ACS Surgery News

Stephanie J. Drew, DMD, FACS, was elected president of the American College of Oral and Maxillofacial Surgeons (ACOMS) at its Annual Scientific Conference in April. She is the 26th president of ACOMS and the first woman elected to the position.

Stephanie J. Drew, DMD, FACS, was elected president of the American College of Oral and Maxillofacial Surgeons (ACOMS) at its Annual Scientific Conference in April. She is the 26th president of ACOMS and the first woman elected to the position.

Stephanie J. Drew, DMD, FACS, was elected president of the American College of Oral and Maxillofacial Surgeons (ACOMS) at its Annual Scientific Conference in April. She is the 26th president of ACOMS and the first woman elected to the position.

Measuring success when it comes to political action, particularly in the current climate, can be challenging. Just as the American College of Surgeons (ACS) strives to represent all of surgery and focuses on an extensive list of priorities, the American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) works to maintain relationships with numerous lawmakers to ensure the College’s advocacy and health policy agenda remains at the forefront.

Leading up to the November midterm elections, every surgeon should be familiar with some basic facts about ACSPA-SurgeonsPAC fundraising and disbursement efforts.
 

Fundraising and disbursements

Fundraising is on par with the 2016 election cycle, a record year for “hard” dollars, or personal funds used to support candidates. SurgeonsPAC supports both Democrat and Republican candidates running in U.S. House and Senate races across the nation. SurgeonsPAC has a track record of balanced giving, contributing to candidates and incumbents of both parties who are willing to champion issues of importance to surgeons and surgical patients. All 2017‒2018 election cycle disbursements can be viewed at www.surgeonspac.org/disbursements. Legally, SurgeonsPAC cannot earmark contributions for a particular candidate or based on a single issue.

Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c (6) of the Internal Revenue Code.

Measuring success when it comes to political action, particularly in the current climate, can be challenging. Just as the American College of Surgeons (ACS) strives to represent all of surgery and focuses on an extensive list of priorities, the American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) works to maintain relationships with numerous lawmakers to ensure the College’s advocacy and health policy agenda remains at the forefront.

Leading up to the November midterm elections, every surgeon should be familiar with some basic facts about ACSPA-SurgeonsPAC fundraising and disbursement efforts.
 

Fundraising and disbursements

Fundraising is on par with the 2016 election cycle, a record year for “hard” dollars, or personal funds used to support candidates. SurgeonsPAC supports both Democrat and Republican candidates running in U.S. House and Senate races across the nation. SurgeonsPAC has a track record of balanced giving, contributing to candidates and incumbents of both parties who are willing to champion issues of importance to surgeons and surgical patients. All 2017‒2018 election cycle disbursements can be viewed at www.surgeonspac.org/disbursements. Legally, SurgeonsPAC cannot earmark contributions for a particular candidate or based on a single issue.

Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c (6) of the Internal Revenue Code.

Measuring success when it comes to political action, particularly in the current climate, can be challenging. Just as the American College of Surgeons (ACS) strives to represent all of surgery and focuses on an extensive list of priorities, the American College of Surgeons Professional Association Political Action Committee (ACSPA-SurgeonsPAC) works to maintain relationships with numerous lawmakers to ensure the College’s advocacy and health policy agenda remains at the forefront.

Leading up to the November midterm elections, every surgeon should be familiar with some basic facts about ACSPA-SurgeonsPAC fundraising and disbursement efforts.
 

Fundraising and disbursements

Fundraising is on par with the 2016 election cycle, a record year for “hard” dollars, or personal funds used to support candidates. SurgeonsPAC supports both Democrat and Republican candidates running in U.S. House and Senate races across the nation. SurgeonsPAC has a track record of balanced giving, contributing to candidates and incumbents of both parties who are willing to champion issues of importance to surgeons and surgical patients. All 2017‒2018 election cycle disbursements can be viewed at www.surgeonspac.org/disbursements. Legally, SurgeonsPAC cannot earmark contributions for a particular candidate or based on a single issue.

Contributions to ACSPA-SurgeonsPAC are not deductible as charitable contributions for federal income tax purposes. Contributions are voluntary, and all members of ACSPA have the right to refuse to contribute without reprisal. Federal law prohibits ACSPA-SurgeonsPAC from accepting contributions from foreign nations. By law, if your contributions are made using a personal check or credit card, ACSPA-SurgeonsPAC may only use your contribution to support candidates in federal elections. All corporate contributions to ACSPA-SurgeonsPAC will be used for educational and administrative fees of ACSPA and other activities permissible under federal law. Federal law requires ACSPA-SurgeonsPAC to use its best efforts to collect and report the name, mailing address, occupation, and the name of the employer of individuals whose contributions exceed $200 in a calendar year. ACSPA-SurgeonsPAC is a program of the ACSPA, which is exempt from federal income tax under section 501c (6) of the Internal Revenue Code.

The 2018 American College of Surgeons (ACS) Comprehensive General Surgery Review Course, July 26–29 in Chicago, IL, is an intensive three-and-a-half-day review course that will cover essential content areas in general surgery, including alimentary tract, endocrine and soft tissue, oncology, skin and breast, surgical critical care, trauma, and vascular operations, as well as perioperative care.

Course Chair John A. Weigelt, MD, DVM, MMA, FACS, and a distinguished faculty will use didactic and case-based formats to present a comprehensive and practical review. Dr. Weigelt recently retired from the Medical College of Wisconsin, where he was the Milt & Lidy Lunda/Charles Aprahamian Professor of Trauma Surgery, as well as professor and chief, division of trauma and critical care. He is joining the University of South Dakota and the Sanford Health System, Sioux Falls, this summer as professor of surgery. Dr. Weigelt is Medical Director of the ACS Surgical Education and Self-Assessment Program (also known as SESAP®).

The course offers a pragmatic review designed to focus on practice issues and will offer several special features, such as self-assessment materials, including pre- and posttests. It may be helpful in preparing for examinations. Self-assessment credit will be available.

