| Practice_Alerts__October_18__2018 | Practice Alerts: October 18, 2018 | Latest_News | Shared_Content/News/Practice_Alerts/Practice_Alerts__October_18__2018 | <div class="col-md-12">
<div class="col-md-5 pull-right"><img alt="" src="/images/Logos/Practice-Alerts-ArticleImage-Tagline_645x425.jpg" class="pull-right" /></div>
<h5>
October 18, 2018
</h5>
<h2>Practice Alerts</h2>
<p>In this issue: guidance on ERISA claims, new state opioid prescribing rules, Medicare open enrollment and much more.</p>
<p>For personal assistance, contact the <a href="https://wsma.org/WSMA/Services/Physician_Practice_Helpline/WSMA/Services/Physician_Practice_Helpline/Physician_Practice_Helpline.aspx?hkey=fc908a57-5820-41dc-8a1f-e2a7b1498e3b">WSMA Physician Practice Helpline</a> by emailing Bob Perna, MBA, FACMPE, at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a> or Michelle Lott, CPC, CPMA at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
<p>Jump to section:</p>
<p>
<a href="#education">
Educational Programs</a>
</p>
<p>
<a href="#medicare">
Medicare</a>
</p>
<p>
<a href="#qpp">
Medicare / MACRA Quality Payment Program / MIPS</a>
</p>
<p>
<a href="#healthierwa">
State Agencies – Medicaid / Healthier Washington
</a>
</p>
<p>
<a href="#clinical">
Clinical Issues</a>
</p>
<p>
<a href="#healthit">
Health Information Technology / Cybersecurity</a>
</p>
<p>
<a href="#operations">
Practice Operations
</a>
</p>
<p>
<a href="#value">
Value-based Payment
</a>
</p>
<p>
<a href="#help">
WSMA Physician Practice Helpline</a>
</p>
<!-- EDUCATIONAL PROGRAMS -->
<a name="education"></a>
<h3>
<span style="color: #4bacc6;">EDUCATIONAL PROGRAMS</span>
</h3>
<h3>New free webinar: Dealing with ERISA claims; WSMA advocacy with U.S. Department of Labor</h3>
<p>ERISA, the Employee Retirement Income Security Act of 1974, affects self-insured health plans. Claims payments and denials with ERISA plans are becoming increasingly problematic for physician practices. In years past, only very large companies took on self-insured health care coverage; now, insurers are marketing third-party administrator/"administrative services only" to companies as small as 50–100 employees. As the employers bear full financial risk, these arrangements are not "insurance" products regulated by the state Office of the Insurance Commissioner, meaning the OIC cannot intervene to protect those patients. However, the U.S. Department of Labor does have oversight of ERISA arrangements.</p>
<p>The WSMA can assist you in two ways: first, we're collaborating with the Seattle office of the U.S. Department of Labor to offer a new webinar, ERISA and Payment of Healthcare Claims, to be held on Wednesday, Nov. 28, from noon–1 p.m. <a href="https://attendee.gotowebinar.com/register/4782950741761434882">Register online</a> for this free event. This presentation will provide an overview of ERISA Title I, as well as explain fully insured vs. self-insured health plans, claims procedures and participants' rights, and the role of the Department of Labor.</p>
<p>The WSMA can also assist your practice, should you receive a denial or other adverse action on a submitted ERISA claim, through our advocacy on behalf of WSMA members with the U.S. Department of Labor. Please join us for this important presentation.</p>
<h3>New free webinar: Understand new state opioid prescribing rules</h3>
<p>On Jan. 1, Washington state's <a href="https://wsma.org/Shared_Content/News/Membership_Memo/20180912/medical_commission_finalizes_opioid_prescribing_rules.aspx">new opioid prescribing rules</a> for physicians and physician assistants treating all phases of pain (acute, subacute, and chronic) go into effect. Plan now to attend this new free WSMA webinar on Wednesday, Dec. 19 from noon–1 p.m. designed to help you understand how to comply with the new requirements. Register for this free session&nbsp;<a href="https://register.gotowebinar.com/register/1349059379828828930">online</a>. For questions, contact Jeb Shepard at&nbsp;<a href="mailto:jeb@wsma.org">jeb@wsma.org</a><strong>.</strong></p>
<!-- MEDICARE -->
<a name="medicare"></a>
<h3>
<span style="color: #4bacc6;">MEDICARE</span>
</h3>
<h3>Medicare Advantage: Opioid prescribing in 2019</h3>
<p>WSMA staff are researching imminent changes on opioid prescribing in the Medicare Advantage program. Under provisions of the Comprehensive Addiction and Recovery Act of 2016, effective Jan. 1, Medicare Advantage plans will be allowed to apply prescribing restrictions on opioids and benzodiazepines. For example, United Healthcare has posted on its website a <a href="https://www.uhcprovider.com/content/dam/provider/docs/public/resources/pharmacy/MEDADV-Opioid-Readiness-QRG.pdf" target="_blank">2019 Opioid Readiness: Quick Reference Guide</a>, and will include related information in its November provider network bulletin. United Healthcare advises it also has sent a detailed notification letter to its participating providers.</p>
