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Knee Scope: Nope
Officials at the Centers for Medicare and Medicaid Services are instructing Medicare contractors not to pay for most knee arthroscopy for osteoarthritis. In its July decision memo, the CMS wrote that arthroscopic lavage is not reasonable or necessary for patients with the condition, and debridement shouldn't be covered in patients presenting only with knee pain or even severe osteoarthritis (Outerbridge classification III or IV). Other indications of debridement for beneficiaries with knee osteoarthritis will at the discretion of contractors. The report cited the American College of Rheumatology's position that routine arthroscopic lavage with or without debridement should not be routine for patients with knee osteoarthritis. The college told the CMS, however, that arthroscopic debris removal can be useful for pain relief and improving joint function.
FDA to Review Bisphosphonates
Two expert panels will meet Sept. 9 to advise the Food and Drug Administration on the benefits and risks of long-term treatment of osteoporosis using bisphosphonates, the FDA announced. The agency's Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee will discuss concerns that cases of osteonecrosis of the jaw and atypical femur fractures may be associated with the long-term use of the osteoporosis drugs.
Many Power Chairs Unneeded
Medicare spent about $95 million in the first 6 months of 2007 for power wheelchairs that were either not medical necessary or had no proof of being so. The figures come from an audit by the Health and Human Services' Office of Inspector General. The investigation of 375 claims for power wheelchairs found that 9% of those provided were medically unnecessary. In some cases, beneficiaries needed only less-expensive equipment, such as a scooter or manual wheelchair, while other beneficiaries should have received a different type of power wheelchair. Another 52% of the claims for power wheelchairs did not have adequate documentation to show they were medically necessary.
Medicare Moves Against Fraud
Medicare is turning to the technology of credit card companies to fight fraud. The CMS has started using “predictive modeling” technology to look for beneficiary, provider, and other patterns suggesting fraudulent billing. Alerts should prompt CMS officials to deny payment and investigate, the agency said. Meanwhile, the HHS Office of Inspector General said that it expects to recover up to $3.4 billion from fraud investigations concluded October 2010 to March 2011. The bulk of those funds, $3.2 billion, resulted from criminal investigation. About $222 million was recovered after audits of health care providers.
FDA May Change Consumer Ads
The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. The research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. In contrast, prescription drug ads use densely packed, small-type paragraphs to describe a drug's risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.
Maine Repeals Disclosure Laws
Maine's legislature has voided provisions of three laws that required prescription drugmakers to disclose marketing costs, prices, and details of clinical trials. The repealed provisions, similar to those still in effect in several other states, required drugmakers to report gifts to health care professionals and travel support valued at more than $25. The laws required manufacturers to disclose all costs of marketing drugs to Maine residents, unless those costs were part of a regional or national ad campaign, and to disclose data that could affect prices paid by the state's Medicaid program. The clinical trials disclosures covered any drug marketed in Maine.
Managers Face Challenges
Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO Dr. William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.
Knee Scope: Nope
Officials at the Centers for Medicare and Medicaid Services are instructing Medicare contractors not to pay for most knee arthroscopy for osteoarthritis. In its July decision memo, the CMS wrote that arthroscopic lavage is not reasonable or necessary for patients with the condition, and debridement shouldn't be covered in patients presenting only with knee pain or even severe osteoarthritis (Outerbridge classification III or IV). Other indications of debridement for beneficiaries with knee osteoarthritis will at the discretion of contractors. The report cited the American College of Rheumatology's position that routine arthroscopic lavage with or without debridement should not be routine for patients with knee osteoarthritis. The college told the CMS, however, that arthroscopic debris removal can be useful for pain relief and improving joint function.
FDA to Review Bisphosphonates
Two expert panels will meet Sept. 9 to advise the Food and Drug Administration on the benefits and risks of long-term treatment of osteoporosis using bisphosphonates, the FDA announced. The agency's Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee will discuss concerns that cases of osteonecrosis of the jaw and atypical femur fractures may be associated with the long-term use of the osteoporosis drugs.
Many Power Chairs Unneeded
Medicare spent about $95 million in the first 6 months of 2007 for power wheelchairs that were either not medical necessary or had no proof of being so. The figures come from an audit by the Health and Human Services' Office of Inspector General. The investigation of 375 claims for power wheelchairs found that 9% of those provided were medically unnecessary. In some cases, beneficiaries needed only less-expensive equipment, such as a scooter or manual wheelchair, while other beneficiaries should have received a different type of power wheelchair. Another 52% of the claims for power wheelchairs did not have adequate documentation to show they were medically necessary.
Medicare Moves Against Fraud
Medicare is turning to the technology of credit card companies to fight fraud. The CMS has started using “predictive modeling” technology to look for beneficiary, provider, and other patterns suggesting fraudulent billing. Alerts should prompt CMS officials to deny payment and investigate, the agency said. Meanwhile, the HHS Office of Inspector General said that it expects to recover up to $3.4 billion from fraud investigations concluded October 2010 to March 2011. The bulk of those funds, $3.2 billion, resulted from criminal investigation. About $222 million was recovered after audits of health care providers.
