WAFP February 2018 Newsletter
Health of the Public
Registration Now Open for 2018 Annual Scientific Assembly
Online registration is now open for WAFP’s 2018 Annual Scientific Assembly.
The 2018 ASA will be held May 4 and 5 at the Davenport Hotel in Spokane. The themes for ASA are physician resiliency and combating the opioid epidemic. Workshop topics include transgender health, basic osteopathic manipulation, global medicine, cancer survivorship, and recognizing child abuse and neglect.
Three Knowledge Self-Assessment courses will be held: one each on depression, childhood illness and pain management. A course for earning your buprenorphine waiver will also be available.
Early-bird pricing is available, so register today!
First-Year Medical Students: Apply for WAFP’s Summer Research Externship Program
The WAFP Foundations is offering grants to Washington medical students who are interested in participating in Family Medicine Summer Research Externship. These are usually scheduled between their first and second years of medical school. Medical students complete independent research projects under the mentorship of family physicians in the community and at their medical school. These studies meet research requirements for graduation and the final reports may be presented at research forums or conferences. Some studies result in peer-reviewed publications.
The deadline to apply is March 30. Learn more on the WAFP website.
Local Chapter News
If your chapter has upcoming meeting information, let us know! Email Brian Hunsicker at email@example.com with details.
Members in the News
- Tanny Davenport, MD, MMM, FAAFP, talked with the Yakima Herald about five health symptoms that patients should not ignore: symptoms of heart disease, sudden or unexplained weight loss or gain, lumps in or near the neck, loss of appetite, and unusual bowel movements.
- Chris Frank, MD, PhD, wrote a column for KevinMD.com about the shortsightedness of ignoring health disparities when trying to transform health care. “I worry that the transition to value-based payment systems may exacerbate the inequities in our society that are the major driver of poor outcomes,” Frank wrote. “We could inadvertently create a system that tries to improve health outcomes but actually worsens health equity.”
- A feature in The (Lewis County) Chronicle explains how the residency program at Chehalis Family Medicine is helping to improve patient care not only in Chehalis but in all of rural southwest Washington. Among the members featured in the story were faculty members Rein Lambrecht, MD, and Juan Miguel Lee, MD, as well as residents Kristina King, MD, and Jordan Snell, DO.
- Martin Levine, MD, was the subject of a CNBC story reporting that he has been hired to an unspecified role with Amazon. CNBC speculated about how Levine — previously an executive with Boston-based Iora Health — could help Amazon enter the health care industry.
- Enrique Leon, MD, has been appointed to fill an opening on the Tacoma School Board of Directors. He was one of the five finalists for the position and will serve until November 2019. Leon then has the option of running to serve the remainder of the term, which expires in November 2021. He replaces Catherine Ushka, who resigned after being elected to Tacoma City Council.
- Bob Lutz, MD, MPH, and David Ward, MD, were quoted in a Spokesman-Review story about ways patients can reduce medical spending. Lutz is the health officer for the Spokane Regional Health District, while Ward is a physician at Kaiser Permanente’s South Hill Clinic.
- Christopher Moore, MD, MPH, was interviewed in a KIRO-TV piece about a celebration of Black History Month in Seattle’s Central District. Moore hosted an “Ask a Doctor” panel at the event and talked about health disparities within the black community, including diabetes, high blood pressure and HIV.
- Pamela Pentin, MD, FAAFP, was quoted in a MedPage Today article about the small percentage of America’s doctors who have buprenorphine waivers. “I saw patients walking into a doctor’s office with chronic pain, being prescribed opioids without regard for any true functional improvement, and then coming in again with opioid addiction as their primary problem,” said Pentin, who obtained her waiver in 2004.
- The research of Poyrung Poysophon, MD, MPH, and Ashwin Rao, MD, was featured in MD Magazine. Poysophon, a third-year resident with the University of Washington School of Medicine Department of Family Medicine, and Rao, program director for the University of Washington Sport Medicine fellowship, found that concussed athletes with ADHD suffered more cognitive dysfunction and took longer to recover. Their research was originally published in Sports Health.
