Surgery News - December 2008 - (Page 19) DECEMBER 2008 • SURGERY NEWS PRACTICE TRENDS es. In addition, physicians need to use a qualified system that is able to generate a medication list, allows health care professionals to print and transmit prescriptions electronically and conduct safety checks, and provides information on lower-cost alternatives, formularies, and insurance authorization requirements. Physicians who are able to meet the eprescribing requirements can earn a 2% incentive in 2009 and 2010. The incentive will drop to 1% in 2011 and 2012, and 0.5% in 2013. And starting in 2012, the CMS will begin reducing physician payments by 1% for failure to use e-prescribing. The physician fee schedule final rule Incentives May Bump Gain to 5.1% Fee Rule • from page 1 To realize the incentive payments outlined in the physician fee schedule final rule, physicians must successfully participate in the Physician Quality Reporting Initiative (PQRI) and meet requirements for being a successful electronic prescriber. The new e-prescribing initiative is similar to but separate from the PQRI, according to the CMS. To earn an incentive payment for e-prescribing, physicians will need to report on Medicare’s e-prescribing measure in at least half of applicable cas- several years, Congress has stepped in to eliminate scheduled pay cuts under the formula. However, since the SGR formula has not been altered, over time physicians will face even more significant pay cuts unless Congress acts to change or replace the SGR. In addition to the payment update and incentives provided in the final rule, the CMS is making a technical change to how it calculates the statutorily required budget neutrality adjustment. Previously, the CMS has applied budget neutrality to work relative value units (RVUs), but under a mandate in the MIPPA, the agency now will make the adjustment to the conversion factor. As a result, the conversion factor for 2009 will be $36.0666, compared with $38.087 in 2008. However, the combination of modifications to work RVUs, practice expense changes, and other policies also includes increased incentives for participating in the PQRI from 1.5% to 2% of covered professional charges. In addition, the CMS has added 52 new quality measures for a total of 153 available measures in 2009. The new measures are related to the management of osteoarthritis, rheumatoid arthritis, back pain, coronary artery bypass graft, chronic kidney disease, melanoma, oncology, coronary artery disease, hepatitis, and HIV/AIDS. The 2009 PQRI program also offers physicians the option of reporting data as part of Medicare claims or using a clinical registry. ■ MODIFICATIONS TO WORK RVUS, PRACTICE EXPENSE CHANGES, AND OTHER POLICIES ARE EXPECTED TO GIVE GENERAL SURGERY A 2% PAY HIKE. passed by Congress is expected to result in a 2% payment increase for general surgery, according to the American College of Surgeons. Another provision of the final rule will change Medicare enrollment policies. Under the rule, the effective billing date for physicians will be either the date of filing an enrollment application that receives Medicare contractor approval or the date the physician first started furnishing services at the practice location in the application, whichever occurs later. The final rule did not include an earlier proposal that would have required physicians who perform certain diagnostic testing services to meet most of the quality and performance standards established for Independent Diagnostic Testing Facilities, including requiring a supervising physician to prove proficiency in the performance and interpretation of each diagnostic procedure and maintaining an inventory of diagnostic testing equipment. INDEX OF ADVERTISERS Adolor Corporation Entereg Ethicon Endo-Surgery, Inc. Ligamax General Scientific Corporation SurgiTel Surgi-Cam I-Flow Corporation ON-Q PainBuster Novartis Pharmaceuticals Corporation Corporate Wyeth Pharmaceuticals Inc. Tygacil 2-4 13 15 7 9 19-20 TYGACIL® (tigecycline) Brief Summary See package insert for full Prescribing Information. For further product information and current package insert, please visit www.wyeth.com or call our medical communications department toll-free at 1-800-934-5556. CONTRAINDICATIONS TYGACIL is contraindicated for use in patients who have known hypersensitivity to tigecycline. WARNINGS Anaphylaxis/anaphylactoid reactions have been reported with nearly all antibacterial agents, including tigecycline, and may be life-threatening. