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PHILADELPHIA – Genitourinary syndrome of menopause (GSM) replaced vulvovaginal atrophy in 2014 as a way to describe the changes to the genital and urinary tracts after menopause, but preliminary research shows it may be missing some symptoms.

In 2015, Amanda Clark, MD, a urogynecologist at the Kaiser Center for Health Research in Portland, Ore., and her colleagues surveyed women aged 55 years and older about their vulvar, vaginal, urinary, and sexual symptoms within 2 weeks of a well-woman visit to their primary care physician or gynecologist in the Kaiser system. In total, 1,533 provided valid data.

The researchers then used factor analysis to see if the symptoms matched up with GSM. If GSM is a true syndrome and only a single syndrome, then all of the factors would fit together in a one-factor model, Dr. Clark explained at the annual meeting of the North American Menopause Society. Instead, the researchers found that a three-factor model – with vulvovaginal symptoms of irritation and pain in one group, urinary symptoms in another group, and vaginal discharge and odor in a third group – fit best with the symptoms reported in their survey.

“This work is very preliminary and needs to be replicated in many other samples and looked at carefully,” Dr. Clark said in an interview. “But what we think is that genitourinary syndrome of menopause is a starting point.”

The study was funded by a Pfizer Independent Grant for Learning & Change and the North American Menopause Society. Dr. Clark reported having no relevant financial disclosures.

[email protected]

On Twitter @maryellenny

PHILADELPHIA – Genitourinary syndrome of menopause (GSM) replaced vulvovaginal atrophy in 2014 as a way to describe the changes to the genital and urinary tracts after menopause, but preliminary research shows it may be missing some symptoms.

In 2015, Amanda Clark, MD, a urogynecologist at the Kaiser Center for Health Research in Portland, Ore., and her colleagues surveyed women aged 55 years and older about their vulvar, vaginal, urinary, and sexual symptoms within 2 weeks of a well-woman visit to their primary care physician or gynecologist in the Kaiser system. In total, 1,533 provided valid data.

The researchers then used factor analysis to see if the symptoms matched up with GSM. If GSM is a true syndrome and only a single syndrome, then all of the factors would fit together in a one-factor model, Dr. Clark explained at the annual meeting of the North American Menopause Society. Instead, the researchers found that a three-factor model – with vulvovaginal symptoms of irritation and pain in one group, urinary symptoms in another group, and vaginal discharge and odor in a third group – fit best with the symptoms reported in their survey.

“This work is very preliminary and needs to be replicated in many other samples and looked at carefully,” Dr. Clark said in an interview. “But what we think is that genitourinary syndrome of menopause is a starting point.”

The study was funded by a Pfizer Independent Grant for Learning & Change and the North American Menopause Society. Dr. Clark reported having no relevant financial disclosures.

[email protected]

On Twitter @maryellenny

PHILADELPHIA – Genitourinary syndrome of menopause (GSM) replaced vulvovaginal atrophy in 2014 as a way to describe the changes to the genital and urinary tracts after menopause, but preliminary research shows it may be missing some symptoms.

In 2015, Amanda Clark, MD, a urogynecologist at the Kaiser Center for Health Research in Portland, Ore., and her colleagues surveyed women aged 55 years and older about their vulvar, vaginal, urinary, and sexual symptoms within 2 weeks of a well-woman visit to their primary care physician or gynecologist in the Kaiser system. In total, 1,533 provided valid data.

The researchers then used factor analysis to see if the symptoms matched up with GSM. If GSM is a true syndrome and only a single syndrome, then all of the factors would fit together in a one-factor model, Dr. Clark explained at the annual meeting of the North American Menopause Society. Instead, the researchers found that a three-factor model – with vulvovaginal symptoms of irritation and pain in one group, urinary symptoms in another group, and vaginal discharge and odor in a third group – fit best with the symptoms reported in their survey.

“This work is very preliminary and needs to be replicated in many other samples and looked at carefully,” Dr. Clark said in an interview. “But what we think is that genitourinary syndrome of menopause is a starting point.”

The study was funded by a Pfizer Independent Grant for Learning & Change and the North American Menopause Society. Dr. Clark reported having no relevant financial disclosures.

[email protected]

On Twitter @maryellenny

ORLANDO – Mechanical enhancements to existing colonoscopes may be better than optical enhancements for improving adenoma detection, according to findings from a meta-analysis of data from 240 studies.

