Nov. 4, 2017
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Coming April 2018: ALL Medicare patients will carry brand new ID cards
In about six months, more than 57.7 million new Medicare ID cards will enter the postal mail system in the United States - on their way to beneficiaries. Why? The Centers for Medicare and Medicaid Services is preparing an initiative designed to combat fraud and better protect patients.
Click here to learn what you can do to prepare your practice and how you can assist your patients.
The Pathology Laboratory - 2018 Member Renewal
Many thanks to The Pathology Laboratory on their 100% physician group participation and continued commitment to the LSMS. The Pathology Laboratory has been in business for more than 50 years and provides a full range of services to Southwest Louisiana including Fine Needle Aspirations, Pap smear screening, full surgical pathology and cytology services, as well as complete clinical laboratory testing. In addition, The Pathology Laboratory offers courier services throughout the area, picking up specimens within a 60-mile radius at more than 200 locations daily. With seven pathologists, the lab provides a wide range of expertise including Dermatopathology, Hematopathology, Gastrointestinal Pathology and Cytopathology.
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Physician-Owned Hospitals
Click here to read the letter to Majority Leader McConnell, Leader Schumer, Speaker Ryan, and Leader Pelosi urging Congress to pass legislation that would lift the Affordable Care's Act (ACA) moratorium on physician-owned hospitals (POHs).
CMS Issues Final Rule with Comment Period on the CY 2018 MACRA Quality Payment Program
Below, please find a final rule with comment period issued today by the Centers for Medicare and Medicaid Services (CMS) that implements the second year of the Quality Payment Program for CY 2018, as required by Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), as well as an interim final rule with comment. An Executive Summary and Overview document, prepared by CMS, are also attached.
CMS states the CY 2018 QPP final rule "continues many of the flexibilities included in the transition year, while also preparing clinicians for a more robust program in Year 3." CMS adds that the rule is designed to minimize provider burdens while improving care coordination and "supporting a pathway" to participation in Advanced Alternative Payment Models (APMs). For example, the CY 2018 QPP rule adds "virtual groups" as a participation option for providers in the Merit-Based Incentive Payment System (MIPS) track, and awards up to five bonus points on the MIPS final score for the treatment of certain complex patients.
According to the Fact Sheet accompanying the QPP final rule, the "major highlights" of the rule include:
- Weighting the MIPS Cost performance category to 10% of providers' total MIPS final score, and the Quality performance category to 50%.
- Raising the MIPS performance threshold to 15 points in Year 2 (from 3 points in the transition year).
- Allowing the use of 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in Year 2 for the Advancing Care Information performance category, and giving a bonus for using only 2015 CEHRT.
- Awarding up to 5 bonus points on the MIPS final score for treatment of complex patients.
- Automatically weighting the Quality, Advancing Care Information, and Improvement Activities performance categories at 0% of the MIPS final score for clinicians impacted by Hurricanes Irma, Harvey and Maria and other natural disasters.
- Adding 5 bonus points to the MIPS final scores of small practices.
- Adding Virtual Groups as a participation option for MIPS.
- Decreasing the number of doctors and clinicians required to participate as a way to provide further flexibility by excluding individual MIPS eligible clinicians or groups with ≤$90,000 in Part B allowed charges or ≤200 Medicare Part B beneficiaries.
- Providing more detail on how eligible clinicians participating in selected APMs (known as MIPS APMs) will be assessed under the APM scoring standard.
- Creating additional flexibilities and pathways to allow clinicians to be successful under the All Payer Combination Option. This option will be available beginning in performance year 2019.
CMS is also issuing an interim final rule with comment that addresses "extreme and uncontrollable circumstances MIPS eligible clinicians may face as a result of widespread catastrophic events affecting a region or locale in CY 2017, such as Hurricanes Irma, Harvey and Maria."
These provisions of this final rule with comment period and interim final rule with comment period are effective on January 1, 2018. Comments on the rule must be received no later than 5 p.m. ET on January 2, 2018.
Energy & Commerce Health Subcommittee Schedules MACRA Alternative Payment Model Hearing November 8
Below, please find a press release from House Energy & Commerce Health Subcommittee Chairman Michael Burgess, M.D. (R-TX) announcing the Subcommittee will hold a hearing Wednesday, November 8, 2017 on "MACRA and Alternative Payment Models: Developing Options for Value-based Care." The hearing, which begins at 10 am, will focus on Alternative Payments Models (APMs), including those that are qualified APMs under the Medicare Access and CHIP Reauthorization Act (MACRA). Chairman Burgess emphasized that APMs, among many "improvements created" via MACRA, "have shown promise in helping to improve patient outcomes and deliver savings."
More information, including witness testimony, will be available here.
