News in brief: New tool predicts CVD risk in CML patients; Extracorporeal photophoresis funded for cGVHD; Nurse practitioner repays $80,000 for Medicare claims


New tool predicts CVD risk in CML patients

An Australian algorithm could help predict cardiovascular risk in chronic myeloid leukaemia (CML) patients “of all ages and prior cardiovascular disease (CVD) statuses”, according to Melbourne-based clinicians.

The tool uses age, prior CVD, Framingham Risk Score and coronary artery calcium scoring to stratify patients into low-, intermediate- and high-risk categories.

A retrospective study of 88 CML patients on tyrosine kinase inhibitors found zero ‘low-risk’ patients, including those downgraded from intermediate-risk due to coronary artery calcium score, experienced a major adverse cardiovascular event (MACE) within median 3.8 years’ follow-up, Monash Health Haematologist, Dr Diva Baggio and her team wrote in the Internal Medicine Journal.

Meanwhile, 10% and 19% of intermediate- and high-risk patients had MACE, respectively.

Using the tool with coronary artery calcium scoring could help identify intermediate- and high-risk patients that may benefit from tyrosine kinase inhibitors and “merits validation” in future studies, the authors concluded.


Extracorporeal photophoresis funded for cGVHD

Chronic graft-versus-host disease (cGVHD) patients could soon access government funded extracorporeal photophoresis (ECP) and methoxsalen, following recommendations from MSAC and the PBAC.

MSAC recommended ECP be subsided for use with methoxsalen after it found the combination had “acceptable safety, superior effectiveness and acceptable cost-effectiveness” for cGVHD patients versus “the current standard of care alone”.

The PBAC agreed, recommending methoxsalen for the “Highly Specialised Drugs Program” in public and private hospitals for use with ECP in steroid dependent, intolerant or refractory cGVHD patients.


Nurse practitioner repays $80,000 for Medicare claims

Nurse practitioners have not escaped the scrutiny of the Medicare claims watchdog, the Professional Services Review (PSR), with one practitioner receiving a reprimand and agreeing to repay $80,000 to Medicare for inappropriate claims for long consultations.

The PSR’s update for September 2021 reports an investigation it mounted into claims made by an un-named nurse practitioner who was the highest ranked provider nationally of MBS item 82215. The item covers consultations over 40 minutes for the purposes of taking an extensive history; undertaking clinical examination; arranging necessary investigations; implementing a management plan and providing appropriate preventive health care,

According to the PSR, the investigation revealed concerns that the MBS requirements were not always met, “as the clinical input and complexity of the service was not consistent with at least 40 minutes of clinical input being provided, as required by the MBS item descriptor and the practitioner’s records were not always adequate or contemporaneous.”

The PSR also had concerns that the nurse practitioner’s handwritten records were extremely difficult to read and did not reflect that nursing processes were followed.

“In some cases no record for the date of service could be identified in the patient record,” it noted.

The nurse practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 82215, received a reprimand from the PSR, agreed to repay $80,000 and was disqualified from providing MBS item 82215 for a period of 12 months.

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