Published 5/10/2017 

WSMA responds after House Republicans pass American Health Care Act

WSMA President Shane Macaulay, MD issued a statement on Friday following the U.S. House of Representatives’ passage of an amended version of the American Health Care Act, where he expressed concern on the bill’s impact on patient access to care and disappointment in the process used by lawmakers to pass the bill. Dr. Macaulay urged Senators to consider the legislation’s effect on patients and the provider community as it begins its deliberations.

The statement reads:

“The Washington State Medical Association is deeply disappointed that the U.S. House of Representatives passed the American Health Care Act. As amended in the House, the AHCA would reduce access to affordable health care coverage for thousands of Washingtonians. The WSMA cannot support the version of the AHCA passed yesterday. Thousands of our most vulnerable patients—those who are low income, disabled and older—and patients purchasing plans through the exchange may lose access to affordable health care coverage if this legislation is enacted into law.

“We at the WSMA are firmly committed to seeking solutions that bring better care for our patients. While we stand ready to engage in finding solutions that will address the flaws in our current health care system, this work cannot be done in isolation. To date, there have been no public hearings on the AHCA. The legislation has been drafted and amended by House lawmakers with virtually no input from health care stakeholders. Moreover, the House passed the AHCA without waiting for an updated score from the Congressional Budget Office.”

“We are grateful that most of Washington state’s congressional delegation stood with us, as all six U.S. House Democrats along with Republican Reps. Dave Reichert and Jaime Herrera Beutler voted against the plan. As this bill passes out of the House, we urge lawmakers in the Senate to take a thoughtful and deliberate approach when considering this version of health care reform and its potential impact on patients and health care providers. The physicians of Washington state stand on the frontlines of care. It is our goal to work together toward positive health outcomes for all.”

Earlier this year, to guide their work reviewing Republican efforts to repeal and replace the Affordable Care Act, the WSMA Executive Committee and Board of Trustees identified 10 Principles for Health Care Reform, those elements of most benefit to WSMA members and their patients that are essential to any health care reform legislation. Dr. Macaulay and WSMA Executive Director/CEO Jennifer Hanscom visited Washington, D.C. in March to meet with our state’s congressional delegation, sharing the principles with each lawmaker and voicing our concerns about the American Health Care Act. The principles will continue to guide WSMA’s work as the Senate considers its own version of possible repeal and replace legislation.

Previous media coverage of WSMA’s position on the AHCA:

Published 5/10/2017

Published 5/10/2017 

State Supreme Court agrees with WSMA in decision addressing medical malpractice testimony

The WSMA is celebrating a significant decision by the Washington State Supreme Court in a case addressing who may testify about a physician's standard of care in a medical negligence lawsuit.

In Frausto v. Yakima HMA LLC (Yakima Regional), a pediatric advanced registered nurse practitioner was hired as an expert witness to testify on behalf of the plaintiff, a man with quadriplegia who developed pressure sores while in a hospital. The ARNP testified that the pressure sores were caused by the nursing care and the care of the plaintiff’s physician. The physician was not named as a defendant, just the hospital and its employed nurses.

With this case, the primary question before the court was whether an ARNP could testify as to causation in a medical negligence lawsuit, something that previously had been the purview of only physicians. Another important concern was if the court might even go so far as to allow ARNPs to testify in a medical negligence case involving physicians.

In an amicus brief submitted to the court, the WSMA argued that an ARNP should only be allowed to testify as to causation in the area in which she/he has received specialized training. In its decision, the court agreed, maintaining its position that only physicians may testify about a physician's standard of care. The court held that ARNPs may testify on questions of causation and standard of care in a medical negligence lawsuit against a nurse only if the court determines the ARNP is qualified to testify as an expert under the rules of evidence. This must be done on a case-by-case basis.