The ACS is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education for physicians.

The ACS designates this live activity for a maximum of 28 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Register today at bit.ly/2s19VtX. Space is limited and registration will be accepted on a first-come, first-served basis. For more information and registration, visit the Comprehensive General Surgery Review Course web page at facs.org/gsreviewcourse or e-mail [email protected] or [email protected]. 

The 2018 American College of Surgeons (ACS) Comprehensive General Surgery Review Course, July 26–29 in Chicago, IL, is an intensive three-and-a-half-day review course that will cover essential content areas in general surgery, including alimentary tract, endocrine and soft tissue, oncology, skin and breast, surgical critical care, trauma, and vascular operations, as well as perioperative care.

Course Chair John A. Weigelt, MD, DVM, MMA, FACS, and a distinguished faculty will use didactic and case-based formats to present a comprehensive and practical review. Dr. Weigelt recently retired from the Medical College of Wisconsin, where he was the Milt & Lidy Lunda/Charles Aprahamian Professor of Trauma Surgery, as well as professor and chief, division of trauma and critical care. He is joining the University of South Dakota and the Sanford Health System, Sioux Falls, this summer as professor of surgery. Dr. Weigelt is Medical Director of the ACS Surgical Education and Self-Assessment Program (also known as SESAP®).

The course offers a pragmatic review designed to focus on practice issues and will offer several special features, such as self-assessment materials, including pre- and posttests. It may be helpful in preparing for examinations. Self-assessment credit will be available.

The ACS is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education for physicians.

The ACS designates this live activity for a maximum of 28 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Register today at bit.ly/2s19VtX. Space is limited and registration will be accepted on a first-come, first-served basis. For more information and registration, visit the Comprehensive General Surgery Review Course web page at facs.org/gsreviewcourse or e-mail [email protected] or [email protected]. 

The 2018 American College of Surgeons (ACS) Comprehensive General Surgery Review Course, July 26–29 in Chicago, IL, is an intensive three-and-a-half-day review course that will cover essential content areas in general surgery, including alimentary tract, endocrine and soft tissue, oncology, skin and breast, surgical critical care, trauma, and vascular operations, as well as perioperative care.

Course Chair John A. Weigelt, MD, DVM, MMA, FACS, and a distinguished faculty will use didactic and case-based formats to present a comprehensive and practical review. Dr. Weigelt recently retired from the Medical College of Wisconsin, where he was the Milt & Lidy Lunda/Charles Aprahamian Professor of Trauma Surgery, as well as professor and chief, division of trauma and critical care. He is joining the University of South Dakota and the Sanford Health System, Sioux Falls, this summer as professor of surgery. Dr. Weigelt is Medical Director of the ACS Surgical Education and Self-Assessment Program (also known as SESAP®).

The course offers a pragmatic review designed to focus on practice issues and will offer several special features, such as self-assessment materials, including pre- and posttests. It may be helpful in preparing for examinations. Self-assessment credit will be available.

The ACS is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide Continuing Medical Education for physicians.

The ACS designates this live activity for a maximum of 28 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Register today at bit.ly/2s19VtX. Space is limited and registration will be accepted on a first-come, first-served basis. For more information and registration, visit the Comprehensive General Surgery Review Course web page at facs.org/gsreviewcourse or e-mail [email protected] or [email protected]. 

The National Accreditation Program for Rectal Cancer (NAPRC), which the American College of Surgeons (ACS) launched in 2017, has awarded its first accreditation to the John Muir Health Rectal Cancer Program, Walnut Creek and Concord, CA. To earn the voluntary accreditation, the John Muir Health Rectal Cancer Program met 19 standards, including the establishment of a rectal cancer multidisciplinary team (RC-MDT) with clinical representatives from surgery, pathology, radiology, radiation oncology, and medical oncology.

Thirteen of those standards address clinical services that the program was required to provide, including carcinoembryonic antigen testing, magnetic resonance imagining, and computed tomography imaging for cancer staging, and ensuring a process whereby the patient starts treatment within a defined time frame. One of the most important clinical standards requires all rectal cancer patients to be present at both pre- and post-treatment RC-MDT meetings.

The National Accreditation Program for Rectal Cancer (NAPRC), which the American College of Surgeons (ACS) launched in 2017, has awarded its first accreditation to the John Muir Health Rectal Cancer Program, Walnut Creek and Concord, CA. To earn the voluntary accreditation, the John Muir Health Rectal Cancer Program met 19 standards, including the establishment of a rectal cancer multidisciplinary team (RC-MDT) with clinical representatives from surgery, pathology, radiology, radiation oncology, and medical oncology.

Thirteen of those standards address clinical services that the program was required to provide, including carcinoembryonic antigen testing, magnetic resonance imagining, and computed tomography imaging for cancer staging, and ensuring a process whereby the patient starts treatment within a defined time frame. One of the most important clinical standards requires all rectal cancer patients to be present at both pre- and post-treatment RC-MDT meetings.

The National Accreditation Program for Rectal Cancer (NAPRC), which the American College of Surgeons (ACS) launched in 2017, has awarded its first accreditation to the John Muir Health Rectal Cancer Program, Walnut Creek and Concord, CA. To earn the voluntary accreditation, the John Muir Health Rectal Cancer Program met 19 standards, including the establishment of a rectal cancer multidisciplinary team (RC-MDT) with clinical representatives from surgery, pathology, radiology, radiation oncology, and medical oncology.

Thirteen of those standards address clinical services that the program was required to provide, including carcinoembryonic antigen testing, magnetic resonance imagining, and computed tomography imaging for cancer staging, and ensuring a process whereby the patient starts treatment within a defined time frame. One of the most important clinical standards requires all rectal cancer patients to be present at both pre- and post-treatment RC-MDT meetings.

