Archive for January 2010

Refer refractory afib for catheter ablation

In this unblinded trial, 167 patients with recurrent symptomatic afib despite anti-arrythmic therapy were randomized to catheter ablation or another anti-arrythmic therapy. At 9 months, 66% of the catheter group remained free of recurrent afib, compared to only 16% of the anti-arrythmic group. Treatment related major adverse effects occurred in 5% of the catheter group compared to 9% of the anti-arrythmic group at 30 days. Catheter ablation is a reasonable treatment strategy for patients with symptomatic paroxysmal afib refractory to medical therapy (abstract)

Consult Code Conversions and Consequences

Troy Ahlstrom writes... As I’m sure you’re aware, CMS has eliminated consult codes for 2010.  (We’ve discussed this topic on this blog previously with Drs. Nelson and Bessler.)  Interestingly, our practice ran an analysis on the effect of changing these inpatient consultation codes (99251-55) over to new patient history and physical codes (99231-33) and found that we might actually do a bit better financially with the conversion.  Welcome findings, no doubt… However, what about the impact on our colleagues with traditional practice models? (more…)

Glenn Steele at CMS – A “Not So Fast, Schwartz”?

FYI, Glenn wrote to family and friends last night saying that he is not the new CMS administrator. We'll see...(Lesson – don't believe everything you read in the blogosphere. Yes, even mine.) Turning to more important matters, now I've gotta decide about that iPad...

Glenn Steele at CMS?

If you’re in healthcare, the most important announcement today will not be Steve Jobs’ introduction of the iPad (thrilling as that is). Rather, it will be President Obama’s expected announcement of the appointment of Dr. Glenn Steele as the new director of the Centers for Medicare & Medicaid Services.At this writing, it is still rumor (although I have it on fairly good authority that it’s legit), but it is starting to appear in the blogosphere. I know Glenn fairly well (we’ve spoken at a few conferences together), and I think he would be an inspired choice.Glenn has a unique pedigree, one that has prepared him exceptionally well for the position. He is an MD, PhD, and an accomplished academic surgeon, having spent many years at the University of Chicago – rising to become dean of the medical school. He also led the American College of Surgeons earlier in his career.…

Pro-calcitonin to reduce antibiotics in the ICU

In this prospective multi-center trial of 630 ICU patients, patients were randomized to pro-calcitonin guided antibiotics or usual care. The pro-calcitonin group had antibiotics started or stopped based on pre-determined pro-calcitonin levels. There was no difference in 28 or 60 day mortality between the groups, but days of antibiotics were less in the pro-calcitonin group (12 vs 14 days). Although this study did not show any difference in outcomes measures, antibiotic use can be reduced by the use of pro-calcitonin guided therapy (abstract).