The Zika virus persisted in some body fluids for unexpectedly long periods, researchers reported at the Conference on Retroviruses and Opportunistic Infections. Analysis of a Puerto Rican cohort of people newly infected with Zika suggested that the flavivirus lasts longer than others in its class, such as dengue, according to Gabriela Paz-Bailey, MD, PhD, of the CDC in Atlanta, and colleagues. he medians and 95th percentiles for the time until the loss of detectable Zika virus RNA detection were 14 days (95% CI 11-17) and 54 days (95% CI 43-64), respectively. The prolonged time might have implications for both diagnosis and prevention of Zika, Paz-Bailey told reporters at the annual Conference on Retroviruses and Opportunistic Infections (CROI). The study was published simultaneously in the New England Journal of Medicine.
Small Number of Zika Cases in Haiti
From October 2015 to November 2016, Haiti has reported 3,036 suspected cases of Zika virus disease, and 29 cases of microcephaly, but researchers cautioned that the country may have difficulty responding to the Zika outbreak. Overall, a little under 10% (294) patients underwent testing for the virus.Writing in the Morbidity and Mortality Weekly Report, they noted that suspected cases and testing are lower than expected. Of 19 living infants with microcephaly, all tested negative for Zika via RT-PCR. Three-quarters of mothers reported Zika symptoms during their pregnancy. The authors credited Haiti's department of public health for its response to the virus, but noted that Haiti still has not implemented in-service national clinical training and may require additional financial resources to increase Zika virus testing.
NAID Reissues Zika Funding Opportunity Announcement
Due to "incredible response," the National Institute for Allergy and Infectious Disease announced it is reissuing a funding opportunity announcement for the study of Zika virus. This FOA will aim to examine complications of Zika virus disease, specifically focusing on high-priority areas of research. These topics include studies of Zika-associated Guillain-Barré, encephalitis or encephalomyelitis both in an attempt to develop new treatments and to determine the disease course and related outcomes. Studies on the effects of Zika and the development of epilepsy, as well as the effects of Zika on hearing are also requested. The NAID noted that the last funding opportunity produced about "a dozen" funding awards.
The overuse of health services is old news. In the U.S., the problem emerges in the form of variations in practice patterns and overdiagnoses. Here, underuse usually falls under the heading of access.In both cases, efforts are underway to expand coverage and discourage the use of low-value services. But the worldwide problem of inappropriate care described in a series of research papers goes beyond anything that could be addressed through quality measures or the Affordable Care Act. The 27 researchers who contributed to the series published in The Lancet see overuse and underuse as symptoms of a profoundly dysfunctional healthcare system immune to incremental reforms.
They make their case in a series of four articles that describe the problem, identify causes, and call for systemic change. They sum up their findings this way: "Because poor care is ubiquitous and has considerable consequences for the health and well-being of billions of people around the world, remedying this problem is a morally and politically urgent task." In a related commentary, Donald Berwick, MD, president emeritus and senior fellow at the Institute for Healthcare Improvement, described the research as a "call-to-arms to improve healthcare globally by better matching care to needs, and practice to science."
The Lown Institute, which inspired and shepherded the research, is working to spark a grassroots movement "to transform the health system," he said. "One of the things we recognized through the work of the papers, which I don't think we would have recognized without it, is that overuse and underuse occur all around the world," Saini said. The findings on inappropriate care are staggering. Some are familiar: The WHO estimates 1.5 million children died of vaccine-preventable illnesses in 2015. Other findings may be unfamiliar: Hypertension is considered undertreated in the US, where 70% of Americans with hypertension are treated. In sub-Saharan Africa, only 18% receive treatment.
And the lists go on: 500,000 cases of faulty thyroid cancer diagnoses. Excessive antibiotic use in China. Inappropriate hysterectomies and colonoscopies in the US. Unneeded knee replacements in Spain and 6.2 million excess caesarean sections each year - half in Brazil and China.In France, China, and Cameroon, researchers cite the underuse of anticoagulation drugs in certain patients at high risk of stroke.
Who's to Blame?
Causes of this misdirected care are many, according to the study authors. But they cite three overriding drivers - money, knowledge, and power. The commercial nature of healthcare is high on the list and the authors are not afraid to use the word "greed" to describe the motivations of for-profit players. In some cases, underuse is driven by patients, who don't seek or comply with care. Another well-known driver, healthcare financing schemes, often influence provider and hospital behavior. Yet another driver is the lack of planning, Saini said. "Hundreds of millions of dollars are devoted to health resources: buildings, hospitals, training of physician and nurses," he said. "Yet, there is remarkably poor clarity on how to figure out what you really need. What does your population need?"
In India, for example, poor care comes from a push to move childbirth into new hospitals instead of local birthing centers, which are less expensive and just as safe, Saini said. In order to address all this, the Lown researchers envision a healthcare system that will be very different than the one we have now. Hospitals will need to find what Saini called a "glide path" that will allow them to adapt. "In the end, a highly efficient healthcare system is going to need less hospital care and a lot more outpatient, preventative, primary, and in-home care," he said. "People who think deeply and hard about healthcare see that. Everyone is stuck with the transition. How do we get there?" Saini believes it will take universal coverage and global payments to hospitals to address the problem. But, he said it will take more research, experimentation, and a political movement to bring about change.
It's About Power
"Care delivery is the net result of the relative power of various stakeholders to influence the process of decision making in the doctor/patient relationship," Saini and his co-authors write. "Stakeholders with sufficient economic capital can use that ability to financially support and influence others, and reinforce terms most favourable to their interests." He is convinced that change will not happen without the kind of activism and buy-in he thinks was absent in the run-up to the Affordable Care Act. "The allocation of healthcare is such an important issue around the world, it really does require a greater engagement on the part of the public in order to come to an understanding of what kind of solutions are going to be appropriate and acceptable to people," he said. Without it, he said, "We'll see change. We'll see improvements, but not enough to move the needle."
Zika-related birth defects have been documented in about 6% of fetuses or infants in Zika-associated pregnancies, according to preliminary data from the U.S. Zika Pregnancy Registry. The portion of these birth defects, including brain abnormalities, neural tube defects, and eye abnormalities, did not vary by maternal symptom status, reported Margaret A. Honein, PhD, of the CDC, and colleagues; approximately 80% of Zika infections are asymptomatic.
Incidence of defects was slightly higher (11%) among mothers who reported Zika symptoms or exposure during the first trimester, the authors wrote in a special online edition of the Journal of the American Medical Association. Honein and colleagues examined data from 442 pregnant women with laboratory evidence of travel-associated Zika infection, consisting of 395 live births and 47 pregnancy losses (defined as terminations, spontaneous abortions, or stillbirths) from December 2015 to Sept. 22, 2016. Of these, 26 were were identified with Zika-related birth defects (21 live-born infants and five pregnancy losses); 22 of these (85%) had microcephaly or brain abnormalities. There were 18 with a finding of microcephaly, which translated to a 4% incidence rate, consistent with modeled data from Brazil that estimated a 1% to 13% risk of microcephaly. They also characterized the U.S. "background" rate of microcephaly as 7 per 10,000 live births -- that is, less than 0.1%.
