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Congress Moves to Delay Stage 3 of Meaningful Use

The U.S. Congress may step in to the Centers for Medicare & Medicaid Services (CMS) electronic health record (EHR) meaningful use program, with both chambers taking action on the third and final stage of the program.

Rep. Renee Ellmers, R-N.C., introduced her Further Flexibility in HIT Reporting and Advancing Interoperability Act (Flex IT 2 Act), which would provide more flexibility in the meaningful use program and ensure EHR systems address interoperability challenges. The bill also would pause Stage 3 rulemaking to align it with technology advancements and the new merit-based incentive payment system, which will combine current quality programs.

“This important bill addresses many of the fundamental shortcomings in government regulations that have made many EHR systems very difficult to use,” AMA President Steven J. Stack, MD, said in a statement. “We heard loud and clear from physicians at the AMA’s first-ever town hall meeting on EHRs and the Meaningful Use program that the systems they use are cumbersome, poorly designed and unable to ‘talk’ to each other thereby preventing necessary transmission of patient medical information.”

Meanwhile, Sen. Lamar Alexander, R-Tenn., chair of the U.S. Senate Health, Education, Labor and Pension Committee (HELP), last week asked U.S. Secretary of Health and Human Services Sylvia Burwell to consider a delay in the release of the final rule on Stage 3.

Physicians ramp up calls for changes to program

The action in Congress comes just days after the AMA’s town hall meeting on EHRs and the meaningful use program, held with the Medical Association of Georgia. About 50 Atlanta-area physicians attended the event last week, which was live-streamed to about 500 registrants. Physicians discussed their everyday challenges with EHRs and burdensome government regulations that detract from patient care.

One physician at the event, Albert Johary, MD, who practices internal medicine in an Atlanta suburb, is in his fourth year of meaningful use. He said the program has slowed down productivity in his practice by about 25-30 percent.

“There are so many more things that you have to report on that I don’t think really add to patient care,” Dr. Johary said. “I’m trying to work with it. I think meaningful use is not necessarily a bad thing. But I don’t think [patients] have an idea what we’re going through. To give them a copy of their note, it’s not just printing it … there are four or five steps just to give somebody a copy of their note.”

At the event, Dr. Stack asked physicians to contact their members of Congress and ask them to halt Stage 3 of meaningful use until the program is fixed. The AMA has been calling for CMS to stop Stage 3 to assess how changes to earlier stages of the program will affect physician participation and success.

Visit breaktheredtape.org to watch the town hall meeting, share your stories about EHRs and meaningful use, and contact your members of Congress.

Two Opportunities to Share Your Research at MSMS Foundation Annual Scientific Meeting

Call for Abstracts Open July 8 to September 1, 2015 Option 1 **New in 2015**Resident/Fellow Saturday Clinical Vignette Presentations  MSMS will offer an Interactive Case Study Session to the course line-up on Saturday, October 24 from 8:00 – 9:30 am at the Somerset in Troy. The top six resident authors will be invited to share their abstract for a 15 minute interactive presentation with conference attendees. Click here for complete completion guidelines. Submission Rules: 1. Limited to only residents and fellows. 2. Deadline for abstract submission is September 1, 2015. 3. Submission must be entered in Clinical Vignettes. 4. Entries may also be submitted for poster competition.However, please submit a separate entry for each.    Category: “Clinical Vignettes” involve the presentation of one or more patient encounters that illuminate unique observations of a known disease, or that describe a novel disease process   Judging and Awards:  1. Top six entries selected by the ASM Planning Committee will be announced by September 22. 2. Participants must agree to present a 15 minute presentation (including 5 minutes for Q&A) on Saturday, October 24, 2015, between the times of 8:00 – 9:30 am. 3. Presenters are encouraged to engage the audience in case discussion. 4. Presenters will be awarded a check for $100 at the conclusion of their verbal presentation. Option 2  Resident/Fellow and Student Poster Competition You are invited to submit an abstract for the 2015 poster competition to be held from Wednesday, October 21 through Friday, October 23, at the Somerset Inn in Troy in conjunction with the Annual Scientific Meeting.  Click here for complete completion guidelines. Submission Rules: 1. Deadline for abstract submission is September 1, 2015. 2. Student to be judged separately from Residents and Fellows. 3. There will only be one accepted per individual. 4. Send all abstracts to mbenhamza@msms.org. 5. All must be work of the individual actively engaged in residency, fellowship training, or medical training. Category: 1. Clinical Medicine and Vignettes Judging and Awards:  The panel of Poster Competition Judges wil be represented by members of the ASM Planning Committee.  There will be one award given in each category.  The top two winners, as determined by the panel of judges, will win a cash prize of $300/$200, plaque, and recognized in MSMS communications. Click here for office competition guidelines; or, contact Marianne Ben-Hamza at 517-336-7581.

