CMS Introduces New Program To Supplant Meaningful Use
The Centers for Medicare and Medicaid Services (CMS) has announced that the new Advancing Care Information program will replace meaningful use as of January 2017.
As part of the new program, eligible providers will not have to meet every requirement as they do for meaningful use incentives. According to a recent Medscape report, the number of measures will be reduced from 18 to 11 under the new program and providers can obtain 50 percent credit for reporting on measures.
Jeffrey D. Lehrman, DPM, FASPS, cites the advantages of Advancing Care Information’s point system, noting that it addresses some concerns about the all or nothing criteria with meaningful use. With meaningful use, he notes an eligible provider had to meet every objective to be considered for meaningful use incentives. However, with the Advancing Care Information program, Dr. Lehrman says one can earn up to 131 points but any point total of 100 or over will earn providers the maximum score toward the Merit-Based Incentive Payment System (MIPS) point total. Dr. Lehrman, a member of the American Podiatric Medical Association Coding Committee, also notes that physicians can earn half of the Advancing Care Information point total just by reporting, even if they do not meet numerator/denominator thresholds.
Anthony Poggio, DPM, concurs that the Advancing Care Information program is advantageous in that providers will have to meet fewer standards. He also points out that there is supposed to be more flexibility to align these measures with the practice type and specialty.
The disadvantage is that eligible providers still have to take time to document data of questionable value, argues Dr. Poggio, a member of the American College of Podiatric Medical Reviewers. As many offices are small practices with small numbers of staff, he feels the new program is still very burdensome and will drive more doctors out of practice, thereby limiting patient access to doctors.
“All we seem to be doing is sending in data or getting penalized if we don’t,” says Dr. Poggio. “Can CMS prove that the data we are submitting has in fact improved patient care in some way? Are the patients of doctors who submit this data doing better than those of doctors not submitting this data?”
As Dr. Poggio says, the reality is that the more time doctors spend meeting government mandated measures, the less time they and their staff have to actually diagnose and treat patient problems as collecting and entering data into electronic health records (EHR) take time. Dr. Poggio notes one big complaint by patients is that doctors and staff always seem to be hurried and patients do not get the time they feel they deserve. By not having to document as much information, Dr. Poggio believes patients will get better care.
Dr. Lehrman notes CMS has reduced the burdensome reporting requirements by having fewer objectives, citing elimination of the two objectives of Computerized Physician Order Entry (CPOE) and clinical decision support rules. However, he says whether or not the elimination of these objectives is advantageous will depend on the individual needs of practices.
“I suspect some providers will appreciate the decreased reporting requirements while others will think this is not enough of a compromise,” says Dr. Lehrman. “Many would like to see proof that these programs are actually improving patient care and having a positive effect on our healthcare system before feeling good about participating in them.”
Father And Son DPMs Complement One Another In Practice
By Brian McCurdy, Managing Editor
When Peter Blume, DPM, became the President of the Connecticut Podiatric Medical Association in April, he was not the only one in the family to earn an honor. Dr. Blume presented his father and partner, James Blume, DPM, with a lifetime achievement award.
During the past 22 years of practicing with his father at Affiliated Foot and Ankle Surgeons in New Haven, Conn., Dr. Blume has learned the importance of caring for an entire community as his father has done for 59 years.
“The empathy that he has shown to families through multiple generations is quite unique,” says Dr. Blume of his father. “The ability to provide podiatric care generation after generation is a phenomenal experience for all of us in practice. “
Through his father’s years of experience, Dr. Blume says he has learned much about the clinical evaluation that leads to an appropriate diagnosis with minimal technologies. Although DPMs are all aware of technologies that help with the clinical dilemmas of patients with complex diseases and diagnoses, he notes there is much to glean from an individual who has practiced in a high volume setting for many years without the benefit of newer technologies.
As Dr. Blume notes, he began his career in reconstructive foot surgery with a high volume as a result of referrals from his father, who practiced mostly in an office-based setting. The senior Blume, he says, did not have the surgical training or hospital appointments that are common in today’s practice of podiatric medicine and surgery. The father and son complement each other as Dr. Blume says his dad was known as an individual who provided outstanding podiatric care in a non-surgical manner.
Dr. Blume notes his practice continues to evolve as the father and son partner with Farlyn Charlot-Hicks, DPM, a well-trained podiatric foot and ankle surgeon. He adds that the practice is well integrated into the Yale New Haven hospital system and plays a major role in the teaching program at Yale New Haven Hospital, continuing a hybrid academic and clinical practice.
Study Cites High Survival Rates Of Total Ankle Implants
By Brian McCurdy, Managing Editor
A recent study in Foot and Ankle Specialist finds a high survival rate of total ankle replacements.
The study analyzed 1,545 patients who received 1,593 total ankle arthroplasties. The authors found a 90.1 percent five-year survival rate of the implants across the study population. Over 55 percent of the patients had primary osteoarthritis, over 30 percent had posttraumatic arthritis and over 8 percent had rheumatoid arthritis. The study authors noted that patients with rheumatoid arthritis had an increased risk of implant failure and defined failure as revision, arthrodesis, amputation or implant removal.
Lawrence DiDomenico, DPM, FACFAS, finds appropriate selection of the “right patient” is the most important factor for the survival of total ankle arthroplasties. He notes many other factors for implant survival, including age, activity, weight, preexisting deformity, vascular status, skin integrity, bony anatomy and systemic diseases such as rheumatoid arthritis. Any wound issues and infections put the patient and implant at risk, notes Dr. DiDomenico, who is in private practice at Ankle and Foot Care Centers in Youngstown, Ohio.
If the candidate is too young, Dr. DiDomenico notes the ankle replacement has to last a long time and more likely than not, revisions will be required. If the patient is too old, he says the bone quality may not be good enough.
Dr. DiDomenico says an older patient who is thin and has low physical demands would be the “ideal” candidate for a total ankle arthroplasty. He notes this would be someone who wants to garden, golf and walk, and not play a lot of sports. Dr. DiDomenico says athletics are potentially detrimental to the long-term survival of total ankle arthroplasties.
In Brief
Integra LifeSciences has received approval from the Food and Drug Administration (FDA) for the packaging of its new product, Integra® Omnigraft™ Dermal Regeneration Matrix, which is indicated for use in the treatment of partial and full-thickness neuropathic diabetic foot ulcers present for more than six weeks.
DePuy Orthopaedics recently announced the acquisition of BioMedical Enterprises (BME), a leading manufacturer of nitinol orthpaedic implants for small bone fixation for bunions, hammertoes and other foot and ankle deformities. The company called BME’s technology an “excellent complement” to its orthopaedic portfolio.