Registration is now open for the American College of Surgeons Clinical Congress 2018, October 21–25 in Boston, MA. The Clinical Congress is one of the largest educational meetings of surgeons in the world and offers outstanding educational opportunities for every stage of your career. The theme of this year’s conference is the Joy and Privilege of a Surgical Career. The scientific program, online registration, travel and hotel reservation links, and previews of other planned events for the conference are available on the Clinical Congress 2018 website at facs.org/clincon2018.

The Clinical Congress 2018 program addresses essential clinical and nonclinical topics. It includes a series of Named Lectures to be delivered by world-renowned experts in their fields, Didactic/Experiential and Surgical Skills Courses, and Video-Based Education Sessions to showcase surgical procedures. The Scientific Forum will include surgical research presentations and posters. This year, all posters will be e-posters, available online for viewing throughout the entire Clinical Congress.

Register now at facs.org/clincon2018/register.

Registration is open to all physicians and individuals in the health care field. To receive the early bird registration fees, be sure to register by 11:59 pm (Central time) Monday, August 27.

Registration is now open for the American College of Surgeons Clinical Congress 2018, October 21–25 in Boston, MA. The Clinical Congress is one of the largest educational meetings of surgeons in the world and offers outstanding educational opportunities for every stage of your career. The theme of this year’s conference is the Joy and Privilege of a Surgical Career. The scientific program, online registration, travel and hotel reservation links, and previews of other planned events for the conference are available on the Clinical Congress 2018 website at facs.org/clincon2018.

The Clinical Congress 2018 program addresses essential clinical and nonclinical topics. It includes a series of Named Lectures to be delivered by world-renowned experts in their fields, Didactic/Experiential and Surgical Skills Courses, and Video-Based Education Sessions to showcase surgical procedures. The Scientific Forum will include surgical research presentations and posters. This year, all posters will be e-posters, available online for viewing throughout the entire Clinical Congress.

Register now at facs.org/clincon2018/register.

Registration is open to all physicians and individuals in the health care field. To receive the early bird registration fees, be sure to register by 11:59 pm (Central time) Monday, August 27.

Registration is now open for the American College of Surgeons Clinical Congress 2018, October 21–25 in Boston, MA. The Clinical Congress is one of the largest educational meetings of surgeons in the world and offers outstanding educational opportunities for every stage of your career. The theme of this year’s conference is the Joy and Privilege of a Surgical Career. The scientific program, online registration, travel and hotel reservation links, and previews of other planned events for the conference are available on the Clinical Congress 2018 website at facs.org/clincon2018.

The Clinical Congress 2018 program addresses essential clinical and nonclinical topics. It includes a series of Named Lectures to be delivered by world-renowned experts in their fields, Didactic/Experiential and Surgical Skills Courses, and Video-Based Education Sessions to showcase surgical procedures. The Scientific Forum will include surgical research presentations and posters. This year, all posters will be e-posters, available online for viewing throughout the entire Clinical Congress.

Register now at facs.org/clincon2018/register.

Registration is open to all physicians and individuals in the health care field. To receive the early bird registration fees, be sure to register by 11:59 pm (Central time) Monday, August 27.

Doctors could spend less time with their EHRs under Medicare’s proposed physician fee schedule for 2019.

The sweeping proposal also would improve Medicare telemedicine opportunities and update portions of the Quality Payment Program and the Medicare Shared Savings Program, according to documents posted online July 12. There would also be more opportunities to be paid for telemedicine services under the proposed rule, released by the Centers for Medicare & Medicaid Services online July 12 and scheduled for publication July 27 in the Federal Register.

“We are streamlining the system of office E&M codes and reducing the requirements for documentation,” CMS Administrator Seema Verma said during a July 12 press conference.

The proposal would condense all four levels of E&M coding to one level, with one payment – there would no longer be higher payments provided for high levels.

While the change could reduce payments to specialists who generally bill only at the highest level for E&M visits, that difference should be made up in the additional time physicians should have to see patients, according to a fact sheet on the proposed physician fee schedule.

“We estimate that this proposal would save approximately 51 hours of clinic time per clinician per year,” Ms. Verma said, or an additional 500 years of time available for patient care across the system.

The proposed schedule also would expand the list of services that qualify for telemedicine payments and would add payments for virtual check-ins via phone or other communication technologies such as Skype, paying clinicians for time spent reviewing patient photos submitted via text or e-mail.

More time savings could come from proposed reductions to the documentation required to qualify for bonus payments under the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program.

CMS proposes to remove 34 process measures that are considered to be low-value or low-priority, Ms. Verma said, noting that most physicians are doing these measures but seeing no meaningful difference in the performance that would differentiate payment under the program.

The proposed update continues on with the MyHealthEData initiative by supporting greater patient access to their individual health records. Ms. Verma said that the agency will “reward providers that offer interoperability and provide patients access to their health information.”

While the proposal would not change most of the thresholds for participating MIPS – physicians still would be exempted if they bill Medicare $90,000 or less annually and see 200 or fewer Medicare patients – they also would be exempted if they perform 200 or fewer services under Medicare fee schedule. However, the agency is proposing for the first time to allow physicians to opt-in to the MIPS program if they are prepared to meet the program’s requirements, according to a fact sheet on the proposed changes to QPP.

CMS also is proposing changes to how it pays for new drugs administered in the physician office under Medicare Part B. The proposal would reduce reimbursement for drugs that have not yet been on the market long enough to establish an average sales price from wholesale acquisition cost (WAC) plus 6% to WAC plus 3%, potentially saving money for both patients and Medicare.

The agency also asked for information related to price transparency as part of the proposal. It is looking for perspectives on whether providers and suppliers can and should be required to provide charge and payments information, for health care services and out-of-pocket costs, as well as what data elements would be most useful to consumers to promote price shopping.

Comments on the proposed rule will be accepted at www.regulations.gov until Sept. 10.
 

[email protected]

Doctors could spend less time with their EHRs under Medicare’s proposed physician fee schedule for 2019.

