Archive for the ‘Medical News’ Category

AAFP Shares Additional Vaccine Resources and Recognizes National Immunization Month

Vaccine Resources to Support Critical Patient Conversations (reprinted from AAFP.org)

Vaccines are the best way to protect against potentially deadly diseases. But many patient still have questions when its time to get vaccinated. These resources can help you with those difficult conversations.

Fact Sheets

 

Other Resources

These tools are developed in collaboration with Pfizer, Inc.

Advertorial: ASGE Colorectal Cancer Screening Campaign

The Georgia Academy is encouraging every physician in the state to visit the American Society for Gastrointestinal Endoscopy (ASGE) ‘Colorectal Cancer Screening Appropriate Use’ web page to download some great patient education resources, including a printable office/practice poster, patient letter templates (for positive and negative test results), and an article for local newspapers.     

ASGE Immediate-Past President Douglas Rex, MD, MASGE, explains, “More than 30 percent of U.S. adults aren’t getting screened for colon cancer and it’s a disease that has a 90 percent survival rate when detected early. Further, most cancers can be prevented through polyp removal at colonoscopy. So, this campaign will save many lives.” 

Dr.  Rex also stresses that, “It is crucial for physicians to help their patients understand which colorectal cancer screening option is appropriate for them, keeping in mind that this can vary for each individual based on their history and risk factors.”

Today, colorectal cancer screening is recommended to begin at 45 years of age and screening options include colonoscopy, fecal immunochemical test (FIT) and MT-sDNA (Cologuard).

Dr. Rex says, “Colonoscopy can be used to screen high- and average-risk patients, meaning patients with no history of precancerous colorectal polyps or cancer, or who have no symptoms. For those who have had previous colorectal cancer or precancerous polyps, then surveillance colonoscopy is the only appropriate tool to monitor the patient and prevent cancer. The same is true for patients with colorectal symptoms, who should only be evaluated by colonoscopy.”

He adds, “For asymptomatic average-risk patients undergoing screening, stool tests are also appropriate options for screening. Average-risk means that age is the only risk factor, and particularly when there is no strong family history of colorectal cancer.  For such patients, FIT and MT-sDNA tests can also be used for screening and are an alternative to colonoscopy. These tests aren’t appropriate options for high-risk screening patients, surveillance patients who have a history of adenomatous polyps, sessile serrated polyps or colorectal cancer, or symptomatic patients.”

ASGE recommends that patients of any age who are exhibiting symptoms (e.g., rectal bleeding, anemia, a change in bowel habits, persistent abdominal pain, or unintentional weight loss) or who are high-risk (e.g., they’ve had a pre-cancerous colorectal polyp or colorectal cancer) or whose family has a strong history of colorectal cancer should talk to their gastroenterologist or primary care physician about the need for colonoscopy.

Visit ASGE.org/Screening-Physicians to download ASGE’s ‘Colorectal Cancer Screening Appropriate Use’ resources for physicians.

Physicians can refer their patients to www.asge.org/home/crc-screening for an easy-to-understand infographic on the appropriate screening test.

With nearly 15,000 members, ASGE has been the global leader in the GI field for more than 80 years. ASGE empowers its members with the latest information, state-of-the art education, and unparalleled professional resources. Visit www.ASGE.org for additional information.  

Updated Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology

CDC HEALTH UPDATE

Distributed via the CDC Health Alert Network

May 11, 2022, 12:15 PM ET  

CDCHAN-00465

Summary

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to provide clinicians and public health authorities with updated information about an epidemiologic investigation of pediatric cases of hepatitis of unknown etiology in the United States. This investigation focuses on collecting information to describe the epidemiology, etiology, clinical presentation, severity, and risk factors related to illness and to identify any relationship between adenovirus infection or other factors and hepatitis. As of May 5, 2022, CDC and state partners are investigating 109 children with hepatitis of unknown origin across 25 states and territories, more than half of whom have tested positive for adenovirus with more than 90% hospitalized, 14% with liver transplants, and five deaths under investigation. Because this investigation is ongoing and includes reviewing cases of hepatitis of unknown cause with onset since October 2021, patients under investigation are not limited to current or newly diagnosed pediatric hepatitis illnesses.

