Quality of Life for Cats with Heart Disease

Reynolds C, Oyama M, Rush J et al: Perceptions of quality of life and priorities of owners of cats with heart disease, J Vet Intern Med 24:1421, 2010.

A shared goal of veterinarians and the owners of cats with heart disease is to provide high quality of life (QoL) while achieving the extension of quantity of life. Because heart disease in cats is rarely cured with treatment, therapy is directed to palliation of clinical sings and maximizing survival time with a progressive disease. Treatment usually consists of medications that improve QoL. This study utilized a questionnaire to owners of 239 cats with heart disease to help identify important parameters when assessing their cat’s QoL, the importance of quality versus quantity of life, and willingness to trade survival time for QoL. Deemed important to QoL were parameters such as appetite, owner interaction, sleep patterns, and litter box habits. Most owners did not feel it was difficult to administer oral medications to their cat though a large enough number indicated their cat was extremely difficult to medicate. The level of concern by owners increased as the number of medications and dosing frequency increased. Owners have significantly greater concern over pet suffering than concern over life expectancy. Most (93%) of owners were willing to trade survival time for good QoL. These priorities and concerns of owners of cats with heart disease should be taken into account by veterinarians in their pursuit to provide optimal care. [VT]

Related articles:
Payne J, Luis Fuentes V, Boswood A et al: Population characteristics and survival in 127 referred cats with hypertrophic cardiomyopathy (1997 to 2005), J Small Anim Pract 51:540, 2010.

More on cat health: Winn Feline Foundation Library
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Reynolds C, Oyama M, Rush J et al: Perceptions of quality of life and priorities of owners of cats with heart disease, J Vet Intern Med 24:1421, 2010.

A shared goal of veterinarians and the owners of cats with heart disease is to provide high quality of life (QoL) while achieving the extension of quantity of life. Because heart disease in cats is rarely cured with treatment, therapy is directed to palliation of clinical sings and maximizing survival time with a progressive disease. Treatment usually consists of medications that improve QoL. This study utilized a questionnaire to owners of 239 cats with heart disease to help identify important parameters when assessing their cat’s QoL, the importance of quality versus quantity of life, and willingness to trade survival time for QoL. Deemed important to QoL were parameters such as appetite, owner interaction, sleep patterns, and litter box habits. Most owners did not feel it was difficult to administer oral medications to their cat though a large enough number indicated their cat was extremely difficult to medicate. The level of concern by owners increased as the number of medications and dosing frequency increased. Owners have significantly greater concern over pet suffering than concern over life expectancy. Most (93%) of owners were willing to trade survival time for good QoL. These priorities and concerns of owners of cats with heart disease should be taken into account by veterinarians in their pursuit to provide optimal care. [VT]

Related articles:
Payne J, Luis Fuentes V, Boswood A et al: Population characteristics and survival in 127 referred cats with hypertrophic cardiomyopathy (1997 to 2005), J Small Anim Pract 51:540, 2010.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

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Limit set on popular procedure on spines

Blue Cross is under fire for seeking to curb use of expensive spinal fusions.

By Alan M. Wolf
alan.wolf@newsobserver.com

Posted: Saturday, Dec. 25, 2010

More Information

• By the numbers
  3,593: number of spinal fusion surgeries Blue Cross and Blue Shield of North Carolina covered last year, up 22 percent from 2007.
  $105 million: amount the insurer paid in claims for the procedures last year, up 44 percent from 2007.
  Nine: number of medical associations that signed a Dec. 15 letter to Blue Cross, urging changes to its new policies, which take effect Jan. 1.
  3.7 million: Blue Cross members statewide.

The state's largest health insurer is coming under fire from surgeons across the country for implementing tougher restrictions on an increasingly common type of spinal surgery.
Blue Cross and Blue Shield of North Carolina's new rules, which take effect Jan. 1, are designed to reduce overuse of spinal-fusion surgery, a costly and controversial procedure to ease patients' lower back pain . The Chapel Hill-based insurer says it wants to ensure the surgeries are approved based on the latest medical evidence.