"This shows that the rate of microcephaly and other fetal malformations related to Zika is similar among babies born in the United States – whose mothers were infected during travel to a dozen countries with active Zika transmission – to the estimated rate in Brazil," said CDC Director Tom Frieden, MD, in a statement. "Zika poses a real risk throughout pregnancy, but especially in the first trimester."
Adding to the growing body of evidence that earlier infection is linked with more severe birth defects, there were no birth defects in infants or fetuses among women who reported exposure or symptoms during the second or third trimester. However, the authors noted that the confidence intervals ranged from 0% to 11%, demonstrating the "imprecision of these estimates based on current data." Not surprisingly, sensitivity analyses limiting data to completed pregnancies with first trimester or periconception symptom onset or exposure found the rate of birth defects was seven out of 49 (or 14%). The researchers noted that 41% of infants did not have Zika virus testing. Offering a pediatrician's perspective, an accompanying editorial characterized this finding as a "significant gap in practice," given that the CDC recommends both serologic testing and polymerase chain reaction (PCR) testing for infants whose mothers have evidence of Zika themselves.
"This suggests either a knowledge gap among clinicians who care for children or a communication gap between obstetric and pediatric providers who cared for these patients," wrote William J. Muller, MD, and Emily S. Miller, MD, both of Northwestern University in Chicago. The editorialists praised the Zika Pregnancy Registry for their "significant progress" in such a short period of time in the understanding of how Zika impacts the developing brain after in utero infection. Honein and colleagues concluded that the data supported the CDC's current guidance about Zika screening, as well as counseling patients to avoid travel to endemic areas, where women or their partners may be exposed during pregnancy or the periconceptional period.
Physicians who are wondering if they can fit into any of the Advanced Alternative Payment Models (APMs) under the Medicare Access and CHIP Reauthorization Act (MACRA) will now have a few more options to consider. The Centers for Medicare & Medicaid Services (CMS) "expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year," the agency said. "In addition, CMS is announcing that the Innovation Center's Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an Advanced APM beginning in the 2017 performance year."
"Every day, the CMS Innovation Center is improving the future of Medicare by testing innovative care models across the country," CMS acting administrator Andy Slavitt said in the release. "Now, thanks to ... MACRA, clinicians have more opportunities and motivation to join these evidence-based approaches, which aim to improve care quality while creating cost savings."
Under the APM program, clinicians meeting specific requirements would earn incentive payments of approximately 5% for 5 years in a lump-sum payment every year from 2019 to 2024. Those ineligible for the advanced APMs will be assigned to a default framework, the Merit-Based Incentive Payment System (MIPS). From 2019 to 2024, these providers would receive small bonuses or penalties based on their ability to meet a series of metrics across four categories: quality improvement, performance, resource use, and appropriate use of electronic health records. Physicians must start collecting data on their metrics in 2017 in order to avoid a payment penalty.
In 2017, physicians will be able to participate in a variety of APMs in order to earn the incentive payment, including the Comprehensive ESRD [end-stage renal disease] Care Model, CPC+, Medicare Shared Savings Program ACOs (tracks 2 and 3), the Oncology Care Model, and the Comprehensive Care for Joint Replacement payment model, CMS said. "With these new opportunities, CMS expects that by the 2018 performance period, 25% of clinicians in the Quality Payment Program will earn incentive payments by being a part of these advanced models," said CMS deputy administrator Patrick Conway, MD, said in the press release.
The Health Care Payment Learning and Action Network, a group organized by the Department of Health and Human Services, released a report showing that in 2015, 38% of dollars spent on healthcare by commercial insurers, Medicaid, and Medicare Advantage were tied to quality metrics, alternative payment models, or population-based health measures. "This report shows the meaningful progress we've made to improve quality and lower costs," Marilyn Tavenner, president and CEO of America's Health Insurance Plans, a trade group for health insurers, said in a statement. "Health plans, doctors, hospitals, businesses, and public programs are all changing, all collaborating – and all improving the way we deliver care."
The Centers for Medicare & Medicaid Services said it is trying to ease administrative hassles for physicians participating in Medicare, and physician groups seemed pleased with the idea. "The American Medical Association (AMA) welcomes this new initiative to reduce regulatory burdens on physicians," AMA president Andrew Gurman, MD, said in a statement. "Acting Administrator [Andy] Slavitt is leading a timely effort to be responsive to physicians' concerns. We look forward to working with CMS on this initiative so all physicians can spend more time on patient care and less time on paperwork."
If any of this seems familiar, that is because it is: here is a 1991 version. This latest initiative will start with an 18-month pilot program, in which "providers practicing within specified Advanced Alternative Payment Models (APMs) will be relieved of some scrutiny under certain medical review programs," CMS said in apress release. "Advanced APMs were identified as a potential opportunity for this pilot because participating clinicians share financial risk with the Medicare program ... After the results of the pilot are analyzed, CMS will consider expansion along various dimensions including additional Advanced APMs, specialties, and provider types."
In particular, next generation accountable care organizations (ACOs), certain Medicare Shared Savings programs, and Pioneer ACOs will be included in the pilot program, as well as Oncology Care Model 2-sided Track participants, CMS said in a fact sheet. In the program's first phase, from Jan. 1, 2017 to June 1, 2018, "CMS will direct Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), and the Supplemental Medical Review Contractor to consider as a low priority for post-payment medical record review claims from providers participating in Advanced APMs for beneficiaries aligned to the model. "In the pilot's second, overlapping phase, which runs from April 1, 2017 to June 1, 2018, "providers in certain Advanced APMs will also be considered as a low priority for prepayment medical record review by MACs," CMS said.
Slavitt is appointing Shantanu Agrawal, MD, to lead the overall initiative, "which will cover documentation requirements and existing physician interactions with CMS, among other aspects of provider experiences. To ensure CMS is hearing from physicians on the ground, each of the 10 CMS regional offices will oversee local meetings to take input from physician practices within the next 6 months and regular meetings thereafter. These local meetings will result in a report with targeted recommendations to the CMS Administrator in 2017."
The American College of Physicians (ACP) also sounded positive about CMS's announcement, noting that it had urged the agency to lighten review for physicians in advanced APMs since they were already accepting financial risk.
"ACP is committed to working with CMS to ensure that this program truly results in meaningful reductions in onerous administrative tasks, and is expanded to include other advanced APMs, including the Comprehensive Primary Care Plus program and other patient-centered medical homes," ACP president Nitin Damle, MD, said in a statement. "It is critical to us that this initiative be conducted in addition to – not in lieu of – other needed reforms to reduce burdensome administrative tasks and simplify MACRA implementation."
