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Transcript of depuy.com/intouchsynthes.vo.llnwd.net/o16/LLNWMB8/US Mobile/Synthes North America... · INTOUCH....
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HEALIX KNOTLESS™ANCHOR: My ExperienceRichard L. Angelo, MD
MANAGINGTHROUGH CHANGES: Payment and Policy ImpactsWilliam R. Beach, MD& Louis F. McIntyre, MD
A NEW ERA FORHEALTHCARE POLICY Samir K. Bhattacharyya, PhD
AN INNOVATIONIN PARTIAL THICKNESS REPAIRS Ron Farkash, BSME
Welcome
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Dear Customer,
Welcome to the second edition of INTOUCH - our new digital newsletter aimed at reaching out to you, our valued surgeon
customer. I want to start by thanking those amongst you that took the time to visit our website - www.depuy.com/intouch
- to checkout our digital content from the first edition of INTOUCH. We were overwhelmed by the number of people that
signed up for future news and editions of INTOUCH and encourage you to invite your colleagues to take a couple of
minutes to do the same at www.depuy.com/intouch.
Coming from an engineering background, I am always incredibly excited when we have the opportunity to launch a new
meaningful technological innovation. In this edition, we are delighted to have an article on the very latest addition to DePuy
Mitek’s Rotator Cuff Portfolio– the Healix Knotless™ anchor! We are proud to have Dr. Richard Angelo share some of
his early impressions and experiences with the DePuy Mitek Healix Knotless™ anchor.
While we continue to strive to bring you the best innovations in minimally invasive mobility therapies, we must also be
mindful about the rapidly changing healthcare environment around the globe. These changes can pose some real chal-
lenges and opportunities for key stakeholders in the healthcare system - payors, providers and patients. We have chosen to
focus a significant portion of this INTOUCH edition on topics related to the changes in healthcare:
•Samir K. Bhattacharyya, PhD – Our Director of Market Access - looks at some of the ways in which DePuy
Mitek is working to help physicians and their Hospitals understand the meaningful clinical value of our new
technologies and innovations.
•Dr. William Beach and Dr. Louis McIntyre look at the impact of our changing healthcare environment on
physicians and more specifically, surgeons.
Finally, we have a short article from our Shoulder R&D Manager, Ron Farkash, highlighting another procedural innovation
from DePuy Mitek - our HEALIX TRANSTEND™ Implant System. Ron takes us through all the reasons he is excited
about this meaningful advancement in the treatment of partial thickness rotator cuff tears.
We hope you will enjoy this second edition and the associated digital content we have made available for you at
www.depuy.com/intouch
As always, we welcome your input and contributions at [email protected]
Kind regards,
Meghan Scanlon
WW Director of Marketing
Click Here to experience the digitalversion of this edition of INTOUCH
The Second Edition of the INTOUCH Newsletter
Meghan Scanlon WW Director of Marketing,DePuy Mitek
Attractive features of the Healix Knotless™ BR & PEEK Lateral Row Anchor:
• Accepts4#2braidedsuturesthroughtheanchoreyelet
• Suturesloadsmoothlythroughtheanchor/driverviathedeliveryloopmechanism
• Anchoriseasytodelivertothepreparedholeinthelateralaspectofthegreatertuberositywithout
theentanglementofsutures
• Accurate,selectivetensioningofsuturesispermittedpriortofinaldeploymentoftheanchor
• Theconvolutedpathwhichthesuturestakethroughtheimplantresultsinaddedsecurityforfixation
ofthelateralrow
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Richard L. Angelo, MDPresident of the Arthroscopy Association of North AmericaEvergreen Orthopedic Clinic;Kirkland, WA
DePuy Mitek Healix Knotless™ Anchor MyExperience
Dual Row Rotator Cuff Fixation:
Biomechanicalstudiesofdualrowcuffrepair,whencontrastedtosinglerowrepair,havedemonstratedimprovedfootprintcoverage,greatercontactpressureofthecuff
withthegreatertuberosity,decreasedgapformationandgreaterloadtofailure.Concerns,however,havebeenraisedregardingthepossibilityofover-constrainingthe
repairedcuffandthepotentialcompromiseofcuffvascularity.Whilethereisacleartendencytowardimprovedbiomechanicalstabilityandstructuralhealingwithdual
rowrepairs,todate,datasupportingimprovedclinicaloutcomesfordualrowrepairsissparse.
