Dashboard tracks CMS moves toward regulatory relief

From the American Medical Association website, www.ama-assn.org

By: Andis Robeznieks, Senior Staff Writer, www.ama-assn.org

The Centers for Medicare and Medicaid Services (CMS) included several ideas for easing physician administrative burdens in its proposals for the second year of the Medicare Quality Payment Program (QPP) and the 2018 Medicare Physician Fee Schedule, but there is still more that can be done to provide meaningful regulatory relief.

The AMA is tracking these measures in a 2017 regulatory relief dashboard.. The tool details where the AMA suggestions and CMS proposed rules are in agreement as well as the AMA’s “top asks” for regulation flexibility and burden reduction. It also cites the list of 21 prior-authorization and utilization-management reform principles that the AMA and more than 100 other organizations have endorsed.

“We believe reducing the administrative burden for physicians will reduce cost, improve quality, and create a more accessible health care system for patients,” wrote AMA CEO and Executive Vice President James L. Madara, MD, in a Sept. 11 letter to CMS Administrator Seema Verma regarding the 2018 Medicare Physician Fee Schedule proposed rule.

“Regulatory wins” stemming from the fee schedule proposed rule listed on the dashboard include the delay in implementing the requirement that physicians consult appropriate use criteria (AUC) before ordering advanced diagnostic images, along with retroactive modification of legacy reporting programs such as Meaningful Use (MU) and the Physician Quality Reporting System (PQRS) to reduce penalties physicians may face in 2018 under the QPP’s Merit-based Incentive Payment System (MIPS).

Regulatory wins originating from the QPP proposed rule include proposals to increase the low-volume threshold exempting practices with few Medicare beneficiaries from the MIPS program and postponing a mandate for physicians to upgrade to 2015 edition certified electronic health records (EHRs).

A number of victories were also secured with respect to EHRs. For example, a process is being established for physicians to register complaints with an EHR product directly to the federal government for action, and EHRs must now include enhanced interoperability technology and support for apps.

The dashboard’s top asks for QPP regulatory relief include: simplifying MIPS scoring methodology, allowing specialty practices to qualify as APM medical homes and creating new exemptions and safe harbors from anti-kickback statutes to facilitate coordinated care.

Increasing Number of Tennesseans Dying from Drug Overdose

Press Release from TN Department of Health

September 18, 2018

Fentanyl Identified as Primary Cause of Increase in Overdose Deaths

NASHVILLE, Tenn. – Tennessee Department of Health data show 1,631 Tennesseans died from drug overdoses in 2016, the highest annual number of such deaths recorded in state history. This is an increase from the 1,451 overdose deaths recorded among Tennessee residents in 2015.

“Each of these numbers represents a person, with families and friends who are now facing the loss of someone dear to them to a cause that is preventable,” said TDH Commissioner John Dreyzehner, MD, MPH. “The rate of increase in these deaths is slower than in the previous year, but it is still a horrible increase, and as we feared, our data show illegal drugs like fentanyl are the primary cause.

“If this is a threat to any of us, it’s a threat to all of us,” Dreyzehner continued. “Now more than ever, we have to work across our sectors and communities, recognize this epidemic is changing and evolving and find new and better ways to address it together.”

Overall, rates of death from drug overdose among Tennesseans have increased 12 percent from 2015 to 2016. Overdose deaths related to fentanyl have dramatically increased 74 percent from 169 to 294 in that time period. The biggest increase in fentanyl deaths is in those aged 25 – 34, where deaths increased from 42 in 2015 to 114 in 2016.

“We are alarmed by the growing number of Tennesseans dying as a result of fentanyl, and by the changing demographic of those who died,” said TDH Chief Medical Officer David Reagan, MD, PhD. “This tells us we need to put additional focus on prevention of substance abuse, particularly for those younger than 25, as we believe people are initiating their use of illegal drugs such as fentanyl before that time.”

TDH data show heroin was associated with the deaths of 260 Tennesseans in 2016, a 26 percent increase over the previous year.

“We know as it becomes harder to obtain illicit prescription pills, people are turning in greater numbers to substances such as heroin and life-threatening combinations with fentanyl and other substances,” said Tennessee Department of Mental Health and Substance Abuse Services Commissioner Marie Williams. “The increase in heroin use is especially concerning in larger cities. This increase in overdose deaths shows the vital importance of the additional funding Gov. Bill Haslam and the legislature allocated in the current fiscal year that will help up to 5,000 more Tennesseans battling addiction receive treatment.”

Tennessee drug overdose deaths due to stimulants like methamphetamine also increased substantially, especially in people aged 25 – 44, where they increased from 57 deaths in 2015 to 101 in 2016. Most people who die from drug overdose are found to have more than one drug in their systems that contributed to their deaths. TDH data show an increase in deaths where both opioids and stimulants were used, from 65 deaths in 2015 to 111 in 2016.

Buprenorphine, which is often used in medication-assisted treatment to help people recover from abuse of opioids, is increasingly associated with drug overdose deaths in Tennessee. TDH found 67 deaths associated with buprenorphine in 2016; 61 percent were also found to have a benzodiazepine drug in their systems at the time of death. Almost all of these people were between the ages of 25 and 54. Benzodiazepines are tranquilizers such as Valium and Xanax, and are easily abused and best avoided when taking opioids due to worsening of respiratory depression and increased risk of death.

“We have worked to improve our surveillance when deaths occur, so this may contribute to some extent to the increase in the number of deaths attributed to drug overdose,” said Tennessee Chief Medical Examiner Julia Goodin, MD. “However, we believe these deaths remain undercounted and continue our efforts to improve data collection so we can better understand this crisis of drug overdose deaths in our state, and use that information to develop strategies for prevention.”

TDH has created the Tennessee Drug Overdose Dashboard to provide state, regional and county-level data on fatal overdoses, non-fatal overdoses and drug prescribing in the state. This interactive tool is the result of collaboration between the TDH Office of Informatics and Analytics and the Tennessee Department of Finance and Administration. Find the dashboard at http://tn.gov/health/topic/pdo-data-dashboard.

Substance abuse is a treatable and preventable disease. Call the Tennessee REDLINE at 1-800-889-9789 for immediate help for anyone suffering from a substance abuse disorder.
The mission of the Tennessee Department of Health is to protect, promote and improve the health and prosperity of people in Tennessee. TDH has facilities in all 95 counties and provides direct services for more than one in five Tennesseans annually as well as indirect services for everyone in the state, including emergency response to health threats, licensure of health professionals, regulation of health care facilities and inspection of food service establishments. Learn more about TDH services and programs at www.tn.gov/health.

This news release can be accessed online at www.tn.gov/health/news.

Connect with TDH on Facebook and Twitter @TNDeptofHealth!


Cleaveland: Appalachia suffering from deteriorating health

Dr. Clif Cleavaland explores the health disparities found in Appalachia. 

Appalchia map.JPG

The statistics are devastating: From 1992 to 1994, infant mortality in Appalachia, 9.2 per 1,000 live births, was close to the rest of the country, 9.3 per 1,000 live births. From 2009 to 2013, infant mortality showed a 16 percent increase relative to the areas outside Appalachia. Income is a determining factor in infant mortality. Appalachian infant mortality is 39 percent higher than low-poverty regions of the country.

Life expectancy shows striking disparities. Appalachian residents died 0.6 years earlier than people outside the region in the interval 1990-1992. By 2009-2013, the gap had increased to 2.6 years. The starkest gap in life expectancy — 13 years — was seen between African-American males in high-poverty areas of Appalachia compared with white females in low-poverty regions in the rest of the nation.

Click here to read more about the state of health in Appalachia.