WAFP November 2017 Newsletter
Health of the Public
Workforce and Education
Sunday is the Deadline to Register for 2018 Medical Student & Resident Retreat
The deadline is nearing for registrations for the 2018 Student & Resident Retreat on Jan. 6-7, 2018, at the Icicle Village Resort in Leavenworth.
The agenda for the 2018 retreat includes numerous topics intended for medical students, including chronic pain, basic and advanced OMT, family medicine advising, transgender health, residency 101 and clerkships, casting, OB stations, IUDs, and palliative care/hospice. The advanced resident track will include dermatology procedures, harm reduction, an addiction medicine course to focus on suboxone, and a session on negotiating a contract and resume review.
Registration will close at 11:59 p.m. on Sunday, Dec. 3.
WAFP Members are Welcome to Attend Virtual Committee Meetings
Did you know that WAFP Board and are meeting virtually in between formal, in-person meetings? Each committee is planning to meet at least once before the next formal meeting in February to get its work done on time to report its recommendations to the Board to support knowledge-based decision making.
All WAFP members are welcome to attend these virtual sessions.
As meetings are scheduled, they will be posted on WAFP’s website.
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.
The deadline for both awards is Jan. 31, 2018.
Apply Today for a WAFP Foundation Vision 2020 Stipend
The Washington Academy of Family Physicians Foundation is offering WAFP members a leadership and advocacy skill development opportunity with Vision 2020. The Foundation will make $1,500 stipends available to up to six WAFP members in 2017-2018 to be utilized in a training program or course of their choice.
The program is designed to assist practicing family physicians in developing leadership and communication skills to enhance their success at work, in the community, or in WAFP policy development and advocacy opportunities.
Submit a letter of interest along with your CV and a brief application form.
Nominations are Being Accepted for the 2018 Virak Award
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.
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 late February.
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.
Members in the News
- Kim Bauer and Daniel Low, MD, wrote an op-ed for The Seattle Times on the need for the American health care system to recognize homelessness as a medical issue. “Homelessness is not only a symptom of morbidity and mortality, it is a root cause. And it is a condition that we know how to effectively treat. Multiple studies have demonstrated how stable housing improves the health of the chronically homeless. Providing housing is not only morally just, it is also cost-effective,” they wrote. Bauer is a fourth-year medical student at the University of Washington School of Medicine, and Low is a family medicine resident at Swedish Cherry Hill.
- George Fox University in Newburg, OR, has announced that Jon Bishop, MD, will be the speaker for the school’s midyear commencement. Bishop had worked at Snohomish Family Medical Center for 35 years; he and his wife, Marita — also a George Fox graduate — are currently volunteering in Central Asia.
- PNWU medical student Rebecca Bolla was quoted in a lengthy Yakima Herald feature on the school’s Roots to Wings program, which aims to get Native American and Hispanic youths interested in careers in medicine and science. The program pairs PNWU students with local children; the PNWU students mentor the children on learning and pursuing careers in science, while the children teach the PNWU students about their traditions and heritage. “I really want to encourage more women of color to come into this field, because we do need a more representative population,” Bolla told the newspaper. “You need people from your background to connect with, or just feel comfortable with. You need to be able to talk to your physician and let them know what’s going on without worrying about them judging.”
- On the western side of the Cascades, the winter rainy season has begun, and so has the annual return of seasonal affective disorder. Two WAFP members — Nina Maisterra, MD, and Pam Sheffield, MD — were quoted in local news outlets about SAD. The Everett Herald unearthed a 2015 interview with Maisterra and used it as a basis for an article about SAD and the return to Pacific Standard Time. The Seattle Times, meanwhile, quoted Sheffield in a story about Seattleites cope with the increasingly long and dark winter days.
PALI to be Held Jan. 24 in Olympia; Sign Up Today!
Registration is now open for WAFP’s annual advocacy event, the Policy and Advocacy Leadership Institute – Family Physician Day at the Capitol, on Jan. 24, 2018, at the Capitol complex in Olympia.
The event, typically held during the first legislative session, represents a chance for WAFP members to meet with their elected representatives to discuss issues of importance to family physicians. The event also typically begins at 8 a.m. and ends around 5 p.m.
During the morning session, attendees hear from advocacy experts, legislators and other officials on relevant topics. A working lunch is used for discussion about current Academy priorities and to answer questions. Legislative appointments are scheduled between 1:30 p.m. and 5 p.m., so participants must keep this time available.
Members of WAFP’s Thurston-Mason-Lewis chapter have volunteered to host members who may need overnight accommodations. If you’re interested, please contact Brian Hunsicker at email@example.com.
Though free of charge, the event is open only to WAFP members. Registrations must be received by Jan. 12, 2018.
