Newsletters Articles

From our CMS Rep

July 2016

Ashby Wolfe, MD, MPP, MPH

Chief Medical Officer, CMS Region 9

San Francisco, CA

Here at CMS, we’ve been working for several months on some of the new programs and initiatives created by the Medicare Access and CHIP Reauthorization Act signed of 2015.  Additionally, we are now seven years in to the concerted launch of a truly national health information technology platform.  A lot if important steps have been made in this effort, but we’re still at a stage where technology often hurts, rather than helps, physicians provide better patient care. CMS is committed to taking a user-centered approach to designing policy.  

Understanding what we want from technology means first understanding how we provide and receive care today in America, where the patient is more diverse, more mobile and more demanding than ever before.  The consumers CMS serves are a good representation of all of our care needs – 140 million Americans, most on fixed or low incomes – in every type of care situation: the Medicare patient leaving the hospital with five prescriptions to fill and 2 appointments to book; the Marketplace customer who will have coverage for the first time and finally be able to have his wife’s chronic fatigue looked at; the daughter who has made the difficult decision to move her father in a nursing home and wants to know staffing ratios and quality ratings; the family with a child with disabilities on Medicaid that requires 24-hour care and is watching every dollar and interviewing every home care worker.

The way people get care today – on the go, on their own terms, often not anchored in the system – means their information needs are ever more vital and yet so basic.  People ask: “Am I recognized when I show up? Are my needs, preferences, and history available?”  Today’s technology at its best is ideally suited to meet these needs: the cloud, social media, one-click purchases, information at our fingertips, everything wired, convenient devices, expert systems, intelligent agents. We know what we need to do and the technology is available.

To address these issues, our agency is charged with implementing the new bipartisan Medicare Access and CHIP Reauthorization Act (MACRA) – legislation intended to bring value-based care to the everyday physician practice. We have created a new playbook at CMS by making our most concerted effort ever at listening to front-line physician and patient input upfront.  After first collecting feedback from across the health care sector, we launched our work with a four-day session with physicians and technology companies and sought more comment through a public Request for Information. But the bulk of our work has been directly with front-line physicians. In coordination with our Central Office in Baltimore, we have completed eight focus groups with front-line physicians in four separate markets and have many more coming. I’ve been on the road meeting with a number of physicians to learn more specifically how they interact with technology and what their day-to-day challenges are. My colleagues and I have received powerful feedback, including comments that current EHR platforms and systems put too much of a burden on physicians and their teams, taking time away from caring for patients.  Many physicians report challenges with needing information from a different EHR that doesn’t communicate well with their practice EHR, so there remains a heavy reliance on faxing or “snail mail” to coordinate care and follow-up.  One person pointed out that it takes eight clicks on a computer to order aspirin for a patient.  Many physicians see fewer patients each day because they are spending more time doing data entry into their EHR.  At times, there is too much information but it is still very difficult to find on a busy EHR screen.

Three themes have emerged that are shaping CMS’ agenda moving forward:

  1. Physicians are hampered and frustrated by the lack of interoperability. Simple issues such as needing to simply track a patient referral, or review a hospital discharge summary to ensure proper follow-up, can be terribly difficult and onerous in a busy practice.
  2. Regulations in their current form slow down physician practice, create documentation burdens and often distract from patient care.
  3. Physicians find their EHR technology hard to use and cumbersome. It slows them down, and doesn’t speed their path to answers.

CMS will be addressing these themes in very specific ways, as we work to implement the new MACRA legislation.  We have issued our first proposed regulation on MACRA with the Quality Payment Program proposed rule, published in April 2016.  Information related to the content of the proposed rule, and how the Quality Payment Program will work, is available at http://go.cms.gov/QualityPaymentProgram.  Below, I share the concepts of our approach and how our agency views the work moving forward.  

The first area we are addressing is the documentation overhead associated with the Meaningful Use program.  The following represents the vision for the approach to this work.  We have been working to try to close the gulf between our public policy work and what is happening in the reality of patient care.  From a number of focus groups and listening sessions, we are hearing the message loud and clear: “stop measuring clicks, focus instead on allowing technology to become a tool and focus on the results technology can create. Give us more flexibility to suit our practice needs and ultimately more control.”  Where possible, we favor letting outcomes rather than activities drive the agenda. We can take advantage of how the landscape has changed over the last five years with the proliferation of programs that depend on care coordination and population health.

