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Health Evidence Review Commission January 16, 2020 1:30 PM - 4:30 PM Clackamas Community College Wilsonville Training Center, Room 111-112 29373 SW Town Center Loop E, Wilsonville, Oregon, 97070 Section 1.0 Call to Order AGENDA HEALTH EVIDENCE REVIEW COMMISSION Clackamas Community College Wilsonville Training Center, Rooms 111-112 29353 SW Town Center Loop E Wilsonville, Oregon 97070 January 16, 2020 1:30-4:30 pm (All agenda items are subject to change and times listed are approximate) Action # Time Item Presenter Item 1 1:30 PM Call to order Kevin Olson 2 1:35 PM Approval of minutes (November 14, 2019) Kevin Olson X 3 1:40 PM Director’s report Jason Gingerich 4 1:45 PM Subcommittee appointments Jason Gingerich X Ariel Smits 5 1:50 PM Value-based Benefits Subcommittee report X Cat Livingston Coverage Guidance Topic: Temporary Percutaneous Mechanical Circulatory Support Cat Livingston 6 2:45 PM with Impella Devices Adam Obley X • Coverage guidance • Prioritized List changes Next steps 7 4:20 PM • Schedule next meeting – March 12, 2019 Kevin Olson Wilsonville Training Center, rooms 111-112 8 4:30 PM Adjournment Kevin Olson Note: Public comment will be taken on each topic per HERC policy at the time at which that topic is discussed. MINUTES HEALTH EVIDENCE REVIEW COMMISSION Clackamas Community College Wilsonville Training Center, Rooms 111-112 Wilsonville, Oregon November 14, 2019 Members Present: Kevin Olson, MD, Chair; Holly Jo Hodges, MD, Vice-Chair; Mark Gibson; Leda Garside, RN, MBA (arrived at 1:35 p.m.); Angela Senders, ND; Gary Allen, DMD; Lynnea Lindsey, PhD; Leslie Sutton; Adriane Irwin, PharmD, Michael Adler, MD (by phone); Kevin Cuccaro, DO; Kathryn Schabel, MD. Members Absent: Devan Kansagara, MD. Staff Present: Darren Coffman; Ariel Smits, MD, MPH; Cat Livingston, MD, MPH; Jason Gingerich; Daphne Peck, Jaime Taylor. Also Attending: Dana Hargunani, MD (Oregon Health Authority); Adam Obley, MD, MPH (OHSU Center for Evidence-based Policy); Chris Hennessy (Abiomed); Katy McDowell (Tonkon Torp). Call to Order Kevin Olson, Chair of the Health Evidence Review Commission (HERC), called the meeting to order; roll was called. A quorum of members was present at the meeting. Minutes Approval MOTION: To approve the minutes of the August 8, 2019 meeting as presented. CARRIES 10-0. (Absent: Garside, Adler) Director’s Report Darren Coffman announced his retirement at the end of November. Membership Coffman thanked Mark Gibson and Dr. Kevin Cuccaro as this is their last meeting. He announced the Governor has appointed two new members who are awaiting Senate confirmation: Maximilian Kaiser, DO, of Corvallis and Michael Collins, who is with the Warm Springs Tribe. Dana Hargunani, MD then thanked Coffman for his years of service as it is also his last meeting and presented him with some gifts. She also thanked Gibson and Cuccaro. Hargunani also spoke about Jason Gingerich’s new role as Director. Gibson spoke about the early days of the Prioritized List and praised Coffman for his years of service. HERC Minutes 11/14/2019 1 Coffman reintroduced Kathryn Schabel, MD who joined the Commission in August. With the Health Technology Assessment Subcommittee (HTAS) being sunset, Coffman discussed subcommittee roles. Drs. Schabel (an orthopedic surgeon) and Brian Duty (a urologist and surgeon), had served on HTAS and would now like to serve on the Value-based Benefits Subcommittee (VbBS). Leda Garside had originally been on the Evidence-based Guidelines Subcommittee (EbGS) but was moved at some point to HTAS and would like to move back to EbGS. MOTION: To appoint Schabel and Duty to the Value-based Benefits Subcommittee (VbBS) and Garside to the Evidence-based Guidelines Subcommittee (EbGS). CARRIES 11-0. (Absent: Adler) Conflicts of Interest (COI) Coffman reminded the members of the importance of asking those testifying or presenting to declare their potential conflicts of interest. He mentioned that Hargunani is currently reviewing all the COI processes and procedures with the Department of Justice. Value-based Benefits Subcommittee (VbBS) Report on Prioritized List Changes Meeting materials, pages 66-250 Ariel Smits reported the VbBS met earlier in the day, 11/14/2019. She summarized the subcommittee’s recommendations. RECOMMENDED CODE MOVEMENT (changes to 1/1/2020 Prioritized List) • Add the 2020 CDT, CPT, and HCPCS codes on various lines and lists o HCPCS H0004 (Behavioral health counseling and therapy, per 15 minutes) was not added to Line 1 PREGNANCY • Add wraparound services to the covered autism line o Leslie Sutton asked if OHA and DHS were involved in this discussion and connected; she will connect with Gingerich after the meeting • Add neuropsychological status exams and neuropsychological testing services to the Diagnostic