ESHB 1427 Implementation Stakeholder Meetings Continue
The Washington State Department of Health is continuing to hold stakeholder meetings across the state as part of its implementation of ESHB 1427. The law, which passed the legislature by wide margins and was signed by Gov. Jay Inslee on May 16, establishes new opioid prescribing rules, expands access and use of Prescription Monitoring Program data, and improves access to MAT.
WAFP has convened an opioid task force to develop comments and education materials to ensure family physicians are represented and informed.
Over the next four months, DOH will hold stakeholder meetings along the Interstate 5 corridor:
- Dec. 12: Centerpoint Conference Center, Kent
- Jan. 8: Fort Vancouver Regional Library District Headquarters, Vancouver
- Feb. 9: Everett Community College’s Jackson Conference Center, Everett
- March 14: Department of Labor & Industries, Tumwater
Each meeting is scheduled to begin at 8:30 a.m. and conclude at 3:30 p.m. People not affiliated with a designated participant group are welcome at the meetings and welcome to comment.
HHS Nominee Alex Azar Testifies Before Senate HELP Committee
Alex Azar, President Donald Trump’s pick to be the next secretary of the Department of Health and Human Services, testified Wednesday that making medicines more affordable would be a key tenet to his tenure.
Azar identified three other priorities, according to the Washington Post: making health care more affordable and accessible, continued movement toward value-based payment, and combating the opioid epidemic. But, the Post reported, he did not get into specifics on any of those priorities.
Prior to his nomination, Azar was the president of Lilly’s U.S. division. He had previously served as the general counsel at HHS during the George W. Bush administration.
Sen. Patty Murray (D-WA), the ranking Democrat on the HELP Committee, likened Azar’s power over federal policy on drug prices to “the fox guarding the henhouse,” the Post reported.
Congress’ Massive December To-Do List Impacts Health Care
Though tax reform and preventing a government shutdown are critical action items for congressional Republicans in December, other priorities await — including some with a direct impact on the country’s health care.
The tax reform debate itself has a direct impact on health care. A bill before the Senate would eliminate a key mandate of the Affordable Care Act, which levies penalties against individuals who do not carry health insurance. Politico notes that Sens. Susan Collins (R-ME) and Jerry Moran (R-KS), among others, are displeased that tax reform legislation is being used to change health care law. Related to the ACA, Politico reports that Congress also faces pressure to stabilize the health insurance market after President Donald Trump’s decision to stop paying cost-sharing reduction subsidies to insurers.
Federal funding has already run out for the Children’s Health Insurance Program (CHIP), forcing states to find cash to cover expenses. But states won’t be able to cover the funding for very long; on Monday, the state of Colorado began notifying residents that its children’s health insurance program will shut down next month unless Congress restores funding. Georgetown University’s Health Policy Institute forecasts that Washington will run out of funding in February.
Washington Beats National Average in 7 of 10 Childhood Vaccines
The National Immunization Survey (NIS) Childhood data, produced by the Centers for Disease Control and Prevention, shows that Washington is ahead of the national average for seven of 10 childhood vaccines. Additionally, the state has met national Healthy People 2020 targets for two vaccine series, with six others very close to hitting their targets.
Washington trailed the national average for the hepatitis B and varicella vaccines, while it equaled the national average in MMR. For both the PCV vaccine and the 4:3:1:3:3:1:4 schedule, Washington finished more than five percentage points ahead of the national average.
The polio and MMR vaccines had the most penetration, with rates above 90 percent. Hepatitis A was by far the lowest, with a 61 percent vaccination rate in Washington and 60.6 percent nationally.
Consumption of Sugar-Sweetened Beverages Among Washington Teens Continues to Decline
The Healthy Youth Survey, which asks adolescents throughout the state about a range of safety, community and individual behaviors and risks, has found that teens continue to drink fewer sugar-sweetened beverages.
Data from the 2016 survey shows that consumption of sugar-sweetened beverages is nearly half of what it was a decade ago. Well under half of the survey’s respondents — a sampling of eighth, tenth and twelfth graders — said they had drank at least one sugar-sweetened beverage at school during the previous seven days.
The most dramatic drop in consumption came in the 2014 survey, when any school that participated in the National School Lunch Program was mandated to replace sugary beverages sold on campus with lower sugar alternatives. That year, consumption fell 20 percent among all three groups. The 2016 survey saw continued lower trends among eighth and tenth graders; consumption among twelfth graders remained flat at 44 percent.
Overdose Deaths Spike in 2016, CDC Reports
Deaths by drug overdose rose by 17 percent from the fourth quarter of 2015 to the same time period in 2016, according to the Centers for Disease Control and Prevention.