A large portion of recently approved $1.1 billion in funds for Zika virus will be distributed to U.S. states and territories, in addition to planned additional clinical trials for a Zika vaccine and enhanced surveillance for mosquito-borne diseases, said researchers from the CDC, HHS, and the National Institute for Allergy and Infectious Diseases (NAIAD).
On a conference call with officials from all three government agencies, CDC director Tom Frieden, MD, said that $350 million of recently approved funds will be distributed to U.S. states, local governments, and territories to help "fight Zika more effectively and robustly." This will include sending teams to deal with local outbreaks, such as the type of assistance the CDC provided to the state of Florida.
A portion of these funds will also be put toward funding clinical trials for a Zika virus vaccine. The NIH currently has five clinical trials of a Zika vaccine in development, either alone or in collaboration with other agencies, including the Biomedical Advanced Research and Development Authority (BARDA). This includes the DNA-based vaccine that started human trials.
NIAID director Anthony Fauci, MD, announced that over the weekend, that phase I trial had enrolled the 80th patient. NIH researchers project they will have enough information from this trial to determine safety and the type of protective response so the phase II trial can begin in early 2017. Included will be 15 sites in areas with ongoing local transmission, such as South America, Central America, and Puerto Rico.
Nicole Lurie, MD, assistant secretary for preparedness and response at HHS, added that BARDA is currently supporting a range of vaccine candidates in conjunction with manufacturers. Between the NIH and BARDA, there are nine vaccine candidates currently in development, as well as more that are still in the earliest stages of research. "Our experience in BARDA has reinforced that in order to get a vaccine candidate across the finish line, it takes five to nine starts, because not all vaccine candidates will be successful," she said. She said that in addition to vaccine candidates, HHS is also consulting with diagnostic testing manufacturers in hopes of developing a point-of-care diagnostic test for Zika virus.
While research continues on vaccination, the CDC is putting funding toward the development of Research Centers of Excellence, such as the kind that have been developed for West Nile virus. Frieden said that requests for proposals have been distributed to encourage universities to work with health departments and optimize tools to attempt to control vector-borne diseases. These proposals are due at the end of October. "We will move money as fast as government procedures allow, but most money going out to the states will be processed in fiscal year 2017," said Frieden.
Research at a Cost
But researchers from all three agencies made it clear that due to delays in funding from Congress, they are potentially behind in their understanding of Zika virus. They also said that other research efforts have suffered, as money was pulled from studies on mental health, diabetes, and cancer to fund the fight against Zika. In fact, $44 million of the allocated funds will be used to restore money to the CDC's emergency preparedness fund, said Frieden. "Because we had to wait seven months, we couldn't get a running start on critically important studies to fully understand the impact of Zika and the effects on a fetus, mosquito control efforts, and progress on a vaccine."
Lurie said lack of funding meant that researchers were "significantly behind" on vaccine development efforts, and that certain vaccine and diagnostic testing manufacturers "walked out the door" because they were not entirely certain the money to fund their research was going to be there. "The time and energy was spent on trying to get the funding versus trying to use the funding," she said. "That money would be out the door if we had received that money when we asked for it." Fauci said that their research is going to "be able to continue rather smoothly, but at a significant cost," as they were forced to borrow from itself, depriving other areas of clinical focus of research funds in order to fund the work on Zika vaccines. "It speaks to the importance of having a fund in place for emergency health issues in a FEMA-like way - that would be very helpful, and that's something that should be seriously considered so we don't have to wait for the appropriations process," he said.
Responding to complaints from Congress and organized medicine, the Centers for Medicare & Medicaid (CMS) announced that it will give physicians several options to comply with Medicare payment rules set to go into effect next year. "In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017," CMS acting administrator Andy Slavittwrote in a blog post. "During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019."
Under the Medicare Access and CHIP Reauthorization Act (MACRA) - the bill that repealed the sustainable growth rate formula for physician reimbursement under Medicare - physicians must choose from one of two paths beginning next year: they can either participate in an alternative payment model such as an accountable care organization, or they can join in the Merit-Based Incentive Payment System (MIPS), which requires doctors to submit quality reporting data to Medicare.
Slavitt outlined four options for physicians:
More details on these options will become available when CMS releases its final rule for implementing the Quality Payment Program, sometime before Nov. 1, Slavitt noted. "We appreciate the sincere and constructive participation in the feedback process to date and look forward to advancing step by step in that same spirit."
Reactions to Slavitt's announcement were swift. "The AMA strongly applauds [Health and Human Services] Secretary [Sylvia] Burwell and Acting Administrator Slavitt – and their teams – for listening to physicians' concerns about the timeline that was originally proposed for MACRA," AMA president Andrew Gurman, MD, said in a statement. "By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country."
Rep. Michael Burgess, MD (R-Texas), an ob/gyn and member of the House Energy & Commerce Health Subcommittee, also hailed the announcement. "Today's announcement from CMS regarding the agency's dedication to flexibility in the implementation of MACRA is proof of the benefits of keeping Congress involved in policy implementation," he said in a statement. "Just as this policy was carefully crafted with the input of everyone affected by the payment policies, the implementation process should be conducted in the same way. I am committed to leading the charge for continued Congressional oversight of MACRA implementation to ensure simplified, streamlined requirements that allow for all doctors to succeed."
Slavitt hinted at a Senate hearing in July that CMS might be open to delaying parts of the law. "We remain open to multiple approaches," he said. "Some things on the table include alternative start dates, looking at whether shorter [reporting] periods could be used, and finding other ways for physicians [to get used to] the program before the impact really hits them."
With 10 additional cases of Zika virus discovered over the weekend and mosquito control efforts less effective than hoped, the CDC has issued a travel advisory for a 1-mile radius north of downtown Miami, researchers announced Monday. CDC researchers noted that this is the first time the organization has advised against travel to an area within the continental U.S.
Pregnant women are advised against traveling to this specific area, and those who did travel there on or after June 15, 2016 are advised to get tested for potential Zika virus exposure. Pregnant women who reside or work in the area are advised to make every effort to avoid mosquito bites, as well as avoid sexual contact with their partners for the duration of pregnancy. The 1-mile radius covers the 150-meter area where the four initial cases of Zika virus in Florida were discovered on Friday, plus a "buffer zone" with natural boundaries. "Today, [the Florida Department of Health or DOH] has confirmed that 10 additional people have contracted the Zika virus locally, likely through a mosquito bite," said Florida governor Rick Scott (R), in a statement. "Following today's announcement, I have requested that the CDC activate their Emergency Response Team to assist DOH in their investigation, research and sample collection efforts."At this point, no broader travel advisory is being issued, though CDC researchers said this is consistent with CDC guidance that has been published and updated recently.