<p>WSMA staff are reviewing this matter with CMS Region 10 representatives. CMS' webpage <a href="https://www.cms.gov/Medicare/Prescription-Drug-coverage/PrescriptionDrugCovContra/RxUtilization.html">Improving Drug Utilization Review Controls in Part D</a>&nbsp;provides some further background, yet that webpage currently includes an "Under Construction" reference for 2019 guidance. The WSMA will provide further details as those become available. For questions on Medicare Advantage, contact Bob Perna at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a>. For questions on Washington state prescribing rules, contact Jeb Shepard at <a href="mailto:jeb@wsma.org">jeb@wsma.org</a>.</p>
<h3>Premera to acquire Soundpath Health Medicare Advantage plan contract</h3>
<p>Premera Blue Cross announced that it has received CMS' approval to acquire Catholic Health Initiative's Soundpath Health Medicare Advantage contract, effective Jan. 1. Soundpath Health currently serves over 22,000 customers in Washington state.</p>
<p>In its posted <a href="https://www.premera.com/wa/provider/medicare-advantage/premera-acquire-soundpath-health/">press release</a>, Premera noted that Soundpath Health customers will continue to receive their current benefits through the end of the year and that all seniors who receive benefits through Soundpath Health will be properly notified and aware of their plan choices for 2019.</p>
<p>Important: In the posted Q&amp;A, Premera states:</p>
<p>"You'll need to be contracted and credentialed with Premera in order to see your Soundpath Health patients.To begin the credentialing process, visit <a href="https://www.premera.com/wa/provider/reference/join-our-network/">Join Our Network</a>. You'll need to allow 60 days for the credentialing process.Premera will notify members about in-network providers beginning October 2018."</p>
<p>"You can continue to see your Soundpath Health patients through December 31, 2018. Otherwise, you'll need to be contracted and credentialed through Premera to see your Soundpath Health patientswho are enrolled in one of Premera's Medicare Advantage plans in 2019."</p>
<p>Physicians and practices that have patients covered through Soundpath Health should determine if they are currently contracted and credentialed with Premera. If they are not, Premera likely will not honor claims for services provided as of Jan. 1 and beyond. This presumes that the patient does not change to a different Medicare Advantage plan during the open enrollment period. For questions, contact Bob Perna at <a href="mailto:rjp@wsma.org">rjp@wsma.org</a>.</p>
<h3>Medicare 2019 open enrollment started Oct. 15</h3>
<p>Medicare's open enrollment period for Part D prescription drug plans and Medicare Advantage plans began Oct. 15 and runs through Dec. 7. Decisions by Medicare patients regarding their choice of Medicare Advantage plans can impact your payer mix. Consider making your Medicare patients aware of which plans your practice will be contracted with in 2019 to help guide their decision-making. This approach can help avoid the problem of having your patients seek appointments next year only to find they have switched to a plan with which you are not contracted.</p>
<p>Also, practice staff may not have time available to provide your Medicare patients with detailed guidance on how to review and select from among the confusing array of plan offerings. Be aware that the Washington state insurance commissioner's Statewide Health Insurance Benefits Advisors (SHIBA) program is ready to provide Medicare counseling. Here are some tips you can share with your patients:</p>
<ul>
<li>Plan costs and coverage can change every year, so review and keep all letters and notices your current plan sends.</li>
<li>List all of the current prescription drugs, the doses, and how often. Then, use <a href="https://www.medicare.gov/find-a-plan/questions/search-by-plan-name-or-plan-id.aspx">Medicare's Plan Finder</a>&nbsp;to compare Part D plans. </li>
<li>Review the 2019 Medicare &amp; You handbook, posted on <a href="https://www.medicare.gov/forms-help-resources/medicare-you-handbook/download-medicare-you-in-different-formats">the CMS website</a>. </li>
</ul>
<p>For more personalized guidance, schedule a one-on-one counseling appointment with a SHIBA volunteer, Monday through Friday, by calling the OIC's Insurance Consumer Hotline at 800.562.6900; ask to speak with a SHIBA volunteer. For help with Medicare for Spanish-speaking patients, call CMS' Spanish language line at 800.633.4227 or call the National Alliance for Hispanic Health at 866.783.2645.</p>
<p>Also, those Medicare patients on a limited income who need help paying for prescription drugs might qualify for the "Extra Help" program. SHIBA staff can provide more details and help with the application. SHIBA also offers free, unbiased Medicare open enrollment workshops in local areas throughout the state. To see if there's an event in your area, visit <a href="https://www.insurance.wa.gov/shiba-events-calendar">SHIBA's event calendar</a>.</p>