The WSMA would like to extend its thanks and appreciation to our partners in this amicus curiae brief, the Litigation Center of the American Medical Association, the Washington Academy of Family Physicians and the Washington Chapter of the American College of Emergency Physicians. For questions, contact Denny Maher, MD, JD, WSMA general counsel, at

Published 5/10/2017

Published 5/10/2017 

WSMA’s Virtual Mentoring Forum is tonight—there’s still time to join the discussion

Starting at 6:30 p.m. tonight, Drs. Alex Hamling, Matthew Grierson and Claire Murphy will kick off WSMA’s first Virtual Mentoring Forum, using an online video platform to answer your questions in real time. It’s not too late to join us—register online and tune in to this free event from the comfort of your home or office. Submit your questions during the registration process or after you’ve joined the forum. We’ve already received questions from physicians, medical students, a fellow and a physician assistant. Join us!

Published 5/10/2017

Published 5/11/2017 

State immunization rates for kindergartners remain below target

No news is not necessarily good news: According to Department of Health data for 2016-17, the immunization rate for incoming kindergarteners is holding steady at 85 percent for the second year in a row, remaining below the 90 percent federal baseline for preventing outbreaks, with nearly 5 percent of kindergarteners having an exemption or waiver on file for a medical, personal or religious reason. While the exemption rate hasn’t increased since 2011, it’s more than double the national average of 2 percent, meaning more than 4,000 Washington children are not receiving vaccinations that can prevent the spread of serious diseases.

The WSMA House of Delegates adopted policy in 2014 supporting elimination of the personal and philosophical vaccine exemptions for school, child care and preschool immunization requirements. In 2015, a bill supported by the WSMA that would have removed the personal/philosophical vaccine exemption failed to pass the state legislature. Similar legislation in other states, such as California, has shown to be successful in increasing vaccination rates and lowering exemption rates. The WSMA continues to participate in a special project with the Washington State Department of Health and the Office of Superintendent of Public Instruction to explore ways to increase immunization coverage in Washington.

Research into vaccine hesitancy continues. WSMA members who work with immunizations are encouraged to register for a new, free e-learning course on vaccine hesitancy called “There Never Was An Age of Reason: Vaccines, Vaccine Hesitancy, and Vaccine Decision Making,” presented by Edgar K. Marcuse, MD, MPH and UW emeritus professor of pediatrics, and sponsored by WithinReach. Learn about the history, origins, and impact of vaccine hesitancy on our vaccination rates and outbreaks of disease across Washington state and beyond. Get information and tips on how parents make decisions about vaccines and how best to approach conversations about vaccines. Register for the one-hour course online.

Published 5/10/2017

Published 5/10/2017 

Have your patient safety initiative recognized—submit for the 2017 William O. Robertson Award

The yearly William O. Robertson Patient Safety Award gives the WSMA a chance to recognize innovative patient safety initiatives in the ambulatory care setting. To have your patient safety initiative considered for the award, please submit information on your initiative online by Friday, June 30.

The WSMA established the award in honor of its past-president, the late William O. Robertson, MD, who was a champion for patient safety, risk management and quality improvement throughout his long and distinguished career. The award winner will be announced at the 2017 WSMA Annual Meeting, Oct. 14-15 in Seattle. If you have any questions, contact Jessica Martinson at or 206.956.3628.

Published 5/10/2017

Published 5/10/2017 

Registration ends Monday for 2017 WSMA Leadership Development Conference

It’s not too late to register to attend the WSMA Leadership Development Conference, May 19 & 20 in Chelan. Don’t miss this opportunity to join health care executives, clinic/health system leaders, WSMA leadership and practice staff in a beautiful resort setting for a weekend of visionary and strategic-level leadership skill-building.

This is a great event for physicians of all types and leadership levels, as well as for groups and physician-administrator teams. Register today and enjoy presentations from:

  • Theater of War – Featuring actors Tate Donovan and Marjolaine Goldsmith
  • Jon Burroughs, MD (Keynote) – What Top Performing Medical Staffs Do and Don’t Do
  • Kent Bottles, MD – Repeal and Replace Fails: What’s Next for the ACA
  • Shari Harley – Just Say It!
  • Steve Harden – Overcoming A Culture of Silence: Why Your Staff Won’t Speak Up, Why You Should Care, and What You Can Do About It

See full agenda and faculty. Bring your family and use your free time on Saturday afternoon to explore the resort setting at Lake Chelan, play golf, tour some of the state's finest wineries and network with your colleagues.