This HAN Health Update also provides updated recommendations for testing specimens from patients under investigation. It is an update to a HAN Health Advisory that CDC issued on April 21, 2022, that initially notified clinicians and public health authorities of children identified with hepatitis of unknown origin and adenovirus infection.

Background

A cluster of pediatric cases of hepatitis without an apparent etiology was identified and reported to CDC in November 2021. A possible association between pediatric hepatitis and adenovirus infection is under investigation after laboratory testing identified adenovirus infection in all nine patients in the initial cluster; the five specimens that could be typed were all adenovirus type 41. Investigators continue to examine the role of other possible causes and identify contributing factors.

Recommendations for Clinicians

  • Clinicians should continue to follow standard practice for evaluating and managing patients with hepatitis of known and unknown etiology.
  • Clinicians are recommended to consider adenovirus testing for patients with hepatitis of unknown etiology and to report such cases to their state or jurisdictional public health authorities.
  • Because the potential relationship between adenovirus infection and hepatitis is still under investigation, clinicians should consider collecting the following specimen types if available from pediatric patients with hepatitis of unknown cause for adenovirus detection:  
  • Blood specimen collected in Ethylenediaminetetraacetic Acid (EDTA) (whole blood, plasma, or serum); whole blood is preferred to plasma and serum)
  • Respiratory specimen (nasopharyngeal swab, sputum, or bronchioalveolar lavage [BAL])
  • Stool specimen or rectal swab; a stool specimen is preferred to a rectal swab
  • Liver tissue, if a biopsy was clinically indicated, or if tissue from native liver explant or autopsy is available: 
  • Formalin-fixed, paraffin embedded (FFPE) liver tissue
  • Fresh liver tissue, frozen on dry ice or liquid nitrogen immediately or as soon as possible, and stored at ≤ -70°C

Nucleic acid amplification testing (NAAT), such as polymerase chain reaction (PCR), is preferred for adenovirus detection (currently not available for FFPE liver biopsy or native liver explant). Testing whole blood by PCR is more sensitive to and is preferred over testing plasma by PCR. 

Were possible, clinical specimens should be tested locally to ensure timely results for patient care. For any diagnostic testing needs beyond the local capacity, CDC recommends that clinicians contact their state public health laboratory. For More Information

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

 

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Categories of Health Alert Network messages:

Health Alert          Requires immediate action or attention; highest level of importance

Health Advisory   May not require immediate action; provides important information for a specific incident or situation

Health Update      Unlikely to require immediate action; provides updated information regarding an incident or situation

HAN Info Service Does not require immediate action; provides general public health information

AAFP Shares New Vaccination Resources For World Immunization Week

AAFP has developed fact sheets for physician members and clinical staff to address vaccine skepticism and fear.

Click the links to download resources.

Building Confidence When Talking to Parents About Children’s Vaccine- Responses to common questions and misconceptions parents may have about vaccines for children.

How to Approach Conversations With Parents About Routine Pediatric Vaccinations –Tips for effectively communicating with families.

Are You Prepared for Zika?

This webinar is hosted by Nina Ahmad, M.D., Medical Director of the Division of Epidemiology for the New York State Department of Health.

At the end of this activity, participants should be able to:

·        Discuss epidemiology transmission patterns
·        Recognize clinical manifestations
·        Identify complications
·        Know reporting guidelines

The Zika virus webinar can be reviewed at the AAFP website.

Proposed MACRA Implementation Rule Misses Mark

On April 28, just eight short weeks ago, HHS released a long-awaited proposed rule intended to guide implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). Once fully implemented, MACRA will, by all accounts, drastically change the way CMS pays physicians to take care of their Medicare patients.  
The proposed rule(www.gpo.gov), titled “Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models,” was published in the May 9 Federal Register.

