Our congratulations to YourCare Health Plan Chief Medical Officer Joe Stankaitis, MD on his Lifetime Achievement Award from the American Diabetes Association of Rochester! Well deserved! http://bit.ly/2pijiU4
Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don’t wait until the last minute to submit your data. Submit early and often.
Here are key upcoming dates for MIPS:
Please join Kelly Reed and the Huther Doyle team and more than 300 Health and Human Service Providers for a cost-effective professional development event.
8th Annual Health & Human Service Conference & Recovery Institute
March 27 & 28, 2018
Rochester Riverside Hotel, Rochester, NY
“Developing Competence – Facilitating Change"
The conference is designed as a two-day experience. The first day has been developed with a focus on accelerating clinical skills and understandings. The three focus tracks include The Opiate Emergency, Personal Trauma and Systems Transformation. An array of speakers will facilitate interesting discussions around the various presentations. The second day will provide a broader array of workshops concerned with human service practice and conditions and will promote discussions about key issues such as poverty, wellness, housing and Self-Sufficiency. Tracks in day two include Best Practice Models, Care Management and Service Coordination, Strong and Healthy Communities, Youth and Young Adult Issues, and Poverty and Self-Sufficiency. We encourage everyone to participate both days; however, you may choose one or the other if you wish. Continuing education credits for Licensed Mental Health Counselors and CASAC credit hours. Special Lunch Recognition on March 28th Celebrating Retiring Champions of Poverty -James Norman, Jean Carroll and Donna Ecker.
Registration Link:Click here to register for the 2018 HHSC & Recovery Institute
Important Items and dates to rememember We encourage you to register today as the Early Bird Registration Rate deadline is Saturday, March 10, 2018.
The Regular Registration Rate deadline is Tuesday, March 20, 2018
Large organizations should assign a designated person to coordinate the registrations for your organization to ensure that proper discounts are applied.
Questions and Information please contact: Sara Taylor at (585) 654-9083 / events@taylorjonesenterprises.comor Craig Johnson at (585) 325-5100 / cjohnson@hutherdoyle.com
Webcast Highlights Two New FAIR Health Reports
Aim Is Clarity in Healthcare Pricing and Industry Trends
On Thursday, March 22, 2018, from 2 to 3 pm ET, FAIR Health President Robin Gelburd will host a webcast entitled, “FAIR Health Economic Index and Industry Trends: Providing Clarity in a Rapidly Changing Environment.” The webcast will introduce two new ways to derive insights from healthcare data: the FAIR Health Economic Index™ and FAIR Health Industry Trends™. Drawing on the independent nonprofit’s national database of billions of privately insured healthcare claims—the largest in the country—these two tools apply different approaches to illuminate different aspects of the national healthcare sector.
Click here to register for FAIR Health’s free, one-hour webcast to learn more about these valuable new analytic tools and how they can inform decision making for all healthcare stakeholders.
MEMBERS OF MCMS RECEIVE A $50 REGISTRATION DISCOUNT! Click here to register: https://goo.gl/GkaNb1
Over 620 Rochesterians have already taken this course which is being given for the 15th time!
When: 6 Monday evenings from March 5, 2018 through April 9, 2018 6:15 PM to 8:30 PM
Where: Monroe County Medical Society, 132 Allens Creek Rd. Suite 100, Rochester, NY 14618
Cost:
Professionals enrolled for credit will receive a link to download a certificate from the University of Rochester.
All other students will receive a certificate of completion from Rochester Lifestyle Medicine, PLLC.
All profits will go to the Rochester Lifestyle Medicine Institute.
Rationale: Our nation’s economy is being jeopardized by our expensive health care system which costs nearly twice as much per person as most other advanced nations. At the same time, our population is heavier and, in many ways, sicker than it as ever been. We rank approximately 30th among the nations of the world in expected longevity. Many health care professionals and members of the public have become interested in addressing these issues with simple and inexpensive lifestyle changes. This course is designed for them.
