Does the Mammography Debate Miss a Key Point?

Every time the US Preventive Services Task Force issues a recommendation about when women should start getting mammograms – and how often they should have these screenings – it sends shockwaves through the breast-cancer world.

modiglianiThis last time was no different.

But now two influential breast cancer experts assert that – as important as the debate is – it misses an essential point about evaluating a woman’s individual risk of getting breast cancer.

Those experts – Dallas breast surgeon Dr. Peter Beitsch and Nashville breast surgeon Dr. Pat Whitworth – say the key question is how to evaluate “risk.”

The latest recommendations from the task force call for women at “average risk for breast cancer” to begin every-other-year screening at age 50. It casts doubt on the true value of screening beginning at age 40 – citing the high number of false-positive test results in women 40 to 50, plus potential harm from overdiagnosis and unnecessary treatment. Continue reading “Does the Mammography Debate Miss a Key Point?”

Cost Conundrum: How Accountable Are ACO’s?

Among the many ways the Affordable Care Act tries to drive down healthcare costs is through Accountable Care Organizations.

acoJust what are ACOs? HMOs in drag? And are they working?

Here’s how we see the ACO landscape today:

  • Although their launch has been somewhat troubled, Accountable Care Organizations are here to stay.
  • The Centers for Medicare and Medicaid Services (CMS) is driving the adoption of ACOs, with some private payers joining in.
  • Data collection and analysis hold out the promise of reducing inefficiencies.
  • ACOs don’t take on a lot of risk if they can avoid it. That in turn will affect how much money they can actually save the healthcare system.
  • In a related development, some payers – including a new industry alliance – are looking closely at the role of health insurance third-party administrators (TPAs), to see if further cost can be taken out of the system there.

What Is an ACO?

First, a bit about terminology. While ACOs undertake some responsibility for the cost of delivering care, they are not “all in,” as are HMOs. (For a good video explaining ACOs, see this from Kaiser Health News.)

Here’s how healthcare economist Austin Frakt, writing in the New York Times, explains the differences between ACOs and HMOs: Continue reading “Cost Conundrum: How Accountable Are ACO’s?”

IORT with Oncoplastic Surgery: A Beautiful Combination?

Julie Reiland SOS 2016 (1)
Julie Reiland, MD, FACS

Breast cancer care continues to see remarkable growth in knowledge of the disease and advances in treatment. That was certainly evident at the recent School of Oncoplastic Surgery (SOS), in Dallas last month.

The school, which was founded by breast surgeon Gail Lebovic, M.D. with a grant from the Mary Kay Ash Foundation, recently had its eighth annual session in Dallas. This year’s session was sponsored by the National Consortium of Breast Centers and the American Society of Breast Disease Clinical Track.

Among the highlights of that three-day training workshop was a talk by Julie Reiland, MD, FACS. An SOS faculty member, Dr. Reiland is a breast surgeon at Avera Medical Group Comprehensive Breast Care, in Sioux Falls, SD. Speaking to a packed room at SOS, Dr. Reiland talked about the convergence of oncoplastic surgery and intraoperative radiation therapy (IORT).

In particular she talked about Continue reading “IORT with Oncoplastic Surgery: A Beautiful Combination?”

Brighter Days for Ambulatory Surgery Centers with Innovative Breast Care

Ambulatory surgery centers face plenty of financial (some might even say “existential”) challenges. Among these are a tightening reimbursement environment, competition from hospital systems, and high health insurance deductibles.

Cross in OR - XL-2
Dr. Michael Cross is establishing an international reputation for innovations in breast cancer surgery.

Nonetheless, breast cancer care is emerging as a bright spot for ASCs, including two centers we talked with recently.

In a large New York City surgery center, for example, breast care helps lead the way. In an Arkansas center, transparent pricing and use of a relatively new surgical marker called BioZorb are part of the story.

First, though, let’s talk about those challenges.

“The changes in healthcare have been accelerated with passage of the 2010 Affordable Care Act, a.k.a. Obamacare, the expansion of Medicaid programs, an economy that is improving at a slower than normal rate, and stagnant increases in wages,” Laura Dyrda wrote recently in Becker’s ASC Review, “Reimbursement is in flux for many surgical specialties,” and high-deductible Continue reading “Brighter Days for Ambulatory Surgery Centers with Innovative Breast Care”

School of Oncoplastic Surgery Shows the Way to Better Breast Cancer Care

Dr. Gail Lebovic
Dr. Gail Lebovic founded the School of Oncoplastic Surgery

Among the many improvements in the care of women who have breast cancer, one of the most promising is oncoplastic surgery.

