Jerry D. Kennett, MD, MACC 2017-07-19 03:35:00
AMA House of Delegates Address Immigration Reform, AUC Mandate, Nutrition and More The annual meeting of the American Medical Association (AMA) was held from June 9-14 in Chicago, IL, and, as usual, a whole host of reports and resolutions were presented to the House of Delegates (HOD) for discussion and debate. The ACC submitted a resolution titled, “Immigration Reform Impacts on International Graduate Training and Patient Access,” which contained three resolves: 1) the AMA advocate for timely processing of visas for physicians to fill residency and training slots; 2) that AMA study the current impact of immigration reform efforts on residency and fellowship training programs, physician supply and timely access of patients to health care throughout the United States; and 3) that AMA report back to the HOD by the 2017 interim meeting. This resolution, combined with six other resolutions on the same topic, lead to the following seven resolve clauses: • That AMA recognize the valuable contributions and affirm support of international medical students and international medical graduates and their participation in U.S. medical schools, residency and fellowship training programs and in the practice of medicine. • That AMA oppose laws and regulations that would broadly deny entry or re-entry to the U.S. of persons who currently have legal visas including permanent resident status and student visas based on the country of origin, and or religion. • That AMA oppose policies that would broadly deny issuance of legal visas to persons based on the country of origin and or religion. • That AMA advocate for immediate reinstatement of premium processing of H-1B Visas for physicians and trainees to prevent any negative impact on patient care. • That AMA advocate for the timely processing of visas for all physicians including residents, fellows, and physicians in independent practice. • That AMA work with other stakeholders to study the current impact of immigration and reform efforts on residency and fellowship programs, physicians supply, and timely access to patient’s health care throughout the U.S. • That AMA update the HOD for the 2017 Interim Meeting on the impact of immigration barriers on physician workforce. Several organizations including our nuclear medicine colleagues also submitted Resolution 229 regarding Medicare’s Appropriate Use Criteria (AUC) program. An amended version passed the HOD, stating that AMA continue to advocate to delay the effective date of the AUC program until the Centers for Medicare and Medicaid Services can adequately address technical and workflow challenges with this implementation and any integration between the Quality Payment Program and the use of advanced diagnostic imaging AUC. The ACC delegation felt this language was well in line with the ACC’s policy statement on the AUC Program and supported this final language. The ACC also co-sponsored two resolutions submitted by the AMA District of Columbia Delegation. These resolutions had been reviewed by the ACC’s Prevention Council, prior to the AMA meeting. Resolution 407, requests that the federal government support supplemental nutritional assistance program (SNAP) initiatives to incentivize healthy foods and dis-incentivize or eliminate unhealthy foods and to harmonize SNAP food offerings with those of special supplemental nutrition programs for women, infants and children. This language was agreed upon by the reference committee and passed by the HOD. The second resolution, also passed by the HOD, was related to healthful hospital foods and stated that AMA hereby call on U.S. hospitals to improve the health of patients, staff and visitors by providing and promoting plant-based meals low in fat, sodium and added sugars and eliminate the use of processed meats from patient menus. Other resolutions and reports of importance to the ACC, included those focused on protecting patients access to emergency services; expansion of the U.S. Veterans health care choices; support for pharmaceutical pricing negotiations by the Medicare program; the Medicare Access and CHIP Reauthorization Act and the Quality Payment Program; Maintenance of Certification; medical student debt and the expansion of graduate medical education slots; hospital consolidation; and more. Additionally, David Barbe, MD, a family physician from southern Missouri, was installed as the new AMA president. For all HOD actions, visit the AMA website at www.ama-assn.org. The ACC delegation to the AMA included: Jerry D. Kennett, MD, MACC (Chair); Kim Allan Williams Sr., MD, MACC; L. Samuel Wann, MD, FACC; and Suma Thomas, MD, FACC. Eugene Sherman, MD, FACC, and Benjamin Galper, MD, FACC, served as alternate delegates. CMS Releases Proposed Rule Outlining