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The Leading Source for Healthcare Business News January 2017 • Volume 13, Issue 10 • $3.50

INSIDE ▼ Smaller artificial heart implanted at Baylor St. Luke’s

see page 6

INDEX ▼ Financial Perspectives.......3 Infectious Disease.............4 Hospital Headlines...........6 THA.................................7 Integrative Medicine.........8 Moving On Up.................9 Special Feature................11

The power of inactivity see page 8

. . . . . . . . . . . .

New Anti-Kickback safe harbors and CMP exceptions in the new year BY MARY M. BEARDEN AND ALLISON SHELTON, Brown & Fortunato, P.C. On December 7, 2016, the Office of Inspector General (OIG) published a Final Rule adopting new safe harbors to the Anti-Kickback Statute and new exceptions to the Civil Monetary Penalty (CMP) prohibition on beneficiary inducements. The new regulations became effective during the first week of the new year. The federal Anti-Kickback Statute is broadly written and criminalizes many business arrangements that are acceptable outside the health care industry. Under the Anti-Kickback Statute, health care providers may not “knowingly and willfully offer or pay any remuneration . . . to any person to induce such person . . . to refer” business reimbursable by a federal healthcare program. Likewise, whoever receives anything of value in return for referring such business can be prosecuted under the statute. Violation of the AntiKickback Statute may result in civil and criminal penalties, including imprisonment. Because of the breadth of the AntiKickback Statute, Congress has directed the OIG to develop “safe harbor” regulations which protect certain arrangements that might otherwise violate the statute. Failure to comply with a safe harbor does not result in an automatic violation of the Anti-Kickback Statute. Nevertheless, safe harbor compliance is advisable in most arrangements involving referral sources

because of the immunity afforded by the safe harbor. In the Final Rule, the OIG has adopted three new safe harbors and has modified existing safe harbors. One such modification provides safe harbor immunity to pharmacies that waive or reduce copayments and other cost-sharing obligations for beneficiaries of federal health care programs in certain situations. Specifically, safe harbor protection is available when the following conditions are met: First, the waiver or cost-reduction may not be advertised. Second, the pharmacy may not routinely waive or reduce cost-sharing obligations. Finally, the pharmacy must make a “good faith” determination that the patient has a financial need before the pharmacy waives or reduces the patient’s cost-sharing obligation. As an alternative to the financial need assessment, the pharmacy may reduce

or waive a cost-sharing obligation in the event the pharmacy fails to collect after making “reasonable collection efforts.” The OIG declined to establish specific methods for determining whether a beneficiary has a financial need. The OIG did indicate, however, that acceptance of a patient’s representations regarding his or her financial need is unlikely to qualify as a “good faith” assessment of the patient’s financial need. In the preamble to the Final Rule, the OIG recommended that pharmacies establish and uniformly apply written policies that have objective income guidelines for determining financial need. Moreover, the OIG indicated that a pharmacy’s documentation regarding waivers and cost-reductions should reflect financial need assessments performed in Please see LEGAL AFFAIRS page 10

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical . . . Journal . . . -.Houston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

January 2017

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. . . . . . . . . . . . . . . FINANCIAL PERSPECTIVES

BY REED TINSLEY, CPA, CVA, CFP, CHBC

How physicians can prepare for the Medicare Access and CHIP Reauthorization Act (MACRA)? transition from a fee-for-service healthcare system to an APM that rewards quality of care over quantity of services. The MIPS path provides for reduced existing requirements by combining three existing quality programs into one—MU, PQRS, and

time to prepare for participation in the system by combining weighted score of quality, resource use, MU, and clinical improvement activities to determine how payments will be adjusted.

