A Medical Device Daily

The Advanced Medical Technology Association (AdvaMed; Washington) has released a report that questions the methodology and findings of a survey commissioned by the Medicare Payment Advisory Commission (MedPAC) on utilization rates of magnetic resonance imaging (MRI) and computed tomography (CT) equipment. The report, prepared by United BioSource Corporation (UBC; Bethesda, Maryland), concluded that the results of the MedPAC survey “should not form the basis for evidence-based decision-making.”

AdvaMed said it is concerned the flawed information from the MedPAC survey might be used by the Centers for Medicare and Medicaid Services (CMS) to justify significantly raising their current assumptions of imaging equipment use rates, which in turn would lead to drastic reductions in Medicare payments for imaging services.

“Patient access to potentially lifesaving imaging services will be threatened if CMS bases its reimbursement decisions on the information contained in the MedPAC survey,” said Stephen Ubl, AdvaMed president/CEO. “The resulting Medicare payment reductions will not cover the costs of imaging services, which can help detect diseases earlier and often eliminate the need for more expensive and invasive exploratory surgeries.”

The UBC report details a number of key concerns with the accuracy of the findings from the survey, including:

• Lack of sufficient statistical power to represent MRI/CT utilization on a national level.

• Failure to capture a distribution of physician office and Independent Diagnostic Testing Facilities (IDTFs) that is indicative of the balance in many parts of the nation.

• The low number of responses combined with the selected geographical areas from which surveys were completed prevents statistically significant regional and national conclusions from being made.

• Focusing only on MRI and CT scans, which account for approximately 11% of all noninvasive diagnostic imagining (NDI) procedures in the U.S., would not capture the full range of imaging utilization rates for all imaging modalities.

CMS offers Internet-based services to beneficiaries.

The Centers for Medicare & Medicaid Services (CMS; Washington) reported a new project expanding its efforts to encourage Medicare beneficiaries to take advantage of Internet-based tools to track their healthcare services and provide them with other resources to better communicate with their providers.

This pilot program will enable certain beneficiaries to access and use a personal health record (PHR) provided through participating health plans. In general, a PHR is a collection of information about an individual’s health or healthcare services, such as medical conditions, hospitalizations, doctor visits and medications. The data that will be made available to the beneficiaries include registration information such as name, address, and policy number as well as lists of their medications and medical conditions.

The PHR tools will allow the beneficiary to look up information about their own medications and medical conditions to help them manage their own healthcare. The beneficiary is in charge of his or her own PHR and will control who is able to see the information it contains.

This month, CMS will launch the program in conjunction with four health plans to test the use of their PHRs. The plans are: HIP USA (New York), Humana (Louisville, Kentucky), Kaiser Permanente (Oakland, California), and the University of Pittsburgh Medical Center (Pittsburgh). Each plan has a unique PHR tool that will be accessible to beneficiaries. The availability of different tools will provide valuable information to CMS on the various features offered, including which are most popular and useful to the individual.

The pilot is expected to run for eighteen months, and during this time CMS will collect both quantitative and qualitative data to assess the use, usefulness, usability, and feature preferences of the tools.

Back surgery backed

A new study shows that for degenerative spondylolisthesis with spinal stenosis, surgery provides significantly better results than nonsurgical alternatives. The study, published in the May 31 issue of the New England Journal of Medicine, is the second in a series reporting findings of the Spine Patients Outcomes Research Trial (SPORT), a five-year, multicenter study supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases , a part of the National Institutes of Health.

Degenerative spondylolisthesis is a condition in which breakdown of the cartilage between the vertebrae of the spine causes one vertebra to slip over the one below. This can result in narrowing of the spinal column (spinal stenosis), which can put pressure on the nerves, resulting in pain in the buttocks or legs with walking or standing. The condition generally occurs after age 50 and it affects six times as many women as men.

SPORT followed 601 patients diagnosed with degenerative spondylolisthesis and symptomatic spinal stenosis. Of those, 372 received a surgery called decompressive laminectomy, which involved removing bone and soft tissue to relieve pressure on the nerves. Two years after enrollment in the trial, patients in the non-operative groups reported modest improvement in their condition; however, patients who had the surgery reported significantly reduced pain and improved function. Furthermore, for the surgery group, relief from symptoms came quickly; some reported significant improvement as early as six weeks after the procedure.