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Physicians Advancing Health Care

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a newsletter for the medical communityTulsa Medicine»

JULY 2016

ART RX, JULY 28, OU LEARNING CENTER, 6:00 p.m.Chairs, Marc & Mary Milsten, Presenting Sponsor, Blue Cross Blue Shield of Oklahoma2016 Art RX featured artist, John Hammer, whose style has been described as “Pop Impressionism”, created this 48 X 36 painting of Bob Dylan to be sold in a live auction at the event. More than 40 pieces of art will be offered in a silent auction along with 35 non-art items. Boston Deli is providing food with their “fine dining flair” as well as a signature drink, wine and beer. All proceeds from the auction benefit Project TCMS. Go to TCMS Facebook to see additional art included in the auction.

To rsvp, email tcms@tcmsok.org, call 918-743-6184 or buy tickets at;http://tcmsok.org/online-payment/tcms-foundation/

“Tan

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PRESIDENT’S LETTER Peter P. Aran, M.D. I want to give you an update on the MACRA program.

As you remember from last month’s issue all physicians caring for Medicare patients will need to choose one of two tracks that the Centers for Medicare and Medicaid (CMS) will use to monitor the care of our Medicare patients.MACRA, the Medicare Patient Access and Chip Reauthorization Act, did away with the onerous Sustainable Growth Rate (SGR) formula that yearly threatened to reduce physician reimbursements. As of April 2015 physicians were scheduled to have a 24% reduction in Medicare reimbursements until both parties, in a rare show of unity, did away with the SGR. They replaced it with MACRA which was a 962 page legislation that created the Quality Payment Program that has two tracks, MIPS and APS. We will have to choose one of these two programs in the next year for payments beginning in 2019. But CMS typically measures care going back 2-3 years for its various programs and for this program it starts to measure patient care on January 1, 2017 so we can’t wait until 2019 to decide.This is a complicated program that will require every practice to read and discuss which track is better for you. MIPS will be the choice of 80-90% of physicians and has 4 categories of measures that I mentioned last month. APS will fit probably less than 10% of physician practices-those involved in ACOs, Oncology Care Projects, Comprehensive Primary Care Plus, a Dialysis Care Project, and Patient Centered Medical Homes. So review the last two issues where we discuss these programs and go to these two websites for more information: www.cms.gov: their home page, then click on MACRA www.ama-assn.org/go/medicarepayment: click on MACRAThe CMS administrator, Andrew Slavitt, spoke at the AMA meeting last week. He said that physicians will have 33% less quality measures to comply with in MIPS since they will do away with the Physician Quality Reporting System (PQRS), the Value Based Payment Modifier, and the Meaningful Use EMR. He said that the measures that they will track should be clinically relevant. If you are a primary care physician you have been involved in these programs the last several years. Subspecialists will find much of this new however. CMS is going through a comment/feedback period through the end of the month so hopefully changes will be made to make this less confusing. For most of you designating one of your partners and your office manager to research this and discuss it with your group makes the most sense. Next month we will go over the financial aspects, the penalties and bonuses related to these programs.

