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MIPS, the New PQRS by David Friedenson, M.D

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MIPS, the New PQRS by David Friedenson, M.D December 2016 COLORADO CHAPTER American College of EPIC Emergency Physicians® FROM THE PRESIDENT MIPS, the new PQRS by David Friedenson, M.D. FACEP Decreasing costs and radiation exposure to our patients is the 2017 rolls out a host of new pay for performance measures. goal. You’ll need to make sure patients have an Historically, Emergency Physicians have been limited in appropriate indication prior to ordering a CT scan of the their ability to participate in pay for performance and have head for minor blunt head trauma. The nice thing is, been left behind in the fee for service world, held hostage unlike the last time they tried to have us order fewer CTs, to our hospital systems’ dated and user unfriendly EHRs. this measure actually makes sense. When patients have an We are criticized for our costs, while actually being the indication, you should order the CT. However, when they most efficient piece of the health care delivery system. don’t, you shouldn’t let a patient talk you into getting one done. The list of indications matches some good decision While we as a specialty have been working on real quality rules such as PCARN for kids and are more liberal with changes, CMS has been a little slow on the uptake. Over inclusion criteria than the Canadian CT rule for adults. the last couple of years as So they’re not asking you to hold back on appropriate a specialty, we’ve utilization but just don’t order them ‘because’. We are criticized decreased inappropriate for our costs, while CT utilization; we’re The next new measure deals with antibiotic stewardship. decreasing excessive Basically, CMS is asking that we prescribe only topical anti- actually being the opiate prescriptions in biotics for otitis externa and that we prescribe no antibiotics most efficient piece the ED-opting for novel for presumably viral infections. Not bad rules and we now of the health care pain management have the government’s backing when having those shared decision making discussions with our patients. delivery system. techniques such as trigger point injections and The next one is the infamous blood pressure measure Lidocaine for kidney that most of us have figured out how to conquer—so stones, and changed the course of sepsis care, drastically keep on trucking on with that one. improving survival in the sickest patients who show up at our doors. This coming year, PQRS changes to MIPS and Finally, there are the pregnancy measures. We all know things are changing as 2017 marks the new world of CMS we see lots of pregnant Medicare patients so it’s pay for performance in the emergency department. important you’re perfect with this one in case you do see one of the few patients who qualify for the ultrasound in Out with the old and in with the new; since we do certain pregnancy with abdominal pain or bleeding and the things really well like performing EKGs on patients with Rhogam for women at risk measures. chest pain and saving lives through sepsis bundles, CMS is eliminating the EKG measure and came up with a few new CMS didn’t quite get the specifications completed in time measures for us to learn. This year’s big additional for the New Year so more details will be forthcoming but measures come in the form of utilization control. for now, those are the measures that have been fully vetted. President’s Letter continued on page 2 Annual Meeting at Denver ChopHouse . pg 2 Residents’ Corner ................ pg 6 Nominate A Colleague ............ pg 3 2017 Legislative Reception ......... pg 7 INSIDE: 2016 ACEP Council Report ......... pg 4 Legislative News ................. pg 8 Upcoming COACEP Meetings ....... pg 5 Update on Free Standing EDs ....... pg 11 President’s Letter continued from page 1 In addition to quality reporting, Emergency Physicians will have to report new advancing care information and practice improvement EPIC measures this year. These two components replace HER meaningful use which we’ve gotten a pass on in the past. Some of those measures are actually good patient centered measures such as using the CORHIO and PDMP, letting PCPs know that you saw their patients and for what, or reporting to public health databases, all of which many of us are already doing. “The mission of the Colorado Chapter, American It will be a little more work to report successfully this year but the College of Emergency Physicians is to serve as the measures are starting to be reasonable attempts to appropriately control primary organization in the State of Colorado costs and limit unnecessary testing and treating. CMS also gives you an representing the specialty of Emergency Medicine, out this year if you just want to avoid a penalty and not shoot for the promoting the interests and values of emergency stars, you can report “something” for 90 days instead of all for a year. More to come in January. physicians and patients by giving physicians the tools to support the highest quality of See you at the Annual Meeting. E emergency medical care.” OFFICERS David