Each Patient Counts: Massachusetts Medical Society Weblog

MMS Flu Advisory: September 30 Statewide H1N1 Webcast

The state Department of Public Health will host a webcast of its Statewide H1N1 Conference.

The webcast will be archived on the webcast web site for one year. The program will include an H1N1 situation update and outlook for the months ahead, and discussion of activities related to H1N1, clinical management, surge capacity, vaccination, DPH communications activities, school and university issues.

To view the webcast, visit: http://video.webcasts.com/events/pret001/32329/

If you have trouble with the link, please copy and paste it into your web browser.

Source: Massachusetts Department of Public Health (September 29, 2009).

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MMS Flu Advisory: New CPT Codes for H1N1 Immunizations

The AMA today announced two new CPT codes for the upcoming H1N1 immunizations. Coding from the AMA:

Use code 90470 to report H1N1 immunization administration and counseling. Code 90663 was revised by the CPT Editorial Panel to refer specifically to the H1N1 vaccine product. Both, revised code 90663 and Category I CPT Code 90470 are effective immediately.

For quick reference, the two codes are below:

90470-H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

90663-Influenza virus vaccine, pandemic formulation, H1N1

For more information:

http://www.ama-assn.org/ama/pub/news/news/cpt-codes-h1n1-immunizations.shtml

MMS Flu Advisory: FDA Approves H1N1 Vaccine; Some Seasonal Flu Vaccine Shipments Delayed

The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. The state will be responsible for distributing vaccine to health care and public health providers. Massachusetts health care practices wishing to receive vaccine must complete an online registration by October 9. Click here to read the FDA press release.

Seasonal Flu Vaccine Delayed
Due to prioritization of H1N1 vaccine and other challenges, remaining shipments of seasonal flu vaccine may be delayed. The state Department of Public Health (MDPH) has received over 40% of its seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks. The majority of doses are still expected by the end of October and all doses expected by early November. Additionally, doses of both state-supplied and privately purchased pediatric formulation vaccines (0.25ml pre-filled syringes for <4 years of age) have also been delayed. Currently, less than 30% of the state’s total supply is available now; the majority of doses are expected to be delivered by the end of October. 

Almost all of the influenza viruses currently circulating are H1N1.

MDPH Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Pediatric Providers
MDPH recommends that pediatric providers:

• Continue to vaccinate patients based on their available vaccine supply and formulation types.
• For infants who cannot now be vaccinated due to lack of current supplies, schedule vaccination appointments in late October, when MDPH expects supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine to be sufficient.
• Plan for simultaneous administration of both seasonal and H1N1 flu vaccine starting in mid-late October. H1N1 flu vaccine will become available starting in early October. Young children are one of the highest risk groups for H1N1 influenza. Pediatric providers will be allocated some of the initial doses of H1N1 vaccine that become available in Massachusetts. Note: Doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but  you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

School and Public Clinics
MDPH is recommending that large public clinics and school based flu clinics be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand.  By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts. 

MDPH is advising schools and public health departments to anticipate holding clinics for H1N1 flu vaccine starting in early November as well, and to consider offering both seasonal and H1N1 flu vaccine at these clinics.

Sources: U.S. Food and Drug Administration (September 15, 2009) and Massachusetts Department of Public Health (September 17, 2009).

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Senate Finance Committee Releases Health Reform Bill

The U.S. Senate Finance Committee today released its long-awaited health reform bill, "America's Healthy Future Act of 2009" (PDF).

This bill does not include an option for public health plan, but does allow the federal government create to exchanges that would allow consumers to shop for health insurance.

The bill does not offer a comprehensive fix of the Medicare physician payment formula, but it does replace the 21% fee cut scheduled for next year with a 0.5% increase.

Committee markup is expected to begin next week. Senate leaders hope to bring a bill to the floor for a vote by Columbus Day - less than a month away.

