Solution to treat DVT & PE with better outcomes and reduced costs
Posted on January 31st, 2012
The reduction of DVTs and PEs is a core area of focus for CMS cost reductions, and a standard set of guidelines must be developed and adhered to. There must be a team approach to dealing with and treating patients with DVT. This hospital-based team should include multiple physicians and allied health professionals across a variety of specialties, including but not limited to:
• Vascular Surgeons/Vascular Medicine
• Interventional Radiologists
• Cardiologists
• Hematologists
• Internal Medicine
• Oncologists
Additionally, these patients need to be followed across the continuum of care, beyond just the in-hospital encounter.
It is critical for these specialists to come together as key opinion leaders to help shape the government guidelines for treating these patients. Specialists who deal with these patients every day are in the best position to share their knowledge and experience, to determine the best standards of care to treat patients suffering from venous thromboemboli, and to define preventive measures.
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Medicare Costs of Treating DVT and PE
Posted on January 23rd, 2012
With the healthcare crisis being battled on Capitol Hill and in the news daily, we are being bombarded with statistics of the cost of care increasing while the quality is decreasing. There are a few primary diseases or chronic conditions that account for the majority of Medicare spending. One of these conditions is deep venous thrombosis (DVT). DVT is not only costly at the time the patient is in the hospital being treated, but it becomes even costlier when it’s not treated and resolved. DVTs lead to emboli. When emboli manifest in the lungs (pulmonary embolism) or brain or other critical organs, they become fatal. There is a very high recurrence rate with DVTs and PEs. This recurrence further increases the total financial burden of the patient on the
Centers for Medicare Services (CMS). CMS is evaluating means to reduce the incidence, and therefore the costs, of DVT.
The Centers for Medicare Services has established core quality measures upon which care providers will be evaluated to determine whether optimal quality of care and reduced costs have been met. These core measures include evaluating DVT incidence and hospital readmissions (DVT and PE are leading causes of costly hospital readmissions). Initially providers will be financially rewarded to reduce or eliminate hospital readmissions within 30 days. Eventually, every hospital and provider will become financially accountable for the outcomes of patients with DVT according to the national guidelines and benchmarks against the quality measures. To ensure they receive their incentives and prevent a reduction in pay down the road, providers are closely evaluating how patients with venous thromboemboli or who are susceptible to DVTs are being treated.
In my next post on the topic of deep vein thromboses and pulmonary emboli, I will present a strategy to treat these conditions in such a way that we can reduce costs while also improving patient outcomes.
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Overview of Deep Vein Thrombosis and Pulmonary Embolism
Posted on January 16th, 2012
What are DVT and PE, and why should patients care?
Deep Vein Thrombosis (DVT) is one of the most prevalent medical problems today. DVT, while in some cases life-threatening, can lead to an even more serious condition called pulmonary embolism (PE). In fact, death occurs in about 6% of DVT cases and 12% of PE cases within one month of diagnosis.1 DVT and PE are caused by blood clots in the veins. A pulmonary embolism occurs when one of these clots travels to the lungs where it may obstruct air flow. Annually, it is estimated that 600,000 patients will be diagnosed with venous thromboembolism, and anywhere from 50,000-200,000 will die from PE. PE is stated to be the leading cause of preventable death in hospital patients, responsible for approximately 10% of all hospital deaths.
Who is at risk?
People with varicose veins are more prone to thrombosis and embolism; other factors that contribute to increased risk are advanced age, obesity, and cardiac problems, among other conditions. If you are at risk of DVT, there are preventive measures you can take, such as wearing compression stockings during air travel or for prolonged periods of standing or sitting. Be sure you discuss this with your physician. You should consider asking for a referral to a Venous Specialist if you have any symptoms of varicose veins, leg spider veins, restless leg syndrome, heavy or aching legs, venous ulcers, or if you have a family history of DVT or PE.
1 http://circ.ahajournals.org/content/107/23_suppl_1/I-4.full
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This past November, I attended and presented at the 38th annual VEITHsymposium. The symposium is a five day event filled with the world’s leading vascular specialists presenting and educating others on the most current methods of diagnosing and treating patients who suffer from vascular disease. With vascular disease being a leading cause of death and disability for a large percentage of Americans, treating these patients effectively is an important initiative. It was encouraging to see that Venous and Endovenous Diagnosis and Treatment topics monopolized the opening day for the sixth consecutive year. Of the 57 talks given by 41 speakers, topics ranged from the basic anatomy to more advanced discussions, such as Chronic CerebroSpinal Venous Insufficiency: Is This a Real Syndrome? There were two very intriguing debates. The first was whether Hypercoaguable Testing is Needed in Most Cases and the second was We Should Treat Calf Vein DVT with Standard Anticoagulation.
A fellow member of American Venous Forum and the American College of Phlebology (ACP), Dr. Jose Almeida, opened the session with a look forward to new therapies being tested and discussed for the treatment of venous disease in the future. Some of the new therapies discussed include those that don’t require tumescent anesthesia such as glue, foam sclerotherapy, and pharmacomechanical treatments. He also highlighted deep venous pathology with a focus on venous outflow obstruction, intravascular ultrasound, and stents.
Dr. Mauriello, President of the ACP, lectured on the significance of venous anatomy knowledge in order to avoid injury to the saphenous, sural, or peroneal nerves while performing vein ablation or other venous treatments. This highlights the significance of selecting a certified and qualified vascular surgeon to diagnose and treat a venous or vascular condition.
I have been evaluating treatment for Endothermal Heat Induced Thrombosis (EHIT2) post ablation, and am still undecided on whether or not anticoagulation is necessary. I will continue to gather more data and to work with my peers to determine the best method of treatment. It is apparent that more data is needed to ensure the best standard of care based on the fact that 50% of the audience in attendance did anticoagulate with EHIT2 and 50% did not. I also presented a conclusion from my recent pilot studies that both wavelength of a laser and non-contact fibers are important factors in postoperative recovery.
There was also a significant amount of time spent on discussions of treating and diagnosing deep vein thrombosis (DVT). Momentum is gaining in new pharmacomechanical treatments for acute DVT, though there do appear to be some device limitations for now.
Overall, the VEITHsymposium remains one of the leading conferences for the discussion and progression of treatment for venous disease, and I am proud to have been a part of the faculty once again.
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