5 Tips to Help Your Patients Make Their New Year a Healthy One

5 Tips to Help Your Patients Make Their New Year a Healthy One

Here are five simple ways to help you maximize your patients’ health and make a concerted effort at management and prevention of such chronic diseases as type 2 diabetes and hypertension.

1. Educate your patients on their risk for prediabetes.

According to the Centers for Disease Control and Prevention (CDC), 84 million adults have prediabetes. But the good news is that prediabetes is often times a reversible condition. So it’s important that you screen patients to determine who may be at risk.

To make it easier for physicians to screen patients, the CDC and the American Medical Association developed the Prevent Diabetes STAT toolkit. The toolkit encourages physicians to:

  • Screen patients using a simple 1-minute risk assessment test, available online or in paper form
  • Test patients using one of three blood tests and
  • Act Today, which encourages physicians to refer patients with prediabetes to a lifestyle modification program to reduce their chances of developing type 2 diabetes

2. Encourage patients with prediabetes to enroll in lifestyle prevention programs.

Once you’ve identified patients who have prediabetes, their participation in a lifestyle change program that is part of the National Diabetes Prevention Program (National DPP) becomes vital to their success.

Study results reveal that participation in a lifestyle change program that included counseling and motivation support on proper physical activity, diet and behavioral changes lowered participants’ risk of developing type 2 diabetes by 58 percent. And for those aged 60 years and older, the risk was reduced by 71 percent.

Talk with your patients about how lifestyle change programs work and what the benefits of joining a DPP are. The Prevent Diabetes STAT toolkit includes helpful handouts and additional resources that can help you educate patients on the importance of it and how to partner with DPP providers in your community.

3. Learn how new BP guidelines affect your patient population.

New comprehensive hypertension guidelines have been released with key recommendations on the diagnosis, treatment and prevention of the condition.

The new lower target for blood pressure treatment is now 130/80 mmHg for most patients, which stresses the need for early detection, prevention and treatment to reduce the risk of future cardiovascular events.

By better understanding how the new guidelines work in practice, you can best serve your patient population and help to keep high blood pressure under control.

4. Help patients control their high blood pressure.

If you’re committed to taking action to help manage your patients’ rates of hypertension, the BP Improvement Program can serve as a great resource.

This evidence-based guide highlights three critical areas:

  • Measuring blood pressure accurately
  • Acting rapidly with a clear treatment plan and
  • Partnering with patients to enable them to self-manage their condition

When you work with your patients to improve their blood pressure control, you improve their quality of care and also help lower their risk of heart attack, stroke and death.

5. Make health a family affair.

As you encourage and support your patients in having a healthier lifestyle, it’s also important that they have the support of loved ones as well. Encourage all family members to work together to get healthy.

Suggest that they prepare healthy meals together, do fun physical activities together and spend time connecting as a family unit. That added support system makes it more likely that they will be successful and reinforces the importance of health for the rest of the family and encourages healthy habits that will last throughout the year.

Legislative Update – February 1, 2019

Thank you to all of our physicians, physician assistants, and medical students who participated in our January White Coats on Call Lobby Day! Over 100 doctors, PAs, and medical students visited with over 65 legislators to advocate for the practice of medicine and patients in Virginia.

Key Issues 

The GA saw great progress with several important bills before the legislature this week – but we need your support. See this week’s updates and how to help.

Medicaid Reimbursement Rates

Del. Scott Garrett, MD and Sen. Emmett Hanger submitted budget amendments (303 #23h and 303 #4s) that would increase Medicaid reimbursement rates for physicians currently reimbursed below 75% of Medicare. This is the one of the most significant pieces of legislation to impact access to care for Virginia patients. With the House and Senate budgets being announced on Sunday, all members of the General Assembly, must hear from you immediately. Get more information on our website.

Send a Message

Surprise/Balance Billing

MSV is working with the entire physician, patient, and hospital community to advocate for patient-friendly solutions that also secure reasonable and sustainable reimbursements. The health plans have blocked our efforts to protect patients in this legislation. We are down to one bill that is supporting these efforts: SB 1763 (Sturtevant).

