FINAL MEDICARE FEE SCHEDULE: The Centers for Medicare and Medicaid Services (CMS) has made considerable changes to policies in its proposed Medicare Physician Fee Schedule (MPFS) with the release of its final rule. Learn more at AMA Wire.
ABOR ENDS UA-PHOENIX INVESTIGATION: Arizona Regents announced it was ending its independent investigation into the circumstances surrounding the departures of Dr. Stuart Flynn, longtime dean of UA's Phoenix medical school, and a half-dozen leaders on his management team. The announcement came after a closed-door meeting last week. Following the announcement members of the media and Arizona Medical Association requested to see a copy of the final report but the request was denied. You can find more at:
MACRA FINAL RULE RELEASED: The Centers for Medicare and Medicaid Services (CMS) released the final version https://qpp.cms.gov/education of its physician Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaced SGR and moves physicians to a value-base payment system. The law takes effect on January 1.
The new rule provides more flexibility, lessens reporting burdens and provides training for physicians in practices with 15 or fewer doctors. For more information click here.
GOVENOR ISSUES EXEC ORDER TO LIMIT OPIOID SCRIPS: Gov. Ducey issued an executive order requiring the Directors of the Arizona Health Care Cost Containment System (AHCCCS) and the Arizona Department of Administration (ADOA) to adopt policies and rules to limit the initial fill of opioid prescriptions to no more than seven days and limit initial and subsequent opioid prescriptions for minors to no more than seven days, except for cancer, chronic conditions and traumatic injuries, for individuals on AHCCCS and state employee health plans.
ArMA is seeking physician input about how this new directive will impact patient care. To comment please contact Pele at email@example.com or (602) 347-6910, or Ingrid Garvey at firstname.lastname@example.org or (602) 347-6905.
ARE THE PROMISES OF ACOs PANNING OUT? Vitalyst Health Foundation, in their new report titled The Progress and Promise of Accountable Care Organizations, offers a look at the standing and role of ACOs in Arizona. Lead author, Palmer Evans, MD interviewed ACO leaders throughout the state for the report. National studies indicate that the most successful ACOs to date are physician-owned or led. The report offers key observations from ACOs and other health care leaders on what is and is not working in ACO implementation, as well as offering strategies to improve ACOs, specifically payment/delivery reform. Download the complete report or summary here.
ArMA ANNOUNCES CANDIDATE ENDORSEMENTS: The Arizona Medical Association Political Action Committee (ArMPAC) exists to support national and state candidates who have demonstrated their support for medicine and the health of Arizonans. The ArMPAC Board of Directors (led by PCMS member and ArMPAC Chair Gary Figge, MD) has considered the candidates and recommends the following be supported on November 8th.
John McCain (R)
U.S. Congressional District 4
Paul Gosar (R)
U.S. Congressional District 6
David Schweikert (R)
U.S. Congressional District 7
Ruben Gallego (D)
U.S. Congressional District 8
Trent Franks (R)
U.S. Congressional District 9
Kyrsten Sinema (D)
State Legislative Elections:
Karen Fann (R), Senate
Noel Campbell (R), House
Charlene Fernandez (D), House
Regina Cobb (R), House
Frank Pratt (R), Senate
David Cook (R), House
Thomas “TJ” Shope, (R), House
Steve Farley (D), Senate
Randall Friese, M.D. (D), House
David Bradley (D), Senate
Stephanie Mach (D), House
Vince Leach (R), House
Gail Griffin (R), Senate
Drew John (R), House
Heather Carter (R), House
Doug Coleman (R), House
Steve Yarbrough (R), Senate J.D. Mesnard (R), House, Jeff Weninger (R), House
Bob Robson (R), House
Jill Norgaard (R), House
Kimberly Yee (R), Senate
Debbie Lesko (R), Senate
John Kavanaugh (R), Senate
Jay Lawrence, (R), House
Katie Hobbs (D), Senate Lela Alston (D), House Ken Clark (D), House
Bob Worsley (R), Senate
Michelle Udall (R), House
Catherine Miranda (D), Senate Reginald Bolding (D), House Rebecca Rios (D), House
Kate Brophy McGee (R), Senate
Eric Meyer, M.D. (D), Senate
Kelli Butler (D), House
Mary Hamway (R), House
Maria Syms (R), House
Robert Meza (D), Senate
CMS ISSUES NEW PHYSICIAN FEE SCHEDULE: In early July, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017.