State Legislative Session Pulls into Home Stretch
This is the final week for bills under consideration by the Washington Legislature to advance to the desk of Gov. Jay Inslee. By the end of the week, any bill will need to have been passed both by its “house of origin” and by the opposing house. Per the state constitution, the 60th — and final — day of the regular session will be Thursday, March 8.
Several pieces of legislation of importance to the WAFP are still under consideration, including bills dealing with social determinants of health, medical student loans and scholarships, opioid use disorder treatment and prevention, housing discrimination based on source of income, health coverage for Pacific Islanders residing in the state, and increasing Washington’s smoking age.
Our weekly legislative updates webpage has more detail on these bills. Please note that you must be logged in to view the page. You can also use that page to sign up to have the updates delivered to your inbox.
AAFP, Others Call for Immediate Congressional, Presidential Action on Gun Violence
In the wake of a Florida mass shooting, the AAFP — along with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Psychiatric Association — called on Congress and President Donald Trump to immediately address gun violence.
The groups advocated for identifying gun violence as a national public health epidemic; funding appropriate research at the Centers for Disease Control and Prevention in the 2018 federal budget; and establishing constitutionally appropriate limits on high-capacity magazines and firearms with features designed to increase their rapid and extended killing capacity.
“We urge our national leaders to recognize in this moment what the medical community has long understood: We must treat this epidemic no differently than we would any other pervasive threat to public health,” the organizations wrote. “We must identify the causes and take evidence-based approaches to prevent future suffering.”
The announcement was issued after a gunman killed 17 students and teachers at Marjory Stoneman Douglas High School in Parkland, FL.
Closer to home, the Washington Legislature is considering legislation related to gun violence. S.B. 5992 would ban bump stocks, which allow semiautomatic rifles to fire more rapidly. Both houses of the legislature have approved the measure, and The Seattle Times reports that Gov. Jay Inslee has signaled that he would sign it.
Other proposals, including S.B. 6620 (which would, among other things, prohibit the sale or a semiautomatic rifle or shotgun with tactical features to anyone under 21 or the sale or transfer of such a weapon to anyone without having undergone a state and federal background check) and H.B. 2442 (which would create a way for students to anonymously report threats), did not advance out of the legislature.
CHIP, THCGME Addressed — Though Not Permanently — in Federal Budget Deal
The Children’s Health Insurance Program now has funding through 2027 and funding for the Teaching Health Center Graduate Medical Education was extended for two years and doubled. The funding was codified in the bipartisan budget deal that was passed earlier this month, thereby addressing two longstanding concerns of primary care advocates.
“While the AAFP has called for much longer funding — and preferably permanent funding — for teaching health centers, we are pleased that the program will be extended and funded,” AAFP President Michael Munger, MD, FAAFP, said.
According to AAFP News, the legislation also maintains Medicare’s current Geographic Practice Cost Index for two years, preventing a cut in physician fees in areas where labor costs differ from the national average.
FDA’s Gottlieb Outlines Agency’s Work on Opioids, E-Prescribing
At a recent conference in Washington, DC, FDA Commissioner Scott Gottlieb, MD, described his agency’s work in preventing opioid use disorder, identifying new problem areas and his hope for a nationwide e-prescribing system.
His comments were reported in Regulatory Focus, the blog of the Regulatory Affairs Professionals Society.
Gottlieb said FDA agents are now more focused on the Internet and social media to identify sources of illicit fentanyl, as well as spot new trends before they become a problem. One such trend is the abuse of gabapentinoids, including Neurontin and Lyrica.
“We’ve looked at social media sites where opioid users share comments that describe methods and motivations for misusing or abusing gabapentinoids,” Gottlieb said.
He was also hopeful of the potential on a nationwide e-prescribing system, which he believed could alleviate interoperability problems between states’ own prescribing systems and prescription monitoring programs.
Washington Sees 23 Cases in Salmonella Outbreak, Among More Than 1,100 Nationally
An outbreak involving backyard poultry has led to 1,120 cases of salmonella across the U.S. Though the Washington State Department of Health has recorded only 23 of those, that is more than double the number of similar cases during the past two years combined.