Goal: Participants will learn the rationale behind eating a whole-food, plant-based diet. The power of lifestyle changes to prevent, arrest, and reverse our nation’s most expensive and devastating diseases—including obesity, diabetes, and heart disease—will be addressed. Participants will discover that a healthy plant-based diet is abundant as well as optimal for human health. They will learn how to nourish themselves, and their families and friends, with a diet free of animal products, and will be given advice on shopping for food, and eating at restaurants and social gatherings. They will be able to explain how this way of eating benefits their health, the future of the planet, the welfare of animals, and our nation’s prosperity and security. Physicians and other health care providers will learn how to empower their patients to take charge of their own health by moving as close as possible to a plant-based diet.
Course Instructors: Ted D. Barnett, M.D. (primary instructor) with Carol H. Barnett, Ph.D., J.D. assisting. Dr. and Mrs. Barnett are Co-Coordinators of the Rochester Area Vegan Society (RAVS rochesterveg.org). As of January 2018, they and their three children (ages 30, 28, & 25) will have been vegan for 27 years. Dr. Barnett graduated from Yale College in 1976 and Tufts University School of Medicine in 1980. He received his board certifications in Diagnostic Imaging in 1984, and Vascular & Interventional Radiology in 1995. He has practiced in the Rochester area since 1986.
Dr. Barnett is also the Founder and executive Medical Director of Rochester Lifestyle Medicine, PLLC and founder of Rochester Lifestyle Medicine Institute.
Who should take this course: Physicians, dentists, nurses, chiropractors, PA’s, NP’s, RD’s, medical students, and members of the general public.
Should RLM's CHIP patients take this course? The principles taught in this course are completely compatible with CHIP. This course is more academic than CHIP and many people take both.
CLICK HERE to review the online resources for the course.
CLICK HERE for the current syllabus and course description.
ACCREDITATION: The University of Rochester School of Medicine and Dentistry is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
CERTIFICATION: The University of Rochester School of Medicine and Dentistry designates this live activity for a maximum of 12.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
No commercial funding was received to support this activity.
Format: This is a 6-session course given over 6 weeks, with each class lasting 2 1⁄4 hours. Each class will consist of two entertaining multi-media lectures with a 15-minute break in between. During the break, there will be sampling of dishes prepared by Carol Barnett following recipes that are included with the handouts for that class. Although not a cooking demo, students can see and sample the dishes as prepared, and Carol will be happy to answer questions about ingredients, techniques, and variations on the recipes. There will be ample opportunity for Q&A. Attendees will receive printed materials and other handouts; they will also have access to many websites, resource lists, and recipe files to complement their learning. During the course, many important points will be repeated, and the key concepts of the course will be presented in every one of the classes.
In addition to the weekly handouts, we highly recommend the following video and books:
“Forks Over Knives” (DVD) as well as companion book and cookbook of the same name
Prevent and Reverse Heart Disease, Caldwell Esselstyn, Jr., M.D. Dr. Neal Barnard’s Program for Reversing Diabetes, Neal Barnard, M.D. 21-Day Weight Loss Kickstart, Neal Barnard, M.D.
The Engine 2 Diet, Rip Esselstyn The China Study, T. Colin Campbell, Ph.D. and Thomas Campbell, MD Whole, T. Colin Campbell, Ph.D. with Howard Jacobson, Ph.D.
Power Foods for the Brain, Neal Barnard, M.D.
Defeating Diabetes, Brenda Davis, R.D. and Tom Barnard, M.D.
The McDougall Program, John McDougall, M.D.
Supplemental reading:
Younger Next Year, Chris Crowley and Henry S. Lodge, M.D. (Exercise and motivation)
Wherever You Go, There You Are, Jon Kabat-Zinn, Ph.D. (Mindfulness and meditation)
The Pleasure Trap, Doug Lisle, Ph.D. (How modern culture tricks our paleolithic brain)
All of the above titles are available in the Monroe County Library System, and also can be purchased from area bookstores or Amazon. We recommend any other titles by Dr. Barnard, Dr. McDougall, or Brenda Davis, RD (all of them have written several books). Rip Esselstyn’s book is an especially good practical guide to adopting a no- oil-added plant-based diet, with accessible recipes and even exercises you can do at home without special equipment.
If possible, attendees should measure and document their weight and blood pressure at the beginning and end of the 6-week period; we also urge attendees to have their cholesterol and blood sugar tested before starting the program and, again, at the end. If you are on medication for cholesterol, high blood pressure, or diabetes, your dosages may need to be adjusted. Please be prepared to discuss this with your doctor.