Registration ends Monday. Discounted registration fees are available for WSMA members and members of MGMA-Washington. This activity has been approved for AMA PRA Category 1 Credit™.

Published 5/10/2017

Published 5/10/2017 

Nominations requested for WSMA Judicial Council

The WSMA is accepting nominations to fill two positions on the WSMA Judicial Council, the standing committee that meets as needed to interpret the medical ethics of the WSMA and to offer opinions to the WSMA House of Delegates. Terms on the council are for five years and members are limited to one term. Nominees must be current active members of the WSMA and must have been active members for 10 or more years. Nominations can be sent to Shannon Bozarth ( at the WSMA Seattle office or faxed to 206.441.5863 no later than August 31. A curriculum vitae must be submitted with each nomination. For more information about the work of the council, contact Denny Maher, MD, JD, in our Seattle office at 206.441.9762 or

Published 5/10/2017

Published 5/10/2017 

MACRA update: MIPS participation status letter coming soon to your practice

Physicians unsure as to whether they are eligible to participate in the Merit-based Incentive Payment System of Medicare’s new Quality Payment Program should note that the Centers for Medicare & Medicaid Services is sending letters to practices, clarifying clinician eligibility for the MIPS 2017 performance year. These letters are being mailed no later than May 31; the WSMA has heard from a number of practices that have already received their letter.

Rather than mailing to individual clinicians, CMS is sending the letters to the practice identified by its taxpayer identification number and addressed to the representative specified in Medicare’s PECOS database. The letter has three parts:

  • Cover letter introducing information on the Medicare Quality Payment Program.
  • Attachment A, listing the participation status for each National Provider Identifier for the clinicians associated with the taxpayer identification number, according to the PECOS database.
  • Attachment B, including important Q&As.

After receiving the letter, we advise practice leadership to review Attachment A and advise the clinicians assigned to your TIN whether they are either eligible for MIPS or exempt.

If you believe the information provided in Attachment A is inaccurate, contact the Quality Payment Program either by email at or by calling 866.288.8292 (Monday-Friday 8 a.m.-8 p.m. ET). TTY users can call 877.715.6222. Locally, you can contact Qualis Health at CMS has engaged Qualis Health as one of a handful of organizations nationally to assist in these educational efforts.

The WSMA continues its collaboration with our Washington state partners, and serves as a resource for our members and practice staff on MACRA issues, primarily via our publications and our dedicated MACRA webpage. If you have questions on next steps for MIPS, please contact Bob Perna, director of the WSMA Practice Resource Center at or 206.441.9762.

Medicare Quality Payment Program Resource Center launched: Qualis Health, in collaboration with the WSMA and the Washington State Hospital Association, has introduced a new Quality Payment Program Resource Center. The webpage offers a new interactive toolkit to help you succeed with MACRA’s MIPS pathway.

You’ll also find the MIPS Minutes, an online learning series with brief topic-specific guidance, and the MIPS Tracking Tool, designed to offer clinicians an opportunity to develop a MIPS reporting plan and track results throughout the year. The tool also provides the ability to estimate (or model) how their performance on each MIPS category will eventually translate into a MIPS Final Score for Performance Year 2017.

Links to the Qualis Health resources, prepared under contract with CMS, are being added to the WSMA’s dedicated MACRA webpage.

Published 5/10/2017

Published 5/10/2017 

State urges action as infectious syphilis rates soar

Washington State Health Officer Kathy Lofy, MD is calling on physicians providing perinatal services to act as the state faces a dramatic increase in infectious syphilis.