<h3>New Medicare card mailing: Update</h3>
<p>In September, CMS started mailing new Medicare cards to people with Medicare who live in "Wave 6" states: Arizona, Colorado, Idaho, Montana, Nevada, New Mexico, Texas, Utah, Washington, and Wyoming. This process was scheduled to take about a month and should be wrapping up by the end of October.</p>
<p>If your Medicare patients say they did not get a card, ask them to:</p>
<ul>
<li>Call 1.800.MEDICARE (1.800.633.4227). There might be something that needs to be corrected, such as updating their mailing address.</li>
<li>Sign into MyMedicare.gov to see if CMS mailed their card. If so, they can print an official card. They must create an account if they do not already have one.</li>
</ul>
<p>You can use either the former Social Security number-based health insurance claim number or the new alpha-numeric Medicare beneficiary identifier (MBI) for all Medicare transactions through Dec. 31, 2019. Direct your Medicare patients to <a href="https://www.medicare.gov/NewCard">Medicare.gov/NewCard</a> for information about the mailings and to sign up to get email updates on the status of card mailings.</p>
<!--MEDICARE / MACRA QUALITY PAYMENT PROGRAM / MIPS -->
<a name="qpp"></a>
<h3>
<span style="color: #4bacc6;">MEDICARE / MACRA QUALITY PAYMENT PROGRAM / MIPS</span>
</h3>
<h3>Guidance on Medicare's Quality Payment Program</h3>
<p>To better your understanding of Medicare's Quality Payment Program (QPP) and its two payment pathways—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), the WSMA, working in collaboration with Qualis Health, recommends these useful resources.</p>
<p><strong>QPP Participation Status tool<br />
</strong>CMS has updated its lookup tool to include 2018 Qualifying APM Participant (QP) and MIPS APM status. This update uses calculations from the first snapshot of data from APM entities, with data from Medicare Part B claims with dates of service between Jan. 1 and March 31, 2018<strong>.</strong> To view your status at the individual level, go to the <a href="https://qpp.cms.gov/participation-lookup">QPP Participation Status</a>&nbsp;webpage and enter your 10-digit National Provider Identifier (NPI) number.</p>
<p>To check your group's 2018 eligibility at the APM entity level: Log into the <a href="https://qpp.cms.gov/login">CMS Quality Payment Program website</a> with your <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-EIDM-User-Guide.pdf" target="_blank">EIDM credentials</a>. Then browse to the Taxpayer Identification Number affiliated with your group. Then access the "details" screen to view the eligibility status of clinicians, based on their NPI.</p>
<p><strong>2017 MIPS performance feedback and payment adjustment update<br />
</strong>If you submitted 2017 MIPS data through the <a href="https://qpp.cms.gov/login">Quality Payment Program website</a>, you can now view your performance feedback and MIPS final score. Access your 2017 MIPS performance feedback and final score by logging to the <a href="https://qpp.cms.gov/login">Quality Payment Program website</a>&nbsp;using your Enterprise Identity Management (EIDM) credentials. If you don't have an EIDM account, refer to <a href="https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Enterprise-Identity-Data-Management-EIDM-User-Guide.pdf" target="_blank">this guide</a>.</p>
<!-- STATE AGENCIES &ndash; MEDICAID / HEALTHIER WASHINGTON -->
<p>
<a href="#healthierwa">
State Agencies – Healthier Washington
</a>
</p>
<h3>
<span style="color: #4bacc6;">STATE AGENCIES – MEDICAID / HEALTHIER WASHINGTON</span>
</h3>
<h3>Healthier Washington: WSMA Guide for Physician Practices</h3>
<p>Our state’s <a href="http://www.hca.wa.gov/about-hca/healthier-washington">Healthier Washington</a> initiatives comprise a “demonstration projectâ€â€”not a grant—funded by the federal Centers for Medicare &amp; Medicaid Services and intended to transform care delivery, starting with the Medicaid program.</p>
<p>The project runs from 2017-21. The Health Care Authority will receive funding from CMS, contingent upon achieving specific targets, framed around <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation-resources">three core strategies</a>:</p>
<ul>
<li>Improving how health care services are paid (value-based payment).</li>
<li>Ensuring that health care focuses on the whole person (care integration).</li>
<li>Build healthier communities through a collaborative approach (through nine regional Accountable Communities of Health, or ACHs).</li>
</ul>
<p>Each of the nine ACHs have selected projects to address the transformation of care, including two required projects: Integration of Physical and Behavioral Health and Addressing the Opioid Use Public Health Crisis.</p>
<p>Physicians and their practices can consider participating in this dramatic redesign of care delivery to Medicaid patients and the incremental introduction of value-based payment methodologies, replacing traditional fee-for-service payments. However, these models of care and payment can be complex and confusing.</p>