The sweeping proposal also would improve Medicare telemedicine opportunities and update portions of the Quality Payment Program and the Medicare Shared Savings Program, according to documents posted online July 12. There would also be more opportunities to be paid for telemedicine services under the proposed rule, released by the Centers for Medicare & Medicaid Services online July 12 and scheduled for publication July 27 in the Federal Register.

“We are streamlining the system of office E&M codes and reducing the requirements for documentation,” CMS Administrator Seema Verma said during a July 12 press conference.

The proposal would condense all four levels of E&M coding to one level, with one payment – there would no longer be higher payments provided for high levels.

While the change could reduce payments to specialists who generally bill only at the highest level for E&M visits, that difference should be made up in the additional time physicians should have to see patients, according to a fact sheet on the proposed physician fee schedule.

“We estimate that this proposal would save approximately 51 hours of clinic time per clinician per year,” Ms. Verma said, or an additional 500 years of time available for patient care across the system.

The proposed schedule also would expand the list of services that qualify for telemedicine payments and would add payments for virtual check-ins via phone or other communication technologies such as Skype, paying clinicians for time spent reviewing patient photos submitted via text or e-mail.

More time savings could come from proposed reductions to the documentation required to qualify for bonus payments under the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program.

CMS proposes to remove 34 process measures that are considered to be low-value or low-priority, Ms. Verma said, noting that most physicians are doing these measures but seeing no meaningful difference in the performance that would differentiate payment under the program.

The proposed update continues on with the MyHealthEData initiative by supporting greater patient access to their individual health records. Ms. Verma said that the agency will “reward providers that offer interoperability and provide patients access to their health information.”

While the proposal would not change most of the thresholds for participating MIPS – physicians still would be exempted if they bill Medicare $90,000 or less annually and see 200 or fewer Medicare patients – they also would be exempted if they perform 200 or fewer services under Medicare fee schedule. However, the agency is proposing for the first time to allow physicians to opt-in to the MIPS program if they are prepared to meet the program’s requirements, according to a fact sheet on the proposed changes to QPP.

CMS also is proposing changes to how it pays for new drugs administered in the physician office under Medicare Part B. The proposal would reduce reimbursement for drugs that have not yet been on the market long enough to establish an average sales price from wholesale acquisition cost (WAC) plus 6% to WAC plus 3%, potentially saving money for both patients and Medicare.

The agency also asked for information related to price transparency as part of the proposal. It is looking for perspectives on whether providers and suppliers can and should be required to provide charge and payments information, for health care services and out-of-pocket costs, as well as what data elements would be most useful to consumers to promote price shopping.

Comments on the proposed rule will be accepted at www.regulations.gov until Sept. 10.
 

[email protected]

Doctors could spend less time with their EHRs under Medicare’s proposed physician fee schedule for 2019.

The sweeping proposal also would improve Medicare telemedicine opportunities and update portions of the Quality Payment Program and the Medicare Shared Savings Program, according to documents posted online July 12. There would also be more opportunities to be paid for telemedicine services under the proposed rule, released by the Centers for Medicare & Medicaid Services online July 12 and scheduled for publication July 27 in the Federal Register.

“We are streamlining the system of office E&M codes and reducing the requirements for documentation,” CMS Administrator Seema Verma said during a July 12 press conference.

The proposal would condense all four levels of E&M coding to one level, with one payment – there would no longer be higher payments provided for high levels.

While the change could reduce payments to specialists who generally bill only at the highest level for E&M visits, that difference should be made up in the additional time physicians should have to see patients, according to a fact sheet on the proposed physician fee schedule.

“We estimate that this proposal would save approximately 51 hours of clinic time per clinician per year,” Ms. Verma said, or an additional 500 years of time available for patient care across the system.

The proposed schedule also would expand the list of services that qualify for telemedicine payments and would add payments for virtual check-ins via phone or other communication technologies such as Skype, paying clinicians for time spent reviewing patient photos submitted via text or e-mail.

More time savings could come from proposed reductions to the documentation required to qualify for bonus payments under the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program.

CMS proposes to remove 34 process measures that are considered to be low-value or low-priority, Ms. Verma said, noting that most physicians are doing these measures but seeing no meaningful difference in the performance that would differentiate payment under the program.

The proposed update continues on with the MyHealthEData initiative by supporting greater patient access to their individual health records. Ms. Verma said that the agency will “reward providers that offer interoperability and provide patients access to their health information.”

While the proposal would not change most of the thresholds for participating MIPS – physicians still would be exempted if they bill Medicare $90,000 or less annually and see 200 or fewer Medicare patients – they also would be exempted if they perform 200 or fewer services under Medicare fee schedule. However, the agency is proposing for the first time to allow physicians to opt-in to the MIPS program if they are prepared to meet the program’s requirements, according to a fact sheet on the proposed changes to QPP.

CMS also is proposing changes to how it pays for new drugs administered in the physician office under Medicare Part B. The proposal would reduce reimbursement for drugs that have not yet been on the market long enough to establish an average sales price from wholesale acquisition cost (WAC) plus 6% to WAC plus 3%, potentially saving money for both patients and Medicare.

The agency also asked for information related to price transparency as part of the proposal. It is looking for perspectives on whether providers and suppliers can and should be required to provide charge and payments information, for health care services and out-of-pocket costs, as well as what data elements would be most useful to consumers to promote price shopping.

Comments on the proposed rule will be accepted at www.regulations.gov until Sept. 10.
 

[email protected]

AMSTERDAM – Patients with rheumatoid arthritis who underwent elective knee or hip arthroplasty had a doubled rate of hospitalization for infection when they averaged more than 10 mg/day oral prednisone during the 3 months before surgery, based on a review of about 11,000 U.S. insurance claims.

Mitchel L. Zoler/MDedge News

“Limiting glucocorticoid exposure before surgery should be a focus of perioperative management,” Michael D. George, MD, said at the European Congress of Rheumatology. “Glucocorticoid use, especially greater than 10 mg/day, is associated with a greater risk of infection and hospital readmission,” said Dr. George, a rheumatologist at the University of Pennsylvania in Philadelphia.