MACRA provides two tracks for providers: The Meritbased Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). To start preparation for MACRA, you should educate and discuss the new regulations by participating and attending professional organization meetings where thought leaders discuss the two tracks. You should also evaluate individual quality measures identifying areas of high performance, as well as reviewing Quality and Resource Use Reports. If not currently reporting Meaningful Use (MU) and the Physician Quality Reporting System (PQRS), you need to evaluate potential penalties and their readiness for MACRA. The first decision for physicians would be determining which track you or your group would choose as it will impact their

accountable care organizations (ACOs) and patient-centered medical homes and would provide more generous incentive programs that are exempt from MIPS requirements. Physicians will need to determine how they would meet MIPS or APM reporting requirements to evaluate qualification for bonus payments. Physicians can also prepare for MACRA by: Determine if you are exempt from participating. You may be one of the many physicians who might be exempt from penalties for not participating in MIPS. The Centers for Medicare & Medicaid Services (CMS) has developed a lowvolume threshold exemption from the MIPS program. Courtesy of the Harris County Medical Society here in Houston, you can check eligibility here: http://tinyurl.com/ zgxgk6r.

the Value-based Payment Modifier (VPBM). MIPS allows for flexible performance and

The APM track would be best for clinicians already participating in alternate

Reviewing the timelines. The first performance period for MIPS began on January 1, 2017. This means that every eligible clinician will need to be sensitive to MIPS reporting and documentation Please see FINANCIAL PERSPECTIVES page 18

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January 2017

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continued efforts to fight the disease. The report highlights 10 critical contributions: • Issuing travel guidance to warn pregnant women not to travel to areas with Zika

• Establishing a causal link between Zika virus infection during pregnancy and microcephaly and serious brain defects • Gathering and analyzing Zika pregnancy surveillance data to understand the magnitude of the risk and the full range of possible health

Although these contributions demonstrate significant progress this past year, the fight against Zika is not over. “Fighting Zika is the most complex epidemic response CDC has taken on, requiring expertise ranging from pregnancy and birth defects to mosquito control, from laboratory science to travel policy, from virology to communication science,” said CDC Director Tom Frieden, M.D., M.P.H. “CDC experts in every field will continue to protect women and their families from the devastating complications of this threat.”

CDC highlights significant contributions in the fight against Zika in 2016 Seventy years after CDC was founded to fight mosquitoes that carried malaria, CDC found itself entrenched in combat with another mosquito-borne illness, Zika virus. CDC activated its Emergency Operations Center to fight Zika on January 22, 2016, after a widespread Zika outbreak in the Americas was linked to a large increase in the number of babies born with microcephaly. As the emergency response approaches one year, CDC’s Morbidity and Mortality Weekly Report highlights 10 critical contributions towards the fight against Zika virus in 2016. CDC joined the global health community to rapidly address the many emerging public health needs on the front lines against Zika. To respond effectively, new public health surveillance and infection control tools were developed that will reduce the effect of Zika virus infection on children and families and will provide a foundation for

strategies and building the evidence base for best practices • Improving understanding of the link between neurologic conditions (Guillain-Barré syndrome) and Zika virus infection.

• Publishing clinical guidance for the care of pregnant women, their fetuses, and infants • Identifying sexual transmission of Zika virus • Monitoring blood safety and availability • Developing and distributing laboratory test kits and reagents

effects for fetuses and infants following infection during pregnancy • Improving access to the full range of voluntary, reversible contraceptive methods to decrease unintended pregnancies as a strategy to reduce the impact of Zika virus infection • Implementing mosquito control

CDC’s top priority in the Zika response is to protect pregnant women. To do that, efforts must continue to focus on preventing mosquito-borne spread of Zika virus through mosquito control and personal protective measures, collaborating to accelerate vaccine development, developing improved diagnostic testing, improving contraceptive access to reduce unintended pregnancies, and improving understanding of long-term outcomes for infants exposed to Zika virus infection during pregnancy. Zika virus remains a serious threat to public health, and focused efforts on these key priorities will help advance the fight against Zika. t

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical . . . Journal . . . -.Houston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

January 2017

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January 2017

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Support, Baylor College of Medicine. For the last half-century, the Texas Heart® Institute at Baylor St. Luke’s has led the world in the push to develop a viable, durable, total artificial heart.

a transplant last year, the device is designed to be used either as a bridge to a donor heart transplant or for destination therapy which provides long-term support to patients who are not candidates for transplant.