New Rules for Immunization Waivers

YPSILANTI, Mich., July 23, 2015 – New rules are in place for Michigan parents or guardians opting out of one or more of the required vaccinations for their child or children to attend school or childcare. Under the new rules parents or guardians must participate in a science-based educational session with their local public health department. In Washtenaw County, waiver appointments can be scheduled by calling Washtenaw County Public Health at 734-544-6700.

 

If a child is not up-to-date on her or his vaccinations, a waiver is required for the child to enroll in: 

·         a licensed childcare

·         preschool or Head Start

·         kindergarten

·         seventh grade

·         a new school district.

 

Parents or guardians of school-age children entering other grades or remaining in the same school district do not need to request a wavier at this time, even if their child or children are not fully vaccinated.

 

“There’s been a lot of debate in recent years. We can provide reliable information and local data about the benefits of vaccination and the risks of vaccine-preventable illnesses,” says Jane Nickert, MSN, MSBA, director of nursing for Washtenaw County Public Health. “Local families can then make their own, informed decisions.”

 

Parents and guardians are encouraged to schedule an appointment at their earliest convenience. Waivers cannot be mailed or completed over the phone. Appointments take approximately 30 minutes.  Washtenaw County Public Health has issued over 220 waivers as of the end of June. Up to 900 more educational sessions may need to be scheduled prior to the start of school in September.

“This is an opportunity for us to speak directly with families and answer any questions they may have,” says Nickert. “But, to accommodate everyone, we encourage families to schedule their appointments with us sooner rather than later.”

Why the Change?

Michigan has one of the highest waiver rates in the country. Washtenaw County has a higher waiver rate (8%) than other Michigan counties (6% overall). 

 

When are Waivers Required?

Michigan Public Health Law requires that all infants and children have certain vaccinations or a valid waiver before entering public or private school or licensed childcare settings. These requirements exist to prevent the spread of disease and to prevent injury or death in the community. Immunization records are checked every fall for all licensed childcare, preschool and Head Start students. Public and private schools check immunization records at the beginning of the school year for kindergartners, seventh graders and all newly enrolled students. 

 

The new rules apply to non-medical waivers, or those requested based on religious, philosophical or other objections to receiving required vaccines. Waivers are only reviewed at the grade levels and conditions specified above. The new rules do not change the existing process for children who have a medical reason for not receiving a vaccine (a medical contraindication or precaution).

 

Michigan State Medical Society Celebrates 150 Years

 

Infant Mortality Disparity Resource Released for Public Health Professionals

LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) has released the Practices to Reduce Infant Mortality through Equity (PRIME): Guide for Public Health Professionals.  This is an informational resource for transforming public health through equity education and action.

“Achieving health equity for all residents is a goal of public health work within Michigan and across the country,” said Sue Moran, deputy director for the Public Health Administration at MDHHS. “This guide provides valuable strategies for developing a training model and resources that promote the understanding of the root causes of health inequities, as well as methods for creating changes in policy going forward.”

Health disparities are the metric used to measure progress toward ensuring that all residents have a fair opportunity to reach their potential. In Michigan, black and white infants died at a rate of 13.1 and 5.7 respectively in 2013, and these gaps in infant mortality rates between whites and blacks and whites and American Indians have persisted for decades.

The PRIME guide includes methods used by the department since 2010 to create a public health training model. These methods include consideration of the overall goals and design of the training components used, a description of specific content and concepts covered, the processes used, a description of the evaluation tools, lessons learned, and copies of existing tools and resources about health equity.

Additionally, the primary focus of PRIME has been to assist practitioners in the maternal child health arena, however, this guide will be a valuable resource for state and local public health systems interested in addressing racial and ethnic inequities related to other health outcomes.

The PRIME initiative is led by the Bureau of Maternal and Child Health within the department and a steering team that includes internal partners from the Health Disparities Reduction and Minority Health Section and the Lifecourse Epidemiology and Genomics Division of MDHHS.  External partners that assisted with the development of this guide include the University of Michigan School of Public Health, Vanderbilt University, Michigan Public Health Institute, Inter-Tribal Council of Michigan, Ingham County Health Department, and Wayne County Department of Public Health.

To view the full report and accompanying documents, visit www.michigan.gov/dchprime.   The PRIME initiative and publications were supported through a grant from the W.K. Kellogg Foundation.

Deadline Today for 2016 Medicare EHR Hardship Exemption

Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception. The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply. To file a hardship exception, you must: Show proof of a circumstance beyond your control. Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use. Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted. You do not need to submit a hardship application if you: are a newly practicing eligible professional are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology) CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception. Apply by July 1 As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered. If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year. In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include: Medicaid only No claims to Medicare Hospital-based Want more information about the EHR Incentive Programs? Visit the EHR Incentive Programs website for the latest news and updates on the programs.

