthermore, a variety of follow-up measures subsequent to patient discharge are aimed at avoiding relapses due to forgetfulness or negligence on the part of patients.

The Proven Results of RED

When put into application, the new RED steps were deemed to be successful in lowering readmission rates. According to the researchers, RED resulted in a 30 percent reduction in hospitalization utilization within 30 days of patient discharge. The researchers also saw a 34-percent reduction in per-patient costs during that time period as well.

These results serve as a positive reminder of what increased efficiency measures within the healthcare system can do for both patient health and healthcare provider productivity.

Hospital Readmission Rates are Down

Hospital Readmission Rates are Down

New data from the Centers for Medicare & Medicare Services shows that there has been improvement in hospital readmission rates over the last several years. While hospital readmission rates have been steady over the last five years, these new numbers show a small but significant readmission downturn in recent times.

Readmission Numbers

When analyzing this new data, CMS applied a broad focus. Specifically, CMS looked at 30 day readmission rates for Medicare patients without focusing on a specific cause for readmission. In the year of 2012, CMS concluded that Medicare patient readmission rates had fallen from a steady 19 percent over the last five years to 18.4 percent in 2012. This translates to approximately 70,000 less readmissions in 2012 than in previous years. Additionally, when looking specifically at the last quarter of 2012, 30 day readmission rates were down to 17.8 percent, which may suggest a trend of further positive movement.

Reasons for Less Readmission

When releasing these numbers, CMS did not attempt to explain the specific reasons behind a positive trend in readmission rates. Still, there are some theories as to what has caused readmission rates to dip. Jonathan Blum, who is the director of the Center for Medicare believes that reforms in payment and delivery have aided the drop in readmissions.

Additionally, readmission rates may have dropped as a result of a new program aimed at lowering them. This program went into effect on October 1, 2012 as part of the Affordable Care Act. Under this new program, hospitals must lower their readmission rates in critical areas or else face financial penalties. These financial penalties are set to increase each year through 2015, and must no doubt serve as motivation for hospitals to improve their readmission numbers. This new data from the CMS seems to suggest that the penalty program is beginning to have an effect on readmission rates.

Medicare Spending Doesn’t Lead to Increase

Increased Medicare Spending on Advanced Cancer Care Doesn’t Lead to Increase in Survival Rates

A new study has called into question the notion that increased spending on cancer care results in greater patient survival rates. The study looked at hospitals in 80 different referral regions. These referral regions collectively represented 25 percent of the US population. In order to provide a context for cancer care and its link to spending, the study focused on patients suffering from advanced cases of prostate, pancreatic, breast and colorectal cancer between the years of 2002 and 2007.

The Findings

Results of this broad study yielded some interesting results: regionally, variance in cancer care costs was high; there was a 41 percent discrepancy between the highest and lowest-spending regions of the country. Most of the lowest-spending regions lay in the Midwestern and Western areas of the country, while the higher-spending regions were mostly located in Louisiana, southern California and central New Jersey. Yet despite the large degree of variance between regional cancer care spending rates, there was no clear data to demonstrate that increased spending resulted in greater rates of advanced cancer survival. Although survival rates certainly varied by hospital referral region, this could not be linked to spending with any sort of statistical certainty. Increased spending was linked to lengthier and more frequent hospital stays, however.

This study is particularly significant when considered in light of the high cost of cancer care in general – currently cancer care represents a full 10 percent of all Medicare spending. The authors of the study called for an increased focus on providing palliative care to those with advanced cases of cancer.

The primary guiding principle for those working in the medical field is to improve patients’ quality of life. But the associated costs can sometimes be instructive indicator as to what methods work best to make this so. It should be noted however that the results of this study are somewhat at odds with a study completed between 1983 and 1999 which compared higher cancer care costs in the US to lower costs in 10 European countries – in the case of that study, increased spending resulted in two year increase in patient life expectancy.

CMS Extends Payment Programs

CMS Extends Payment Programs for Rural and Low-Volume Hospitals

Rural and low volume hospitals will be experiencing a bit of good fortune in the coming months – this is because the Centers for Medicare and Medicaid Services have recently announced an extension to provisions which provide supplemental payment to hospitals which have fewer than 100 beds and a high volume of Medicare patients. The effects of these provisions are retroactive to October 1, 2012.

These policy extensions come as part of the deal which allowed the federal government to sidestep the fiscal cliff; The American Taxpayer Relief Act includes payment policy extensions for rural and low-volume hospitals. All told, revenue for these types of institutions may increase by millions of dollars.

Payment Extension Details

In the case of low volume hospitals, payment adjustments fall within certain ranges – for hospitals with 200 or less yearly Medicare discharges, payments will be augmented by 25 percent. But for those hospitals which fall above the 1,600 Medicare discharge per year mark, no further compensation will be made available.

Nationally, it’s estimated that approximately 600 hospitals qualify for low volume status. The specific qualifiers for this designation include being outside a 15 mile range of a comparable facility as well as reporting fewer than 1,600 Medicare discharges per year. It’s estimated that collectively, these 600 hospitals should qualify for $326 million in additional compensation in the coming year.

