WAFP March 2018 Newsletter
Health of the Public
Today is the Last Day for Early-Bird Pricing at 2018 ASA
March 30 is the deadline to take advantage of the early bird prices for the 2018 Annual Scientific Assembly on May 4 and 5 and the Davenport Hotel in Spokane.
After today, registration prices increase for all but medical students and retired WAFP/AAFP members.
The twin themes for this year’s ASA are physician resiliency and combating the opioid epidemic, and many of the plenaries and workshops support those themes. David Tauben, MD, chief of pain medicine at UW Medicine, will deliver this year’s Mead Lecture to kick off the ASA on Friday morning. Following Tauben’s presentation are several other opioid-related plenaries: a history of opioid use and misuse with Chris Frank, MD, PhD; a session on team-based chronic opioid management with Michael Parchman, MD, MPH; recognizing and combating opioid use disorder in patients with chronic pain by Pamela Pentin, MD; and a presentation on family physicians’ role in turning the tide on the opioid epidemic by Caleb Banta-Green, PhD, MPH.
New this year: The ASA will offer a four-hour course for providers to obtain their buprenorphine prescribing waiver.
Other workshop topics include transgender health, performance reporting and the Quality Payment Program, basic osteopathic manipulation in primary care, global medicine in clinical practice, cancer survivorship, point-of-care ultrasound, choosing the best antidepressant, and antibiotic stewardship.
There will also be three, three-hour Knowledge Self-Assessment modules on depression, childhood illness and pain management.
The ASA is the largest part, but not the only part, of the WAFP Annual Meeting. The event begins with a Board of Directors on the evening of Wednesday, May 2, followed by the all-day House of Delegates on May 3. The Board of the WAFP Foundation will also meet that day. Family Fun Night commences at 6 p.m. on May 3 to celebrate the hard work of those participating in the House of Delegates.
Friday’s lunch will celebrate the WAFP Foundation’s annual award winners. And Friday evening’s banquet honors the 2018 family physician of the year and family medicine educator of the year. The auction will raise money for the Foundation’s philanthropic efforts, and the new officers for the 2018-19 term will be installed by AAFP Board Chair John Meigs, Jr., MD, FAAFP. If you have an item you’d like to donate to the auction, please use the form on the WAFP website. The deadline for donations is April 9.
Medical Students Elect Butler, Williams as Co-Trustees
Collena Butler, OMS2, of PNWU, and Ashley Williams, MS1, of UWSOM’s Seattle campus, have been elected as WAFP medical student co-trustees in an election completed earlier this month.
The House of Delegates will formally approve their appointment in early May.
Butler completed her undergrad at the University of Washington, majoring in medical anthropology and global health with a minor in Spanish. She is currently president of PNWU’s family medicine interest group and also serves on committees for the Washington Osteopathic Medical Association and the American College of Osteopathic Family Physicians.
Williams completed her undergrad at Stanford University, majoring in human biology with a concentration in human behavior and interpersonal relations. She currently serves as the leader for both the medical humanities and narrative medicine interest group as well as the family medicine ROOTs Young Adult Homeless Shelter Program.
AAFP Seeks Nominations for Public Health Award
The AAFP is now accepting nominations for its Public Health Award. The deadline nomination has been extended until May 31, and self-nominations are welcome.
Nominees must be a current member of AAFP, submit a complete nomination form and submit a letter of support from their chapter. If you’re interested in applying or want to nominate someone else, please contact us at firstname.lastname@example.org so that we may process your request for a letter of support.
According to the AAFP, strong nominees will have any of the following:
- A career dedicated to leadership in a traditional public health organization;
- Have gone beyond their patient panel to advocate for the health of the public, engage their community or provide leadership to help resolve major public health issues;
- Work to enhance health equity and promote diversity and inclusion;
- Or who work to realize the triple aim of improving the health of populations, improving patient experience and reducing per capita costs.