This approach combines methods to remove cancer with reconstructive techniques to insure complete tumor control. At same time it achieves better aesthetic outcomes.

This month’s upcoming School of Oncoplastic Surgery will help surgeons develop new skills they can use when performing breast-conserving surgery (lumpectomy) on patients with breast cancer. The three-day course will be held Jan. 22-24, 2016 in Dallas.

The 2016 version of the school is sponsored by the National Consortium of Breast Centers, the Senologic International Society, and the Postgraduate Institute for Medicine.

The course provides a spectrum of skills for attendees. Through a sculpture lab, anatomy lab and interaction with live models, surgeons learn essential tools with hands-on experiences. Panel discussions and case presentations also allow surgeons to openly discuss challenges they face in their practices, and to learn various ways to address complex clinical situations in cancer care.

The founder and leader of the school is Dr. Gail Lebovic. She’s a past president of the American Society of Breast Disease, recipient of several distinguished awards and the inventor of multiple successful medical technologies in women’s healthcare.

Continue reading “School of Oncoplastic Surgery Shows the Way to Better Breast Cancer Care”

Team Spirit: A Vascular Access Team Is Placing CVCs and Arterial Lines – And Why That Matters

InConnie Girgenti an earlier post, we detailed the advantages that both hospitals and patients gain when non-physician vascular access specialists (VAS’s) are allowed to place central venous catheters (CVCs) and arterial lines. Now a recently published article describes how a vascular access team at a large community hospital in Illinois expanded its scope of practice to encompass these lines.

Continue reading “Team Spirit: A Vascular Access Team Is Placing CVCs and Arterial Lines – And Why That Matters”

New White Paper: More Options to Reduce CAUTIs

Bladder wall damage caused by a Foley catheter that can lead to a CAUTI
Bladder wall damage caused by a Foley catheter that can lead to a CAUTI

We’ve posted previously about the dangers of catheter-related bloodstream infections and the option of using safer technology to prevent them. With the emergence of a new, safer device for urinary catheterization, it’s time to apply the same logic to catheter-associated urinary tract infections (CAUTIs).

The association between CAUTIs and the common use of Foley catheters is outlined in this new multimedia white paper. For results of a national survey of infection preventionists about CAUTIs, click here.

Continue reading “New White Paper: More Options to Reduce CAUTIs”

The Affordable Care Act and Vascular Access

How the ACA’s Pay-For-Performance Programs Target Catheter-Related Bloodstream Infections

body-veinsThe mainstream media has primarily covered the Patient Protection and Affordable Care Act (also known as the ACA or Obamacare) for how it affects health insurance. But as healthcare insiders, readers of this blog know there’s much more to this groundbreaking piece of legislation — including its provisions aimed at upping healthcare quality and lowering healthcare costs. Many of those provisions affect the practice of vascular access because catheter-related bloodstream infections (CRBSIs) have both quality and cost implications.

Healthcare providers should be taking a close look at these sections of the law because they can affect everything from reimbursements to materials management. Vascular access specialists (VAS’s) should know the provisions, too, because the ACA targets vascular access outcomes.

Continue reading “The Affordable Care Act and Vascular Access”

Study Shows Chlorhexidine-Impregnated PICC Eliminated Bloodstream Infections and Reduced Thrombosis

Teleflex Good Shepherd fotoA study published in the Fall 2014 issue of the Journal of the Association for Vascular Access (JAVA) showed that a chlorhexidine-impregnated peripherally inserted central catheter (PICC) eliminated central line-associated bloodstream infections (CLABSIs) during the two-year study period (July 2011-July 2013). In addition, only one incidence of thrombosis occurred during the study period – a non-occlusive thrombus associated with device insertion. When the study ended, the good results continued: No CLABSIs or episodes of thrombosis were associated with the catheter between the end of the study and the study’s publication.

Continue reading “Study Shows Chlorhexidine-Impregnated PICC Eliminated Bloodstream Infections and Reduced Thrombosis”