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Health Evidence Review Commission

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Health Evidence Review Commission Health Evidence Review Commission August 9, 2012 Meridian Park Hospital Community Health Education Center, Room 117B&C 19300 SW 65th Avenue, Tualatin, OR 97062 AGENDA HEALTH EVIDENCE REVIEW COMMISSION Meridian Park Room 117 August 9, 2012 2:00-5:00 pm (All agenda items are subject to change and times listed are approximate) Action # Time Item Presenter Item 1 2:00 PM Call to Order Alissa Craft 2 2:05 PM Approval of Minutes (June 14, 2012) Alissa Craft X Director’s Report Darren Coffman 3 2:10 PM Dissemination of coverage guidances and Cat Livingston guideline discussion Subcommittee policies 4 2:20 PM 1) Attendance and appointment to the Darren Coffman X subcommittees 2) Acceptance of public written testimony Lisa Dodson Value-based Benefits Subcommittee Report Ariel Smits 5 2.35 PM 1) Specialty recommendations X 2) Approval of 2014-15 Prioritized List Cat Livingston Darren Coffman 1) Health Technology Assessment Subcommittee Report 2) CGs for HERC approval Alissa Craft 6 3:15 PM a. Artificial Disc Replacement Wally Shaffer X b. Lumbar Discography Alison Little c. Hip Resurfacing 1) Evidence-based Guidelines Subcommittee Report 2) CGs for HERC review (pending 8/2 EbGS approval) Wiley Chan 7 3:45 PM a. Advanced Imaging for LBP Cat Livingston X b. Nonpharmacologic Interv for Tx Alison Little Resistant Depression c. Neuroimaging in Dementia d. Neuroimaging in Headache e. Hip Surgery Procedures FAI 8 4:35 PM Topic prioritization review and next topics Cat Livingston X Next Steps 9 4:45 PM Schedule next meeting – October 11, Alissa Craft 2012 Meridian Park Room 117 B&C 10 4:50 PM Public Comment 11 5:00 PM Adjournment Alissa Craft Minutes HEALTH EVIDENCE REVIEW COMMISSION Clackamas Community College Wilsonville Training Center, Conference Room 112 Wilsonville, Oregon June 14, 2012 Members Present: Som Saha, MD, MPH, Chair; Alissa Craft, DO, MBA, Vice-Chair; Irene Croswell, RPh; Lisa Dodson, MD; James Tyack, DMD; Beth Westbrook, PsyD; Gerald Ahmann, MD; Leda Garside, RN. Members Absent: Kathryn Weit; Mark Gibson; Wiley Chan, MD; Vern Saboe, DC. Staff Present: Darren Coffman; Cat Livingston, MD, MPH; Dave Lenar; Wally Shaffer, MD; Dorothy Allen. Also Attending: Denise Taray, DMAP; Alison Little, MD MPH, Shannon Vandegriff, and Valerie King, MD MPH, OHSU CeBP; Chris Kirk, MD, OHP Medical Director; Steve Marks, MD, EbGS Vice-chair (via teleconference); Kate Skoglund and Paul Lewis, MD, OHA volunteers; Tracy Oman, Oregon Optometric Physicians Association; Joanie Cosgrove, Medtronic; Danielle Sobel, Oregon Medical Association; Venus Holder & Jenny Blackham, Lilly; Bill Struyk, Johnson & Johnson; Richard Kosesan, private citizen; Jack Isselmann, Oregon Bioscience Association. Call to Order Som Saha, Chair of the Health Evidence Review Commission (HERC), called the meeting to order. Role was called. Approval of Minutes MOTION: To approve the minutes of the April 12, 2012 meeting as presented. CARRIES 7-0.(Garside absent) Director’s Report Darren Coffman introduced two individuals who have volunteered to help the Commission over the next few months. Dr Paul Lewis, the Health Officer for Clackamas County will help the clinical staff in Dr. Smits absence. Kate Skoglund pre-med student at the University of Georgia, is an intern working on the unresolved ICD-10 coding issues. He reported DMAP's decision to hold off implementation of a new list until October 1, 2014, which would encompass the ICD-10-CM conversion, rather than implementing a new ICD-9-CM code version for 9 months. HERC Minutes June 14, 2012 Page 1 Subcommittee Reports Value-based Benefits Subcommittee (VbBS) Report Cat Livingston and Lisa Dodson reported the VbBS has met twice since the last HERC meeting, May 10th and earlier today, June 14th. Each helped to summarize a number of topics discussed at both subcommittee meeting. Recommendations for the biennial list include: • ICD-10/Biennial Review specialty group recommendations include infectious disease, cardiology, ophthalmology, endocrinology, internal medicine, pediatric metabolic, genetics and ophthalmology. • Create a new prevention line which would be prioritized well below the funding line that would include preventive services with insufficient evidence of effectiveness such as encounters for screening for certain cancers or for carriers of certain infectious diseases and drug abuse counseling for family members of drug abusers. Recommendations for interim changes, effective 10/1/12 include: • Add appropriate amputation codes to line 64, Burn Full Thickness Greater Than 10% of Body Surface. • Revising the spinal stenosis guideline to clarify that both foraminal and central stenosis are included. • Balloon dilatation for transient cerebral ischemia was considered but not added due to the experimental nature of the procedure. Detailed information may be found in the VbBS Minutes. MOTION: To approve the report of the VbBS with their recommendations. Carries 8-0. Health Technology Assessment Subcommittee (HTAS) Report Wally Shaffer and Dave Lenar reported the subcommittee