Whitney McKnight

WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.

For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.

“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.

Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.

“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.

Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.

Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.

Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.

But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.

For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.

“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.

Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.

“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.

Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.

Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.

Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.

But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.

For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.

“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.

Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.

“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.

Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.

Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.

Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.

But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.

“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.

Copyright thinkstockphotos.com

As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.

He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.

Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.

Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.

“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.

Copyright thinkstockphotos.com

As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.

He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.

Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.

Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.

“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.

Copyright thinkstockphotos.com

As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.

He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.

Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.

Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.

The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.

“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.

Whitney McKnight/Frontline Medical News

“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.

Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.

“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.

The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.

Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.

A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.

“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”

The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.

Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.

The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.

“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.

Whitney McKnight/Frontline Medical News

“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.

Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.

“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.

The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.

Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.

A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.

“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”

The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.

Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.

[email protected]

On Twitter @whitneymcknight

WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.

The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.

“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.

Whitney McKnight/Frontline Medical News

“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.

Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.

“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.

The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.

Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.

A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.

“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”

The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.

Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.

[email protected]

On Twitter @whitneymcknight

The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.

“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.

As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.

In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.

Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.

In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.

A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.

Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.

As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.

Vaccine progress

In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.

Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.

“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.

Research gaps

Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.

“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”

Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.

“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.

Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.

Communicating risk

Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”

The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.

How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”

Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.

On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.

The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.

“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.

As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.

In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.

Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.

In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.

A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.

Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.

As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.

Vaccine progress

In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.

Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.

“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.

Research gaps

Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.

“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”

Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.

“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.

Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.

Communicating risk

Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”

The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.

How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”

Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.

On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.

The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.

“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.

As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.

In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.

Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.

In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.

A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.

Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.

As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.

Vaccine progress

In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.

Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.

“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.

Research gaps

Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.

“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”

Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.

“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.

Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.

Communicating risk

Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”

The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.

How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”

Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.

On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.

Pregnancy rates among Hispanic and black teens are at an all-time low, reflecting overall declines in teen birth rates, new data show.

The Centers for Disease Control and Prevention reported on April 28 that the rate of Hispanic teens giving birth in the United States has dropped by more than half since 2006. During that same time period, there was a 44% drop in the birth rate for black teens.

Although these dramatic declines occurred against the backdrop of an overall decrease of about 40% in teen birth rates during the last decade, the CDC also reported that birth rates among Hispanics and black teens are still twice as high as they are for whites.

“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” Dr. Tom Frieden, CDC director, said in a statement. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”

Overall, the birth rate among girls aged 15-19 years dropped from 41.1 to 24.2 per 1,000 from 2006 to 2014. The largest decline occurred in Hispanics, going from 77.4 to 38.0 per 1,000. The next biggest rate decline was in black teens, which fell from 61.9 to 34.9 per 1,000. The rate for white teens declined by 35%, falling from 26.7 to 17.3 per 1,000 (MMWR Morb Mortal Wkly Rep. 2016 Apr;65:409-14).

The CDC report indicated state- and community-level patterns, including that rates were notably higher among all races and ethnicities where unemployment is also high, but income and education levels are low. In some states with low overall birth rates, certain counties experienced higher rates. The highest rates nationwide tended to be in counties located in southern and southwestern states.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all – teen birth rates vary greatly across state lines and even within states,” Lisa Romero, Dr.P.H., a health scientist in the CDC’s Division of Reproductive Health, and the report’s lead author, said in a statement. “We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues. Together, we can work to implement proven prevention programs that take into account unique, local needs.”

The study is based on statistics for births to girls aged 15-19 years occurring between 2006 and 2014, taken from the National Vital Statistics System (NVSS). County-level NVSS data from 2013 and 2014 was also used, as were data from the American Community Survey between 2010 and 2014.

Pregnancy rates among Hispanic and black teens are at an all-time low, reflecting overall declines in teen birth rates, new data show.

The Centers for Disease Control and Prevention reported on April 28 that the rate of Hispanic teens giving birth in the United States has dropped by more than half since 2006. During that same time period, there was a 44% drop in the birth rate for black teens.

Although these dramatic declines occurred against the backdrop of an overall decrease of about 40% in teen birth rates during the last decade, the CDC also reported that birth rates among Hispanics and black teens are still twice as high as they are for whites.

“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” Dr. Tom Frieden, CDC director, said in a statement. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”

Overall, the birth rate among girls aged 15-19 years dropped from 41.1 to 24.2 per 1,000 from 2006 to 2014. The largest decline occurred in Hispanics, going from 77.4 to 38.0 per 1,000. The next biggest rate decline was in black teens, which fell from 61.9 to 34.9 per 1,000. The rate for white teens declined by 35%, falling from 26.7 to 17.3 per 1,000 (MMWR Morb Mortal Wkly Rep. 2016 Apr;65:409-14).

