WAFP December 2017 Newsletter

Organizational Health

Nominations are Open for Family Physician of the Year, FM Educator of the Year

Register Today for PALI

Apply Today to Represent WAFP at NCCL

Nominations are Being Accepted for the Resident, Medical Student Scholarships

Local chapter news

Members in the News

Advocacy

UW School of Law Report on Volk: “Unworkable,” “Substantially Changed” Duty to Protect, Warn

Inslee Releases Proposed 2018 Supplemental Budget

Washington State Legislature to Convene Jan. 8

Statement to Senate Committee Details AAFP’s Priorities

ACA’s Individual Mandate to be Eliminated in Tax Reform Legislation

Health of the Public

Flu Activity Increasing, According to DOH and CDC

CDC Releases HPV Vaccination Report for Washington

Washington Ninth in 2017 America’s Health Rankings

AAFP Declines to Endorse Recent Hypertension Guidelines from AHA, ACC

Study Shows Anti-Vaccine Parents Value Liberty, Purity

Embracing Learners

113 Registered for 2018 Medical Student & Resident Retreat

Less is More for EHRs, Study Finds

Dr. Warren Newton to Become New President, CEO of ABFM

Female Residents More Likely to Suffer Depression, Research Finds

End of Net Neutrality Damaging to Telehealth, Advocates Say

Practice Enhancement

MIPS Corner: It’s Not Too Late to Avoid a Penalty

CMS’ ‘Meaningful Measures’ Intended to Reduce Physician Burden, but Will They?

Integrating Pharmacists into Medical Homes Improves Outcomes

 

Nominations are Open for Family Physician of the Year, FM Educator of the Year

WAFP wants to know about a family physician who inspires you or — to borrow a phrase from a recent testimonial — who you strive to be like. Nominations are now being accepted for the 2018 Family Physician of the Year and 2018 Family Medicine Educator of the Year.

These annual awards showcase the best our specialty has to offer, but we need your help.

Download nomination forms for Family Physician of the Year and Family Medicine Educator of the Year today!

The deadline for both awards is Jan. 31, 2018.

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Register Today for PALI

The 2018 Policy and Advocacy Leadership Institute will be held Jan. 24, 2018, in Olympia. Open only to WAFP members, PALI brings together family physicians and state government officials. Registration is required; fill out the form on the WAFP website.

PALI’s morning session is spent with legislators, agency heads and the governor’s staff in a discussion about key issues for family physicians. A working lunch provides attendees with an overview of current Academy priorities. Legislative appointments are made for the afternoon for attendees to meet with their elected officials. The appointments will be scheduled between 1:30 p.m. and 5 p.m., so participants must keep this time available.

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Apply Today to Represent WAFP at NCCL

Nominations are now being accepted to represent the WAFP at the National Conference of Constituency Leaders. This is your chance to effect positive change in family medicine while also building your leadership skills. Previous attendees have been overwhelmingly positive about their experiences at NCCL.

The NCCL will be held April 26-28 in Kansas City, MO. The WAFP seeks a representative for each of NCCL’s constituencies: women, minorities, new physicians (in the first seven years of practice following residency), international medical graduates (from outside the U.S., Canada or Puerto Rico), and LGBT physicians or their physician allies.

After submitting an application, candidates will be selected by WAFP’s Diverse Constituencies Subcommittee.

In addition, the WAFP supports three third-year residents to attend NCCL. Candidates must submit an application, which includes a residency recommendation form.

The deadline for both constituency and resident applications is Feb. 9.

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Nominations are Being Accepted for the Resident, Medical Student Scholarships

Deadlines are nearing for several scholarships offered by the WAFP Foundation for residents and medical students.

2018 Roy Virak Memorial Family Medicine Resident Scholarship: If you know a second-year resident who consistently demonstrates outstanding patient care and strong community service, consider nominating her or him for the 2018 Roy Virak Memorial Family Medicine Resident Scholarship.

