Avalere Health Research Articles

Clinical Leadership and Innovation Help Achieve Malnutrition Quality Improvement Initiative Success

Malnutrition is a frequent, but often overlooked clinical issue that can significantly impact patient health outcomes and thus has been identified as a critical target for quality improvement. One recent advancement helping build momentum in quality improvement is the Malnutrition Quality Improvement Initiative (MQii). Frameworks like the MQii need clinical leadership to achieve success. A new taxonomy for clinical dietetics leadership describes five components of leadership behaviors—change, patient focus, self-direct, technical, and relationship—that align with the MQii tools and resources. Qualitative interviews were conducted with four clinical nutrition leaders from three health care systems or institutions who were part of the 2018-2019 MQii Learning Collaborative and had reported success and innovations using the MQii framework. The clinical dietetics leadership taxonomy was applied to describe how the clinical nutrition leaders demonstrated and supported leadership opportunities for clinical nutrition staff through implementation of the MQii. Funding/SupportPublication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.

Quality Improvement as the Foundation for Health Care Advancement

The rising cost of health care continues to be a key driver of the growing national debt. Improving the nation’s health requires a dedicated and holistic advancement of access to quality and affordable patient-centered health care, as well as a strong focus on the core elements of prevention, including nutrition. Programs must be put in place, such as the Malnutrition Quality Improvement Initiative (MQii), to identify and address the root causes of malnutrition. Registered dietitian nutritionists have an important role to lead malnutrition quality improvement efforts in their organizations to promote better patient health outcomes, keep health care costs affordable, and protect Medicare. It is a unique time where there is an opportunity to achieve meaningful change in malnutrition care, and working together to implement quality improvement programs can ensure the health and vitality of current and future generations of Americans. Funding/SupportPublication of this supplement was supported by Abbott. The Academy of Nutrition and Dietetics does not receive funding for the MQii. Avalere Health's work to support the MQii was funded by Abbott.

Bridging gaps in heart valve disease care: Opportunities for quality improvement.

In January 2018, the Society of Cardiovascular and Angiography Interventions (SCAI) and Avalere Health ("Avalere") launched the development of the Heart Valve Initiative to advance the identification and management of patients with heart valve disease. To define the priority gap areas in identification and management of valve disease, a formal environmental scan was conducted to uncover current and planned initiatives that might inform the development of the initiative and bring to light stakeholder activities that seek to address the target patient population. This document summarizes the methodology and key findings from the scan, which will inform the development of interventions, research questions, and quality measure concepts to consider. Understanding that quality improvement initiatives and evidence in cardiovascular care may evolve rapidly, this synopsis represents a snapshot of information gathered from February 2018 to May 2019.

Current Value Frameworks—What's New?

Current Value Frameworks—What's New?

Preventing Hypoglycemia in Type 2 Diabetes.

The Society and Avalere Health are working to develop and test interventions in clinical settings that will improve early identification and management of T2D patients at high risk for hypoglycemia.

Pharmacovigilance of Biologics in a Multisource Environment.

This work was funded by Sandoz, a Novartis division. The authors were fully responsible for the content, editorial decisions, and opinions expressed in this article. No author received an honorarium related to the development of this manuscript. Sagi and Cohen are employees of Sandoz, and Woollett is an employee of Avalere Health. Study concept and design were contributed by Sagi and Woollett, along with Cohen. Data were primarily collected by Sagi, along with Woollett, and data interpretation was provided by all the authors. The manuscript was written by Woollett, along with Sagi and Cohen, and revised by Sagi and Cohen, along with Woollett.

