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CMS Cardiac Bundle

CMS Episode Payment Model to Bolster Hospital Cardiovascular Services

By | CMS Cardiac Bundle | No Comments

MD Labs Offers Turnkey PGx Program for Cath Lab Implementation

 

Heart disease kills 1 in 4 men and women in the United States each year, according to the National Institute of Heart, Lung, and Blood Institute (NHLBI). Additionally, coronary heart disease (CHD) is the number one killer for women. (NHLBI) (National Heart, Lung, and Blood Institute, “What Causes Heart Disease,” April 2014).

 

Risk factors, such as traits, conditions, and habits raise the risk for coronary heart disease and heart attacks in female patients. More than 75 percent of women from ages 40 to 60 have one or several risk factors for CHD.  Despite this, heart diseases can affect women all of ages with symptoms starting as early in childhood (NHLBI).

 

2017 CMS Payment Updates & Potential Savings

Under the Centers for Medicare and Medicaid Services (CMS) FY2017 hospital inpatient final rule as reported in Cath Lab Digest (Cath Lab Digest, “The FY 2017 Financial Future: How the Cath Lab Impacts the Hospital Bottom Line,” October 2016), all cardiovascular (CV) services will receive increases for inpatient payments with hospitals gaining more in reimbursements.  Adjustments will decrease based on evidence of financial productivity, documentation, coding, and adjustments under the Accountable Care Act. There will only be an increase in two-midnight policy adjustments.

 

There is mounting evidence on the cost saving opportunities to hospitals utilizing Pharmacogenetic (PGx) testing for pharmacotherapy following cardiovascular services. In concert with an interventional cardiologist, MD Labs has developed a PGx protocol for Catheter Labs that hospitals are in the process of adopting across the U.S.

 

CMS Inpatient and Outpatient Payments will Affect Hospital Budgets in 2017

 

The CMS proposed the “cardiac bundle” Episode Payment Model (EPM), directly impacting cardiovascular services. CMS recognizes the role that cardiac rehab plays in the 90-day post-discharge continuum of care, and is encouraging hospitals by providing additional payment: $25 per session for the first 11 sessions and $175 per session for each additional session, up to a total of 36 sessions.

 

This EPM will follow the Comprehensive Joint Replacement (CJR) model and will include Coronary Artery Bypass Graft (CABGs) and the Acute Myocardial Infarction (AMI) services. AMIs is one of the highest reasons for patient readmission.

This proposal will also introduce payment models that calculate the costs for Medicare inpatients plus 90 days post discharge for 98 randomly selected Metropolitan Service Areas (MSAs).

 

Since close to 50% of Cath lab procedures are paid as outpatients, CMS recommends that payments for this population must also be seriously considered. “CMS continues to aggressively shift outpatient payments to a true prospective payment system,” according to the Cath Lab Digest article.

 

EPM  Model Incentives Care

 

The EPM proposal will begin July 2017 and continue on a calendar year basis until 2021, called a Performance Year. Throughout the EPM, hospitals, providers, and suppliers will continue to bill and still collect in the fee-for-service payment systems.  After a performance year, all claims data for an episode are put together for an actual episode payment. Then, the actual episode payment will be adjusted compared with a quality adjusted target price.

 

Target prices will be created with a hospital and regional historical data. If the actual payment is less than the target price, the hospital will profit which is called the reconciliation payment. If the actual payment is more than the target price, CMS will receive reimbursement from the hospital.

 

With the proposed EPM model, the efficiency and quality of cardiovascular services is expected to improve and PGx testing will play a crucial role in determining appropriate pharmacotherapy, as bolstered by research such as  Expert Opinion on Drug Metabolism & Toxicology The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19 (July 2015) which surveyed clinical outcomes of using pharmacogenetics to guide antiplatelet therapy used for preventing ischemic events in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) and other indications. The pharmacogenetics of available antiplatelet agents – Aspirin, Clopidogrel, Prasugrel and Ticagrelor – were analyzed.