 

Nearly every day since the proposed rule was first released, a team of AAFP payment and policy experts has scoured the details of this complicated proposal looking for ways to ease family physicians’ transition into a variety of new payment models. The fruits of that combined effort are evident in a 100-plus page letter(1014 KB PDF) brimming with recommendations for CMS Acting Administrator Andy Slavitt to consider. Family physicians looking for a simpler, slimmed-down version of the AAFP’s comments can explore the high points in an executive summary.(8 page PDF)
AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., began the June 24 letter by expressing the AAFP’s overall support for MACRA. “We believe it was intended to strengthen primary care and make primary care a strong foundation” on which to build health care payment and delivery reform, he said. “But the importance of a successful implementation of the final rule cannot be overstated,” he added. With that in mind, CMS needs to “step back and reconsider” its approach to a proposed rule that is “overly complex and burdensome” for all physicians, said Wergin.“The implementation of MACRA will impact our health care system for years to come, and it must be done thoughtfully, carefully and as simply as possible.”This proposed rule “falls short of these goals,” he concluded.The Academy covered a lot of ground in its response to CMS’ proposed rule; a few red-hot issues most pertinent to family physicians are covered here.
Virtual Groups
The AAFP came down hard on CMS’ plan to delay implementation of virtual groups until 2018. The concept of virtual groups — as related to MIPS — would allow individual physicians or group practices of 10 or fewer eligible professionals to join forces as a virtual group during a MIPS performance period. Wergin pointed out that CMS would run afoul of MACRA by not having this process in place by 2017. But more importantly, lack of the virtual group option in 2017 would negatively affect many family physicians. This inaction on the part of CMS means that “solo and small-group physicians who had been counting on the virtual group option to be successful under MIPS will not have the opportunity,” said Wergin. He noted that more than a few family physicians had expressed enthusiasm for this opportunity, and from their conversations with the AAFP, it was clear that members “viewed it as an option to band together to share resources while maintaining their independence.” Taking this option off the table in 2017 will harm practices that were otherwise ready to engage with MACRA, said Wergin. “We are concerned they will be the hardest hit when CMS implements MIPS in 2017,” he added. The AAFP strongly urged CMS to create a “safe harbor” to exempt solo and small group practices (defined by the AAFP as five or fewer clinicians) from MIPS until the framework for virtual groups is in place.
MIPS Performance Period
The AAFP reiterated an earlier appeal to CMS regarding the initial performance period start date for MACRA. “The AAFP urgently and strongly calls on CMS to consider using 2018 as the initial assessment period for MACRA, and under no circumstances should the initial performance period start any earlier than July 1, 2017,” said Wergin. Wergin pointed out that if the final rule is issued around Nov. 1, 2016, with a start date of Jan. 1, 2017, physicians would have only two months to do a lot of prep work, including selecting quality measures and identifying clinical practice improvement activities. He suggested that 2017 be designated as a reporting preparation year and 2018 “be a year of judgment.” The AAFP also refuted the notion that two-year old data were clinically actionable or meaningful to physicians and urged CMS to find a way to provide feedback to physicians within one year or less. “The law mandates that the performance period and payment period be as close together as possible, and a two-year gap simply ignores this legislative mandate,” said Wergin.
Quality Measures
The AAFP stood its ground on previous recommendations regarding the use of quality measures. “The AAFP supports reasonable and achievable quality improvement programs that promote continuous quality improvement and measure patient experiences. The AAFP opposes an approach that requires physicians to report on a complex set of measures that do not impact or influence the quality of care provided to patients,” said Wergin. He insisted that all measures used in MIPS and APMs “be clinically relevant, harmonized among all public and private payers, and minimally burdensome to report.” Wergin called on CMS to use the core measure sets developed by the Core Quality Measures Collaborative, a multistakeholder group of which the AAFP is an active member. In addition, he expressed concern about “parity in reporting” across all specialty and subspecialty physician groups in regard to quality measure sets related to MIPS. “If CMS requires a lower number of quality measures for particular specialty groups in MIPS, that lower number of measures for reporting should be available to all MIPS-eligible clinicians,” said Wergin. “Reducing what seem to be reasonable/achievable requirements for some specialties will result in a continued disproportionate burden on those specialties (such as family medicine) that have been engaged in quality measurement and development,” he added.
Medical Homes
The AAFP has been a leader in the medical home movement dating back to mid-2000 when the Joint Principles of the Patient-Centered Medical Home(3 page PDF) were developed by the Academy and three other physician organizations and officially adopted by the groups in 2007. With that background in mind, it’s no surprise that Wergin insisted that physicians not be forced to “pay a third-party accrediting body to receive recognition as an advanced primary care practice,” such as a PCMH. The AAFP suggested that CMS “use a deeming authority to grant any entity which meets the necessary criteria as a PCMH accreditor to be an approved program,” and encouraged the inclusion of state-based, payer sponsored and regional PCMH recognition programs. Furthermore, the Academy adamantly opposes CMS’ proposed financial standard for the medical home model and called its inclusion in the proposed rule an “arbitrary imposition of financial risk placed upon clinicians in the models,” said Wergin. “This is a significant misinterpretation of the law, which was designed to protect and foster medical homes,” he added. Wergin called the medical home model “the crux of a value-based health care system” and a concept that has been proven to reduce spending and utilization.
Additional Issues
The AAFP commented on numerous other provisions in the proposed rule. For instance, Wergin
  •  objected to CMS’ application of the total per capita cost of care and Medicare spending per beneficiary measures to primary care physicians who are not part of an advanced APM,
  •  deemed the current proposal for “advancing care information” too complex and in fact said it had “missed the mark in a major way,”
  •  called CMS’ definition of a “medical home model expanded” too narrow and a deterrent to physicians looking to participate in the APM program, and
  •  expressed concern about CMS’ proposal to implement a “MIPS APM” category.
Regarding the final bullet point, Wergin said, “Unfortunately, throughout this section of the proposed rule, there are so many different rules and exceptions that no practicing physician could reasonably understand and report accurately to get a fair payment.”  

