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November 2014 Vol. 1, Issue: 6
 

Vote for Your Next AAAAI Leaders

Every year, AAAAI full members and Fellows have the opportunity to elect the future President of the AAAAI and new members to the Board of Directors. The current candidate slate represents the culmination of months of work vetting numerous colleagues from the various interest sections and assemblies to ascend to these very important leadership positions. This is your opportunity to have a say in the future of your AAAAI. Voting will close on December 9 at 5:00 pm CT.

RSL Matters

Epinephrine Laws Potentially Save Lives
AAAAI members have been working to advocate for access to epinephrine in schools. New York and Pennsylvania have recently been added to the list of states with laws addressing this issue. New data suggests that these advocacy efforts are saving lives. A study of the Chicago Public Schools, the first large, urban U.S. school district to stock an undesignated supply of epinephrine, found that 38 autoinjectors were used during the 2012-2013 year. More than half were administered for first-time allergic reactions. Congratulations to all who have worked on behalf of our patients to make this life saving medication readily available.

AAAAI Twitter Chats Reach Nearly 2 Million
The AAAAI recently held two Twitter chats with Allergic Living on the topics of "Back to School with Allergies and Asthma" and "Allergy Ready for the Holidays." These Twitter chats resulted in over 21 million impressions and reached over 1.7 million twitter accounts. Social media is a very active area where the AAAAI continues to promote the expertise of A/I physicians. To learn more about social media and how it can impact your practice visit the Practice Management resources on the AAAAI website.

ICD-10 Codes for Sinus Disease
As part of the AAAAI's commitment to ease the transition to ICD-10 coding, find the link below for the codes for sinus disease. Notice that these codes, like ICD-9, ask one to identify the specific sinus involved, and add the additional 5th code of 0 or 1 with acute sinusitis to signify if this is unspecified (0) or recurrent (1) acute sinusitis. If you have a coding question, please email it to coding@aaaai.org.

As a reminder, the AAAAI is building a set of resources for ICD-10 and other coding issues. You can find more information linked below as well as other ICD-10 codes from previous Practice Matters issues.

Collection Issues?
Increased out of pocket costs for patients because of increased copays, co-insurance and/or high insurance deductibles are becoming more commonplace. This shift of financial responsibility to patients makes your practice's collection policies and your practice's communication with patients about their insurance plans more important than ever. By looking at your methods of collection at the time of service, you may avoid negative patient interaction and possibly reduce the need to involve collection agencies. Please note, the following links will direct you to PhysiciansPractice.com where you will be prompted create a free account.

 

Practice Changers

We have partnered with the editors of JACI: In Practice to bring you monthly "Practice Changers" from recently published journal articles.

Highlighting cutting-edge information keeps you current and assists you in educating patients and physicians who rely on the expertise of our specialty!

 Safety and Outcomes of Test Doses for the Evaluation of Adverse Drug Reactions: A 5-Year Retrospective Review. By Melissa Iammatteo et al.

Although graded challenges are considered the gold standard for the evaluation of adverse drug reactions, evidence-based guidelines regarding the optimal number of steps are lacking. This study demonstrated that test doses, defined as 1/10 of the full dose for a parenteral medication or ¼ of a pill for an oral medication followed by administration of the full dose after a specific period of observation, are safe in appropriately selected patients. The overwhelming majority of test doses do not result in adverse drug reactions. Furthermore, when reactions did occur, they were mild and often did not require any treatment.

Clinical and Immunologic Assessment of a Cluster Method During Allergen Immunotherapy Refill Dosing
Kirk H. Waibel et al.

While a refill for allergen immunotherapy (AIT) based on current guidelines (i.e., dose reduction by 50-90% with a buildup over multiple visits) required a mean of 4.6 + 1.4 visits over 31.0 + 19.5 days, this study observed the safety and satisfaction of a 2-step cluster refill for 52 consecutive patients who attained their maintenance dose in a single visit without a systemic reaction (95%CI 93.8-99.9). This is the first study to assess the safety and satisfaction of a cluster refill method and may offer allergists another technique to reduce the main reason for AIT discontinuation: inconvenience.

Advocacy Matters

AAAAI President James T. Li, MD, PhD, FAAAAI, (right) with Senator Al Franken (MN).

AAAAI Leaders Visit Capitol Hill
As part of the November AAAAI Board meeting in Washington, DC, AAAAI leaders met with Senators and Representatives who play leadership roles with respect to health policy and research. Both Washington Health Advocates and Hart Health Strategies worked with AAAAI leaders to strategize on which key topics should be the focus of discussions. The AAAAI has advocated for many years on issues including research funding, GME and comparative effectiveness of immunotherapy in allergy and asthma patients, and this year added a range of additional issues around physician reimbursement and patient access. Visit the Advocacy webpage below for more photos and links to the supporting materials that AAAAI leaders distributed during their Capitol Hill visits.

AAAAI Addresses CMS 2015 Physician Fee Schedule
The AAAAI commented on a wide range of issues in the Centers for Medicare & Medicaid Services (CMS) proposed rules for the 2015 Physician Fee Schedule. The final rules were recently released and published last week in the Federal Register. To view the AAAAI letter and a breakdown of the comments submitted, along with how those issues were finalized, please click on the link below.