The 50cc device is designed to fit patients, smaller in stature, with life-threatening non-reversible biventricular (both sides) heart failure. These patients are typically women and adolescents who do not have the body surface area (1.85m² or less) to

Similar to a heart transplant, SynCardia’s Total Artificial Heart replaces both failing heart ventricles and the four heart valves. In most cases, SynCardia’s heart restores blood flow, pumping up to 9.5 liters per minute and eliminates complications

Smaller artificial heart implanted at Baylor St. Luke’s, bringing new hope to more patients Doctors at CHI St. Luke’s Health–Baylor St. Luke’s Medical Center (Baylor St. Luke’s) recently announced that they have successfully implanted the new 50cc SynCardia Total Artificial Heart (TAH) into a patient suffering from biventricular end-stage heart failure. The new device is a smaller version of its predecessor, the 70cc SynCardia temporary Total Artificial Heart, which received FDA approval in 2004. The patient is the third person in the country and the first in Texas to be discharged home with this smaller artificial heart. The procedure was performed by Jeffrey Morgan, MD, Surgical Director, Mechanical Circulatory Support and Cardiac Transplant, Texas Heart® Institute (THI) at Baylor St. Luke’s, and Chief, Division of Cardiothoracic Transplant and Circulatory

candidates when a donor heart does become available. As a result, patients usually see an improvement in their activity levels and overall quality of life. The recently implanted patient is a 55-yearold woman who previously had a pacemaker. Other artificial heart devices were too large for her. “This is an important step in the evolution of artificial heart devices,” said James T. Willerson, MD, President, THI. “We’re proud that THI continues to lead the way in such technology to help patients.” Other notable accomplishments include the world’s first artificial heart implant in 1969 by Denton A. Cooley, MD, and when THI surgeons implanted the SynCardia device in four patients over a 12-day period. O.H. “Bud” Frazier, MD, performed those implants and also worked on research for the first pump used in the very first artificial heart implant.

Baylor physician proposes value-based incentive structure for emergency care

Dr. Jeffrey Morgan, patient Cynthia McGuffie, and Dr. Leo Simpson receive the 70cc device. With as many as 100,000 people in the U.S. in need of new hearts and a little more than 2,500 receiving

associated with the patient’s failing heart. This helps vital organs to recover faster and allows patients to be better transplant

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Emergency physicians are judged by different criteria than many other types of physicians, which significantly impacts their incentives to develop a value-based, long-term plan for their patients. In a paper published in Annals of Emergency Medicine, Dr. Laura Medford-Davis, assistant professor in the Department of Emergency Medicine at Please see HOSPITAL HEADLINES page 13


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January 2017

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State needs to invest in healthcare

. . . . . . . . . . . . . . . THA

From a clinical perspective, it is hard to understand why our state lawmakers would consider skimping on these services.

Special to Medical Journal – Houston BY TED SHAW, President/CEO, Texas Hospital Association

It is also hard to understand from a financial perspective.

bottom line reveals a program whose costs are aggressively controlled. The healthcare cost per Texas Medicaid enrollee grew just ten percent over the last ten years compared with 45 percent per enrollee in the state employee retirement system and 60 percent

This is a good and appropriate way to contain costs.

When state lawmakers return to Austin this month for the 85th legislative session, the one bill they must pass is a balanced state budget. The budget will govern revenue collection and spending for 2018-2019 and pay for education, children’s protective services, public safety, and other essential government services.

Underpaying healthcare providers, however, is not. Unfortunately, Texas Medicaid for years has paid hospitals, doctors, nurses, and other healthcare providers far less than what it costs for them to provide healthcare services. Currently, for Texas hospitals, reimbursement covers, on average, just 58 percent of the costs of providing healthcare services in an inpatient setting.

One of those essential services is healthcare. This includes life-saving trauma care for victims of accidents, falls, and violent crimes; behavioral health services for those with serious mental illness; and preventive and primary care for low-income children and pregnant women.

in the number of people enrolled in the program. This cost containment is partly the result of the state requirement that nearly all Texas Medicaid enrollees get services through a managed care plan. Managed care alone has generated $4 billion in savings over six years and is projected to save an additional $3.3 billion over the next three years.