Overdoses are now the leading cause of death for Americans under 50.
In all, the CDC estimated that 64,000 Americans died from drug overdoses in 2016. The highest rates were reported in New Hampshire, Kentucky, West Virginia, Ohio and Rhode Island.
ACIP Recommends New Herpes Zoster Subunit Vaccine
During the most recent meeting of the Advisory Committee on Immunization Practices (ACIP), the committee voted to recommend preferential use of a newly approved herpes zoster subunit vaccine (HZ/su; Shingrix) for adults 50 and older.
Shingrix — a non-live, recombinant subunit vaccine that was approved by the Food and Drug Administration two days before the ACIP meeting — is now preferred for adults 50 and over instead of the current herpes zoster live vaccine, Zostavax. Shingrix is given intramuscularly in a two-dose series (0.5 mL does each), with the second dose given two to six months after the first.
Google to Pursue Research to Automate Clinical Notetaking
By adapting technology already employed in some of its services, Google has developed — and intends to refine — software that recognizes and transcribes medical conversations.
In its announcement, Google notes that current automatic speech recognition models are limited to a single speaker using predictable terminology. The company intends to take that a step further by recognizing multiple speakers who may be speaking of complex medical diagnoses. Google has already undertaken research to that effect.
Google said it will partner with physicians and researchers at Stanford University, who have previously research the positive effect of medical scribes on physician satisfaction.
“We hope these technologies will not only help return joy to practice by facilitating doctors and scribes with their everyday workload, but also help the patients get more dedicated and thorough medical attention, ideally, leading to better care,” Google’s Katherine Chou and Chung-Cheng Chiu wrote in the blog post.
Authors Propose Using Primary Care Spending Rate to Assess “Orientation” to High-Value Care
In a column in the New England Journal of Medicine, Christopher Koller — WAFP’s 2016 Mead Lecturer — and Dhruv Khullar, MD, advocate for using the primary care spending rate, as opposed to more traditional measures, as a way to determine a health system’s “orientation” to high-value care.
The primary care spending rate, which is the proportion of all medical spending devoted to primary care, is preferable to more widely used metrics, such as PCPs per capita and the ratio of PCPs to specialists, they write. First, since finances most readily display a community’s priorities, the PC spending rate is a more accurate measure of how important primary care really is. Second, people of all ideologies can understand the metric, as can people with limited knowledge of the health care industry. Lastly, the authors believe these metrics could push insurers and delivery system to invest more in primary care.
Already, Oregon and Rhode Island require disclosure of these records.
“Given the persistent gap between the evidence supporting an emphasis on primary care and U.S. spending in this area, policymakers may need to take a more active role in fostering investment in primary care,” the authors wrote. “There is reason to believe such an approach would be palatable, even welcome.”
Koller is president of the Milbank Memorial Fund, and Khullar is an instructor in health care policy and research at Weill Cornell Medicine.
Patients’ Primary Care Physicians Provide Better Health Outcomes than Hospitalists
Hospital patients who were cared for by their primary care physician had longer hospital stays but were more likely to be discharged to home and were less likely to die within 30 days, according to research published in JAMA Internal Medicine.
The research also found that patients cared for by hospitalists or other generalists had fewer consultations with specialists.
The study looked at more than 560,000 admissions of patients who had a mean age of 80.
Smithsonian Features Harriot Hunt, ‘The Mother of the American Women Physician’
It wasn’t just that Harriot Hunt was a pioneer among women practicing medicine; her advocacy for women to be treated as equals in the medical field led one cultural historian to call her “the mother of the American woman physician.” The Smithsonian Magazine’s website ran a feature recently on this early innovator.
When Hunt’s sister, Sarah, became ill in 1830, physicians administered the treatments of the day — leeches, medical blistering and mercury-laced ointments among them. When these “treatments” served only to worsen Sarah Hunt’s condition, the sisters took matters into their own hands by scouring medical texts on their own.
Eventually, they gave up on traditional medicine and came upon Elizabeth Mott, a naturalist originally from England. Mott and her husband, Richard Dixon Mott, practiced “botanic medicine” and, according to the Smithsonian story, were considered quacks by much of Boston. By Elizabeth Mott’s sympathetic bedside manner made a lasting impression on the Hunt sisters; upon Sarah’s recovery, they began an apprenticeship with Mott. (The story notes that Sarah’s health likely improved after being given a chance to recover from the treatments she’d received.)
Mott returned to England in 1835, handing over her practice to the Hunts. They developed a then-novel approach to studying a patient’s history to aid in their diagnoses, a practice which remains a pillar of Western medicine. After Sarah Hunt married and left the practice in 1840, Harriot made the unusual decision to apply to Harvard Medical School. Though she was allowed to attend lectures along with three black students, the rest of the student body rebelled and petitioned the faculty to not accept female students. The school’s president, Oliver Wendell Holmes, persuaded Hunt not to attend; with the policy codified, Harvard Medical School did not admit female students for another century.