“Even though colonoscopy is felt to be our best test compared to others … we also recognize that we do not see every square inch of the colon,” Seth Gross, MD, of New York University Langone Medical Center said in a video interview at the World Congress of Gastroenterology at ACG 2017.

There has been a “tremendous drive” to improve the ability to inspect blind spots in the colon, and also to better recognize subtle precancerous lesions in visible areas of the colon, but it has been unclear whether optical or mechanical enhancements will better achieve that goal, Dr. Gross said.

Based on the findings of his meta-analysis, it appears that mechanical enhancements, including integrated balloons and single-use caps with finger-like projections or discs that clip on to the colonoscope to engage the colon wall and flatten areas to allow access to areas behind folds, are most effective.

The preliminary data should lead to more clinical questions about what can be done to improve exams, he said.

In fact, one four-arm study looking at standard colonoscopy vs. colonoscopy with various mechanical enhancements was just completed, and others looking at “deep learning” and computer assistance are underway.

The latter technology is intriguing, as “not every polyp that we’re missing is behind a fold,” Dr. Gross noted.

Preliminary findings from a study out of China demonstrated the feasibility of such computer assistance, and the researchers are now working on a prospective study of real-time cases to see if that type of integrated learning with computer assistance can improve polyp detection.

“Sometimes it’s just these subtle mucosal changes that we have to train our eye to identify,” he said. “So imagine having another set of eyes … where there’s a computer sort of highlighting an area that we should focus on.”

Dr. Gross reported having no relevant financial disclosures.

[email protected]

ORLANDO – Mechanical enhancements to existing colonoscopes may be better than optical enhancements for improving adenoma detection, according to findings from a meta-analysis of data from 240 studies.

“Even though colonoscopy is felt to be our best test compared to others … we also recognize that we do not see every square inch of the colon,” Seth Gross, MD, of New York University Langone Medical Center said in a video interview at the World Congress of Gastroenterology at ACG 2017.

There has been a “tremendous drive” to improve the ability to inspect blind spots in the colon, and also to better recognize subtle precancerous lesions in visible areas of the colon, but it has been unclear whether optical or mechanical enhancements will better achieve that goal, Dr. Gross said.

Based on the findings of his meta-analysis, it appears that mechanical enhancements, including integrated balloons and single-use caps with finger-like projections or discs that clip on to the colonoscope to engage the colon wall and flatten areas to allow access to areas behind folds, are most effective.

The preliminary data should lead to more clinical questions about what can be done to improve exams, he said.

In fact, one four-arm study looking at standard colonoscopy vs. colonoscopy with various mechanical enhancements was just completed, and others looking at “deep learning” and computer assistance are underway.

The latter technology is intriguing, as “not every polyp that we’re missing is behind a fold,” Dr. Gross noted.

Preliminary findings from a study out of China demonstrated the feasibility of such computer assistance, and the researchers are now working on a prospective study of real-time cases to see if that type of integrated learning with computer assistance can improve polyp detection.

“Sometimes it’s just these subtle mucosal changes that we have to train our eye to identify,” he said. “So imagine having another set of eyes … where there’s a computer sort of highlighting an area that we should focus on.”

Dr. Gross reported having no relevant financial disclosures.

[email protected]

ORLANDO – Mechanical enhancements to existing colonoscopes may be better than optical enhancements for improving adenoma detection, according to findings from a meta-analysis of data from 240 studies.

“Even though colonoscopy is felt to be our best test compared to others … we also recognize that we do not see every square inch of the colon,” Seth Gross, MD, of New York University Langone Medical Center said in a video interview at the World Congress of Gastroenterology at ACG 2017.

There has been a “tremendous drive” to improve the ability to inspect blind spots in the colon, and also to better recognize subtle precancerous lesions in visible areas of the colon, but it has been unclear whether optical or mechanical enhancements will better achieve that goal, Dr. Gross said.

Based on the findings of his meta-analysis, it appears that mechanical enhancements, including integrated balloons and single-use caps with finger-like projections or discs that clip on to the colonoscope to engage the colon wall and flatten areas to allow access to areas behind folds, are most effective.

The preliminary data should lead to more clinical questions about what can be done to improve exams, he said.

In fact, one four-arm study looking at standard colonoscopy vs. colonoscopy with various mechanical enhancements was just completed, and others looking at “deep learning” and computer assistance are underway.