The largest portion of state healthcare spending goes to Texas Medicaid, a program that the state administers according to federal requirements. But a look at the

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in the teachers’ retirement system. In addition, total Medicaid spending in Texas has remained largely flat in recent years despite a nearly 135 percent increase

This underpayment is a huge disincentive for healthcare providers to participate in the program, which, in turn, means that Medicaid enrollees have fewer options Please see THA page 18

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January 2017

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The power of inactivity

. . . . . . . . . . . . . . . INTEGRATIVE MEDICINE

first place. In order to enact lasting change, the strength of one’s mind also has to be

develop a longer attention span, increased memory capacity and foster more lasting

BY PRADEEP K PRAMANIK, resident physician at UTMBGalveston and RJ GIGLIO, Civil Litigator, Tulane Law Review Alumnus

The same is true for the mind. Cognitive rest renews our control over our attention span and lubricates our behavioral gears so old habits and perspectives can be broken and re-formed into new ones. Reorienting stress in a positive light enables us to develop healthier physical reactions to stress, tangibly increasing our longevity (Saron, 2011).

People often use catalysts to change their habits. “As soon as I get this new job, I will start eating better.” “Once I finish my graduate program, I will quit drinking so much coffee and smoking so many cigarettes.” The New Year’s resolutions many of us are about to make are prime examples: “Once the new year starts, I will go to the gym more often.” But is this method of changing individual traits effective? By identifying an undesired behavior, we make superficial changes and leave intact the psychological foundations which created maladaptive habits in the

to know how to turn it on, speed it up, slow it down, and turn it off.

We simply need to consistently commit a small amount of time each day to mindful rest, preferably in the morning and evening.

improved. Rather than filling a dirty bowl with more detritus, perhaps we should take the time to empty out and clean the vessel.

behavioral changes. By inactivity, we mean rituals of restfulness and reflection as opposed to goal-oriented activity.

We specifically recommend the following practices: • Three gratitudes - document three experiences of gratitude • Journaling – take two minutes to write down the most meaningful event of the past 24 hours • Meditation – breathe deeply and rhythmically in a firm fixed posture for

Dedicated periods of inactivity allow us to

In order to use a machine properly, we need

Please see INTEGRATIVE MEDICINE page 17

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January 2017

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. . . . . . . . . . . . . . . MOVING ON UP

After an extensive nationwide search, the Memorial Hermann Health System has announced the appointment of Anne E. Neeson as Executive Vice President and CEO of the Memorial Hermann Foundation. Currently the Vice President of Donor Relations at the United Way of Greater Houston, Neeson will lead the Memorial Hermann Foundation’s fundraising and planned giving programs – among other initiatives – with the goal of supporting Memorial Hermann’s legacy of world-class patient care, research, and education. A native Houstonian, Neeson has enjoyed a 30-year career at United Way of Greater Houston, working her way up from a campaign associate to become the organization’s Vice President of Donor Relations. During the journey, Neeson earned a notably distinguished record as a development executive raising more than $1.5 billion while creating or co-creating innovative donor groups that expanded and advanced the United Way’s fundraising initiatives.

Anne E. Neeson

Among her accomplishments are: • Spearheading the fourth largest annual United Way campaign in the nation • Building the largest Alexis de Tocqueville Society membership in the nation • Directing the capital campaign to build the United Way Center for Philanthropy Leadership & Volunteerism • Co-creating the United Way LINC, a Millennial-focused initiative volunteer group • Launching the United Way Women’s Initiative

Anne E. Neeson named to lead the Memorial Hermann Foundation Neeson also created the United Way Community Bus Tours to showcase the organization’s community work in key areas and give donors, potential donors, business and community leaders an up-close view of United Way programs in action. Neeson holds a bachelor’s degree from

Texas A&M University. Among her affiliations and awards, Neeson is a member of the United Way’s Alexis de Tocqueville Society and the Association of Fundraising Professionals. She has been cited as one of the city’s 50 Most Influential Women by Houston Women’s Magazine, selected as a Woman on the Move by Texas Executive

Women and is currently a fellow in the American Leadership Forum Class XXXVII. She is also a Eucharistic Minister at All Saints Catholic Church. t


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January 2017

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. . . . . . . . . . . . . . . accordance with the pharmacy’s written policy.

and ambulance-level transportation. Additionally, the transportation services may not be advertised, drivers may not be paid on a per-patient basis, and health care items and services may not be marketed

the provider may offer the service to any person, including friends and family of a patient. The provider has the flexibility to determine the shuttle’s route and schedule, and the provider may post such information

One exception adopted in the Affordable Care Act permits the provisions of items or services that “promote[ ] access to care and pose[ ] a low risk of harm to patients and [f]ederal health care programs.” In the Final Rule, the OIG provides that items or services promote access to care if they “improve a beneficiary’s ability to obtain items and services payable by Medicare or Medicaid.” Such items or services pose a low risk of harm if they (i) are “unlikely to interfere with, or skew, clinical decision making”; (ii) are unlikely to increase costs through overutilization or inappropriate utilization; and (iii) do not pose “patient safety or quality-of-care concerns.”