 

Sources:

Cath Lab DigestThe FY 2017 Financial Future: How the Cath Lab Impacts the Hospital Bottom Line” (October 2016).

National Heart, Lung, and Blood Institute “What Causes Heart Disease” (April 2014).

National Heart, Lung, and Blood Institute “Who Is at Risk for Heart Disease” (April 2014).

MayoClinic “Heart Disease in Women: Understand Symptoms and Risk Factors” (June 2016)

Utility of PGx Testing in Hospitals Bolstered by Research on the Pharmacogenetics (PGx) of Antiplatelet Response

By | CMS Cardiac Bundle, Provider | No Comments

MD Labs Has Turnkey PGx Program for Hospital Implementation

Target Audience: Hospital Executives; Hospital-based Cardiologists, Quality Directors and Pharmacists
 
There is mounting evidence on the cost saving opportunities of applying Pharmacogenetic (PGx) testing following percutaneous coronary intervention (PCI) and coronary stent procedures. In concert with an interventional cardiologist, MD Labs has developed a PGx protocol for Catheter Labs that U.S. hospitals are in the process of adopting. This is of particular importance given the new CMS Cardiac Bundle being introduced into hospitals.
 
The benefits of this protocol are bolstered by studies such as the one in Expert Opinion on Drug Metabolism & Toxicology “The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19” (July 2015) which surveyed clinical outcomes of using pharmacogenetics to guide antiplatelet therapy used for preventing ischemic events in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) and other indications. The pharmacogenetics of available antiplatelet agents – aspirin, clopidogrel, prasugrel and ticagrelor – were analyzed.
 

CYP2C19 Implicated in Clopidogrel Response Variability

 
The authors found abundant data in its literature meta-analysis supporting the clinical validity of CYP2C19 and clopidogrel response variability among ACS/PCI patients, stating “[t]he increased risks for reduced clopidogrel efficacy among ACS/PCI patients that carry CYP2C19 loss-of-function alleles should be considered when genotype results are available.” It was also found that “insufficient candidate genes” have thus far been implicated for prasugrel or ticagrelor.
 

The Clinical Utility of Pre-emptive PGx Testing for Plavix

 
The authors concluded by citing the need for pre-emptive PGx testing for clopidogrel (Plavix), for which they found a “clear association” with CYP2C19, explaining that pre-emptive pharmacogenetics testing would circumvent the issue of the need for rapid turnaround which is one of the frequently cited barriers to implementing CYP2C19 genetic testing for antiplatelet therapy.
 
A  pre-emptive approach – as offered by genotyping platforms such as MD Labs’ Rxight® – would integrate CYP2C19 genotype data into cath labs and the patient EMRs to alerts prescribers through clinical decision support at the point-of-care if and when clopidogrel is ordered and the patient carries an at-risk CYP2C19 genotype.
 
“Although this model has inherent challenges … pre-emptive CYP2C19 genetic testing has recently been deployed at several academic medical centers,” the authors stated. The authors called for “an ongoing effort towards the application of clinical pharmacogenetics by increasing clinician education and acceptance.”
 

CMS Cardiac Bundle Paves Way for PGx Testing for ACS Patients

 
With the coming of the CMS Cardiac Bundle program for hospitals (effective Oct 1, 2017) there is now added financial incentive to implement PGx testing as part of the standard of care for cardiac patients about to undergo antiplatelet pharmacotherapy.
 
1,200 participating hospitals in 98 metropolitan areas in the U.S. are mandated to be held financially accountable for the costs of heart attacks and bypass surgery under the CMS protocol for cardiac care.  There is therefore significant incentive to reduce costs through various measures such as integrating PGx testing into standing orders for coronary stent procedures and percutaneous coronary interventions (PCIs). For these treatments, anti-platelet pharmacotherapy is an established standard of care to reduce thrombotic risk, with Plavix (clopidogrel) as a first-line agent tested.
 