The Virak Scholarship is the WAFP Foundation’s highest award for residents. Nominations are accepted only from Washington’s family medicine residency program directors, and a winner will be selected by leadership from the WAFP Foundation. The winner will be honored at WAFP’s annual meeting in early May in Spokane.

For more information on submission requirements, please see our informational flyer for the 2018 Virak Award. The deadline for submissions is Friday, Feb. 2, 2018.

Diverse Constituencies Scholarships: The Diverse Constituencies Scholarships are awarded to two first-year medical students who represent a racial, ethnic or sexual minority. For the purposes of the scholarship, minority student status is defined by race as American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian, or other Pacific Islander; by ethnicity as Hispanic or Latino; by sexual minority as lesbian, gay, bisexual and/or transgender (LGBT). Applications for the $1,000 scholarships are evaluated on an interest in primary care, financial need, a personal statement and the intent to pursue a career in family medicine. Invitations to apply are sent out by the medical schools in the fall to all eligible first-year medical students.

FMAS Scholarships: The WAFP Foundation supports a $1,500 scholarship for one medical student and the Academy supports a $1,500 scholarship for one resident to attend the AAFP’s Family Medicine Advocacy Summit (FMAS) in Washington, D.C. in the spring. During the two-day event, participants learn about the legislative process and current priorities for family medicine, practice advocacy skills and meet with members of Washington’s congressional delegation. Medical students are required to submit an application and an academic recommendation form; residents are required to fill out an application and submit a signed residency recommendation form. The deadline for both residents and medical students is Feb. 9, 2018.

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Local Chapter News

The Thurston-Mason-Lewis chapter will hold its winter meeting on Tuesday, Jan. 30, from 6:30 p.m. to 8 p.m. The tentative agenda includes a legislative update, resolutions and selection of delegates for the 2018 House of Delegates, public health news, the chapter’s web page and other topics. If you have additions to the agenda, please email chapter president Cindy Grande, MD, at cgrande@pioneerfamilypractice.com.

If your chapter has upcoming meeting information, let us know! Email Brian Hunsicker at brian@wafp.net with details.

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Members in the News

  • Chris Frank, MD, PhD, wrote an op-ed in The Seattle Times about the health costs of tobacco usage and why raising the age to purchase tobacco makes sense. “The opioid crisis is complicated and requires a wide range of interventions across our medical, mental-health, treatment and law-enforcement systems. I wish we had something as easy as the Tobacco 21 legislation to address the opioid crisis,” Frank said. “Having a straightforward intervention with a proven track record should make this an easy decision. Every year that we wait to make this change creates another cohort of young people who will suffer the negative health impacts of smoking and create unnecessary costs for our publicly funded health-insurance system.”
  • William R. Phillips, MD, MPH, was honored with the Distinguished Research Mentor Award by the North American Primary Care Research Group at its 45th annual meeting in Montreal on Nov. 20. NAPCRG is the world’s premier organization for family medicine and primary care research. The award recognizes outstanding career contributions through mentorship in research. Phillips is Clinical Professor Emeritus of Family Medicine at the University of Washington. He previously served as president of NAPCRG and currently is senior associate editor of the Annals of Family Medicine.
  • Brianne Huffstetler Rowan, MD, MPH, wrote an op-ed in the News Tribune on the state obtaining approval to use Medicaid funds to support housing. But in Tacoma, where the need for low-income housing far outstrips capacity, that isn’t enough. “Without concrete action by the city to create additional housing and provide rent support, Tacoma is likely to find itself with newfound services funneling the homeless into housing that simply doesn’t exist,” she wrote. “… Individuals will find themselves with a plan for how to apply for non-existent housing. They will learn relationship-building skills to work with non-existent landlords. But they will still be homeless and often sick.”
  • Thomas Schaaf, MD, president-elect of the Washington State Medical Association, was quoted in an Inlander feature about Washington’s prescription monitoring program. The story addressed PMP’s potential as well as its potential drawbacks, including adding to administrative burden and the lack of interoperability with EHR systems.

