WAFP August 2017 Newsletter

Dynamic Academy

WAFP Board of Directors Approves 2018-2020 Strategic Plan

WAFP Hosts Leadership Orientation, Committee and Board Meetings

Two Members Added to Washington FamilyMedPAC Board Amid Reinvigoration Efforts

Submit your Nomination for FPOY and FMEOY Today!

2018 House of Delegates and Annual Scientific Assembly

WAFP Signs On with the Patient-Centered Primary Care Collaborative

Both WAFP Resolutions Adopted at AAFP Congress of Delegates

2018 FMX Faculty Proposals Due by Oct. 26

WAFP Twitter Account

AAFP Launches Physician Health First

Local chapter news

Members in the News

Advocacy

DMS Sunrise Review Canceled

UW Law School to Study Volk Decision

AAFP Responds to Congressional Request for Red Tape Examples

Senate Republicans Concede on Graham-Cassidy Bill

Health of the Public

First In-State West Nile Cases Recorded in Spokane County

Vision Screening Recommended in Children 3-5, USPSTF Says

Childhood Obesity Raises Costs by 159 Percent, Most of Which is Borne by Third-Party Payers

CDC: Record-High Number of STD Cases Reported in 2016

Cervical Cancer Screenings Regimen Updated

Workforce and Education

Residents in THCs More Likely to Practice in Underserved Settings

AAFP Requests More Flexibility for Residents to Train Across State Lines

More Research Confirms the Amount of Time Physicians Spend in Front of a Computer

AAFP Credit System Seeks Comments on Functional Medicine; Deadline Oct. 6

Practice Transformation

MIPS Corner: The Countdown to the Quality Payment Program (QPP) Continues

Sign Up for WA All-Payer Claims Database by Oct. 6

All Nine Washington ACHs Achieve Phase 2 Certification

More Than Half of FQHCs Say Financial Sustainability is a Challenge

 

WAFP Board of Directors Approves 2018-2020 Strategic Plan

During its Sept. 23 meeting, the WAFP Board of Directors unanimously approved the adoption of a new, three-year strategic plan.

The plan includes goals in six areas: advocacy, health of the public, practice enhancement, brand development, embracing learners and organizational health.

The plan takes effect in January and grew from the WAFP’s two-day strategic planning retreat in June.

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WAFP President-Elect Jeremia Bernhardt, MD, left, presents a leadership orientation session in SeaTac on Sept. 22.

WAFP President-Elect Jeremia Bernhardt, MD, left, presents a leadership orientation session in SeaTac on Sept. 22.

WAFP Hosts Leadership Orientation, Committee and Board Meetings

The WAFP Board of Directors and extended leadership held a series of meetings during a busy September weekend.

On Friday, Sept. 22, WAFP President-Elect Jeremia Bernhardt, MD, presented a leadership orientation session for new and experienced leaders alike. Bernhardt’s presentation focused on responsibilities of Academy leadership, building trust with members, representative governance, continuous process improvement, and ideas for implementing the 2018-2020 strategic plan.

The next morning was dedicated to WAFP committee meetings. Following a lunch presentation by Jon Brumbach of the Health Care Authority, the WAFP Board opened its session. In addition to approving the next strategic plan, the Board approved the nominations of June Bredin, MD, and Matthew Logalbo, MD, to the Washington FamilyMedPAC Board of Directors. WAFP President Lydia Bartholomew, MD, MHA, FACPE, FAAFP, announce she will appoint a task force to undertake brand development work, as identified in the 2018-2020 strategic plan.

In addition, the Board heard reports from each of the WAFP’s committees, the delegation to the AAFP’s Congress of Delegates, the delegation to WSMA’s House of Delegates, and representatives from the Elson S. Floyd College of Medicine and the UWSOM’s Department of Family Medicine.

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Two Members Added to Washington FamilyMedPAC Board Amid Reinvigoration Efforts

June Bredin, MD, and Matthew Logalbo, MD, were approved as new Washington FamilyMedPAC (FMP) Board members on Sept. 23. Bredin, of Ellensburg, is WAFP’s immediate past president, while Logalbo, of Seattle, is co-chair of WAFP’s Governmental Affairs Committee.