Effects of simulation-based educational program in improving the nurses' self-efficacy in caring for patients' with COPD and CHF in a post-acute care (PACU) setting

The 2014 national percentage for 30-day readmissions among Medicare recipients from Post-Acute Care Unit (PACU) showed: Heart Failure (HF) with major complications and co-morbidities, an average of 24.09%, and Chronic Obstructive Pulmonary Disease (COPD) with complications and co-morbidities 23.12%. The percentage of readmissions for New Jersey among PACU showed: HF with major complications and co-morbidities, an average of 24.40% and COPD 26.35% (Avalere Health, 2014). For this study site, the hospital readmission rate was not specifically broken down according to condition/diagnosis. Overall, the hospital readmission rate was approximately 20%. A few percent lower than the national and state average, but still a considerable number.This study is significant in finding out whether a simulation based educational program will increase the nurses' self-efficacy in caring for these patients. The positive outcome of this study can provide a template for training PACU nurses to aid in decreasing hospital readmissions in this vulnerable population. The simulation-based educational program was approximately 5h in length, and it was divided into two parts, a presentation on HF and COPD, and the actual simulation scenario, using a low-fidelity manikin (LFM). There were approximately 20 Registered nurses as participants but 4 did not complete the post-simulation self-efficacy scale, and the 16 were included in the actual study. This study was able to define the effects of simulation-based educational program on the RNs self-efficacy in caring for COPD and HF patients. The participants' demographic information, i.e. age, educational attainment, years of experience, and previous work experience, did not show any differences in how much the nurses' self-efficacy improved. The post-simulation self-efficacy score of the participants showed approximately 5% increase compared to the pre-simulation score. The outcome of the study concluded the simulation-based educational program as having a significant effect on the participants' self-efficacy post-simulation.

Learning Collaborative 2.0: Achieving Optimal Malnutrition Care

Support efforts enhancing quality malnutrition care under the Learning Collaborative 2.0 (L.C. 2.0) led by the Academy of Nutrition and Dietetics (Academy), Avalere Health and Abbott.

Prescription Drug Utilization and Reimbursement Increased Following State Medicaid Expansion in 2014.

The Affordable Care Act (ACA) expanded health care and medication insurance coverage through Medicaid expansion in select states. Expansion has the potential to increase the availability of health services to patients, including prescription medications. However, limited studies have examined how expansion affected prescription drug utilization and reimbursement. To compare prescription drug utilization (number of prescriptions filled) and reimbursement trends between states that did and did not expand Medicaid coverage in 2014, while accounting for known effects of expansion on Medicaid enrollment. We conducted a comparative interrupted time series using retrospective Medicaid state drug utilization data from 2011 to 2014. After inclusion/exclusion criteria, 8 states that expanded Medicaid in 2014 and 10 states that did not expand Medicaid were studied. Primary outcomes were changes in quarterly prescription drug utilization and quarterly total prescription drug reimbursement before and after expansion. To account for increases in enrollment in expansion states, secondary outcomes were per-member-per-quarter (PMPQ) utilization and reimbursement before and after expansion. Expansion states experienced a 1.4 million prescriptions per quarter and $163 million per quarter increase in utilization and reimbursement above the change in rates observed in nonexpansion states after expansion (P < 0.001). Specifically, 1 year after ACA implementation, expansion states used 17.0% more prescriptions and spent 36.1% more in reimbursement than the quarter preceding expansion. Expansion and nonexpansion states experienced significant drops in PMPQ prescriptions immediately after expansion (P < 0.001), but PMPQ prescriptions and reimbursement trends increased by the end of the postexpansion period in expansion states (P < 0.029 and P < 0.001, respectively). Study results suggest that Medicaid expansion offers vulnerable patients who were previously uninsured increased access to health care resources, specifically prescription drugs. Although this hypothesis would benefit from further testing, it aligns with previous studies that have shown that Medicaid expansion has led to increased access to coverage and care. While enrollment contributes to the increase in prescription utilization and reimbursement, the drop in PMPQ utilization suggests that the patients entering the program are healthier than existing patients. This shows that risk pooling is working. However, the increase in PMPQ reimbursement suggests that new enrollment may not be the only factor driving reimbursement changes. Factors such as changes in product mix, risk pool composition, and drug pricing and their effects on total and per-member reimbursement should be evaluated in future studies. No outside funding supported this study. Mahendraratnam is currently a Worldwide Health Economics and Outcomes Research Pre-doctoral Fellow at Bristol-Myers Squibb and previously provided advisory services to public and private sector clients while employed at Avalere Health, an Inovalon Company, as well as completed an internship at Genentech, a member of the Roche Group. Farley and Dusetzina have no conflicts of interest to report. Preliminary results of this study were presented at the 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 21st Annual Meeting in Washington, DC, on May 21-25, 2016, and the 2016 AcademyHealth Annual Research Meeting (ARM) in Boston, Massachusetts, on June 26-28, 2016. Study concept and design were contributed by Farley, Mahendraratnam, and Dusetzina. Mahendraratnam, Farley, and Dusetzina collected the data, and data interpretation was performed by all the authors. The manuscript was written by Mahendraratnam, Farley, and Dusetzina and revised by Farley, Dusetzina, and Mahendraratnam.