Procedures File with a new guideline • Add coverage for intestinal transplants for patients with short gut syndrome failing total parenteral nutrition (TPN) to include all ages • Add two codes for umbilical hernias to the uncovered hernia line • Add a vestibular rehabilitation procedure to a dysfunction line • Add a code for fall risk to the dysfunction line to enable coverage according to U.S. Preventive Services Task Force (USPSTF) recommendations • Add new codes for patient-provider online interaction codes to E&M lines. Interprofessional consultation codes are recommended for addition to the Fee Schedule. • Make other various straightforward coding and guideline note changes as described in meeting materials RECOMMENDED GUIDELINE CHANGES (changes to 1/1/2020 Prioritized List) • Add a new guideline regarding neuropsychological status exams and neuropsychological testing services • Add a new guideline regarding counseling for prevention of peripartum mood disorders HERC Minutes 11/14/2019 2 o The second paragraph of the new guideline “Supervision of pregnancy codes (ICD-10 O09.X, Z34.X), encounter for screening for maternal depression (ICD-10 Z13.32), and encounter for routine postpartum follow-up (ICD-10 Z39.2) are appropriate to pair with health behavior assessment and interventions for these purposes” was struck as it was determined to not be needed • Edit the non-prenatal, non-hereditary cancer guideline to include indications for pharmacogenetic (P450) testing, modify the microarray analysis entries and include additional cystic fibrosis testing codes • Edit the prenatal genetic testing guideline to remove restrictions on one non-prenatal test • Edit the hereditary cancer genetic testing guideline to update NCCN references and clarify when breast cancer panel testing is covered • Add a new Ancillary guideline on non-face-to-face visits and telephonic and electronic consultation • Delete the prior Guideline Note on telephone consultations • Modify the preventive services guideline to clarify intended coverage of falls prevention • Add a new guideline to the intestinal transplant line outlining when a patient was eligible for consideration for transplant • Edit the breast reconstruction guideline and create a new guideline outlining coverage for revisions to breast surgeries • Edit the hernia guideline to further define ventral hernia to include umbilical hernia and distinguish between incarcerated and obstructed hernias • Edit the guidelines regarding cervical cancer screening and other preventive services to reflect U.S. Preventive Services Task Force (USPSTF) recommendation updates MOTION: To accept the VbBS recommendations on Prioritized List changes not related to coverage guidances, as amended. See the VbBS minutes of 11/14/2019 for a full description. Carries: 12-0 Multisector Intervention Report: Community Health Workers for Patients with Chronic Disease Meeting materials, pages 251-305 Adam Obley, MD and Cat Livingston, MD MPH presented an overview of the evidence. Livingston read the proposed multisector intervention box language. Garside added she has worked with community health workers for many years and has seen a lot of improvement in care. There are many layers to the services they provide. Lynnea Lindsey asked if it were possible to parse the providers so that, for example, doulas were not in the same category as peer wellness specialists. It seems there are many diverse categories of providers in the same “bucket.” She said these factors may affect preference, efficacy and outcome. Obley said parsing out different types of providers would be difficult since sensitivity analysis was not performed in the meta-review. Livingston said Oregon has their own definitions for community health workers that may differ from the definitions in the studies. Schabel asked why the report calls out the three conditions listed that have limited or insufficient evidence (HIV, serious mental illness and congestive heart failure). Staff explained it is because they looked for evidence for those topics and felt it right to include their findings. There was discussion about how that information might be misleading to Coordinated Care Organizations (CCOs); it may be HERC Minutes 11/14/2019 3 incorrectly interpreted to mean that services are not effective when in fact it simply means less research has been conducted in these populations. Lindsey said this is evolving topic and suggested retaining that information in the in-depth multisector interventions report research but to not include the MSI statement attached to the Prioritized List. After discussion, text was added to the Prioritized List MSI statement to clarify: Community health works may be effective for patients with other conditions however, limited
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