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New to Medicare: Some DNA Tests

“The CMS announced Friday that it will cover diagnostic laboratory tests using gene sequencing technology for Medicare cancer patients.

“The CMS said the tests — called next generation sequencing — can help patients and their oncologists make better treatment decisions as well as help more patients enroll in clinical trials. Patients with recurrent, metastatic, relapsed, refractory or stages III or IV cancers will be eligible to get the tests covered under Medicare, according to the agency.

“‘We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways,’ said CMS Administrator Seema Verma in a statement. ‘That is why we are establishing clear pathways to coverage, while at the same time supporting laboratories that currently furnish tests to the people we serve.’

“The CMS’ decision to cover such tests comes shortly after the FDA’s recent approval of Foundation Medicine’s genomic profiling test called FoundationOne CDx. The CMS worked with the FDA to review the effectiveness of the test.” Source: Maria Castellucci, Modern Healthcare.

Changes in Cardiac Device Coverage

CMS, the Centers for Medicare and Medicaid, has finalized its changes to its Medicare coverage of implantable cardiac devices, which should reduce the wait-times required to get the implantation procedure done and cut the regulatory burden for providers that use the devices for their patients.

This “is the first major change to Medicare’s implantable cardioverter defibrillator, or ICD, coverage in more than a decade. The CMS wants to reduce some of the barriers to care outlined in its most recent coverage determination, issued in 2005.

“The CMS is eliminating waiting periods for device implantation and dropping a policy that requires patients to be tracked in a registry.”

“It is also requiring shared decision-making, which the agency said would empower patients…

“The agency is also looking to hasten access to ICDs by allowing patients with an existing ICD who suffer a heart attack or undergo a coronary revascularization procedure to obtain a replacement device without waiting. Previously, the devices could not be implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty…

“ICDs have been used since the 1980s, and the CMS began covering them in 1986. Initially, they were mostly used in patients with recurrent cardiac arrest who were not responsive to drug treatments. In 2005, the agency finalized coverage for primary prevention of arrhythmia.

“The devices are wired to the heart and deliver an electric shock if they detect an abnormal rhythm. They are a significant revenue driver for hospitals. It’s estimated that 10,000 ICDs are implanted every month, and the average hospital stay after placement is eight days. That generates an average of $12,423 in hospitalization costs per patient.”
Source: Virgil Dickson, Modern Healthcare.

CMS: “Patients Over Paperwork”

CMS Administrator, Seema Verma,  has announced the initiative to ease the burden of records and reporting management in medical pracctices.  Nationally, medical providers and staff typically spend a disproportionate amount of time on maintaining medical records in comparison to actual patient care.

“On a typical day, primary care doctors spent about 27% of their time on “meaningful patient care” and about 49% on administrative activities, he said, according to a 2016 study published in Annals of Internal Medicine.”

The new initiative, “Patients Over Paperwork,”  seems to be set to review current regulations and eliminate those that may not be adding to quality of care, or possibly unnecessary altogether.  The coming steps to be taken have the potential, in the long run, to lower today’s healthcare costs, increase efficiency and benefit both the healthcare industry and the people in America directly.  Source:  Medpage.

Approved! Glucose Monitor: No Sticks

In what could be the a huge relief for millions in America with Type 1 or Type 2 diabetes- the FDA has approved the first glucose monitor that doesn’t require a person to stick themselves with a needle daily, or regularly, to keep an eye on their blood sugar levels.  This is a major advancement in the healthcare industry because of the potential ease of use, the lack of additional durable medical equipment like testing strips and needles.   Not to mention that this has the potential to monitor glucose over time more accurately than just taking a one-moment-in-time kind of measurement.  For more details click here.

1ST EVER: Less Than Half of Docs Own Their Practices

According to a study by the American Medical Association only 47.1% of practicing physicians had an ownership stake in their practice last year. This is the first time in American history that less than half of physicians owned their practices. Many factors were cited as reasons for the change, and among them were the market effects of payment models, information technology requirements, compliance costs, etc. Source: Modern Healthcare.

Update: Non-Profit Hospitals

A study using 2016 data has shown that charity care provided by non-profit hospitals in America equals anywhere from 0.46% to 16.69% of a hospital’s expenses.   These figures reflect uncompensated care and losses from care given to Medicaid-covered patients.  These figures do not include bad debt, or write-offs from patients who do not pay.