One of the most highly anticipated safe harbors adopted by the OIG protects free and discounted local transportation services provided by an “eligible entity.” Hospitals, home health agencies, laboratories, physicians, and Accountable Care Organizations are all considered eligible entities under the new safe harbor. Pharmacies, pharmaceutical manufacturers, and other persons or entities that primarily provide health care items are not eligible entities, however. If a provider qualifies as an eligible entity and wants to provide free or discounted transportation services, the terms of the service must be set out in a written policy. The policy and practice of the provider must enable “established patients” to obtain medically necessary care. An established patient is one who, on his or her own initiative, selects and initiates contact with the provider. In addition to offering transportation services in accordance with a written policy, providers must comply with several limitations set forth in the safe harbor in order to qualify for immunity under the statute. Among these limitations is the prohibition against air, luxury,

the offeror knows or should know that it will likely influence the beneficiary’s selection of health care providers. In the Final Rule, the OIG adopted five new exceptions to this prohibition, four of which were mandated by the Affordable Care Act.

during transports. The new safe harbor also protects local shuttle services provided by eligible entities. The OIG defines “local” for both personal and shuttle transportation as 25 miles in an urban area and 50 miles in a rural area. When a provider furnishes shuttle services,

for the public to view. However, the provider may not advertise the shuttle service. In addition to new safe harbors, the OIG adopted new exceptions to the CMP relating to beneficiary inducements. Under the CMP, no one may offer an inducement to a Medicare or Medicaid beneficiary when

The new safe harbors and CMP exceptions provide more flexibility for providers to develop programs that increase access to high-quality and affordable health care. Before implementing programs designed to comply with a new safe harbor or CMP exception, providers should review the preamble to the Final Rule and should fully assess the risks associated with any new program. Failure to fully consider such risks may result in significant consequences due to the weighty penalties associated with violations of the Anti-Kickback Statute and the prohibition against beneficiary inducements. t

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical . . . Journal . . . -.Houston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

January 2017

Page 11

. . . . . . . . . . . . . . . SPECIAL FEATURE

PANDAS/PANS BY DR. CHARLES ANTHONY HUGHES, Pediatric Otolaryngologist, Texas Children’s Hospital-The Woodlands PANDAS is an acronym for Pediatric Acute-onset Neuropsychiatric Disorders Associated with Streptococcus while PANS stands for Pediatric Acute-onset Neuropsychiatric Sy ndrome. Children and adolescents diagnosed with PANS have severe symptoms of obsessivecompulsive disorder (OCD) and/or tics that come on very suddenly. They can display episodic sudden and severe anxiety, mood swings, irritability, or uncontrollable movements. They can also have sleep problems, urinary frequency and bedwetting, and regression to younger childhood behaviors. PANDAS refer to the same set of rapid onset of symptoms and are believed to be brought on by recurrent streptococcus infections, like strep throat. Researchers have discovered that similar symptom complexes can be brought on by environmental triggering factors including other infections such as the flu, chickenpox, mycoplasma, and Lyme disease. It is theorized that recurrent infections produce antibodies that stimulate the immune response. People who are susceptible, possibly due to a genetic predisposition, produce an exaggerated cellular response which crosses the bloodbrain barrier and affects areas of the brain producing neuropsychiatric and behavior changes. One theory is that these events can trigger an autoimmune reaction resulting in inflammation of the brain. There are other medical conditions, such as Rheumatic fever and Sydenham chorea,

