Two Glaucoma Implants Equally Good at 3 Years

The Ahmed glaucoma valve and the Baerveldt glaucoma implant, the 2 most commonly used glaucoma drainage implants in the United States, are equally successful in the treatment of refractory glaucoma, according to the 3-year results of the Ahmed Baerveldt Comparison (ABC) study.

The number of glaucoma drainage implants, according to Medicare database studies, has tripled in the past 20 years, with half of glaucoma specialists using one type of implant and half the other. They are being used based more on surgeon preference than on evidence-based medicine.

The study enlisted the help of 16 centers with glaucoma specialists doing implant surgery and 25 surgeons. The surgeons were asked to randomize patients to receive either the Baerveldt glaucoma implant (model 101-350) or the Ahmed glaucoma valve (model FP7). A total of 276 patients age 18-85 with refractory glaucoma and intraocular pressure (IOP) of 18mmHg or more who were planning to hav ean aqueous shunt were enrolled in the study. At 3-year follow-up, 218 patients (75%) remained in the study.

The study found that the risk for failure by any criterion was similar, however, the risk for reoperation for glaucoma was 2 times higher with the Ahmed implant. The IOP was lower in the patients receiving the Baerveldt implant at 3 years (about 1mmHg lower).

The implants are very different in terms of design. The Ahmed implant has a valve that allows early pressure control, whereas the Baerveldt implant doesn’t. If the patient needs immediate pressure control, the Ahmed implant provides that, whereas the Baerveldt doesn’t. But if you want lower pressures, the Baerveldt implant is more likely to achieve those.


Deadline for Avoiding 2013 E-Prescribing Penalty Is June 30

Physicians need to electronically transmit 10 prescriptions to the pharmacy by June 30 to avoid a Medicare penalty in 2013. The federal government is serious about digitizing healthcare, and in addition to rewarding physicians who e-prescribe for their Medicare patients, it is penalizing thsoe who are still writing on prescription pads or even computer-faxing scripts (a true electronic prescription goes from the clinician’s computer to the pharmacy’s). This year the Centers for Medicare and Medicaid Services (CMS) began to reduce Medicare reimbursement by 1% for physicians and other prescribers who failed to e-prescribe at least 10 times during the first half of 2011. This adjustment will grow to 1.5% in 2013 and 2% in 2014.

The CMS exempts physicians from the e-prescribing penalty if they qualify for 1 of several hardship exemptions, such as practicing in a rural area that lacks high-speed internet access. However, such physicians must request an exemption no later than June 30 of this year.

In addition, physicians are not subject to the 2013 penalty if they fall into various exclusion categories. Two involve the 50-plus billing codes that must be associated with an e-prescription for it to be counted toward the bonus: physicians will not incur the 2013 penalty if they do not have at least 100 claims for Medicare patients in the first half of 2012 with 1 of these required codes, or if the codes account for less than 10% fo their Medicare allowable charges during that period.


Big Regional Differences in Glaucoma Diagnosis Found

A new analysis of Medicare records finds dramatic differences across the United States in rates of new glaucoma diagnoses, suggesting the eye disease is likely being overdiagnosed in some regions and underdiagnosed in others.

Looking at all Medicare claims for a seven-year period, the team found glaucoma rates had risen slightly overall, but that people in New England or the Mid-Atlantic states had about 30% higher odds than people in the Southeast of being diagnosed with glaucoma-and some 70% higher chances of being diagnosed with suspected glaucoma. The study published in Ophthalmology reports that potentially both physicians and patients in (predominantly rural) areas are not getting the healthcare that would be obtained in a large urban setting such as the New York-Baltimore-Philadelphia area. Lower diagnosis rates in less-urbanized settings may stem from different physician styles in examining patients and detecting glaucoma or fewer eye-care visits by patients, or both.

More than 2.2 million Americans are estimated to have glaucoma, which can lead to blindness. For the new study, researchers examined a random sample of Medicare claims submitted by ophthalmologists, optometrists, and outpatient surgery centers. They looked at claims data from 2002 through 2008, across nine large geographic regions and 179 subregions. The researchers report that the overall prevalence of diagnosed glaucoma increased from 10.4% in 2002 to 11.9% by 2008, largely owing to an increase in suspected open-angle glaucoma diagnoses (from 3.2% to 4.5%). The relative prevalence of diagnosed open-angle glaucoma compared with diagnosed angle-closure glaucoma was 32 to 1. Thuse, acute glaucoma was seriously underdiagnosed.

The New York City area had the highest rates of the condition of all the 179 subregions, which indicated that physicians there were either overdiagnosing it or doing a better job of detecting it. The low rates of diagnosis in all the other areas suggest its’ the latter.

Healthcare providers need to be performing gonioscopy on a regular basis. Women are more likely than men to have the condition and rates of most forms of the condition rose until age 80, and then fell thereafter. This may indicate lack of continuity in care among the very old. Only about 50% of the beneficiaries made an office visit to an optometrist or ophthalmologist in 2008. Blacks, Hispanics and Asians were less likely than non-Hispanic whites to have an eye exam, but they also showed the highest rates of glaucoma and greater risk of developing it.

Deadline Extended for Appealing Medicare EHR Bonus

Physicians who believe they were incorrectly denied a Medicare bonus for using an electronic health record (EHR) system last year have a few more weeks to appeal their case.

The Centers for Medicare and Medicaid Services (CMS) announced that it is extending the deadline for such eligibility appeals from March 31 to April 30. In 2011, CMS began paying bonuses to physicians and other clinicians who demonstrated meaningful use of an EHR system. They can receive up to $44,000 under Medicare over 5 years or up to $64,000 under Medicaid over 6 years in the incentive program, created by the American Recovery and Reinvestment Act of 2009.

The new deadline applies only to EHR bonuses under Medicare.

ICD-10 Deadline Delayed 1 Year Under HHS Proposal

Physicians would have until October 1, 2014-an extra year-to begin using a new and expanded set of diagnostic codes, called ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision), under proposed regulations announced by the US Department of Health and Human Services (HHS).

The American Medical Association (AMA) said the switch to the more voluminous and complex set of diagnostic codes could both cost medical practices tens of thousands of dollars apiece and interfere with their adoption of electronic health records and electronic prescribing.

In 2009, the Centers for Medicare and Medicaid Services (CMS) ordered the change from the ICD-9 code set, which is now in use, to ICD-10, as part of implementing the Health Insurance Portability and Accountability Act.

Controlling Risk Factors May Reduce Risk for Cataracts

Controlling modifiable risk factors such as hyperglycemia, hypertension, and smoking may reduce the risk of developing cataracts, according to a population-based cross-sectional study published in Ophthalmology. Out of the total 5945 participants, 468 had cortical-only lens opacities, 217 had nuclear-only lens opacities, 27 had posterior subcapsular (PSC)-only opacities, and 364 had mixed-type lens opacities. Mean age for cortical lens opacities was 62.4, for nuclear lens opacities was 69.4, for PSC lens opacities was 59.1, and for mixed-lens opacities was 70.9.

Smoking was identified as a risk factor for nuclear lens opacities, but that being a former smoker was not significantly associated with this type of cataract. Diabetes and hypertension are risk factors for PSC opacities.

Cataract surgery is probably one of the most common surgical procedures that Medicare pays for. Thus, controlling hyperglycemia and diabetes, hypertension and uncontrolled blood pressure, and smoking will prevent lens opacities.