January 2016
Vol. 2, Issue: 8

-Advocacy Matters-

What You Need to Know about Proposed Changes to USP 797 and How to Submit Comments to USP
As reported in the December issue of Practice Matters and a special Practice Matters alert emailed to AAAAI members yesterday, the practice of allergen immunotherapy as we know it is at risk. The United States Pharmacopeia (USP) has proposed changes to be required of all sterile compounding, including allergen extract preparation. These changes include more complicated mixing procedures, significantly shortened timeframes for how long extracts can be used, and add burden to your storage and documentation processes. These changes are included in a draft update of the USP Chapter 797, which governs sterile compounding, and which is available for public comment until January 31.

This is a critical issue that the AAAAI and ACAAI have been working together to address. If you have not already submitted comments to USP, you are urged to do so by the January 31 deadline. Keep these details in mind:

  • The AAAAI's representation in Washington, DC, and a jointly retained consultant have informed us that having members submit personalized comments will be most effective in getting our voice heard. The AAAAI has compiled a variety of information here, which you can use to help put together your personalized comments to USP. The most important information is in all capital letters.
  • The section of the USP document linked here that actually shows the changes USP intends to make to Chapter 797 does not have line numbers, despite the fact that USP is asking commenters to reference line numbers. Members should fill out USP's comment submission template linked here as best as they can. You can mention that the Allergen Extracts as CSPS section on pages 17-18 of the USP document is what we want restored and not deleted.
  • Members should absolutely communicate with their patients about these proposed USP changes. If the changes are finalized, it will significantly impact patient access to immunotherapy. If you have patients who will personally attest to an improved quality of life thanks to allergen immunotherapy, please invite them to participate in this public comment period as well.

January 27 Webinar to Cover the Future of Healthcare Payments
You may have heard the announcement that Meaningful Use will be ending, but remember this is one part of larger changes. Attend this webinar to learn more about ongoing requirements and make sure you are ready for the changes coming in 2017.The Medicare Access and CHIP Reauthorization Act (MACRA), the replacement for the Sustainable Growth Rate, incorporates Merit-Based Incentive Payment Systems (MIPS) and Alternative Payment Models (APMs) as new mechanisms through which physicians will be paid by Medicare. Through the Healthcare Planning and Learning Action Network, a public-private partnership between CMS and private payers, insurers have committed to evolving their payment structures to include the changes as well, starting as early as 2017.

What we know about MIPS and APMs, how these are related to the current requirements of reporting for the Physician Quality Reporting System (PQRS), Meaningful Use, and the Value Based Modifier (VBM), and what you can be doing now to prepare for the changes that lie ahead, will be tpresented by Emily Graham, RHIA, CCS-P, of Hart Health Strategies, part of AAAAI's Advocacy Team in Washington, DC. The webinar, which takes place January 27 at 8:00 pm CT, is open to all AAAAI members. You will also be able to submit questions during the webinar.

A/I Represented at the RUC
This past week the AAAAI, working in collaboration with the ACAAI, AAOHNS and AAOA, was at the AMA/Specialty Society Relative Value Scale Update Committee (RUC) meeting to address the idenitification of 95165 and 95144 as potentially mis-valued codes in the 2016 CMS Physician Fee Schedule. Expenses related to the mixing of allergen extracts were presented to the Practice Expense Committee, and the full RUC heard the defense of the current value of the codes. The presentation of survey data developed by the various specialty societies and a jointly retained consultant was well received. AAAAI leadership thanks those of you who received and responded to surveys and requests for input for the data collection process.


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!

Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review. By Giselle S. Mosnaim et al.

While adolescence poses unique challenges to asthma self-management, it offers opportunity because lifelong patterns of health behaviors are established during this important developmental stage. The authors identify new approaches for the delivery of asthma guideline recommendations for self-management and medication adherence among adolescents. Several studies in this review demonstrated that school-based interactive group asthma education improved asthma knowledge and self-management skills. Directly observed therapy by school nurses increased adherence. Allergist/immunologist electronic monitoring of and feedback on use of medications shows promise for increasing adherence.

Click here to read the abstract.

Depression, Asthma, and Bronchodilator Response in a Nationwide Study of US Adults. By Yueh-Ying Han et al.

In a cross-sectional study of U.S. adults, depressive symptoms were significantly associated with asthma, independent of anxiety symptoms. Moreover, major depression was associated with a 4.2% reduction in bronchodilator response in adults with asthma. Although a temporal relationship between the onset of depressive symptoms and asthma could not be determined in this particular study, the co-existence of depressive symptoms and asthma is both common and often overlooked. Thus, physicians should be aware of potential depressive symptoms in patients with asthma. Whether managing depression helps prevent or treat asthma is unknown, but this question should be evaluated in future studies.

Click here to read the abstract.


The AAAAI is now represented at the RUC by Cheryl Lynn Walker-McGill, MD, MBA, FAAAAI. Dr. Walker-McGill is a past Chair of the AAAAI Committee on the Underserved and is Board President of the North Carolina Medical Board. She is also a Medical Director for Daimler Trucks, NC, Gastonia and Mt. Holly facilities.The AAAAI remains committed to working together with the ACAAI and other related organizations to get the best outcomes possible for all allergist/immunologists.