Among other changes, the proposal will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities and expands the Diabetes Prevention Program.
For more information on the proposed rule go here:
NEW OCR GUIDANCE ON RONSOMWARE PUTS PRESSURE ON PROVIDERS: The Department of Health and Human Services’ Office for Civil Rights (OCR) has recently release new HIPAA guidance on the risks of being victimized by file-encrypting malware.
Under the new guidelines if any healthcare organization’s computers are infected with ransomware the government considers it a data breach thereby triggering HIPAA’s breach notification provisions which include notifying effected patients. OCR’s guidance release underscores the seriousness of the situation and the providers’ responsibility in preventing and recovering from such attacks.
For more information about attack prevention and recovery go here.
HHS ANNOUNCES NEW ACTIONS TO COMBAT OPIOID EPIDEMIC: U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced several new actions the department is taking to combat the nation’s opioid epidemic.
The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.
The actions build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reverse opioid overdoses. They also build on the National Pain Strategy, the federal government’s first coordinated plan to reduce the burden of chronic pain in the U.S.
Buprenorphine Final Rule
Expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT. The rule finalized today by the Substance Abuse and Mental Health Services Administration (SAMHSA) allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients. Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.
Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals. But those payments currently have a very limited connection to the pain management questions on the HCAHPS survey. In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.
IHS PDMP Policy
While many Indian Health Service (IHS) clinicians already utilize PDMP databases, IHS will now require its opioid prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid for more than seven days. The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids. Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs. This policy builds on IHS efforts to reduce the health consequences associated with opioid use disorder. As a part of this work, IHS announced that it would train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.
New Research Priorities
Research on opioids conducted and funded by HHS helps the department better track and understand the epidemic, support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid misuse and overdose, and improve opioid use disorder treatment – all areas of research that are critical to our national response to the opioid epidemic. HHS will launch more than a dozen new scientific studies on opioid misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report will also help these stakeholders and external funders of research avoid unnecessarily duplicating research that is currently underway. For more information, download the HHS infographic on the department’s research priorities.
Prescriber Training RFI
HHS is actively working to stem the overprescribing of opioids in a number of ways, including by providing prescribers with access to the tools and education they need to make informed decisions. In particular, HHS has developed a number of activities that support opioid prescriber education. This request for information seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities.
For more information on other actions HHS has taken to address the opioid epidemic, download the department’s new Opioid Epidemic fact sheet.
NEW CDC FLU RECOMMENDATIONS: The Centers for Disease Control and Prevention has stated that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016-2017 flu season. CDC continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone six (6) months and older. More information can be found here.
PCHD RELEASES UPDATED ZIKA VIRUS GUIDANCE: The Pima County Health Department has released the following guidance to answer questions about identifying and testing for Zika. This information is intended to inform the way providers in Pima County consider Zika virus infection as a diagnosis for their patients and outlines the Arizona Department of Health Services guidance for testing.
- Testing for Zika virus infection should be considered among for individuals who
- Have travel to a Zika virus-endemic areas (http://www.cdc.gov/travel/notices); OR
- Have had sex (including vaginal, anal, and oral) with someone suspected to have Zika virus infection; AND
- Have at least two of the following four symptoms/signs that constitute the clinical case definition: fever (low-grade, 37.8-38.5 degrees C),
- Rash (maculopapular),
- arthalgias (small joints of hands and feet), and/or
- conjunctivitis (nonpurulent, bilateral); OR
- Are pregnant (including asymptomatic)
Decisions to test based on travel history are made on an individual basis at the discretion of the local health department with input from the healthcare provider. Although some countries (such as Mexico) have ongoing Zika virus transmission, the risk level for disease transmission is not the same in all areas (for example, Zika virus has not been detected in the northern states of Mexico). Please see the attached testing algorithms for detailed testing information and Arizona Department of Health Service’s full Interim Zika Testing Guidance document on their website.
All suspected cases should be reported to the local health department. We are available 24-hours a day by calling (520) 724-7797. Local health department staff will help coordinate testing if warranted.
This is a rapidly evolving situation and the Pima County Health Department is eager to work closely with PCMS to ensure the health and safety of this community. You are encourage to PCHD’s website, for additional information that includes guidance for healthcare providers, informational handouts, and other resources to share with the public.