Their appointments are part of the efforts to reinvigorate the FMP. A task force was appointed in February and recommended that the size of the FMP Board be reduced from eight members to five, that all Board members are appointed by the WAFP Board, and that two members be appointed immediately upon approval of the prior changes.

The FMP Board — which also includes Stephen Albrecht, MD, FAAFP; Dino Ramzi, MD, MPH, FAAFP; and Jessica Van Fleet-Green, MD, FAAFP — will now forward with plans for fundraising and continuing the development of an effective voice for family medicine during the 2018 elections.

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Submit your Nomination for FPOY and FMEOY Today!

The WAFP is now accepting nominations for the 2018 Family Physician of the Year (FPOY) and 2018 Family Medicine Educator of the Year (FMEOY). Both awards will be presented at the 2018 WAFP Annual Meeting in Spokane on May 4.

Nominations for FMEOY are due Jan. 31, 2018. Nominees will be evaluated based upon the following:

  • Recognized for exemplary teaching skills and outstanding progression of abilities over several years by medical students, residents or peers; or
  • Developed and implemented innovative curriculum, teaching model(s) or program(s) in a variety of educational spheres; and
  • Must be a current member of the WAFP/AAFP.

Learn more about eligibility criteria and submission process on WAFP’s FMEOY webpage.

Nominations for FPOY are due Jan. 31, 2018. The Family Physician of the Year Award honors a physician who exemplifies, in the tradition of family medicine, a compassionate commitment to improving the health and well-being of people and communities throughout Washington.

Any WAFP member in good standing, with a few exceptions, is eligible for the award; current members of the WAFP Board of Directors and previous FPOY winners are not eligible. Previous nominees, if they have not won the award, are eligible. Likewise, any current WAFP member is welcome to submit a nomination.

Learn more about nomination requirements on WAFP’s FPOY webpage.

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2018 House of Delegates and Annual Scientific Assembly

Mark your calendars now for WAFP’s annual meeting, including the 61st Annual House of Delegates and the 69th Annual Scientific Assembly.

The meeting will be held May 3-5, 2018, at the Hotel Davenport in Spokane.

Information about registering, serving as a delegate, and workshop offerings at the ASA will be released later this year.

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WAFP Signs On with the Patient-Centered Primary Care Collaborative

WAFP has joined the Patient-Centered Primary Care Collaborative (PCPCC), an organization which advocates for an effective and efficient health system built on a strong foundation of primary care and the patient-centered medical home.

PCPCC is guided by seven shared principles of care: person and family centered; continuous; comprehensive and equitable; team-based and collaborative; coordinated and integrated; accessible; and high-value.

AAFP and nine of its state chapters are members of the PCPCC.

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Both WAFP Resolutions Adopted at AAFP Congress of Delegates

Two resolutions brought forward from WAFP’s 2017 House of Delegates were adopted by this year’s AAFP Congress of Delegates in San Antonio.

One resolution, asking the AAFP to advocate for policies supporting “Housing First” approaches, was adopted without modification. The second, asking AAFP to advocate on behalf of evidence-bases treatment of opioid use disorder in correctional facilities, was modified slightly but maintained the original intent of the WAFP resolution.

The WAFP was represented by East Side Delegate Russell Maier, MD, FAAFP; West Side Delegate Jonathan Sugarman, MD, MPH, FAAFP; East Side Alternate Delegate Tony Butruille, MD; and West Side Alternate Delegate Gregg VandeKieft, MD, MA. Other WAFP officers attending the Congress of Delegates included President Lydia Bartholomew, MD, MHA, FACPE, FAAFP and President-Elect Jeremia Bernhardt, MD. Additional members attending were Lucinda Grande, MD; Kevin Wang, MD; and Lillian Wu, MD, FAAFP, as well as WAFP Executive Vice President Karla Graue Pratt.