5 Keys to Successful Dual Row Rotator Cuff Repair:
1. AdequateTissue–rotatorcufftissueofadequatelengthandintegritymustbeavailabletospanthegreatertuberosityandavoidover-constraint;
sufficienttendonthicknessisnecessary,especiallymedially,toavoidtendoncut-throughandmedialrowfailure
2. SafeMedialRowAnchorPlacement–whenpreparing/introducingmedialrowanchorsthroughalateralacromialapproach,theshoulder
mustbesubstantiallyadductedtopermitpositioningtheanchorsadjacenttothearticularcartilageandyetavoida“shallow”approachtothe
tuberositywhichrisksanchorpenetrationofthehumeralheadarticularcartilage
3. AccurateMedialRowSutures-themedialrowsuturesshouldbeplacedattheanatomicmedial
marginofthecuff;excessivemedialplacementrisksover-tensioningofthecuffandcreating
anteriorandposterior“dogears”intherepair
4. Broad,SecureMedialFixation–multiplepassesofsuturematerialthroughthecuffina
broadly-spacedpattern,aswellastheuseofacombinedsimpleandhorizontalmattresslocking
configurationwillimprovethestrengthandsecurityofthemedialrow
5. SecureLateralRowConstruct–thelateralrowofanchor/smustoptimizefixationinthelateral
aspectofthegreatertuberosity,whichisoftenosteopenic,andprovideforsecureanchorfixation
ofspanningsuturesfromthemedialrow
Click Here to experience ourHealix Knotless™ digital animation!!
Inthecurrentenvironmentofdebtandregulation,physicians,especiallysurgeons,arechallengedwithvariousattempts
atcostreductionbytheCenterforMedicareandMedicaidServices(CMS)andprivateinsurers.Despitethefactthat
physicianservicesareasmall(13%)portionofthetotalcostofMedicareexpenditures,thisfocusonusiscuriousand
instructive.Acaseinpointistherecent“confrontation”betweenCMS,MEDPACandtheRelativeValueUpdateCommit-
tee(RUC).MEDPAC,anindependentcongressionalagency,criticizedCMSandtheRUCfornotaggressivelydecreasing
therelativevalueunits(RVUs)forsurgicalproceduresandnotcuttingcostsorslowingthegrowthofMedicarespending.
AthoroughdiscussionoftheRUC,therelativevalueofprocedures,andthepolicyofdecreasingthevalueofanRVUis
outsidethescopeforthisarticle.TherearemanypoliticalandprocessrelatedissuesregardingtheMEDPAC/CMS/RUCre-
lationship,butitistheonlymechanismthatcurrentlyallowsphysicianinputtoCMSpaymentpolicydiscussions.Despite
thisprovisionforinputs,thevalueofsurgicalservicesappearstobeselectivelydiscountedinthisforum.
Whatdoesthismeantothepracticingarthroscopicsurgeon?Lessreimbursementfromcodingchangesforthreecom-
monarthroscopicprocedures:arthroscopicsubacromialdecompression/acromioplasty(29826),arthroscopicmeniscec-
tomy–medialandlateral(29880),andarthroscopicmeniscectomy–medialorlateral(29881).
Letusreviewtherationaleandchangesfor29826(acromioplasty).CMShasdecidedtoreviewallproceduresthat
areperformedandbilledwithanotherproceduregreaterthan50%oftimes.Thisistheirattempttodecreasecostsby
denyingpaymenttoprovidersforallegedly“redundant”services;servicesperformedatthesametimearenowdeemed
inclusiveofeachotherwhenreimbursementisconsideredAcromioplastyisperformedwitharthroscopicdistalclavicle
resection(29824),rotatorcuffrepair(29827)andbicepstenodesis(29828)inover90%ofMedicarebillings.Because
ofthisrelationship,thedecisionwasmadethatarthroscopicacromioplasty(29826)shouldnolongerbeabletobelisted
alone,i.e.itmustbean“add-on”procedureandmustalwaysbelistedwithanothershoulderprocedure(forCMS).
Asforthedecreaseinthereimbursement,thatdiscussionismorecomplicatedandillustratesthelackofuniformityinthe
currentsystem.Mostphysiciansareawareofhowprivateinsurersreimbursesurgeonsformultipleprocedures.Reim-
bursementforthefirstprocedureis100%ofthecarrierallowanceandtheotherprocedures(sometimeswithalimiton
howmanycanbeadded,oftenuptofive)arereimbursedat50%ofthecarrierallowance.