MEASELS: The Arizona Department of Health Services has confirmed eleven cases of Measles in Maricopa and Pinal Counties. No confirmed cases have been report by Pima County.
Seven of the cases are inmates at the Eloy Detention Center and four are workers there. Health officials are working to control its spread; prior immunizations against the highly contagious disease are having beneficial results.
You’ll find more provider news and information here.
VA PROPOSES SCOPE OF PRACTICE EXPANSION FOR NURSES: The U.S. Department of Veterans Affairs released its proposed rule regarding Advanced Practice Registered Nurses. It grants independent practice to all APRNs in the VA health system, including nurse anesthetists.
While nurse practitioners (NPs) and certified nurse midwives (CNM) can practice independently in Arizona, certified registered nurse anesthetists (CRNA) and clinical nurse specialists (CNS) cannot. With the adoption of this new rule expanding the scope-of-practice for CRNA and CNS, VA will put in jeopardy the quality care our veterans receive from a physician-led treatment team. It’s important that we let VA know our veterans don’t deserve second-tier treatment.
VA will accept public comment about the proposed rule for the next 60 day, which began May 25. After that, they’ll issue their final rule.
Make your objection to the new rule heard by going to www.safevacare.org.
PDMP: The Prescription Drug Monitoring program is now law. The mandate to use the system is effective October 1, 2017, and 60 days after the Arizona Health-e Connection has integrated the PDMP data into the state health information exchange.
It’s important that you are fully informed about the law’s requirements and exemptions available. You can find more information here.
SCAMMERS CONTINUE TO FILE FALSE PHYSICIAN RETURNS: Physicians continue to be targeted under a tax return scam that began in 2014. ArMA reports more than 50 physicians have notified them that they have been victimized by the cyber scam. Some have been victimized more than once.
Under the scam, criminals us fraudulent federal income tax returns using physician names, addresses and Social Security numbers to file electronically for refunds.
If you are a victim, please contact PCMS Executive Director Bill Fearneyhough, email@example.com. He will forward your full name, home address and phone number to ArMA’s Chic Older. Older is working directly with Arizona IRS to monitor the situation.
KEEP AMB CONTACT INFO CURRENT: The Arizona Medical Board (AMB) is urging physicians to keep their contact information current. In an email, physicians were reminded of their statutory obligation to maintain their contact information with the Arizona Medical Board.
In part the email read: As your licensing agency, there are times when we need to contact you and/or send you reminders regarding the status of your license. For example, the Board does send an email reminder regarding your renewal deadline. It is imperative we have up-to-date information which will allow us to communicate directly with you. In order to facilitate communication between you and the Board, please take a moment to click on this link Online Change of Address (https://azdo.glsuite.us/glsuiteweb/clients/azbom/Private/changeaddress/login.aspx) to access your profile and update your contact information. Please see the statute below that requires you to report a change of address and allows for a penalty if this information is not maintained with the Board.
A. Each active licensee shall promptly and in writing inform the board of the licensee's current residence address, office address and telephone number and of each change in residence address, office address or telephone number that may later occur.
B. The board may assess the costs incurred by the board in locating a licensee and in addition a penalty of not to exceed one hundred dollars against a licensee who fails to comply with subsection a within thirty days from the date of change. Notwithstanding any law to the contrary, monies collected pursuant to this subsection shall be deposited in the Arizona medical board fund.”
NOMINATE A COLLEAGUE FOR “PHYSICIAN OF THE YEAR”: A highlight of every PCMS/Alliance Stars on the Avenue event is the presentation of several recognition awards including “Physician of the Year.” If you would like to single out a colleague for the prestigious 2016 POY Award please forward a brief letter or email outlining why they should be 2015’s Physician of the Year and mail it to 5199 E. Farness Drive, Tucson, AZ 85712 or email to Executive Director Bill Fearneyhough at firstname.lastname@example.org. For more information call Bill at 795-7985.
WALK-WITH-A-DOC: The Society is teaming with the Arizona Chapter of the American College of Physicians (ACP) to host and provide physician leaders for the monthly Walk-With-A-Doc outings. Walkers sign in at the ramada east of Swan Bridge on the south bank.PCMS physicians are encouraged to urge patients to participate in the program. Each walk begins with a brief discussion on a health topic and includes a one- or two-mile walk on level ground. Please contact Dennis Carey at 795-7985 or email@example.com for more information or if you have questions.