"We are not going to stop coverage, but we do want to make sure the ones being done are appropriate," said Dr. Don Bradley, Blue Cross' chief medical officer. "In some cases, we're seeing technology being used when more conservative measures might be more appropriate."
But some spine surgeons worry that the restrictions will limit care for thousands of patients and could set a new coverage standard among other insurers.

A coalition of surgeons representing nine medical associations, including the American Association of Neurological Surgeons and the North American Spine Society, wrote to Blue Cross this month, urging the company to reconsider.


The group also suggested various changes that would ease the new restrictions.
"If this intrusion into the physician-patient relationship goes unchallenged, other insurers will follow suit," said Dr. John Wilson, a neurosurgeon at Wake Forest University Baptist Medical Center who is president of the N.C. Neurological Society and one of nine physicians who signed the letter to Blue Cross.
"It will be a progression of ever-more restrictive policies that will handcuff us as we try to treat patients," Wilson said.

The surgeon groups requested a meeting with Blue Cross executives before the rules kick in one week from today to discuss the new policy. But the insurer responded in an e-mail message that because of the holidays, a meeting could not be scheduled until the third week of January.
Wilson estimates that he performs about 100 spinal-fusion surgeries a year. Only a small percentage of his practice's patients would be ineligible for coverage under the new Blue Cross rules.
"Even if it's just a few patients, if we're limited in how we can help them, it doesn't sit right with us," he added.
The new spine-surgery rules come as Blue Cross faces increasing pressure to keep costs down and control premiums. The company announced plans in July to slash administrative costs up to 20 percent by 2014.
"The tendency is to label us as the big, bad insurance company," Bradley said. "We understand folks rely on us to cover the things that should be covered. They also assume that we're making decisions about appropriate care" to keep premiums affordable.

Blue Cross reports that it covered 3,593 spinal fusion surgeries last year, up 22 percent from 2007. The insurer paid $105 million in claims for the procedures last year, up 44 percent from 2007. The procedures require longer hospital stays and cost more than three times the amount of a simpler surgery, according to the Journal of the American Medical Association.

The new rules will require patients and physicians to get approval before spinal-fusion surgery. The insurer still will cover the surgery for some ailments, such as scoliosis, injury and tumors.
But Blue Cross won't cover the surgery for degenerative disk disease. The condition is caused by aging disks and can cause debilitating back pain.

"We feel that to completely omit this as a covered procedure under any circumstance is overly restrictive," the national group of surgeons wrote in their letter to Blue Cross.
The surgeries involve implanting rods and screws to repair vertebrae. JAMA reports that patients who had a complex fusion procedure were nearly three times as likely to develop a life-threatening complication and that the surgeries didn't result in dramatically better outcomes.

But spinal implants have become a booming business for surgeons and medical-device companies since winning Food and Drug Administration approval in 1995. Minneapolis-based Medtronic is the biggest maker of spinal implants, accounting for about half of the $7 billion market last year, The Wall Street Journal reported.

Critics in Congress and elsewhere are calling for a review of Medicare's coverage of the procedures. Spinal-fusion claims cost Medicare $2.24 billion in 2008, up nearly 400 percent since 1997 after adjusting for inflation, The Wall Street Journal reported.
Blue Cross has tried to work with physicians for several years to develop guidelines on the procedures, but it hasn't stemmed the surge in the number performed, Bradley said.
"We have tried the kinder, gentler approach," he said. "It's unfortunate that it takes looking at each case each time, but other approaches haven't really worked."

A Blue Cross patient or surgeon could appeal any denial of coverage, and the process would include at least one review by a physician who isn't employed by the insurer, Bradley said.
In late September, the company notified spine surgery practices across the state about the new rules. Before issuing the new policy, officials met with several spine surgeons in the Chapel Hill area and incorporated their input into the new rules.

In some cases, where doctors have tried physical therapy and other types of treatment, the only other option may be surgery, Wake Forest's Wilson said. "To say you're not going to cover them at all, you're hurting some patients," he added. "We don't want there to be patients left suffering."
Blue Cross continually reviews its coverage policies and makes adjustments based on the latest medical guidelines, Bradley said. But the new rules will take effect Jan. 1, despite the outcry from surgeons.
"We always listen to providers," he said. "It's unlikely we would not implement this. But if there's new data that says our criteria are incorrect, we'll be open to that."