Medicaid Payment Notice: And Not a Moment Too Soon- Medicaid to Mass Adjust for Medicaid Rates

Hewlett Packard Enterprise (HPE) will perform a mass reprocessing of the impacted FFS physicians and physician extenders’ claims for dates of service July 1, 2015- June 30, 2016. Practitioners that previously attested to the initial ACA PCP rate increase between January 1, 2013 through December 31, 2014 should not resubmit any new day claims on or after July 1, 2016. All claims that paid at the old rate will be reprocessed in the Mass Adjustment. The Mass Adjustment is scheduled to be completed by July 31, 2016.

The Care Management Organizations (CMOs) have already reimbursed these new HB 76 PCP rate increases to their network providers into their capitation rates effective July 1, 2015. Thank you for your patience during the FFS implementation and mass adjustment process of the new HB 76 PCP rate increase for SFY 2016.

May’s Public Health Webinars are now on the GAFP Website

May 12th’s Severe Combined Immunodeficiency Screening and May 20th’s Developmental Screening Webinars from the Department of Public Health are now available on the GAFP website.

May 12th DPH Webinar: Severe Combined Immunodeficiency Screening, is available!
Objectives:
  •  Identify the rational for performing newborn screening for SCID/T cell lyphopenia
  • Understand the next steps for testing after an abnormal screening test is reported
  • Identify other non-SCID disorders that may be detected by this screening test
To participate in this activity, click here: https://gafp.org/education/webinars/
May 20th DPH Webinar: Developmental Screening, is available!
Objectives:
  • Review rates of developmental disabilities 
  • Understand that early identification and intervention leads to improved outcomes
  • List developmental and Autism Screening recommendations
  • Review Georgia EPSDT recommendations for screening
  • Understand challenges to screening in practice
  • List referral resources for further evaluation
  • Review developmental monitoring and screening resources
To participate in this activity, click here: https://gafp.org/education/webinars/