Clinical trials in the development of biosimilars: future considerations

Clinical trials in the development of biosimilars: future considerations Brenda J Huneycutt,1 Earl Gillespie,2 Gillian R Woollett,1 1FDA Regulatory Strategy and Policy, Avalere Health, LLC, Washington, DC, 2Health Advances, LLC, Weston, MA, USA Abstract: A number of biosimilars have been approved in highly regulated markets throughout the world. Biosimilar development follows its own unique path – relying primarily on analytics to compare a potential biosimilar to its reference product and giving a reduced, confirmatory role to clinical trials. In addition, the ability to extrapolate data to support approval for indications without a clinical trial gives this abbreviated pathway potential significant value. In fact, so far, all the approved biosimilars in Europe received approval for all the reference product's indications. However, this is not the case in other regions. Regulatory agencies of the highly regulated markets agree in general on many principles underlying biosimilar product development and approval, but differ in important aspects as reflected by the data burdens and approval decisions for four classes of products explored in this paper – somatropins, filgrastims, epoetins, and infliximabs. These case studies also highlight some biosimilar sponsor latitude as reflected in the varying clinical data packages submitted to the same regulatory agency for biosimilars to the same reference product. There also exists biosimilar sponsor latitude in deciding whether to use the biosimilar pathway at all or seek approval through the stand-alone biologics regulatory pathway. This, of course, is a commercial decision based on the weights each biosimilar sponsor gives to the various risks and benefits for each option, for each product, and for each market. Further, it remains an open question whether a single, biosimilar development plan for global commercialization can be used to satisfy each regulatory agency. Keywords: somatropin, filgrastim, epoetin, infliximab

As U.S. health care becomes more team-based, Avalere releases report on pharmacists’ role