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UW School of Law Report on Volk: “Unworkable,” “Substantially Changed” Duty to Protect, Warn

An analysis by the University of Washington School of Law to the state legislature found that the state Supreme Court’s controversial Volk decision is out of step with most other states’ laws. The analysis says the decision has “substantially changed” providers’ duty to protect and duty to warn; moreover, the decision leads to “an unworkable and counter-intuitive standard.”

Only Wisconsin has laws similar to Washington, and those were created under circumstances similar to Washington’s, the report found. Eight states do not recognize any provider responsibility to warn in the context of mental health care; nine states (including D.C.) allow for provider discretion but stop short of calling it a “duty”; and 33 of the remaining 34 impose a duty to warn or protect but only to third parties who are “readily identifiable, clearly identifiable, specific, or in the zone of risk,” according to the analysis.

“Post Volk, the duty is broader for outpatient mental health providers who have less control over the patient, and in the case of DeMeerleer, may not even have contact, let alone control. The result is an unworkable and counter-intuitive standard,” the report stated.

In its final conclusion, the report noted that the Volk ruling gives clearer guidelines to inpatient providers. For most everyone else, the report stated, “Volk seems to impose an undue burden on outpatient providers; one that is rife with uncertainty and confers an unrealistic unsustainable duty upon them.”

The House Judiciary Committee also heard testimony from the report’s authors; the hearing is available online. The authors also separately released a set of appendices — 288 pages in all — to accompany their report.

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Inslee Releases Proposed 2018 Supplemental Budget

Gov. Jay Inslee (D) has released his proposed supplemental budget that would modify 2017-19 biennial budget adopted in July.

Among health care-related funding, Inslee highlighted numerous areas related to mental health treatment and staffing. Inslee’s budget would also provide for the Department of Health the begin collecting fees to conduct blood testing for Pompe disease and MPS-I as part of the mandatory newborn screening panel. His budget would bring behavioral health integration under the auspices of Healthier Washington and restore hearing-aid benefits for Medicaid-eligible adults.

The budget proposal also includes specific funding amounts and policy changes for both the Department of Health and the Washington State Health Care Authority.

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Washington State Legislature to Convene Jan. 8

The 2018 regular session of the Washington State Legislature will convene Monday, Jan. 8, 2018.

WAFP will stay abreast of happenings through our Olympia-based advocacy team, Jonathan and Patty Seib. And WAFP will communicate those happenings to its membership via a weekly report on our website; members can also choose to have those reports emailed.

WAFP’s draft legislative agenda lays out the Academy’s priorities for the upcoming session. Among those priorities: increasing reimbursement to match the increased expectations of family physicians under Healthier Washington; reducing the legal, administrative and tax burden imposed on family physicians; maintaining or improving health care coverage under CHIP or the ACA; sustaining community health centers and teaching health centers; enacting evidence-based policies to slow the opioid and homeless crises; and opposing inappropriate new programs, requirements or educational mandates.

You can keep up to date with happenings in the legislature via the body’s webpage. The main pages displays a current list of hearings and floor sessions, as well as how to find your district and how to contact your representatives. Hearings are broadcast on TVW’s State House of Representatives channel or its State Senate channel.

The legislature welcomes comments on pending legislation. To comment, enter the bill number or browse the bills by topic page.

Each proposed law has its own webpage, and those webpages contain links for comments. To leave a comment, you must provide your address and contact information; declare your support, opposition or neutrality on the legislation; and leave a comment of no more than 1,000 characters.

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Statement to Senate Committee Details AAFP’s Priorities

The AAFP laid out its priorities for improving public health outcomes with a wide-ranging statement to the Senate Health, Education, Labor and Pensions (HELP) Committee. Sen. Patty Murray (D-WA) is the ranking member on the committee.

Key among those priorities is the recognition of the primacy of primary care; the statement calls it “the foundation of an efficient health system” and urges the committee to support programs to improve patient access to primary care and reduce the nationwide physician shortage.

The statement also addresses mental health and substance abuse; chronic disease prevention; immunization and infectious diseases; child health; and barriers to achieving health equity.

