Coming Soon: ProPublica’s Surgeon Scorecard

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Millions of patients a year undergo common elective operations – things like knee and hip replacements or gall bladder removals. But there’s almost no information available about the quality of surgeons who do them. ProPublica analyzed 2.3 million Medicare operations and identified 67,000 patients who suffered serious complications as a result: infections, uncontrollable bleeding, even death. Next week, we report the complication rates of 17,000 surgeons – so patients can make an informed choice. Sign up for our investigations email to be alerted when we publish our Surgeon Scorecard findings.


This information comes from the CMS data files available to anyone who knows how to access and utilize them.  ...

The report illumiates the drastic difference in complication rates of individual surgeons  The rate is unique for each surgeon, not hospital dependent.

Since the Propublica announcement regarding rates of surgical complications, Dr. Jen Gunter takes one case that proves how erroneous a statistic can be, as well as misleading.

Backlink to new article   POSTED BY DR. JEN GUNTER ⋅ JULY 12, 2015 ⋅

Dr. Gunter uses a personal case about her mother.  Readers can read the entire story at the backlink.

In summary she points out how some surgeons inherit or are referred other surgeon's (A) complications. Statistically the complication may show up on Surgeon B record. .  Statistics can be very misleading.  The devil is in the details

AMA and MAG to host EHR Town Hall on July 20 - gmlevinmd@gmail.com - Gmail

AMA and MAG to host EHR Town Hall on July 20 

On July 20 from 7 p.m. to 8:30 p.m. (EDT), the AMA and the Medical Association of Georgia (MAG) will be hosting a town hall meeting in Atlanta to discuss electronic health records (EHR), featuring Rep. Tom Price, MD (GA-6), and AMA President Steven J. Stack, MD. This event is being held for physicians who have concerns about EHRs with Stage 3 Meaningful Use regulations potentially looming just around the corner. Physicians across the country will be able to watch live online and join the conversation on Twitter. Meaningful Use is not working, but bureaucrats in Washington, D.C., still want to move forward with Stage 3 implementation. That could mean less time with patients, less practice innovation and costly penalties if physicians do not comply. Currently, physician participation in Meaningful Use Stage 2 sits at less than 10 percent, compared to 80 percent adoption of EHRs. Please join the AMA and MAG for a conversation with Rep. Price as well as national and local physician leaders about EHRs, the potential consequences of Meaningful Use Stage 3 and what you can do to stop it. This event will be streamed live online – please register today!

A 'Very Cruel' Medicare Rule - Golden Geezers Golden Geezers

Patients and providers are both caught up in Medicare's Catch 22 rules.  There are many, too many for 'whistle-blowers' and legislators to fix. Fix one and another pops up.



Here is one example of multiple conundrums.  What ever happened to 'Precision Medicine" and "Patient-Centered Care" ?  This is really all about money, and the aphorisms and politically correct mantras are a camoflage for what is embedded in the health system.  The only other similar situations is government contracting for Defense and  other agencies.  It costs more to file for a grant and accomlish the followup paperwork than to build a product.  Example: Federal Health Insurance Exchanges.



Now, on to Medicare Catch 22 rules and Skilled Nursing Facilities



It’s bad enough to be hospitalized. But thousands of seniors across the country are finding their medical problems compounded with financial frustration and large bills because of a Medicare technicality that can cost them dearly.

The problem starts when their doctors want them to go to a skilled nursing facility as an interim, rehabilitative step between the hospital and home. That’s fairly typical when a patient needs to regain strength but no longer requires hospitalization.

But if the hospital has not classified the patient properly for Medicare billing purposes, then Medicare, the government health insurer for seniors, refuses to pay the skilled-nursing bill. Even a short stay costs the patient thousands of dollars.

For Marilyn “Micki” Gilbert, 83, an assisted-living resident at Menorah Park in Beachwood, the bills came to $17,000 after more than four weeks of skilled nursing care. Following a hospital stay of several nights last August after she fell and was hospitalized “with a head broken open and sutures,” as she put it, she expected Medicare to cover her rehabilitative care.

But Medicare administrators refused. The problem was that when the hospital sent the bill to the Centers for Medicare and Medicaid Services, or CMS, for payment, it said that Gilbert was in the hospital for “observation” rather than admitted in the “inpatient” category.