The latter technology is intriguing, as “not every polyp that we’re missing is behind a fold,” Dr. Gross noted.

Preliminary findings from a study out of China demonstrated the feasibility of such computer assistance, and the researchers are now working on a prospective study of real-time cases to see if that type of integrated learning with computer assistance can improve polyp detection.

“Sometimes it’s just these subtle mucosal changes that we have to train our eye to identify,” he said. “So imagine having another set of eyes … where there’s a computer sort of highlighting an area that we should focus on.”

Dr. Gross reported having no relevant financial disclosures.

[email protected]

SAN DIEGO – Earlier this month, an article in Lancet Psychiatry reported the results of a prospective, randomized, sham-controlled trial that tested deep brain stimulation of the Brodmann area 25 within the subcallosal cingulate white matter in 90 patients with treatment-resistant depression. Unfortunately, the study showed no significant benefit at 6 months.

The approach had shown promise in some previous open-label studies, which prompted the multicenter trial (Lancet Psychiatry. 2017 Oct 4. doi: 10.1016/S2215-0366(17)30371-1).

Although the 6-month results were disappointing, the open-label phase of the study told a different story. At 2 years, 48% of patients in the stimulation group achieved an antidepressant response, higher than what would be expected from treatment as usual in this difficult population.

In this video interview at the annual meeting of the American Neurological Association, Helen Mayberg, MD, one of the study authors and professor of psychiatry, neurology, and radiology at Emory University, Atlanta, discusses these long-term results and their implications, as well as lessons learned and how they might inform future research.

SAN DIEGO – Earlier this month, an article in Lancet Psychiatry reported the results of a prospective, randomized, sham-controlled trial that tested deep brain stimulation of the Brodmann area 25 within the subcallosal cingulate white matter in 90 patients with treatment-resistant depression. Unfortunately, the study showed no significant benefit at 6 months.

The approach had shown promise in some previous open-label studies, which prompted the multicenter trial (Lancet Psychiatry. 2017 Oct 4. doi: 10.1016/S2215-0366(17)30371-1).

Although the 6-month results were disappointing, the open-label phase of the study told a different story. At 2 years, 48% of patients in the stimulation group achieved an antidepressant response, higher than what would be expected from treatment as usual in this difficult population.

In this video interview at the annual meeting of the American Neurological Association, Helen Mayberg, MD, one of the study authors and professor of psychiatry, neurology, and radiology at Emory University, Atlanta, discusses these long-term results and their implications, as well as lessons learned and how they might inform future research.

SAN DIEGO – Earlier this month, an article in Lancet Psychiatry reported the results of a prospective, randomized, sham-controlled trial that tested deep brain stimulation of the Brodmann area 25 within the subcallosal cingulate white matter in 90 patients with treatment-resistant depression. Unfortunately, the study showed no significant benefit at 6 months.

The approach had shown promise in some previous open-label studies, which prompted the multicenter trial (Lancet Psychiatry. 2017 Oct 4. doi: 10.1016/S2215-0366(17)30371-1).

Although the 6-month results were disappointing, the open-label phase of the study told a different story. At 2 years, 48% of patients in the stimulation group achieved an antidepressant response, higher than what would be expected from treatment as usual in this difficult population.

In this video interview at the annual meeting of the American Neurological Association, Helen Mayberg, MD, one of the study authors and professor of psychiatry, neurology, and radiology at Emory University, Atlanta, discusses these long-term results and their implications, as well as lessons learned and how they might inform future research.

If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:
 

Measure #47: Care Plan

This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.

What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.

Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

CMS has a full list of measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.
• Those who have Medicare Part B–allowed charges of $30,000 or less.
• Those who have 100 or fewer Medicare Part B patients.
• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:
 

Measure #47: Care Plan

This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.

What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.

Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

CMS has a full list of measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.
• Those who have Medicare Part B–allowed charges of $30,000 or less.
• Those who have 100 or fewer Medicare Part B patients.
• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:
 

Measure #47: Care Plan

This measure is aimed at capturing the percentage of patients aged 65 years and older who have a documented advance care plan in their medical records.

What you need to do: Discuss with the patient the creation of an advance care plan or the naming of a surrogate decision maker and then document that in the medical record. If the patient does not wish to make a plan or is unable to name a decision maker, document that along with the fact that the issue of advance care planning was discussed.