Shingles is described as “excruciating”, “intense”, and “debilitating”. A local doctor is conducting a research study enrolling participants who have recently developed a shingles rash. We are searching for qualified participants who are available to receive the study medication within 120 hours (5 days) of the suspected shingles rash appearing. To qualify (additional criteria applies): • Be at least 30 years of age • Be able to receive the study medication within 120 hours (5 days) of a possible shingles rash appearing • Have not received the shingles vaccine

which have similar patterns of development, mechanisms, and etiologies. In the case of PANDAS, the child rapidly begins to exhibit life-changing symptoms such as OCD, tics, uncontrollable movements, anxiety, personality changes, a decline in school performance such as in math and handwriting abilities, sensory sensitivities, and regression to younger childhood behaviors. Unlike typical cases of OCD, where symptoms begin gradually in children, the PANDAS subgroup experiences a very sudden, dramatic symptom onset. Compulsive behaviors, obsessive thoughts, u ncontrollable movements, and tics can appear “overnight or out of the blue” and are full-blown usually within one to two days. The severity and rapid onset of this syndrome are devastating to the patient and their families. PANDAS/PANS syndrome is a clinical diagnosis; it depends on a careful history and a physical examination. Clinicians who treat children with this disorder usually approach the problem in a multidisciplinary manner, encouraging cooperation among various specialties to care for the patient and their families. Current treatment protocols can include antibiotics, nonsteroidal anti-inflammatories, steroids, immunoglobulin (IVIG), or plasmapheresis. Adenotonsillectomy with or without sinus procedures may be beneficial in a subset of patients. Dietary counseling with attention to the consumption of Omega 3s and probiotics, as well as avoidance of reactive substances, can be helpful. Behavior counseling is also beneficial, including Cognitive Behavioral Therapy (CBT) and/ or Exposure and Response Prevention (ERP). A coordinated treatment plan utilizing the expertise and services of a committed group across medical and social specialties is essential for optimal therapy. t

If you qualify, you’ll receive at no cost study-related medication and study-related care from a local doctor. Health insurance is not needed and referrals are not required to participate. Doctors will check other requirements to confirm qualification.

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Medical Journal - Houston

January 2017

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January 2017

HOSPITAL HEADLINES continued from page 6

. . . . . . . . . . . . . . . Baylor College of Medicine, examines the varying incentives for physicians and how these need to change in order to advance emergency department care.

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activities and advancing care information, all of which add up to 100 percent. “Emergency care has been disconnected from a patients’ overall, long-term care,” said Medford-Davis. “When a patient presents at an emergency department, the physicians

providers and payers more than we realize, decreasing costs and improving quality of care.” Looking at the four MIPS categories, Medford-Davis first outlines how to address quality, noting that emergency department

“Emergency department physicians have typically been incentivized based on a fee-for-service model, which provides reimbursement based on how many patients are treated, as opposed to a value-based approach, which would be more encouraging to developing a long-term treatment and follow-up plan for patients,” said MedfordDavis.

Because emergency medicine care providers often lack a full medical history when a patient is admitted, they are required to employ different strategies than primary care providers when it comes to resource use. Medford-Davis presents several strategies that can help improve resource use and value by gauging resource use by all physicians involved in making a diagnosis, which aligns emergency, ambulatory and inpatient providers to encourage coordination of care and shared responsibility. Other methods include creating bundled payment approaches and the use of computed tomography (CT) scans.

In order to succeed in changing the incentives structure for emergency care physicians, the emergency department itself needs to be viewed as a healthcare solution that can play a key role in developing coordinated care at a high value, not a place to be avoided. In the paper, Medford-Davis outlines a strategy for improving the value of emergency care using the Merit-Based Incentive Payment System (MIPS) from the Medicare Access and CHIP Reauthorization Act, a value-based mechanism that ties a portion of fee-for-service payments to value using a composite physician performance measure. The physician performance measure consists of four categories, including quality, resource use, clinical practice improvement

unintended consequences of increasing healthcare costs and fragmenting procedures from value, thereby limiting the time available for value-based care activities, like coordinating care or identifying social determinants of health,” explained Medford-Davis. ”To incentivize emergency medical services and hospitals to improve their coordination of care and the outcomes in an area, it would be valuable to correlate population-based outcomes with population-based measures.”

typically have no access to their previous medical history and records, but if we can integrate emergency care with primary and specialty care, emergency care has the potential to meet the needs of patients,

quality is largely measured by speed of throughput and care for a small number of time-sensitive diagnoses. “Emphasizing speed of throughput has the

“Emergency care providers make decisions based on three factors, which significantly impact resource use,” says Medford-Davis. “They are judged on making decisions quickly, their patients likely have a higher baseline risk of serious conditions, and a CT scan can change the treating physician’s decision to admit the patient, which is one Please see HOSPITAL HEADLINES page 15