FDA May Change Consumer Ads
The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. The research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. In contrast, prescription drug ads use densely packed, small-type paragraphs to describe a drug's risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.
Maine Repeals Disclosure Laws
Maine's legislature has voided provisions of three laws that required prescription drugmakers to disclose marketing costs, prices, and details of clinical trials. The repealed provisions, similar to those still in effect in several other states, required drugmakers to report gifts to health care professionals and travel support valued at more than $25. The laws required manufacturers to disclose all costs of marketing drugs to Maine residents, unless those costs were part of a regional or national ad campaign, and to disclose data that could affect prices paid by the state's Medicaid program. The clinical trials disclosures covered any drug marketed in Maine.
Managers Face Challenges
Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO Dr. William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.
Knee Scope: Nope
Officials at the Centers for Medicare and Medicaid Services are instructing Medicare contractors not to pay for most knee arthroscopy for osteoarthritis. In its July decision memo, the CMS wrote that arthroscopic lavage is not reasonable or necessary for patients with the condition, and debridement shouldn't be covered in patients presenting only with knee pain or even severe osteoarthritis (Outerbridge classification III or IV). Other indications of debridement for beneficiaries with knee osteoarthritis will at the discretion of contractors. The report cited the American College of Rheumatology's position that routine arthroscopic lavage with or without debridement should not be routine for patients with knee osteoarthritis. The college told the CMS, however, that arthroscopic debris removal can be useful for pain relief and improving joint function.
FDA to Review Bisphosphonates
Two expert panels will meet Sept. 9 to advise the Food and Drug Administration on the benefits and risks of long-term treatment of osteoporosis using bisphosphonates, the FDA announced. The agency's Advisory Committee for Reproductive Health Drugs and the Drug Safety and Risk Management Advisory Committee will discuss concerns that cases of osteonecrosis of the jaw and atypical femur fractures may be associated with the long-term use of the osteoporosis drugs.
Many Power Chairs Unneeded
Medicare spent about $95 million in the first 6 months of 2007 for power wheelchairs that were either not medical necessary or had no proof of being so. The figures come from an audit by the Health and Human Services' Office of Inspector General. The investigation of 375 claims for power wheelchairs found that 9% of those provided were medically unnecessary. In some cases, beneficiaries needed only less-expensive equipment, such as a scooter or manual wheelchair, while other beneficiaries should have received a different type of power wheelchair. Another 52% of the claims for power wheelchairs did not have adequate documentation to show they were medically necessary.
Medicare Moves Against Fraud
Medicare is turning to the technology of credit card companies to fight fraud. The CMS has started using “predictive modeling” technology to look for beneficiary, provider, and other patterns suggesting fraudulent billing. Alerts should prompt CMS officials to deny payment and investigate, the agency said. Meanwhile, the HHS Office of Inspector General said that it expects to recover up to $3.4 billion from fraud investigations concluded October 2010 to March 2011. The bulk of those funds, $3.2 billion, resulted from criminal investigation. About $222 million was recovered after audits of health care providers.
FDA May Change Consumer Ads
The FDA is considering changing how it regulates direct-to-consumer drug ads to reflect results of agency studies of how patients perceive and recall ad information. The research found that people better understood the “brief summary” section of prescription drug ads that are presented in a format similar to the simpler labels on over-the-counter drugs. In contrast, prescription drug ads use densely packed, small-type paragraphs to describe a drug's risks. The studies also found that noting a serious risk or providing extra details on side effects didn't hinder consumers' understanding of overall risk information.
Maine Repeals Disclosure Laws
Maine's legislature has voided provisions of three laws that required prescription drugmakers to disclose marketing costs, prices, and details of clinical trials. The repealed provisions, similar to those still in effect in several other states, required drugmakers to report gifts to health care professionals and travel support valued at more than $25. The laws required manufacturers to disclose all costs of marketing drugs to Maine residents, unless those costs were part of a regional or national ad campaign, and to disclose data that could affect prices paid by the state's Medicaid program. The clinical trials disclosures covered any drug marketed in Maine.
Managers Face Challenges
Managers of group practices say that preparing for risk-based reimbursement and implementing electronic health records are their biggest challenges, according to a survey from the Medical Group Management Association. Dealing with rising operating costs and implementing an accountable care organization or a patient-centered medical home are also significant challenges, according to the MGMA survey. Electronic health records and other technologies are increasingly problematic, said MGMA President and CEO Dr. William Jessee. “The pressure to adopt technology and the morass our members face in determining the best systems for their practices, and then complying with the various government programs to receive incentives and avoid penalties, are proving to be of particular concern,” he said in a statement.