Genetic testing is seemingly everywhere today. No longer are discussions of tumor profiling, gene panels, genomics and proteomics confined to the scientific realm. Major news outlets cover new advances in genetic testing, as well as some of the hidden risks associated with their exponential growth in the consumer market (See our blog Evidence Shines a Light on the Hidden Dangers of Genetic Testing). Technical innovations, such as next-generation sequencing, have accelerated the development of such tests. Consequently, there is increasing demand on you as both physicians and payers to provide your patients and clients with the best possible test solutions. But how do you decide? There are three essential criteria to consider when making your determinations regarding genetic testing.
There’s no disputing that the current state of healthcare is in flux. Regardless of public opinion and political leanings about the topic, the manner in which clinicians and health systems deliver care is changing, and more disruption to long-accepted paradigms is on the horizon. Though the move away from fee-for-service medicine has been in existence for some time, the adoption of an evidence-based approach in the provider market has been uneven at best. Perhaps now more than ever, a refocusing is required on just what evidence-based medicine (EBM) is, and why the application of the scientific method to healthcare delivery is essential to achieving the crucial Triple Aim.
Last week, the Journal of the American Medical Association (JAMA) released a report about research performed at the University Of Pittsburgh School Of Medicine and the VA Pittsburgh Healthcare System. The findings revealed that sepsis, a potentially fatal condition triggered by an infection in the bloodstream, has a greater readmission rate (12.2%) than all four of the medical conditions currently tracked by the Centers for Medicare & Medicaid Services (CMS). Those conditions are:
As part of the Patient Protection and Affordable Care Act (ACA), the Hospital-Acquired Condition Reduction Program (HACRP) was established to incentivize hospitals to reduce the number of HAC’s per year (Source:www.cms.gov). HAC’s differ slightly from hospital-acquired infections (HAI’s) although both designations fall under the regulations set forth by the HACRP.
- HAI’s: infections patients may contract while under treatment in a healthcare facility (urinary tract infections, sepsis, etc).
- HAC’s: any other situation or condition that may occur (including medication errors, pressure sores, falls).
As 2016 draws to a close, we here are keeping our eyes fixed on the future for you. Increasingly healthcare-savvy patients want their providers to be up to date on the latest health technology advances, no matter what their stage in the FDA approval process. And while both patients and physicians may want these new drugs, procedures, or devices, payers may be equally unaware of the safety, efficacy, or patient appropriateness of the technologies they’re being asked to cover, particularly when they’re new to market and the peer-reviewed, published evidence is scarce.
With respect to health technologies, the cornerstone of any coverage policy determination requires an understanding of the following:
Does the technology work?
Is it safe?
For whom does it work?
This week, the Centers for Medicare & Medicaid Services (CMS) issued a proposed Decision Memorandum regarding coverage for leadless pacemakers. If approved, it will provide conditional coverage for leadless pacemakers only if they are used in an approved clinical study as determined by the Coverage with Evidence Development (CED) program.
by Jill Shuman, MS, ELS, Managing Editor, News Service
According to a study published in the January 2012 issue of Health Affairs, the United States could improve clinical outcomes and save money by adopting the use of more disease registries. Disease registries are online databases that incorporate clinical information on a specific condition from many different physicians and patient populations.
Comparative effectiveness research (CER) has received much attention ever since the Affordable Care Act set a goal of achieving patient-centered, cost-effective care. Comparing healthcare technologies to determine which ones result in improved patient outcomes is not a new concept. However, in light of the requirement that hospitals and healthcare systems provide high-quality patient care in a cost-effective manner, providers will need to better examine the scientific evidence before making spending decisions for healthcare technologies such as medical devices, physician preference items, medical equipment, and drugs.