Quick Hits

Physicians’ group challenges MOC

They claim recertification is a revenue-producing scheme.

The American Association of Physicians & Surgeons (AAPS) has filed an antitrust lawsuit in US District Court in New Jersey seeking to end the Maintenance of Certification (MOC) program the American Board of Medical Specialties (ABMS) and its 24 affiliated organizations, including the American Board of Ophthalmology runs.

The suit charges the ABMS program provides no benefits in patient care, keeps doctors from their patients in a time of physician shortage, leads to some doctors losing their hospital privileges for not participating in MOC, and produces significant revenues for the ABMS and its affiliated organizations that enable these organizations to pay high salaries to their executives.

The ABMS is vigorously defending its MOC program. The organization has issued a “Myths and Facts” document at www.abms.org stating that the MOC program is “anchored in evidence-based guidelines, national clinical and quality standards, and specialty best practices.”

The AAPS lawsuit, the details of which are available at www.aapsonline.org, states that “money-making schemes” that reduce access by patients to physicians are “against public policy and harmful to the timely delivery of medical care.

“There is no justification for requiring the purchase of defendant’s product as a condition of practicing medicine or being on hospital medical staffs, yet ABMS has agreed with others to cause exclusion of physicians who do not purchase or comply with Defendant’s program,” the AAPS contends in its lawsuit. AAPS adds that the ABMS “program is a moneymaking, self-enrichment scheme that reduces the supply of hospital-based physicians and decreases the time physicians have available for patients, in violation of Section 1 of the Sherman Act.”

Software can find patients lost to follow-up

Targeted recall can boost profits.

By René Luthe, Senior Associate Editor

The average practice has thousands of dollars of losses in overdue patients despite its best efforts, points out Steve Gottfredson, vice president of sales and marketing at Brevium Inc. To help practices overcome this universal problem, the company has launched software that Mr. Gottfredson likens to a “safety net to catch patients who are falling through the cracks.”

Each night, it automatically searches every patient history in a practice’s database to find lost patients in a two-step process. First, it searches ignored recalls to find those who either missed or never scheduled an appointment after the practice reached out to them. Second, the software analyzes claims data to identify patients based on their disease state: glaucoma, diabetes, AMD or other.

While offices attempt to identify and reactivate lost patients themselves, Brevium’s software offers the ability to circumvent many common problems with those do-it-yourself efforts.

“A lot of offices struggle to follow-up with lost patients on the basis of their disease state.” Mr. Gottfredson explains. “Brevium helps you target the right patient, to see the right doctor, at the right location. We recommend office staff call the patients. Our software will automatically keep your calling campaign current and track the results.”

With Brevium’s service, he says, the staff doesn’t work off an old paper list. “Just log on and the names are presented one at a time,” he says. “Your staff doesn’t have to worry that between the time the list was run and the time they are ready to call, the patient might have already called back.” The software also ensures patients who were referred by a local optometrist do not get a call.

The software does not require EMR and it interfaces with most practice management systems. Is it worth the investment? Mr. Gottfredson claims the typical office will collect 15 to 20 times more than the company’s fees over the course of a year. “Brevium offers a five-time return on investment guarantee because the software tracks the actual revenue — to the penny — that each patient generates,” he says.

“Implementing Brevium was one of the smartest decisions I ever made for the practice,” says James D. Dawes, chief administrative officer at Center For Sight in Sarasosta, Fla. “Last year, Brevium-reactivated patients added an additional $1 million of revenue to our organization. And in Brevium’s business model, you only pay for what they do — a true pay-for-performance agreement.”

Eye banks can pre-strip DMEK tissue, removing a barrier to wider adoption

A cost-effective solution for transplant surgeons.

Amajor issue that has caused many corneal transplant surgeons to hold back adopting the more advanced and effective Descemet’s membrane endothelial keratoplasty (DMEK) is their fear that in cutting the very thin, partial-thickness graft tissue they would damage the donor tissue, thus incurring both a financial loss and a cancelled case.

As a way to determine whether an eye bank could effectively pre-strip the donor tissue, eliminating this issue from a surgeon’s list of concerns, researchers from the Devers Eye Institute in Portland, Ore., led by corneal transplant pioneer Mark Terry, MD, traced the performance of 43 DMEK grafts that had been pre-stripped at a local eye bank one to two days prior to surgery. All 43 cases were performed for Fuchs’ dystrophy eyes using the Yoeruck tap technique.

Their goal was to compare the complication rates of this pre-stripped donor tissue with the published complication rates of surgeon-cut DMEK grafts.

The researchers recorded three DMEK grafts that used eye bank tissue (7%) had to be replaced for non-attachment. In addition, 17 eyes (40%) provided with eye bank tissue had to be re-bubbled, with 16 of the re-bubbled eyes quickly attaining clear corneas and good vision and the other eye placed in the replacement group. The researchers compared these numbers to previously published studies of surgeon-prepared DMEK tissue showing similar to much higher rates of non-attachment and re-bubbling.

The Devers researchers, who presented their findings at the recent ARVO meeting, noted their study was the first US report of eye bank technicians prestripping DMEK donor tissue.

They concluded that DMEK donor tissue pre-stripped by an eye bank does not increase the risk of graft failure or re-bubbling compared to surgeon-prepared tissue. They also noted that pre-stripped tissue transfers the risk of donor tissue damage and case cancellations from the surgeon to the eye bank, removing one large obstacle to the adoption by surgeons of DMEK.

Reference:

Terry MA, Straiko MD, Talajic J, Davis-Boozer D. Descemet’s Membrane Endothelial Keratoplasty (DMEK): Early results using eye bank prepared, pre-stripped donor tissue in the first 43 cases. Invest Ophthalmol Vis Sci. 2013;54:ARVO E-Abstract 3094.

B + L boosts Valeant eye-care portfolio

Canadian firm adds to Visudyne, Macugen and more.

By Jerry Helzner, Senior Editor

Valeant Pharmaceuticals has made a huge addition to its growing portfolio of ophthalmic companies with the $8.7 billion cash purchase of eye-care giant Bausch + Lomb in late May from private equity firm Warburg Pincus.

Valeant, based in suburban Montreal, has been growing quickly by acquisition in a number of specialty pharmaceutical categories. Valeant Ophthalmics now consists of the wet AMD treatments Visudyne (verteporfin) and Macugen (pegaptanib sodium), the glaucoma medication preservative-free Timoptic (timolol maleate) and the dry eye treatment Lacrisert in addition to B + L. Ophthalmologists who perform aesthetic procedures should also be familiar with another Valeant subsidiary, Medicis, which offers wrinkle-removing Dysport as a competitor to Botox (Allergan) as well as the dermal filler Restylane.

B + L was well into in the process of readying a public stock offering when it accepted the Valeant bid, having already chosen an underwriting group and adding additional independent directors. Warburg Pincus and Valeant had been talking for several months before reaching an agreement. Wall Street analysts praised the deal, viewing B + L as a “bolt-on” acquisition that could continue to operate successfully under its current management team. They also noted that Valeant could provide a worldwide distribution network that would enlarge the overall market for Bausch + Lomb products.

In other B+ L news, the company settled federal civil and criminal charges against its Ista subsidiary for approximately $34 million. The charges that Ista promoted its NSAID Xibrom (bromfenac) for unapproved indications came before B + L acquired the company in 2012. The Xibrom approval was for pain and inflammation following cataract surgery.

Ista was also accused of providing ophthalmologists with illegal “perks” such as wine tastings, golf outings and payments to induce them to prescribe Xibrom. B + L said it was aware of the complaints against Ista when it acquired the company and was eager to settle the matter.