The analysis also showed that treatment with any biologic drug – including abatacept (Orencia), rituximab (Rituxan), tocilizumab (Actemra), and any of several tumor necrosis factor (TNF) inhibitors – had a similar impact on both postsurgical infections requiring hospitalization and 30-day hospital readmissions.

The findings suggest “it’s more important to reduce glucocorticoids than biological drugs,” commented John D. Isaacs, MD, professor of clinical rheumatology at Newcastle University in Newcastle upon Tyne, England. “This is a really important question that has been very difficult to answer.”

Mitchel L. Zoler/MDedge News

Dr. George and his associates used data from patients with rheumatoid arthritis during 2006-2015 who underwent knee or hip arthroplasty and were in databases from Medicare, or MarketScan, which includes commercial insurers. This identified 11,021 RA patients on any of several biologic drugs before their surgery: 16% on abatacept, 4% on rituximab, 4% on tocilizumab, and the remaining 76% on a TNF inhibitor, either adalimumab (Humira), etanercept (Enbrel), or infliximab (Remicade). About 43% of all patients were on a glucocorticoid during the 3 months before surgery. Biologic use was defined as a minimum of one dose within 8 weeks of surgery, and at least three total dosages during the prior year, except for rituximab, which was at least one dose given 16 weeks before surgery and at least two doses during the prior year.

The rate of hospitalized infections ranged from 6.6% to 8.5% depending on the biologic drug used, and 30-day readmissions ranged from 4.8% to 6.8%. A third outcome the analysis assessed was prosthetic joint infection during 1-year follow-up, which was again similar across most of the biologics, except for patients on tocilizumab, who had prosthetic joint infections roughly threefold more often than the other patients. Although this was a statistically significant difference, Dr. George discounted the finding given the very small number of tocilizumab-treated patients who had these infections and said that any conclusion about tocilizumab’s effect on this outcome had to await data from more patients.

The glucocorticoid analysis divided patients into four subgroups: those not on a glucocorticoid, those on an average daily dosage of 5 mg/day prednisone or equivalent or less, patients on 6-10 mg/day prednisone, and those on more than 10 mg/day. In a propensity-weighted analysis, these three escalating levels of glucocorticoid use showed a dose-response relationship to the rates of both hospitalized infections and 30-day readmissions. At the highest level of glucocorticoid use, hospitalized infections occurred twice as often as in patients not on a glucocorticoid, and 30-day readmissions were more than 50% higher than in those not on an oral steroid, both statistically significant differences. For the outcome of 1-year prosthetic joint infections, the analysis again showed a dose-related link among glucocorticoid users, topping out with a greater than 50% increased rate among those on the highest glucocorticoid dosages when compared with nonusers, but this difference was not statistically significant.

The study was partially funded by Bristol-Myers Squibb, the company that markets abatacept. Dr. George has received research funding from Bristol-Myers Squibb, and some of his coauthors on the study are employees of the company.

[email protected]

SOURCE: George MD et al. EULAR 2018. Abstract OP0228.

AMSTERDAM – Patients with rheumatoid arthritis who underwent elective knee or hip arthroplasty had a doubled rate of hospitalization for infection when they averaged more than 10 mg/day oral prednisone during the 3 months before surgery, based on a review of about 11,000 U.S. insurance claims.

Mitchel L. Zoler/MDedge News

“Limiting glucocorticoid exposure before surgery should be a focus of perioperative management,” Michael D. George, MD, said at the European Congress of Rheumatology. “Glucocorticoid use, especially greater than 10 mg/day, is associated with a greater risk of infection and hospital readmission,” said Dr. George, a rheumatologist at the University of Pennsylvania in Philadelphia.

The analysis also showed that treatment with any biologic drug – including abatacept (Orencia), rituximab (Rituxan), tocilizumab (Actemra), and any of several tumor necrosis factor (TNF) inhibitors – had a similar impact on both postsurgical infections requiring hospitalization and 30-day hospital readmissions.

The findings suggest “it’s more important to reduce glucocorticoids than biological drugs,” commented John D. Isaacs, MD, professor of clinical rheumatology at Newcastle University in Newcastle upon Tyne, England. “This is a really important question that has been very difficult to answer.”

Mitchel L. Zoler/MDedge News

Dr. George and his associates used data from patients with rheumatoid arthritis during 2006-2015 who underwent knee or hip arthroplasty and were in databases from Medicare, or MarketScan, which includes commercial insurers. This identified 11,021 RA patients on any of several biologic drugs before their surgery: 16% on abatacept, 4% on rituximab, 4% on tocilizumab, and the remaining 76% on a TNF inhibitor, either adalimumab (Humira), etanercept (Enbrel), or infliximab (Remicade). About 43% of all patients were on a glucocorticoid during the 3 months before surgery. Biologic use was defined as a minimum of one dose within 8 weeks of surgery, and at least three total dosages during the prior year, except for rituximab, which was at least one dose given 16 weeks before surgery and at least two doses during the prior year.

The rate of hospitalized infections ranged from 6.6% to 8.5% depending on the biologic drug used, and 30-day readmissions ranged from 4.8% to 6.8%. A third outcome the analysis assessed was prosthetic joint infection during 1-year follow-up, which was again similar across most of the biologics, except for patients on tocilizumab, who had prosthetic joint infections roughly threefold more often than the other patients. Although this was a statistically significant difference, Dr. George discounted the finding given the very small number of tocilizumab-treated patients who had these infections and said that any conclusion about tocilizumab’s effect on this outcome had to await data from more patients.

The glucocorticoid analysis divided patients into four subgroups: those not on a glucocorticoid, those on an average daily dosage of 5 mg/day prednisone or equivalent or less, patients on 6-10 mg/day prednisone, and those on more than 10 mg/day. In a propensity-weighted analysis, these three escalating levels of glucocorticoid use showed a dose-response relationship to the rates of both hospitalized infections and 30-day readmissions. At the highest level of glucocorticoid use, hospitalized infections occurred twice as often as in patients not on a glucocorticoid, and 30-day readmissions were more than 50% higher than in those not on an oral steroid, both statistically significant differences. For the outcome of 1-year prosthetic joint infections, the analysis again showed a dose-related link among glucocorticoid users, topping out with a greater than 50% increased rate among those on the highest glucocorticoid dosages when compared with nonusers, but this difference was not statistically significant.