Subscribe to The Charlotte Observer.

Read more: http://www.charlotteobserver.com/2010/12/25/1933698/limit-set-on-popular-procedure.html#ixzz19MkLdATa

Blue Cross is under fire for seeking to curb use of expensive spinal fusions.

By Alan M. Wolf
alan.wolf@newsobserver.com

Posted: Saturday, Dec. 25, 2010

More Information

• By the numbers
  3,593: number of spinal fusion surgeries Blue Cross and Blue Shield of North Carolina covered last year, up 22 percent from 2007.
  $105 million: amount the insurer paid in claims for the procedures last year, up 44 percent from 2007.
  Nine: number of medical associations that signed a Dec. 15 letter to Blue Cross, urging changes to its new policies, which take effect Jan. 1.
  3.7 million: Blue Cross members statewide.

The state's largest health insurer is coming under fire from surgeons across the country for implementing tougher restrictions on an increasingly common type of spinal surgery.
Blue Cross and Blue Shield of North Carolina's new rules, which take effect Jan. 1, are designed to reduce overuse of spinal-fusion surgery, a costly and controversial procedure to ease patients' lower back pain . The Chapel Hill-based insurer says it wants to ensure the surgeries are approved based on the latest medical evidence.

"We are not going to stop coverage, but we do want to make sure the ones being done are appropriate," said Dr. Don Bradley, Blue Cross' chief medical officer. "In some cases, we're seeing technology being used when more conservative measures might be more appropriate."
But some spine surgeons worry that the restrictions will limit care for thousands of patients and could set a new coverage standard among other insurers.

A coalition of surgeons representing nine medical associations, including the American Association of Neurological Surgeons and the North American Spine Society, wrote to Blue Cross this month, urging the company to reconsider.


The group also suggested various changes that would ease the new restrictions.
"If this intrusion into the physician-patient relationship goes unchallenged, other insurers will follow suit," said Dr. John Wilson, a neurosurgeon at Wake Forest University Baptist Medical Center who is president of the N.C. Neurological Society and one of nine physicians who signed the letter to Blue Cross.
"It will be a progression of ever-more restrictive policies that will handcuff us as we try to treat patients," Wilson said.

The surgeon groups requested a meeting with Blue Cross executives before the rules kick in one week from today to discuss the new policy. But the insurer responded in an e-mail message that because of the holidays, a meeting could not be scheduled until the third week of January.
Wilson estimates that he performs about 100 spinal-fusion surgeries a year. Only a small percentage of his practice's patients would be ineligible for coverage under the new Blue Cross rules.
"Even if it's just a few patients, if we're limited in how we can help them, it doesn't sit right with us," he added.
The new spine-surgery rules come as Blue Cross faces increasing pressure to keep costs down and control premiums. The company announced plans in July to slash administrative costs up to 20 percent by 2014.
"The tendency is to label us as the big, bad insurance company," Bradley said. "We understand folks rely on us to cover the things that should be covered. They also assume that we're making decisions about appropriate care" to keep premiums affordable.

Blue Cross reports that it covered 3,593 spinal fusion surgeries last year, up 22 percent from 2007. The insurer paid $105 million in claims for the procedures last year, up 44 percent from 2007. The procedures require longer hospital stays and cost more than three times the amount of a simpler surgery, according to the Journal of the American Medical Association.

The new rules will require patients and physicians to get approval before spinal-fusion surgery. The insurer still will cover the surgery for some ailments, such as scoliosis, injury and tumors.
But Blue Cross won't cover the surgery for degenerative disk disease. The condition is caused by aging disks and can cause debilitating back pain.

"We feel that to completely omit this as a covered procedure under any circumstance is overly restrictive," the national group of surgeons wrote in their letter to Blue Cross.
The surgeries involve implanting rods and screws to repair vertebrae. JAMA reports that patients who had a complex fusion procedure were nearly three times as likely to develop a life-threatening complication and that the surgeries didn't result in dramatically better outcomes.