Interoperability is the second area of our focus. It is an essential ingredient not only for better patient care, but as President Obama mentioned in early March, it is also a key part of the precision medicine initiative that will unlock an entirely new future of better health.  We are making a concrete effort to commit to this work; on February 29 HHS Secretary Burwell announced that companies representing 90 percent of EHRs are committing to three vital steps to work towards true interoperability to prevent data blocking or firewalls from getting in the way of coordinating patient care.  Our agency has also recently announced funding to connect many of the remaining parts of the system that are not part of the EHR incentive program but serve our neediest Medicaid patients every day – long-term care, behavioral health and substance abuse providers.  Ultimately clear communication pathways between electronic systems will give physicians and patients what they want from their technology, so called bottom-up interoperability. Our agency will help facilitate two goals that practicing physicians have identified: closing the referral loop and patient engagement.

That leads to the third area CMS is focused on: to give the physician better tools that help him or her with patient care. It’s not only Meaningful Use (MU) regulations that concern physicians, they want better technology. It is time to finally create the improved workflows and the apps that physicians are looking for.  Shifting from MU-oriented design to developing certified technology that is user-centered is a big opportunity. Flexible EHR incentives should give tech companies new products to develop.  As part of this effort, our sister agency, the Office of the National Coordinator, is launching an App Discovery Site as an EHR-neutral place for new apps that can securely move data in and out of an EHR.

CMS is working to ensure that our policies communicate what is important – improved patient care, better spending, and healthier people. A challenging goal, but one made easier by talking about it publicly and listening to physician and clinician input.  The implementation of the MACRA legislation is an ongoing process and our agency is committed to closing the gap between on-the-ground care delivery and policies that promote the tools for better care. Connecting to what happens in daily patient care is vital to our policy-making as we seek a better, smarter healthier system and better patient outcomes.  To that end, please do not hesitate to contact me with questions or concerns at ashby.wolfe1@cms.hhs.gov.  In addition, you can keep track of new developments and sign up for our listserv at the Quality Payment Program website: http://go.cms.gov/QualityPaymentProgram.

Ashby Wolfe, MD, MPP, MPH
Chief Medical Officer, Region IX
Centers for Medicare and Medicaid Services
90 Seventh Street, Suite 5-300
San Francisco, CA 94103
(Ph) 415.744.3631
(Fax) 415.744.3517
ashby.wolfe1@cms.hhs.gov

MACRA- Medicare Access & CHIP Reauthorization Act of 2015

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA)

http://www.aafp.org/practice-management/payment/medicare-payment.html

What Can I do TODAY to prepare for MACRA implementation?

If you haven’t reported data on quality measures through the PQRS or as part of meaningful use, start as soon as possible. Penalties for not reporting or for low quality may impact you this year. More information on Medicare penalties is available.

If you submitted quality data during the last calendar year, you should have access to your Quality and Resource Use Report (QRUR). This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement.

If your practice doesn’t provide chronic care management (CCM) services, consider starting now. Medicare began paying for CCM codes on January 1, 2015. By offering CCM services, your practice will be a step closer to implementing the five comprehensive primary care functions promoted by the CPC initiative. You may also qualify to participate in the APM track. Information on chronic care management and resources to help you start providing CCM services in your practice are available.

FAQ’s on MACRA

 

 

PETERS, CANNATA & MOODY, PLC Presents your Legislative Wrap up:

May 10, 2016

PETERS, CANNATA & MOODY PLC

The legislature worked through Friday night to process more than 250 bills and end the 2016 legislative session at 5:45 on Saturday morning. The final hours of the session had both congeniality and tension. A small number of bills failed, while some bills failed only to be revived on a second vote. Many others passed without discussion or controversy.

In the 117 days of this legislative session, 1,361 bills, memorials, and resolutions were introduced. Thirty-four memorials and resolutions were transmitted to the Arizona Secretary of State with legislative statements of support for a variety of causes. The legislature passed 387 of the introduced bills, and thus far Governor Ducey has signed 115 into law. The Governor has almost two weeks to act on the remaining legislation on his desk. Only three have been vetoed.