President's Opioid Commission Final Report
Below, please find the Draft Final Report of the President's Commission on Combating Drug Addiction and the Opioid Crisis, providing more than 50 recommendations to the President for federal action. The recommendations include those regarding federal funding, opioid addiction prevention, supply reduction, opioid addiction treatment, and research and development. Highlights of health-related recommendations include the following:
Federal Funding and Programs: "Congress and the Administration [should] block grant federal funding for opioid-related and SUD-related activities to the states...."
- Opioid Addiction Prevention: (1) the Department of Health and Human Services (HHS), Department of Labor (DOL), and other agencies should work with stakeholders to "develop model statutes, regulations, and policies that ensure informed patient consent prior to an opioid prescription for chronic pain;" (2) HHS should "coordinate the development of a national curriculum and standard of care for opioid prescribers;" (3) the Administration should "develop a model training program to be disseminated to all levels of medical education (including all prescribers) on screening for substance use and mental health status to identify at risk patients;" (4) the Administration and Congress should "amend the Controlled Substances Act to allow the [Drug Enforcement Administration] DEA to require that all prescribers desiring to be relicensed to prescribe opioids show participation in an approved continuing medical education program on opioid prescribing;" and (5) HHS, other federal agencies and pharmacy associations should "train pharmacists on best practices to evaluate legitimacy of opioid prescriptions, and not penalize pharmacists for denying inappropriate prescriptions."
- Prescription Drug Monitoring Program Enhancements: the Office of National Drug Control Policy and the DEA should "increase electronic prescribing ... [and] the DEA should revise regulations regarding electronic prescribing for controlled substances."
- Supply Reduction and Enforcement Strategies: the Centers for Medicare & Medicaid Services (CMS) should (1) "remove pain survey questions entirely on patient satisfaction surveys, so that providers are never incentivized for offering opioids to raise their survey score;" and (2) "review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain."
- Opioid Addiction Treatment, Overdose Reversal, and Recovery: (1) HHS and other agencies should "incorporate quality measures that address addiction screenings and treatment referrals;" (2) HHS and other agencies should "remove reimbursement and policy barriers to SUD treatment, including those, such as patient limits, that limit access to any forms of [Food and Drug Administration] FDA-approved medication- assisted treatment (MAT), counseling, inpatient/residential treatment, and other treatment modalities, particularly fail-first protocols and frequent prior authorizations;" (3) Because DOL "regulates health care coverage provided by many large employers," Congress should "provide DOL increased authority to levy monetary penalties on insurers and funders, and permit DOL to launch investigations of health insurers independently for parity violations;" (4) federal agencies should "revise regulations and reimbursement policies to allow for SUD treatment via telemedicine;" and (5) HHS should "develop new guidance for Emergency Medical Treatment and Labor Act compliance with regard to treating and stabilizing SUD patients and provide resources to incentivize hospitals to hire appropriate staff for their emergency rooms."
- Research and Development: (1) HHS and other agencies "should engage in a comprehensive review of existing research programs and establish goals for pain management and addiction research (both prevention and treatment);" (2) Congress and the Federal Government should provide additional resources to the National Institute on Drug Abuse (NIDA), the National Institute of Mental Health, and National Institute on Alcohol Abuse and Alcoholism "to fund the research areas cited above. NIDA should continue research in concert with the pharmaceutical industry to develop and test innovative medications for SUDs and OUDs, including long-acting injectables, more potent opioid antagonists to reverse overdose, drugs used for detoxification, and opioid vaccines;" (3) commercial insurers and CMS should "fast-track creation of Healthcare Common Procedure Coding System (HCPCS) codes for FDA-approved technology-based treatments, digital interventions, and biomarker-based interventions. NIH should develop a means to evaluate behavior modification apps for effectiveness;" and (4) the FDA should "establish guidelines for post-market surveillance related to diversion, addiction, and other adverse consequences of controlled substances."
Also attached, the November 1, 2017 letter to the President from Governor Chris Christie (R-NJ), Chairman of the Commission. In the letter, Governor Christie described a "disturbing trend in federal health care reimbursement policies that incentivizes the wide-spread prescribing of opioids and limits access to other non-addictive treatments for pain, as well as addiction treatment and medication-assisted treatment." He emphasized the need to "incentivize insurers and the government to pay for non-opioid treatments for pain beginning right in the operating room and at every treatment step along the way." He also noted the Commission's recommendation that CMS "remove pain questions entirely when assessing consumers so that providers won't ever use opioids inappropriately to raise their survey scores. We urge you to order HHS to do this immediately." Governor Christie also states that the Department of Labor "must be given the real authority to regulate the health insurance industry," noting that "health insurers are not following the federal law requiring parity in the reimbursement for mental health and addiction. They must be held responsible."
- Click here to read the draft final report.
- Click here to read Governor Chris Christie's letter to the President.