SB 1763 (Sturtevant) addresses emergency balance billing; the bill would protect patients from balance billing and ensure physicians are paid directly. In addition, the bill would pay providers a fair and reasonable amount. SB 1763 is supported by the entire physician community, patient groups, and the Virginia Hospital and Healthcare Association (VHHA). This week it passed the Senate Commerce and Labor Committee and Senate Finance Committee and will now head to the Senate floor for a vote. The opposing bill (Wagner), was defeated by the Medical Society and health care community fighting for our patients. SB 1763 is now the only bill in the Senate that reforms emergency balance billing.

HB 1714 (Ware) was the House version of this bill and successfully reported out of House Commerce and Labor Committee this week but was sent to the House Committee on Appropriations due to Anthem raising speculative financial concerns about the state employee health plan. Anthem applied substantial pressure of future risk which resulted in the Appropriations Committee deciding to not hear the bill; therefore the bill is now dead despite the physician, hospital, and patient community fighting together for a patient-friendly solution.

Public Health

SB1727 (Norment) and HB2748 (Stolle) increase the minimum age for persons prohibited from purchasing or possessing tobacco products, nicotine vapor products, and alternative nicotine products, and the minimum age for persons such products can be sold to, from 18 years of age to 21 years of age. These bills have passed their respective bodies and have crossed over.

HB 2026 (Stolle) would include a screening for congenital cytomegalovirus in newborns who fail the initial newborn hearing screen. The bill passed out of House Appropriations Committee and is now on the House floor.

House of Medicine Wins

This week, the House of Medicine had significant victories. Next week is Crossover, which is the halfway point for session. After February 5, each body can only consider legislation from the other body. It is important to keep pressure on these bills, so that their initial wins can make it across the finish line.

Health Insurance

HB 2515 (Hugo) and SB 1596 (Dunnavant) Co-pay Accumulator bills, both passed out of their respective committees. These bills would require any insurance carrier in the Commonwealth to count any payments made by another person on the enrollee’s behalf, including prescription drug coupons, toward a patient’s out-of-pocket maximum or cost-sharing requirement.

Balance Billing

HB 2544 (Byron) Emergency balance billing bill, which would have given insurance companies unilateral authority to establish rates with no transparency, ultimately limiting patient access to emergency care, died this week in House Commerce and Labor Committee.

HB 2543 (Byron) ancillary services balance billing bill was struck by the patron this week. This bill would have applied onerous requirements on the referring and treating physicians before the patient could receive treatment or services.  

Prior Authorization and Step Therapy

MSV’s priority prior authorization legislation, SB 1607 (Dunnavant), passed Senate Commerce and Labor Committee and will now move to the Senate floor. This is a huge victory for physicians and patients.

The bill would also ensure payment for pre-approved surgeries and invasive procedures; during an approved procedure, if a physician provided appropriate additional medical care they would be reimbursed without requiring an additional authorization.

HB 2126 (Davis) would reform step therapy and would improve clinical criteria as well as create expedient exemptions processes for patients already on an effective treatment or with an urgent need. This bill passed House Commerce and Labor and will now advance to the House floor.

Get More Information

Physician Assistants

HB 1952 (Campbell) passed the House and will now move to the Senate. SB 1209 (Peake) has passed the Senate and has moved to the House. Both bills would make administrative updates to Physician Assistant practice, bringing Virginia’s code in line with current Board of Medicine regulations.  MSV has been working closely with our Physician Assistant members as well as the Virginia Academy of Physician Assistants to support this effort.

Medicaid Common Core Formulary “Quick List” for Physicians

Virginia Medicaid implemented a Common Core Formulary – a “core” list of covered drugs for all Medicaid members enrolled with the Fee-for-Service, Medallion 4.0 and Commonwealth Coordinated Care Plus (CCC Plus) Managed Care programs across the Commonwealth – effective on December 1, 2018. 