Also at the Congress of Delegates, John Cullen, MD, of Valdez, AK, was elected AAFP president-elect during the 2017 Congress of Delegates in San Antonio on Sept. 13. Cullen will ascend to AAFP’s presidency during the 2018 Congress of Delegates. Others chosen or elected to AAFP positions during the 2017 Congress include:

  • Speaker of the Congress: Alan Schwartzstein, MD, of Oregon, WI
  • Vice Speaker: Russell Kohl, MD, of Stillwell, KS
  • Directors: Sterling Ransone, MD, of Deltaville, VA; Windel Stracener, MD, of Richmond, IN; and Erica Swegler, MD, of Austin, TX
  • New physician Board member: Benjamin “Frankie” Simmons III, MD, of Concord, ND
  • Resident Board member: Alexa Mieses, MD, of Durham, NC
  • Student Board member: John Heafner, MPH, of St. Louis

Michael Munger, MD, was elevated to AAFP president during the Congress, while John Meigs, MD, moved from president to Board chair.

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2018 FMX Faculty Proposals Due by Oct. 26

The AAFP is seeking faculty for the 2018 FMX conference in New Orleans. Proposals must be submitted online by Oct. 26 to be considered.

Submission requirements are posted online. The AAFP is seeking faculty across a number of disciplines, including cardiovascular; clinical procedure workshops; emergency and urgent care; endocrine; gastrointestinal; geriatrics; hematology/immune; infectious disease; integumentary; men’s health; musculoskeletal; nephrologic; pain; pediatrics; practice management; psychogenic; public health; respiratory; special sensory; and women’s health.

Notification of acceptance or non-selection will be sent via email in mid-December.

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WAFP Twitter Account

The WAFP is on Twitter! If you’re on Twitter too, follow us at @WAFamilyDocs.

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AAFP Launches Physician Health First

Improving physician well-being is a strategic goal and priority for the AAFP Board of Directors. To that end, the AAFP, in conjunction with the AAFP, recently launched Physician Health First.

“Family doctors, hear me when I say you are indispensable. And to be strong family physicians and to serve your patients best, you must put your well-being first,” said Clif Knight, MD, AAFP’s senior vice president for education. “I promise your patients, your practice, your families will thank you for it.”

Physician Health First is a web portal with resources on a variety of topics, including burnout, emotional well-being, paperwork, payment, self-care and work-life balance. There is also the opportunity to take a test to see where members fall on the Maslach Burnout Inventory as well as information on the AAFP’s first Family Physician Health and Well-Being Conference, which will be held April 18-21, 2018, in Naples, FL.

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Local Chapter News

The Thurston-Mason-Lewis chapter will meet Tuesday, Oct. 24.

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

  • Patricia Egwuatu, DO, was featured on Tuko, an online news outlet based in Kenya, along with her sister, Stephanie, a student at PNWU. The story focused on the sisters’ use of social media to document their medical training.
  • AAFP news quoted John Merrill-Steskal, MD — a recent AAFP Vaccine Science Fellow — in a story about the incidence of miscarriage in pregnant women who had received the flu vaccine. A recent study had found that women who were vaccinated early in their pregnancy with a vaccine containing H1N1pdm09 who had also received the H1N1pdm09 component the previous flu season had an increased risk for spontaneous abortion within 28 days after vaccination.
  • Maria Verduzco, MD, was part of a panel on the primary care physician shortage convened by National Health Service Corps program. The panel agreed that continuing several key federal programs and addressing burnout will aid in mitigating the shortage. Fierce Healthcare had a writeup on the panel’s discussion.
  • Sloane Winkes, MD, was quoted in a KOMO-TV story about a rally in Seattle against the Graham-Cassidy legislation that would replace the Affordable Care Act. “I take care of patients who have benefitted from the ACA every single day, and it has saved some of my patients’ lives,” Winkes said.

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DMS Sunrise Review Canceled

The state Department of Health has announced the cancellation of the legislative request for sunrise review of the doctor of medical science. As a result, the review process has been stopped and no report will be issued to the Washington legislature.

Tennessee-based Lincoln Memorial University, which had sought the sunrise review, notified Rep. Eileen Cody (D-Seattle) that it wished to cancel the sunrise review process. Cody — who, as chair of the House Health Care & Wellness Committee, had sent the review request to the Department of Health — then notified the DOH of the cancellation.