Among the Top 20 hospitals, by revenue, the average amount of charity care provided is 5.21% of expenses.   Source:  Modern Healthcare.

FDA: Codeine in Cough Syrup

“The FDA issued its strongest level of drug warnings Thursday concerning opioid pain-reliever use in children.

“Medicines containing codeine and another narcotic, tramadol, will now require a label indicating that they should not be used by children under 12. For children ages 12-18, and for breastfeeding mothers, the FDA said, the use of these medications should be limited.”

Source: Kate Sheridan, STAT

For more details, click here.

Pence: No Change To Medicare

Finally there is good news for about 57 million Americans, tons of insurance companies, and thousands of insurance agents nationwide!

Early this month Vice President-Elect Mike Pence made it clear that the Trump administration will not be pursuing any changes to Medicare health insurance.  This is refreshing news as America has weathered 6 years of turbulent times in the health insurance market.

When asked about renewed calls from House Speaker Paul Ryan and others to change Medicare, Mike Pence clearly stated a Medicare overhaul that others are wanting to enact- is not an option on the table.

What seems to be in the works:   Changes to Medicaid, which is a joint state-funded and federally-funded program, that would put more control of designing Medicaid in the hands of states- where it should be.

The United States is a republic of 50 states with 50 different populations and each state controlling their own options for their residents makes the most sense.  Source:  Fiscal Times.

CDC Advisory: No Live Flue Vac

The Center for Disease Control’s Advisory Committee has said the Live Attenuated influenza vaccine, (LAIV) FluMist, that is licensed for use in people ages 2-49 years old should not be used during the 2016-17 flu season.  “Their decision was based on data showing that the effectiveness of LAIV from 2013 through 2016 was poor and/or lower than expected, according to a CDC media statement.(www.cdc.gov).”

“In late May, the U.S. Influenza Vaccine Effectiveness Network released preliminary study data on the effectiveness of LAIV in children ages 2-17 during the 2015-16 influenza season that showed the estimated vaccine effectiveness (VE) against any flu virus was 3 percent (with a 95 percent confidence interval [CI] of -49 percent to 37 percent).

“This 3 percent estimate means no protective benefit could be measured,” said the media statement…

“The agency said other non-CDC studies also supported this conclusion that LAIV was far less effective than IIV (inactivated influenza vaccine) this past flu season. The ACIP followed up its overall recommendation against use of LAIV with a vote to specifically recommend that the Vaccines for Children program also should not provide LAIV this upcoming flu season.

“AAFP liaison to the ACIP Margot Savoy, M.D., M.P.H., of Wilmington, Deleware, ‘From an evidence-based medicine perspective,’ Savoy said this decision is clearly the right thing to do…In fact, Savoy said, ACIP members discussed the fact that even with needle-phobic, vaccine-hesitant patients, LAIV still could not — in good conscience — be recommended.”  Source: American Academy of Family Physicians.

Bottom Line Issued on E-Cigs, etc.

The US Surgeon General has issued a Bottom Line report on E-cigs and other tobacco forms used by America’s youth and young adults.

“In response, the AAFP joined the American Academy of Pediatrics, the American College of Physicians, the American Congress of Obstetricians and Gynecologists, and the AMA in expressing support for the report.

“‘As leading medical organizations representing, collectively, 630,000 physicians across the country, we join together today to applaud Surgeon General Vivek Murthy, M.D., M.B.A., for issuing the first comprehensive federal government review of the public health impact of e-cigarettes on youth and young adults in the United States,’ said a joint statement from the five medical organizations.

“The report found that although nicotine is a highly addictive drug at any age, youth and young adults are uniquely vulnerable to the long-term consequences of exposing the brain to nicotine, and it concluded that youth use of nicotine in any form is unsafe. The report also found that secondhand aerosol exhaled by e-cigarette users can expose others to potentially harmful chemicals.

“‘All Americans need to know that e-cigarettes are dangerous to youth and young adults,’ said Murthy in a Dec. 8 news release.(www.hhs.gov) ‘Any tobacco use, including e-cigarettes, is a health threat, particularly to young people.'”  Source:  Family Medicine Smart Brief.