3 Things the Supreme Court’s ACA Ruling Means for Physicians

An AMA Viewpoints post by AMA President Steven J. Stack, MD.

The Supreme Court of the United States delivered an historic decision Thursday morning, June 25, in King v. Burwell.

In a 6-3 decision, the justices ruled that subsidies should remain available for lower-income people who purchase their health insurance through the Affordable Care Act (ACA) marketplaces, regardless of whether their marketplace is maintained by the federal or state government.

This ruling affects physicians in three ways I’d like to highlight:

1. The decision supports our chief goal of helping patients stay healthy.

The Supreme Court’s ruling means that about 6.4 million people in the 34 states that did not create their own marketplaces will retain their ability to purchase coverage going forward. This is particularly important for low-income patients in states that did not expand their Medicaid programs. Without the subsidies, many of them could never afford health insurance.

As an emergency physician, I regularly see how important insurance coverage is to facilitate patients getting the medical care they need to recover from unexpected injury or illness. It also enables them to lead healthier, happier lives through better care of chronic diseases that can be devastating for them and their families.

The decision also means that insurance premiums will remain more affordable for most patients than would have otherwise been the case. A recent RAND study estimated that eliminating subsidies for patients who purchase their insurance through the federally run marketplace would result in a 47 percent increase in premiums. In such a scenario, a 40-year-old nonsmoker who purchased an unsubsidized silver-level plan would have needed to pay $1,610 more next year.

2. The decision lets us move forward.

With this case behind us, we as a profession and as a nation now must focus on the issue at the heart of health care reform: Ensuring every American has access to high-quality, affordable health care.

Regardless of differing opinions, access to high-quality, affordable health care is an issue we can all support. And by continuing to work together toward this end—whether through refining individual elements of the ACA, such as repealing the Independent Payment Advisory Board, or making changes to the current health care system—we can improve the health of all Americans.

3. The decision means we can turn our attention to improving the practice environment.

In moving forward, we must also devote our attention to transforming the practice environment so that both patients and physicians are healthier and more satisfied.

At the AMA, we’re working to enhance professional satisfaction and practice sustainability by pressing for relief from the tsunami of regulatory burdens that gets in the way of providing the highest-quality care for our patients. Among those burdens are the electronic health record meaningful use program, implementation of ICD-10 and the value-based payment modifier. Lawmakers, too, are now able to turn their attention to these pressing topics.

We’re also providing the tools physicians need to minimize professional stress and overcome barriers to providing the best possible care. Our newly launched STEPS Forward website offers a free online series of proven solutions that are developed by physicians to make practices thrive. We’ll be adding more modules over the coming months, so be sure to explore the website often.

Also, on the STEPS Forward website, we invite you to submit your own innovative solutions to clinical challenges to win $10,000 and help us create more modules to help physicians.

Even in these early years of health care reform, implementation of the ACA has affected much of the health care system. To examine this issue further, I encourage you to check out the July issue of the AMA Journal of Ethics, which takes a look at how patient care has changed in the era of health care reform.

Childhood Obesity in Washtenaw County

Local reports highlight positive trends and areas of concern

YPSILANTI, Mich., June 29, 2015 – Washtenaw County Public Health is pleased to announce the publication of new childhood obesity reports for Washtenaw County. They include an overall Washtenaw County report and community reports for Ann Arbor, Ypsilanti, Saline, Dexter, Chelsea, Whitmore Lake and Manchester.

 

Being overweight or obese in childhood increases the risk of obesity and other chronic diseases in adulthood. The reports show trends and identify factors that put local children at risk of being overweight or obese. They also provide a way to measure local progress.

 

“We want these reports to be as useful as possible for all of our partners working in the community to make a difference in children’s health,” says Laura Bauman, RN, MPH, epidemiology program manager with Washtenaw County Public Health. The reports are available at http://publichealth.ewashtenaw.org.  The Washtenaw childhood obesity surveillance project began in 2013. Through the Health Improvement Plan (HIP) collaborative, Washtenaw County Public Health worked with Saint Joseph Mercy Health System and the University of Michigan Health System to create the first Washtenaw Child Body Mass Index (BMI) Dataset.

 

Washtenaw County Public Health compiled and analyzed records for over 18,000 children, ages 2-17 years old, to create the local reports. Future waves of data will allow us to track progress of initiatives aimed at moving all children to a healthier weight.

 

Good News

Washtenaw County children as a whole have a lower rate of overweight and obesity than their counterparts nationally.

 

Challenges

Local children of African American descent, however, surpass national rates. Children of African American descent as well as Hispanic and Latino children have the highest risk of being overweight or obese. This is a national trend that is reflected locally.