The announcement brings to a close the possibility that would allow physician assistants to achieve a DMS degree after two additional years of training in primary care.

WAFP, along with numerous other groups and individuals, opposed the measure. Of the 151 publicly submitted comments before Aug. 10, only two were in favor of the proposal.

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UW Law School to Study Volk Decision

The appropriations legislation passed over the summer includes funding dedicated to the University of Washington School of Law to convene a study on the state Supreme Court’s decision in the Volk v. DeMeerleer case. The study is directed to see if the decision “substantially changed” the law on the duty of care for mental health providers and whether the decision has impacted access to mental health care services in the state.

UWSOL is also required to consult a number of groups, including WAFP.

The report must be submitted to appropriate committees of the legislature by Dec. 1. Read the entire passage on page 241 of the legislation text.

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AAFP Responds to Congressional Request for Red Tape Examples

In July, the House Ways and Means Committee’s health subcommittee asked for examples of red tape in Medicare. The AAFP responded in September with a seven-page letter that detailed six areas in which undue burdens are placed on family physicians: prior authorization, appropriate use, translation, evaluation and management, quality measures, and chronic care payment.

Prior authorizations, for instance, should be prohibited for procedures or items below a certain price threshold, the AAFP wrote. When they are required, all Medicare plans should use a standard form; and if prior authorizatons exceed a certain number of steps or not resolved in a specified period of time, Medicare should pay physicians for their time, AAFP wrote.

Reps. Suzan DelBene (D-Redmond) and Dave Reichert (R-Auburn) are both members of the Ways and Means Committee.

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Senate Republicans Concede on Graham-Cassidy Bill

Facing three firm “no” votes, Republican leadership in the Senate has opted not to vote on its latest attempt to repeal the Affordable Care Act.

On Monday, Sen. Susan Collins (R-ME) announced her opposition to the legislation introduced by Sens. Lindsey Graham (R-SC) and Bill Cassidy, MD (R-LA). In doing so, she became the third Republican to decline; the GOP could afford only two defections to pass the bill without Democratic support.

Collins joined Sens. John McCain (R-AZ) and Rand Paul (R-KY) in opposing the Graham-Cassidy measure, while Sen. Ted Cruz (R-TX) had withheld his support as well. Collins and McCain also played pivotal roles in scuttling a previous ACA replacement.

The end of September represents a critical deadline for Republicans, who would need Democratic votes to replace the ACA once October begins.

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First In-State West Nile Cases Recorded in Spokane County

The Spokane Regional Health District has confirmed the state’s first two human cases of West Nile virus this year.

Both patients were males, one in his 60s and the other in his 50s. A third Spokane County resident tested positive for West Nile, but SRHD believes that patients acquired the virus in another state.

In 2016, the state had nine West Nile cases; of those, one resulted in the death of a person in Benton County.

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Vision Screening Recommended in Children 3-5, USPSTF Says

The U.S. Preventive Services Task Force has issued a “B” recommendation for at least one vision screening for all children ages 3-5. However, the task force added, there is not enough evidence to support vision screening to detect amblyopia or its risk factors in children under age 3. (The AAFP has released its own guidance, which mirrors that of the USPSTF.)

The task force found that several vision screening tools correctly detected visual abnormalities such as amblyopia, strabismus and refractive errors. Children who have a positive screening result should be referred for a complete eye examination.

Amblyopia or its risk factors may appear in as much as six percent of preschool-age children; it typically becomes irreversible if not treated by ages 6-10.

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Childhood Obesity Raises Costs by 159 Percent, Most of Which is Borne by Third-Party Payers

Obesity in children ages 11-17 adds $1,349 in annual medical expenditures, according to new research undertaken by the National Bureau of Economic Research. All told, obesity accounted for $17.5 billion in additional health care spending in 2013 — 99.3 percent of which was paid by third-party payers.

“We find that the impact of youth obesity on medical expenditures is greater than previously estimated,” the study’s authors — John Cawley, PhD, of Cornell University, and Adam Biener, PhD, and Chad Meyerhoefer, PhD, both of Lehigh University — write, “suggesting that endogeneity of weight and measurement error cause attenuation bias. We also find that the increase in medical expenditures caused by obesity is paid almost entirely by third-party payers instead of out-of-pocket by the child’s family members in the household; as a result, youth obesity imposes negative externalities through health insurance.”