"Nothing that we've seen indicates widespread transmission, but it's certainly possible that there could be sustained transmission in some areas, especially those who don't have [window] screens or live in crowded areas," said CDC director Tom Frieden, MD, in a conference call with reporters. "We may well see more infections in that area because of how efficient a vector that mosquito is. "There are several reasons why efforts to control the Aedes Aegypti mosquito may not be successful, he added - the mosquitoes may be immune to insecticide; there may be "cryptic breeding sites," or small areas of standing water where the mosquitoes continue to hatch; and, in general, the Aedes Aegypti is a difficult mosquito to control.In addition to their counseling for pregnant women, CDC officials also advise that women who are considering pregnancy, and have traveled to the affected area, delay their attempts to conceive for up to 8 weeks upon return.
Local Zika transmission in Florida appears to be associated with a trendy neighborhood in North Miami but there's no immediate need to urge people to stay away, according to CDC Director Tom Frieden, MD. The four cases reported in Florida appear to have no other risk factor for Zika than an association with the Wynwood Arts District, Frieden said.
What would help pin down the apparent local transmission is finding infected mosquitoes in the area, he said, but that hasn't happened yet. In the meantime, Frieden said, it remains unlikely that Florida will see a widespread outbreak that would increase the need for a travel advisory like those the CDC has issued for many countries in Latin American and the Caribbean, including Puerto Rico. But, he added, "we will reassess that every single day."
The four patients were probably infected in the neighborhood early in July, became sick a week later, and were diagnosed a couple of days after that, Frieden said. The Florida health department immediately began an epidemiological investigation, which suggested the association with the Wynwood area. One of the patients lives in nearby Broward county, but works in the Wynwood area.Florida has begun door-to-door surveys to see if other cases can be found, he said, as well as conducting mosquito abatement measures in the Wynwood district. He noted that Zika is a "very focal disease" - it is spread by the Aedes aegypti mosquito, which travels only a few hundred feet during its entire lifetime, so that local abatement measures can have an important effect.
Experts have been predicting that some local transmission would occur in the parts of the southern U.S. where A. aegypti lives, so the Florida cases were "not unexpected," Frieden said. He added that the timing was also expected - it coincides with an upsurge in mosquitoes and it is roughly the same time of year that previous outbreaks of dengue fever have been seen. Frieden also pointed out 89% of people infected by the virus have no symptoms, so finding cases in Miami doesn't mean residents or visitors are at greater risk than they would be elsewhere. It might just mean that cases elsewhere haven't been detected, he said. But like dengue fever and chikungunya - two related viruses also carried by A. aegypti - it's likely that locally acquired cases in Florida will be "dead ends" and will not result in further transmission, Frieden said.
On the other hand, he repeated the CDC's advice to pregnant women - use a DEET-based mosquito repellent, wear long sleeves and pants, and generally avoid mosquito bites. Frieden's comments on the Florida cases came as the agency reported that some 5,582 people in Puerto Rico have been infected with the virus, including 672 pregnant women, from Nov. 1, 2015 to July 7, 2016.
As the U.S. Senate begins reconciling its bill to stem the opioid epidemic with the House, one health system in Massachusetts is already using e-prescribing technology, newly enabled to include controlled substances, to help reduce opioid abuse. An executive at Massachusetts-based Cambridge Health Alliance said the system, in place for a year, has already saved its more than 700 physicians hundreds of hours and has made patients' lives immeasurably easier. Using two-factor physician authentication technology from Imprivata, a year ago CHA bid farewell to the lion's share of use of secured, controlled paper printing for writing prescriptions for controlled substances. In its place is a system that requires physicians to enter a username and password, then, using Imprivata's e-prescribing app for controlled substances (EPCS) on their smartphones, a sequence of numbers, which refreshes every 30 seconds. This protocol meets the strict authentication and audit requirements that the Drug Enforcement Administration insisted upon before permitting EPCS in the U.S. Before rolling out EPCS, Cambridge Health Alliance physicians found themselves having to drive across town to another clinic to sign prescriptions, printed on a secured printer, for maintenance doses of controlled substances. Now signing these scrips is as simple as approaching any Cambridge Health Alliance physician's workstation, said Art Ream, chief information security officer at CHA.
For the first time, researchers have found a person in the United States carrying a bacteria resistant to antibiotics of last resort, an alarming development that the top U.S. public health official says could mean "the end of the road" for antibiotics. The antibiotic-resistant strain was found last month in the urine of a 49-year-old Pennsylvania woman. Department of Defense researchers determined that carried a strain of E. coli resistant to the antibiotic colistin, according to a study published Thursday in Antimicrobial Agents and Chemotherapy, a publication of the American Society for Microbiology. The authors wrote that the discovery "heralds the emergence of a truly pan-drug resistant bacteria."
Colistin is the antibiotic of last resort for particularly dangerous types of superbugs, including a family of bacteria known as CRE, which health officials have dubbed "nightmare bacteria." In some instances, these superbugs kill up to 50 percent of patients who become infected. The Centers for Disease Control and Prevention has called CRE among the country's most urgent public health threats. It's the first time this colistin-resistant strain has been found in a person in the United States. Last November, public health officials around the globe reacted with alarm when Chinese and British researchers reported finding the colistin-resistant strain in pigs, raw pork meat and in a small number of people in China. The deadly strain was later discovered in Europe and elsewhere.
“It basically shows us that the end of the road isn’t very far away for antibiotics -- that we may be in a situation where we have patients in our intensive-care units, or patients getting urinary tract infections for which we do not have antibiotics,” CDC Director Tom Frieden in an interview Thursday. “I’ve been there for TB patients. I’ve cared for patients for whom there are no drugs left. It is a feeling of such horror and helplessness,” Frieden added. “This is not where we need to be.”
CDC officials are working with Pennsylvania health authorities to interview the patient and family to identify how she may have contracted the bacteria, including reviewing recent hospitalizations and other healthcare exposures. CDC hopes to screen the patient and other contacts to see if others might be carrying the organism. Local and state health departments will also be collecting cultures as part of the investigation. Scientists and public health officials have long warned that if the resistant bacteria continue to spread, it could seriously limit available treatment options. Routine operations could become deadly. Minor infections could become life-threatening crises. Pneumonia could be more and more difficult to treat.
Already, doctors had been forced to rely on colistin as a last-line defense against antibiotic-resistant bacteria. The drug is hardly ideal. It is more than half a century old and can cause serious damage to a patient’s kidneys. And yet, because doctors have run out of weapons to fight a growing number of infections that evade more modern antibiotics, it has become a critical tool in fighting off some of the most tenacious infections. Bacteria develop antibiotic resistance in two ways. Many acquire mutations in their own genomes that allow them to withstand antibiotics, although that ability can't be shared with pathogens outside their own family. Other bacteria rely on a shortcut: they get infected with something called a plasmid, a small piece of DNA, carrying a gene for antibiotic resistance. That makes resistance genes more dangerous because plasmids can make copies of themselves and transfer the genes they carry to other bugs within the same family as well as jump to other families of bacteria, which can then "catch" the resistance directly without having to develop it through evolution. The colistin-resistant E. coli found in the Pennsylvania woman has this type of resistance gene.