The Common Core Formulary includes all the “preferred” drugs on DMAS’ Preferred Drug List (PDL) in approximately 90 therapeutic drug classes. Medallion 4 and CCC Plus health plans are contractually required to cover all “preferred” drugs on Virginia Medicaid’s PDL/Common Core Formulary and cannot place additional restrictions (such as prior authorizations, step therapies, quantity limits, etc.) on the “preferred” drugs.  The Medicaid managed care health plans may add drugs to therapeutic drugs classes on the DMAS PDL/Common Core Formulary but cannot remove drugs.

DMAS PDL/Common Core Formulary “Quick List” of Preferred Medications

Additional provider information including service authorization forms and a drug look-up tool.

The Medicaid health plans will accept the DMAS/Magellan service authorization from this website for any of the preferred medications.

It is important to note that the DMAS PDL/Common Core Formulary does not apply to Medicaid members that receive Medicare benefits and full Medicaid benefits (dual eligibles).  The drug benefits for dual eligibles members are defined by the member’s Medicare Part D plan.  

The DMAS PDL is not a comprehensive formulary, so the health plans’ formularies will be more extensive. For therapeutic drug classes not included on the DMAS PDL (e.g., oral oncology drugs, HIV drugs, etc.), each health plan will publish a formulary with the plan’s covered drugs.  

DMAS has established a mailbox for providers to send questions or concerns regarding Common Core Formulary drug coverage. 

Issues related to drug coverage and/or denials for preferred drugs on the DMAS PDL should be sent to [email protected].

Legislative Update – January 18, 2019

Key Issues – ACTION NEEDED

Two top priority issues are now before the legislature that need your support. See this week’s updates and how you can help.

Medicaid Reimbursement Rates

Del. Scott Garrett, MD and Sen. Emmett Hanger submitted budget amendments (303 #23h and 303 #4s) that would increase Medicaid reimbursement rates for physicians currently reimbursed below 75% of Medicare. The budget amendments will first be considered by the Senate Finance and House Appropriations Committees.  At this critical point, these committee members, as well as all members of the General Assembly, must hear from you to include the amendments in the final budget proposal.  This is a critical and urgent opportunity. Call and send a message now. Get more information on our website.

SEND A MESSAGE

Surprise/Balance Billing

On Thursday, MSV and physician specialty groups attended the House Commerce and Labor subcommittee balanced billing hearing. This year, balanced billing has been a hot topic before the General Assembly and legislators have considered prohibiting balanced billing altogether if the physician community did not develop a patient-friendly solution.

HB 1714 (Ware) would address emergency balanced billing; the bill would protect patients from balanced billing and ensure physicians are paid directly. In addition, the bill would pay providers a fair and reasonable amount. HB 1714 is supported by the entire physician community; MSV President, Dr. Richard Szucs, and Dr. Tricia Anest, MSV and VACEP member, testified in support of the bill. However, there are other bills supported by the insurance industry. If you have a relationship with a member of the House Commerce and Labor Committee, please reach out to our GA team.

Stay tuned for email legislative alerts that will have specific action steps to take to support these bills.

GET MORE INFO

Prior Authorization and Step Therapy

MSV supports SB 1607 (Dunnavant), a bill that would reform and streamline prior authorization for medications. The bill would also ensure payment for pre-approved surgeries and invasive procedures; during an approved procedure, if a physician provided appropriate additional medical care they would be reimbursed without requiring an additional authorization. This bill has been sent to the Senate Commerce and Labor Committee, but has not yet been scheduled for a hearing.

HB 2126 (Davis) is a step therapy reform bill that would create medically necessary exemptions to step therapy protocols and create an expedient exemption process for patients already on an effective treatment. This bill has not yet been heard, however, VCU first year medical students were at the Capitol advocating with several legislators this week on the issue.