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. TYGACIL should be administered with caution in patients with known hypersensitivity to tetracycline class antibiotics. TYGACIL may cause fetal harm when administered to a pregnant woman. If the patient becomes pregnant while taking tigecycline, the patient should be apprised of the potential hazard to the fetus. Results of animal studies indicate that tigecycline crosses the placenta and is found in fetal tissues. Decreased fetal weights in rats and rabbits (with associated delays in ossification) and fetal loss in rabbits have been observed with tigecycline. (See PRECAUTIONS, Pregnancy.) The use of TYGACIL during tooth development (last half of pregnancy, infancy, and childhood to the age of 8 years) may cause permanent discoloration of the teeth (yellow-gray-brown). Results of studies in rats with TYGACIL have shown bone discoloration. TYGACIL should not be used during tooth development unless other drugs are not likely to be effective or are contraindicated. Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including TYGACIL, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated. PRECAUTIONS General Caution should be exercised when considering TYGACIL monotherapy in patients with complicated intra-abdominal infections (cIAI) secondary to clinically apparent intestinal perforation. (See ADVERSE REACTIONS.) In Phase 3 cIAI studies (n=1642), 6 patients treated with TYGACIL and 2 patients treated with imipenem/cilastatin presented with intestinal perforations and developed sepsis/septic shock. The 6 patients treated with TYGACIL had higher APACHE II scores (median = 13) vs the 2 patients treated with imipenem/cilastatin (APACHE II scores = 4 and 6). Due to differences in baseline APACHE II scores between treatment groups and small overall numbers, the relationship of this outcome to treatment cannot be established. Glycylcycline class antibiotics are structurally similar to tetracycline class antibiotics and may have similar adverse effects. Such effects may include: photosensitivity, pseudotumor cerebri, and anti-anabolic action (which has led to increased BUN, azotemia, acidosis, and hyperphosphatemia). As with tetracyclines, pancreatitis has been reported with the use of TYGACIL. The safety and efficacy of TYGACIL in patients with hospital acquired pneumonia have not been established. In a study of patients with hospital acquired pneumonia, patients were randomized to receive TYGACIL (100 mg initially, then 50 mg every 12 hours) or a comparator. In addition, patients were allowed to receive specified adjunctive therapies. The sub-group of patients with ventilator-associated pneumonia who received TYGACIL had lower cure rates (47.9% versus 70.1% for the clinically evaluable population) and greater mortality (25/131 [19.1%] versus 15/122 [12.3%]) than the comparator. As with other antibacterial drugs, use of TYGACIL may result in overgrowth of non-susceptible organisms, including fungi. Patients should be carefully monitored during therapy. If superinfection occurs, appropriate measures should be taken. Prescribing TYGACIL in the absence of a proven or strongly suspected bacterial infection is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Information for Patients Patients should be counseled that antibacterial drugs including TYGACIL should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When TYGACIL is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by TYGACIL or other antibacterial drugs in the future. Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible. Drug Interactions Prothrombin time or o http://www.wyeth.com http://www.wyeth.com
Table of Contents Feed for the Digital Edition of Surgery News - December 2008 Surgery News - December 2008 Contents The 20/20 Vision: Health Reform News From the College: Nominations Thoracic: Breathing Easier Postop Management: Renal Failure Surgery News - December 2008 Surgery News - December 2008 - Contents (Page 1) Surgery News - December 2008 - Contents (Page 2) Surgery News - December 2008 - Contents (Page 3) Surgery News - December 2008 - Contents (Page 4) Surgery News - December 2008 - Contents (Page 5) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 6) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 7) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 8) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 9) Surgery News - December 2008 - News From the College: Nominations (Page 10) Surgery News - December 2008 - News From the College: Nominations (Page 11) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 12) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 13) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 14) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 15) Surgery News - December 2008 - Postop Management: Renal Failure (Page 16) Surgery News - December 2008 - Postop Management: Renal Failure (Page 17) Surgery News - December 2008 - Postop Management: Renal Failure (Page 18) Surgery News - December 2008 - Postop Management: Renal Failure (Page 19) Surgery News - December 2008 - Postop Management: Renal Failure (Page 20)
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