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Page 14

Medical Journal - Houston

January 2017

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . Medical . . . Journal . . . -.Houston . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

January 2017

HOSPITAL HEADLINES continued from page 13

. . . . . . . . . . . . . . . of the most expensive decisions they make.” To alleviate this issue of resource use, Medford-Davis says new physician payment incentives must be established to more broadly consider the effects on quality of life, well-being and total cost. To enhance approaches to clinical practice improvement in the emergency setting, Medford-Davis proposes incorporating emergency department-based case managers, social workers or health navigators to assist with care coordination and alleviate some of the time constraints faced by emergency physicians, thereby substantially improving the value of care. Medford-Davis also stresses the importance of the seamless transition of patients from the emergency department to another hospital or institution, should they require care elsewhere. Finally, because many visits to emergency departments are unplanned and outside of primary care provider hours, emergency departments face a challenge with communication of patient records. “ T i m e l y communication of patient clinical data between providers can help reduce costs by decreasing testing and admission while simultaneously creating a more patient-centered experience,” said MedfordDavis. “Reliably available patient data and exchange of health information is a promising tool for unscheduled care and coordination, and encouraging emergency departments to alert the patient’s primary care provider at check-in can advance the use of health information technology in the emergency environment.” “MIPS is the first step in changing the incentives structure, and it can serve as a framework for new opportunities to generate greater value in the emergency setting. I hope to see the shift continue to gain momentum, but until the strict fee-forservice method is viewed as obsolete, change will be difficult,” said Medford-Davis.

UTMB awarded $10 Million from CDC to help stop spread of vector-borne diseases To help stop the spread of diseases carried by arthropod vectors such as mosquitoes and ticks, the Centers for Disease Control and Prevention awarded $10 million to The University of Texas Medical Branch at Galveston to establish the Western Gulf Center of Excellence for Vector-Borne Diseases. The Center’s work will protect public health in the region, the nation and beyond.

Page 15

“With UTMB’s unparalleled expertise in arthropod-borne diseases, we along with our partners, are uniquely positioned to improve lives all across the Americas,” said Scott Weaver, director of UTMB’s Institute for Human Infections and Immunity and leader of the new center. “The center will enhance both the regional and national capacity to anticipate, prevent and control emerging and exotic vector-borne diseases.” The award is a part of the CDC’s funding provided under the Zika Response and Preparedness Appropriations Act of 2016. “Texas is a gateway for vector-borne diseases entering or emerging in the U.S.,” said Weaver. “We have seen dangerous viruses spread by arthropod vectors such as mosquitoes and ticks, including dengue, chikungunya, West Nile virus and Zika, establishing themselves and spreading, especially in the Gulf Coast region.” Texas is particularly vulnerable to vectorborne diseases because of its climate, its location at the U.S.Mexico border, and its major hubs for land, sea and air travel from the Caribbean and Latin America. “The goal of the Center is to greatly improve our ability to anticipate mosquito- and tickborne diseases,” said Weaver. “We will approach this problem from many different angles, including safe and reliable control of mosquitoes while safeguarding against insecticide resistance, new point-of-care methods for faster and more reliable disease diagnosis, improved predictions of disease emergence and spread, better understanding of how to serve communities affected by insect-borne diseases, and training a new generation of public health professionals highly skilled in vector-borne disease research and management.” “Although we are able to predict the arrival of many vector-borne diseases, the U.S. is not adequately prepared to prevent these diseases from spreading and to protect at-risk populations, Weaver said. “The failures stem from complex problems such as difficulties in controlling the Aedes aegypti mosquito, the rise of vectors that are resistant to insecticides, and a decrease in public health expertise and preparedness in recent years.” Partners in the new Center of Excellence will include The University of Texas Rio Grande Valley, The University of Texas at Austin, The University of Texas at El Paso, Texas A&M AgriLife, Texas A&M AgriLife Extension, Texas A&M Engineering Experiment Station, Vanderbilt University, the University of Colorado and the University of Houston as well as Harris County and 5 other local public health agencies, and the Texas Department of State Health Services. t


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January 2017

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Healthcare Marketplace


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January 2017

INTEGRATIVE MEDICINE continued from page 8

. . . . . . . . . . . . . . . a short period of time • Random acts of kindness Two weeks of these daily practices correlate with positive psychological change. In truth, a meditative state can only be experienced first hand. If you are curious, then it is time to set aside a little time each day to find out for yourself. The supporting evidence is voluminous. Find evidence that speaks to you.

