EPtalk by Dr. Jayne 8/1/19

The Federal Trade Commission has agreed to a $5 billion settlement with Facebook following allegations that the social media giant misled users about their ability to protect personal data. Privacy advocates argued that Facebook deceived patients about the “Groups” function, encouraging them to share personal health information which was then exposed to the public. Although the settlement also requires Facebook to create an internal privacy oversight board, some say the penalty doesn’t do enough to protect user privacy. The settlement order will be in place for 20 years and sets up multiple compliance channels. The settlement, nearly 20 times larger than any previous settlement, must still be approved by a federal judge.

CMS announces additional Primary Care First Model Payment Office Hours sessions aimed at reviewing the proposed model payment structure and various model components and measures. CMS still hasn’t released the Request for Application for the program, so many of us are waiting for the details before we make decisions on participation. They did update the anticipated timeline for the RFA from “spring” to “summer” on their website, however.

CMS did, however, release the proposed rule for the 2020 Medicare Physician Fee Schedule this week. The Relative Value Unit (RVU) conversion factor went up a whopping $.05. Bundled episode of care codes were added for telehealth treatment of opioid use disorders. There is additional refinement of Evaluation and Management (E&M) codes for outpatient visits, including retention of five levels of coding for established patients and the reduction to four levels for new patients. There are also changes to the time requirements and medical decision making requirements for all of the codes. History and Physical are now required only “as medically appropriate,” which should be interesting when audits start occurring.

Medicare supervision of physician assistants will have increased flexibility for PAs to practice more broadly; requirements for physicians who precept students will be relaxed so that re-documentation is no longer necessary. Payments for Transitional Care Management will be increased along with the development of new HCPCS codes for certain Chronic Care Management services. I’m not sure that this addition of Medicare-specific codes will make things more simple, although it should allow physicians who spend additional time and resources to be able to differentiate that in their billings. A new code for Principal Care Management will also be created to compensate clinicians for providing care management services to patients with a single serious or high-risk condition.

Since they can’t release just one proposed rule, they also released the 2020 proposed rule for the Quality Payment Program. Highlights include:

• Increasing the performance threshold from 30 to 45 points.
• Decreasing the category weight for Quality and increasing the weight for Cost.
• Increasing the data completeness threshold for quality data submission.
• Increasing the threshold for Improvement Activities for group reporting.
• Updating requirements for Qualified Clinical Data Registry measures.

I’ve long been a follower of CIO Sue Schade and really enjoyed her recent blog post on meeting norms. Sue is currently doing interim IT work at the University of Vermont Health Network and is getting used to their rules regarding meetings. It sounds like they’re walking the walk and talking the talk on the fabled “50-minute meetings” that I always try to get my clients to adopt. People need time to refresh and readjust between meetings and the back-to-back culture I see with most of my clients doesn’t add to a positive working environment. Their “meeting norms” include providing agendas and meeting materials in advance with the invitation, and allowing people to bypass meetings that don’t have an agenda. They’ve also adopted meeting-free Fridays to allow people to focus on work and individual interactions.

It takes time for organizations to move to this kind of structure, but when they do, productivity typically increases and frustration decreases. You no longer see harried people scurrying from meeting to meeting or zoning out because they’re overextended.

I missed this newsy tidbit last week, but AHIMA and CHIME went to Capitol Hill to lobby to eliminate the 20-year prohibition of federal funding for a unique patient identifier. Representatives urged the Senate to support the Foster-Kelly House amendment to the Departments of Labor, Health and Human Services, and Education, and Related Appropriations Act of 2020. Removal of the ban would allow HHS to fund efforts towards a unique identifier. After working with patients from around the world who are used to having to provide a national health card prior to receiving services, it certainly seems like it might be an improvement over the matching algorithms we have that use name, DOB, address, and phone numbers.

JAMA Network Open confirms what we all already know: US adults are becoming more sedentary. In a cross sectional study looking at more than 27,000 adults, the time spent on sedentary behaviors increased from 5.7 to 6.4 hours per day in 2015 and 2016.

I wish they were here to collect data at the World Scout Jamboree, where I’ve walked 71 miles since I arrived. There’s still a few days to go, so that total will continue to increase. We’re seeing lots of tired feet, a bit of athlete’s foot, and plenty of orthopedic injuries as tens of thousands of scouts try to maximize the time they have left at the Jamboree.

Neckerchief trading is in full swing and I was excited to score one from the UK, but I had to trade away my medical neckerchief to get it. The nations of the world are relatively uninterested in sporting “neckers” from the US. Especially prized are neckerchiefs from Brazil and Belgium. Lots of people are interested in the ones from the Swedish contingent, but from what I’ve been told, they only receive one and don’t typically trade them.

We’ve survived our heat wave here in West Virginia and are having some rain showers that have already brought cooler temperatures. The next milestone is the closing show on Thursday night. I get to attend this one since I was working during the first one, and hope they bring back the fleet of 250 drones that swarmed across a 900 x 400 foot of aerial canvas during the first show. Everyone said the effect was outstanding, with attendees’ wristbands lighting up as the drones formed the shape of their home continents.

It’s only a few days until hundreds of buses roll back in to take the scouts to their next adventures. Some toured the US prior to the Jamboree and others plan to tour after. Either way, they (and the nearly 10,000 staff that have supported them) have had the adventure of a lifetime.

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