Judging will be determined by the executive committee of the AAFP’s Commission on Health of the Public and Science.
Members in the News
- Bob Crittenden, MD, has joined Cambia Grove — a health care startup hub in Seattle — as its first executive-in-residence. Crittenden had been the senior health policy advisor for Gov. Jay Inslee.
- Ann Diamond, MD, was featured in a Crosscut story about the Washington Independents organization. Diamond is running as an independent for a state House seat in the 12th district against Rep. Cary Condotta (R-Wenatchee). Washington Independents was formed by former Democratic congressman Brian Baird, PhD, and Chris Vance, former state representative and chair of the state’s Republican party.
- Janelle Guirguis-Blake, MD, was mentioned in a Medscape piece about her article in Family Practice. Guirguis-Blake and her team’s article explores the unsafe prescribing of NSAIDs in patients with stage 3 and 4 chronic kidney disease. “Although guidelines and recommendations that include lists of relatively contraindicated medications and those requiring renal dose adjustment are widely available, rates of non-compliance with dosing guidelines and use of relatively contraindicated medications are common in patients with CKD and may lead to toxic effects or ineffective pharmacotherapy,” Guirguis-Blake and her co-authors wrote.
- Tony Lundberg, DO, was the subject of a lengthy Q&A in the Spokesman-Review. Lundberg described his upbringing in Las Vegas, how he became interested in medicine and his work as a rural family physician in St. John in Whitman County. “The biggest advantage is knowing our patients,” Lundberg said of his work in rural health care. “When you see a physician in a bigger city, it’s usually quick. And they’re not your neighbor – they don’t see you in other situations. Knowing someone’s family dynamics is so important, especially in end-of-life situations.”
- Don Solberg, MD, recently retired as chief medical officer of Kittitas Valley Healthcare, was the subject of a feature on KVH’s website regarding his retirement. “There’s something very special about being a family doctor,” he said in the piece. “I’ll always treasure the experiences I’ve had in this community. I’ve had the opportunity to become not just a friend but also the person to walk beside them through physical and emotional difficulties.”
- Shawn West, MD, was quoted in sponsored content by Premera that was published on Crosscut’s website recently. The story traces the addiction and recovery of former Seattle University basketball player Leigh Swanson. “Sometimes we think we know what people with addiction issues look like,” said West, medical director for Premera and a family physician in Edmonds. “[But] it can be anybody — anyone you know at any time for different reasons.”
Legislative Session Wraps Up with Some Wins, Some Losses for WAFP Priorities
The Washington Legislature concluded its 60-day session on time for the first time since 2014 and only the third time in the past decade.
Notable was the passage of the 2018 supplemental operating budget, which included a number of items of interest to family medicine: increasing the Medicaid MAT rate for opioid use disorder; directing the Bree Collaborative to create a workgroup to identify best practices for mental health services; directing the Health Care Authority to study strategies to enhance primary care access for medical assistance clients; Washington State Institute of Public Policy and the State Actuary to complete a study of single payer and universal coverage health care systems; and requiring relevant authorities to develop a plan to restructure and strengthen the rural health care system.
Other bills passed and signed by Gov. Jay Inslee include:
- B. 1570 on increasing funding to provide housing and other assistance to the homeless;
- B. 2143 on medical student loan and scholarship opportunities;
- B. 2257 on prohibiting maintenance of certification from being required for physician licensure or renewal;
- B. 2443 on adding the Elson S. Floyd College of Medicine to the Family Medicine Residency Network;
- B. 5683 on a premium assistance program for Pacific Islanders residing in Washington;
- and B. 6399 on directing the state to take initial steps toward telemedicine payment parity.
Two other key pieces of legislation did not make it to the governor, however. H.B. 1054, which would raise the legal age to purchase tobacco from 18 to 21, was passed out of the House late in the session but received no consideration in the Senate. S.B. 6620, to address school gun violence, was introduced in the aftermath of a mass shooting at Marjory Stoneman Douglas High School in Parkland, FL, that killed 17 students and staff members. It was introduced late in the session but is expected to undergo reconsideration in 2019.