The Obama Administration proposed two rules Wednesday, April 27 that officials say will ease physicians' documentation requirements and give them new opportunities to earn bonuses for providing high-quality care. One rule implements what is called the Quality Payment Program, which gives doctors two options for getting reimbursed under Medicare: they can participate either in the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).
"There have been a myriad of programs [for physician payment] developed over the years,"Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), told reporters on a conference call. He gave alternative programs such as accountable care organizations and shared savings programs as examples. The Quality Payment Program "replaces all these programs with a single platform. Physicians will have the opportunity to get paid more for investments that support patients, and do so with minimal burden."
In addition, said CMS chief medical officer Patrick Conway, MD, "The proposed system would reward clinical practice improvements such as activities focused on care coordination, patient engagement and patient safety, and also reduce reporting requirements ... by reducing the number of measures required, and eliminating redundant quality reporting. If physicans do well in the program, they could earn more than a 4% bonus in incentive payments ... with additional bonuses for the highest performers."
Physicians choosing the MIPS program would get paid based on their reporting on a single set of quality measures; the set combines measures from earlier programs such as the Physician Quality Reporting System and the Value-Based Payment modifier. However, to increase flexibility, "The program allows physicians ... to select quality measures from a range of options to reflect differences among specialties, and report technology utilization based on customizable measures that reflect how clinicians use technology in their day-to-day practice," Conway explained.
Those choosing the Advanced APM program would be paid based on their participation in newer payment models such as the Comprehensive Primary Care Plus model and the Next Generation Accountable Care Organization model. Both programs are slated to go into effect in January 2017, beginning with a reporting period that will affect physician pay in 2019.
The second proposed rule makes changes to the highly unpopular Meaningful Use program, which requires physicians to document making "meaningful use" of electronic health records (EHRs). "We are proposing to replace Meaningful Use with a new effort that moves the emphasis away from the use of information technology to one that supports patient care that is supported by better and more connected technology," Slavitt said on a second conference call. "The program, Advancing Care Information (ACI), is designed to be more flexible and less burdensome," and would also take effect in January 2017, he said.
The ACI program "will allow physicians and other clinicians to select measures to reflect how [information] technology best suits their day-to-day practice; the proposal eliminates a number of measurements and entirely focuses on patient care and connectivity goals," Slavitt said. "The proposal allows 'acknowledgement reporting' to comprise 50% of the program, and it removes the all-or-nothing grading system. It also aligns with other quality and reporting programs, so it's simpler."
The proposed rule, which will be available for 60 days for public comments, applies only to physician offices, not to hospitals, and only to Medicare payments, not to Medicaid, he noted. "Even after it's implemented, as the programs meet the real world and physicians and patients begin having actual experience with it, we will need to continue" to listen to clinician concerns.
The expectations included in the ACI program "support our work around the changing culture of data-sharing," said Karen DeSalvo, MD, MPH, national coordinator for Health Information Technology (IT). "It advances... expectations around transparency reporting for vendors and putting information out into the public domain so clinicians are better able to compare products and understand what they're actually purchasing. There is also an expectation upon providers themselves ... attestations they will not block data and that it's moving on behalf of consumers."
Asked if there were any provisions in the rule that would penalize vendors who tried to block data, DeSalvo replied that although the rule applies to providers rather than vendors, her agency is working to prevent data blocking "through every lever we can find, through voluntary certification and otherwise, working in concert with providers and health IT developers."
"The 'good news' story is that everybody has a shared goal that we begin to compete within standards, not between standards, and toward meeting expectations of everyone in the country that their health information will be available when and where it matters to them," she said. "Through creating the right business case, we're creating an environment where people will continue to work together ... we want to help make sure it makes business sense for everybody."
The rules got positive reviews from several physician groups. "Our initial review suggests that CMS has been listening to physicians' concerns," Steven Stack, MD, president of the American Medical Association, said in a statement. " In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens." He also announced that the AMA was releasing "new online information and resources to help physicians navigate the changing landscape." The American Academy of Family Physicians (AAFP) also applauded the proposed rules. "Today's proposed regulations move toward meeting Congressional intent, which is to place greater priority on primary care that is comprehensive, continuous, coordinated, connected and a patient's first contact with the healthcare system," AAFP presidentWanda Filer, MD, MBA, said in a statement." The law's emphasis on these priorities ... is a direct expression of the Congressional desire to see our healthcare delivery system more aggressively promote, reward and emphasize primary care."
With global infection rates increasing rapidly, physicians should
be prepared to handle possible cases of Zika virus and answer patients’
questions. No locally transmitted cases of the virus have been reported in the
continental United States, but more than 30 cases have been confirmed in
Prepare your practice and your patients with resources developed
by infectious disease experts and assembled by the AMA in one convenient
Visit the AMA’s online ZikaVirus Resource Center for information from the CDC and other public health
groups. Resources cover:
The resource center will be updated regularly to
give you, your practice staff and your patients the most up-to-date information
The CDC has added eight countries to its list of places where the risk of Zika virus merits a travel alert for pregnant women.The additions, listed in an early release from Morbidity and Mortality Weekly Report, are Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa. Last week, the agency had urged expectant mothers or women planning to get pregnant to avoid visiting Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico. The advice came in light of a surge in microcephalic infant births in Brazil believed to stem from the mosquito-borne Zika virus. If women visit any of the regions anyway, they should take precautions against mosquito bites, the agency said.
Patterns of genetic response to infection can be used to tell if a cough is caused by bacteria, viruses, or neither, and have promise for slowing the inappropriate use of antibiotics, researchers reported. In an observational study, host gene expression classifiers were highly accurate in helping to pin down the cause of community-onset acute respiratory illness in people seeking care at an emergency department, according to Ephraim Tsalik, MD, PhD, of Durham VA Medical Center in Durham, N.C., and colleagues.
The test was more accurate in distinguishing bacterial from viral causes than procalcitonin, a biomarker that's increasingly being used in the clinic, and also outperformed previously reported genetic tests, Tsalik and colleagues reported online in Science Translational Medicine. Quicker and more accurate diagnosis could help reduce inappropriate prescriptions for antibiotics, an issue that is especially important in the setting of acute respiratory illness, the researchers noted. The key advance, Tsalik said, was using a sick population to develop the classification system, and using patients with non-infectious respiratory illness as a control group. Previous attempts to use host gene responses to distinguish etiologies had used healthy controls, he said, a method that's good for pinning down some of the biology but doesn't maximize diagnostic performance. In contrast, he said, the current system uses changes in expression of 130 genes and "allows us to identify all three of the possibilities."
Even a few years ago, Tsalik said, pinning down those changes in a time that would be useful for diagnosis would have been impossible, but technological advances mean that several groups now have systems that could be adapted for the clinic. His group is currently working with collaborators in industry to "ultimately develop a test that would really require no pre-processing -- you simply load your blood sample onto a test cartridge, load it into the machine, and in an hour or even less you have your answer," he said. Tsalik said the development and approval processes will probably take 2-3 years.
