A Medical Device Daily

As the debate over healthcare reform raged last week over the expected impact of reforms on the federal deficit, the Centers for Medicare & Medicaid Services was busy compiling data for Monday's statement on how payment reform can trim costs and improve outcomes.

The Aug. 17 statement announced the results from three demonstration projects, one each for hospitals and large and small physician practices. However, CMS took the opportunity to announce the start of three more demonstrations built on the value-based purchasing (VBP) model.

CMS notes that data from the Hospital Quality Incentive Demonstration (HQID) show "continued quality improvement." According to CMS, the project, sponsored in partnership with Premier (San Diego), boosted overall quality scores by an average of 17 percentage points over four years for the 30 standardized care measures covering the five clinical areas of interest, namely heart attack, coronary artery bypass graft, heart failure, pneumonia, and replacements of hip and knee joints.

CMS states it will award $12 million in the fourth year of the program to 225 hospitals for their improvements, an annual amount roughly in line with the average for the three previous years, said to have totaled slightly more than $36 million. The program is in the final year of the second three-year leg of the demonstration, and the latest results cover 4Q08.

"We continue to be encouraged by the progress of our ongoing programs that test value based-purchasing across a variety of healthcare services," said acting CMS administrator Charlene Frizzera. She also said that CMS "will build on those efforts" with the roll-out of a VBP program for nursing homes and two gainsharing demonstrations.

According to CMS, the nursing home demonstration will key in on four specific areas, staffing, resident outcomes, avoidable hospitalizations and reductions in deficiency citations. As for the gainsharing programs, CMS will evaluate "whether gainsharing leads to improvements in quality and efficiency" while helping providers "establish effective means to govern use of inpatient resources, reduce costs, and share the rewards."

Each of the 10 large physician groups participating in the demonstration registered scored that hit benchmarks on at least 28 of the 32 measures for the third year. CMS states that two of the groups, Geisinger Clinic (Danville, Pennsylvania) and Park Nicollet Health Services (St. Louis Park, Minnesota) scored benchmark performance on all 32 measures.

CMS states that for the first three years of the demonstration, the large physician groups increased their quality scores an average of 10 percentage points on 10 diabetes measures and 11 points on 10 measures for congestive heart failure. Aggregate scores for seven measures of coronary artery disease treatment rose by an average of six points and for two cancer screening measures, scores rose by 10 points. The top five performers in this group will get more than $25 million of the more than $32 million allocated.

More than 600 small physician practices took part in the demo for their sector, and 560 of those will split a total of $7.5 million, with the average coming in at about $14,000.

Jonathan Blum, director of CMS's Center for Medicare Management said in the statement that the lessons learned will "help to achieve the administration's goals of paying for high quality and efficient healthcare in America" and that CMS "will aggressively test new demonstration concepts to continue to meet these goals."

NIH to record imaging exposures

The National Institutes of Health (NIH) made a fairly innocuous-seeming announcement Monday that might nonetheless have a significant impact on how radiology labs operate in the future.

According to an Aug. 17 announcement, NIH will henceforth record the radiation exposure of patients who undergo CT and PET tests at the NIH Clinical Center in Bethesda, Maryland. The statement indicates that equipment at the center is capable of recording those levels of exposure automatically.

John Gallin, MD, director of the center, said in the statement that the move "is an important first step in making it possible to more easily document and track information about a patient's exposure to radiation." NIH's clinical operations are no slouch where volume is concerned. According to the statement, roughly 25,000 CT and 1,250 PET/CT scans are performed each year for research protocols. The load is split up between five CT scanners, and two PET/CT scanners.

NIH is motivated in part by a recent report by the National Council on Radiation Protection and Measurements (Bethesda, Maryland) which is said to have reported recently that Americans absorbed seven times the amount of radiation during radiological exams and treatments in 2006 than 20 years earlier. Ronald Neumann, MD, chief of nuclear medicine and deputy associate director for imaging sciences at the center, said that CT and cardiac nuclear medicine studies "accounted for much of this increased medical radiation exposure."

Routine recording of radiation exposure "could become a standard element of a universal electronic medical record used to assess radiation risk from life-long medical testing," the statement notes, and Neumann is quoted in the statement as saying such tracking is "an ethical imperative."

NIH will also press industry to get on board. According to the statement, NIH "will require that newly purchased equipment allows patients to record their radiation dose exposure in their own personal health record," the statement notes.