AAFP Supports Recently Passed Omnibus Spending Bill
With a late-night approval in the Senate, Congress avoided a government shutdown by passing a $1.3 trillion spending bill which was subsequently signed by President Donald Trump.
In response, the AAFP praised the bill’s language to clarify that the Centers for Disease Control and Prevention is not specifically prohibited from researching gun violence. (However, Congress has not funded, and likely will not fund, any research on the topic.)
The AAFP also cited the $3 billion increase to fight the opioid epidemic as well as increases among other health-related federal agencies.
“The Consolidated Appropriations Act passed by Congress today moves in the right direction on addressing violence involving a gun and the opioid misuse crisis,” said AAFP President Michael Munger, MD, FAAFP, in the statement. “The American Academy of Family Physicians welcomes language in today’s omnibus legislation that clarifies the parameters of Centers for Disease Control and Prevention research into violence involving a gun and increases funding to fight the epidemic of opioid misuse. This legislation sets the stage for developing solutions to both challenges.”
CMS to Overhaul Meaningful Use; Details Sparse, However
At the HIMSS annual conference in early March, CMS Administrator Seema Verma said that the agency is planning on overhauling its meaningful-use requirements.
According to Modern Healthcare, Verma said that CMS is looking to reduce time and compliance costs associated with the program. But, in her speech at the conference, Verma didn’t go into detail beyond that. Follow-up requests from Modern Healthcare to CMS went unanswered. Modern Healthcare notes that providers have complained for years that the meaningful use program is too burdensome and hard to implement.
Verma did announce two initiatives that give patients more access and control over their medical records.
Washington Firearm Tragedy Prevention Network to Meet in Kennewick
The Washington Firearm Tragedy Prevention Network will hold its spring meeting on Thursday, June 14, at the Benton-Franklin Health District in Kennewick.
The network is a partnership between Seattle Children’s Hospital, the Washington chapter of the American Academy of Pediatrics, Lok-It-Up, and the Harborview Injury Prevention and Research Center. The group aims to prevent firearm tragedies by sharing information and resources and identifying areas of opportunity in a non-political way. Membership is open to anyone who is interested.
Washington DOH Releases Opioid Dashboard
The maps show a representation of patients in each of the following categories: with any opioid prescription, with chronic opioid prescriptions, with high-dose opioid prescriptions, with concurrent opioid and sedative prescriptions, with new opioid prescriptions, and with new chronic opioid prescriptions. Each of those categories is further broken down by county and by age range (for the graphic on patients with any opioid prescription) or quarterly rate per 1,000 over time (the other five).
DOH is soliciting feedback on the maps; please email Jennifer Sabel with comments.
State Releases 2018 Health Assessment
The Washington State Department of Health has released the 2018 Washington State Health Assessment, which aims to “better facilitate strategic thinking about improving health in Washington,” according to the state.
The report identified eight issue areas that will serve as a focus: child immunization, diabetes, drug and alcohol abuse, health care access, healthy weight with a focus on healthy eating and active living, housing and homelessness, mental health, and tobacco use.
“It will take committed leadership to address our priority health issues and the longstanding disparities in health,” the report states. “Our state values collaboration; partnerships are numerous, and marshalling our efforts and resources to truly make a difference will require us to develop a shared vision and framework to move forward together.”
CDC: ED Visits for Opioid Overdoses Jump
From June 2016 to September 2017, visits to the emergency department for opioid overdoses jumped 30 percent, according to new data from the Centers for Disease Control and Prevention.
The data, released in the March 6 Morbidity and Mortality Weekly Report, analyzed syndromic data from around the country. In 16 states with a known high prevalence of overdose mortality (which didn’t include Washington), ED visits rose 35 percent.