Implementing PGx in Your Hospital

 
A crucial part of MD Labs’ Rxight® turnkey program is the incorporation of PGx trained and certified pharmacists as part of the protocol to serve as expert resources for physicians and to provide consultations with the patients; pharmacist involvement in patient care has been shown to reduce hospital readmission rates.  DNA test kits are provided by MD Labs, and results are accessible via online provider and patient portals. Contact MD Labs (1-888-888-1932 or info@rxight.com) for details on the PGx protocol as applied to PCI and stent procedures, and how to integrate the Rxight® pharmacogenetics program into your cath lab.

Another Study Confirms Financial Benefit of Pharmacogenetic Testing for Patients Receiving a Stent

By | CMS Cardiac Bundle, Provider | No Comments

Contact MD Labs to Learn How You Can Implement PGx in Your Cath Lab

 
Target Audience: Hospital Executives, Hospital-based Cardiologists, Quality Directors and Pharmacists
 
Evidence continues to grow demonstrating the financial utility and cost-saving opportunity of applying Pharmacogenetic (PGx) testing following coronary stent procedures and percutaneous coronary intervention (PCI). MD Labs, working with an interventional cardiologist, has developed a PGx protocol for Catheter Labs that is being adopted by hospitals around the country. This is especially important given the new CMS Cardiac Bundle being introduced into hospitals.
 
The benefits of this protocol are reinforced by the article “Financial Analysis of CYP2C19 Genotyping in Patients Receiving Dual Antiplatelet Therapy Following Acute Coronary Syndrome and Percutaneous Coronary Intervention” published in the Journal of Managed Care and Specialty Pharmacy (Jul 2015). This study, discussed in the article, analyzed the financial impact of CYP2C19 genotyping for a set of patients with ACS who received percutaneous coronary intervention and coronary stent implantation and were treated with clopidogrel, prasugrel, or ticagrelor in a managed care setting.
 

CYP2C19 Metabolism Determines Clinical Response and Adverse Events in Plavix Users

 
Diminished CYP2C19 activity impairs clopidogrel metabolism and thereby increases risk of adverse clinical outcomes. Specifically, slow and intermediate CYP2C19 metabolizers treated with clopidogrel suffer higher cardiovascular event rates – including myocardial infarction, stent thrombosis, and stroke – than patients with normal CYP2C19 genotypes, and conversely rapid metabolizers are found to be hypo-responsive. It was concluded from the study that clopidogrel should be used as a first-line agent for all but this subset of patients.
 

Pharmacogenetics Reduces Costs by an Estimated $444K Annually, per One Thousand Patients

 
A budget impact analysis based on market share rates was conducted using overall and average cost per patient modelling based on the rate of CYP2C19 genotyping in a theoretical patient cohort. The magnitude of the financial impact from CYP2C19 genotype-guided antiplatelet therapy was emphasized, and it was expected that use of CYP2C19 genotyping would displace market share from clopidogrel to either prasugrel or ticagrelor. Total estimated annual costs of adverse clinical outcomes (e.g., MI, bleeding, stroke) and antiplatelet treatment were measured. The analysis showed an estimated annual savings of roughly $444,852 when PGx was employed in all patients in the theoretical 1,000 person cohort versus none.
 
Contact MD Labs to learn more. 1-888-888-1932 or info@Rxight.com

More Time To Prepare for the CMS Cardiac Bundle Program – Start Date Pushed to Oct 1 2017

By | CMS Cardiac Bundle, Provider | No Comments

Contact MD Labs to Learn How You Can Implement PGx in Your Cath Lab

 
Target Audience: Hospital Executives, Hospital-based Cardiologists, Quality Directors and Pharmacists
 
The CMS (Centers for Medicare & Medicaid Services) has pushed the implementation of its bundled payment initiatives for cardiac care from July 1 to Oct. 1, 2017, according to an interim final rule posted to the Federal Register “Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; Delay of Effective Date.”
 

New Start Date Gives Hospitals Additional Preparation Time

 
The three-month delay “allow[s] time for additional review, to ensure that the agency has adequate time to undertake notice and comment rulemaking to modify the policy if modifications are warranted, and to ensure that in such a case participants have a clear understanding of the governing rules and are not required to take needless compliance steps,” the interim rule stated.
 