Refund policy: 100% of the tuition is refundable until 1 week before the course begins.
Missed classes: Missed classes can be made up by viewing the recorded videos which are posted online.
by Mary Dimmock, Susan Levine, MD, and Terri L. Wilder, MSW
Introduction
Myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS) or ME/CFS remains an elusive diagnosis to most physicians. There are no simple diagnostic tests or biomarkers, and there are no FDA approved treatments specific to this disease. Clinical guidance has often recommended cognitive behavioral (CBT) and graded exercise therapy (GET), but these therapies are inappropriate and potentially harmful for patients with ME/CFS. In 2015, the Institute of Medicine (IOM, now called the National Academy of Medicine) issued new clinical diagnostic criteria for ME/CFS and summarized the growing evidence of biological impairment. Since then, the National Institutes of Health (NIH) has funded three Centers of Excellence to study ME/CFS, a pediatric ME/CFS primer has been published, and the Centers for Disease Control and Prevention (CDC) has updated its website.
Demographics and Presentation
ME/CFS is believed to affect approximately one million Americans, but actual disease prevalence could be higher. The IOM reported an estimated prevalence of 1 to 2.5 Million Americans, which amounts to 62,000 to 125,000 in New York State (NYS). ME/CFS affects more women than men and affects people of all socioeconomic backgrounds, age range, and ethnic and racial diversity. The IOM report estimated that as many as 84-91% of patients are not diagnosed.
The onset of ME/CFS is often sudden, typically following a viral or other type of infection but may occur following other types of physical trauma. In other cases, the disease may develop gradually. Patients describe feeling `flu-like’ symptoms chronically. In addition to the characteristic post-exertional malaise (PEM), patients may also experience cognitive impairment, unrefreshing sleep, autonomic manifestations, such as heart rate variability and excessive sweating, and also experience muscle and joint pain and sound, light, and chemical sensitivity. Elevated antibody titers to viruses may be present, in addition to low levels of autoimmune serology.
ME/CFS can present with a wide range of severity. Even in the same patient, the level of severity can change over time and from day to day as symptoms wax and wane. People with ME/CFS are unable to go about their daily activities in a predictable or consistent manner. The IOM report states that up to 70% of patients are unable to work and one quarter remain bed- or housebound (the latter however may be an underestimate). The IOM report also states that patients with ME/CFS are more functionally impaired than those with ”type 2 diabetes mellitus, congestive heart failure, hypertension, depression, multiple sclerosis, and end-stage renal disease.” Recovery is rare and as a result, patients can remain ill for decades.
Clinical Diagnosis
Previously, ME/CFS was considered a diagnosis of exclusion but the IOM criteria provide for the presence of certain “core” criteria in order to make a diagnosis. The IOM clinical diagnostic criteria for ME/CFS require:
A number of co-morbidities can be seen in ME/CFS, the most common of which include fibromyalgia, postural orthostatic tachycardia syndrome (POTS), mast cell disturbances, and certain autoimmune disorders.
Treatment
A noted above, there are no FDA approved treatments for ME/CFS. However, there are interventions that the physician can provide to help patients with this disease. First and foremost, the physician can explain PEM and the associated aerobic metabolism impairment. For some people, exertion as minor as tooth brushing or eating can trigger PEM and a crash. People with ME/CFS should not exceed their “energy envelope” and they should use an activity management approach called “pacing” to not exceed their limits. Physicians can also prescribe therapies that relieve symptoms, including those for sleep, pain, and orthostatic intolerance, including IV saline and Florinef. For patients with elevated viral titers, antiviral medications can help reduce symptoms. Patients often use earphones, earplugs, sunglasses, and eye masks to relieve sensitivities to light and sound.
Physicians can also support applications for disability. Social security accepts the 2-day CPET as objective evidence to support a disability claim. If this test is not easily available, a thorough explanation that describes the patients’ daily activities may suffice.
Conclusions
Physicians have an important role to play in the diagnosis and care of people with ME/CFS. In May 2017, NYS Commissioner of Health Dr. Howard Zucker sent a letter to physicians encouraging them to include ME/CFS as part of the differential diagnosis when evaluating patients with these symptoms. The clinical diagnostic criteria published by the Institute of Medicine (IOM) are an important tool and can result in faster and more accurate diagnosis. They can also provide the basis for treatment recommendations that can relieve symptoms and minimize post-exertional crashes. Most importantly, the physician can validate the patient’s experience and ensure that the patient is not harmed by inappropriate treatment recommendations.