<p>To assist you in this process, we have prepared the <strong>Healthier Washington: WSMA Guide for Physician Practices</strong>. The guide describes in detail the three initiatives, along with the various projects being undertaken regionally by the nine ACHs. The guide also explains the value-based payment models that can be used to reimburse physicians and practices for their participation in the selected projects. These payments are separate and distinct from payments made by managed care organizations for traditional Medicaid services.</p>
<p>Visit our new <a href="[@]WSMA/Resources/Health_Insurers/Healthier_Washington__WSMA_Guide/Healthier_Washington__WSMA_Guide_for_Physician_Practices.aspx">Healthier Washington page</a> under our Health Insurers section to download a copy of the guide. If you have any questions about the guidance, contact Bob Perna (<a href="mailto:rjp@wsma.org">rjp@wsma.org</a>) or Michelle Lott (<a href="mailto:mml@wsma.org">mml@wsma.org</a>) at the WSMA Practice Resource Center.</p>
<h3>WSMA guidance available on Healthier Washington's Initiative 3</h3>
<p>WSMA now offers help for physicians and practice staff in referring their Apple Health (Medicaid) patients. <a href="https://www.hca.wa.gov/about-hca/healthier-washington/medicaid-transformation">Healthier Washington</a>&nbsp;is structured around three Initiatives.</p>
<p><a href="https://www.hca.wa.gov/about-hca/healthier-washington/initiative-3-supportive-housing-and-supported-employment">Initiative 3, the Foundational Community Supports (FCS) program</a>, creates two new targeted benefits that include services to help the most vulnerable patients <em>get and keep stable housing and employment&nbsp;</em>in support of their broader health needs.</p>
<p>The FCS program offers benefits for <em>supportive </em>housing and <em>supported </em>employment for Medicaid-eligible beneficiaries with complex needs. Amerigroup Washington administers the FCS program, working with housing and employment organizations to help clients find and maintain jobs, acquire stable, independent housing and gain the necessary skills to be successful.</p>
<p>WSMA's "Referring Provider" guidance can assist clinicians and practice staff in identifying patients who may be eligible for these support services and offers detailed assistance on how to refer your patients. That guidance is available on WSMA's website on the <a href="https://wsma.org/WSMA/Resources/Health_Insurers/WSMA/Resources/Health_Insurers/Health_Insurers.aspx">Health Insurers webpage</a>&nbsp;under Medicaid, then Healthier Washington.</p>
<p>Healthier Washington now offers a newsletter about the supportive housing and supported employment program. <a href="https://public.govdelivery.com/accounts/WAHCA/subscriber/new?topic_id=WAHCA_410">Sign up to receive the new FCS newsletter</a>. There are currently over 1,500 enrollees in the two programs, with another 100 people in the pipeline. </p>
<p>Also, just posted on YouTube is <a href="https://www.youtube.com/channel/UC2_tBogIUnVye4GBwbVXxNw">a new video telling the story of one person who is getting services through the Foundational Community Support program</a>,showing how this program is having a positive impact on Washingtonians.</p>
<!-- CLINICAL ISSUES -->
<a name="clinical"></a>
<h3><span style="color: #4bacc6;">CLINICAL ISSUES</span></h3>
<h3>Empanelment offers improved patient management</h3>
<p>For many practices, empanelment is a cultural transformation. Providers and care teams must shift their focus from caring for individual patients to managing the health of a defined population of patients. Empanelment also requires a shift from reactive to proactive care. Empanelment benefits patients, providers, care teams, and the practice. Empanelment is also a basic premise of population management.</p>
<p>Currently Washington state has been conducting a clinic pilot with funding from CMS focusing on empanelment for pediatric practices. The Pediatric Transforming Clinical Practices Initiative (P-TCPI) has done a webinar that provides information on the pilot program. There is also a CME module available from the AMA on <a href="https://www.stepsforward.org/modules/panel-management">panel management</a>.</p>
<!-- HEALTH INFORMATION TECHNOLOGY / CYBERSECURITY -->
<a name="healthit"></a>
<h3><span style="color: #4bacc6;">HEALTH INFORMATION TECHNOLOGY / CYBERSECURITY</span></h3>
<h3>Most common phishing attack "subjects"</h3>
<p>A new report reveals the most frequently encountered "subjects" that appear in phishing attackers by hackers. "Payment notification" led the way at 58 percent, followed by "New Message in Mailbox" and "Attached Invoice." The report, The State of Phishing Defense 2018 by Cofense, is available <a href="https://cofense.com/whitepaper/state-of-phishing-defense-2018/">online</a>. Practice staff should exercise caution when screening emails for potential cyberattacks and should adhere closely to their practice's internal policies and procedures. Remember to stay current on all anti-virus and malware software updates.</p>
