Medicare and Medicaid Move Aggressively to Encourage Greater Patient Safety in Hospital and Reduce Never Events

The Centers for Medicare & Medicaid Services (CMS) announced that it is taking several actions to improve the quality of care in hospitals and reduce the number of “never events” -- preventable medical errors that result in serious consequences for the patient. Hospital acquired deep vein thrombosis and pulmonary embolism is amongst these “Never Events”. Hospitals will no longer be reimbursed for medical costs that occur as a result of deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.

More information can be found on the July 31, 2008 CMS press release.

National Quality Forum endorses standards designed to reduce VTE during hospitalization

Each year, in the United States alone, somewhere between 900,000 to 2,000,000 people will develop blood clots (venous thromboembolism or VTE) in the lungs or major veins.  Annually, more people die from blood clots and the resulting complications than from AIDS, breast cancer, and motor vehicle accidents combined.  Fatal pulmonary embolism (PE) – blood clot in the lungs – may be the most common preventable cause of hospital death in the United States. 
 
In May 2008, the National Quality Forum (NQF) endorsed 6 proposed standards designed to improve the performance of acute care hospitals.  Included in the measures are prevention and care of VTE.  The specified measures are:

• VTE Prophylaxis
  
• VTE Prophylaxis in the ICU
  
• Patients with overlap in anticoagulation therapy
  
• Patients with UFH (Unfractionated Heparin) dosages who have platelet count monitoring and adjustment of medication per protocol or nomogram
  
• Discharge instruction to address: follow-up monitoring compliance, dietary restrictions, and adverse drug reactions/interactions
  
• Incidence of preventable VTE
  

CMS Expands Coverage for INR Home Monitoring

Courtesy of Tom Hogan, Secretary - National Alliance for Thrombosis and Thrombophilia (NATT)

The Center for Medicare and Medicaid Services (CMS) is expanding its coverage of INR home monitoring to include patients on warfarin for DVT (deep vein thrombosis) and PE (pulmonary embolism), i.e., VTE (venous thromboembolism, blood clots in the legs and arms). Previously, CMS provided coverage only for home INR testing of patients with mechanical heart valves.
 
The CMS Decision Summary is as follows:

"After examining additional medical evidence, we are expanding Medicare coverage of home prothrombin (INR) monitoring to include chronic atrial fibrillation and venous thromboembolism under the following conditions:

• The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism; and
  
• The beneficiary has been anticoagulated for at least three months prior to use of the home INR device; and
  
• The beneficiary has undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home, and
  
• Home-testing with the device occurs no more frequently than once a week."
  

"The Surgeon General's DVT Workshop and Call-To-Action"

Samuel Z. Goldhaber, MD
Professor of Medicine, Harvard Medical School

Click here to view the Adobe Presenter version of Dr. Goldhaber's North American Thrombosis Summit 2007 lecture.

Rear Admiral Steven K. Galson, MD, MPH was appointed Acting Surgeon General on October 1, 2007.

Meanwhile, on September 13, 2007, a treasure chest of information from the May 8-9, 2006 Surgeon General’s DVT Workshop was finally opened!  The 22 sets of slides and 22 manuscripts from the two-day workshop were posted on the Surgeon General’s website under “DVT Proceedings” at: www.surgeongeneral.gov/topics/deepvein/workshop/agenda.htm

If this link doesn’t work, try the following 5 steps:

1. access www.surgeongeneral.gov
2. click on “Reports and Publications”
3. click on “Workshop Reports and Proceedings”
4. click on “DVT Workshop Proceedings”
5. click on “Agenda”

Each set of slides is formatted in both PowerPoint (so that the slides can be easily copied) and in pdf files.  Each manuscript that accompanies a slide set is well referenced and often contains supplemental tables and figures.

Under joint sponsorship of the NHLBI and Office of the Surgeon General, the Surgeon General’s DVT workshop took place on May 8-9, 2006 in Bethesda, MD.  Thomas Ortel, MD, PhD and I were the science co-chairs for this meeting.  We organized seven panels:  epidemiology, high risk groups, diagnosis, treatment, awareness and best practices, prevention, and finally, translation and application.  WE also assembled five workshops:  enhancing diagnosis and treatment, primary prevention, DVT science base and accelerating public health, public health priorities, and enhancing collaborations and developing new partnerships.

At the conclusion of the 2-day workshop, Richard Carmona, MD, the Surgeon General, issued a “Call To Action.”  However, his appointment as Surgeon General expired in August 2006, and he was not renominated.  James W. Holsinger, Jr., MD, a Kentucky cardiologist, has been nominated for Surgeon general.  He underwent a blithering Senate confirmation hearing on July 12, 2007.  The vote on his nomination was supposed to be held on September 2007 but has obviously been delayed. 