The Centers for Disease Control and Prevention noted that California’s 61 cases were the most of any state. The highest concentration of cases came in an 11-state area bounded by Minnesota and Missouri in the west and New York and North Carolina in the east.
Flu Season on the Decline, but It Left 189 Deaths in Its Wake
In its most recent influenza update, the Washington State Department of Health declared flu activity to be on the decline across the state. As it stands, 189 state residents died as a result of the flu this season.
Over the past two flu seasons, 467 Washingtonians have died from the illness. That’s more than the combined totals from the 2010-11 flu season through the 2015-16 season.
Snohomish County was hit hardest, with 31 deaths, followed by Spokane (28), King (24), Pierce (18), Benton (14) and Clark (11).
Report Finds WA Patients Received $280 Million in Low-Value Medical Services
The Washington Health Alliance, in conjunction with the Choosing Wisely initiative in Washington state, has found that more than 600,000 state residents received medical services that were likely unnecessary and probably should not have occurred. The total bill for those procedures: approximately $282 million.
The calculations were performed using Milliman’s MedInsight Waste Calculator.
Further, the report identified 11 low-value services, which accounted for 93 percent of the services delivered and 89 percent of the cost. The 11 services were:
- Too frequent cervical cancer screening in women
- Preoperative baseline laboratory studies prior to low-risk surgery
- Unnecessary imaging for eye disease
- Annual cardiac screening (including EKGs) for low-risk, asymptomatic individuals
- Prescribing antibiotics for acute upper respiratory and ear infections
- PSA screening
- Population-based screening for OH-Vitamin D deficiency
- Imaging for uncomplicated low-back pain in the first six weeks
- Preoperative EKG, chest X-ray and pulmonary function testing prior to low-risk surgery
- Cardiac stress testing
- Imaging for uncomplicated headache
“While a goal of zero harm is desirable, it is not realistic. What we strive for is substantially reducing the risk of preventable harm. Reducing unnecessary overuse of health care services is one important way to do this,” the report states. “The result of the ‘more is always better’ culture present in today’s health care delivery seems to be: ‘first, do something.’ It is time to get back to, ‘first, do no harm.’”
CDC, AAFP Release 2018 Immunization Schedules
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, along with AAFP and other medical organizations, have released the 2018 adult and childhood immunization schedules.
AAFP News reports that the changes this year include recommending preferential use of the new herpes zoster subunit vaccine (HZ/su; Shingrix), which is approved for use in adults 50 and older, over the currently available herpes zoster live vaccine (Zostavax).
Among the other changes were adding a third dose of MMR vaccine for at-risk patients during outbreaks and introducing a more user-friendly format to the childhood immunization schedule.
USPSTF: Don’t Screen Average-Risk Women for Ovarian Cancer
The U.S. Preventive Services Task Force has advised against the use of screening for ovarian cancer in asymptomatic women. The advice, however, doesn’t apply to women who are at high risk for ovarian cancer, such as those who have a BRCA gene mutation associated with hereditary breast and ovarian cancer syndrome.
Public feedback noted the aggressive nature of ovarian cancer and how its symptoms often appear at later stages, but the task force responded that current tests do not detect ovarian cancer and can cause harm by causing healthy women to undergo surgical removal of their ovaries even when no cancer is present. Other feedback caused the task force to clarify which factors would put a woman at high risk for ovarian cancer.
Apply for AAFP Foundation Family Medicine Cares Resident Service Award by March 15
The AAFP Foundation is offering first- and second-year residents a chance to address an unmet health care need of underserved patients in their community. The foundation will offer up to two $16,500 awards.
Residents must work with an organization that provides care to develop a project that addresses a health disparity in the community. That project should have an enduring benefit to the patients and the community after the 12-month project period. And the winning resident is expected to present results at the AAFP National Conference of Family Medicine Residents and Medical Students.
The deadline for entries is 5 p.m. Pacific on Thursday, March 15, 2018.