<h3>HHS OIG launches cybersecurity webpage</h3>
<p>The Department of Health and Human Services' Office of Inspector General has launched a new <a href="https://oig.hhs.gov/reports-and-publications/featured-topics/cybersecurity/">webpage</a> to draw attention to the growing importance of the watchdog agency's <a href="http://www.govinfosecurity.com/cybersecurity-c-223">cybersecurity-related</a> activities, ranging from security audits to fraud investigations.</p>
<p>This year, HHS OIG issued four cybersecurity-related reports, including a review of information security programs used by Medicare contractors, as well as a report of a 2016 review of <a href="https://oig.hhs.gov/oei/reports/oei-01-14-00570.asp">hospital contingency plans</a>&nbsp;for EHRs in case their systems are impacted by cyberattacks and technical malfunctions, as well as other major disruptions, such as natural disasters.</p>
<!-- PRACTICE OPERATIONS -->
<a name="operations"></a>
<h3><span style="color: #4bacc6;">PRACTICE OPERATIONS</span></h3>
<h3>NPDB: Self-query</h3>
<p>A key component of a practice's due diligence in hiring a physician is to query the National Practitioner Data Bank. While the practice cannot query the NPDB directly, the applicant physician can perform a self-query.</p>
<p>Learn more about the NPDB:</p>
<ul>
<li><a href="https://www.npdb.hrsa.gov/guidebook/CSelfQueries.jsp">Self-queries - overview</a>.</li>
<li><a href="https://www.npdb.hrsa.gov/helpCenter/selfquery.jsp">Self-query FAQs</a>.</li>
<li><a href="https://www.npdb.hrsa.gov/pract/selfQueryGuide.jsp">Self-query infographic</a>.</li>
<li><a href="https://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp">NPBD – comprehensive web-based guidebook</a>&nbsp;or <a href="https://www.npdb.hrsa.gov/resources/NPDBGuidebook.pdf" target="_blank">downloadable pdf document</a>.</li>
</ul>
<!-- VALUE-BASED PAYMENT -->
<a name="value"></a>
<h3><span style="color: #4bacc6;">VALUE-BASED PAYMENT</span></h3>
<h3>Medicare: CMS announces participants in new value-based bundled payment model</h3>
<p>The Centers for Medicare &amp; Medicaid Services announced that 1,299 entities have signed agreements with the agency to participate in the Administration's Bundled Payments for Care Improvement – Advanced (BPCI Advanced) Model. The participating entities will receive bundled payments for certain episodes of care as an alternative to fee-for-service payments that reward only the volume of care delivered.</p>
<p>Participants include 832 acute care hospitals and 715 physician group practices—a total of 1,547 Medicare providers and suppliers, located in 49 states plus Washington, D.C. and Puerto Rico. BPCI Advanced qualifies as an Advanced Alternative Payment Model under MACRA, so participating providers can be exempted from the reporting requirements associated with the Merit-based Incentive Payment System (MIPS).</p>
<p>CMS also released its fifth evaluation report for Models 2 through 4 of the original BPCI Initiative. The&nbsp;<a href="https://downloads.cms.gov/files/cmmi/bpci-models2-4-yr5evalrpt.pdf" target="_blank">full report is posted online</a>&nbsp;along with a&nbsp;<a href="https://innovation.cms.gov/Files/reports/bpci2-4-fg-evalyrs1-3.pdf" target="_blank">summary "Findings at a glance</a>."</p>
<h3>Succeeding in value-based payment</h3>
<p>The WSMA can help our members and their practice staff succeed with value-based payment models through our three tiers of guidance and services.</p>
<p><strong>Tier 1: Reference materials<br />
</strong>For foundational knowledge on value-based payment, review AMA's online module <a href="https://www.stepsforward.org/modules/value-based-care">Preparing Your Practice for Value-Based Care</a>.</p>
<p><strong>Tier 2: Educational programs<br />
</strong><a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#vbptakeaction">Value-Based Payment, MACRA/MIPS, Healthier Washington – Take Action Now!</a></p>
<p>Both Medicare's MACRA Quality Payment Program and the state's Healthier Washington initiatives are built around value-based payment models. This free 45-minute OnDemand webinar, presented by the WSMA and Attune Healthcare Partners, provides an overview of the value-based payment models currently in play and focuses on specific actions to consider.</p>
<p><strong>Tier 3: Practice-specific engagements<br />
</strong>The WSMA and Attune Healthcare Partners have partnered to offer practice-specific consulting engagements to our members on value-based transformation strategies.</p>
<p>Attune's "5-Step Process" provides a path for practices to optimize earnings and simplify daily operations with a mix of traditional and value-based payment methods. Attune Healthcare Partners are experts in practice success under value-based payment and can help practices create a complete and individualized practice solution for mixed payment models.</p>