Making a Difference: Kelly’s Story

Kelly Clark is a 40-year-old professional and mother of two young children, who resides in Aliso Viejo, California. In early 2007, Kelly was diagnosed with a pulmonary embolism following arthroscopic knee surgery. Thrombosis awareness, education, and prevention have now become her passion. We are pleased to welcome Kelly as a NATF Patient Advocate.

Click here to view Kelly's Story: Deep Vein Thrombosis and Pulmonary Embolism

Making a Difference: Nicole's Story (DECEMBER 2008 UPDATE)

In April 2008, as I was thinking about my one year survival anniversary, I was taken back to another aspect of my life that was at the forefront of my mind during my thrombosis experience. I am an adoptee. I was adopted at birth, and had never known any medical or personal family history with regards to my biological parents. This April I made the choice to contact the California Department of Public Social Services and request any medical and personal information about my biological parents. I was most concerned with having that information available to my daughter, in hopes that she would be better prepared if any serious medical condition ever arose in her life.    

I cannot put into words the anticipation, fear, and years of emotional build up that was involved in that meeting. Among the many questions and answers we both had for each other, I learned that my biological great-grandmother and great aunt had both died of heart disease at very young ages, and that my great uncle, Lyle, and my grandmother, Patricia, had both undergone triple bypass heart surgeries. A year after my grandmother's triple bypass she already again had 100% heart blockage in those arteries. My grandmother takes both aspirin (81 mg) and Plavix daily for the prevention of more clotting. And although they had never been diagnosed with any genetic predisposition for thrombosis, all their doctors had warned the family that they had extremely "sticky blood". I so far was the youngest to experience the effects of it.    

Since that first meeting we have continued building a relationship, and are now a normal part of each other's everyday lives. I have met all my maternal biological family and in turn they have learned they have three new family members: myself, my daughter, and my fiancé. My adoptive family was a constant support through the whole process; they understood that after my thrombosis experience it was a part of myself that I needed to connect with. We all became such a part of each other's lives that at my wedding in September I was blessed to truly have my whole family present! It was the best gift I could have ever dreamed of!

Now with my two-year survival anniversary coming up in April 2009, I look back on my original thrombosis experience as my true second chance at life!

Click here to view Nicole's Story: Cerebral Venous Thromboembolism

Patient Advocacy: Melanie Bloom and The Coalition to Prevent DVT

Click here to view Melanie's lecture from North American Thrombosis Summit 2007 – September 29, 2007

Melanie Bloom’s husband, David, was an NBC correspondent embedded with the 3rd Infantry Division in Iraq when he suddenly collapsed and died from massive pulmonary embolism (PE).  That tragedy was Melanie’s rude awakening to the realities of PE and deep vein thrombosis (DVT), a condition that affects approximately 2,000,000 Americans every year.  She, like most Americans, had never heard of the “silent killer” that took her husband’s life.

Inspired by the enormous outpouring of support for her personal loss, Melanie pledged to increase awareness of PE and DVT by working with the Coalition to Prevent DVT, a group of organizations committed to educating the public and healthcare community about DVT.  The Coalition’s mission is:

To reduce the immediate and long-term dangers of DVT and PE, which together comprise one of the nation’s leading causes of death.  The Coalition will educate the public, healthcare professionals, and policy-makers about risk factors, symptoms, and signs associated with DVT, as well as identify evidence-based measures to prevent morbidity and mortality from DVT and PE.

The Coalition’s website is: www.preventdvt.org.

As the Coalition’s patient advocate, Melanie educates audiences of healthcare professionals, consumers, and members of the media to be alert to the risk factors and symptoms of DVT, which can strike even healthy adults seemingly at random.  Common risk factors include restricted mobility, major surgery, cancer, and certain heart or respiratory diseases.  Symptoms of DVT include pain, swelling, tenderness, discoloration, or redness of the affected area, and skin that is warm to the touch.

To date, the Coalition’s message has reached millions of people across the country.  Melanie has appeared on the Today Show, Access Hollywood, CNN’s American Morning, the Jane Pauley Show, and Larry King Live.  She shared her story in the Coalition to Prevent DVT’s public service announcement that continues to air nationally, and she has been featured in both Ladies Home Journal and the 2005 Oscar issue of People magazine.  In March 2005, Melanie and the Coalition drew members of Congress, staffers, and members of the media to a Capitol Hill celebration of a Senate Resolution officially declaring March as DVT Awareness Month.  Melanie represented the Coalition at major medical meetings for the American College of Chest Physicians (ACCP) and Vascular InterVentional Advances (VIVA), spoke at a DVT lecture series at Jefferson Medical College in Philadelphia, and participated in a film shoot and Web cast for internal distribution at the Hospital Corporation of America (HCA).  At every event, Melanie recounts her loss to emphasize the importance of increased awareness of DVT and to encourage the widespread implementation of prophylaxis measures.

Throughout 2006, Melanie will continue working with the Coalition, telling her story and encouraging other patients to share their experiences with DVT.  Together with the Coalition, she will help reach policy leaders and a wider audience of healthcare professionals.