Example–29826’sworkRVUfor2011is9.16andsoifitislistedwithaprocedurethathasahigherRVUvalue(29824,
29827,29828)itwouldbereimbursedatarateof4.58(9.16x50%).CMS,however,createdthe“endoscopy”rules
Managing Through Changes:PaymentandPolicyImpacts
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William R. Beach, MD Secretary of the Arthroscopy Association of North AmericaTuckahoe Orthopaedic Associates, Richmond, VA
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todecreasetheirreimbursementformultipleproceduresatahigherrate.CMS,forthesecondaryprocedures/
codes,subtractsthereimbursementforadiagnosticarthroscopyfromeachofthesecondarycodes.Thus
forCMS,thereimbursementfordiagnosticashoulderarthroscopy(29805)wouldbesubtractedfromthe
reimbursementforarthroscopicacromioplasty(29826).For2011,29826=9.16RVU’sandifyousubtract
theRVU’sfor29805(6.03)thenthereimbursementfor29826inconjunctionwithotherprocedureswouldbe
3.13.AtthelastRUCmeeting,29826wasvaluedat3.00RVUandthiswasacceptedbyCMS.
Whatisunknowniswhattheprivateinsurerswilldo.Wouldtheyfollowsuitandtakeadvantageoftheir
serviceproviders(US!)astheyusuallyadoptMedicarerulesthataretotheireconomicadvantage?
Changesinthereimbursementof29880and29881areevenmoresevere.Thetotal(work+practice
expense+malpracticeexpense)RVUreimbursementhasbeendecreasedfor29880from20.14to16.85
andfor29881from18.82to16.16.Inaddition,forCMS,arthroscopicchondroplasty(29877orG0289)
cannolongerbelisted/reimbursedwitheither29880or29881!Youmaystillperform29877(arthroscopic
chondroplasty/debridement)butwillnotbereimbursedbyCMS.Whataboutforpatientswithaprivateinsur-
ance?Youcanperformandcanbereimbursedforanisolatedchondroplasty(29877).Arthroscopicabra-
sionchondroplasty/microfracture(29879)isnotbundledwitheither29880or29881soitcanbebilledand
reimbursedwithbothcodes.
Inthisarticle,wecitedsomeexamplesonhowrecentpaymentstrategiesimplementedbyCMSaffectreim-
bursementforarthroscopicsurgeries.Costcontainmentpressureisrealandweallneedtoworkthroughit.
Thereimbursementinformationcontainedinthisarticleisprovidedforinformationalpurposesonlyandrepresentsnostatement,promise,orguaranteebyDePuyMitek,Inc.concerninglevelsofreimbursement,payment,orcharge.Similarly,allCPTandHCPCScodesaresuppliedforinformationalpurposesonlyandrepresentnostatement,promise,orguaranteebyDePuyMitek,Inc.thatthesecodeswillbeappropriateorreimbursementwillbemade.Theinformationpresentedisnotintendedtoincreaseormaximizereimbursementbyanypayor.Westronglyrecommendthatyouconsultyourpayororganizationwithregardtoitsreimbursementpolicies.
JCodeSource:FederalRegister/Vol.72,No.227,pp66774/Tuesday,November27,2007.AllCurrentProceduralTerminology(CPT)five-digitnumericcodes,descriptions,numericmodifiers,instructions,guidelines,andothermaterialareCopyright2007AmericanMedicalAssociation.AllRightsReserved.
Louis F. McIntyre, MDBoard of Directors or the Arthroscopy Association of North AmericaChief of Orthopaedics, Westchester Orthopaedic Associates, White Plains, NY
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Wehaveenteredintoanunprecedentederaofcostcontainmentpressure,qualityscrutiny,andglobalizationinhealth
care,whichcollectivelybrewaperfectstorm.Risinghealthcarecostsasapercentofgrossdomesticproducts(GDP)
intheUnitedStates(approaching16%)havepromptedseveralmeasuresbypayersandpolicymakers–compara-
tiveeffectiveness,valuebasedpurchasing,healthtechnologyassessment,accountablecareorganization,payfor
performance,sharedsavings,bundledpayments–tonameafew.
Sportsmedicinemaynotbeimmunefromthesemeasures.ThestateofWashington’sHealthTechnologyAssessment
process(HTA)recentlycompletedareviewonFemoroacetabularImpingementSyndrome(FAI)andrecommendeda
non-coveragedecision(http://www.hta.hca.wa.gov).AsimilarreviewwascompletedforOsteochondralAllograft/
AutograftTransplantation(OATS/Mosaicplasty)thatresultedinacoveragedecisionwithconditions(November18,
2011).Thesedecisionswerepredominantlybasedonanassessmentofthepublishedliteratureandagradingofthe
evidenceforthestrengthoftheconclusionsthatcouldbederivedfromtheevidence.Thequestionthatremainsto
beaddressediswhetherthecriteriaemployedforsuchreviewsareappropriateforsurgicalproceduresastheywere
developedlargelywiththepharmaceuticalmodelofevidenceinmind.Thetimehascometoappreciatethefactthat
medicaldevicesposeuniquechallengesinconductingblinded,randomizedclinicalstudiesanddifferentlevelsof
evidenceneedtobeappropriatelyconsideredforpayerdecisionmaking.