Mary Dimmock is the parent of a son with ME/CFS. She is a biochemist by training and retired from the pharmaceutical industry. She is on the board of Solve ME/CFS Initiative.
Susan Levine, MD has been seeing ME/CFS patients in her clinical practice for over 30 years. She is Board Certified in Internal Medicine and Infectious Diseases and has served as past Chairperson of the Chronic Fatigue Syndrome Advisory Committee (CFSAC).
Terri L. Wilder, MSW is a volunteer with #MEAction (www.meaction.net) and was diagnosed with ME in March 2016. She received a Master’s in Social Work from the University of Georgia and currently manages a large clinical education program in New York City.
CMS Region II will be hosting a webinar at 4pm on February 22nd to provide basic information on how clinicians can submit their data successfully under QPP and MIPS to maximize their future reimbursement.
The webinar will also provide them with information on other resources that can help. As you know, those practices that are successful can receive significantly higher reimbursement from CMS in the future, but many clinicians still have questions and concerns and unsure about the upcoming deadlines or the technical assistance and resources.
Register: https://www.eventbrite.com/e/qpp-data-submission-webinar-tickets-43177533164
Register: https://tinyurl.com/FaithMed2018
MIPS Eligible Clinicians Can Now View Performance Scores for 2017 Claims Data on qpp.cms.gov
If you’re an eligible clinician who submitted 2017 Quality performance data for MIPS via claims, you’ll now be able to view your performance scores through the MIPS data submission feature. Reminder: claims data submission is only an option if you’re participating in MIPS as an individual (not as part of a group).
Submitting Quality Performance Data via Claims
If you’ve already submitted quality data via claims, you don’t have to take any additional action. Claims-based quality measures are calculated automatically by CMS based on the Quality Data Codes (G-codes) submitted on your 2017 claims. You can simply login at qpp.cms.gov and view your calculated individual measures' scores and category score for Program Year 2017.
Please note, scoring of claims data is subject to change monthly based on the processing of any additional 2017 claims and adjustments up to 90 days after the end of 2017. It is possible that claims or adjustments that were submitted towards the end of 2017 have not yet processed. Please check back after March 31st, 2018.
Still Time to Submit Claims for 2017
If you still have 2017 claims you’d like to submit for the Quality performance category, make sure to submit them now. Claims, which are processed by Medicare Administrative Contractors (MACs) (including claims adjustments, re-openings, or appeals), must get to the national Medicare claims system data warehouse (National Claims History file) by March 1, 2018 to be analyzed. The MACs can provide you with specific instructions on how to bill.
Submission Resources
To prepare for 2017 submission, review the following resources on the Quality Payment Program website:
The Centers for Medicare & Medicaid Services (CMS) has identified an additional advancing care information identifier for use with the 2017 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) Version 1.0 for Eligible Clinicians and Eligible Professionals Programs. The identifier ACI_IACEHRT_1 for Advancing Care Information Improvement Activities Bonus should be used when submitting for an ACI bonus for the use of certified electronic health record technology (CEHRT) for an improvement activity. An updated version of the 2018 CMS QRDA III IG will be published to reflect the addition of this identifier. This announcement is for vendors and data submitters about the additional identifier missing from the table ‘Advancing Care Information Objectives and Measures Identifiers’.
If you have not yet submitted QRDA III data to the Quality Payment Program for 2017 and need to account for the ACI_IACEHRT_1, you can simply include this measure identifier as part of your advancing care information section of your submission file.
If you have already submitted QRDA III data to the Quality Payment Program for 2017 and need to include the ACI_IACEHRT identifier, you can either:
Additional QRDA-Related Resources
You can find additional QRDA related resources, as well as current and past implementation guides, on the eCQI Resource Center and the CMS eCQM Library. For questions related to the QRDA Implementation Guides and/or Schematrons, visit the ONC QRDA JIRA Issue Tracker. For questions related to Quality Payment Program/Merit-based Incentive Payment System data submissions, visit the Quality Payment Program website or contact us by phone 1-866-288-8292, TTY: 1-877-715-6222 or email QPP@cms.hhs.gov.