That difference, which is many cases is a technicality, means the difference of thousands of dollars for every patient affected.

The hospital prefers to bill for observation the first 24 hours since Medicare will pay more than if the patient is 'admitted'.  In fact hospitals have developed an intermediary 'holding area' near an emergency room where a patient will stay  for 24 hours while a determination is made.  It is not about the diagnosis or  treatment...it's about the dollars lost to the hospital if the patient is directly admitted. And this is an issue over which  doctors have no say. The hospital does the facility billing.

The problem is a result of Medicare rules that only authorize follow-up, skilled nursing care after a patient has had inpatient hospital care for at least three consecutive days. Even splitting that classification – say, as one day for observation and two for inpatient care – will not satisfy the three-day inpatient requirement, regardless of the fact that the patient stayed and was treated in a hospital the whole time.

The inspector general for the U.S. Department of Health and Human Services said that in 2012, Medicare beneficiaries had more than 600,000 hospital stays that lasted three or more nights but did not qualify for skilled-nursing facility payment. In a small share of those cases, 4 percent, Medicare mistakenly paid for skilled nursing care anyway, costing $225 million. (sic)

The distinction – observation versus inpatient — has financial consequences for hospitals as well. That may be part of the problem, say several members of Congress as well as authorities from such organizations as the American Health Care Association and Center for Medicare Advocacy. Hospitals have their own financial reasons for classifying some multi-day stays as observational.

One is that hospitals with billing mistakes can be subjected to intense CMS audits with deep financial consequences. Since 2010, CMS has used outside contractors to aggressively review admission records and seek repayment for improper admissions, according the office of U.S. Sen. Sherrod Brown, an Ohio Democrat who has repeatedly expressed displeasure for the way seniors are winding up with large medical bills.

For healthcare providers, it may be safer for many to simply classify a hospitalization as observational. That usually means they’ll get less money in reimbursement than if they coded the bill with inpatient fees, and the patients may get stuck with more out-of-pocket costs for care and prescription drugs. But for hospitals, it is better than getting hit with an audit and facing claw-back demands from CMS, health professionals say.

Hospitals may also do this to avoid Medicare penalties they can face if they have an excessive number of in-patient re-admissions within 30 days of discharge.

Part of the Affordable Care Act, the Readmissions Reduction Program started in October 2012 and was supposed to result in better care the first time a patient is admitted. Excessive re-admissions now can cost a hospital money, and many hospitals are reporting that their readmission rates are, in fact falling.

But one way to get around the risk of readmission penalties may be to avoid as much as possible the inpatient classification.

Among those pushing to change these Catch-22 rules are Brown, the senator from Ohio, and Reps. Marcia Fudge of Warrensville

Gilbert, the 83-year-old woman in Beachwood, summed it up during a telephone interview in more impassioned terms. She described calling CMS, to no avail, and asking a lawyer what she could do.

“Everybody said there was nothing they could do. It’s the law,” she said.

“It’s bad enough as you start getting older. My husband passed away about two years ago, and I can’t tell you the loss I felt.” She and Leonard had been married for 64 years.

Then she fell and was hospitalized. And “no one knew how to help.”

CMS may have its reasons. Micki Gilbert can only surmise them.

“I think it’s very cruel,” she said

A 'Very Cruel' Medicare Rule - Golden Geezers Golden Geezers

Modern Doctors’ House Calls: Skype Chat and Fast Diagnosis - The New York Times

The same forces that have made instant messaging and video calls part of daily life for many Americans are now shaking up basic medical care. Health systems and insurers are rushing to offer video consultations for routine ailments, convinced they will save money and relieve pressure on overextended primary care systems in cities and rural areas alike. And more people like Ms. DeVisser, fluent in Skype and FaceTime and eager for cheaper, more convenient medical care, are trying them out.

But telemedicine is facing pushback from some more traditional corners of the medical world. Medicare, which often sets the precedent for other insurers, strictly limits reimbursement for telemedicine services out of concern that expanding coverage would increase, not reduce, costs. Some doctors assert that hands-on exams are more effective and warn that the potential for misdiagnoses via video is great.

Legislatures and medical boards in some states are listening carefully to such criticisms, and a few, led by Texas, are trying to slow the rapid growth of virtual medicine. But many more states are embracing the new world of virtual house calls, largely by updating rules to allow doctor-patient relationships to be established and medications to be prescribed via video. Health systems, facing stiff competition from urgent care centers, retail clinics and start-up companies that offer video consultations through apps for smartphones and tablets, are increasingly offering the service as well.