More Details of Quality Payment Program The Centers for Medicare and Medicaid Services (CMS) released the proposed 2018 Medicare Quality Payment Program (QPP) rule, addressing participation requirements for 2018 and future years under the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (Advanced APM) pathways. The QPP was created by the Medicare Access and CHIP Reauthorization Act (MACRA). Under the proposal, CMS will continue to treat the 2018 performance year as another transition year of QPP and maintain program flexibility. Based on 2018 performance, clinicians and groups will be eligible to receive up to +/- 5 percent in bonuses or penalties on Medicare Part B services provided in 2020 under MIPS. Qualifying participants in an Advanced APM will be eligible to receive a five percent lump sum bonus. Highlights of the proposed rule include: • MIPS Weighting For 2018 Performance Year/2020 Payment Year • Maintain 60 percent weight for Quality. • Maintain 15 percent weight for Improvement Activities. • Maintain 25 percent weight for Advancing Care Information; clinicians can use 2014 or 2015 certified electronic health record technology (CEHRT), with a bonus for using 2015 CEHRT. • Maintain zero weight for Cost; however, CMS seeks comments on introducing this category at 10 percent. CMS continues to develop and test episode-based measures which will be introduced over time. • Increasing the low-volume threshold to less than or equal to $90,000 in Medicare Part B allowed charges or less than or equal to 200 Part B patients to allow more small practices to qualify for MIPS exemption. • Implementation of virtual groups, allowing small groups and solo practitioners under two or more taxpayer identification numbers to participate in MIPS as a single group for both 2018 and 2019. Technical assistance will be made available to these practices. • Implementation of facility-based measures in MIPS to allow clinicians to be assessed based on their facility’s performance. • Continued recognition of qualified clinical data registries such as NCDR’s PINNACLE Registry and Diabetes Collaborative Registry as MIPS data reporting options. • Advanced APM • Maintenance of the nominal risk and qualifying participant thresholds for the Advanced APM pathway. • Implementation of the ‘All-Payer Combination Option’ for the Advanced APM pathway starting in the 2019 performance year. • CMS seeks comments on broadening the definition of Physician-Focused Payment Models to include Medicaid or Children’s Health Insurance Program beneficiaries. • Other key items are included in the CMS fact sheet. The ACC is reviewing this rule in further detail and will provide more details via the ACC Advocate newsletter or online at ACC.org/Advocacy. Additionally, the College is soliciting feedback from member groups in preparation for submitting written comments. “Next year (2018) will be another transition year for clinicians adjusting to the Quality Payment Program,” notes ACC President Mary Norine Walsh, MD, FACC. “While the ACC will be reviewing the rule in detail, we were encouraged to see that CMS has listened to feedback from the public and recognizes a need to continue supporting clinicians in their transition to a value-based payment environment.” The policies in this proposed rule impact the 2018 performance year and future years under QPP. To learn about the current requirements for the 2017 performance year, visit ACC’s MACRA Information Hub at ACC.org/MACRA. ACC Comments on Medicare Coverage for ICDs Last month the Centers for Medicare and Medicaid Services (CMS) began the information collection process to update the national coverage determination (NCD) governing ICD implants. The ACC, in collaboration with the Heart Rhythm Society, submitted comments to CMS outlining improvements that should be made to the clinical indications based on studies and guideline recommendations that have changed since the policy was issued in 2005. CMS will consider the public comments submitted during this information collection phase, undertake its own reviews and issue a draft NCD by the end of November. Another round of comments will be accepted at that time with a final policy issued before March. Bill Expanding Access to Cardiac Rehabilitation Introduced in Senate Sen. Mike Crapo (R-ID), of the Senate Committee on Finance, has introduced legislation (S.1361) to allow physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac, intensive cardiac and pulmonary rehabilitation programs, increasing patient accessibility to these services. The ACC has been working closely with the American Heart Association to usher this legislation through the House and Senate. “As the burden of cardiovascular disease continues to rise, cardiac rehabilitation remains critical to heart failure