AAAAI Continues Efforts to Correct ICD-10 Mapping Errors
Since the transition to ICD-10 on October 1, 2015, Novitas, a Medicare Area Contractor (MAC), has denied reimbursement for bee immunotherapy and asthma treatment due to mapping errors in its Local Coverage Determination (LCD) policies for allergen immunotherapy (LCD 36240) and allergy testing (LCD 36241). Current Procedural Terminology (CPT) codes 95004, 95024, 95017, 95115, 95117, 95145-95149, 95165, 95170, and 95180 do not map to diagnoses codes J45.40 and J45.50, and T63.421A, D, S – T63.484A, D, S for the treatment of asthma and bee immunotherapy, respectively. In addition, CPT codes 95004, 95017, 95018, 95024, 95027, 95028 and 86003 do not map to diagnoses codes J30.2, J30.81, J30.89, J30.9, T63.421A-T63.484S, T78.00xA-T78.09xS.

As a result of AAAAI leadership expressing concerns regarding these errors, Novitas has informed the AAAAAI that revisions to these LCDs are scheduled to be posted by mid-February. Novitas suggests that providers hold their claims until these revisions are completed. Novitas is the MAC in Arkansas, Colorado, Delaware, the District of Columbia, Maryland, Mississippi, New Jersey, New Mexico, Oklahoma, Louisiana, Pennsylvania, and Texas.

  • AAAAI members can contact with coding questions and concerns.

-RSL Matters-

How Can Physician Burnout Be Addressed?
As more demands are placed on physicians, physician stress and burnout are having are becoming more prevalent and having an impact on patient care. Below are several links that re-look at practice style, improve practice efficiency and help take steps to avoid physician burnout.

Get Ready to Tweet in Los Angeles Using #AAAAI16
The 2016 Annual Meeting is almost upon us and A/I physicians attending the Los Angeles meeting will once again be tweeting updates on the latest advances in the specialty. Follow #AAAAI16 on Twitter to get all the latest information from the 2016 Annual Meeting and participate in onsite conversations. Don't forget to re-tweet #AAAAI16 tweets to your followers so others can become more informed about the advances in A/I.

Explore the Life Spectrum of Asthma, July 29-31 in Chicago
You are invited to attend a unique AAAAI educational program that will provide you with a comprehensive understanding of the clinical spectrum of asthma throughout life. An initiative of AAAAI President Robert F. Lemanske, Jr., MD, FAAAAI, the Life Spectrum of Asthma course takes place July 29-31 in Chicago and is built around four themes: asthma inception and progression; reducing and/or eliminating asthma exacerbations; preventing and treating severe asthma; and Asthma and COPD Overlap Syndrome (ACOS).

2016 RSLAAIS Assembly Forum to Focus on the Future of Allergy Practice
Allergy/immunology thought leaders will speak about the future of allergy/immunology practice at the AAAAI RSLAAIS Assembly Forum and Business Meeting during the 2016 AAAAI Annual Meeting, Friday, March 4 from 4:45 to 6:30 pm. This year's forum will focus on several areas of practice including the future application of technology, healthcare payment systems strategies, quality measures, future practice frameworks and the role of academic allergy in community practice. This session is open to all AAAAI members.

-Practice & Policy Matters-

EHR Specification Developments Now Underway for A/I Specialty Measures
The AAAAI Board of Directors has committed to investing in the further development of quality measures to better facilitate electronic health records (EHR) connectivity to the AAAAI Allergy, Asthma and Immunology Quality Clinical Data Registry in Collaboration with CECity (AAAAI QCDR). These electronic specifications will also assist providers, including those not using the registry, in collecting data on specialty-specific measures for reporting to payers, systems or academic institutions.

Save the Date: 2016 Practice Management Workshop Registration Opens March 1
Looking for monumental ideas? The AAAAI Practice Management Workshop is a unique AAAAI annual event that focuses on the day to day issues that all A/I physicians face—whether in solo private practice, a multi-specialty group or the academic setting. It is specifically programmed by practicing allergists for practicing allergists. Mark your calendars now for the 2016 Practice Management Workshop July 22-24 in Washington, DC. Registration will open March 1. If you are unable to attend, consider sending your practice administrator or manager.

Make Sense of Reporting Requirements and Learn About the AAAAI QCDR
Understand the latest reporting requirements for allergy practices and find out how the AAAAI Allergy, Asthma and Immunology Quality Clinical Data Registry (AAAAI QCRD) can help you meet them in a unique session at the 2016 Practice Management Workshop. Titled "Making Sense of Reporting Requirements and Keeping Your Practice in Compliance," it will feature a panel of speakers including Linda Cox, MD, FAAAAI. You will hear their personal experiences helping their practices meet reporting requirements. Again, registration for the Practice Management Workshop will open March 1.

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