Applications are Being Accepted for FMIG Network Program of Excellence Award
The AAFP is now accepting applications for its FMIG Network Program of Excellence Award. Two winning schools — one a historical, consistent winner of the award, one not a historical winner — will receive a $600 cash prize each and be recognized at the National Conference of Family Medicine Residents and Medical Students.
Awards are given in two segments: 10 overall Program of Excellence Award winners, and special consideration or categorical awards. The categories include excellence in community service, excellence in professional development, excellence in exposure to family medicine and family physicians, excellence in promoting the value of family medicine as primary care, first-time applicant, and most improved FMIG.
AOA Match Produces 500 New Residents for Family Medicine
Results of the 2018 American Osteopathic Association AOA Intern/Resident Registration Program show that family medicine accounted for one-third of the filled residency slots.
In all, 503 are bound for a family medicine residency program. A total of 65.7 percent of osteopathic medical students matched into a residency program, a slightly lower number than previous years, according to the AOA.
The AOA also noted that this is the third of a five-year transition to a single accreditation system for graduate medical education.
“My interpretation is that we are seeing the results of the transition to the single accreditation system, Clif Knight, MD, FAAFP, the AAFP’s senior vice president for education, told AAFP News. “We’ll be monitoring NRMP results closely, and when those are added to the AOA results, we’ll have a better understanding of the full picture for family medicine.”
Research Paper Identifies Four Workforce Reforms to Ease Physician Shortage
New research from the Mercatus Center at George Mason University has found four ways to ease America’s physician shortage.
Jeffrey Flier, MD, of Harvard Medical School, and Jared Rhoads, MPH, of the Dartmouth Institute for Health Policy and Clinical Practice, argue for:
- Minimizing barriers to license doctors. Flier and Rhoads identify a second possible pathway to earning a doctorate: attaching medical schools to integrated health systems.
- Hiring more international medical graduates. Given that IMGs are more likely to practice primary care in rural, low-income settings, this presents the most direct route to easing the physician shortage. The study further recommends that the Educational Commission for Foreign Medical Graduates (ECFMG) reduce retraining licenses for IMGs.
- Hiring more nonphysician providers. In the absence of physicians, nonphysician providers can help fill the gap, the authors write.
- Embracing technology. While technology could improve access while also reducing costs, the regulatory environment and industry hesitance could be barriers.
MIPS Corner: MIPS Reporting Deadlines Fast Approaching: Important Dates to Keep in Mind
Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Submit early and often.
Here are key upcoming dates for MIPS:
- March 1:Deadline for final claims to be processed for the quality performance category via your Medicare Administrative Contractors (MACs), including claims adjustments, re-openings or appeals. The claims data submission fact sheet as well as your MAC can provide you with specific instructions for the Quality Payment Program. Please note that claims reporting is only available for individual eligible clinicians.
- March 16 at 5 p.m. Pacific: Deadline for 2017 data submission for groups reporting via the CMS web interface.
- March 31: Deadline for 2017 data submission for all other MIPS reporting, including via qpp.cms.gov.
Qualis Health can help with your QPP questions! Contact us: 877-560-2618 or QPP@qualishealth.org.
New CMS QPP Resources Now Available
CMS recently released new QPP resources that include:
- Year 2 Overview fact sheet
- Final rule executive summary
- 2017 Extreme & Uncontrollable Circumstances Policy for MIPS fact sheet (interim final rule with comment fact sheet)
Additional training videos:
- Merit-based Incentive Payment System (MIPS) Data Submission
- Advancing Care Information (ACI) Data Submission for Alternative Payment Models (APMs)
- Data Submission via a Qualified Clinical Data Registry and Qualified Registry
Having a MIPS Moment? Contact Qualis Health
Whether you’re new to the world of quality reporting or a veteran with a burning question, we can help.
- Qualis Health: 877-560-2618 or QPP@qualishealth.org
- Qualis Health QPP Online Resource Center
- Quality Payment Program Website
NAM Discussion Paper Details Factors Affecting Clinician Well-Being and Resilience
Authors representing the spectrum of clinicians collaborated, in conjunction with the National Academy of Medicine, to create an “all-encompassing, conceptual” model of factors that could lead to clinician burnout. The results of their work were released in late January by NAM.
