August 2014 Vol. 1, Issue: 3

RSL Matters

AAAAI Hires Coding Consultant Teresa Thompson
Coding of patient visits continues to be a challenge for physicians and the recent 2014 AAAAI Practice Management Workshop reinforced that coding issues remain a hot topic. With the development of new codes and the looming challenges of ICD-10, AAAAI members would benefit from coding expertise. To that end, the AAAAI has announced the hiring of Teresa Thompson, CPC, CMSCS, as our coding consultant.

Ms. Thompson brings years of coding experience and has been a very sought after expert in A/I coding. She has also been a key speaker at the Practice Management Workshop for several years. Questions for Ms. Thompson will be sent to the AAAAI office. Additional details will be coming soon.

Update on Compounding Legislation
A/I physicians in Maryland continue to address the compounding issue in their state. More than a dozen Maryland A/I physicians recently participated in a town hall-style meeting in Baltimore with MedChi, Maryland's state medical society, and representatives of numerous other specialties to discuss Maryland’s compounding legislation. AAAAI staff attended the meeting in support of the local allergists and will continue to provide appropriate resources as needed to support our A/I colleagues in Maryland. MedChi is taking the lead in a multi-specialty collaborative effort to address this issue.

We remind everyone to continue to monitor legislative and regulatory actions within their respective states on the compounding issue. Partnering with state medical societies and other specialty societies can be very productive.

Epinephrine Law Amended in Delaware, Passes in North Carolina
Anaphylaxis is a life-threatening emergency that requires prompt action. Recently, through the advocacy efforts of local A/I physicians, patients, parents, legislators and lay organizations, the state of Delaware amended its current law to allow ease of access of epinephrine in school for the treatment of life threatening allergic reactions. In addition, North Carolina recently passed legislation that would require epinephrine in every school. This is an exciting development for the citizens of Delaware and North Carolina and a testament to local grass-roots advocacy.

Help Promote the Role of A/I Physicians
Media outreach is an important tool to promote the role of A/I physicians to the public. The AAAAI provides members the opportunity to be a part of the AAAAI Media Link team. As requests from the media come to the AAAAI, you can be one of the AAAAI physician members asked to serve as an expert source and speak to journalists. Through the end of July this year, AAAAI mentions in print and online outlets have reached nearly 15 million people.

Practice Changers

We have partnered with the editors of JACI: In Practice to bring you monthly "Practice Changers" from recently published journal articles. Highlighting cutting-edge information will keep you current and assist you in educating patients and physicians who rely on the expertise of our specialty!

Treatment of Chronic Urticaria in Children With Antihistamines and Cyclosporine. By Lisa Neverman and Miles Weinberger

In this retrospective observational study, cyclosporine was associated with benefit in antihistamine-resistant chronic idiopathic urticaria (CIU), in 46 patients ranging in age from 1 to 22 (median = 9.5) years. Cyclosporine was well tolerated. Antihistamine resistance was not significantly associated with the CU index (p=.67). Other agents proposed for antihistamine-resistant CIU include sulfasalazine, hydroxychloroquine, and omalizumab. This study provides further support for use of cyclosporine in children with antihistamine-resistant CIU.

Management of Hypersensitivity Reactions to Carboplatin and Paclitaxel in an Outpatient Oncology Infusion Center: A Five-Year Review. By Aleena Banerji et al.

The clinical symptoms and timing of hypersensitivity reactions to carboplatin are distinct from hypersensitivity reactions to taxol. Many patients with taxol hypersensitivity reactions tolerated rechallenge in the outpatient infusion center without desensitization. Desensitization should be offered to all patients with severe hypersensitivity reactions to carboplatin and paclitaxel who need to remain on first line therapy. Whether paclitaxel reactive patients with mild to moderate reactions can be safely rechallenged with pre-medications needs further study.

Advocacy Matters

Government Funding Opportunities Now on AAAAI Website
A new section called “Government Funding Opportunities” has been added to the AAAAI Grants & Awards page and the AAAAI advocacy page. This section has direct links to government funding opportunity announcements for which you may be eligible.

Veterans’ Care Bill Increases Number of Training Positions
Hart Health recently alerted AAAAI about a new bill that was passed by Congress and signed into law by President Obama. The Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 authorizes the Department of Veterans Affairs (VA) to hire and train more physicians and allows veterans access to care at non-VA facilities. The bill instructs the VA to add at least 1,500 graduate medical education residency slots over five years at VA facilities that are experiencing shortages or located within a federally designated Health Professions Shortage Area.

Hart Health continuously monitors health-related legislation for the AAAAI, and we will share further updates we receive.