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Early Voting Began Friday, November 3
Early voting to decide the state Treasurer's race as well as several local elections, including filling the legislative seat in House District 77 (on the Northshore), began yesterday and runs through November 11. The general election date is November 18.
Download the Geaux Vote Mobile app or visit the Voter Portal website for early voting locations and ballot information.
Don't forget to participate and GEAUX VOTE!
The 2017 Pennington Biomedical Research Center Childhood Obesity & Public Health Conference
Making the Grade: Impact of Public Health Report Cards on Physical Activity and Obesity; Wednesday, November 15, 2017
This is the 10th annual childhood obesity and public health conference to be held at the Pennington Biomedical Research Center. The topic of this year's conference is on the role of "report cards" in the public health strategy to tackle childhood obesity. This year we are pleased to announce that we have four nationally and internationally recognized speakers who will present their work to improve children's health using public health approaches. Unfortunately, Louisiana does not score well on national health report cards, and this conference will help highlight ways to "improve the grade", especially with respect to childhood obesity and health.
Learning Objectives
The participants in this conference will be able to:
- describe national and international efforts to monitor children's weight status and other health parameters;
- understand the role of "report cards" in public health surveillance - what they can tell and what they can't tell us;
- describe the role of schools in improving physical activity, obesity and health;
- understand the role of federal physical activity guidelines in promoting physical activity in children and youth; and
- identify strategies to improve Louisiana's grades on national report cards.
Who Should Attend?
This conference is designed for professionals engaged in public health efforts, including: physicians, nutritionists, physical activity specialists, registered dietitians, nurses, health educators, psychologists, counselors, healthcare policy makers, researchers, media, business and civic leaders, parks and recreation personnel, and early childhood and school-age educators and decision-makers.
Affordable Care Act enrollment begins: shorter, more confusing, cheaper for most
The 122,000-plus Louisiana consumers who get health coverage through the Affordable Care Act's federal online marketplace will have less time to find a 2018 plan and a wealth of confusion to work through.
Enrollment on Healthcare.gov begins Wednesday and ends Dec. 15 for what are commonly referred to as Obamacare plans, just half the time consumers had to pick a plan a year ago. In addition to compressing the enrollment period, the Trump administration cut the funding for advertising and outreach efforts to promote enrollment efforts.
"Forty-five days is not going to be enough, but CMS (the Centers for Medicare & Medicaid Services) says the 45 days is needed to stabilize the market," said B. Ronnell Nolan, president and chief executive officer of Health Agents for America. "So we're just doing our best to see how many people we can see in a 24-hour period, seven days a week for 45 days."
Blue Cross and Blue Shield of Louisiana and Vantage Health Plan are the only Louisiana insurers offering Obamacare health plans through healthcare.gov.
Other State News & Information
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Just two sugary drinks per week may raise type 2 diabetes risk
In the United States, a study from 2012 reports that in that year, 702,308 people died from a cardiometabolic disorder, and dietary factors such as food and beverages seemed to raise the risk of cardiometabolic mortality.
Another recent study suggested that two soda drinks every day makes consumers 2.4 times more likely to develop diabetes, regardless of whether these beverages contain sugar or not.
However, as the authors of the new research explain, the results of such studies have been deemed "controversial."
So, in the new review, the researchers - led by M. Faadiel Essop, Ph.D., of Stellenbosch University in Stellenbosch, South Africa - decided to investigate overall trends in the findings of 36 studies, spanning over a decade.
Other Science and Technology News
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Focus On
JOIN CIS FOR THE GREAT AMERICAN SMOKEOUT ON NOVEMBER 16
Theme: Destination Tobacco-Free
HOUMA- Visit any Cardiovascular Institute of the South (CIS) location on Thursday, November 16 for the Great American Smokeout, an all-day tobacco cessation event. Stop by to learn more about Commit to Quit, the CIS tobacco cessation program, and participate in interactive displays for your chance to win various prizes. No matter where you are on your quit journey, come to learn how CIS can support you through the quit process and help you reach your destination.
Octavia Ledet, 56 of Lafayette, started her cessation journey in July. She previously smoked three packs a day. She utilized provider visits, pharmacotherapy, and support from friends and fellow team members. She has seen an improvement in her health since quitting and said she feels much better. "I tell everyone to join the program and take advantage of the benefits," she said. "There is help out there; you don't have to be afraid."
Commit To Quit combines physician evaluations, medications (both prescription and nicotine replacement) and supportive counseling sessions (both individually and as a group). Some of these services may be available to you FREE of charge through benefits of the Louisiana Smoking Cessation Trust.
For more information about the Commit To Quit program, call CIS tobacco treatment coordinators at 1-877-288-0011 or visit www.cardio.com/smoking-cessation.
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