Though the legislature adjourned, they will not be absent from the Capitol. Eight study committees were established this year, creating official mechanisms for ongoing study and debate on topics ranging from transportation funding needs to cosmetic lasers (more information is included in this report). In addition, state agencies and the Auditor General were tasked

with evaluating potential changes to government processes.

As the session ends, many lawmakers are shifting to campaigns for renewed terms in the legislature next year. But an unusually high number are leaving the Capitol – many after years of public service there. Fifteen lawmakers have reached the maximum years allowed by the state’s term limits, opted to retire, or started a run for another public office. The legislature will lose up to 150 years of experience from their departure. Among those departing are Representative Debbie McCune-Davis (D-Phoenix), who has served 30 years in the legislature. Her deep knowledge of key policy areas will be missed by everyone at the Capitol.

With the loss of experience, however, comes the opportunity to inform a new body of legislators eager to serve and better understand the information we are ready to share as the 2016 campaign season moves toward the 2017 legislative session.

KidsCare Restored in Arizona

In a surprising shift at the legislature, a bipartisan coalition in both the House and the Senate overruled legislative leaders and forced a vote to restore the state’s KidsCare health insurance program. The Governor, who had remained quiet on the topic as public support and legislative focus on the topic increased throughout the session, signed the bill the same day it arrived on his desk. The proposal, SB 1457, also expands access to empowerment scholarship account funds for students with disabilities that are found to need education beyond the age of 18.

© 2016 Peters, Cannata & Moody PLC. All rights reserved. MONDAY, MAY 9, 2016

PETERS, CANNATA & MOODY PLC

The sudden success in reinstating the health insurance program was heralded by legislators, AzAFP, and other advocacy groups who have long argued that Arizona should no longer be the only state rejecting federal dollars for insurance to children of the working poor.

Medical Compacts Reach Governor’s Desk

Despite an unpredictable and contentious path through the legislative process, four proposals to establish or expand medical compacts in the state are now on the Governor’s desk for consideration. HB 2502 (medical licensure compact, HB 2503 (psychologists licensure compact), HB 2504 (physical therapy licensure compact), and HB 2362 (nurse licensure compact) were all approved in the final days of the legislative session.

The House adopted the amendments from the Senate, which place strict limitations on the medical compacts to ensure state autonomy and transparency are emphasized.

Legislature Directs Further Study on Key Issues

Every year, the legislature considers bills that seek to start a conversation about a particular topic through a study committee established in state law. This session was no exception – the legislature approved the creation of eight new study committees:

  •   HB 2035 establishes a Study Committee on Cosmetic Lasers to review regulations for laser certification, and monitoring and opportunities for cosmetic laser businesses. The report is due January 1, 2017.

  •   HB 2666 creates a Workforce Data Task Force within the newly created Office of Economic Opportunity, to oversee workforce system evaluation data sharing and methodologies used for data collection, retention, distribution and storage. An initial report is due November 1, 2016, and the Task Force continues until 2024.

  •   HB 2677 establishes a Peace Officer Employment Study Committee, charged with researching and reporting on peace officer staffing levels and recruitment and retention policies and practices, and on the impact these have on the rate of attrition and public safety. The Committee is required to report its recommendations by December 31, 2016, and would be removed from statute on October 1, 2017.

  •   HB 2701, the budget bill for criminal justice issues, creates the Study Committee on Incompetent, Non-restorable and Dangerous Defendants Committee to evaluate and recommend a program to provide long-term service to individuals found to be incompetent and non-restorable who are charged with crimes involving violent or dangerous behavior. The report is due by December 15, 2016; the committee is repealed on January 1, 2017.

  •   SB 1248 creates a Dog and Cat Breeder Study Committee, charged with the study of pet breeding by licensed and unlicensed breeders in this state and other states, and options to encourage spay or neuter clinics, adoption of dogs or cats and healthy breeding of dogs and cats. The Committee is required to report findings and recommendations by December 31, 2016, and would be removed from statute on October 1, 2017.