Meeting Update:The annual AMA meetings were held in Chicago from June 9-15th. Oklahoma was well represented at the meeting. Dr. Mary Anne McCaffree was one of two candidates for AMA president. She was defeated by Dr. David Barbe, a family physician from Missouri. She was a great ambassador for the state of Oklahoma, everyone that we had contact with during the meeting held her in extremely high regard. Both candidates were on the AMA board of directors and both of our states should be proud of them. As Midwestern primary care physicians they understood the unique challenges of medical care, medical education, physician and nursing manpower shortages facing those communities in America that have few large hospitals but predominantly small and medium sized hospitals caring for patients that generally live outside of large urban centers of care. (take a deep breath after this long sentence which is worth re-reading.)Two residents and six medical students were among the 950 residents and students who attended the meeting. The residents from OU Tulsa were Drs. Chris Sudduth and Eudy Bosley. Dr. Sudduth was the Vice Speaker for the Residents’ House of Delegates-the second highest resident’s position nationally. Bob Aran, M3 and Sarah Tran, M2, from the OSU School of Community Medicine, John Carradini, M2, OU Tulsa School of Community Medicine, Austin McCullough, M2, Brady Iba, M1, and Sara Williams, M1, from the OU Oklahoma City School of Medicine. Carradini and Iba won elected student positions. I served on the Medical Education panel for the AMA House of Delegates and saw firsthand the influence the students and residents had at the meeting. Another member of the Oklahoma delegation serving on a national panel was Dr. Jane Fitch, the Chair of Anesthesiology at the University of Oklahoma, Oklahoma City. She chaired the committee dealing with public policy and board of trustees’ issues.Other physicians representing Oklahoma were Dr. Bruce Storms who headed the delegation, Dr. Jack Beller, Dr. Jay Gregory, Dr. Sherri Baker-the OSMA President, Dr. Woody Jenkins-OSMA past president, and Dr. Jenny Boyer. Dr. Bob McCaffree represented the Society of Chest Physicians. Drs. Mary Anne McCaffree and Gregory are physician liaisons with the Joint Commission for the Accreditation of Hospitals. I also served on a panel dealing with hospital/physician interactions.We worked on a number of issues that should help us take better care of our patients here in Oklahoma including less onerous electronic medical records restrictions, modification of maintenance of certification requirements, improvement of the MACRA requirements set to go into effect in 2019 making them more clinically based and physician friendly, improving care coordination between hospital physicians and primary care physicians, delinking patient survey results on pain control from physician performance measurements, public health efforts related to gun violence, improved care of our veterans, improvements in the medical student match, and efforts to lessen the medical school debt.Ken King’s staff from the OSMA coordinated all of these efforts and the physicians, students, and staff worked hard on behalf of the physicians and patients of Oklahoma.

WELCOME BACK

RICHARD D. RANNE, M.D.Pediatric Surgery, St. John’s Clinic, 1705 E. 19th St Ste 701, Tulsa, OK (74101). (918) 748-7878. Pre-Med: University of Arizona, 1971-1974. Medical Education: University of Arizona College of Medicine, 1974 -1977 .Res idenc i e s : University of Iowa, Abdominal Surgery, 1977-78, University of Arizona, Gynecology, 1978-1979, General Surgery, 1979-1983, Children’s Mercy Hospital, Kansas City, MO, Pediatric Surgery, 1985-1987 and St. Lukes Hospital, Kansas City, Missouri, Cardiothoracic Surgery.

NEW MEMBER

WENDY B. EMERSON, M.D.Orthopedic Surgery, Central States Orthopedics, 6585 S. Yale Ave Ste 200, Tulsa, OK (74136). (918) 481-2767. Pre-Med: Oral Roberts University, 1995-2000. Medical Education: University of Texas Medical Branch, Galveston, TX, 2001-2005. Residencies: University of Washington, Seattle, WA, Internship, 2005-2006 and Orthopaedic Surgery, 2006-2010. Fellowship: TRIA Orthopaedic Center, Minneapolis, MN, 2010-2011.