The statement was released in conjunction with a HELP Committee hearing, “Encouraging Healthy Communities: Perspective from the Surgeon General.” The hearing featured testimony from U.S. Surgeon General Jerome Adams, MD, MPH.

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ACA’s Individual Mandate to be Eliminated in Tax Reform Legislation

Controversial tax reform legislation – passed by the House and Senate and expected to be signed by President Donald Trump in January – will also eliminate the individual mandate that was a feature of the Affordable Care Act.

Doing so would likely increase the number of uninsured individuals in the U.S. According to the Washington Post, which studied the findings of the nonpartisan Congressional Budget Office, an additional 4 million Americans would be without insurance in 2019 and 13 million would be without insurance a decade from now.

Though the federal government would save more than $300 billion because of fewer people signing up for coverage through the ACA, premiums would increase because those who do sign up would be sicker.

“The data is very murky on how much of an effect the individual mandate has had,” Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, told the Post. “I think it’s likely that millions more people will be uninsured with the individual mandate repealed but not to the extent that CBO projected. Insurance premiums will certainly go up.”

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Flu Activity Increasing, According to DOH and CDC

The Washington State Department of Health is reporting that influenza activity is on the rise across the state.

In the 2017-2018 season, 10 deaths have been attributed to influenza: three in Pierce County, two each in Kitsap, Spokane and Whatcom counties, and one in King County. The 10 deaths are the highest at this point in the flu season in at least the past eight years. In the 2016-17 season, there were nine deaths; in the six seasons before that, the highest number of deaths at this point in the season was four.

Nationally, data from the Centers for Disease Control and Prevention indicate that H3N2 is the dominant subtype so far – as is also the case in Washington. Influenza B cases have accounted for just over 13 percent of flu cases this year; B/Yamagata has comprised nearly two-thirds of B cases.

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CDC Releases HPV Vaccination Report for Washington

According to the most recent data from the Centers for Disease Control and Prevention, Washington had ordered 53 percent of the estimated total annual doses of HPV vaccine to cover every 11-year old in the state.

The data runs through the second quarter of 2017, meaning that the state has ordered an excess of vaccines compared to the estimated 88,413 11-year olds in the state. That means the state also has enough doses for catch-up vaccinations for older adolescents and younger adults.

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Washington Ninth in 2017 America’s Health Rankings

Citing our state’s low incidence of smoking, preventable hospitalizations and low birthweights, America’s Health Rankings listed Washington as the ninth healthiest state in the country.

In clinical care, the state ranked fifth – despite a 21st-place ranking in ratio of primary care physicians.

The report, which is produced annually by the United Health Foundation, identified the state’s challenges as a high incidence of pertussis, the low meningococcal immunization coverage by adolescents, and the large health disparity by educational attainment as ongoing barriers.

Massachusetts, Hawaii and Vermont were the top three states, while Mississippi, Louisiana and Arkansas were at the bottom.

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AAFP Declines to Endorse Recent Hypertension Guidelines from AHA, ACC

The AAFP has decided to continue usage of guidelines developed in 2014 for the treatment of hypertension in adults in light of guidelines issued recently by the American Heart Association, the American College of Cardiology and nine other organizations.

The 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, developed by panel members appointed to the Eighth Joint National Committee (JNC8), remains the guideline of record for the AAFP.

“Based on the methodology, applicability and consistency within the JNC8 guideline, the AAFP felt strongly that the JNC8 upheld the scientific rigor that provided strong recommendations to family physicians and patients on appropriate treatment of hypertension,” David O’Gurek, MD, chair of the AAFP’s Commission on Health of the Public and Science, told AAFP News.

O’Gurek added that a number of factors played into the decision: the bulk of the guideline wasn’t based on a systematic evidence review and the heavy weight placed on the Systolic Blood Pressure Intervention Trial (SPRINT) at the minimization of other studies.

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Study Shows Anti-Vaccine Parents Value Liberty, Purity

Using the Moral Foundations Theory, researchers at Emory University found that adults who valued liberty and purity were most likely to be vaccine hesitant.