<p>For more information on the new service, review our free OnDemand webinar&nbsp;<a href="https://wsma.org/WSMA/Resources/Practice_Management/OnDemand/Webinars_OnDemand.aspx#path">Mapping Your Path to Value-Based Care</a>. The webinar addresses: The Problem with Payment Change; The Solution: A Customized Map to Value-based care; How the Process Works, Advantages &amp; Results.</p>
<p>For more information on WSMA's value-based payment guidance, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
<!-- WSMA PHYSICIAN PRACTICE HELPLINE -->
<a name="help"></a>
<h3><span style="color: #4bacc6;">WSMA PHYSICIAN PRACTICE HELPLINE&nbsp; (formerly the WSMA Coding Hotline)</span></h3>
<p>– Michelle Lott, CPC, CPMA<strong> </strong>(<a href="mailto:mml@wsma.org">mml@wsma.org</a>)</p>
<p><strong>New ICD-10 codes on human trafficking</strong></p>
<p>Human trafficking is a public health concern that many physicians and other providers are combating every day. Effective Oct. 1, 2019, there are unique ICD-10-CM codes available for data collection on adult or child forced labor or sexual exploitation, either confirmed or suspected.</p>
<p>In addition, new codes are also available for past history of labor or sexual exploitation, encounter for examination and observation of exploitation ruled out, and an external cause code to identify multiple, repeated, perpetrators of maltreatment and neglect.</p>
<p>While clinicians increasingly are trained to identify and document their care for victims of forced labor and sexual exploitation, there is still much work to be done in tracking these patients. Physicians and practice staff should become familiar with using these new codes and learn more on identifying these victims.</p>
<p>Review the two-page <a href="https://www.aha.org/system/files/2018-09/icd-10-code-human-trafficking.pdf" target="_blank">quick reference guide</a>&nbsp;for these new codes. For more detailed background, review the <a href="https://www.cdc.gov/nchs/data/icd/topic_packet_part_II.pdf">CDC's 2017 committee materials</a>&nbsp;(pages 20-24) and the <a href="https://www.cdc.gov/violenceprevention/sexualviolence/trafficking.html">CDC's resource page on sex trafficking</a>.</p>
<p><strong>ICD-10 code changes went live on Oct. 1</strong></p>
<p>There were 473 code changes to ICD-10 as of Oct. 1, including 279 new codes, 143 revised codes and 51 deactivated codes, according to the <a href="https://www.cdc.gov/nchs/icd/icd10cm.htm">CDC website</a>. These revisions should be used for dates of services occurring from Oct. 1, 2018 through Sept. 30, 2019.</p>
<p>The majority of these changes affect Chapter 2 (Neoplasms), Chapter 6 (Diseases of the Nervous System), and Chapter 7 (Diseases of the Eye and Adnexa). With most of the changes there is additional specificity regarding location. To implement these changes, practices should:</p>
<ul>
<li>Review and become familiar with these changes.</li>
<li>Add new codes to your "favorites" list.</li>
<li>Review the ICD-10 codes in your EHR to ensure these changes have been updated in your software.</li>
<li>Review and update any "code rules" in your EHR that would be are affected by the new and deleted codes.</li>
</ul>
<p>For questions or problems regarding these changes, contact Michelle Lott at <a href="mailto:mml@wsma.org">mml@wsma.org</a>.</p>
</div> | 10/18/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |
| weekly_rounds_2018_10_18_if_physicians_do_not_lead_someone_else_will | Weekly Rounds: October 18, 2018 - If physicians don't lead, someone else will | Latest_News | Shared_Content/News/Weekly_Rounds/2018/weekly_rounds_2018_10_18_if_physicians_do_not_lead_someone_else_will | <div class="col-md-12">
<div class="col-md-5 pull-right" style="text-align: center;"><img alt="" src="/images/News/weekly_rounds_tom_schaaf.jpg" class="pull-right" /></div>
<h5>October 18, 2018</h5>
<h2>If physicians don't lead, someone else will</h2>
<p>
Tom Schaaf, MD, WSMA President
</p>
<p>
<em>On Sunday at the 2018 Annual Meeting of the WSMA House of Delegates, we inaugurated our new incoming president, Tom Schaaf, MD, MHA. For those of you who couldn't be with us, we wanted to be sure you had an opportunity to read his speech, so I've invited him to be our guest columnist for Weekly Rounds. - Jennifer Hanscom, WSMA executive director/CEO</em>
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Tom Schaaf, MD, WSMA 2018-19 incoming president's speech, Sunday, Oct. 14, 2018, 9 a.m. at the Historic Davenport Hotel in Spokane.</strong>
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I'd like to thank you all for being here today. It's a significant chunk of time to be away from your families, your practices and your weekend, and I know it's tough to sit inside—even in the Davenport Hotel—on a classic fall day in Spokane. I'd also like to say a special thanks to my family, friends, and colleagues from Providence for their support this morning.