has met twice since the last HERC meeting, April 23 and May 21, 2012. HTAS Coverage Guidance Recommendations: Coffman noted approved coverage guidances will be given to the VbBS who will review the Prioritized List for compliance. • MRI Screening for Breast Cancer (pages 34-35) The 30-day public comment period on the draft guideline closed May 2, 2012. Public comments were received and considered. This guidance is not for individuals who have been diagnosed with breast cancer. The subcommittee members recommend not covering MRI screening for breast cancer due to a lack of proven benefit on morbidity or mortality, as well as concerns about over-diagnosis leading to potential harms. See guidance for specific details. HERC Minutes June 14, 2012 Page 2 Coffman mentioned he had received and responded to an email from a state legislator who pointed out this guidance did not match the Washington HTA review. Coffman noted the Washington report weighted expert opinion more than evidence and came to a different conclusion than the HTAS, who followed the evidence. MOTION: To approve the HTAS recommendations and report. Carries 8-0. Evidence-based Guidelines Subcommittee (EbGS) Report Steve Marks, EbGS Vice-chair, and Livingston reported the subcommittee has met twice since the last HERC meeting, May 3 and June 7, 2012 and have been working on numerous coverage guidances. Each draft document underwent a 30-day public review; public comments were received and considered. The EbGS reviewed and revised the guidances and now submits the amended draft versions for approval of the Commission today. HTAS Coverage Guidance Recommendations: Saha began the discussion by sharing some of the thought process behind this work. Each coverage guidance attempts to address: • individuals for which there is benefit (green light conditions) • individuals for which there is harm (red light conditions) • individuals for which there is insufficient evidence, when individual/clinician shared decision making is recommended (yellow light conditions) – Several factors to take into consideration here include community standard of care and other viable options. Further, Saha discussed an issue that has come up where public comment references studies outside the timeframe and scope of the evidence from trusted sources upon which the guidances are built. The subcommittee’s approach has been if the study was published in the same time frame as the evidence we used, the person/organization suggesting that study should contact those who published the studies as to why it was not included. If the study is newer than the evidence we have used, and it is a game-changer, then we would consider it. The members agree the HERC’s process focuses on evaluating evidence already determined by the trusted sources to be of high quality. Livingston explained there are six coverage guidances proposed today (overview of the six available in the meeting materials on pages 44-51). • Knee Arthroscopy for Osteoarthritis (pages 52-55) The 30-day public comment period on the draft guideline closed May 22, 2012. There is no evidence either arthroscopic lavage or debridement improves pain or functional outcomes in patients with osteoarthritis of the knee. The subcommittee recommends not covering those procedures. There was some discussion around the wording of the treatment; industry input lead to the phrase “lavage and debridement.” Codes added to the guidance were also discussed. MOTION: To approve the proposed coverage guidance. Carries 8-0. HERC Minutes June 14, 2012 Page 3 • Routine Ultrasound in Pregnancy (pages 56-63) The 30-day public comment period on the draft guideline closed May 22, 2012. The evidence review showed routine ultrasound for average risk pregnant women should be covered only once in the first trimester and once after 18 weeks gestation. Further, only one type of routine prenatal ultrasound should be covered in a single day (i.e., transvaginal or abdominal). See guidance for specific details. There was no discussion. MOTION: To approve the proposed coverage guidance. Carries 8-0. • Induction of Labor (pages 64-70) The 30-day public comment period on the draft guideline closed May 22, 2012. The evidence review showed induction of labor should be covered for gestational age beyond 41 0/7 weeks, pre-labor rupture of membranes at term or diabetes, pre-existing and gestational. It should not be covered for macrosomia (in the absence of maternal diabetes), elective purposes (without a medical or obstetrical indication) or breech presentation. In areas of insufficient evidence, coverage should be based on an individualized treatment plan. See guidance for specific details. The members confirmed their agreement regarding areas of insufficient evidence, stressing the need for individual treatment plans. MOTION: To approve the proposed coverage guidance. Carries 8-0. • Indications for Planned Cesarean Section (pages 71-80) The 21-day public comment period on the re-posted draft guideline closed May 14, 2012. There was interest about the evidence for multiple births beyond twins. The evidence shows there is no reason not to try a vaginal birth.
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