During 2016, Washington experienced a 30 percent increase in infectious syphilis. In a dear provider letter, Dr. Lofy notes the epidemiology of the disease is changing from primarily affecting men who have sex with men to affecting more heterosexuals, with five women delivering babies with congenital syphilis in 2016—the most since 1992.

In the letter, Dr. Lofy urges perinatal providers take the following actions:

  • Test all pregnant women for syphilis at the first prenatal visit or at the time pregnancy is confirmed.
  • For pregnant women at high risk for syphilis (e.g., has multiple current partners or a new partner, has sex while under the influence of alcohol or drugs, has sex in exchange for money or drugs), repeat testing during the third trimester (at approximately 28 weeks’ gestation) and at delivery.
  • Make sure all mothers have been tested for syphilis at least once during pregnancy or at delivery before discharging them from the hospital.
  • Treat women infected with syphilis immediately according to CDC’s STD Treatment Guidelines.
  • Report cases of syphilis to your local health department.

Published 5/10/2017

Published 5/10/2017 

Free webinar on opioid prescribing variations featuring State Health Officer Kathy Lofy, MD

Join us for a free lunchtime webinar on Wednesday, May 24 to learn how to access data through the new Washington Health Alliance Community Checkup website to identify variations in opioid prescribing patterns and discover opportunities for improvement. Washington State Health Officer Kathy Lofy, MD, will join John Gallagher, WHA’s director of communication and development, and Jeb Shepard, WSMA’s associate director of policy and regulatory affairs as webinar presenters.

Translating Data to Action: Improving Opioid Prescribing Patterns is scheduled for Wednesday, May 24, noon-1 p.m. PT. Register online for this free event. This activity has been approved for AMA PRA Category 1 Credit™.

Published 5/10/2017

Published 5/10/2017 

Update on state’s Clinical Data Repository

The Health Care Authority and OneHealthPort are continuing efforts to develop the Washington Link4Health Clinical Data Repository, a component of the state’s Healthier Washington initiative. Originally, the CDR was scheduled to be operational by Feb. 1, 2017, which was then delayed by the state until May 1, 2017. Here’s a status report, drawn from ongoing communications with HCA and OneHealthPort staff.

OneHealthPort reports it is actively working with 60 EHR vendors and their client health care organizations on a daily basis. The variety of methods for health care organizations to submit clinical data to the CDR adds to the complexity of development process. For those organizations wanting more detailed information, OneHealthPort recommends reviewing their CDR webpages and participating in any of the three webcasts they host monthly: Clinical Webcast; Introductory CDR Technical Webcast; and the Technical Update/Open Forum. The latter webcast addresses any new technical information, tips and ideas for implementing technical requirements for the C-CDA data submissions, with time allotted for questions.

OneHealthPort currently has four health care organizations actively engaged in the production phase, across a wide range of practice sizes, and a number of organizations in the final phases of testing and likely to move into the production phase soon, possibly before June 1.

The WSMA has been periodically posting to our Practice Resource Center webpage an aggregated list of each vendor’s progress, drawn from OneHealthPort’s EHR Vendor Data Tracker webpage. Those lists date back to Jan. 6; the most recent list was compiled as of May 1.

In addition to the readiness of the EHR vendors and their client health care organizations in undertaking the technical aspects of this data streaming, a key aspect is the expense borne by the practices. In its April HIT newsletter, the HCA released preliminary findings from its own survey of health care organizations, which asked respondents if their EHR vendors were imposing fees for using EHRs to send data to the CDR. HCA’s survey of all provider types found:

  • Monthly fees ranging from $30 - $1,200
  • Annual fees ranging from $540 - $4,929
  • Implementation fees ranging from $500 - $31,401

The other concern is the potential risk of privacy violations, should the physician/practice release sensitive protected health information into the CDR. The WSMA has asked the HCA’s privacy officer to provide us with a summary report of the analysis that the state agencies have conducted regarding privacy protections of patients’ data within the CDR. That report should be available by late May.

For questions, contact Bob Perna, director of the WSMA Practice Resource Center at or 206.441.9762.

Published 5/10/2017