    © 2016 Peters, Cannata & Moody PLC. All rights reserved. MONDAY, MAY 9, 2016

PETERS, CANNATA & MOODY PLC

  •   SB 1350 establishes a Joint Legislative Study Committee on Transient Lodging, to evaluate existing state and local government regulations on transient lodging businesses. The report is due by December 15, 2017, and the committee is repealed in 2020.

  •   SB 1490 creates a Surface Transportation Funding Task Force, which will bring together nine individuals with the experience needed to review the state’s needs and recommend changes that will help address the long-term viability of transportation infrastructure.

  •   SB 1525 establishes a Continuing Educational Task Force to study course offerings and other critical information. The report is due December 15, 2016, and the task force is repealed in 2019.

    The legislature also requested additional study and oversight of the Department of Child Corrections. HB 2705, a part of the budget, requires the Department of Child Safety and the Arizona Early Childhood Development and Health board to report on their collaborative efforts to address child welfare issues by February 1, 2017. The bill also requires the Arizona Auditor General to report on specific areas of Department of Child Safety responsibilities and outlines annual updates on any plans to close facilities with the Arizona Training Program.

    HB 2704, the health budget bill, requires several reports. It requires AHCCCS and the Arizona Department of Health Services to submit a joint report on hospital charge master transparency by January 1, 2017, requires AHCCCS to report on the receipt of credits for funding the state share of medical assistance expenditures that qualify for federal financial participation by December 31, 2016 and June 30, 2017, and requires AHCCCS to report on the use of emergency departments for non-emergency purposes by AHCCCS enrollees by December 1, 2016. The bill also requires AHCCCS to report by January 2, 2017 on the availability of inpatient psychiatric treatment for children, adults, and adolescents that receive RBHA services, and by December 1, 2016 requires AHCCCS to report on Medicaid payments for health care services for Native American populations. An AHCCCS report on the technological feasibility and costs of applying a 340B drug pricing program to licensed hospitals and facilities is due by November 1, 2016.

    Thirteen additional bills required further study on a specific topic:

 HB 2033 creates a Post-9/11 Veteran Education Relief Advisory Committee to establish and oversee a newly created fund to provide assistance for tuition to state universities for veterans.

  •   HB 2388 establishes an Achieving a Better Life Experience Act (ABLE) Oversight Committee in the Arizona Department of Economic Security, tasked with responsibilities associated with the newly created ABLE program.

  •   HB 2442 requires the Arizona Health Care Cost Containment System to do a network adequacy study on Regional Behavioral Health Associations that provide behavioral health services to children enrolled in the Comprehensive Medical and Dental Care Program by July 1, 2017.

  •   HB 2613 requires the Arizona Department of Administration to conduct a cost/benefit study regarding the transfer of all non-health related boards and occupational licenses to a new licensing and regulatory division within their agency. The report must be completed by September 1, 2016.

© 2016 Peters, Cannata & Moody PLC. All rights reserved. MONDAY, MAY 9, 2016

PETERS, CANNATA & MOODY PLC

  •   HB 2620 requires the State Board of Education and the Arizona Department of Education to jointly develop and implement a transition plan for moving the state employees that investigate teacher complaints from SBE to ADE by August 1, 2016. (The employee transition was also required in the bill.)

  •   HB 2695 appropriates money for a feasibility study to replace the tax accounting system at the Arizona Department of Revenue.

  •   SB 1060 requires the Arizona Auditor General to complete a performance audit of the Arizona Power Authority.

  •   SB 1399 requires the State Land Commissioner and the Director of the Department of Water Resources to develop a plan to construct a potential new water storage facility on state trust land.

  •   SB 1421 requires each board, commission, council, or advisory committee to report compensations and reimbursements paid in fiscal year 2016, and requires the Department of Administration to provide the data in a report by December 15, 2016.

  •   SB 1428 requires the Public Safety Pension Retirement System to study methods for structured risk pooling and local board consolidations. The report is due by July 1, 2017.

  •   SB 1457 requires the Arizona Department of Education to create an Annual Education Plan Development Council to develop and oversee the expansion of Empowerment Scholarship Account funds to students that qualify for funding through the program between the ages of 18-22.