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A photomicrograph reveals McCoy cell monolayers with Chlamydia trachomatis inclusion bodies. (Photo courtesy of the CDC)

A photomicrograph reveals McCoy cell monolayers with chlamydia trachomatis inclusion bodies. (Photo courtesy of the CDC)

CDC: Record-High Number of STD Cases Reported in 2016

The Centers for Disease Control and Prevention reports that more 2 million cases of chlamydia, gonorrhea and syphilis were reported in 2016, the most in U.S. history. Chlamydia accounted for nearly three-quarters of the new diagnoses; the nearly 1.6 million cases is double that of 2002.

Gonorrhea, though down drastically from its peak in the late 1970s, nonetheless surged from nearly 350,000 cases in 2014 to more than 465,000 in 2016. Syphillis, likewise, has declined markedly from its peak of half a million cases in 1943. Still, the 88,000 cases in 2016 is a 91 percent increase from the 2011 total.

“Increases in STDs are a clear warning of a growing threat,” said Jonathan Mermin, MD, MPH, director of CDC’s division on STDs. “STDs are a persistent enemy, growing in number, and outpacing our ability to respond.”

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Cervical Cancer Screenings Regimen Updated

The U.S. Preventive Services Task Force has issued an “A” recommendation for cervical cancer screenings: Women ages 21-29 should receive screening through cervical cytology every three years; women ages 30-65 should receive screening through cervical cytology alone every three years or, with high-risk HPV testing alone every five years.

However, screening is not recommended for women who are over 65 (with adequate prior screening and not otherwise at high risk), under 21 or who have had a hysterectomy.

Even more important than screening method is ensuring that screening happens in the first place.

“It’s important to remember that most deaths from cervical cancer in the U.S. occur in women who do not receive screening or have inadequate follow-up,” Jennifer Frost, MD, medical director of AAFP’s Health of the Public and Science Division, told AAFP News. “Increasing adherence to screening will have a much greater impact on cervical cancer deaths than whether you screen with cytology or HPV.”

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Residents in THCs More Likely to Practice in Underserved Settings

Research published in Academic Medicine has found that residents who train in teaching health centers (THCs) are more likely to practice in underserved areas.

Information in the study was generated by a survey sent to 1,153 THC residents in the 2013-14, 2014-15 and 2015-16 academic years. Eighty-nine percent responded, and two-thirds of the respondents were family medicine residents.

Previous surveys had found that only 24 percent of residency graduates ended up practicing in underserved settings. But 55 percent of the THC residents said they planned on practicing in an underserved setting; among family medicine residents, the rate was even higher — 66 percent.

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AAFP Requests More Flexibility for Residents to Train Across State Lines

The AAFP has asked the Federation of State Medical Boards to establish a method to help residents who train in programs that have facilities in multiple jurisdictions.

In a mid-August letter to FSMB President and CEO Humayun Chaudhry, DO, MS, then AAFP Board Chair Wanda Filer, MD, MBA, FAAFP, asked the FSMB to open a discussion about encouraging state licensing boards to recognize training licenses from neighboring jurisdictions.

Filer cited the Georgetown University Providence Hospital Family Medicine Residency as one example; residents there must be licensed in both the District of Columbia and Maryland in order to fulfill their residency requirements.

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More Research Confirms the Amount of Time Physicians Spend in Front of a Computer

Research conducted by the American Medical Association and the University of Wisconsin has found that primary care physicians spend more than half of their workday typing data on a computer screen and completing other EMR tasks.

The research was published in the Annals of Family Medicine.

The authors conclude that EMR event logs can be used to help identify EMR-related work that could be delegated to other members of the medical team.

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AAFP Credit System Seeks Comments on Functional Medicine; Deadline Oct. 6

Ahead of a February review, the AAFP Credit System is seeking comments from members and the CME community on functional medicine.