Friedenson, MD, FACEP. President JOIN US Andrew French, MD, FACEP, President-Elect Kevin McGarvey, MD, FACEP, Secretary/Treasurer Eric Olsen, MD, FACEP, ANNUAL Immediate Past President BOARD OF DIRECTORS MEETING Caleb Hernandez, DO, FACEP Nathaniel Hibbs, DO, FACEP Christopher Johnston, MD January 18, 2017 • 12:00 noon Garrett Mitchell, MD, FACEP Carla Murphy, DO, FACEP Denver ChopHouse Dave Ross, DO, FACEP Fred Severyn, MD, FACEP 1735 19th Street • Suite 100 Lee Shockley, MD, FACEP Donald Stader, MD Denver, CO 80202 EXECUTIVE DIRECTOR See You There! Barb Burgess CHAPTER OFFICE Colorado ACEP 10465 Melody Drive #101 Northglenn, CO 80234 Phone: 303-255-2715 Fax: 303-255-2704 Email: [email protected] www.coacep.org 2 2017 Colorado ACEP Board of Directors Elections Gain new perspectives on emergency medicine! Nominations are now being accepted for Colorado ACEP Board of Director Positions. If you are interested in serving on the Colorado ACEP Four positions are available on the Colorado ACEP Board Board of Directors or would like to nominate someone of Directors beginning January 18, 2017. As per the please contact Barb Burgess at the Colorado Chapter office. Colorado ACEP Bylaws: Section 3. Terms: Elected directors Candidates must complete the Board Candidate Data Sheet shall serve a term of two (2) years and may serve no more (Download the Board Nomination Form HERE. Return than 2 consecutive terms. Resident representative term will Board Nomination Form and CV to Colorado ACEP by be for one (1) year. Terms shall begin at the end of the December 31. In your candidate statement you may comment annual meeting. Terms of office shall be staggered in such a on any ACEP issues, plans or ideas for the Chapter. fashion so that Board vacancies occur annually. E Nominate Your Colleagues Award Nominations are now being accepted This is your opportunity to recognize those individuals who have made significant contributions to the profession and ACEP. Awards will be given at the Annual Meeting. CLICK HERE 3 October 14 & 15, 2016 • Las Vegas 2016 ACEP Council Report By Doug Hill, DO, FACEP Board Officer Elections. Paul Kivela, individual resolutions that were passed reimburse emergency physicians for MD, FACEP (California) was elected addressing these. Included were: these services and support efforts to President-elect of the American appeal denials; oppose exclusive imaging College of Emergency Physicians. John 1. Free Standing Emergency Centers contracts limiting EM ultrasound and Rogers, MD, FACEP (Georgia) was 2. Ultrasound support those who face opposition from elected Chairman of Board, Bill 3. Substance Abuse and Opioids those that hold such contracts. Jaques, MD, FACEP (Maryland) 4. Psychiatry and Behavioral Health elected Vice-President, and Vidor Issues Substance Abuse and Opioids: develop Friedman, MD, FACEP (Florida) was guidelines and provide educational elected Secretary-Treasurer. FSECs: explore minimum resources for harm reduction accreditation standards and serve as strategies and transitioning substance Board of Directors Elections. the accrediting (not licensing) entity; use disorder patients to long-term Incumbents James Augustine, MD, lobby MedPAC & CMC that all FSECs treatment; review evidence on ED FACEP (Ohio) and Debra Perina, MD, be subject to same regulations and initiated treatment of patients with FACEP (Virginia) were reelected to payment schedule for technical care substance use disorders and support their 2nd three-year terms, and Kevin and suggest AMA also join the lobbying novel induction programs; seek Klauer, DO, FACEP (Ohio) and Gillian effort; develop an information paper reimbursement for counseling on safe Schmitz, MD, FACEP (Government analyzing use of FSECs to maintain opioid use, reversal agent instructions, Services) were elected to their 1st terms. access to emergency care where and drug abuse counseling, and Critical Access and Rural Hospitals develop a toolkit and education for Resolutions. There were some have closed or in process of closing. implementation; support training and recurring themes present in this years’ equipping all first responders in the use resolutions and the following four Ultrasound: develop a statement of Nasal Spray Naloxone, pharmacists issues are summaries of the several declaring insurance companies must CO ACEP Councillors in Action 4 2016 ACEP Council Report cont. to dispense naloxone without Rx; devel- examinations for MOC; national promoting the interests and values of op a comprehensive policy on prevent- decriminalization of small amounts emergency physicians and their ion and treatment of opioid use disorder of marijuana; emergency medical patients, and supporting quality epidemic including innovative treatment. treatment of marijuana intoxication; emergency medical care. The collaboration with non-medical entities award was presented to Barb at the Psychiatry and Behavioral Health: on quality and standards; and the President’s Award Banquet and she develop throughput quality data insurance collection of beneficiary made us extremely proud with her measures and dashboard reporting for deductibles.
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