The study was published in Nature Human Behavior.

“This is important because many of our go-to arguments about herd immunity and keeping your children safe are themed around values of harm and fairness,” epidemiologist Avnika Amin, a PhD candidate at Emory and the study’s lead author, told Vox.

Framing messages that align with people’s beliefs may result in a better outcome, said Saad Omer, PhD, MPH, another author and the Emory’s William H. Foege Chair in Global Health.

“You could increase the salience of disgust associated with certain diseases, and say vaccines fight those,” Omer said. “Or you could frame purity positively — saying vaccines are a very natural product, they work with a natural system. Messages that talk about liberty, that the freedom to choose for your child is being taken away if other others don’t vaccinate, might work.”

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113 Registered for 2018 Medical Student & Resident Retreat

The 2018 Medical Student and Resident Retreat, sponsored by the WAFP Foundation, is expected to welcome 113 attendees on Jan. 6 and 7 at Icicle Village Resort in Leavenworth.

Each of the state’s four medical schools will be represented, as will several residency programs. Medical students from the WWAMI site in Moscow, ID, will also be in attendance.

In all, 16 workshops have been offered, including a track dedicated to residents.

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Less is More for EHRs, Study Finds

Recent research published in the Journal of the American Board of Family Medicine found that cluttered documentation may obscure high-value data in an EHR.

Researchers designed four physician notes documents and tested them on 16 physicians in a random order. The physicians were asked to find key information within the EHR during a timed task. They were then asked to rate the usability, and underwent additional interviews with researchers to provide additional insight.

The designs were based on the APSO (assessment, plan, subjective and objective) prototype.

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Dr. Warren Newton to Become New President, CEO of ABFM

Warren Newton, MD, MPH, currently the vice dean of School of Medicine at the University of North Carolina (UNC) and Executive Director of the North Carolina Area Health Education Center, will become president and CEO of the American Board of Family Medicine on Jan. 1, 2019.

Newton will replace James Puffer, MD, who will retire at the end of 2018. Newton will become CEO-elect on July 1, 2018, before officially succeeding Puffer in 2019.

“Warren Newton’s extraordinary service to the discipline of family medicine and his commitment to improving health has been a core value that has guided every aspect of his professional work over the last three decades,” said Elizabeth G. Baxley, MD, chair of the ABFM Board. “I have had the privilege of working with Warren at the state and national level and can attest to his dedication to continuous improvement and innovation in clinical care and education, as well as his drive to strengthen the discipline of family medicine to serve the American public.”

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Female Residents More Likely to Suffer Depression, Research Finds

Research published in JAMA Internal Medicine found that female residents were more likely to report depressive symptoms six months into their residency training.

The Upshot blog of The New York Times reported that, though both sexes were likely to report depression, family conflict was a significant contributor to women’s depression.

“There’s a saying that you can’t take good care of patients unless you take good care of yourself, but as a colleague recently told me, ‘Try taking care of patients, yourself and two kids at home — while working 80 hours a week,’” wrote Dhruv Khullar, MD, an internist and hospitalist at NewYork-Presbyterian and the author of the NYT blog post.

The study recommends systemic changes to remedy work-life conflict for female residents, since depression among physicians is linked to poorer patient care.

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End of Net Neutrality Damaging to Telehealth, Advocates Say

The Federal Communications Commission’s Dec. 14 repeal of “net neutrality” rules could cause lasting damage to telehealth efforts, according to mHealth Intelligence.

“Reliable low cost service for telehealth is potentially threatened by the loss of [net neutrality],” four authors wrote in Health Affairs in May. “What happens to telehealth if Netflix traffic is preferred above medical applications? Could Internet Service Providers (ISPs) offer better services for one hospital system than another, helping them take over telehealth in a region? The undoing of NN weakens the infrastructure of reliable low cost connectivity that telehealth systems depend upon.”

The AAFP had previously weighed in against changing net neutrality rules.