Page 17

person’s attitude than their objective circumstances. Success in the workplace is only approximately 25% attributable to a person’s intelligence, while 75% is attributable to a person’s optimism, social support, and ability to reimagine stressors as challenges and opportunities. People with a positive orientation towards their life and work experience 31% more productivity, 37% better sales, and higher energy levels (Lyubomirsky, 2005). The old adage, “once I achieve success, then I will be happy,” should be flipped on

From neuroscience, we have learned that periodically resting our brains primes neuronal plasticity and growth. This increases the nervous system’s structural ability to adapt to new tasks. People who regularly meditate exhibit thicker cortical regions associated with organization, executive functioning, and task completion. On a physiological level, we have learned that meditation correlates with a number of positive health indicators, including lower rates of hypertension, headaches, insomnia, depression, anxiety, and functional gastrointestinal disorders. From psychology, we have learned that happiness is far more contingent on a

its head — “once we achieve happiness and peace, then we will achieve success.”

new patient, a new client, an angry spouse, and exciting new job offer, etc., we have tremendous control in our response and physiologic outcome. In conclusion, let us make our New Year’s resolutions more effective by also choosing to dedicate time for inactivity and selfrenewal. If we clean out the vessel of the mind, then we may find that achieving new goals becomes almost effortless. And if you miss a day, that is okay too. Just begin again the next. t

While we may have limited control over given stimuli we may encounter in a day – a

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Medical Journal - Houston

Page 18

January 2017

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FINANCIAL PERSPECTIVES

• Clinical nurse specialists

to report using MIPS for 2017.

continued from page 3

Understanding the basics—MIPS vs. APMs. For 2017, CMS is forecasting that 87% of ECs will need to report on MIPS. Only “qualifying participants” (QPs) in Advanced APM will not need to report

Determining vendor support. MIPS data will be able to be submitted via relevant third-party intermediaries (including EHR vendors) in order to help providers with attestation. ECs should contact their EHR vendor to understand their plans to support MIPS and MIPS attestation and the timelines for the availability of any required software updates.

. . . . . . . . . . . . . . . requirements now as performance in 2017 will affect clinician reimbursement in 2019. Determining eligible clinicians (ECs). MACRA defines additional types of providers compared to Meaningful Use so clinicians should not assume that because they were not included in Meaningful Use that they will also not be subject to MIPS. For 2017, eligible clinicians for MIPS include: • Physicians • Physician assistants • Nurse practitioners • Certified registered nurse anesthetists

using MIPS; yet, CMS will not make the determination of who is a QP until July 2017 at the earliest. This means that all ECs should be prepared

. . . . . . . . . . . . . . . Publisher & Editor Mindi Szumanski mindi@mjhnews.com Advertising Director Tascha Turnley tascha@mjhnews.com Business Manager & Circulation Tom Turnley tom@mjhnews.com

Staying informed. Review the CMS’ website (https://q pp.cms.gov/) and subscribe to news updates. price for the physician.

Managing Editor Stacy Shilling editorial@mjhnews.com

If you do not want to invest in this kind of insurance, keep in mind you can either pay the buyout out of current cash flow or go to the bank and borrow the money. t

Account Executives Liz Logan liz@mjhnews.com Kristin Lewis kristin@mjhnews.com

THA continued from page 7

. . . . . . . . . . . . . . .

Phone 281.559.4411

for timely care and often have to resort to hospital emergency departments that are required by law to provide care to anyone who seeks it. The financial burden on hospitals is then compounded. And the burden is not limited to hospitals. Premiums for private health insurance – whether provided through an employer or the individual market – are higher in Texas because some of the unfunded Medicaid costs are shifted onto the private market. One of Texas hospitals’ top priorities for this

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legislative session is to secure an investment of state funding in reimbursement rates for healthcare services provided to those in Texas Medicaid so that compensation for care provided more closely approximates the actual cost. This is good financial policy.

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January 2017

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Page 20

Medical Journal - Houston

January 2017

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REAL MUSCLE

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