In Philadelphia, Jefferson University Hospitals now lets patients have video follow-up visits with internists, urologists, and ear, nose and throat specialists. Mount Sinai Health System in New York is starting to offer video visits for primary care patients. Mercy, a health system based in St. Louis, will soon open a $54 million virtual care center to house a number of telemedicine programs, including urgent and primary care video consultations for chronically ill and other high-risk patients who need frequent assessments and advice.

Advocates say virtual visits for basic care could reduce costs over the long term. It is cheaper to operate telemedicine services than brick-and-mortar offices, allowing companies to charge as little as $40 or $50 for consultations — less than for visits to emergency rooms, urgent care centers and doctors’ offices. They also say that by letting people talk to a doctor whenever they need to, from home or work, virtual visits make for more satisfied and potentially healthier patients than traditional appointments that are available only at certain times.

Modern Doctors’ House Calls: Skype Chat and Fast Diagnosis - The New York Times



Several Case Examples.

Hope Sickmeier, 51, a fourth-grade teacher in Ashland, Mo., used her Anthem insurance for a virtual urgent care visit one Saturday night, three days into a toothache that kept getting worse. A week earlier, she had gone to the emergency room with a migraine and owed a $200 co-payment.

This time she grabbed her iPad, downloaded the app for the visits and scanned a list of available doctors, choosing one with “a trustworthy face.”

When the doctor appeared on her screen, she told him her symptoms and, holding her iPad close to her face, showed him her painful tooth and the swelling in her jaw.

“I was in so much pain, I didn’t care that it was weird,” Ms. Sickmeier said. “He got right to the point, which was what I wanted. He prescribed antibiotics and called them into an all-night pharmacy about 20 minutes away.”

Hope Sickmeier, 51, a fourth-grade teacher in Ashland, Mo., used her Anthem insurance for a virtual urgent care visit one Saturday night, three days into a toothache that kept getting worse. A week earlier, she had gone to the emergency room with a migraine and owed a $200 co-payment.

This time she grabbed her iPad, downloaded the app for the visits and scanned a list of available doctors, choosing one with “a trustworthy face.”

When the doctor appeared on her screen, she told him her symptoms and, holding her iPad close to her face, showed him her painful tooth and the swelling in her jaw.

“I was in so much pain, I didn’t care that it was weird,” Ms. Sickmeier said. “He got right to the point, which was what I wanted. He prescribed antibiotics and called them into an all-night pharmacy about 20 minutes away.”

One night, when her face turned puffy and painful from what she thought was a sinus infection, Jessica DeVisser briefly considered going to an urgent care clinic, but then decided to try something “kind of sci-fi.”

She sat with her laptop on her living room couch, went online and requested a virtual consultation. She typed in her symptoms and credit card number, and within half an hour, a doctor appeared on her screen via Skype. He looked her over, asked some questions and agreed she had sinusitis. In minutes, Ms. DeVisser, a stay-at-home mother, had an antibiotics prescription called in to her pharmacy.

As recently as two years ago physicians and state licensing boards were skeptical about televideo since physicians ordinarily want to see and lay hands on their patients. Some state boards such as Texas even passed legislation to prohibit such visits. This case has now gone to apellate court when physicians sued the Texas Medical Board. The case is pending. Other providers, such as those in rural states can now reach out to far flung patients.  

In Philadelphia, Jefferson University Hospitals now lets patients have video follow-up visits with internists, urologists, and ear, nose and throat specialists. Mount Sinai Health System in New York is starting to offer video visits for primary care patients. Mercy, a health system based in St. Louis, will soon open a $54 million virtual care center to house a number of telemedicine programs, including urgent and primary care video consultations for chronically ill and other high-risk patients who need frequent assessments and advice.

But telemedicine is facing pushback from some more traditional corners of the medical world. Medicare, which often sets the precedent for other insurers, strictly limits reimbursement for telemedicine services out of concern that expanding coverage would increase, not reduce, costs.  Advocates say virtual visits for basic care could reduce costs over the long term. It is cheaper to operate telemedicine services than brick-and-mortar offices, allowing companies to charge as little as $40 or $50 for consultations — less than for visits to emergency rooms, urgent care centers and doctors’ offices.