The accelerating movement in the United States toward team-based care and outcomes-based reimbursement is the context for the importance of Avalere Health’s new independent report supporting the value of pharmacists’ services on the patient’s health care team. The accelerating movement in the United States toward team-based care and outcomes-based reimbursement is the context for the importance of Avalere Health’s new independent report supporting the value of pharmacists’ services on the patient’s health care team. “All the work that’s been done in pharmacy to study the outcomes, when pharmacists are integrated in teams, is beginning to pay great dividends. I was hoping this day would come, and I’m just happy it came in my lifetime,” said Brian Isetts, PhD, BCPS, FAPhA, Professor of Pharmaceutical Care & Health Systems at the University of Minnesota College of Pharmacy. Released May 21, the report, Exploring Pharmacists’ Role in a Changing Healthcare Environment, concluded that evidence around pharmacists’ impact on improving clinical and economic outcomes is growing, but that continued research may help to further inform policy makers and health care providers. The report also concluded that reimbursement policies should be aligned to increase use of pharmacists’ services to deliver the highest value health care to patients. (See page 1 of June’s Pharmacy Today for more information.) The analysis found that the most recent and relevant 171 U.S. research articles support the value of pharmacist-provided services such as medication management, medication reconciliation, preventive care services, educational and behavioral counseling, and collaborative care models between pharmacists and physicians. The increasing prominence of accountable care organizations and patient-centered medical homes will further shape new opportunities for pharmacists, according to Avalere Health. While the Avalere report does not quantify pharmacists’ impact, the report’s methodology was appropriate to explore the nature of the literature and to identify areas for future research, said Lisa M. Guirguis, BScPharm, MSc, PhD, Associate Professor on the Faculty of Pharmacy and Pharmaceutical Sciences at the University of Alberta in Edmonton, Canada, and Journal of the American Pharmacists Association Associate Editor. “This paper asserts pharmacists can make a difference in the health of patients,” Guirguis continued. “Further research is not needed to determine if pharmacists can make a difference. Instead, research is needed to determine how pharmacists can best ensure optimal drug therapy outcomes.” According to Isetts, researchers need to study how much work all members of the health care team, including pharmacists, put into helping patients achieve their goals of therapy. He explained the American Medical Association’s concept of relative value units, and suggested that “some of that original research or methodology could be applied to study the contributions of all the health care team members in terms of time and intensity towards those patient outcomes.” The Avalere Health report will be useful in discussions with policy makers by highlighting care and services pharmacists are currently providing as well as identifying opportunities to positively impact our health care system, said Stacie Maass, BSPharm, JD, APhA Senior Vice President of Government Affairs and Pharmacy Practice.MORE ONLINE■Avalere Health report:www.avalerehealth.net/expertise/life-sciences/insights/exploringpharmacists-role-in-a-changing-healthcare-environment ■Avalere Health report:www.avalerehealth.net/expertise/life-sciences/insights/exploringpharmacists-role-in-a-changing-healthcare-environment The report’s emphasis on team-based care also may have immediate implications for practicing pharmacists. “We are at a time when most clinicians are no longer questioning if a pharmacist’s expertise can help with high-risk patients,” said Marie Smith, PharmD, FNAP, Henry A. Palmer Professor in Community Pharmacy Practice and Assistant Dean of Practice and Public Policy Partnerships at the University of Connecticut School of Pharmacy. “Rather, they are asking: ‘Where can I find a qualified pharmacist to help optimize medications and achieve patient outcomes?’“ “As we move from fee-for-service to outcomes-based reimbursement, now the clinics all of a sudden have this group of attributable, or accountable, patients,” Isetts said. “And [the clinics are] looking at their lists of medications and their health care expenditures, and saying, ‘Oh my goodness, now what do I do? Hey, here’s an idea. These pharmacists down the street have a reputation here for helping our most challenging patients. Let’s talk to them.’” Isetts continued, “If you have not created a dialogue or a relationship with your clinics and other health care providers in your community, now is the time.” Avalere Health’s research was funded by APhA, American Society of Health- System Pharmacists, American Association of Colleges of Pharmacy, American Society of Consultant Pharmacists, National Association of Chain Drug Stores, and National Alliance of State Pharmacy Associations. Avalere Health, a strategic advisory company based in Washington, DC, maintained full editorial control. The report’s conclusions are those of its authors. Diana Yap, Senior Assistant Editor