The study was partially funded by Bristol-Myers Squibb, the company that markets abatacept. Dr. George has received research funding from Bristol-Myers Squibb, and some of his coauthors on the study are employees of the company.

[email protected]

SOURCE: George MD et al. EULAR 2018. Abstract OP0228.

AMSTERDAM – Patients with rheumatoid arthritis who underwent elective knee or hip arthroplasty had a doubled rate of hospitalization for infection when they averaged more than 10 mg/day oral prednisone during the 3 months before surgery, based on a review of about 11,000 U.S. insurance claims.

Mitchel L. Zoler/MDedge News

“Limiting glucocorticoid exposure before surgery should be a focus of perioperative management,” Michael D. George, MD, said at the European Congress of Rheumatology. “Glucocorticoid use, especially greater than 10 mg/day, is associated with a greater risk of infection and hospital readmission,” said Dr. George, a rheumatologist at the University of Pennsylvania in Philadelphia.

The analysis also showed that treatment with any biologic drug – including abatacept (Orencia), rituximab (Rituxan), tocilizumab (Actemra), and any of several tumor necrosis factor (TNF) inhibitors – had a similar impact on both postsurgical infections requiring hospitalization and 30-day hospital readmissions.

The findings suggest “it’s more important to reduce glucocorticoids than biological drugs,” commented John D. Isaacs, MD, professor of clinical rheumatology at Newcastle University in Newcastle upon Tyne, England. “This is a really important question that has been very difficult to answer.”

Mitchel L. Zoler/MDedge News

Dr. George and his associates used data from patients with rheumatoid arthritis during 2006-2015 who underwent knee or hip arthroplasty and were in databases from Medicare, or MarketScan, which includes commercial insurers. This identified 11,021 RA patients on any of several biologic drugs before their surgery: 16% on abatacept, 4% on rituximab, 4% on tocilizumab, and the remaining 76% on a TNF inhibitor, either adalimumab (Humira), etanercept (Enbrel), or infliximab (Remicade). About 43% of all patients were on a glucocorticoid during the 3 months before surgery. Biologic use was defined as a minimum of one dose within 8 weeks of surgery, and at least three total dosages during the prior year, except for rituximab, which was at least one dose given 16 weeks before surgery and at least two doses during the prior year.

The rate of hospitalized infections ranged from 6.6% to 8.5% depending on the biologic drug used, and 30-day readmissions ranged from 4.8% to 6.8%. A third outcome the analysis assessed was prosthetic joint infection during 1-year follow-up, which was again similar across most of the biologics, except for patients on tocilizumab, who had prosthetic joint infections roughly threefold more often than the other patients. Although this was a statistically significant difference, Dr. George discounted the finding given the very small number of tocilizumab-treated patients who had these infections and said that any conclusion about tocilizumab’s effect on this outcome had to await data from more patients.

The glucocorticoid analysis divided patients into four subgroups: those not on a glucocorticoid, those on an average daily dosage of 5 mg/day prednisone or equivalent or less, patients on 6-10 mg/day prednisone, and those on more than 10 mg/day. In a propensity-weighted analysis, these three escalating levels of glucocorticoid use showed a dose-response relationship to the rates of both hospitalized infections and 30-day readmissions. At the highest level of glucocorticoid use, hospitalized infections occurred twice as often as in patients not on a glucocorticoid, and 30-day readmissions were more than 50% higher than in those not on an oral steroid, both statistically significant differences. For the outcome of 1-year prosthetic joint infections, the analysis again showed a dose-related link among glucocorticoid users, topping out with a greater than 50% increased rate among those on the highest glucocorticoid dosages when compared with nonusers, but this difference was not statistically significant.

The study was partially funded by Bristol-Myers Squibb, the company that markets abatacept. Dr. George has received research funding from Bristol-Myers Squibb, and some of his coauthors on the study are employees of the company.

[email protected]

SOURCE: George MD et al. EULAR 2018. Abstract OP0228.

Previous rulings by President Trump’s Supreme Court nominee could provide insight into the fate of the Affordable Care Act should Judge Brett M. Kavanaugh be confirmed.

In 2011, Judge Kavanaugh wrote a dissenting opinion on Seven-Sky v. Holder, noting that the ACA’s individual mandate was in fact a tax and that the court could not hear questions about the law’s constitutionality because the tax had not been levied.

That dissenting opinion could become germane in the currently debated Texas v. Azar, which looks destined to reach the high court.

In Texas v. Azar, the Department of Justice has refused to defend the ACA and is siding with Texas and 19 other states. Texas and 19 other states in the case contend that the penalty for not carrying health insurance under the individual mandate is a tax; however, since the penalty was reduced to zero by the Tax Cuts and Jobs Act of 2017, the plaintiffs argue that the individual mandate is unconstitutional. They further contend that the ACA provisions of guaranteed issue and community rating are inseverable and should be eliminated as well.

If confirmed, Judge Kavanaugh’s views that the penalty for the individual mandate is in fact a tax could shift the Supreme Court’s majority view, further putting the law in jeopardy.

Judge Kavanaugh currently serves on the U.S. Court of Appeals for the District of Columbia Circuit, he was appointed by President George W. Bush and has held the position since May 30, 2006. He previously served as White House staff secretary for nearly 3 years.

As an attorney, he had a lead role in drafting the Starr Report, which recommended impeachment of President Bill Clinton.

Judge Kavanaugh will face a contentious confirmation process. In addition to health care, abortion rights will be front and center to the debate as moderate Republican senators who are proponents of abortion rights may not support his nomination. The GOP currently holds a slim 51-49 majority in the Senate, but with the medical absence of Sen. John McCain (R-Ariz.), the majority party may only have 50 members present to vote, meaning only one GOP vote against Judge Kavanaugh could deny his confirmation.