Eligible cases include patients aged 65 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205,99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a Quality Data Code that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 1123F indicates that advance care planning was discussed and documented, and an advance care plan or surrogate decision maker was documented in the medical record. On the other hand, CPT II 1124F should be used if advance care planning was discussed and documented in the medical record, but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan.

CMS has a full list of measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.
• Those who have Medicare Part B–allowed charges of $30,000 or less.
• Those who have 100 or fewer Medicare Part B patients.
• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

BARCELONA – In patients with heart failure with reduced ejection fraction who also have atrial fibrillation, catheter ablation of the arrhythmia produced significantly improved long-term survival and a significant reduction in heart failure hospitalizations, in results from a multicenter randomized trial with more than 350 patients.

During 5-year follow-up, heart failure patients who underwent an ablative procedure for their atrial fibrillation (AF) had a statistically significant 37% lower rate of the combined primary endpoint of all-cause death or hospitalization for worsening heart failure, compared with control patients managed by standard medical therapy, Nassir F. Marrouche, MD, said at the annual congress of the European Society of Cardiology. The results also showed significant reductions from ablation, compared with controls, for the individual secondary endpoints of all-cause mortality, heart failure hospitalizations, cardiovascular mortality, and cardiovascular hospitalizations, said Dr. Marrouche, a professor of medicine and electrophysiologist at the University of Utah in Salt Lake City.

Mitchel L. Zoler/Frontline Medical News

CASTLE AF was funded by Biotronik. Dr. Marrouche has been a consultant to and received research funding from Biotronik and from several other companies. Dr. Brachmann has been a speaker for and has received research funding from Biotronik and from Abbott and Medtronic.

[email protected]

On Twitter @mitchelzoler

BARCELONA – In patients with heart failure with reduced ejection fraction who also have atrial fibrillation, catheter ablation of the arrhythmia produced significantly improved long-term survival and a significant reduction in heart failure hospitalizations, in results from a multicenter randomized trial with more than 350 patients.

During 5-year follow-up, heart failure patients who underwent an ablative procedure for their atrial fibrillation (AF) had a statistically significant 37% lower rate of the combined primary endpoint of all-cause death or hospitalization for worsening heart failure, compared with control patients managed by standard medical therapy, Nassir F. Marrouche, MD, said at the annual congress of the European Society of Cardiology. The results also showed significant reductions from ablation, compared with controls, for the individual secondary endpoints of all-cause mortality, heart failure hospitalizations, cardiovascular mortality, and cardiovascular hospitalizations, said Dr. Marrouche, a professor of medicine and electrophysiologist at the University of Utah in Salt Lake City.

Mitchel L. Zoler/Frontline Medical News

CASTLE AF was funded by Biotronik. Dr. Marrouche has been a consultant to and received research funding from Biotronik and from several other companies. Dr. Brachmann has been a speaker for and has received research funding from Biotronik and from Abbott and Medtronic.

[email protected]

On Twitter @mitchelzoler

BARCELONA – In patients with heart failure with reduced ejection fraction who also have atrial fibrillation, catheter ablation of the arrhythmia produced significantly improved long-term survival and a significant reduction in heart failure hospitalizations, in results from a multicenter randomized trial with more than 350 patients.

During 5-year follow-up, heart failure patients who underwent an ablative procedure for their atrial fibrillation (AF) had a statistically significant 37% lower rate of the combined primary endpoint of all-cause death or hospitalization for worsening heart failure, compared with control patients managed by standard medical therapy, Nassir F. Marrouche, MD, said at the annual congress of the European Society of Cardiology. The results also showed significant reductions from ablation, compared with controls, for the individual secondary endpoints of all-cause mortality, heart failure hospitalizations, cardiovascular mortality, and cardiovascular hospitalizations, said Dr. Marrouche, a professor of medicine and electrophysiologist at the University of Utah in Salt Lake City.

Mitchel L. Zoler/Frontline Medical News

CASTLE AF was funded by Biotronik. Dr. Marrouche has been a consultant to and received research funding from Biotronik and from several other companies. Dr. Brachmann has been a speaker for and has received research funding from Biotronik and from Abbott and Medtronic.