The Utility of PGx Testing for Hospital Cost Reduction

 
Under the CMS bundled payment initiative, participating hospitals in 98 metropolitan areas in the U.S. are mandated to be held financially accountable for the costs of heart attacks and bypass surgery, and thus have incentive to reduce costs through various measures such as integrating PGx testing into standing orders for coronary stent procedures and percutaneous coronary interventions (PCIs). For these treatments, anti-platelet pharmacotherapy is an established standard of care to reduce thrombotic risk, with Plavix (clopidogrel) as a first-line agent tested.
 
Pharmacogenetic testing is shown to reduce drug-related complications and readmission rates, thus sparing added costs to hospitals and providers, as discussed in a recent report out of the University of Illinois Hospital & Health Sciences System, which demonstrated that pharmacogenetic testing reduced 90-Day ER and Hospital Readmission Rates by 68 percent.
 

Contact MD Labs for Information on the CMS Initiative and its Turnkey PGx Testing Program

 
Contact MD Labs (1-888-888-1932) or info@Rxight.com) for details on the PGx protocol as applied to PCI and stent procedures, and how to integrate its Rxight® PGx program into your hospital lab.
 
A cornerstone of MD Labs’ Rxight® program is incorporating PGx trained and certified pharmacist as part of the protocol, as pharmacist involvement in patient care is also proven to help reduce readmission rates. The Rxight® Program provides turnkey implementation and includes pharmacist training in PGx and certification to conduct PGx consultations. DNA test kits are provided by MD Labs, and results are accessible via online provider and patient portals.

PGx as Applied to ACS Protocol

PGx as Applied to ACS Protocol: Maximizing CMS Incentive Payments to Hospitals

By | CMS Cardiac Bundle, PGx in the News, Provider | No Comments

 
Anti-platelet pharmacotherapy is an established standard of care for Acute Coronary Syndrome (ACS) to reduce thrombotic risk. Incorporating pharmacogenetic testing and pharmacist engagement into the prescribing protocol allows the provider to understand the patient’s genetic phenotype to help determine whether the patient will achieve the optimal therapeutic outcome – and thus mitigate potentially serious adverse effects or sub-optimal treatment response.
 

Using PGx/ACS Protocol to Enhance Quality-Based Payments

 
The new PGx/ACS Protocol can help maximize CMS quality-based incentive payments. As discussed in Becker’s Hospital Review “How managing medications based on genetics can enhance quality-based payments” (January 17 2017), pharmacogenetic testing can reduce drug-related complications and readmission rates, thus sparing added costs to hospitals and providers.
 
A recent report out of the University of Illinois Hospital & Health Sciences System demonstrated that PGx reduced 90-Day ER and Hospital Readmission Rates by 68% leading to $2,043 savings per patient and almost $600K overall savings to UIC. This becomes even more important as the new CMS Cardiac Bundle takes effect this coming July.
 

Contact MD Labs for Information on the PGx/ACS Protocol and
its Turnkey PGx Testing Program

 
Contact MD Labs for details on the PGx/ACS Protocol and how to implement it with the Rxight® PGx program. A cornerstone of MD Labs’ Rxight® program is incorporating PGx trained and certified pharmacist as part of the protocol, as pharmacist involvement in patient care is proven to help reduce readmission rates.
 
MD Labs’ Rxight® Program provides turnkey implementation and includes pharmacist training in PGx and certification to conduct PGx consultations. Additionally, the Rxight® program is integrated within the hospital lab offerings for establishing collection procedures. DNA test kits are provided by MD Labs, and results are accessible via online provider and patient portals.
 
Assess your hospital’s cost saving opportunity by calculating the 90-day hospital readmission costs due to drug-related complications (clopidogrel and coumadin), over the last 3 years. Call MD Labs at 1-888-888-1932, or email info@Rxight.com to get started. Rxight.com

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