With this in mind the future is clear.  When pharmacys opened "Minute Clinics" the same attitude prevailed, and today it is accepted widely. The pharmacy's  have set a high standard using only licensed nurse practitioners. It is fast and very efficient. In fact many of these clinics used EHRs  long before private doctor offices.

The convergence of wearables, remote monitoring, telemedicine, mHealth and smartphones make bed-partners for the new era in health care.

ObamaCare's Unbalanced Risk Pools

Health insurance companies are signaling huge health insurance premium increases ahead of the 2016 open enrollment period. This is due to the droves of older and sicker consumers who signed up for coverage on the ObamaCare Exchanges, according to a report from The New York Times.

Rate increases vary by state and health plans offered. Oregon has already announced premium increases between 8 percent and nearly 38 percent for a 40-year-old on a Silver plan purchased through the federal Exchange. The Times notes that Blue Cross and Blue Shield, which dominates the market in a number of states, is seeking premium increases for its plans that "average 23 percent in Illinois, 25 percent in North Carolina, 31 percent in Oklahoma, 36 percent in Tennessee and 54 percent in Minnesota. While the initial rate shock under ObamaCare came from the mandated benefits promulgated by bureaucrats in Washington, taxes and fees, and actuarial benefit requirements, the latest round of premium increases can be partially attributed to unbalanced risk pools. The risk pools have older and sicker enrollees, who utilize their coverage more often than younger and healthier enrollees, than insurers expected. 

Typically, state insurance regulators negotiate with insurers to bring down the requested rate increases. But with ObamaCare's requirement that 80 percent of premiums paid go to the healthcare of the insured, insurers, particularly those that have seen losses due to the higher utilization of care, may not have much of a choice other than to raise premiums to keep their reserves stable. It may not be ideal for consumers, who may have to change plans and risk losing their doctor because of premium increases, but this is the new normal under ObamaCare.

Novartis attempting to convince CMS to reimburse for their new Heart Failure Drug

Novartis' new heart failure medicine LCZ696, now called Entresto(TM), approved by FDA to reduce risk of cardiovascular death and heart failure hospitalization

Press Release (pdf)

A new drug for congestive heart failure was fast-tracked by the Food and Drug Administration because it works so well. The results of Phase III Clinical trials prompted officials to give approval for marketing Entresto. 

Cardiophysiology of Congestive Heart Failure

What Is Heart Failure?

Heart failure does not mean the heart has stopped working. Rather, it means that the heart's pumping power is weaker than normal. With heart failure, blood moves through the heart and body at a slower rate, and pressure in the heart increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened. This helps to keep the blood moving, but the heart muscle walls may eventually weaken and become unable to pump as efficiently. As a result, the kidneys may respond by causing the body to retain fluid (water) and salt. If fluid builds up in the arms, legs, ankles, feet, lungs, or other organs, the body becomes congested, and congestive heart failure is the term used to describe the condition.

What Causes Heart Failure?

Heart failure is caused by many conditions that damage the heart muscle, including:

• Coronary artery disease. Coronary artery disease (CAD), a disease of the arteries that supply blood and oxygen to the heart, causes decreased blood flow to the heart muscle. If the arteries become blocked or severely narrowed, the heart becomes starved for oxygen and nutrients.
• Heart attack. A heart attack occurs when a coronary artery becomes suddenly blocked, stopping the flow of blood to the heart muscle. A heart attack damages the heart muscle, resulting in a scarred area that does not function properly.
• Cardiomyopathy. Damage to the heart muscle from causes other than artery or blood flow problems, such as from infections or alcohol or drug abuse.
• Conditions that overwork the heart. Conditions including high blood pressure, valve disease, thyroid disease, kidney disease,diabetes, or heart defects present at birth can all cause heart failure. In addition, heart failure can occur when several diseases or conditions are present at once.

What Are the Symptoms of Heart Failure?

You may not have any symptoms of heart failure, or the symptoms may be mild to severe. Symptoms can be constant or can come and go. The symptoms can include:

• Congested lungs. Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking coughor wheezing.
• Fluid and water retention. Less blood to your kidneys causes fluid and water retention, resulting in swollen ankles, legs,abdomen (called edema), andweight gain. Symptoms may cause an increased need to urinate during the night. Bloatingin your stomach may cause a loss of appetite or nausea.
• Dizziness, fatigue, andweakness. Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
• Rapid or irregular heartbeats.The heart beats faster to pump enough blood to the body. This can cause a rapid or irregular heartbeat.