The story notes that the experience changed her perspective and made Hunt more politically active. She became famous for refusing to pay her federal taxes, saying she would no longer support a system that refused to allow her to vote. She used that notoriety to advocate on the importance of women physicians and continued to see patients until her death in 1875.
And though she never attended Harvard, her biography continues to reside at the Harvard Medical Library.
MIPS Corner: The Quality Payment Program (QPP) Reporting Period is Underway
October 2, 2017, was the last day to start your 90-day reporting period, and March 31, 2018, is the deadline to attest. 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.
To find out how and learn more, contact Qualis Health’s team of QPP experts by emailing QPP@qualishealth.org or calling 877-560-2618. For QPP online tools and resources, visit medicare.qualishealth.org/QPP.
Upcoming QPP Webinar: Anything Goes!
This webinar offers you an opportunity to ask any QPP-related question that’s on your mind. From how to calculate your final score to improvement activities, anything goes!
New Resources Available on the Qualis Health QPP Online Resource Center
The Qualis Health QPP Online Resource Center is designed to be a comprehensive destination for all QPP needs. It includes a variety of helpful tools and resources, quick links to important QPP websites and information, and a curated list of upcoming QPP learning events. New resources have been added recently, including a new quality measures crosswalk and an advancing care information must-have resource one-pager.
Developed to assist providers with their practice transformation efforts, this tool is a crosswalk of measures and improvement activities shared across the Washington State Medicaid Transformation Project Demonstration, the Health Care Authority (HCA) 2017 Apple Health Contract Metrics and the Medicare Quality Payment Program (QPP). This tool is available on the Qualis Health QPP online resource center. Download your copy today.
The Advancing Care Information (ACI) Must-Have Resources for 2017 is a one-pager that lists key Advancing Care Information (ACI) resource for eligible clinicians. From the MIPS Calculator to informative online videos, it offers a comprehensive list of helpful ACI resources. Download your copy today.
Healthier Washington Practice Transformation Resource Portal Adds New Features
A new feature called My Portal has rolled out on the Healthier Washington Practice Transformation Resource Portal. My Portal introduces new features, including user accounts; the ability to save, rate and share resources; and the creation of online teams.
The My Portal Team feature allows users on the same “team” to interact with each other, share resources and post in protected discussion forums. Teams can be set up to include a number of criteria, such as clinic location, shared work roles or transformation topics.
2017 MIPS Playbook Free for AAFP Members
You must Pick Your Pace in 2017. Are you prepared?
By the end of 2017, you must take action in the Merit-based Incentive Payment System (MIPS) to get paid under Medicare Part B. It’s not too late to collect data — submitting as little as one quality measure or one Improvement Activity will allow you to avoid a negative four percent payment adjustment.
Don’t delay. Let the AAFP guide you down the MIPS path of MACRA’s QPP to help you take action, including the 2017 MIPS Playbook, AAFP’s step-by-step guide to taking action in MIPS. Learn how to Pick Your Pace, select and report quality measures, and more.
It’s time to Pick Your Pace in MIPS. Get started today.
Humana, AAFP Studies Examine Value-Based Payments
Humana, along with the AAFP, released a survey Nov. 29 that found 54 percent of family physicians say their practices participate in value-based payment models. Half of the respondents believe those models will encourage greater collaboration between primary care physicians and specialists.
Barriers remain. Ninety percent of survey respondents said lack of staff time is a barrier to implementing a value-based payment model; 78 percent said a lack of transparency between payors and providers; 78 percent said a lack of standardization of performance measures; and 75 percent said there were no uniform insurance company reports on performance.
“Family physicians are doing the work to prepare for value-based care models,” said AAFP President Michael Munger, MD, FAAFP. “Our members are making changes at the practice level and making investments to prepare for the transition to value-based models that will support better care. However, major barriers still exist that are stifling progress. Among the most commonly noted are issues related to administrative burden like a lack of staff time, lack of standardization for reporting requirements and lack of data transparency. That’s why the AAFP is committed to working on administrative simplification for our members so they can focus more on caring for patients and less on dealing with paperwork. We appreciate Humana’s efforts to partner with us and support family physicians in this effort.”
A separate, internal study conducted by Humana found that medical costs were 15 percent lower in the company’s Medicare Advantage plan that employed value-based payments compared to traditional, fee-for-service payments.
Physicians in value-based contracts had 26 percent higher scores in the government’s Healthcare Effectiveness Data and Information Set (HEDIS).