The CDC report indicated state- and community-level patterns, including that rates were notably higher among all races and ethnicities where unemployment is also high, but income and education levels are low. In some states with low overall birth rates, certain counties experienced higher rates. The highest rates nationwide tended to be in counties located in southern and southwestern states.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all – teen birth rates vary greatly across state lines and even within states,” Lisa Romero, Dr.P.H., a health scientist in the CDC’s Division of Reproductive Health, and the report’s lead author, said in a statement. “We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues. Together, we can work to implement proven prevention programs that take into account unique, local needs.”

The study is based on statistics for births to girls aged 15-19 years occurring between 2006 and 2014, taken from the National Vital Statistics System (NVSS). County-level NVSS data from 2013 and 2014 was also used, as were data from the American Community Survey between 2010 and 2014.

Pregnancy rates among Hispanic and black teens are at an all-time low, reflecting overall declines in teen birth rates, new data show.

The Centers for Disease Control and Prevention reported on April 28 that the rate of Hispanic teens giving birth in the United States has dropped by more than half since 2006. During that same time period, there was a 44% drop in the birth rate for black teens.

Although these dramatic declines occurred against the backdrop of an overall decrease of about 40% in teen birth rates during the last decade, the CDC also reported that birth rates among Hispanics and black teens are still twice as high as they are for whites.

“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” Dr. Tom Frieden, CDC director, said in a statement. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”

Overall, the birth rate among girls aged 15-19 years dropped from 41.1 to 24.2 per 1,000 from 2006 to 2014. The largest decline occurred in Hispanics, going from 77.4 to 38.0 per 1,000. The next biggest rate decline was in black teens, which fell from 61.9 to 34.9 per 1,000. The rate for white teens declined by 35%, falling from 26.7 to 17.3 per 1,000 (MMWR Morb Mortal Wkly Rep. 2016 Apr;65:409-14).

The CDC report indicated state- and community-level patterns, including that rates were notably higher among all races and ethnicities where unemployment is also high, but income and education levels are low. In some states with low overall birth rates, certain counties experienced higher rates. The highest rates nationwide tended to be in counties located in southern and southwestern states.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all – teen birth rates vary greatly across state lines and even within states,” Lisa Romero, Dr.P.H., a health scientist in the CDC’s Division of Reproductive Health, and the report’s lead author, said in a statement. “We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues. Together, we can work to implement proven prevention programs that take into account unique, local needs.”

The study is based on statistics for births to girls aged 15-19 years occurring between 2006 and 2014, taken from the National Vital Statistics System (NVSS). County-level NVSS data from 2013 and 2014 was also used, as were data from the American Community Survey between 2010 and 2014.

Pregnancy rates among Hispanic and black teens are at an all-time low, reflecting overall declines in teen birth rates, new data show.

The Centers for Disease Control and Prevention reported on April 28 that the rate of Hispanic teens giving birth in the United States has dropped by more than half since 2006. During that same time period, there was a 44% drop in the birth rate for black teens.

Although these dramatic declines occurred against the backdrop of an overall decrease of about 40% in teen birth rates during the last decade, the CDC also reported that birth rates among Hispanics and black teens are still twice as high as they are for whites.

“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” Dr. Tom Frieden, CDC director, said in a statement. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”

Overall, the birth rate among girls aged 15-19 years dropped from 41.1 to 24.2 per 1,000 from 2006 to 2014. The largest decline occurred in Hispanics, going from 77.4 to 38.0 per 1,000. The next biggest rate decline was in black teens, which fell from 61.9 to 34.9 per 1,000. The rate for white teens declined by 35%, falling from 26.7 to 17.3 per 1,000 (MMWR Morb Mortal Wkly Rep. 2016 Apr;65:409-14).

The CDC report indicated state- and community-level patterns, including that rates were notably higher among all races and ethnicities where unemployment is also high, but income and education levels are low. In some states with low overall birth rates, certain counties experienced higher rates. The highest rates nationwide tended to be in counties located in southern and southwestern states.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all – teen birth rates vary greatly across state lines and even within states,” Lisa Romero, Dr.P.H., a health scientist in the CDC’s Division of Reproductive Health, and the report’s lead author, said in a statement. “We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues. Together, we can work to implement proven prevention programs that take into account unique, local needs.”