Thecurrentenvironment,asexemplifiedabove,caninducecostsensitivitytonewinnovationsorproductslacking
relevantattributes,quality,orservices.DePuyMitekrecentlyembarkedonanendeavortodevelopandcommunicate
valuepropositionsforsomeofitsdifferentiatedtechnologies.TheseproductValueAnalysisBriefscanhelpsurgeons
communicatethevalueofDePuyMitek’sofferingstoValueAssessmentCommitteesinhospitalswithafocusonthe
clinical,economicandproceduralbenefitsthatmaybemeaningfulforpatients,surgeons,andhospitals.Wehopeyou
willfindtheseProductValueBriefsusefulandinformativeasyourseektosupportthevalueofclinicalinnovationsin
yourpractice.PleaseaskyourDePuyMiteksurgicalsalesrepresentativeforadditionalinformation.
Weareexcitedtohavetheopportunitytoworkwithyoutomakesurepatientshaveaccesstoinnovativetechnology.
Verybest,
Samir
A New Era for Healthcare
Samir K. Bhattacharyya, PhD WWDirectorofMarketAccessDePuy Mitek
Click Here to see Value Analysis Briefs
A New Innovation in Partial Thickness Rotator Cuff Repairs
Ron Farkash, BSMER&D Manager for ShoulderDePuy Mitek
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AstheR&DmanagerforDePuyMitek’sshoulderplatformIamalwaysproudwhenwebringaninnovative
producttothemarket.TheHEALIXTRANSTEND™ImplantSystemrepresentsarevolutionaryadvancement
inthetreatmentofpartialthicknessrotatorcufftears.Thiscomprehensivepercutaneoussolution,featuring
HEALIXTRANSTEND™AnchorsandtheinnovativePERCANNULA™System,enablesthereattachmentofa
partiallytornrotatorcuffwhileminimizingtendontraumaandmaximizingproceduralvisualization.
Weengineeredthisanchorfortherepairofbothsmallandlargepartialthicknessrotatorcufftears.This
novelsolutionnotonlyaidsinthepreventionoftearpropagation,butitalsoallowsfortheretentionofthe
connectedtendon,ultimatelytopreservethepatient’snaturalanatomy.
TheHEALIXTRANSTENDAnchorfeatures:
• ReductionintendontraumabypercutaneouslyaccessingthePASTAlesionwiththe1.1mm
guidewireand4.0mmPERCANNULA®System.
• Enhancementofvisualizationbyretractingthecuffutilizingthedistalribonthe4.0mmcannula.
• OptimalcorticalandcancellousfixationstrengthwiththeHealixthreaddesignonour2.9mmTi
anchorand3.4mmBRandPEEKanchors.
• TissuetobonefixationsupportedbyORTHOCORD®highstrengthsuture
-55lbsoftensilestrength*
-45%lessstiffthanFiberwire†
*DataonfileatDePuyMitek.†FiberwireisaregisteredtrademarkofArthrex,Inc.
908070605040302010
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Anchor Pull-Out Strength
Ave
rage
Loa
d (lb
s)
HEALIX TRANSTEND™ BR
HEALIX TRANSTEND™ Ti
HEALIX TRANSTEND™ PEEK
Click Here to experience a digital animation of THE HEALIX TRANSTEND™ Implant System
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The new HEALIX KNOTLESS™ BR lateral anchor. The reliability you know – now for the lateral row.
• The first and only dual-thread, double-row, 100% biocomposite solution
• Unique dual-thread HEALIX KnoTLEss anchor design provides optimal fixation1
• Knotless design:
Eliminates arthroscopic knot-tying at the lateral anchor site
Easily accommodates up to four suture limbs
Maximizes surgeon control of suture tensioning
• The only knotless anchor made of BIoCRYL® RAPIDE™ biocomposite material,
which allows absorption and bony ingrowth1
FOR TRANSOSSEUS-EQUIVALENT REPAIR
Stronger Together
Healix Knotless BR lateral anchor 1Data on file at DePuy Mitek, Inc.
©DePuy Mitek, Inc. 2012. All rights reserved.
Introducing
Click Here to experience ourHealix Knotless™ digital animation!!