But spinal implants have become a booming business for surgeons and medical-device companies since winning Food and Drug Administration approval in 1995. Minneapolis-based Medtronic is the biggest maker of spinal implants, accounting for about half of the $7 billion market last year, The Wall Street Journal reported.

Critics in Congress and elsewhere are calling for a review of Medicare's coverage of the procedures. Spinal-fusion claims cost Medicare $2.24 billion in 2008, up nearly 400 percent since 1997 after adjusting for inflation, The Wall Street Journal reported.
Blue Cross has tried to work with physicians for several years to develop guidelines on the procedures, but it hasn't stemmed the surge in the number performed, Bradley said.
"We have tried the kinder, gentler approach," he said. "It's unfortunate that it takes looking at each case each time, but other approaches haven't really worked."

A Blue Cross patient or surgeon could appeal any denial of coverage, and the process would include at least one review by a physician who isn't employed by the insurer, Bradley said.
In late September, the company notified spine surgery practices across the state about the new rules. Before issuing the new policy, officials met with several spine surgeons in the Chapel Hill area and incorporated their input into the new rules.

In some cases, where doctors have tried physical therapy and other types of treatment, the only other option may be surgery, Wake Forest's Wilson said. "To say you're not going to cover them at all, you're hurting some patients," he added. "We don't want there to be patients left suffering."
Blue Cross continually reviews its coverage policies and makes adjustments based on the latest medical guidelines, Bradley said. But the new rules will take effect Jan. 1, despite the outcry from surgeons.
"We always listen to providers," he said. "It's unlikely we would not implement this. But if there's new data that says our criteria are incorrect, we'll be open to that."

Subscribe to The Charlotte Observer.

Read more: http://www.charlotteobserver.com/2010/12/25/1933698/limit-set-on-popular-procedure.html#ixzz19MkLdATa

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As Spinal Fusion Volume Grows, So Do Profits for Surgeons & Device Makers

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries. Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data. Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure.  Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language. One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure.  Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales.  In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013. Read the full WSJ report here. Irene Tsikitas

Report outlines controversies over device-heavy spine procedures and surgeon-manufacturer relationships.

Are financial relationships with medical device companies and profitable reimbursement margins inducing spine surgeons to perform more fusions than necessary? A recent report in the Wall Street Journal explores several controversies associated with the growing market for these device-heavy spine surgeries. Medicare paid $343 million for spinal fusion procedures in 1997, compared to $2.24 billion in 2008 — a nearly 400% increase, according to the Journal's analysis of Medicare data. Within the medical community, doctors are divided between more conservative spine surgeons who believe fusion should be used sparingly to treat a small number of conditions, such as scoliosis, and surgeons who advocate using fusion to relieve chronic back pain or to treat degenerative disk disease, one of the most hotly debated uses of the procedure.  Blue Cross and Blue Shield of North Carolina announced earlier this year that it would stop paying for spinal fusions performed to treat aging disks beginning on Jan. 1, 2011. Nine medical associations, including the American Association of Orthopaedic Surgeons, recently sent a letter to the insurer to express concerns over the new policy and advocate for less restrictive language. One thing is certain: The increase in spinal fusions has been a boon for the companies that make and sell the hardware and implants used in spinal fusion surgery, which can cost tens of thousands of dollars for a single procedure.  Meanwhile, companies like Medtronic, the largest manufacturer of spinal implants, pay surgeons millions of dollars in royalties for their help in developing new technologies. Medtronic and the surgeons who collaborate with the company say the payments are a legitimate way for surgeons to give input on new devices and do not create a conflict of interest. Critics, including some members of Congress, argue that they are essentially kickbacks designed to boost medical device sales.  In response to this criticism, Medtronic began disclosing its payments to surgeons publicly on its website in June, and many doctors who partner with device makers say they disclose these relationships to their patients. A provision in the Affordable Care Act requires all companies to disclose such payments made to physicians by 2013. Read the full WSJ report here. Irene Tsikitas

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