Medicare Hospital Readmission Penalties Set to Rise

The penalties are going up in Medicare's hospital readmission-reduction program. Starting on Oct. 1, hospitals could face up to a 2% cut in Medicare payments if their 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia are too high. The program started on Oct. 1, 2012, with a 1% cap on penalties. The government's announcement also said that, starting Oct. 1, 2014, the program will include readmissions associated with an acute exacerbation of chronic obstructive pulmonary disease (COPD) and readmissions for elective total hip or knee arthroplasty. The inclusion of COPD for fiscal year 2015 was expected since that condition was highlighted by Congress in the Affordable Care Act (health reform), which created the readmission reduction program. However, lawmakers had also recommended adding coronary artery bypass graft surgery, percutaneous coronary intervention, and other vascular conditions, which are not included in the latest Centers for Medicare & Medicaid Services' proposal. Combined, primary total hip arthroplasty and total knee arthroplasty represent the largest procedure costs in the Medicare budget. At the same time, inpatient admissions for vascular conditions have been declining, according to Medicare officials, as those services are moving over to hospital outpatient departments. The fiscal proposal includes a revised methodology for calculating hospital readmission rates to better account for certain planned readmissions. But the new method still fails to account for socioeconomic and community factors, according to the Premier Healthcare Alliance. “Hospitals that serve high percentages of lower-income patients will be disproportionately penalized for circumstances outside their control,” Blair Childs, senior vice president of public affairs at Premier, said in a statement. The Medicare program is also moving forward on the Hospital-Acquired Condition Reduction Program, which begins on Oct. 1, 2014, and will levy a 1% penalty on hospitals that rank in the lowest-performing quartile for eight hospital-acquired conditions. During the first year, officials plan to use quality measures that are calculated using claims data or are part of the Inpatient Quality Reporting program. The eight measures are divided into two domains for the purpose of scoring hospital performance. The measures in the first domain are pressure ulcer rate, volume of foreign object left in the body, iatrogenic pneumothorax rate, postoperative physiologic and metabolic derangement rate, postoperative pulmonary embolism or deep vein thrombosis rate, and accidental puncture and laceration rate. CMS is also considering the use of a composite patient safety indicator measure set as an alternative to the first domain. The second domain includes just two health care–associated infection measures: central line–associated bloodstream infection and catheter-associated urinary tract infection. CMS plans to account for risk factors such as age, gender, and comorbidities when calculating the measure rates. There are no surprises in the conditions chosen for the new program, said Erik Johnson, senior vice president at Avalere Health. However, the fact that CMS officials chose to include eight measures at the start of the program indicates how serious they are about hospital-acquired conditions, he said. Through the combination of the hospital-acquired condition program, the readmission reduction program, value-based purchasing, and a few other programs, hospitals now have at least 7% of their Medicare payments at risk based on performance on quality measures, he said. “It's already starting to move behaviors,” Mr. Johnson said. “Hospitals are by and large making a good-faith effort to get better at all of those things. But there are going to be winners and losers, and the losers may end up losing big on a lot of this stuff.” CMS will accept public comments on the proposed rule until June 25 at www.regulations.gov. The agency is scheduled to release its final rule by Aug. 1.