The study is based on statistics for births to girls aged 15-19 years occurring between 2006 and 2014, taken from the National Vital Statistics System (NVSS). County-level NVSS data from 2013 and 2014 was also used, as were data from the American Community Survey between 2010 and 2014.

[email protected]

On Twitter @whitneymcknight

Pregnancy rates among Hispanic and black teens are at an all-time low, reflecting overall declines in teen birth rates, new data show.

The Centers for Disease Control and Prevention reported on April 28 that the rate of Hispanic teens giving birth in the United States has dropped by more than half since 2006. During that same time period, there was a 44% drop in the birth rate for black teens.

Although these dramatic declines occurred against the backdrop of an overall decrease of about 40% in teen birth rates during the last decade, the CDC also reported that birth rates among Hispanics and black teens are still twice as high as they are for whites.

“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” Dr. Tom Frieden, CDC director, said in a statement. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”

Overall, the birth rate among girls aged 15-19 years dropped from 41.1 to 24.2 per 1,000 from 2006 to 2014. The largest decline occurred in Hispanics, going from 77.4 to 38.0 per 1,000. The next biggest rate decline was in black teens, which fell from 61.9 to 34.9 per 1,000. The rate for white teens declined by 35%, falling from 26.7 to 17.3 per 1,000 (MMWR Morb Mortal Wkly Rep. 2016 Apr;65:409-14).

The CDC report indicated state- and community-level patterns, including that rates were notably higher among all races and ethnicities where unemployment is also high, but income and education levels are low. In some states with low overall birth rates, certain counties experienced higher rates. The highest rates nationwide tended to be in counties located in southern and southwestern states.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all – teen birth rates vary greatly across state lines and even within states,” Lisa Romero, Dr.P.H., a health scientist in the CDC’s Division of Reproductive Health, and the report’s lead author, said in a statement. “We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues. Together, we can work to implement proven prevention programs that take into account unique, local needs.”

The study is based on statistics for births to girls aged 15-19 years occurring between 2006 and 2014, taken from the National Vital Statistics System (NVSS). County-level NVSS data from 2013 and 2014 was also used, as were data from the American Community Survey between 2010 and 2014.

[email protected]

On Twitter @whitneymcknight

Pregnancy rates among Hispanic and black teens are at an all-time low, reflecting overall declines in teen birth rates, new data show.

The Centers for Disease Control and Prevention reported on April 28 that the rate of Hispanic teens giving birth in the United States has dropped by more than half since 2006. During that same time period, there was a 44% drop in the birth rate for black teens.

Although these dramatic declines occurred against the backdrop of an overall decrease of about 40% in teen birth rates during the last decade, the CDC also reported that birth rates among Hispanics and black teens are still twice as high as they are for whites.

“The United States has made remarkable progress in reducing both teen pregnancy and racial and ethnic differences, but the reality is, too many American teens are still having babies,” Dr. Tom Frieden, CDC director, said in a statement. “By better understanding the many factors that contribute to teen pregnancy, we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.”

Overall, the birth rate among girls aged 15-19 years dropped from 41.1 to 24.2 per 1,000 from 2006 to 2014. The largest decline occurred in Hispanics, going from 77.4 to 38.0 per 1,000. The next biggest rate decline was in black teens, which fell from 61.9 to 34.9 per 1,000. The rate for white teens declined by 35%, falling from 26.7 to 17.3 per 1,000 (MMWR Morb Mortal Wkly Rep. 2016 Apr;65:409-14).

The CDC report indicated state- and community-level patterns, including that rates were notably higher among all races and ethnicities where unemployment is also high, but income and education levels are low. In some states with low overall birth rates, certain counties experienced higher rates. The highest rates nationwide tended to be in counties located in southern and southwestern states.

“These data underscore that the solution to our nation’s teen pregnancy problem is not going to be a one-size-fits-all – teen birth rates vary greatly across state lines and even within states,” Lisa Romero, Dr.P.H., a health scientist in the CDC’s Division of Reproductive Health, and the report’s lead author, said in a statement. “We can ensure the success of teen pregnancy prevention efforts by capitalizing on the expertise of our state and local public health colleagues. Together, we can work to implement proven prevention programs that take into account unique, local needs.”

The study is based on statistics for births to girls aged 15-19 years occurring between 2006 and 2014, taken from the National Vital Statistics System (NVSS). County-level NVSS data from 2013 and 2014 was also used, as were data from the American Community Survey between 2010 and 2014.

[email protected]

On Twitter @whitneymcknight