Important Update: Georgia Prescription Drug Monitoring Program – Action Requested

An update from the Georgia Prescription Drug Monitoring Program (GAPDMP):
The Georgia Prescription Drug Monitoring Program (GAPDMP) will be switching software vendors. We will be moving from RxSentry to the Appriss PMP AWARxE system.All accounts with RxSentry will be inaccessible beginning July 1, 2016. You will be able to access the new system beginning July 11, 2016. We apologize in advance for any inconvenience caused by the required technical downtime.

Please ensure that the email address on your RxSentry account is private to you as the account holder. Any accounts that share the same email address will NOT be transferred to the new system. If your account is not transferred you will have to fill out the registration and wait for your account to be approved by the State of Georgia.

Please login to your existing GAPDMP account on the RxSentry system and follow the below steps to update your account information. Please complete all updates before June 22, 2016:

  1. Navigate to “User Management”
  2. Click on “Update User Profile” to review and/or update your account information.
    • Please ensure the email address on your account is private to you
    • Any accounts that have the same email address will not be transferred to the new system

Important Information:

  • If you do not already have an account on the existing system you can register until June 22, 2016. Registration on the new GA PDMP software will open on July 11, 2016.
  • If your account is migrated from RxSentry, you will receive an email on 7/11/16, with the website, your login information, and instructions for the new system.
    • You will have access to the new system beginning, 7/11/16. 
  • Please set no-reply-pmpaware@globalnotifications.com as a safe sender within your email client and/or firewall.

You will receive a reminder email with instructions on how to access your account as well as a short training tutorial on how to perform a query on 7/11/16.

MACRA Bytes: Two in a Series of Educational Messages – CMS Transforming Clinical Practice Initiative – Why Join QualityImpact PTN Now?

In the first article of our series, we provided an overview of The Transforming Clinical Practices Initiative (TCPI) launched by CMS and its role in transitioning volume-driven clinical practices to value-based, patient-centered health care practices. QualityImpact, the Consortium for Southeastern Hypertension Control’s (COSEHC) Practice Transformation Network is one of 29 other practice transformation networks receiving TCPI funding to facilitate this transformation.

QualityImpact is CMS’ conduit and agent to work locally with provider groups to assist them in preparation and readiness for alternative payment models and MACRA. QualityImpact covers nine states across the Southeast including Mississippi, Louisiana, Alabama, Georgia, Florida, North Carolina, South Carolina, Tennessee, and Virginia. The goal is to recruit 3,400 providers (physicians, NPs and PAs) into the TCPI (Transformation Clinical Practices Initiative); a four year program aimed to transform healthcare delivery. The QualityImpact PTN presents a tremendous opportunity for practices to receive support and resources to enable their success in transitioning to value-based reimbursement. Participation in the PTN will give you access to a comprehensive transformation “package” at no cost, including:

  • MDinsight – A sophisticated, interoperable population health management platform
  • Care Delivery Consulting – Process improvement facilitation enabling improved efficiency, quality, and proactive patient management
  • Clinical Quality Improvement – Expert-led guidance and CME tailored to care gaps/opportunities

QualityImpact’s transformation package is tailored to each practice, is minimally disruptive and is practical in nature. It offers an opportunity to break down the siloes that exist in the market between public and private payers by aligning clinical metrics and payment incentives and creating a full population health approach across all populations.

QualityImpact also has a strong foundation of a robust clinical advisory board with a number of subject experts across key chronic disease areas that drive specific clinical areas around chronic disease management from an operational and clinical delivery standpoint.

QualityImpact fosters shared learnings among practices to share best practices and key learnings. Lastly, QualityImpact will give your practice a chance to be a part of a national platform and demonstrate to CMS the great outcomes that your practice is achieving. QualityImpact is enrolling providers on a first-come, first-serve basis. The inevitable transition to value-based care will present significant challenges to our members. QualityImpact presents a tremendous opportunity for your practice to receive CMS-funded support and resources free of cost to help you be successful in this new environment.