Sequestration Will Hit Pay But Spare Incentives

Medicare physician pay would be cut by at least 2% in 2013 while some Affordable Care Act programs would be spared the automatic cuts called for under the Budget Control Act of 2011, according to a report from the federal Office of Management and Budget. The report provides details on how to cut $1.2 trillion from the federal budget by 2021 and was mandated after the Joint Select Committee on Deficit Reduction failed to do the same. The process – known as sequestration – would cut funding for most federal agencies across the board. The Office of Management and Budget (OMB) report noted that the estimates are preliminary; the true magnitude of the cuts won't be known until sequestration actually occurs. The Alliance for Quality Nursing Home Care immediately released an analysis by Avalere Health with more specifics on the effect of sequestration on skilled nursing facilities around the country. SNFs will face cuts totaling $782.5 million in 2013 and $9 billion over 10 years, according to the analysis. The five hardest hit states would be California, Florida, Texas, New York, and Illinois. The sequestration cuts would be on top of the $65 billion reduction in Medicare funding that SNFs face over a decade from other recent federal-budget reductions, according to the alliance. In September, AMDA joined more than 100 other medical organizations in a letter urging Congress to “work diligently during the fall to reach a bipartisan agreement to pass legislation nullifying the Medicare physician payment cuts called for under the Budget Control Act's (BCA) sequestration provision and the Sustainable Growth Rate (SGR) formula.” Separately, an AMDA statement said that the association advocates a permanent repeal of the SGR and the implementation of a 5-year period of stable Medicare physician payments that keep pace with the growth in medical-practice costs while the program transitions to new payment models (see story, page 18). “Sequestration is a blunt and indiscriminate instrument. It is not the responsible way for our nation to achieve deficit reduction,” according to the OMB report. The agency called on Congress to avoid sequestration either by passing the President's budget proposals or otherwise approving “a comprehensive and balanced deficit reduction package.” Under sequestration, there would be a 9.4% cut to defense discretionary funding, 10% to mandatory defense programs, 8.2% reduction to nondefense discretionary funding, and 7.6% to nondefense mandatory programs. Medicare – including physician and hospital payment – is slated for an $11 billion cut in 2013 alone. The 2% reduction would continue yearly through 2021. The American Hospital Association, American Medical Association, and American Nurses Association in a joint statement said that as many as 766,000 health care and related jobs could be lost by 2021 if the Medicare cuts are allowed to stand, in part because of the reduction in payments to physicians and hospitals. They also predicted a ripple effect, including reduced spending on goods and services by health care providers and organizations, as well as reduced household purchases by health care workers who lose their jobs. Dr. Jeremy A. Lazarus, president of the AMA, said, “Coupled with the looming 27% Medicare physician payment cut, this 2% sequester will hurt patient access to care and will inject more uncertainty into our Medicare system.” Other programs at the Centers for Medicare & Medicaid Services that would take a hit under sequestration: health insurance exchange grants ($66 million); state demonstration grants ($40 million); fraud and abuse ($78 million); the prevention and public health fund ($76 million); the Office of the National Coordinator for Health Information Technology ($1 million); the Office of Inspector General ($5 million); the Hospital Insurance Trust Fund ($5.6 billion). Many programs would be exempt from sequestration, however, including the Children's Health Insurance Program, Medicare and Medicaid incentive payments for participating in health IT programs, and the consumer operated and oriented plan and the pre-existing condition insurance plan, both of which were part of health care reform. Food and Drug Administration funding would be cut $319 million, and the Centers for Disease Control and Prevention would see at least a $490 million budget reduction, with $14 million of that coming out of the World Trade Center Health Program Fund. Funding for the National Institutes of Health would be cut $2.6 billion.

Commentary: Can You Replace Something With Nothing?

Commentary: Can You Replace Something With Nothing?

Barriers to clinical practice guidelines adherence in the community oncology setting.

e19687 Background: Clinical practice guidelines (CPGs) are an important information source for physicians as they integrate evidence into routine clinical care. However, the use of CPGs may vary by physician and specialty. Methods: The Association of Community Cancer Centers and Avalere Health designed a survey to identify how community oncologists use CPGs, focusing on: physicians’ perceptions of guidelines, which guidelines they follow, and barriers to guideline adherence. The online survey contained 45 items and was closed in June 2010. Results were tabulated and analyzed. Results: Thirty-six physicians from distinct practices responded. Physicians were likely to have more than 25 years experience (74%) and to treat multiple cancer types (47%). The majority worked in community hospitals (56%), cancer clinics (36%), and private practices (28%). Overall, 94% of physicians reported following CPGs, with NCCN (94%) and ASCO (69%) being preferred sources. However, physicians reported barriers to following CPGs in nearly one fifth (16%) of patient cases. Important barriers included limited time (44%) and limited access to CPGs at the point of care (39%). Common reasons physicians cited for not following guideline recommendations was that they were too rigid for a particular patient (53%) or were not appropriate in a given clinical situation (62%). Notably, the majority of physicians (94%) reported that their practices have created their own guidelines or protocols at times, with one quarter (25%) doing so regularly. Conclusions: Despite agreeing that CPGs are important for delivering high quality patient care, physicians report barriers to CPG adherence and do not consider recommendations appropriate for all patients. Furthermore, many practices are creating their own CPGs, which may undermine a fundamental reason for CPGs: increased standardization of care. Further research on individual physician and practice-level deviation from established CPGs is needed.