  •   SB 1525 requires a special audit of Joint Technical Education Districts.

  •   SB 1530, a part of the budget, requires the University of Arizona to provide a study on the services of

    the Arizona Geological Survey by August 1, 2017. The bill also requires a report by the State Geologist, in cooperation with the Mining, Mineral and Natural Resources Educational Museum Advisory Council, detailing the Museum’s operations and funding needs.

    No Referrals Added to November Ballot

    Though the legislature nearly referred numerous policy questions to voters in November, the session adjourned without actually doing so. Almost 40 ballot referrals were introduced this year, and 13 received some consideration from the legislature. Two proposals on solar energy were sidelined by an agreement between Arizona Public Safety and Solar City, and this week the House overwhelmingly rejected a proposal from the Arizona Restaurant Association to increase the minimum wage. A measure to subject the Arizona Clean Elections Commission to rulemaking procedures under an executive oversight commission stalled just before the final vote on the legislature’s last night of work.

    Though the legislature did not pass any of the ballot proposals, voters will likely see questions referred through citizen initiative on the November ballot.

    © 2016 Peters, Cannata & Moody PLC. All rights reserved. MONDAY, MAY 9, 2016

PETERS, CANNATA & MOODY PLC
Governor Considers Regulatory Changes Approved by Legislature

Many bills introduced this year would have impacted regulatory authorities and processes in Arizona; in the end, six of those were approved by the legislature.

  •   HB 2337 requires each state agency to allow a regulated person to correct deficiencies in an inspection or audit if there is uncertainty about whether that individual qualifies for statutory exemptions.

  •   HB 2450 simplifies the process by which a state agency can repeal rules it determines to be unnecessary for the operation of state government, by allowing the agency to amend or repeal those rules through the expedited rule process at the Governor’s Regulatory Review Council.

  •   HB 2487 prohibits a state agency from requiring any authorization or meeting before an application can be filed with the agency, and to limit impacts to the applicant for any pre- application process required by law.

  •   HB 2613 eliminates licensing requirements for professional driving trainers, citrus, fruit and vegetable packers, and yoga instructors, and makes licensing optional for geologists, assayers, and cremationists. It also requires the Arizona Department of Administration to provide a report by September on the costs and benefits of moving all regulatory oversight of non-health regulatory boards and occupational licenses under the oversight of the Department.

  •   SB 1388 requires the Governor’s Regulatory Review Council to review each agency rule enacted under emergency rulemaking within one year after the rule is adopted.

  •   SB 1524 prohibits a local government or state agency from doing any action that increases regulatory burdens on an individual unless it is specifically authorized by state statute, unless the regulation is necessary to address a critical or urgent need. It specifically bans regulations on businesses that use a digital platform to sell goods and services directly to a customer.

    Governor Ducey signed SB 1487 into law, requiring an Attorney General investigation if a legislator believes a local government ordinance violates state law or the state constitution. The local government would be given 30 days to correct the violation; if it is not corrected, the State Treasurer is authorized to withhold revenues that would otherwise be distributed to that local government until it is resolved.

    Five additional regulatory proposals failed to make it through the legislature:

  •   HB 2163 would have stablished a Governor’s Statutory Review Committee to review any statute and determine whether the law should be amended or repealed; each year until 2024, the Committee would make recommendations on their findings.

  •   HB 2201 would have prohibited the state and any political subdivision in Arizona from using any personnel or financial resources to enforce any executive order or policy directive from the federal government, or any ruling from a federal court, that is not constitutional and signed into law. It passed the House 31-27 but failed in the Senate.

    © 2016 Peters, Cannata & Moody PLC. All rights reserved. MONDAY, MAY 9, 2016

PETERS, CANNATA & MOODY PLC

  •   HB 2501 would have established a six-year process that brings existing health professional regulatory boards under the operation and control of the Arizona Department of Health Services (DHS).

  •   HB 2517 prohibits requires municipalities and agencies to limit occupational regulations to only those necessary, and carefully tailored to meet public health, safety or welfare objectives. The Senate narrowed the bill; as introduced, it would have addressed all regulations.