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I'm grateful to you for allowing me the privilege of representing you as president of the WSMA as we face challenging times in the house of medicine.
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Many of these issues you experience every day:
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<li>The rise—and then the disruption—of the Affordable Care Act along with complicated programs for value-based payment causing anxiety about our economic futures. </li>
<li>EMRs brought us access to overwhelming amounts of information—or no useful information at all—while drawing our attention to the ever-demanding keyboard and away from our patients. </li>
<li>Prior authorization, pharmacy benefit managers, and CMS-mandated visits to approve care are maddening. </li>
<li>The relationship with our patients has fractured as health plans change, practices are purchased, internet medicine expands, and convenience becomes the key driver of the health care "consumer." </li>
<li>And the opioid crisis has led to increasing regulation and oversight of our care, in addition to becoming another point of distrust between our patients and ourselves. </li>
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Through all these challenges, the WSMA is working to advocate on your behalf, educate the public and our civic leaders, and bring you the tools to cope, and hopefully thrive, as we all navigate the journey ahead.
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Now, my day-to-day job title may make some of you skeptical about my ability to represent you in this work. First of all, I work for Providence St Joseph Healthcare. While many folks here actually work for Providence, Swedish, or Kadlec, some of you in the audience may view our employers skeptically. My role there is the chief medical officer for home and community care.
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I realize that for some of you that is the epitome of "going to the dark side." In fact, one of my WSMA colleagues has even given me a hairless cat statue to bolster my "Dr. Evil" cred.
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My hope this morning is to share some insight into why I pursued leadership roles, why physician leadership roles are critical to the future of the house of medicine, and why leaderships skills are worth learning.
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I'd like to share a bit about my background. My father was a practicing family doctor for almost 60 years. When I was a youngster, his office was in our home. My earliest memories are of driving to the hospital with him to make rounds, and playing with the models of hearts, brains, and knees in his office. When I was older, I even answered the phone and made appointments.
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I was the kind of kid who read everything. I still have a 1926 edition of "Microbe Hunters" on my bookshelf. The scientists profiled in that book were my heroes growing up. Koch, Pasteur, and Ehrlich not only saved lives, they also had to work against tradition and engrained practices. I was inspired by the possibilities, the adventure, the potential that adapting to change can bring to improving health and life. To me this was exciting stuff. A job as diener and phlebotomist as a high school student pushed me to commit to a pre-med course of studies at Whitworth.
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At UCLA, I enjoyed nearly every clinical rotation I did, leading me to a family medicine residency. My scope narrowed a bit when I joined my dad's geriatric practice at Laguna Hills Leisure World. It was fun to be a practicing physician at the hospital where I had been a phlebotomist in high school. It took a while to overcome the "what are you doing?" reactions!
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Eventually, I left southern California, returning to the Northwest where I spent more than 20 years with Group Health. During that time, I became involved in quality programs, process improvement, and system redesign. In 1996, I had the opportunity to create the hospitalist program that still serves Kaiser patients at Providence Sacred Heart, and I moved from the outpatient clinic to a hospitalist role.
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That experience was pivotal for me. Clinically, I had to adapt my practice from mostly outpatient geriatrics to purely inpatient. From a leadership perspective, I had to learn a thousand things in a short timeframe.
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One of the key things I learned was to shut up and listen to people trying to cope with a changing world. I also learned to be humble in the presence of people of who often knew more than I did. But they did need help fixing broken systems and adapting to a changing environment.
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After some time, I became regional medical director for the Group Health clinics in Spokane and Couer d'Alene, leaving in 2014 when they laid off a number of physician leaders.
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At that point in my career I was 55, a bit salty about the layoff, and had to figure out what I really wanted to do when I grew up. It was clear that our health care system was not going to fix itself, and that physicians were needed to lead the effort to get things on track. I realized that my on-the-job training in leadership wouldn't be sufficient if I wanted to be a useful part of the solution.
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I spent two years getting my Master of Health Administration at University of Washington with Dr. Ed Walker and his crew, while also working as a hospitalist at Sacred Heart and at St. Joseph Care Center. I realized that the skills we learn as clinicians are necessary—but not sufficient—to influence CEOs, CFOs, and other health system administrators. Understanding their perspective and the business financials is a necessity in communicating with them. Knowledge of law and health care policy is also helpful to effectively advocate for appropriate policy decisions. Administrators tend to speak a different language than physicians, which makes it hard for them to understand us. But when we effectively translate the language of medicine and tell the story of patients and doctors to non-clinicians in leadership, we can shape the outcome of decisions that dramatically affect our lives.