The AAFP’s Commission on Continuing Professional Development — which steers the AAFP Credit System — determined that insufficient evidence existed to support the practice of functional medicine. The commission placed a two-year moratorium on all functional medicine topics. That moratorium was revisited and extended in February 2016, and it will again be reviewed in February 2018.

Those interested can submit their comments through the AAFP’s website.

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The Countdown to the Quality Payment Program (QPP) Continues

October 2, 2017 is the last day to start your 90-day reporting period and March 31, 2018, is the deadline to attest. Our goal is to help you be successful with the program. Below are three ways to prepare for success. Be sure to follow Qualis Health on Twitter for QPP updates and #MIPSMondays; they offer helpful MIPS Tips in a bite-size format each Monday.

Participate in Quality Payment Program Website Testing
CMS would like the Quality Payment Program website to meet the needs of the clinician community by providing streamlined access to information and minimizing undue burdens for program participation. CMS invites representatives from organizations of all sizes to assess current and future functionality of the website, as well as to make recommendations for improvements. CMS is looking for Medicare clinicians, practice managers, administrative staff, and EHR and registry vendors. Please email
Partnership@cms.hhs.gov if you’d like to participate in a one-on-one feedback session.

CMS Quality Payment Program Presentations
Check out CMS webinar recordings, presentations and transcripts. There is excellent and accurate information about the QPP that practices can use to get up to speed, check for details or use for staff education resources. This is one to bookmark!

New Details on the CMS NPI Checker
CMS continually improves their Quality Payment Program website in response to feedback; the updates to the NPI Checker are no exception. The NPI Checker now includes whether the eligible clinician or practice (TIN) qualifies for any special statuses, including Health Professional Shortage Area (HPSA), Rural, Non-Patient Facing, Hospital-Based and/or Small Practice.

Explanation of Special Status Calculation — Correction

CMS recently sent a message incorrectly stating that clinicians considered to have “special status” would be exempt from the Quality Payment Program. These circumstances are applicable for rural, non-patient facing and hospital-based clinicians, as well as clinicians in Health Professional Shortage Areas and small practices.

Special status affects the number of total measures, activities or entire categories that an individual clinician or group must report. Individual clinicians or groups with special status are not exempt from the QPP because of their special status determination.

Upcoming Learning Opportunities 

Quickinar MIPS Test Participation
Oct. 4, 2017

QPP MIPS Moments Tutorial: The Final Score
Oct. 27, 2017

QPP MIPS Moments Tutorial: Anything Goes!
Nov. 13, 2017

For more learning opportunities, visit the Qualis Health events page.

Having a MIPS Moment? Contact us! 

Whether you’re new to the world of quality reporting or a veteran with a burning question, Qualis Health can help.

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Sign Up for WA All-Payer Claims Database by Oct. 6

Washington’s Office of Financial Management has been working with the Center for Health Systems Effectiveness at Oregon Health & Science University to develop the Washington All-Payer Claims Database (ACPD). When fully operational, the database will publish medical practice quality and cost performance results for the benefit of patients, practitioners and payers.

Primary care practices with four or more practitioners can register for the database by Oct. 6. Those practices that have signed up can then undertake their review between mid-November and mid-December.

Learn more about the program on OHSU’s website or download an FAQ on the ACPD.

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All Nine Washington ACHs Achieve Phase 2 Certification

Healthier Washington has announced that each of the state’s nine accountable communities of health (ACHs) have passed Phase 2 of the Medicaid Transformation Demonstration.

That means that all of the ACHs have documented their compliance with Demonstration requirements and described their approach to achieving the next milestone, submission of project plans.

The next milestone is on Nov. 16.

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More Than Half of FQHCs Say Financial Sustainability is a Challenge

A new survey by Sage Growth Partners of 175 CEOs of federally qualified health centers has found that 56 percent said financial sustainability is moderately or extremely challenging. And 53 percent said revenue diversification is moderately or extremely challenging.

Just under half of respondents said their center was participating in alternative payment models. But 78 percent said that it would take them at least seven months to move to a value-based payment model if a major payer every changed its reimbursement model.

Financial concerns aren’t the only ones facing FQHCs. Just over two-thirds of respondents said it was moderately or extremely challenging to challenging to find the right leadership.

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