  •   HB 2600 repeals numerous advisory and oversight boards in state government: the State Parks Board, the Citizens Transportation Oversight Committee, the Water Quality Assurance Revolving Fund Advisory Board, the State Wildland-Urban Fire Safety Committee, and the Advisory Board of Arizona State Library, Archives & Public Records.

Will you receive your Rx report card?

Arizona law requires all medical practitioners, including MDs and DOs, who are licensed under Title 32 and who possess a DEA registration to also possess a current Controlled Substances Prescription Monitoring Program (CSPMP) registration issued by the State Board of Pharmacy. Earlier this year, we reported in AzMedicine on the Prescription Drug Monitoring Program (PDMP) Report Cards being expanded by the Arizona CSPMP. The PDMP Report Card offers all prescribers the opportunity to review your prescribing patterns in relation to the average data of other prescribers in your specialty type. The State Board of Pharmacy operates the CSPMP and as part of their work to meet new legislative requirements, they are distributing the Prescriber Report Card to all registered prescribers. Update your email address today! Please register or log-in here to verify that your email address is on file with CSPMP

Response Needed 2016-2017 Flu Vaccine Preferences

Dear Vaccines for Children (VFC) Provider,

Early each year the Immunization Program Office must Pre-book Flu vaccine doses for the subsequent flu season.  That time is quickly approaching.  In an effort to ensure that we have pre-ordered the doses that are most desired by VFC Providers we are asking that you complete this brief survey:  https://www.surveymonkey.com/r/227958X.  Your response will help us to pre-book sufficient quantities of the flu vaccine presentations to meet the needs of the VFC community.

Please complete the survey as soon as possible but no later than January 22, 2016.  Please contact the Vaccine Center at (602) 364-3642if you have any questions about this survey.  

Thank you so much for taking the time to complete this survey to help us to pre-book flu doses for the 2016-2017 flu season.

Sincerely,

Lisa Underhill, MPA
Vaccine Center Manager
Arizona Immunization Program Office
ArizonaVFC@azdhs.gov

 

Vaccine Provider Updates:

To continue providing VFC vaccines to eligible patients VFC providers must re-enroll each year in the VFC program. The re-enrollment process for the 2016 VFC program year begins on November 13, 2015 and re-enrollment forms will be due to the Arizona Vaccine Center no later than December 18, 2015. 

Arizona VFC enrollment forms can be found on the AZ VFC website

The forms are electronically fillable, and, once completed, should be emailed to: ArizonaVFC@azdhs.gov. In the subject line of your email include your VFC PIN and the phrase “VFC Re-enrollment.” The following forms are required: 

✓ 2016 Arizona VFC Provider Enrollment Agreement 
✓ 2016 ASIIS HIPAA Pledge to Protect Confidential Information 
✓ 2016 VFC ASIIS User Agreement Form 
✓ 2016 VFC Provider Profile Form 
✓ 2016 VFC Refrigerator-Freezer Verification Statement 

Your site’s VFC Coordinator and Backup VFC Coordinator are required to complete annual training such as the CDC webinar “You Call the Shots.” The instructions and link for the webinar can also be found on the AZ VFC website

 

Valley Fever stakeholder meeting attended by the AzAFP Staff

Your AzAFP Staff attended the stakeholder meeting on November 17th as part of the Valley Fever Awareness Week proceedings. The stakeholder meeting offered an opportunity for members of the clinician community to gather, learn and collaborate. The agenda provided an overview of the current Valley Fever data in Arizona by Ken Komatsu, MPH, State Epidemiologist, Arizona Department of Health Services (ADHS), patient experience and perspective by Mr. Daniel Leis, presentations from industry representatives working on diagnostics and treatment aspects of Valley Fever, and a community action discussion. Dr. Tom Chiller, Deputy Chief, Mycotic Diseases Branch at the Centers for Disease Control and Prevention (CDC) presented a concise national perspective on the State of Valley Fever. ArMA thanks our meeting organizers, Drs. John Galgiani, Peter Kelly, and Michael Grossman, for their invaluable leadership and coordination in bringing together the individuals who contributed to the agenda. We are grateful for the support of our meeting sponsors; The University of Arizona College of Medicine – Phoenix, who hosted the meeting on their campus, and to our industry sponsors DxNA, HealthTell,IMMY, and Nielsen Biosciences.  We urge you to take advantage of FREE Valley Fever online CME offered by the VFCE here or just learn more about Valley Fever here

 

USPSTF: Screen Overweight, Obese Adults for Abnormal Blood Glucose

November 02, 2015 01:53 pm News Staff – On Oct. 27, the U.S. Preventive Services Task Force (USPSTF) released a final recommendation statement (www.uspreventiveservicestaskforce.org) that calls for adults at increased risk for type 2 diabetes to be screened to detect abnormal blood glucose levels or diabetes. This is a grade B recommendation.