Although these payment policy extensions come as good news to smaller facilities looking to keep their doors open, it should be noted that they are only guaranteed to be around for the remainder of the year.

Though the American Taxpayer Relief Act has provided relief for rural and low volume hospitals, it has left many public hospitals frustrated with Medicare payment structure. Because not all appendages of the healthcare system stand to benefit under the current legislation, it’s debatable whether the net effects of these provisions are in fact positive.

Infection Rates Are On the Decline

A new report from the Centers for Disease Control and Prevention shows that hospitals are making headway in reducing patient infection rates.

CDC Infection Findings

Since 2008, infection rates have dropped in a number of categories. Central line-associated infections dropped by 41 percent, and these gains in prevention were particularly strongly represented in intensive care and neonatal intensive care units. Surgical site infections are down 17 percent, and catheter-related urinary tract infections are down 7 percent from 2009 numbers.

CUSP and Mitigated Infection Risk

Much of the drop-off in infections can be specifically attributed to the implementation of the Comprehensive Unit-Based Safety Program, or CUSP. CUSP makes use of a number of methods to address infections, especially in the case of newborns. These include encouraging caregivers to consider central line removal at specific benchmarks and taking closer notes of catheter need and usage. Additionally, front-line caregivers are provided with greater space in which to express their opinion as to potential improvements to infection prevention efforts.

Hospitals which made use of CUSP saw significant reductions in infection rates. In a year-long survey of 100 hospitals across nine states which made use of CUSP initiatives, newborn central-line infections were cut by 58 percent. But CUSP was also instrumental in lowering adult infection rates as well – over a four year period, infections rates dropped 40 percent at hospitals which made use of CUSP protocols.

By applying CUSP methods, hospitals are saving lives. But they are also lowering health costs. It’s estimated that the Comprehensive Unit-Based Safety Program’s efforts to limit infection alongside other proactive initiatives have resulted in a $34 million reduction in health care costs. Although the CUSP program specifically came with a $900 thousand price-tag, it has single-handedly been responsible for $2 million in avoided infection-related expenditures.

These recent, lower infection numbers are encouraging news for health professionals of all stripes, and no doubt bode well for further development of initiatives in the same vein as CUSP.

Change in Billing Option Leads to an Increase in Medicare Spending

A new study has found that a Medicare policy change which was intended to be spending-neutral in fact led to a 6.5 percent increase in spending on medical office visits during the year 2010. This measure, which eliminated a popular consultation billing option, has been tied to a resultant increase in billing by physicians for other higher-intensity services.

Because of the elimination of the consultation billing code, CMS proportionally raised the rates for other outpatient services. This was predicted to allow costs to remain flat. But although the number of patient visits did not change over the course of 2010, the resulting Medicare costs which were billed did. The findings of this study, which examined the claims of 2.2 million beneficiaries, found that per quarter in 2010, costs per beneficiary increased by $10.20.

The authors of the study caution that their findings do not make any broad statements about the effects of coding changes in general. It is important to realize that the spike in Medicare spending during the year of 2010 could in fact be a one-off anomaly as opposed to a trend. But the researchers were able to conclude that in this particular case of Medicare billing structure alteration, the projected results of the change were out of alignment with the actual real-world repercussions.

In the years since this change was made to policy, both the American Medical Association and American College of Cardiology have pushed to have the removed consulting code reinstated. In an arena where public policy shifts can affect your bottom-line, it is important that as a physician you stay abreast of the implications of these changes. In order to ensure your continued prosperity, having a skilled medical billing provider is a logical and necessary step.

Universal EMR Implementation in Taiwan

In the United States, current regulations and incentives have been put in place to pave the way for more widespread usage of EMR technology. In a perfect world, this will eventually lead to universal compliance by medical professionals and a streamlined system that improves patients’ care, while at the same time allowing medical professionals to discover greater success. As the United States experiences a few growing pains on the way towards universal EMR usage, it is instructive to look at how other countries have implemented the technology. It is encouraging to see that EMR software is working for them.

The Road to Success

During the past 16 years, Taiwan has moved toward simplifying the way that interconnected parts of the medical system communicate with each other. EMR software plays a key role in this process by standardizing doctor-patient interactions. The country’s health insurance providers were consolidated into a single, national health insurance provider in 1994. Electronic billing was then introduced into the country in 1995, as a logical first step towards integrating new technology into the traditional medical system.

EMR and the IC Card

In 2004, Taiwan introduced the IC Project. This initiative implemented the use of “smart cards” for all patients. Taiwanese citizens carry a small card that contains their complete medical record. When the card is swiped by the patient, and a complementary card is swiped by a medical professional, the patient’s complete EMR is made available for use in their diagnosis and treatment. It is estimated that the use of EMR and IC cards in Taiwan has led to a 10% reduction in outpatient visits, as well as a decrease in both fraud and the waste of medical resources.

The United States is far from Taiwan’s universal implementation of EMRs; however, the gains in efficiency are still possible on a localized level. Try utilizing EMR software for greater improvement within your personal practice.

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