What Are the Types of Heart Failure?

Systolic dysfunction (or systolic heart failure) occurs when the heart muscle doesn't contract with enough force, so there is less oxygen-rich blood that is pumped throughout the body.

Diastolic dysfunction (or diastolic heart failure) occurs when the heart contracts normally, but the ventricles do not relax properly or are stiff, and less blood enters the heart during normal filling.

A calculation done during an echocardiogram, called the ejection fraction (EF), is used to measure how well your heart pumps with each beat to help determine if systolic or diastolic dysfunction is present. Your doctor can discuss which condition you have.

How Is Heart Failure Diagnosed?

Your doctor will listen to your heart and look for signs of heart failure as well as other illnesses that may have caused your heart muscle to weaken or stiffen.

Your doctor may also order other tests to determine the cause and severity of your heart failure. These include:

• Blood tests. Blood tests are used to evaluate kidney and thyroidfunction as well as to checkcholesterol levels and the presence of anemia. Anemia is a blood condition that occurs when there is not enoughhemoglobin (the substance in red blood cells that enables the blood to transport oxygen through the body) in a person's blood.
• B-type Natriuretic Peptide (BNP) blood test. BNP is a substance secreted from the heart in response to changes inblood pressure that occur when heart failure develops or worsens. BNP blood levels increase when heart failure symptoms worsen, and decrease when the heart failure condition is stable. The BNP level in a person with heart failure -- even someone whose condition is stable -- is higher than in a person with normal heart function. BNP levels do not necessarily correlate with the severity of heart failure.
• Chest X-ray. A chest X-ray shows the size of your heart and whether there is fluid build-up around the heart and lungs.
• Echocardiogram. This test is an ultrasound which shows the heart's movement, structure, and function.
• The Ejection Fraction (EF) is used to measure how well your heart pumps with each beat to determine if systolic dysfunction or heart failure with preserved left ventricular function is present. Your doctor can discuss which condition is present in your heart.
• Electrocardiogram (EKG or ECG) . An EKG records the electrical impulses traveling through the heart.
• Cardiac catheterization. This invasive procedure helps determine whether coronary artery disease is a cause of congestive heart failure.
• Stress Test. Noninvasive stress tests provide information about the likelihood of coronary artery disease.

Is There a Treatment for Heart Failure?

There are more treatment options available for heart failure than ever before. Tight control over your medications and lifestyle, coupled with careful monitoring, are the first steps. As the condition progresses, doctors specializing in the treatment of heart failure can offer more advanced treatment options.

The goals of treating heart failureare primarily to decrease the likelihood of disease progression (thereby decreasing the risk of death and the need for hospitalization), to lessen symptoms, and to improve quality of life.

Together, you and your doctor can determine the best course of treatment for you.

Treatment can begin with simple health and wellness advice.

Stage	Definition of Stage	Usual Treatments
Stage A	People at high risk of developing heart failure (pre-heart failure), including people with: High blood pressure Diabetes Coronary artery disease Metabolic syndrome History of cardiotoxic drug therapy History of alcohol abuse History of rheumatic fever Family history of cardiomyopathy	Exercise regularly. Quit smoking. Treat high blood pressure. Treat lipid disorders. Discontinue alcohol or illegal drug use. An angiotensin converting enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor blocker (ARB) is prescribed if you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions. Beta blockers may be prescribed if you have high blood pressure or if you've had a previous heart attack.
Stage B	People diagnosed with systolic left ventricular dysfunction but who have never had symptoms of heart failure (pre-heart failure), including people with: Prior heart attack Valve disease Cardiomyopathy The diagnosis is usually made when an ejection fraction of less than 40% is found during an echocardiogram test.	Treatment methods above for Stage A apply All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) or angiotensin II receptor blocker (ARB) Beta-blockers should be prescribed for patients after a heart attack Surgery options for coronary artery repair and valve repair or replacement (as appropriate) should be discussed If appropriate, surgery options should be discussed for patients who have had a heart attack.
Stage C	Patients with known systolic heart failure and current or prior symptoms. Most common symptoms include: Shortness of breath Fatigue Reduced ability to exercise	Treatment methods above for Stage A apply All patients should take an angiotensin converting enzyme inhibitor (ACE inhibitors) and beta-blockers African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist Diuretics (water pills) and digoxin may be prescribed if symptoms persist An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies Restrict dietary sodium (salt) Monitor weight Restrict fluids (as appropriate) Drugs that worsen the condition should be discontinued As appropriate, cardiac resynchronization therapy (bi ventricular pacemaker) may be recommended An implantable cardiac defibrillator (ICD) may be recommended
Stage D	Patients with systolic heart failure and presence of advanced symptoms after receiving optimum medical care.	Treatment methods for Stages A, B & C apply Patient should be evaluated to determine if the following treatments are available options:heart transplant, ventricular assist devices, surgery options, research therapies, continuous infusion of intravenous inotropic drugs and end-of-life (palliative or hospice) care