management and successful recovery from heart attacks and cardiac surgery. Current health care policy requires physicians to supervise cardiac rehabilitation services, which can create limitations to access for millions of patients, adversely impacting population health outcomes. The passage of S.1361 would remove barriers by allowing all providers to practice to the highest level of their education, training and certification,” said Linda L. Hart, DNP, RN, ACNP-BC, AACC. “We’re grateful to Senate leadership for introducing S. 1361 and encourage commitment to this legislation that will allow patients across the nation to more easily access high-quality cardiovascular care.” MOC Update: JACC Journals Provide More Than Just Latest CV Research By William J. Oetgen, MD, MBA, FACC, and Thad F. Waites, MD, FACC For years JACC Journals have offered Continuing Medical Education (CME) credits to ACC members. Since last September – in response to the American Board of Internal Medicine’s (ABIM) 2016 policy change allowing Maintenance of Certification (MOC) Part II credit to be given simultaneously with certain types of CME activities – JACC Journals have offered members a chance to earn seamless dual CME and MOC Part II credit through monthly education offerings. Fast forward to today and the number of ACC members taking advantage of the free dual CME/MOC offerings has grown steadily (Figure). Between September 2016 and May 2017, 5,265 MOC credits have been claimed. For ACC members, the overall potential impact of this program is large. Five JACC Journals (JACC, JACC: Clinical Electrophysiology, JACC: Heart Failure, JACC: Cardiovascular Imaging, and JACC: Cardiovascular Interventions) feature monthly CME/MOC offerings. JACC: Basic to Translational Science, published bimonthly, also offers credit opportunity with each issue. Through JACC Journals alone, members could earn a total of 66 CME/MOC credits each year – more than enough to provide all the CME credits required by most states for medical licensure renewal (usually 25 credits per year), and more than enough to cover the ABIM Part II credit requirement of 100 credits for each five-year period. Each JACC journal has at least one designated CME editor. Ragavendra R. Baliga, MD, FACC, functions in this capacity for JACC and for JACC: Cardiovascular Imaging. He notes that the CME/ MOC articles from JACC have been carefully selected to enrich the readers’ educational experiences with the view of transforming patient care and improving heart health. “These offerings should not only hone the readers’ diagnostic and therapeutic skills but also expand their knowledge of cutting-edge breakthroughs in cardiovascular medicine,” he says. Other CME editors include: L. Kristin Newby, MD, FACC, (JACC: Basic to Translational Science); Bill Gogas, MD, PhD, (JACC: Cardiovascular Interventions); Smit Vasaiwala, MD, (JACC: Clinical Electrophysiology); and Tariq Ahmad, MD, MPH, FACC, Lauren Cooper, MD, FACC, Adam DeVore, MD, Robert Mentz, MD, FACC, Kishan Parikh, MD, Mitchell Psotka, MD, PhD, and Abhinav Sharma, MD (JACC Heart Failure). All JACC Journals are available for free to members at OnlineJACC.org. Claiming CME/ MOC credit is simple and can be done from any computer, tablet or smartphone. Members need their ACC.org username (or primary email address) and password, which can be obtained from the ACC Resource Center or from ACC.org. For MOC credit, clinicians must also have their ABIM ID, which can be obtained from ABIM.org. Then just follow these steps to obtain your credit: 1.Go to ACC.org and click “Log in to My ACC” 2.Click on “Menu” or “JACC” 3.Click on “JACC” 4.Click on “CME/MOC” 5.Click on “JACC Journals CME/MOC” (As of June 20, there are 59 offerings.) 6.Choose an offering of interest 7.Click on “Start Program” 8.On the Credit Agreement page, click “Agree” and “Submit” 9.Click on the “Article” tab to read the abstract, and then click on “here” at the bottom of the abstract page to receive a PDF copy of the article 10.Read the article 11.Click on the “Post Test” tab to take the quiz 12.Complete the quiz (You may re-take the quiz if a passing grade is not obtained on the first try.) 13.Click on “Evaluation” to complete the evaluation 14.Click on “Claim Credits” (Choose CME and/or MOC to claim respective credits.) 15.Once the module has been completed, return to ACC.org and log in again (if necessary) 16. Click “My ACC” 17.Click “My CME/CE Transcript” to verify that the MOC and CME credits have been added to your ACC transcript 18.After several days, you will receive a notification from ABIM that the MOC credits have been received and posted 19.You may go to ABIM.org and log into your personal page to confirm your credits have been received.
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