Physician Assistants

HB 1952 (Campbell) and SB 1209 (Peake) were heard in the House Health, Welfare, and Institutions subcommittee and Education and Health Committee this week, respectively. Both bills would make administrative updates to Physician Assistant practice, bringing Virginia’s code in line with current Board of Medicine regulations.  MSV has been working closely with our Physician Assistant members as well as the Virginia Academy of Physician Assistants to support this effort.

Certificate of Public Need (COPN)

Bills have been filed for COPN ranging from complete repeal, to individual exemptions, to minor amendments to existing laws. SB 1526 (Sturtevant) would expedite the COPN process to permit additional psychiatric beds and facilities in the case of an emergency or crisis situation. SB 1614 (McDougle) would create a permitting process for endoscopic, urologic, and ophthalmic outpatient/ambulatory surgery centers. MSV maintains its position of modernizing the COPN process to support comprehensive reform that increases access to needed services, while still ensuring safety, quality, and the provision of charitable care.     

House of Medicine Wins

HB 1767 (Jones), SB 1543 (Surovell); Parents of Deceased Added as First Class Beneficiaries

This bill was favorably amended but would have expanded the list of beneficiaries who could recover in a wrongful death action; the bill proposed including the parents of the decedent if the decedent was providing them any support or services.  This change would apply to all wrongful death actions, including medical malpractice cases.

SB 1518 (Carrico) – Non-opioid pharmacological therapy and non-pharmacological therapy; health insurance coverage.

This bill would have directed the Boards of Medicine and Dentistry to develop regulations on opioid prescribing that already currently exist.  The MSV GA team spoke with the patron, explaining the current regulations, and he withdrew the bill.

Welcome to the 2019 General Assembly Session

Keeping You Up-to-Date

If you are an MSV member, each legislative update is sent every Friday to your inbox. Keep your email preferences up to date by logging in to your member profile. If you are not an MSV member, you can join today to start receiving timely communications to your inbox among many other member benefits. MSV is fighting for you to ensure physicians are the table when important decisions are being made that impact Virginia medicine and health care. 

Download the Voter Voice app to send messages to your legislators on key issues: Android | iOS

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Register Now for MSV Lobby Days

We are excited to add another Lobby Day to our 2019 schedule. In addition to January 30, there will also be a Lobby Day held on February 6. We encourage you to register before January 16 so that we can schedule appointments for you.

Register for January 30 Lobby Day

Register for February 6 Lobby Day

Key Issues

MSV is hard at work reviewing the bills that will impact medicine and patient care in Virginia. This week, we are sharing highlights of key issues that are before the legislature. In next week’s issue, expect specific bill descriptions and their progress.

Surprise/Balance Billing

Multiple bills have been filed and MSV, along with other specialty groups, are working to favorably amend the bills to hold patients harmless, while still protecting a physician’s ability to negotiate with payers to receive fair and timely reimbursement. This week, the Richmond Times-Dispatch published an op-ed written by Dr. Mark Monahan, MSV member and Richmond Academy of Medicine Board of Trustees President, about balance billing.  

Prior Authorization and Step Therapy

MSV is building on the work from 2015 to reform the prior authorization process. As a priority issue this session, MSV seeks to ensure patients’ medical care is determined by their physicians, not the insurance companies. Further, MSV is working to guarantee that if a service or procedure is pre-authorized by a health plan, the health plan cannot deny payment for that service.

MSV is also supporting step therapy reforms; it is critical that patients living with chronic health conditions have timely access to the life-saving treatments they need.

Medicaid Reimbursement

Del. Scott Garrett and Sen. Emmett Hanger are submitting budget amendments that would increase Medicaid reimbursement rates for physicians currently reimbursed under 75 percent of Medicare. Stay tuned for an alert from MSV as soon as the amendment is filed. The committees must hear from you to include the amendments in the final budget proposals.

Physician Assistants

A bill has been filed to make an administrative update to Physician Assistant practice, bringing the Code in line with current Board of Medicine regulations.  MSV has been working closely with our Physician Assistant members as well as the Virginia Academy of Physician Assistants to support this effort.  