A July 2015 survey found that 65% of U.S. adults would use telemedicine after an initial in-person meeting with a doctor. Interactive telemedicine involves applications that allow clinicians to treat patients remotely and in real time. The technology varies fromHIPAA-compliant video chat services, to mobile telemedicine carts equipped with stethoscopes, otoscopes, and cameras, to remote-controlled telemedicine robots. While the word "remote" deters some doctors away from utilizing the technology, others believe telemedicine is just another tool to connect with patients.
In a Cochrane Library report published last September, researchers examined mortality rates, disease and health status, healthcare resources, and costs among an assortment of interactive telemedicine modalities, excluding phone consultations."A lot of the telemedicine that we are talking about in this review involve more contact," said Gerd Flodgren, the review's lead author and a researcher at the Norwegian Knowledge Center for the Health Services. "Interactive telemedicine is additive to the doctor-patient experience because there are more frequent interactions and opportunities to connect."
While telemedicine showed similar or improved care among diabetics and those with heart failure, Flodgren was disappointed in some areas of research. They didn't find many studies that set out to increase access for people in remote or underserved areas and almost none of them reported on adverse outcomes after treatment, such as inhibited mobility or abnormal pain and discomfort. Yet, companies and telemedicine programs use these features in marketing their products, which may mislead practitioners, says Flodgren.
Jay Sanders, MD, a primary care internist often called the "father of telemedicine," treats many patients solely though these technologies. He uses his phone to collect EKG and ultrasound data, and has even taught some of his patients to use data recording smartphone applications. "The smartphone has now become my electronic black bag," said Sanders, president of the Global Telemedicine Group and American Telemedicine Association. Sanders said the use of more advanced forms of telemedicine will increase now that the reimbursement barrier has been lifted in 28 states as of 2015. The parity laws established in these states require that every insurance company reimburse telemedicine consultations as if they were in-office visits, explains Sanders. Thus, a neurologist in New York (one of the 28 states) can consult on a stroke patient in another hospital that lacks a neurology department and be paid for it. "The only cost to the neurologist specialist, which is really not a cost, is time," said Sanders.If a doctor manages his or her time well, telemedicine can be a new revenue stream, he adds.
CDC officials said expectant moms planning to visit any of 14 areas in the Caribbean and Central and South America should reconsider, in light of the surge in microcephalic infant births believed to stem from Zika virus infection, and to take steps to avoid mosquito bites if they choose to go anyway.The same advice applies to women trying to become pregnant, the agency said.
Nations and territories named in the alert include: Brazil, Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico."Further spread to other countries in the region is likely," the CDC said in a Health Alert Network announcement.
"Pregnant women in any trimester should consider postponing travel to the areas where Zika virus transmission is ongoing," the agency advised. It added that women who are or may potentially become pregnant who do travel to these regions "should talk to their doctor or other healthcare provider first and strictly follow steps to avoid mosquito bitesduring the trip." Those steps include using insect repellents, staying covered when venturing outside, and using bed nets while sleeping if exposed to the outdoors.
As many providers struggle to comply with the next stage of the Meaningful Use program, they are also trying to prepare for another mandated electronic reporting requirement: Medicare's Merit-based Incentive Payment System (MIPS). The MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and Meaningful Use into one single program based on quality, resource use, and clinical practice improvement. The Centers for Medicare and Medicaid Services (CMS) is still finalizing both the MIPS program and the rules for Stage 3 of Meaningful Use, with a comment period ending Nov. 17th for MIPS and ending in early December for the Stage 3 rules. The two programs are quite intertwined, explainedRobert Tennant, senior policy adviser with the Medical Group Management Association (MGMA), in Washington. "Even though Meaningful Use was sunsetted, it's now effectively 25% of your MIPS score, so it never really goes away," he said in a phone interview. And because it is so much of the MIPS score, "it's potentially more impactful on your reimbursement." The reason for that is that Meaningful Use is still a pass-fail program, "so if you're [only] 99.5% successful in Meaningful Use, you're 100% unsuccessful," he continued. And that in turn means you'll get a score of zero for one-fourth of your MIPS score. The MGMA is pushing to allow partial credits for being partially successful in Meaningful Use, he added.What also makes preparing for MIPS more challenging is that the performance score is based on a "look back," so since Congress has "statutorily set a start date of 2019, that's when the score is calculated, and it's going to be a look back at [the provider's] 2017 performance ... It's right around the corner if you look at it that way."
A novel drug targeting interleukin-5, mepolizumab (Nucala), is approved for treating asthma in patients 12 and older with a history of severe exacerbations while on conventional maintenance therapy, the FDA announced. In so doing, the agency went against one of its own advisory committees, which voted in June not to recommend the drug's approval in adolescents after determining that there was inadequate evidence of safety in this population. The committee did back approval in adults. The FDA's approval announcement didn't indicate why it decided to overrule the committee on the adolescent indication.Mepolizumab is given as a monthly subcutaneous injection, to be administered by a healthcare professional, the agency said. The approval also specifies that it's to be used as maintenance therapy in combination with other asthma medications.Common adverse effects seen in the drug's trials include injection site reactions, back pain, and fatigue. A few cases of hypersensitivity reactions were recorded as well, along with herpes zoster infections. Those trials demonstrated the drug improved asthma control compared with placebo when used in conjunction with conventional medications, with decreases in inhaled corticosteroid doses as well as lower rates of exacerbations requiring hospital admission or emergency treatment, the FDA said.
The new ICD-10 coding system has been in place for nearly 4 weeks, and so far implementation appears to be proceeding relatively smoothly. The new ICD-10 diagnosis coding system, with its 68,000 codes, is a step up in complexity from the ICD-9 version, with only 13,000 codes. Some experts worried that physician practices wouldn't be ready to implement the new system when it debuted on Oct. 1, but that doesn't seem to be an issue thus far.
The ongoing concern now, experts said, is what will happen on the "back end" when the insurers process more of the claims they've received. When it comes to Medicare claims, providers need to make sure they really understand the position of the Centers for Medicare and Medicaid Services. Although the general perception was that Medicare was going to be lenient with claims processing as long as the diagnosis code was in the correct coding family - even if it wasn't exactly the right code - CMS put two clarifications in that policy.
A new law went into effect in New York on March 31, 2015 that protects consumers from surprise bills when services are performed by a non-participating (out-of-network) doctor at a participating hospital or ambulatory surgical center in the patient's HMO or insurer's network or when a participating doctor refers an insured to a non-participating provider.
If your patient has coverage through an HMO or insurer subject to NY law (coverage that is not self-insured):
If your patient is uninsured or has coverage through an employer or union that provides self-insured coverage (that is not subject to New York law), a bill will be a surprise bill if:
Unlike last year, this year's flu vaccine seems to be tracking pretty well with the influenza viruses that are currently circulating, CDC director Tom Frieden, MD, MPH, said."The vaccine has been updated to better match the H3N2 strain," sometimes referred to as the Switzerland variant, Frieden said at a press briefing here sponsored by the National Foundation for Infectious Diseases. "What's spreading are three or four strains that match what's in the flu vaccine this year." A total of 171 million doses of the flu vaccine are available, with 40 million having been distributed so far, he said.
