Tuesday, October 25, 2016

Adults Who Skip Vaccines Cost Americans $9 Billion per Year

By Charles Lerner, MD, San Antonio
Consultant to TMA’s Committee on Infectious Diseases

Adults who decide to skip vaccines cost Americans $9 billion in 2015, according to a recent study. When people decide not to get their recommended shots, we all bear the costs of preventable hospitalizations, physician visits, medications, lost work time, and poor performance while working when ill.  

Influenza, or flu, alone accounts for a significant spike in deaths in the United States almost every year, with as many as 50,000 deaths in some years.  At least two studies (see here and here) show patient deaths nearly double in long-term acute care hospitals (LTACs) when health care workers do not get their annual flu vaccination. Our most vulnerable patients suffer when we ignore best practices. 

If we all received the recommended vaccinations, everyone would be better off. Physicians and other health officials recommend shots to protect against:

  • Influenza; 
  • Herpes zoster (shingles); 
  • Pneumonia; 
  • MMR: measles, mumps, and rubella;
  • Tdap: tetanus (lockjaw), diphtheria, and pertussis (whooping cough);
  • Hepatitis B; 
  • Hepatitis A; 
  • Meningococcal; and 
  • Human papillomavirus.

Not only can we avoid the misery of disease and possible death, but also our pocketbook will benefit. We need to act responsibly to protect ourselves, our loved ones, and our society.

Dr. Lerner is an epidemiologist and infectious disease specialist in San Antonio.

Monday, October 24, 2016

ACIP: Preteens Need Only Two Doses of HPV Vaccine, Not Three

By Jason V. Terk, MD 
Keller pediatrician

We got some very good news this past week from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). This is the body that recommends how the vaccines licensed by the Federal Drug Administration (FDA) should be used in this country. The news this week was about the Human Papillomavirus (HPV) vaccine, which has been recommended for routine use in adolescents starting at 11 years of age for the past 10 years.

We have been giving this vaccine in three doses since its licensure in 2006. Now there is enough data accumulated about how kids’ immune systems respond to this vaccine for the ACIP to recommend only two doses spread over six months for younger teens 11-14 years of age. Older teens and young adults ages 15-26 will still need three doses because they do not have as robust a response as the younger teens do.

This means younger teens can be considered fully vaccinated if they complete their series of just two doses over six months prior to their 15th birthday. Fewer doses means better compliance with this important cancer-preventing vaccine.

By Jason V. Terk, MD 
Cook Children’s Physician Network 
Keller, TX 
Committee on Federal Government Affairs 
American Academy of Pediatrics 
Member, Texas Medical Association Be Wise — ImmunizeSM Physician Advisory Panel

Thursday, October 13, 2016

Flu Shot Boosts Your Health, Protects Others

It’s a fact: People will be hospitalized because of the flu this year, and many — 49,000 based on annual estimates — will die. But taking action now might help prevent that from happening in your community.

Getting a flu shot not only helps you avoid the flu, it also protects people around you who are more likely to get sick — and possibly have complications, or even die. Texas Medical Association (TMA) physicians urge everyone over 6 months of age to get vaccinated now to have protection throughout flu season.

Monday, October 10, 2016

Walk Your Way to Better Health with the Step It Up! Challenge

The Texas Medical Association (TMA) and Walk With a Doc (WWAD) Texas are joining forces with Fitbit and Surgeon General Vivek H. Murthy, MD, by taking the challenge to Step It Up! this fall. The goal? Get as many steps as possible from October 13-26. The challenge aims to get the country up and moving during a time of year typically spent eating holiday candy and watching spectator sports. And walking has great benefits: it can significantly reduce your risk of chronic diseases and related risk factors, and is one of the most important actions people can take to improve their overall health.

Join TMA and Texas physicians on the WWAD Texas team to compete with other teams across the country to see who can take the most steps this month.

Invite your friends to join Step It Up! and make your steps count. As Surgeon General Murthy jokes in this playful interview, “Every time someone signs up [for Step It Up], a bald eagle is born.”

Wednesday, October 5, 2016

More U.S. Adolescents Are Getting the HPV Vaccine ― But We Can Do Better

By Jason V. Terk, MD
Keller pediatrician

Another recently published NIS-Teen survey from the Centers for Disease Control and Prevention (CDC) shows the rates for HPV (human papillomavirus) vaccination are … slightly better than last year. If that seems like an underwhelming result, then you are right. Progress with this vaccine after 10 years of licensure and recommendation for tweens and teens is incremental at best.