Certificate of Public Need (COPN)

Bills have been filed for COPN ranging from complete repeal, to individual exemptions, to minor amendments to existing laws. MSV maintains its position of modernizing the COPN process to support comprehensive reform that increases access to needed services, while still ensuring safety, quality, and the provision of charitable care. Read the informative story from The Virginia Mercury shared this week about the history of COPN in Virginia.

Governor Ralph Northam, MD Declares a State of Emergency for Virginia

On September 8, 2018, I declared that a state of emergency exists in the Commonwealth of Virginia based on the need to prepare and coordinate our response for potential impacts from Hurricane Florence. National Weather Service forecasts indicate Hurricane Florence could produce damaging winds, periods of heavy rainfall, power outages, and flooding in the Commonwealth. These conditions have the potential to impact life safety and create significant transportation issues throughout Virginia.

State action is required to protect the health and general welfare of Virginia residents. The anticipated effects of this situation constitute a disaster wherein human life and public and private property are, or are likely to be, imperiled, as described in § 44-146.16 of the Code of Virginia.

Therefore, by virtue of the authority vested in me by § 44-146.17 of the Code of Virginia, as Governor and as Director of Emergency Management, and by virtue of the authority vested in me by Article V, Section 7 of the Constitution of Virginia and by § 44-75.1 of the Code of Virginia, as Commander-in-Chief of the armed forces of the Commonwealth, and subject always to my continuing and ultimate authority and responsibility to act in such matters, I hereby proclaim a state of emergency exists. Accordingly, I direct state and local governments to render appropriate assistance to prepare for the impacts of Hurricane Florence, to alleviate any conditions resulting from the situation, and to implement recovery and mitigation operations and activities so as to return impacted areas to pre-event conditions as much as possible.

Read the full executive order including measures A through W ordered by the Governor. 

Sections J, M, S, T, U relate directly to physicians and health care providers, specifically regarding the rendering of aid, emergency services, or health care. They are below:

J. Provision of appropriate assistance, including temporary assignments of non-essential state employees to the Adjunct Emergency Workforce, be rendered by state agencies to respond to this situation.

M. Authorization for the heads of executive branch agencies, with the concurrence of their Cabinet Secretary, to act, when appropriate, on behalf of their regulatory boards to waive any state requirement or regulation where the federal government has waived the corresponding federal or state regulation based on the impact of events related to this situation.

S. During this declared emergency, any person who holds a license, certificate, or other permit issued by any state or political subdivision thereof, evidencing the meeting of qualifications for professional, mechanical, or other skills, the person, without compensation other than reimbursement for actual and necessary expenses, may render aid involving that skill in the Commonwealth during this emergency. Such person shall not be liable for negligently causing the death of, or injury to, any person or for the loss of, or damage to, the property of any person resulting from such service as set forth in § 44-146.23(C) of the Code of Virginia. Additionally, members and personnel of volunteer, professional, auxiliary, and reserve groups identified and tasked by the State Coordinator of Emergency Management for specific disaster-related mission assignments, as representatives of the Commonwealth engaged in emergency services activities within the meaning of the immunity provisions of § 44-146.23(A) of the Code of Virginia, shall not be liable for the death of, or any injury to, persons or damage to property as a result of such activities, as provided in § 44-146.23(A) of the Code of Virginia.

T. Designation of physicians, nurses, and other licensed and non-licensed health care providers and other individuals as well as hospitals, nursing facilities, and other licensed and non-licensed health care organizations, political subdivisions and other private entities by state agencies, including the Departments of Health, Behavioral Health and Developmental Services, Social Services, Emergency Management, Transportation, State Police, Motor Vehicles, as representatives of the Commonwealth engaged in emergency services activities, at sites designated by the Commonwealth, within the meaning of the immunity provisions of § 44-146.23(A) of the Code of Virginia, in the performance of their disaster-related mission assignments.

