Medical Device Daily Washington Editor

Healthcare economists routinely argue that the U.S. healthcare tab could be trimmed dramatically without adversely affecting outcomes by stitching together a more seamless continuum of care. However, a recent report by the Agency for Healthcare Research and Quality (AHRQ) indicates that the evidence in support of transitional care for stroke and myocardial infarction does not support the notion that transitional care "consistently" improves measures such as functional recovery, quality of life or depression.

On the other hand, the report also observes that the quality of the evidence is not particularly impressive, noting that a number of the 44 studies reviewed for this analysis were "based on a solid conceptual framework . . . but had too few patients" to generate statistically valid conclusions. Two other problems cited with the studies found in the literature were that terms of follow-up were insufficient in duration, and endpoints used in the studies "were too inconsistent . . . to be able to make comparisons."

All in all, the report hints at an already-publicized opening for telemedicine that some device makers are already attempting to fill, but the demand for which is nearly certain to grow substantially as the effects of healthcare reform make themselves felt.

Healthcare providers that are working to constitute accountable care organizations are probably taking stock of this report. As the report states, provisions in the Patient Protection and Affordable Care Act of 2010 will require that penalties be applied to hospitals with excess re-hospitalization rates, and acute MI will be a target measure for improvements in 2015, although AHRQ indicates that stroke is not yet on the list of those measures.

AHRQ combed through the literature appearing between Jan. 1, 2000, and this past April 12, and came away with 62 articles out of nearly 5,800 hits. These 62 articles dealt with the aforementioned 44 studies, data from which was used to assemble a taxonomy of four types of transitional care, including transition to community care and chronic care. The other two members of this taxonomy are patient education and hospital-initiated support for discharge to home.

This last measure is said to be associated with "a reduction in hospital length of stay without adversely impacting survival, quality of life or functional disability," but follow-up with a physician specialist, a component of hospital-initiated support, "was also associated with a reduction in mortality," the report says.

The report says that the eight studies that reported risks, adverse events or harms associated with transitional care offered "insufficient evidence to determine if there were differential rates of adverse events for transition-of-care interventions or components of transition-of-care services" because the data indicated similar rates of events. However, all the underlying data, drawn from six studies, were for stroke patients, leaving the question of infarcts up in the air.

As to whether the transition of care services rendered by hospitals had any effect on coordination of care among specialists, or drew in new providers, the data were insufficient to allow any conclusions to be drawn. With the exception of disease severity, patient characteristics seemed to exert no influence on outcomes, the report says.

CMS reports round 2 of DME bidding program

The Centers for Medicare & Medicaid Services has announced it will roll out the second round of competitive bidding for durable medical equipment, a program that has stirred resentment from suppliers since the idea was broached more than a decade ago.

According to the agency's Nov. 30 statement, CMS "launched a comprehensive education program to help guide suppliers through the competitive bidding process," which was expanded by the Affordable Care Act and is expected to save more than $28 billion over a decade. CMS claims that the first phase of the program "has saved Medicare 35% compared to the fee schedule and resulted in lower cost for Medicare patients."

CMS administrator Don Berwick, MD, said in the statement, "today marks another step forward in our progress towards obtaining fair prices for equipment like wheelchairs and walkers," adding that the agency is "looking forward to a robust competition that will achieve better value and preserve access for our beneficiaries."

The statement reminds the reader that the first phase of the program involved nine product categories that were bid for in nine areas of the country starting this past Jan. 1. CMS states that its monitoring data "have shown a successful implementation with no changes in beneficiary health status." Registration for the second round will commence Dec. 5, "and the 60-day supplier bidding period will begin in late January of 2012," the statement notes.

The new entries for round 2 bidding include oxygen, oxygen equipment and supplies, as well as manual and power wheelchairs and other mobility equipment along with accessories. Also on the list are continuous positive airway pressure and respiratory assist devices (along with accessories) and negative wound pressure therapy hardware.

CMS's deputy administrator Jonathan Blum said the agency has "considered feedback from many stakeholders to implement process improvements to make the competitive bidding program even stronger," but he also noted that the agency "will be strengthening our rigorous bid evaluation process by increasing our scrutiny of bids."

Michael Reinemer, VP for communications and policy at the American Association for Homecare (AAHomecare, Arlington, Virginia) told Medical Device Daily in an e-mailed statement that the second round "does not represent any improvement in this misguided program." He said "several economists have come up with a far better method of achieving market pricing for home medical equipment and services, and we hope that market pricing program will replace Medicare's bidding system, which is larded with flaws."

Reinemer said that one of the chief problems the association sees with the program is "non-binding bids, which encourage irresponsible bidding." He said that as the program stands, it constitutes "a race to the bottom in terms of the way we care for Medicare beneficiaries who depend on home-based care and equipment."

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