“Long before we receive data from death certificates, emergency department data can point to alarming increases in opioid overdoses,” said CDC Acting Director Anne Schuchat, MD, in a news release. “This fast-moving epidemic affects both men and women, and people of every age. It does not respect state or county lines and is still increasing in every region in the United States.”
Since 2000, Global Antibiotic Consumption Has Risen Dramatically
A study in Infectious Disease News has found that global consumption of antibiotics rose 65 percent from 2000 to 2015. The study’s lead author, Eili Klein, MA, PhD — an assistant professor of emergency medicine at Johns Hopkins University and a fellow with The Center for Disease Dynamics, Economics & Policy — told Healio that the findings are a mixed bag.
“A large portion of increasing consumption in low- and middle-income countries is due to economic growth, which in many ways is actually a great thing. It means that in many of these countries, which have a higher burden of infectious diseases that can be effectively treated with antibiotics, people are getting access to those drugs,” Klein said. “However, rates have actually gone up and above what they are in some high-income countries, suggesting that in at least some LMICs, inappropriate use is a problem.”
Free Buprenorphine Waiver Course to be Held May 25 in Olympia
Physicians, nurse practitioners and physician assistants are welcome to attend a four-hour course to earn their waiver to prescribe buprenorphine. The course will be held May 25 from 1 to 5 p.m. in Room 200 at Providence St. Peter Hospital, 413 Lilly Road NE in Olympia.
CMS Change Portends Good News for Preceptors
While teaching physicians or residents will still be required to be physically present when a medical student participates in and contributes to a billable service, the recording of those services has been made easier by a change in CMS rules.
CMS has announced a change to its Medicare Claims Processing Manual that will allow the teaching physician to “verify in the medical record any student documentation of components of E/M services, rather than re-documenting the work,” according to CMS.
The revised rules are intended to save preceptors time and hassle as well as ease physicians’ path to becoming a preceptor, according to AAFP News.
Authors: Fewer ‘Transactional Tasks,’ More ‘Personalized Care’ to Increase Physician and Patient Satisfaction
In a recent piece in the Annals of Family Medicine, David Reuben, MD, and Christine Sinsky, MD, argue for steps that can be taken to streamline their work, thereby motivating and satisfying physicians.
These steps focus on “shifting physicians’ responsibilities away from transactional tasks and towards personalized aspects of care. By taking steps to close the gap between mission and daily work, physicians will again be able to find joy, purpose, and meaning in their profession and give back what patients and society need from 21st century physicians.”
To achieve that, however, the authors acknowledge that changes are necessary at all levels, including some to the physicians themselves.
MIPS Corner: MIPS Tips
Q: How can I avoid a penalty in 2017?
A: In order to avoid a negative 4 percent payment adjustment in 2019 for newly eligible clinicians, be sure to check the eligibility of your clinicians on the QPP website, and report on any newly eligible clinicians. For the 2017 performance period, CMS has evaluated claims data from Sept. 1, 2015, through Aug. 31, 2016, and from Sept. 1, 2016, through Aug. 31, 2017 to determine eligibility for each group under who’s TIN they bill. The QPP website now reflects eligibility based on the second run of claims data.
Q: When will I see my eligibility for Performance Year 2018?
A: CMS is finalizing Year 1, and the results should be available in early Spring.
QPP Year Two is Here! Here’s What You Need to Know:
CMS is continuing many of its transition-year policies while introducing modest changes. Year 2 Overview fact sheet:
The low-volume threshold (LVT) increases to $90,000 in Part B allowed charges and 200 Medicare Beneficiaries.
Category weights: Quality: 50 percent; cost: 10 percent; advancing care information: 25 percent; and improvement activities: 15 percent. The performance threshold will be increased from 3 to 15. (To avoid a penalty, the final score will need to be at least 15 points.)