Friday, September 30, 2016

The Americas Are Free of Endemic Measles

Great news! North and South America are free of endemic measles.

So says the Pan American Health Organization (PAHO), an arm of the World Health Organization, this week. The group declared North and South America free of endemic measles, meaning we’ve seen no new cases of measles in the Western Hemisphere through local strains (also known as an indigenous measles outbreak) in recent years.

But wait: That does not mean we’ve not seen measles outbreaks here. We have; more on that in a moment.

Tuesday, September 27, 2016

TMA Tries to Lift New Medicare Burden from Small Practices

Patients in some Texas communities may not know their doctor is under immense pressure to adapt to a new law that will determine how they provide care and get paid. According to Texas Medicine magazine, the new government requirement is putting a strain on smaller medical practices — and over time, could force some doctors to retire or surrender their small medical practice. That could reduce patients’ access to doctors’ care.

Congress passed the new law, the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, primarily to replace Medicare’s controversial Sustainable Growth Rate (SGR) formula. Physicians argued the SGR payment formula was flawed because it ignored the cost to care for Medicare patients. Congress passed emergency funding patches each year for a decade to avoid cutting physicians’ pay significantly for caring for America’s seniors and people with disabilities. The SGR forced doctors out of Medicare, leaving patients uncertain over whether their doctor would be there to care for them. MACRA ended that uncertainty.

However, Texas Medical Association (TMA) President Don R. Read, MD, said MACRA is “not what Congress ordered.” It forces doctors to deal with a new set of bureaucratic hassles and payment hurdles. The new law incorporated existing government programs intended to measure physicians’ health care quality — programs doctors also saw as problematic. “When MACRA legislation was enacted, TMA had no reason to expect CMS [Centers for Medicare & Medicaid Services, which oversees Medicare] would propose to continue flawed concepts from the current quality programs along with plans to diminish a physician’s worth down to a complex point system. More disappointing is to learn that CMS proposes to design a program that is stacked against solo physicians and small group practices in its first year of implementation,” said Dr. Read.

MACRA’s two payment options for physicians came with new quality-reporting requirements. Doctors are forced to invest in computer software to capture and report data, and in training to comply by Jan. 1, 2017 — too little time to prepare, in physicians’ minds.

The government’s draft MACRA rule forecast that nearly all smaller physician practices would struggle to adapt. It estimated in the first year MACRA would cut Medicare payments for almost nine in 10 solo doctors, almost three-quarters of small practices (two to nine eligible clinicians), and 59 percent of practices with 10 to 24 eligible physicians.

In Texas, more than 60 percent of patient care physicians are in very small practices of one to three physicians,” TMA wrote CMS in response to the MACRA forecast. “MACRA is very likely to levy penalties on most of them, pushing some or all of them over time to retire, or join large groups or hospitals.”

Some doctors, like Dallas cardiologist Rick Snyder, MD, (a member of TMA’s Board of Trustees) insist even his large and sophisticated practice can’t make it under Medicare’s proposed new pay-for-quality rule. “We pride ourselves on being cutting-edge on regulatory compliance, [but] there’s no way in the world we are going to be ready Jan. 1. Our goal is just not to lose money.”

So in its letter to CMS, TMA recommended the government delay the deadline to start collecting physicians’ data six months, until July 2017, to give doctors more time to prepare. In response to TMA’s letter and a top CMS officer’s meeting with Drs. Read, Snyder and other TMA leaders, federal officials say they will temporarily exempt physicians from penalties if they simply choose one of three reporting options in 2017. Practices struggling to adopt the changes can avoid pay cuts in 2019 by at least attempting to report some data in 2017.

Immediate crisis averted perhaps, but TMA and physician leaders say significant amounts of work remain to make the new law tenable for physicians and the patients in their care.

U.S. Rep. Michael Burgess, MD (R-Lewisville), the primary House author of the MACRA bill and a TMA-member obstetrician-gynecologist, says it’s up to organizations like TMA to show physicians how to be successful in the post-SGR world. “My hope is, people will look at 2019, see the risk of a ding, and realize with a little bit of work they can get a payment bump up. So instead of a ding, you get a bump. How’s that? That would be good,” Rep. Burgess said.

Dr. Read said TMA will continue to offer CMS and Congress recommendations to improve MACRA and protect physicians and their patients. “We strongly believe Congress did not intend many of the adverse consequences that will be the result of the new payment formula. We are hopeful that CMS will use its considerable discretion to act in every way possible to minimize the adverse impact.”
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