Judge Kavanaugh does not have a stated position on Roe v. Wade; however, his dissenting opinion in Garza v. Hargan questioned whether the government should be involved in provisioning abortions for undocumented immigrant minors.

That opinion is a reason Physicians for Reproductive Health have come out against Judge Kavanaugh’s nomination.

“The Trump administration has already enacted numerous policies restricting access to vital reproductive health services, including contraception, abortion, and maternity care, and will continue to chip away at health care access,” Willie Parker, MD, board chair of Physicians for Reproductive Health, said in a statement. “This nominee will harm not only abortion rights, but will imperil other fundamental rights as well.”

Senate Majority Leader Mitch McConnell said in a statement that Judge Kavanaugh “understands that, in the United States of America, judges are not unelected super-legislators whom we select for their personal views or policy preferences. A judge’s duty is to interpret the plain meaning of our laws and our Constitution according to how they are written. Judges need to be unbiased. They need to treat all parties fairly. They need to approach every case with open ears and an open mind. Judges’ decisions must turn on the facts of each case and be based on the texts that it is their job to interpret. By all accounts, Judge Kavanaugh is precisely that sort of judge.”

[email protected]

Previous rulings by President Trump’s Supreme Court nominee could provide insight into the fate of the Affordable Care Act should Judge Brett M. Kavanaugh be confirmed.

In 2011, Judge Kavanaugh wrote a dissenting opinion on Seven-Sky v. Holder, noting that the ACA’s individual mandate was in fact a tax and that the court could not hear questions about the law’s constitutionality because the tax had not been levied.

That dissenting opinion could become germane in the currently debated Texas v. Azar, which looks destined to reach the high court.

In Texas v. Azar, the Department of Justice has refused to defend the ACA and is siding with Texas and 19 other states. Texas and 19 other states in the case contend that the penalty for not carrying health insurance under the individual mandate is a tax; however, since the penalty was reduced to zero by the Tax Cuts and Jobs Act of 2017, the plaintiffs argue that the individual mandate is unconstitutional. They further contend that the ACA provisions of guaranteed issue and community rating are inseverable and should be eliminated as well.

If confirmed, Judge Kavanaugh’s views that the penalty for the individual mandate is in fact a tax could shift the Supreme Court’s majority view, further putting the law in jeopardy.

Judge Kavanaugh currently serves on the U.S. Court of Appeals for the District of Columbia Circuit, he was appointed by President George W. Bush and has held the position since May 30, 2006. He previously served as White House staff secretary for nearly 3 years.

As an attorney, he had a lead role in drafting the Starr Report, which recommended impeachment of President Bill Clinton.

Judge Kavanaugh will face a contentious confirmation process. In addition to health care, abortion rights will be front and center to the debate as moderate Republican senators who are proponents of abortion rights may not support his nomination. The GOP currently holds a slim 51-49 majority in the Senate, but with the medical absence of Sen. John McCain (R-Ariz.), the majority party may only have 50 members present to vote, meaning only one GOP vote against Judge Kavanaugh could deny his confirmation.

Judge Kavanaugh does not have a stated position on Roe v. Wade; however, his dissenting opinion in Garza v. Hargan questioned whether the government should be involved in provisioning abortions for undocumented immigrant minors.

That opinion is a reason Physicians for Reproductive Health have come out against Judge Kavanaugh’s nomination.

“The Trump administration has already enacted numerous policies restricting access to vital reproductive health services, including contraception, abortion, and maternity care, and will continue to chip away at health care access,” Willie Parker, MD, board chair of Physicians for Reproductive Health, said in a statement. “This nominee will harm not only abortion rights, but will imperil other fundamental rights as well.”

Senate Majority Leader Mitch McConnell said in a statement that Judge Kavanaugh “understands that, in the United States of America, judges are not unelected super-legislators whom we select for their personal views or policy preferences. A judge’s duty is to interpret the plain meaning of our laws and our Constitution according to how they are written. Judges need to be unbiased. They need to treat all parties fairly. They need to approach every case with open ears and an open mind. Judges’ decisions must turn on the facts of each case and be based on the texts that it is their job to interpret. By all accounts, Judge Kavanaugh is precisely that sort of judge.”

[email protected]

Previous rulings by President Trump’s Supreme Court nominee could provide insight into the fate of the Affordable Care Act should Judge Brett M. Kavanaugh be confirmed.

In 2011, Judge Kavanaugh wrote a dissenting opinion on Seven-Sky v. Holder, noting that the ACA’s individual mandate was in fact a tax and that the court could not hear questions about the law’s constitutionality because the tax had not been levied.

That dissenting opinion could become germane in the currently debated Texas v. Azar, which looks destined to reach the high court.

In Texas v. Azar, the Department of Justice has refused to defend the ACA and is siding with Texas and 19 other states. Texas and 19 other states in the case contend that the penalty for not carrying health insurance under the individual mandate is a tax; however, since the penalty was reduced to zero by the Tax Cuts and Jobs Act of 2017, the plaintiffs argue that the individual mandate is unconstitutional. They further contend that the ACA provisions of guaranteed issue and community rating are inseverable and should be eliminated as well.

If confirmed, Judge Kavanaugh’s views that the penalty for the individual mandate is in fact a tax could shift the Supreme Court’s majority view, further putting the law in jeopardy.

Judge Kavanaugh currently serves on the U.S. Court of Appeals for the District of Columbia Circuit, he was appointed by President George W. Bush and has held the position since May 30, 2006. He previously served as White House staff secretary for nearly 3 years.

As an attorney, he had a lead role in drafting the Starr Report, which recommended impeachment of President Bill Clinton.