Analysis of the Washtenaw County data focused on factors known to affect the risk of childhood obesity, including poverty, race and ethnicity and age. Differences also exist depending on where children live within the county. 

 

Medicaid coverage is an indication of poverty. The risk of overweight and obesity was higher for children with Medicaid across all age groups and compared to children covered by commercial insurance.

 

There is some good news for local children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Rates of overweight and obesity in low-income WIC children declined between 2010 and 2014 (from 28% to 24% of WIC children age 2-4 years). The addition of peer educators to support local WIC moms in breastfeeding and changes in the WIC food package may have supported this trend.

 

All of the Washtenaw County childhood obesity reports are available at http://www.ewashtenaw.org/government/departments/public_health/family_health/fam_health_mihp_wic_nursing/childhood-obesity-in-washtenaw-county.

 

Washtenaw County Public Health and the HIP partnership hope these reports will assist community leaders, clinicians, schools and others working to improve the health of children. With a greater understanding of which children in our community are most at risk of being overweight or obese, decision makers can direct local interventions and support where needed most. 

 

Top 5 Tips to Survive Severe Storms

University of Michigan Hospital emergency room physician Dr. Brad Uren, and Washtenaw County Medical Society President-Elect, has seen the aftermaths of severe storms and shared his top 5 tips to avoid becoming one of his patients in the ER.

1. Shelter

Like Bob Dylan, your first concern should be for shelter from the storm.

The safest rooms are located in basements, but those without should look for a closet, bathroom or other rooms with no windows on the ground floor.

Those living in mobile homes are particularly at-risk in severe weather events with strong wind. Uren said people in those communities should have a plan to reach more stable and secure structures quickly if a tornado is on the way.

Make sure everyone in your family knows where to go in case of a severe weather warning. If you have small children, it’s a good idea to have run family “drills” so everyone is prepared when the time comes to take cover.

2. Food and Water

Uren recommends having three days of food and one gallon of water per family member per day, including the family’s furrier members.

“People often don’t think about their pets when they’re planning for disasters,” he said. “If you don’t, then you’ll end up sharing your water and food and everyone comes up short.”

A first aid kit, a sharp tool to open cans and a hand crank radio also are on Uren’s list of things to have stocked in a safe room on the interior of the lowest available floor of your home.

3. Did you forget…

The tornado siren sounds in the middle of the night and you run downstairs to a room in your basement.

You’ve prepared for this, and the room is stocked with everything you might need. You have a first aid kit, plenty of food and enough water for you and your family.

But you can’t see any of it.

Uren said many people don’t remember to bring their glasses when they seek shelter.

“If you need those to function, you should make sure to have an old pair with all the rest of your emergency supplies,” he said.

While most people are aware of the necessary steps to take when severe weather strikes, Uren said they are often not fully prepared to deal with the aftermath of a very severe thunderstorm or tornado.

“One thing a lot of people don’t think about is their medications,” he said. “If there are meds you need, you have to make sure you have a few days supply with you. It can take up to 72 hours after a major disaster for help to arrive and refill those.”

It’s also important to remember basic necessities such as diapers if there are infants or toddlers in the home.

4. Cars are not (usually) the answer

Uren said the most dangerous urban legends about severe weather safety mostly have to do with cars.

“People think that if you’re in a car, the rubber tires will keep you safe from any lightning danger,” he said. “That’s just not the case.”

If you’re in contact with the metal frame of a car, you’re liable to receive any electrical shock that would come through the frame from a lightning strike. The strong burst of energy also can damage the car or even set parts of it on fire.

Cars are not fast enough to outrun tornadoes, and pulling over to the side of the road in a storm is only a good idea if you’re dealing with straight-line winds. One common misconception is that an overpass is a safe place to wait out a strong storm.

“Someone once got a video when they were able to pull over and stop under an overpass and they survived a tornado by getting up in between the steel girders,” Uren said.

“These days, most overpasses have concrete girders or you can’t even access them, and without that, an overpass is an incredibly dangerous place because of how the wind can get concentrated there.”

Of course, being in a car is still preferable to being out in the open and completely unprotected during a storm. The best thing to do is know when storms are coming so you can avoid being stranded.

5. Be serious and have a lot of back-ups

Do you have a flashlight? Stock up with extra batteries.

Is your cellphone fully charged? An external charging source is probably also a good idea.

Uren’s biggest message is that things can always go wrong, and even as we hope for the best, we should always prepare for the worst.

“These things can be very real,” he said. “Everyone near Ann Arbor will remember the Dexter tornado we had. We were very fortunate there were no fatalities and not a lot of serious injuries related to that.”

Don’t take severe weather warnings lightly, Uren said. Make sure to pay attention to local news and reports from the National Weather Service. Knowing when a storm is coming can give you enough time to take the proper precautions necessary to keep yourself and loved ones out of harm’s way.