Performance reporting period:
- Quality: 12 months
- Advancing care information and improvement activities are to be done for a minimum of 90 days
Payment adjustments for 2020 (based on 2018 reporting) will range from -5 percent to +5 percent (with the X factor not to exceed three, as required by law).
- Five bonus points to the final score will be added for treatment of complex patients
- Small practices (15 or fewer) will receive five bonus points to the final score
More Options for Small Practices
- Options to join a virtual group
- New hardship exemption for the Advancing Care Information performance category
Improvement Scoring for Quality: Performance will be measured at the quality category score level and will result in up to an additional 10 percentage points for quality.
New Resource Available!
In order to assist practices with how to improve their quality scores and meet the full requirements for the Improvement Activities, Qualis Health created a new information sheet about how to leverage improvement activities to actually improve quality.
April 17, 2018: Using Improvement Activities To Enhance Performance
Scored For Solo Practitioners And Small Group Practices
April 19, 2018: Using Improvement Activities To Enhance Performance
Scored For Solo Practitioners And Small Group Practices
Having a MIPS Moment?
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
PRIME Registry Available Free for Three Years
The ABFM invites board-certified family physicians to enroll in PRIME Registry free for the first three years.
PRIME Registry is a practice and population data tool developed by the ABFM that safely extracts patient data from your electronic health records (EHRs) and turns it into actionable measures, presented in an easy-to-use, personalized dashboard, maintaining its full confidentiality. PRIME not only simplifies quality reporting for payment programs such as MIPS and CPC+, but also allows you to better evaluate aspects of your practice, patient groups and individual patients, illuminating gaps or successes in patient care.
Another bonus for ABFM Diplomates: The integrated Performance Improvement (PI) activity tool allows Diplomates to easily use EHR data to complete PI activities and earn points toward the ABFM continuous certification requirements.
Coming this summer, PRIME will add social determinant and community resource data, showing clusters of disease, poor outcomes and community resources for patients and clinics via the new Population Health Assessment Engine (PHATE).
By enrolling in PRIME now, you will secure free MIPS reporting through PRIME in 2019, and you will be able to take advantage of all the features PRIME has to offer.
All registry data are maintained in compliance with HIPAA, subject to a Business Associates Agreement, but the ABFM has gone farther to protect your data. The registry vendor has no rights to use identified data without your permission, and the ABFM purposefully cannot touch patient data except for research purposes and after institutional review board approval.
AAFP Releases Tool for Starting a Family Medicine Practice
AAFP members looking to open their own practice now have a new tool in their arsenal.
A recently released download, designed specifically for family physicians, has been designed to help guide members through start-up expenses, monthly budgets and revenue assessment. The tool is free for AAFP members and available online, though you must be logged in to access the content.
The same page also offers tips on closing or selling a practice.
The launch of the tool comes from a resolution adopted at the 2017 National Conference of Constituency Leaders, which asked for the creation of such a resource. Academy staff then developed the tool in consultation with the AAFP’s Commission on Quality and Practice.
Survey: Strong Majority of Physicians Indicate Prior Authorizations Negatively Impact Patient Care
A survey conducted by the American Medical Association has found that 92 percent of respondents say that the prior authorization process delays patient access to necessary care and that 78 percent say it sometimes, often or always leads to a patient abandoning a recommended course of treatment.
The AMA surveyed 1,000 physicians who provide patient care.
More than four in five say that burdens associated with prior authorizations are high or extremely high and that such burdens have gotten worse during the past five years.
Medscape reports that the AMA, the AAFP and 15 other organizations created a list of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and to reduce the administrative burden.
Registration Now Open for 2018 Direct Primary Care Summit
The Direct Primary Care Summit, to be held July 13-15 in Indianapolis, is now accepting registrations.
The summit is jointly sponsored by AAFP, the Family Medicine Educational Consortium and the American College of Osteopathic Family Physicians.
For more information, call the AAFP at 800-274-2237 or email them at email@example.com.