Signs and symptoms of heart failure due to structural problems such as aortic stenosis, insufficiency, mitral valve disease may be treated surgically early on. Cardiac arrhythmia's should be corrected.



Treatment is progressive and adjusted accordingly.  Heart failure is chronic and may be progressive. It can present abruptly from an  acute coronary obstruction, or insidiously with aging.



ENTRESTO is not a first line drug and is intended for refractory CHF.  It is very expensive.

Could remote monitoring help Novartis persuade payers to reimburse for new heart drug?

“If you had a remote patient-monitoring device that the patient could use in their home together with Entresto, we could make an even more serious dent in hospitalization.”Beyond the Pill is a growing trend among pharma companies looking for ways to add more value to their medication with digital services aimed at improving medication compliance but also helping their physicians monitor their health between appointments. He added:

“We’re going to have to get smarter about services around the pill…and move into some areas that are different from just discovery of the drug… 

The addition of wearables, remote monitoring and new mHealth devices could make a major impact in reducing hospitalizations, by detecting symptoms early and identifying activities that cause CHF.

This report courtesy of WebMD.  It is not intended as any recomendation for treatment. Always consult with your physician for treatment.



Morning Read: Could remote monitoring help Novartis persuade payers to reimburse for new heart drug?MedCity News

CMS to test New Reimbursement System for Hip and Knee Replacements in the U.S. - FierceMedicalDevices

CMS to study and compare outcomes for hip and knee replacement procedures. Reimbursement amounts will be adjusted for poor outcomes.

Program expected to save $150M; will cover 25% of procedures in the country

STRYKER HIP AND KNEE REPLACEMENT IMPLANTS

The Centers for Medicare & Medicaid Services (CMS) has announced a 5-year plan to test a new system for how it reimburses hospitals for hip and knee replacement surgeries that currently cost about $7 billion a year.
The program, which was announced Thursday, will track patients post-surgery and then pay hospitals based on criteria that measures the quality of the outcomes of the procedures. An assessment will then be made and either a financial bonus will be
granted or a penalty levied.

About 25% of the surgical procedures in the U.S. will be affected, and the agency hopes to save up to $150 million under the program, Bloomberg reported. If approved, the program would begin Jan.
 "Hospitals and physicians would have an incentive to work together to deliver more effective and efficient care," Sylvia Matthews Burwell, the Secretary of Health and Human Services, said on a conference call with reporters.

Medicare shelled out about $586 billion in 2013 to cover more than 50 million elderly and disabled people in the country, the news service said. Reducing those costs has been a major goal under the Obama administration, which introduced the Affordable Care Act.

The test program will be mandatory for more than 800 U.S. hospitals covering 75 regions and should provide CMS with improved data on the effectiveness of the initiative. Stryker ($SYK), Zimmer Biomet ($ZMH) and Johnson & Johnson ($JNJ) are among the top medical device producers of artificial knees and hips.

- see the Bloomberg story

Related Articles:
Devicemakers to offer stronger guarantees on products if they fail to perform
Zimmer Biomet is born after knee implant divesture to S&N
J&J adds $420M to legal stockpile to resolve all-metal hip implant suits
Stryker agrees to pay $1.4B to settle recalled hip implant lawsuits



The exact details from CMS are not yet available.

CMS to test new reimbursement system for hip and knee replacements in the U.S. - FierceMedicalDevices