The report detailed a range of factors, broadly categorized as individual and external factors. Individual factors included a person’s health care role, their personal factors, and their skills and abilities. External factors included socio-cultural factors; regulatory, business and payer environment; organizational factors; and learning/practice environment.
“The Conceptual Model working group set out to create a model that could be used by individuals and organizations to understand the causes and effects of burnout, identify strategies to prevent and treat burnout and promote well-being, and improve health care delivery and patient outcomes,” the authors wrote. “The model depicts the domains and factors associated with burnout and well-being, and applies them across all health care professions and career stages, including that of the student, and clearly identifies the link between clinician well-being and outcomes for clinicians, patients and the health system.”
The authors included Timothy Brigham, MDIV, PhD, of the Accreditation Council for Graduate Medical Education; Connie Barden, RN, of the American Association of Critical-Care Nurses; Anna Legreid Dopp, PharmD, and Christina Martin, PharmD, both of the American Society of Health-System Pharmacists; Art Hengerer, MD, FACS, of the Federation of State Medical Boards; Jay Kaplan, MD, FACEP, of the American College of Emergency Physicians; Beverly Malone, PhD, RN, of the National League for Nursing; Matthew McHugh, PhD, JD, MPH, RN, of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing; and Lois Margaret Nora, MD, JD, MBA, of the American Board of Medical Specialties.
CMS Seeks Physicians for Study on Reporting Burdens
The Centers for Medical and Medicaid Services is now accepting applications for physicians to participate in its Burdens Associated with Reporting Quality Measures Study.
The study is open to MIPS-eligible clinicians who are participating in MIPS as an individual or as part of a group. CMS says there are also limited openings for clinicians who aren’t MIPS-eligible.
Individuals and groups who participate successfully will earn full credit for the 2018 MIPS Improvement Activities performance category. To earn the credit, participants must:
- complete a 2017 MIPS participation survey in April or May 2018;
- fill out a 2018 MIPS planning survey in September or October 2018;
- and meet minimum requirements for the MIPS quality performance category by submitting data for at least three measures.
For more information, email firstname.lastname@example.org.
Medicare Wellness Visits Increase Revenue but May Worsen Disparities
Research published in Health Affairs has found that Medicare wellness visits increase revenue for primary care clinics. But, at practices who care for the underserved, adoption of the annual wellness visit was much less likely, thereby worsening health disparities in those communities.
In 2015, the study found that nearly a quarter of urban practices offered wellness visits; in rural areas, only eight percent of practices did so. Hospital practices were less likely than independent practices to provide the visits. Overall, 51.2 percent of practices offered no wellness visits.
“On average, practices that adopted the annual wellness visit generated greater primary care revenue and had an increase in revenue over the study period, while nonadopters had a slight decline,” the authors — Ishani Ganguli, MD; Jeffrey Souza; J. Michael McWilliams, MD, PhD; and Ateev Mehrotra, MD, all of Harvard Medical School — wrote, according to a Medscape recap.
How to Help a Colleague Who’s Struggling with Burnout
AAFP President Michael Munger, MD, FAAFP, and Senior Vice President Clif Knight, MD, FAAFP, offered advice to Physicians Practice on how to identify and help a colleague who may be burned out.
Knight offered that prevailing medical culture maintains a ‘do not butt in’ attitude, but that approach is misguided. Butting in is difficult, but, he said, it’s “the right thing to do.” His previous experience on the Indiana State Medical Association Commission on Physician Assistance taught him that anger was the predominant emotion of those who were turned in by colleagues.
“But after treatment,” Knight said, “the response is almost always ‘I wish I had gotten help sooner.’”
Munger advocates for a supportive, nonconfrontational approach. Persistence may be necessary.
If, however, patient care is jeopardized or a colleague may be at risk for suicide, a more aggressive intervention may be necessary. Large practices may offer ways to anonymously report such problems; in smaller practices, Munger recommends outreach to the colleague’s family members or close friends.
“We absolutely need to look at and address the drivers of the problem,” Munger said, “but meanwhile, we have to take care of each other.”