[email protected]

On Twitter @mitchelzoler

If you haven’t started reporting quality data for the Merit-based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Measure #112: Breast Cancer Screening

This measure is aimed at capturing the percentage of women 50-74 years old who had a mammogram to screen for breast cancer.

What you need to do: The patient should either be screened for breast cancer on the date of service or there should be documentation that the patient was screened for breast cancer at least once within 27 months prior to the date of service.

Eligible cases include patients 51-74 years of age on the date of encounter and a patient encounter during the performance period. Applicable codes (CPT or HCPCS) include 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 3014F indicates that screening mammography results were documented and reviewed. Code G9708 is an exclusion code for women who had a bilateral mastectomy or evidence of a right or left unilateral mastectomy.

CMS has a full list measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.

• Those who have Medicare Part B allowed charges of $30,000 or less.

• Those who have 100 or fewer Medicare Part B patients.

• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

If you haven’t started reporting quality data for the Merit-based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Measure #112: Breast Cancer Screening

This measure is aimed at capturing the percentage of women 50-74 years old who had a mammogram to screen for breast cancer.

What you need to do: The patient should either be screened for breast cancer on the date of service or there should be documentation that the patient was screened for breast cancer at least once within 27 months prior to the date of service.

Eligible cases include patients 51-74 years of age on the date of encounter and a patient encounter during the performance period. Applicable codes (CPT or HCPCS) include 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 3014F indicates that screening mammography results were documented and reviewed. Code G9708 is an exclusion code for women who had a bilateral mastectomy or evidence of a right or left unilateral mastectomy.

CMS has a full list measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.

• Those who have Medicare Part B allowed charges of $30,000 or less.

• Those who have 100 or fewer Medicare Part B patients.

• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

If you haven’t started reporting quality data for the Merit-based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Measure #112: Breast Cancer Screening

This measure is aimed at capturing the percentage of women 50-74 years old who had a mammogram to screen for breast cancer.

What you need to do: The patient should either be screened for breast cancer on the date of service or there should be documentation that the patient was screened for breast cancer at least once within 27 months prior to the date of service.

Eligible cases include patients 51-74 years of age on the date of encounter and a patient encounter during the performance period. Applicable codes (CPT or HCPCS) include 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, CPT II 3014F indicates that screening mammography results were documented and reviewed. Code G9708 is an exclusion code for women who had a bilateral mastectomy or evidence of a right or left unilateral mastectomy.

CMS has a full list measures available for claims-based reporting at qpp.cms.gov. The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

• Those who enrolled in Medicare for the first time during a performance period.

• Those who have Medicare Part B allowed charges of $30,000 or less.

• Those who have 100 or fewer Medicare Part B patients.

• Those who are significantly participating in an Advanced Alternative Payment Model (APM).

David O. Barbe, MD, is urging physicians to participate in the Medicare Quality Payment Program, even if the business case isn’t quite there.

QPP is the value-based payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). It promotes high-value care through Medicare payment increases. But for some practices, the investment in personnel and technology needed to earn those increases may be more than the increases themselves, leading doctors to do just enough to avoid being penalized.

“I think that many physicians don’t feel they are ever going to get a bonus but sure would like to avoid a penalty,” Dr. Barbe, president of the American Medical Association, said in an exclusive interview. “I am afraid many will simply perform at the lowest level that keeps them out of the penalty. Because many of them find that making the investment it takes to perform highly, there is not a business case for that.”

Full participation in QPP’s Merit-based Incentive Payment System (MIPS) could run small practices an additional $10,000 to $30,000 a year, he said. “If you’ve got $200,000 in Medicare receipts, if you get adjusted even the maximum of 4%, that is $8,000. You can’t cover $20,000 with $8,000. The math doesn’t work. There is not a business case there for it.”

That said, Dr. Barbe still spoke in favor of QPP and noted that the AMA is working with the Centers for Medicare & Medicaid Services as well as Congress to make the program more valuable and meaningful for physicians.

“We understand where we need to go as a profession, as an industry,” he said. “How we get there is the key, it’s the challenge and it requires flexibility. ... CMS has been accommodating but there are limits to how long they can go.”

The AMA is urging doctors who have missed the 90-day window for full participation – which effectively closed for most on Oct. 2 – to consider the Pick Your Pace option offered by the CMS.

[email protected]

David O. Barbe, MD, is urging physicians to participate in the Medicare Quality Payment Program, even if the business case isn’t quite there.