To join or learn more about QualityImpact, (the Georgia Academy endorsed PTN) contact Debra Simmons at dwirth@wakehealth.edu or visit our website, http://www.qualityimpact.org

For more information on the Transforming Clinical Practice Initiative, please visit: http://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

 

Oral Health Assessment and Fluoride Varnish Application Training for Academy of Family Physicians

The Georgia Department of Public Health (DPH), Maternal and Child Health Section, Oral Health Program would like to offer the Georgia Academy of Family Physicians oral health assessment training and fluoride varnish workshops around the state. We have already launched this initiative. The DPH Oral Health Program provided a short half hour oral health assessment and fluoride varnish application overview during the Conclave Meeting at Callaway Gardens in March. The presentation evaluations demonstrated a strong interest by the attendees to include oral health assessments, anticipatory guidance, and fluoride varnish applications as part of their practice protocols.

 Research has demonstrated inclusion of oral health in the family practice for non-dental health care providers complements the comprehensive care model of family medicine and has the potential of improving the overall health of your patients. This is not a substitute for the dental home, but a collaborative opportunity to offer comprehensive care for your patients and determine when early dental practice referrals are needed.

The DPH Oral Health Program will have an oral health staff member, Jorge Bernal, DDS, at the Annual Session in Hilton Head in June. If you are interested in a regional meeting next year, either in Columbus, Savannah, or another region of the state please let Dr. Bernal know at the meeting. He will have a sign-up sheet so we can contact you to schedule presentations beginning in September. Dr. Bernal will also have samples of single-application fluoride varnish for member, as well as copies of handouts for Academy members and educational materials for families. Stop by and visit the Maternal and Child Health exhibit table.

Additional workshops are planned around the state and will continue with hands-on practice training.

Question you may have: How is fluoride varnish different from other professionally applied fluorides?

Fluoride varnish offers several advantages over other professionally applied fluorides:

  • The higher concentration of fluoride and greater viscosity make it less likely to be ingested and only a small amount needed
  •  Varnish comes in child-friendly flavors and is easily tolerated, especially by infants, toddlers, and developmentally disabled people.
  •  Providers find it easy to use and fast to apply.
  •  Fluoride varnish is swabbed onto the teeth in less than two minutes and sets within a minute of contact with saliva.
  •  Fluoride varnish is safe.
  •  It can be applied in any setting and does not require dental equipment.
  • Medicaid will reimburse the practice for this service.

Not all members of the Academy were able to attend the Conclave meeting in March. Due to the positive response to the presentation we would like to offer a slightly longer and more detailed workshop presentation in locations convenient to the members of the Academy. If you have a group of members interested in a workshop please contact Carol Smith at: carol.smith@dph.ga.gov.

What would be recommended after hands on training? The Oral Health staff recommends the medical practice pilot a few test cases to assess office flow, billing, patient satisfaction, and staff satisfaction. Have a meeting to get input from all employees. Have handouts to explain to families the value of the fluoride varnish. The American Academy of Pediatric Dentistry recommends that physicians refer patients to the dentist at eruption of the first tooth and no later than 12 months of age. The medical practice should have a dental referral list; if you need assistance finding a dentist in your community please contact the state oral health office for assistance.

Additionally, online training can be found on a few sites:

The Smiles for Life, a National Oral Health Program (endorsed by the Society of Teachers of Family Medicine) One CME credit is available through the American Academy of Family Physicians (AAFP) upon completion. http://www.smilesforlifeoralhealth.org

The American Academy of Pediatrics (AAP) Oral Health Risk Assessment Training for Pediatricians and Other Child Health Professionals. One CME credit available upon completion.

The DPH Oral Health staff are available to assist you. Please feel free to contact Carol Smith, Director of Oral Health, at carol.smith@dph.ga.gov if you need assistance with your oral health training.