Economic Woes Trickle Down to Elderly, LTC

Economic Woes Trickle Down to Elderly, LTC

The balance of benefit and safety of rosiglitazone: important lessons for our system of drug development and postmarketing assessment

Pharmacoepidemiology and Drug SafetyVolume 17, Issue 8 p. 782-786 Commentary The balance of benefit and safety of rosiglitazone: important lessons for our system of drug development and postmarketing assessment† Robert M. Califf MD, Corresponding Author Robert M. Califf MD [email protected] Duke Translational Medicine Institute, Durham, NC, USAVice Chancellor for Clinical Research; Director, Duke Translational Medicine Institute, Duke University Medical Center, 2400 Pratt Street, Box 17969, Durham, NC 27715, USA.Search for more papers by this authorJudith M. Kramer MD, MS, Judith M. Kramer MD, MS Duke Translational Medicine Institute, Durham, NC, USASearch for more papers by this author Robert M. Califf MD, Corresponding Author Robert M. Califf MD [email protected] Duke Translational Medicine Institute, Durham, NC, USAVice Chancellor for Clinical Research; Director, Duke Translational Medicine Institute, Duke University Medical Center, 2400 Pratt Street, Box 17969, Durham, NC 27715, USA.Search for more papers by this authorJudith M. Kramer MD, MS, Judith M. Kramer MD, MS Duke Translational Medicine Institute, Durham, NC, USASearch for more papers by this author First published: 24 July 2008 https://doi.org/10.1002/pds.1617Citations: 5 † Dr Califf receives significant (≥$10 000) grant support from NICHD 1UL1RR024128-01. Dr Califf receives consulting income from the following: nonsignificant (<$10 000): Avalere Health, Biogen Idec, Brandeis University, Bristol Meyers-Squibb/Sanofi, Five Prime, Sanofi-Aventis, Scios Pharma, Vertex; significant: Bayer, Heart.org (Conceptis), Kowa Research Institute, Merck, Nitrox LLC, Novartis, Schering Plough. All consulting income is donated to non-profit organizations, with the majority being designated for the Duke Clinical Research Institute's clinical fellowship fund. Dr Califf receives salary support from the following: Merck, Novartis Pharmaceuticals, Schering Plough, Scios Pharma (all payments are made to Duke University). Dr Califf's educational activities result in revenue from the following for Duke University: nonsignificant: Merck, Sanofi-Aventis, Schering-Plough; significant: Heart.org/Conceptis, Kowa Research Institute, Novartis Pharmaceuticals, Scios Pharma. Dr Califf holds equity in excess of $10 000 in Nitrox LLC. Dr Kramer's salary is partially supported by a grant from Pfizer. Dr Kramer has received nonsignificant (<$10 000) consulting income from Icagen and Lilly, and receives significant (≥$10 000) consulting income from Sanofi-Pasteur. Dr Kramer is a member of the U.S. Food and Drug Administration's Drug Safety and Risk Management Advisory Committee. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume17, Issue8August 2008Pages 782-786 RelatedInformation

No Relief Yet From Medicare Physician Pay Cuts

No Relief Yet From Medicare Physician Pay Cuts

Reimbursement for Preventive Counseling Services.

The ASCO Cancer Prevention Committee (CAPC) defines cancer prevention as, “a reduction in the risk of developing clinically evident cancer, whether first or second primary cancer, or of developing intraepithelial neoplasia (IEN), a frequent cancer precursor.”1 A recent survey of ASCO members in the United States indicated that despite the significance placed on cancer prevention, the most significant barrier to integration into clinical practice is insufficient reimbursement.2 Therefore, understanding the payment environment for cancer prevention counseling services is a critical step for oncologists to integrate cancer prevention into clinical practice. To provide practical information regarding the types of cancer prevention counseling services that are covered by payers and how these services should be billed, ASCO commissioned Avalere Health, LLC, to conduct a study of Medicare and private payer reimbursement policies. The research focused on prevention scenarios that typically occur during patient encounters, including counseling for smoking cessation, breast cancer or colorectal cancer screening and chemoprevention in high-risk populations, genetics, and the prevention of secondary cancers in cancer survivors.