NFID medical director William Schaffner, MD, said that the last flu season "reinforced that every flu season is a unique experience ... Flu is fickle."During most seasons, flu vaccines offer good protection against circulating viruses, he explained. "But last season was unusual. Not only did we have one strain of influenza that caused almost all of the reported flu cases, but it was different ... It had mutated; it was different than the strain that was represented in the vaccine.""So far, as we track influenza viruses this year, the ones that are causing very early disease are exactly as was predicted, so looks to me as though [those who take] the vaccine will be well protected," said Schaffner, who is also a professor of preventive medicine and infectious diseases at Vanderbilt University School of Medicine, in Nashville, Tenn.
Although no influenza vaccine will prevent people from getting the flu 100% of the time, "the vaccine is usually about 50-60% effective -- not nearly as much as most major vaccines, but far more effective than anything else you can do to prevent the flu," Frieden said. And even though last year, the overall effectiveness was much lower -- and was only about 13% for the H3N2 strain -- "there are still benefits from flu vaccination even at that lower effectiveness," he added.To see how well the flu vaccine is likely to work, U.S. researchers engage in global collaboration, working with countries all around the world to see what's spreading in the Southern Hemisphere, which is usually what spreads in the U.S. the following winter, Frieden explained. They also track flu trends in the U.S. during the summer.
This year, 199 specimens were analyzed; "of those, 118 were the H3N2 type that is closely related to this year's vaccine strain. Another 20 were the H1N1 still circulating from back in 2009, also very closely related to what's in the vaccine strain," said Frieden. "There were 61 influenza B strains that were evenly matched between two different strains that were included in the quadrivalent vaccine. All strains analyzed were susceptible to anti-virals oseltamivir [Tamiflu], zanamivir [Relenza], and peramivir [Rapivab]."Frieden emphasized it was particularly important for healthcare workers to be vaccinated and to make sure all of their eligible patients were vaccinated. To prove his point, he got his own flu vaccination during the press conference. The CDC on Thursday also releasedresults from an online survey of 1,914 healthcare providers which showed that overall, 77.3% of participants reported receiving an influenza vaccination during the 2014–15 season, similar to the 75.2% figure for the 2013-14 season.
Vaccination coverage was highest among healthcare providers working in hospitals (90.4%) and lowest among those working in long term care settings (63.9%), the survey found. In terms of occupation, pharmacists had the highest rate of vaccination (95.3%) while assistants and aides had the lowest (64.4%).Panelists at the briefing also discussed the importance of pneumococcal vaccines, especially for patients 65 and older or those ages 19-64 with chronic illnesses such as diabetes and heart disease. "These vaccines work," said Schaffner, citing as proof a study that was published in last March in the New England Journal of Medicine analyzing the effectiveness of the conjugate vaccine in those 65 and older.The study found that "there was a significant reduction in vaccine-type pneumococcal community-acquired pneumonia," he said, noting that the study was quite large and included 85,000 adults 65 and older with no prior pneumococcal vaccination history.Panelist Kathleen Neuzil, MD, MPH, professor of medicine and director of the Center for Vaccine Development at the University of Maryland School of Medicine, in Baltimore, summed up the flu vaccine situation, saying, "The news is that more people are getting vaccinated, but far too few are getting vaccinated and we need to try to improve that. Lot of gains can be made in the young and middle-aged adult population."
n an effort to prevent foodborne illness, the FDA has finalized requirements for food production facilities to have preventive plans and controls, the agency announced. The move is one of the "most significant steps in decades" to prevent foodborne illness, it said in an announcement posted on the FDA website. The finalization of the two steps would be the first of seven major ones outlined in the FDA Food Safety Modernization Act (FSMA), which was signed into law in 2011 by President Obama.
"This final rule is the product of an unprecedented level of outreach by the FDA to industry, consumer groups, the agency's federal, state, local and tribal regulatory counterparts, academia, and other stakeholders," said the agency on its website. The agency had a long comment period and changed the originally proposed revisions to make them more "practical, flexible, and effective for industry."
The food safety plans by food production facilities must include potential problems that could compromise the safety of their food and an outline of how to minimize or deal with those problems. The food companies will be responsible for monitoring their own facilities, said the FDA. "Under these rules, the FDA will be able to assess these systems and their outcomes to prevent problems, will better be able to respond when food safety problems occur, and better protect the safety of manufactured food," the agency wrote.
According to the guidance regulations, the guidelines will not affect farms in the same way. In addition, this latest finalization changed the rules surrounding supply-chain programs to make them more flexible, and updated Current Good Manufacturing Practices.
About one in six Americans gets sick each year from foodborne illness, according to the CDC, and 3,000 Americans die from such illnesses every year. "Over the past few years, high-profile outbreaks related to various foods, from spinach to peanut products, have underscored the need to make continuous improvements in food safety," said the FDA.
Compliance dates for some companies will begin in September of 2016, and all seven of the rules mandated by the FSMA will be finalized by 2016, said the agency.
"We've been working with states, food companies, farmers, and consumers to create smart, practical, and meaningful rules," said Michael R. Taylor, who is the deputy commissioner for foods and veterinary medicine at the FDA, on its website. "And we have made a firm commitment to provide guidance, technical assistance, and training to advance a food safety culture that puts prevention first."
The number of uninsured adults decreased by more than 3 percentage points in the first quarter of this year, according to a report released Wednesday by the CDC.
In the first 3 months of 2015, the percentage of adults ages 18-64
without insurance stood at 13%, down from 16.3% in 2014, wrote Robin Cohen, PhD, and Michael Martinez, MPH,
both from the CDC's National Center for Health Statistics. The number
of uninsured people of any age also dropped, from 36 million in 2014 to
29 million in 2015.
The number of people getting coverage through the Affordable Care
Act's (ACA) state-run and federally-run health insurance exchanges
increased, going from 2.5%, or 6.7 million, at the end of 2014 to 3.6%,
or 9.7 million, at the beginning of 2015, they found. In particular,
there was a large increase in adults covered by exchange plans, from
2.9% of adults ages 18-64 (5.7 million) in 2015 to 4.4% (8.6 million) in
the first quarter of 2015.
Nurse practitioners are earning more, and more are earning that income as salaried employees.
A survey from the American Association of Nurse Practitioners (AANP) found a 6% jump in average base salary since 2011 and a 10% hike in total annual income over the same period.
Among NPs who practiced at least 35 hours, weekly average
base salaries rose from $91,310 in 2011 to $97,083 in 2015, and total
annual income increased from $98,760 to $108,643.
AANP said 2,233 members -- 92% of whom were female -- participated
in the survey. The average years in practice was 8.3, and participants'
average age was 47.