AAAAI Seeks Revamp of Sunshine Act Roll-Out, Physicians Need to Review Data By September 8
This month, AAAAI was among 112 state and specialty medical societies who signed on to an American Medical Association (AMA) letter that called on the Centers for Medicare & Medicaid Services (CMS) to reconsider how it is rolling out the Physician Payments Sunshine Act, also known as the Open Payments program. It urges CMS to maintain the continuing medical education reporting exclusion and reconsider its decision not to exclude journal article reprints from Sunshine Act reporting. The letter also urges CMS to postpone the public data release so physicians have more time to complete the cumbersome registration, review and dispute process.

Have You Reviewed Your Information?

There are three important Sunshine Act steps to take by September 8. First, complete the e-verification process via the CMS Enterprise Portal (EIDM). Next, register in the Open Payments system within the EIDM. Third, review and dispute data by September 8 for it be flagged in the initial public release on September 30.

AAAAI Supports Important Issues at AMA Meeting
The AAAAI co-sponsored two resolutions at the House of Delegates meeting earlier this summer. George R. Green, MD, FAAAAI, AAAAI’s representative to AMA, spoke in support of Resolution 724, regarding health insurance formulary transparency. He informed the House of Delegates of patients who had chosen health insurance providers based on access to prescriptions for asthma, later to be notified that their medications were removed from the formulary and no longer covered. The second resolution, Resolution 608, encouraged reconsideration of onerous restrictions on travel by government-employed scientists.

Both of these resolutions successfully passed the House of Delegates and are to be supported by AMA advocacy for legislative or regulatory action.

Practice & Policy Matters

The AAAAI Allergy, Asthma & Immunology Quality Clinical Data Registry (QCDR) in collaboration with CECity is now live. The AAAAI QCDR is a new reporting option for the CMS Physician Quality Reporting System (PQRS) in 2014. The registry is one of only 36 newly designated qualified clinical data registries approved by CMS to offer specialty developed measures. The AAAAI QCDR is comprised of sixteen clinical quality measures, two of which are outcomes measures.

The timing couldn’t be better as eligible professionals (EPs) can earn a .5% incentive payment and avoid the 2% payment adjustment on Medicare Part B reimbursements in 2016. In order to do so, EPs will need to report on nine measures covering three National Quality Strategy domains for at least 50% of all patients who qualify for the measures in 2014. One outcomes measure is also required to receive the incentive.

Highlights from the 2014 Practice Management Workshop: ICD-10 and the Future of Healthcare
The 2014 annual AAAAI Practice Management Workshop was held July 18-20 in Atlanta. Organized by the Practice Management Committee, it attracted over 200 physicians, nurses, practice managers and allied health providers from around the country. Over the next several issues of Practice Matters, we will highlight a few workshop sessions to give members who have not attended a better idea of what they missed.

Teresa Thompson’s Saturday plenary, “Your Roadmap to ICD-10 Readiness,” provided practical advice on working with the EHR and PM vendor, educating staff and providers, and finding resources to support the transition to ICD-10. She reviewed several examples of ICD-9 to ICD-10 code conversion and closed with timely updates on meaningful use and PQRS. One of the most important things attendees learned was a timeline to prepare for ICD-10 whether you are already well on your way or have not started yet. Immediate Past-President Linda Cox, MD, FAAAAI, introduced the AAAAI QCDR and also announced that the AAAAI has retained Ms. Thompson as a coding consultant for the benefit of AAAAI members.

Sunday’s plenary session, “The Future of Healthcare,” was led by Rosemarie Nelson, a nationally-recognized practice management consultant and a workshop favorite. She provided a tantalizing look at what A/I practices may look like over the next 10 years and discussed emerging trends in technology, patient engagement and the impact of the Affordable Healthcare Act. One of the most important things attendees learned was that healthcare consumers are ripe for change and demanding access, convenience and value.

Are you interested in attending a future workshop? The 2015 Practice Management Workshop will be in Denver July 17-19, so mark your calendars.

Tell Your IVIG Patients about the IVIG Demonstration Project
Do you have any Medicare patients with primary immunodeficiency disease who are receiving intravenous immunoglobulin (IVIG)? If so, they may now enroll in the Medicare IVIG Demonstration Project to have IVIG home infusions reimbursed. This three-year demonstration project for Medicare Part B recipients with a primary immune deficiency will study the impact of paying for IVIG home infusions. Up to 4,000 Medicare beneficiaries nationwide may enroll into the demonstration project on a first-come, first-served basis.

Please help us spread the word among your IVIG patients. Enrollment period will close September 12, 2014. However, if space is available after the initial enrollment period, CMS will accept and review applications as they come in until all slots are filled.

AAAAI Choosing Wisely Paper Published in JAMA
The Journal of the American Medical Association (JAMA) published a paper this month that supports evidence-based evaluation for allergies in order to avoid inappropriate testing, diagnosis and treatment. Written by David P. Huston, MD, FAAAAI, and AAAAI Immediate-Past President Linda Cox, MD, FAAAAI, it illustrates one of the recommendations on the AAAAI’s list of “Things Physicians and Patients Should Question” for the Choosing Wisely initiative.

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