2016 LEGISLATIVE OVERVIEWBUDGET The budget was obviously the biggest topic of this legislative session. With a $1.3 billion deficit, the budget cast a shadow over almost everything else that went on this session. Due to revenue failures, which trigger automatic budget cuts, Medicaid providers had already seen a 3% cut in reimbursement rates before session even started. And early in the year, the Health Care Authority announced it was starting the public notice process to cut rates by as much as 25%. While that number was admittedly unlikely (only if the Legislature failed to reach a budget agreement and automatic cuts kicked in), double-digit cuts were very much in the realm of possibility. Fortunately, legislators understood the catastrophic impact that these cuts would have had on access to care. In the end, the Health Care Authority actually received a slight funding increase. As of this writing, the OHCA is working to reduce some administrative costs which would make additional provider rate cuts unnecessary. Nothing has been officially announced yet, but any cut should be less than 2%. However, while physicians dodged a bullet this year, we must continue to keep up the drumbeat on this vital issue. To balance the budget, lawmakers used approximately $600 million in one-time revenue sources and other budget tricks. So, even if oil and gas prices rebound, next year’s legislators are already walking into a deficit at least that large. MAINTENANCE OF CERTIFICATION One of OSMA’s top legislative priorities was also one of the first bills signed into law this year. SB 1148 by Sen. Brian Crain (R-Tulsa) and Rep. Mike Ritze, DO (R-Broken Arrow) will prohibit Maintenance of Certification from being required as a condition of licensure, hospital credentialing or reimbursement. The bill passed both chambers of the Legislature unanimously and was signed into law by Governor Fallin on April 12. PUBLIC HEALTH Several pieces of legislation were filed that would raid the funds of the Tobacco Settlement Endowment Trust (TSET) for purposes outside of its intended public health function. OSMA opposes legislation that would take money away from TSET’s public health funding efforts or diminish the autonomy of the TSET Board. Fortunately, none of those bills passed this year. One of the most contentious items this session was immunization. Sen. Ervin Yen, MD filed HB 3017, which would have required all students in public schools to be immunized unless they had a medical reason why they could not receive vaccinations. That bill failed in the Senate Education committee, but it brought the anti-vaccine crowd out of the woodwork. They pushed HB 3016 that, while billed as an informed consent bill, went far beyond and would have placed a new mandate on physicians and only served to scare and intimidate parents. Both Dr. Yen and Rep. Doug Cox, MD attempted to amend the bill to reflect current AAP informed consent guidelines, but their efforts were rejected. Governor Fallin ultimately vetoed the measure and an attempt to override fell short in the House. HB 1471 by Rep. Justin Wood (R-Shawnee) and Sen. Ervin Yen, MD (R-Oklahoma City) would prohibit minors from being allowed into tanning booths. Unfortunately, the bill was not considered by the Senate prior to last week’s deadline and is now dormant for this session.LAWSUIT REFORM One of the disappointments this year has been the failure of one of our key priorities to receiving a hearing in a House committee. SB 765 by Sen. Anthony Sykes (R-Moore) passed the Senate last year on a 37-6 vote. However, it was caught up in an inter-chamber squabble and was not heard in the House Judiciary Committee. This is the last remaining piece of our tort reform efforts and we will be looking for another opportunity to advance Statue of Repose next year. WOMENS’ HEALTH As per the usual in Oklahoma politics, one of the more talked-about debates this session surrounded abortion. SB 1118 would have made anyone who destroys a human embryo or fetus guilty of first-degree murder. That bill was not heard but another troubling bill sailed through the process for most of session. SB 1552 by Sen. Nathan Dahm (R-Broken Arrow) would make performing abortion a felony and would have stripped the medical license of any physician who conducts an abortion. While the OSMA does not take a position on the legality of abortion, as long as it remains a legal act, we will oppose legislation that is designed to intimidate physicians or override their medical judgment. Governor Fallin wisely vetoed the bill and the Senate adjourned before bringing up an override attempt. HB 2601 will require health care facilities to include breast density information in certain mammography reports. There were some concerns about the definitions and mandates in the original language, but Dr. Ritze, the House author, worked with radiologists from OSMA leadership on some revisions that were incorporated in the final bill. PHYSICIAN MANDATES As usual, there were several pieces of legislation that would place new mandates and red tape on physicians. We have been able to kill most of these, but there is one piece of legis-lation that passed of which OSMA members need to be aware. HB 3017 dealt with Physicians’ Orders for Life-Sustaining Treatment (POLST) directives. In its current form, the bill would have required all health care providers to view a one-hour presentation on POLST and end-of-life issues and successfully pass an exam to prove they viewed it. Fortunately, the Senate sponsor was willing to work with us and we were able to remove all mandates on physicians from the bill.

Tulsa County Medical Society5315 South Lewis AvenueTulsa OK 74105-6539

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August 11-12, 2016Embassy Suites Hotel & Convention CenterNorman, OK

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LOCATIONS918.523.3911 1500 S. Utica Ave., Tulsa, OK 74104

918.523.3914 2431 E. 61st St.,Tulsa, OK 74136