Almost all responders -- 91% -- were non-Hispanic white.
A 2008 report from the U.S. Department of Health and Human Services reported that NPs earned an average of $73,776 per year, based on reports from 158,348 NPs. But those data did not differentiate between full-time and part-time status.
Most NPs, 75%, reported that they were salaried workers, leaving 23% to hourly rates, and the rest to self-employed practices.
Even among NPs in primary care, average annual incomes reached the six-figure range at $103,694.
In a historic move late Tuesday, the Senate voted 92-8 to permanently
repeal the sustainable growth rate (SGR) formula for physician
reimbursement under Medicare. The measure includes replacing the
SGR with an increase of 0.5% in Medicare physician reimbursement
starting in July 2015 through December 2015, and then annual 0.5%
increases lasting through 2019. The measure also consolidates various reporting programs, such as the Meaningful Use program for electronic health records
and several quality reporting programs, into a new, merit-based
incentive payment system and would incentivize physicians to participate
in alternative payment models such as accountable care organizations
(ACOs). In addition, the
bill extends the Children's Health Insurance Program as well as funding
for community health centers and the National Health Service Corps.
In an apparent response to providers' concerns with the Meaningful Use
program, the Centers for Medicare and Medicaid Services (CMS) has
announced a proposed rule to simplify meaningful use.
The aim of the new rule is "to align Stage 1 and Stage 2 objectives and
measures with the long-term proposals for Stage 3, to build progress
toward program milestones, to reduce complexity, and to simplify
providers' reporting," the agency announced Friday in a fact sheet.
"These modifications would allow providers to focus more closely on the
advanced use of certified EHR technology to support health information
exchange and quality improvement."
Meaningful use refers to provisions in the 2009 Health Information
Technology for Economic and Clinical Health (HITECH) Act, which
authorized incentive payments through Medicare and Medicaid to
clinicians and hospitals that use electronic health records (EHRs) in a
meaningful way to significantly improve clinical care.
According to CMS, the proposed rule would simplify reporting requirements in several different ways:
"The proposed rule issued today is a critical step forward in helping to
support the long-term goals of delivery system reform; especially those
goals of a nationwide interoperable learning health system and
patient-centered care," according to the fact sheet. "CMS is also
simplifying the structure and reducing the reporting requirements for
providers participating in the program by removing measures which have
become duplicative, redundant, and reached wide-spread adoption (i.e.,
are "topped out"). This will allow providers to refocus on the advanced
use objectives and measures."
"These advanced measures are at the core of health IT [information
technology] supported healthcare which drives toward improving the way
electronic health information is shared among providers and with their
patients, enhancing the ability to measure quality and set improvement
goals, and ultimately improving the way healthcare is delivered and
experienced," the fact sheet concluded.
The Healthcare Information and Management Systems Society (HIMSS), an
organization for health IT professionals, praised the proposed rule.
"HIMSS is encouraged that CMS has listened to our members and other
stakeholder concerns and included more realistic parameters for
providers and hospitals, so they can meet the Meaningful Use
requirements in 2015 and beyond," Carla Smith, the group's North America
vice president, said in a statement.
She noted that "The rule would align the EHR reporting period with the
calendar year, modify the patient action measures in the Stage 2
objectives related to patient engagement, and streamline the program by
removing reporting requirements on measures which have become redundant,
duplicative, or topped out through advancements in EHR function and
provider performance for Stages 1 and 2."
This is the second time in recent months that CMS has loosened Meaningful Use restrictions. In late February, the agency gave physicians an extra 3 weeks to attest that they had met Meaningful Use criteria in 2014 in order to receive monetary incentives.
MedExpress has 141 clinics Accredited with National Urgent Care Center Accreditation. Accreditation is a voluntary process through which an Urgent Care Center is able to measure the quality of its services and performance against nationally recognized standards. The accreditation certificate is a symbol to others that an organization is committed to providing high-quality care. The National Urgent Care Center Accreditation (NUCCA) Program accomplishes the accreditation of Urgent Care Centers by setting standards, measuring performance, and providing consultation and education where needed. Accreditation is ultimately awarded to those urgent care centers that are found to be in compliance with National Urgent Care Center Accreditation Program standards.
The National Urgent Care Center Accreditation program is an independent, non-profit organization that provides Accreditation to properly qualified Urgent Care Centers throughout the United States. The National Urgent Care Center Accreditation program is recognized by the American Academy of Urgent Care Medicine (AAUCM) to provide such Accreditation.
Download the National Action Plan for Combating Antibiotic-Resistant Bacteria
Lawmakers in several states are advancing a proposal, called the Interstate Medical Licensure Compact, to fast-track the licensure process enabling qualified doctors to practice in more than one state. The compact would expand opportunities for eligible providers to practice telemedicine across state lines. Advertisement It could also increase access through face-to-face visits in rural areas near state borders, allowing doctors to have clinic hours and make house calls on both sides of the line. To date, the compact has been introduced in over a dozen state legislatures. Chambers in three -- South Dakota, Utah, and Wyoming -- have passed proposals related to the compact. South Dakota's Senate passed the Compact with abundant support, and the House chambers in Wyoming and Utah voted unanimously in favor of the proposal, according to a press release from the Federation of the State Medical Boards (FSMB). The concept is fairly straight forward. Any qualified physician interested in obtaining licensure in multiple states could do so through an alternative pathway. Instead of requiring a physician to fill out applications in each state and provide documents over and over again, the state with that physician's principal license would confirm that he or she meets the requirements of the compact, she said. All the [state] boards can rely on verified shared information that could speed that physician through the licensing process.
The Centers for Disease Control and Prevention (CDC) has declared a flu (influenza) epidemic in the United States. There has been antigenic drift in one of the strains of the virus seen circulating now versus the strain chosen for the vaccine. Therefore, it is extremely important for providers to promptly treat all patients with influenza-like-illness (ILI), even women who have been vaccinated. To date there have been 21 pediatric deaths and more than double the number of hospitalizations from the previous flu season. So far, among the 35 hospitalized women of childbearing age (15-44 years), 12 (34.3%) were pregnant. ACOG and CDC recommend everyone 6 months and older receive a flu shot each year. Vaccination is particularly important for pregnant women who are at higher risk of complications and severe illness from influenza.
IMPORTANT: If any of your pregnant patients present with influenza-like-illness (ILI) such as fever >37.8°C (100.0°F), cough or sore throat, chills, body aches/muscle pain, headache begin treatment with antivirals immediately. Your decision should be based on clinical assessment and you should not wait nor rely on rapid test results which are often inaccurate. Patient with influenza-like illness should be treated with antiviral medications presumptively regardless of vaccination status.
Although one strain of this year’s vaccine is not a good match, the vaccine can still protect against other strains of the virus and vaccination is still the best form of prevention.
For more information please visit ACOG’s Immunization for Women website.
Click Here to download the Influenza Season Assessment Algorithm.
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