Specifically, the task force recommends screening for abnormal blood glucose in adults 40-70 who are overweight or obese. Furthermore, said the group, physicians should offer patients in whom abnormal blood glucose levels are detected intensive behavioral counseling interventions or refer them, if necessary, to promote a healthful diet and physical activity.

“Diabetes is a leading cause of heart attacks and strokes,” said USPSTF member Michael Pignone, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) “The good news is, we can identify people at risk and help them make lifestyle changes that may ultimately prevent or delay complications associated with this serious illness.”

Risk factors for diabetes include being age 45 or older, being overweight or obese, and having a first-degree relative with diabetes. Women with a history of gestational diabetes or polycystic ovarian syndrome are also at increased risk, as are certain racial and ethnic minorities (i.e., African Americans, American Indians or Alaska Natives, Asian Americans, Hispanics or Latinos, and Native Hawaiians or Pacific Islanders).

This final statement updates a 2008 USPSTF recommendation (www.uspreventiveservicestaskforce.org) calling for diabetes screening in asymptomatic adults with hypertension (sustained blood pressure of greater than 135/80 mm Hg), which also was a B recommendation. In addition, the USPSTF found insufficient evidence to assess the balance of benefits and harms of screening in asymptomatic adults without hypertension.

At the time, the AAFP’s recommendations on screening for diabetes mirrored those of the task force.

Since the previous recommendation statement was issued, six new intervention studies have shown consistent benefit from lifestyle modifications intended to prevent or delay progression to diabetes in those who have impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). The groups also found limited evidence from longer-term studies that suggested such interventions may actually improve outcomes.

Lifestyle modifications such as improved nutrition, healthy eating behaviors and increased physical activity are, in fact, considered first-line therapy for preventing IFG, IGT and diabetes. The USPSTF found adequate evidence that intensive lifestyle modifications result in a lower incidence of diabetes, cardiovascular mortality and all-cause mortality.

However, although this new body of evidence led the USPSTF to conclude there is an overall moderate net benefit to measuring blood glucose levels in adults at increased risk for diabetes, the task force found inadequate direct evidence to show that measuring blood glucose leads to improvements in mortality or cardiovascular morbidity.

“Losing weight reduces the chances of developing diabetes, which is why our recommendation focuses on diet and exercise,” said task force member William Phillips, M.D., M.P.H., in the release. “Patients who have abnormal blood sugar levels can be referred to programs that help them eat a more healthful diet and exercise more often.”

 

Primary Care Caucus Grows

Also on Capitol Hill, Board members met with two House members who last month inaugurated the Primary Care Caucus. Academy leaders thanked Reps. David Rouzer, R-N.C., and Joe Courtney, D-Conn., for their efforts and discussed next steps for the caucus. 

The caucus now has 14 members, and Courtney sent a letter to his colleagues in Congress this week asking them to join. He explained that the caucus will educate legislators and the public about the importance of primary care to the health system. 

“Our hope is that the Primary Care Caucus will transcend politics to focus on a positive path forward for patients, providers and our health care system that will finally achieve the triple aim of higher quality, lower cost and better outcomes,” Courtney wrote. 

He told AAFP leaders that he plans to help organize several events each year to explain the value of primary care. AAFP members can help, he said, by contacting their representatives in Congress and encouraging them to join the caucus. The Academy has created a tool to help members do just that.

Courtney also thanked AAFP leaders for engaging students and residents in advocacy efforts, saying they have an important role to play in shaping the future of public health policy.

“He told us that there are a lot of caucuses that are just ‘window dressing,’ so he wants this one to have a real impact,” Filer said.