“The FCC must ensure that internet service providers do not place fees or constraints on health information exchange above and beyond the usual and customary fees to access the Internet,” former AAFP Board Chair Wanda Filer, MD, MBA, FAAFP wrote to FCC Chairman Ajit Pai. “Our members in rural areas do not have multiple companies providing broadband access to the Internet and therefore are at the mercy of those local monopolies to provide them enough bandwidth to be able to adequately exchange health information.”

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The Quality Payment Program (QPP) Reporting Period is Approaching: It’s Not Too Late to Avoid a Penalty

October 2, 2017, was the last day to start your 90-day reporting period, and March 31, 2018, is the deadline to report. However, it’s not too late to avoid a four percent penalty in 2019 by submitting one quality measure, one improvement activity or the base score of the Advancing Care Information Category.

Qualis Health produced a new resource to help eligible clinicians avoid a penalty. Download the Three Ways To Avoid a MIPS Penalty document today. Additionally, we encourage clinicians to contact us with any QPP-related questions or visit Qualis Health’s online resource center.

Fact or Fiction: Feedback from the Field 
We’ve heard from many clinicians recently and noticed that a few common misconceptions exist around the QPP. We wanted to take the opportunity to address a couple common QPP myths.

Q: Can I still apply for a hardship exception for the ACI category in 2017?
A: Yes, the deadline was extended to December 31, 2017. For more information, learn more about the hardship exceptions on the QPP website.

Q: Can I participate in the QPP if I don’t have an EHR?
A: Yes, there are many ways to participate in the QPP. Qualis Health can help you determine the best path forward. Contact Qualis Health to learn more.

Now Available: Accredited Online Course – QPP MIPS Participation in 2017 

CMS is offering a new QPP web-based training course. This course is eight classes in an evolving curriculum on the Quality Payment Program, where participants will gain knowledge and insight on the program all while earning valuable continuing education credit. For information on how to login or find training, please visit the MLN Learning Management System FAQ sheet.

New CMS QPP Resources Now Available 

CMS recently released new QPP resources that include:

  • Interim Final Rule with Comment Period Fact Sheet
  • CMS Web Interface Upcoming Support Webinars List
  • CMS Web Interface Excel Template
  • CMS Web Interface Excel Template User Guide 2017
  • Instructional Video on CMS Web Interface Excel Template Introduction

These resources are available on CMS.gov.

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CMS’ ‘Meaningful Measures’ Intended to Reduce Physician Burden, but Will They?

Modern Healthcare reports that a recent webinar hosted by the Centers for Medicare and Medicaid Services left physician participants with more questions than answers.

The webinar discussed CMS’ “meaningful measures” quality reporting framework, which is intended to reduce the reporting burden for providers. But, according to the story, those in attendance were unconvinced that the initiative would actually do that.

Six categories comprise the meaningful measures initiative, dealing with communication, chronic disease prevention and management, patient and family engagement, communities, reducing harm caused by care delivery, and affordability.

“We get that there is a burden in terms of what we ask clinicians to do in terms of reporting measures,” said Theodore Long, MD, MHS, senior medical officer for CMS’ Center for Clinical Standards and Quality. “Our goal with the meaningful measures framework is to land at a place where we have measures that have the absolutely lowest level of burden for clinicians but that are still meaningful for patients and clinician.”

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Integrating Pharmacists into Medical Homes Improves Outcomes

A study published in the Journal of International Medical Research found that adding a clinical pharmacist to established primary care medical home practices led to significant impact for patients.

Those patients — patients with diabetes and hypertension with Salt Lake City-based Intermountain Healthcare — were more likely and quicker to achieve their disease management goals. The patients in the study also had increased ambulatory encounters compared with those not in the study.

The pharmacists helped begin and adjust patients’ medications, as well as ensuring those medications were being used properly.

“What was so critical about this study was that the program was able to show a marked improvement for patients even when layered over a team-based care structure that’s already demonstrated improved quality outcomes and decreased annual cost as published earlier in 2016,” Kim Brunisholz, PhD, the study’s lead author, said in a statement, according to Drug Topics.

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