One disconcerting issue in the proposed rule was the inclusion of several key CPT codes in allergy included in CMS' list of "potentially misvalued specialty codes" including 95004, 95165 and 95010. The AAAAI was actively working to address this issue with the Joint Council of Allergy, Asthma & Immunology, the American College of Allergy, Asthma & Immunology, and the American Academy of Otolaryngic Allergy when the final rules were published, indicating that this review process would not be pursued at this time while CMS focuses on development and review of a series of global codes instead.

While the regulations have been presented as final at this time, the AAAAI continues to work with the American Medical Assocation regulatory team and with Hart Health Strategies staff to clarify specific issues with CMS on certain issues around how data from Quality Clinical Data Registries will be reported through the Value Based Modifier.

AAAAI Efforts Lead to Program Announcement on Eosinophilic Diseases
The National Institutes of Health (NIH) recently published a Program Announcement for Research on Eosinophil Associated Disorders. This is the culmination of a 3-year AAAAI effort that helped lead to the appointment and report of the NIH Taskforce on the Research Needs of Eosinophil-Associated Diseases (TREAD), an award that allowed the formation of the Consortium of Eosinophilic Gastrointestinal Disease Researchers, and now this Program Announcement. The specialty has come a long way from little or no NIH-funded research in 2010 to this multi-Institute Program Announcement to encourage research applications on eosinophilic disorders.

AAAAI Supports Bill That Would Exclude Certain Educational Materials from Sunshine Act Reporting
The AAAAI joined the American Medical Association (AMA) and various other physician and medical organizations in expressing their support for H. R. 5539. This bill, introduced by Representative Michael Burgess (R-TX), would exempt medical textbooks and journals, as well as indirect payments that pharmaceutical and device manufacturers offer to CME providers, from Sunshine Act reporting requirements. As stated in the letter, "H.R. 5539 would ensure that efforts to promote transparency do not undermine efforts to provide the most up-to-date independent medical knowledge, which improves the quality of care patients receive through timely dissemination of medical knowledge."

 

Practice & Policy Matters

CME Credited Webinar on AAAAI Registry Now Available
Were you unable to attend the live AAAAI QCDR webinar? You can now view the "AAAAI Allergy, Asthma & Immunology Quality Clinical Data Registry: Maximize Results for Your Asthma and Allergy Immunotherapy Patients" webinar on the Continuing Education Center of the AAAAI website. The webinar will walk you through the AAAAI QCDR and help you learn more about this new PQRS reporting option. It also includes questions and answers from the live session. You can earn up to 1.00 AMA PRA Category 1 Credit™ for this free activity.

Meaningful Use Hardship Exemption Applications Due November 30
The Centers for Medicare & Medicaid Services (CMS) has reopened its Meaningful Use (MU) hardship exemption application for physicians to avoid the 2015 penalty. The new deadline will be November 30, 2014.

This is most relevant to providers who are new to the EHR Incentive Program, also known as Meaningful Use. Medicare physicians who started the program this year were required to attest by October 1, 2014, to avoid a penalty of up to 2% in 2015. Those new to the MU program can now apply for a hardship exception to avoid this penalty if they missed the October 1 deadline. Providers who were unable to implement 2014 certified electronic health record technology (CEHRT) due to delays in software availability or were unable to attest using the flexibility options provided by the CMS 2014 CEHRT Flexibility Rule are also eligible to apply. The American Medical Association has indicated this hardship exemption will be interpreted broadly by CMS and therefore all physicians who meet the eligibility criteria are encouraged to apply by the November 30 deadline. Remember that the hardship exception only provides relief from the MU penalty and will not earn you an incentive.

Six Ways to Avoid a RAC Audit
Does the way you code put your practice at risk for a Recovery Audit? Review six simple steps to learn more and avoid your exposure to an audit.

Highlights from the 2014 Practice Management Workshop: Leveraging Social Media for Your Practice
At the 2014 AAAAI Practice Management Workshop, Gerald Lee, MD, and Nathan Hare, MD, reviewed tips and tricks to market yourself and your practice using social media platforms. Here are some ways to establish your online presence:

1. Create a social media marketing plan. Prioritize your goals: is your target audience current and potential new patients, or your colleagues and potential referrers? Decide how you would like to distinguish your online presence from your competitors and generate content around a core message and platform.

2. Claim your listing on online reputation sites. 59% of patients use online physician rating sites such as Google Places, Healthgrades, Vitals.com and RateMDs.com when selecting a physician. These sites may have inaccurate information, so review each website and correct inaccuracies.

3. Create a professional Facebook page. A 2011 survey found that 1 in 5 Americans use social media as a source of healthcare information and 94% of them use Facebook. Examples of content include announcing pollen seasons, air quality alerts, disease information, office closings, or special events.

4. Establish a Twitter account. Twitter is a micro-blogging platform that can be used to engage patients. In addition, several allergist/immunologists share interesting articles or post key learning points from medical conferences on Twitter. It's like attending a virtual meeting!

5. Take an online course. The Webicina Social MEDia Course and the Mayo Clinic Social Media residency can help you gain new skills and ideas on establishing an online presence.

Interested in attending a future workshop? Mark your calendars for the 2015 AAAAI Practice Management Workshop in Denver from July 17-19.

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