U. A license issued to a health care practitioner by another state, and in good standing with such state, shall be deemed to be an active license issued by the Commonwealth to provide health care or professional services as a health care practitioner of the same type for which such license is issued in another state, provided such health care practitioner is engaged by a hospital, licensed nursing facility, or dialysis facility in the Commonwealth for the purpose of assisting that facility with public health and medical disaster response operations. Hospitals, licensed nursing facilities, and dialysis facilities must submit to 6 the applicable licensing authority each out-of-state health care practitioner’s name, license type, state of license, and license identification number within a reasonable time of such healthcare practitioner arriving at the applicable health care facility in the Commonwealth.

A Legislative Update from MSV

Below is the latest Legislative Update from MSV. Click here to view the continually-updated 2017 Legislative Agenda.

White Coats on Call

On Tuesday, MSV kicked off the first of four White Coats on Call Lobby days with 89 participants including radiologists, anesthesiologists, emergency room physicians, as well as groups from Arlington and Danville.  The group heard from Lieutenant Governor Ralph Northam, M.D., who energized attendees before they headed over to the General Assembly building.  Members visited legislators on every floor of the building, lobbying on issues like COPN reform, opioid misuse, licensure parity, and step therapy.  A group of medical students had the honor of being introduced on the Senate floor by Sen. Siobhan Dunnavant, MD (R-Henrico), who welcomed all White Coats on Call attendees and thanked MSV for its activism. 

Legislation Updates – Bills supported by MSV

  • Del. John O’Bannon, MD’s (R-Henrico) COPN reform bill, HB 2337, was unanimously passed by a subcommittee of the House Health, Welfare, and Institutions committee and will now be heard by the full committee on Tues., Jan. 31.  His bill replaces the current COPN system with a permitting process that mirrors MSV policy, but only in areas that meet a certain population density threshold.
  • Sen. Siobhan Dunnavant, MD’s (R-Henrico) COPN reform bill, SB 1566, was heard in the COPN subcommittee of the Senate Education and Health committee on Fri., Jan. 27.  The subcommittee did not take a vote on any legislation, but is expected to meet again next week for a vote.
  • SB 1046, carried by Sen. Bill Stanley (R-Moneta) which would create licensure parity between U.S. and international medical school graduates passed the Senate 39-0.  HB 2277, the House version carried by Del. Danny Marshall (R-Danville), was passed unanimously by the House Health, Welfare, and Institutions committee and will now move to the House floor for a vote.
  • HB 2053, Del. Steve Landes’ (R-Weyers Cave) bill to stipulate that direct primary care agreements do not constitute insurance, passed the House Commerce and Labor committee and will now move to the House floor for a vote.   
  • Unfortunately, both the House and Senate versions of bills which would’ve created an expedited override process for step therapy failed in their respective committees.

Averted Legislation

  • HB 2042, carried by Del. Kathleen Murphy (D-McLean), would have required providers to take CME specifically on suicide prevention.  The MSV lobby team was able to work with Del. Murphy, offering to provide information on our website regarding suicide prevention, which she was happy to accept.  The bill was laid on the table in subcommittee.
  • HB1424, carried by Del. Mark Cole (R-Spotsylvania), would have required prescriptions to include on the label the reason the medication was prescribed. It was laid on the table in subcommittee. 

Register to take part in national meaningful use and public health surveys

The Center for Disease Control (CDC) National Center for Health Statistics conducts national health care surveys to collect data and information used by Congress, health care services researchers and others to shape health care policy and the future of health care in the United States. 

The National Center for Health Statistics is accepting registration from eligible professionals (EPs), eligible hospitals (EHs) or Critical Access Hospitals (CAHs) of their intent to submit data to the national health care surveys as part of the Medicare and Medicaid EHR incentive programs (Meaningful Use). You may attest to either Objective 10 – Public Health and Clinical Data Registry Reporting, Measure 3 for MU Stage 2 or Objective 8 – Public Health and Clinical Data Registry Reporting, Measure 4 for MU Stage 3. 

Please click here to see the updated National Health Care Surveys Declaration of Readiness and consider registering for the National Health Care Surveys. EPs, EHs and CAHs can register their intent to submit data by emailing [email protected].