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The outcome of my MHA efforts, combined with my clinical work in geriatrics, led to me creating the CMO role at Providence Home and Community Care. This role includes working with administrative and clinical staff to improve care in skilled nursing, home health, and hospice services. It also involves working with Providence system leaders to improve the way care flows across inpatient, outpatient, and continuum services. I'm privileged to work with incredibly creative and committed folks to improve care for the elderly across the whole Providence system, and it is really fun work. There are few other systems where I can have that much impact on a daily basis, and the heart of that work is to make it easier for physicians and nurses to give great care to our patients.
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I do still have a stethoscope, and I still know how to use it. I see hospice patients in Olympia every week, and I help out with patients in King County and Everett when they are short staffed. It's no surprise that this work grounds me in the real world of patient care and helps me understand the systems I'm working to fix. Those who do hospice care know that it is the ultimate in team-based care, and the privilege of caring for people in their homes is hard to describe if you've never done it.
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I am fortunate to be in this leadership role and still get to see patients. Some physician leaders aren't so fortunate. Those physicians who have had to give up direct patient care to help lead our health systems should have our respect and support. I know this idea might be uncomfortable for some of you, but when we scorn our peers who become full time CMOs and leaders, we overlook the fact that they are making a sacrifice to work on issues and systems that affect us all.
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This is all to say, here is my real request of you today: Embrace the leadership roles that come your way, even if—at a minimum—that means embracing the role of clinical leader that is implicit in being a physician working with nurses and support staff.
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Our choice isn't whether we are leaders, it is whether we are good ones or not. Be a good one. The WSMA has tools and classes to help. Attend the Leadership Development Conference in Chelan. Take the leadership courses we run with Dr. Ed Walker. Read books. Look for opportunities to work on committees and to push physician knowledge and experience into the "dark areas" of the hospital and your health system.
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If we don't lead, we will be led by folks who may be talented—and even well-meaning—but who don't know what it means to stand at the bedside and care for patients the way we do.
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It's easy to assume that someone else will do this work and to complain about what they do. If we want to fix what makes us angry, what makes it hard to do good work, what steals our hope, we have to lean in.
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You are leaders. Get even better at it and then do good with what you know. You have a hand in creating the future of medical practice. Most of us will be practicing in that future world. My son, Liam, is applying to medical school this year, and I look forward to him practicing in a better world than we tolerate now. And soon enough, all of us will become patients in that world.
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Thank you for hearing me out and thank you for accepting my service as your president. I look forward to working with you, with the board, and with Jennifer and the staff. I am anxious to hear from you, to learn from you, and am honored to be able to serve you.
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</div> | 10/18/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |
| marie_eaton_to_keynote_the_2018_washington_end_of_life_coalition_annual_meeting | Marie Eaton to keynote the 2018 Washington End-of-Life Coalition Annual Meeting | Latest_News | Shared_Content/News/Membership_Memo/20181010/marie_eaton_to_keynote_the_2018_washington_end_of_life_coalition_annual_meeting | <div class="col-md-12">
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October 10, 2018
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Marie Eaton to keynote the 2018 Washington End-of-Life Coalition Annual Meeting
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<p>This year's <a href="https://wsma.org/WSMA/Events/End-of-Life_Coalition_Annual_Meeting/WSMA/Events/End_of_Life_Coalition_Annual_Meeting.aspx?hkey=b2622d3f-d47a-4a5a-975c-4ab94e13548a">WEOLC Annual Meeting</a> is scheduled for Friday, Nov. 16 at the Seattle Airport Marriott and will feature keynote presenter Marie Eaton, a community champion for the innovative Palliative Care Institute in Whatcom County. The theme of the day-long meeting is "End of Life Choice Comes of Age: Living and Dying by Your Values," and the meeting will check in on two key movements in serious illness and end-of-life care: the start of board certification for palliative care nationally and in Washington state, voter approval of our physician aid-in-dying law.</p>
<p>Meeting highlights include sixteen speakers, starting with a keynote by Marie Eaton, an update on POLST (Physician Orders for Life-Sustaining Treatment) and much more. Registration will be available next week, and exhibitors and sponsors are welcome. Visit the <a href="https://wsma.org/WSMA/Events/End-of-Life_Coalition_Annual_Meeting/WSMA/Events/End_of_Life_Coalition_Annual_Meeting.aspx?hkey=b2622d3f-d47a-4a5a-975c-4ab94e13548a">meeting webpage</a> for more information.</p>
<p>Formed in 1997, the WEOLC provides support for the state's POLST program as well as outreach and networking opportunities through its annual meeting in the fall. <a href="https://wsma.org/WSMA/Resources/Advance_Care_Planning/WELOC/WSMA/Resources/Advance_Care_Planning/Washington_End-of-Life_Coalition/Washington_End-of-Life_Coalition.aspx?hkey=3f9c1df0-ec7e-4a68-ba85-37b02a28b201">Learn more about the WEOLC</a>.</p>
</div> | 10/10/2018 12:00:00 AM | 1/1/0001 12:00:00 AM |