QPP is the value-based payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). It promotes high-value care through Medicare payment increases. But for some practices, the investment in personnel and technology needed to earn those increases may be more than the increases themselves, leading doctors to do just enough to avoid being penalized.

“I think that many physicians don’t feel they are ever going to get a bonus but sure would like to avoid a penalty,” Dr. Barbe, president of the American Medical Association, said in an exclusive interview. “I am afraid many will simply perform at the lowest level that keeps them out of the penalty. Because many of them find that making the investment it takes to perform highly, there is not a business case for that.”

Full participation in QPP’s Merit-based Incentive Payment System (MIPS) could run small practices an additional $10,000 to $30,000 a year, he said. “If you’ve got $200,000 in Medicare receipts, if you get adjusted even the maximum of 4%, that is $8,000. You can’t cover $20,000 with $8,000. The math doesn’t work. There is not a business case there for it.”

That said, Dr. Barbe still spoke in favor of QPP and noted that the AMA is working with the Centers for Medicare & Medicaid Services as well as Congress to make the program more valuable and meaningful for physicians.

“We understand where we need to go as a profession, as an industry,” he said. “How we get there is the key, it’s the challenge and it requires flexibility. ... CMS has been accommodating but there are limits to how long they can go.”

The AMA is urging doctors who have missed the 90-day window for full participation – which effectively closed for most on Oct. 2 – to consider the Pick Your Pace option offered by the CMS.

[email protected]

David O. Barbe, MD, is urging physicians to participate in the Medicare Quality Payment Program, even if the business case isn’t quite there.

QPP is the value-based payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). It promotes high-value care through Medicare payment increases. But for some practices, the investment in personnel and technology needed to earn those increases may be more than the increases themselves, leading doctors to do just enough to avoid being penalized.

“I think that many physicians don’t feel they are ever going to get a bonus but sure would like to avoid a penalty,” Dr. Barbe, president of the American Medical Association, said in an exclusive interview. “I am afraid many will simply perform at the lowest level that keeps them out of the penalty. Because many of them find that making the investment it takes to perform highly, there is not a business case for that.”

Full participation in QPP’s Merit-based Incentive Payment System (MIPS) could run small practices an additional $10,000 to $30,000 a year, he said. “If you’ve got $200,000 in Medicare receipts, if you get adjusted even the maximum of 4%, that is $8,000. You can’t cover $20,000 with $8,000. The math doesn’t work. There is not a business case there for it.”

That said, Dr. Barbe still spoke in favor of QPP and noted that the AMA is working with the Centers for Medicare & Medicaid Services as well as Congress to make the program more valuable and meaningful for physicians.

“We understand where we need to go as a profession, as an industry,” he said. “How we get there is the key, it’s the challenge and it requires flexibility. ... CMS has been accommodating but there are limits to how long they can go.”

The AMA is urging doctors who have missed the 90-day window for full participation – which effectively closed for most on Oct. 2 – to consider the Pick Your Pace option offered by the CMS.

[email protected]

Reaching people at risk of opioid abuse and suicide will require a shift beyond a focus on treating individuals to a more comprehensive public health approach.

“The majority of people aren’t showing up at our treatment doors, so we have to have a very different approach if we’re going to reach everyone,” explained Arthur C. Evans Jr. PhD, chief executive officer of the American Psychological Association.

In an interview at an event sponsored by the Education Development Center and the National Action Alliance for Suicide Prevention, Dr. Evans discussed effective strategies for taking a population-health treatment perspective.

Reaching people at risk of opioid abuse and suicide will require a shift beyond a focus on treating individuals to a more comprehensive public health approach.

“The majority of people aren’t showing up at our treatment doors, so we have to have a very different approach if we’re going to reach everyone,” explained Arthur C. Evans Jr. PhD, chief executive officer of the American Psychological Association.

In an interview at an event sponsored by the Education Development Center and the National Action Alliance for Suicide Prevention, Dr. Evans discussed effective strategies for taking a population-health treatment perspective.

Reaching people at risk of opioid abuse and suicide will require a shift beyond a focus on treating individuals to a more comprehensive public health approach.

“The majority of people aren’t showing up at our treatment doors, so we have to have a very different approach if we’re going to reach everyone,” explained Arthur C. Evans Jr. PhD, chief executive officer of the American Psychological Association.