Judge Kavanaugh will face a contentious confirmation process. In addition to health care, abortion rights will be front and center to the debate as moderate Republican senators who are proponents of abortion rights may not support his nomination. The GOP currently holds a slim 51-49 majority in the Senate, but with the medical absence of Sen. John McCain (R-Ariz.), the majority party may only have 50 members present to vote, meaning only one GOP vote against Judge Kavanaugh could deny his confirmation.

Judge Kavanaugh does not have a stated position on Roe v. Wade; however, his dissenting opinion in Garza v. Hargan questioned whether the government should be involved in provisioning abortions for undocumented immigrant minors.

That opinion is a reason Physicians for Reproductive Health have come out against Judge Kavanaugh’s nomination.

“The Trump administration has already enacted numerous policies restricting access to vital reproductive health services, including contraception, abortion, and maternity care, and will continue to chip away at health care access,” Willie Parker, MD, board chair of Physicians for Reproductive Health, said in a statement. “This nominee will harm not only abortion rights, but will imperil other fundamental rights as well.”

Senate Majority Leader Mitch McConnell said in a statement that Judge Kavanaugh “understands that, in the United States of America, judges are not unelected super-legislators whom we select for their personal views or policy preferences. A judge’s duty is to interpret the plain meaning of our laws and our Constitution according to how they are written. Judges need to be unbiased. They need to treat all parties fairly. They need to approach every case with open ears and an open mind. Judges’ decisions must turn on the facts of each case and be based on the texts that it is their job to interpret. By all accounts, Judge Kavanaugh is precisely that sort of judge.”

[email protected]

The Centers for Medicare & Medicaid Services announced July 7 that it will no longer make adjustment payments to insurers until litigation regarding them is resolved, further destabilizing the individual and small group markets created by the Affordable Care Act.

The risk adjustment payment uses statewide average premiums to draw money from health insurance plans within a state that have low levels of high-need patients and funnels that money to plans in that state with high amounts of high-need patients, as a way to minimize adverse selection and to spread risk.

The government was set to make a budget neutral payment of $10.4 billion for the 2017 plan year. But in a rare Saturday announcement, the agency said July 7 that the reason for putting the risk adjustment payments on hold was differing legal opinions on the validity of the payments.

designer491/Thinkstock

[email protected]

The Centers for Medicare & Medicaid Services announced July 7 that it will no longer make adjustment payments to insurers until litigation regarding them is resolved, further destabilizing the individual and small group markets created by the Affordable Care Act.

The risk adjustment payment uses statewide average premiums to draw money from health insurance plans within a state that have low levels of high-need patients and funnels that money to plans in that state with high amounts of high-need patients, as a way to minimize adverse selection and to spread risk.

The government was set to make a budget neutral payment of $10.4 billion for the 2017 plan year. But in a rare Saturday announcement, the agency said July 7 that the reason for putting the risk adjustment payments on hold was differing legal opinions on the validity of the payments.

designer491/Thinkstock

[email protected]

The Centers for Medicare & Medicaid Services announced July 7 that it will no longer make adjustment payments to insurers until litigation regarding them is resolved, further destabilizing the individual and small group markets created by the Affordable Care Act.

The risk adjustment payment uses statewide average premiums to draw money from health insurance plans within a state that have low levels of high-need patients and funnels that money to plans in that state with high amounts of high-need patients, as a way to minimize adverse selection and to spread risk.

The government was set to make a budget neutral payment of $10.4 billion for the 2017 plan year. But in a rare Saturday announcement, the agency said July 7 that the reason for putting the risk adjustment payments on hold was differing legal opinions on the validity of the payments.

designer491/Thinkstock

[email protected]

Connecticut is the latest state to enact a so-called drug price transparency law that imposes reporting requirements on drug makers, health insurers, and pharmacy benefit managers (PBMs).

The new requirements, signed into law by Connecticut Governor Dannel Malloy (D) on May 31, call on drug manufacturers to provide information about significant drug cost increases, including the factors that triggered the price hike and information about the drug’s development costs and capital expenditures. As part of the law, PBMs must report the volume of formulary rebates received from drug makers, including the portion provided to health insurers.

Connecticut’s law is the first to require that health insurers submit data about the most frequently prescribed and highest-cost drugs, as well as information about the impact of drug costs on the plan and its members.

Connecticut Comptroller Kevin Lembo called the law “groundbreaking” and said enactment of the measure is a victory for patients who pay outrageous prices while corporations are “enriched by big discounts.

Connecticut is the latest state to enact a so-called drug price transparency law that imposes reporting requirements on drug makers, health insurers, and pharmacy benefit managers (PBMs).

The new requirements, signed into law by Connecticut Governor Dannel Malloy (D) on May 31, call on drug manufacturers to provide information about significant drug cost increases, including the factors that triggered the price hike and information about the drug’s development costs and capital expenditures. As part of the law, PBMs must report the volume of formulary rebates received from drug makers, including the portion provided to health insurers.

Connecticut’s law is the first to require that health insurers submit data about the most frequently prescribed and highest-cost drugs, as well as information about the impact of drug costs on the plan and its members.

Connecticut Comptroller Kevin Lembo called the law “groundbreaking” and said enactment of the measure is a victory for patients who pay outrageous prices while corporations are “enriched by big discounts.

Connecticut is the latest state to enact a so-called drug price transparency law that imposes reporting requirements on drug makers, health insurers, and pharmacy benefit managers (PBMs).

The new requirements, signed into law by Connecticut Governor Dannel Malloy (D) on May 31, call on drug manufacturers to provide information about significant drug cost increases, including the factors that triggered the price hike and information about the drug’s development costs and capital expenditures. As part of the law, PBMs must report the volume of formulary rebates received from drug makers, including the portion provided to health insurers.

Connecticut’s law is the first to require that health insurers submit data about the most frequently prescribed and highest-cost drugs, as well as information about the impact of drug costs on the plan and its members.

Connecticut Comptroller Kevin Lembo called the law “groundbreaking” and said enactment of the measure is a victory for patients who pay outrageous prices while corporations are “enriched by big discounts.