In an interview at an event sponsored by the Education Development Center and the National Action Alliance for Suicide Prevention, Dr. Evans discussed effective strategies for taking a population-health treatment perspective.

SAN FRANCISCO – When patients with contact dermatitis who have had a patch test positive to an allergen and are not improving despite avoiding cutaneous exposure, it’s important to consider the possibility of systemic exposure, according to Nina Botto, MD, of the department of dermatology, at the University of California, San Francisco.

“Theoretically, any allergen can cause a systemic contact dermatitis. The ones that we think about and encounter more frequently are earth metals like nickel and balsam of Peru, which is a component of many fragrances and flavorings,” she said in a video interview at the annual meeting of the Pacific Dermatologic Association.

In the interview, Dr. Botto, who is codirector of the Occupational and Contact Dermatitis Clinic at UCSF, provides recommendations on how to approach patients with systemic contact dermatitis, including dietary avoidance. But following these diets can be challenging. She recommends starting with avoiding cutaneous exposure to the suspected allergen. For patients not improving after two months of avoidance, “it may be reasonable to consider a diet,”she advised.

Dr. Botto cited the following two publications with tables and guidelines for diets as helpful resources for patients: Dermatitis. 2013 Jul-Aug;24(4):153-60 (for a diet low in balsam of Peru); and Dermatitis. 2013 Jul-Aug; 24(4):190-5 (for a diet low in nickel).

Another useful resource is the American Contact Dermatitis Society website, which produces a customized list of safe products for patients after they enter the allergen into the system.

Dr. Botto had no disclosures.

[email protected]

SAN FRANCISCO – When patients with contact dermatitis who have had a patch test positive to an allergen and are not improving despite avoiding cutaneous exposure, it’s important to consider the possibility of systemic exposure, according to Nina Botto, MD, of the department of dermatology, at the University of California, San Francisco.

“Theoretically, any allergen can cause a systemic contact dermatitis. The ones that we think about and encounter more frequently are earth metals like nickel and balsam of Peru, which is a component of many fragrances and flavorings,” she said in a video interview at the annual meeting of the Pacific Dermatologic Association.

In the interview, Dr. Botto, who is codirector of the Occupational and Contact Dermatitis Clinic at UCSF, provides recommendations on how to approach patients with systemic contact dermatitis, including dietary avoidance. But following these diets can be challenging. She recommends starting with avoiding cutaneous exposure to the suspected allergen. For patients not improving after two months of avoidance, “it may be reasonable to consider a diet,”she advised.

Dr. Botto cited the following two publications with tables and guidelines for diets as helpful resources for patients: Dermatitis. 2013 Jul-Aug;24(4):153-60 (for a diet low in balsam of Peru); and Dermatitis. 2013 Jul-Aug; 24(4):190-5 (for a diet low in nickel).

Another useful resource is the American Contact Dermatitis Society website, which produces a customized list of safe products for patients after they enter the allergen into the system.

Dr. Botto had no disclosures.

[email protected]

SAN FRANCISCO – When patients with contact dermatitis who have had a patch test positive to an allergen and are not improving despite avoiding cutaneous exposure, it’s important to consider the possibility of systemic exposure, according to Nina Botto, MD, of the department of dermatology, at the University of California, San Francisco.

“Theoretically, any allergen can cause a systemic contact dermatitis. The ones that we think about and encounter more frequently are earth metals like nickel and balsam of Peru, which is a component of many fragrances and flavorings,” she said in a video interview at the annual meeting of the Pacific Dermatologic Association.

In the interview, Dr. Botto, who is codirector of the Occupational and Contact Dermatitis Clinic at UCSF, provides recommendations on how to approach patients with systemic contact dermatitis, including dietary avoidance. But following these diets can be challenging. She recommends starting with avoiding cutaneous exposure to the suspected allergen. For patients not improving after two months of avoidance, “it may be reasonable to consider a diet,”she advised.

Dr. Botto cited the following two publications with tables and guidelines for diets as helpful resources for patients: Dermatitis. 2013 Jul-Aug;24(4):153-60 (for a diet low in balsam of Peru); and Dermatitis. 2013 Jul-Aug; 24(4):190-5 (for a diet low in nickel).

Another useful resource is the American Contact Dermatitis Society website, which produces a customized list of safe products for patients after they enter the allergen into the system.

Dr. Botto had no disclosures.

[email protected]