For more information on the Senate proposal and other federal health reform bills, visit www.massmed.org/healthcarereform

New MMS Workforce Study Shows Continued Shortages in Mass. Primary Care

The Massachusetts Medical society's 8th annual physician workforce study has found that while fewer physician specialties are operating under severe labor market conditions than in previous years, the situation in primary care continues to weaken. The report’s key findings include:  

• The primary care specialties of family medicine and internal medicine are in short supply for the fourth consecutive year.
• The percentage of primary care practices closed to new patients is the highest it’s ever been as recorded by the Medical Society.
• 7 of 18 specialties studied have been classified in short supply, 5 fewer than last year.
• The specialty of obstetrics and gynecology was found to be in short supply for the first time in the eight years of conducting the analysis, adding to primary care difficulties.
• Recruitment and retention of physicians remains difficult, especially at community hospitals and especially with primary care.
• The fear of being sued remains as a substantial negative influence on the practice of medicine, affecting access to and availability of physician services.

Read the study at www.massmed.org/workforce

Target: Childhood Obesity

Obesity has been one of Massachusetts Medical Society's main targets in the public health arena. The Committee on Public Health has designated it as a strategic priority, and the MMS website contains a variety of resources on healthy weight and obesity. Further, In conjunction with the Department of Public Health and Hopkinton Community Television, MMS produced Obesity in Massachusetts, a one-hour special edition of its monthly television program Physician Focus. The program, featuring obesity experts and public health officials, was distributed to public access stations across the state and is available online at Hopkinton Community Television and at the Physician Focus page on the MMS website.

In the continuing effort, Dr. Denise Rollinson, chair of the MMS Committee on Nutrition and Physical Activity, has now contributed a commentary on childhood obesity for the ABCNews.com health website.

Pointing to a new U.S. Health and Human Services/Advertising Council campaign targeting obesity in children, Dr. Rollinson says "We can't get enough of this message about healthy lifestyle, because the news on obesity and especially childhood obesity, is grim. And it's getting worse. The last few months have seen a raft of reports on obesity, all sending a clear message: obesity is overwhelming us."

Read Childhood Obesity: Let's Act Before We Lose a Generation

H1N1 Vaccine Reimbursement Policies in Massachusetts

The MMS has canvassed the payers operating in Massachusetts to determine their reimbursement policies for administration of the H1N1 vaccine.

Aetna, Cigna, Fallon, Health New England, Harvard Pilgrim, Medicare, and Network Health have provided their reimbursement policies. We're waiting to hear from Blue Cross, MassHealth, Tufts and Neighborhood Health Plan.

The emerging trend is that payers will reimburse for the administration, but not for the vaccine or supplies, since those are being supplied free of charge by the federal government.

For an overview and the policies and related billing codes, click here.

Reminder: Practice sites wishing to administer the H1N1 vaccine must register with the state by October 9. Click here to visit the state registration site.

MMS Strongly Supports Obama's Commitment to Pass Health Care Reform

The Massachusetts Medical Society tonight strongly supported President Obama's commitment to pass health care reform in this session of Congress.

MMS President Mario Motta, M.D., said, "The President stated his commitment to several key principles held strongly by physicians and long supported by the Massachusetts Medical Society. Among these are providing coverage for all Americans, enacting reforms that prevent denying coverage for pre-existing conditions, outlawing the practice of insurers dropping patients in their time of need, supporting a public option program designed to compete with private insurers to provide affordable coverage, and ensuring that medical decisions are made between physicians and patients. These are critical issues for effective reform and are strongly supported by physicians."

"We were also highly encouraged by his acknowledgement that the practice of defensive medicine - tests and procedures undertaken to protect providers in the event of legal action - is a cause of wasteful and unnecessary spending in health care. We applaud his action in instructing the Secretary of Health and Human Service to take immediate action in implementing demonstration projects on defensive medicine and patient safety. That is an important and critical step in improving the practice of medicine and the practice environment for physicians."

"Physicians remain committed to working with the President and Congress to ensure that the final reform package will include restructuring of the Medicare physician payment formula, which would go a long way to ensuring seniors' access to care."

MMS to Comment Tonight on President's Speech

The Massachusetts Medical Society will issue a statement tonight following President Obama's address to Congress on health care reform.

MMS Flu Advisory: DPH Opens Online Provider Registration for H1N1 Vaccine

The state Department of Public Health (DPH) has launched its online registration for H1N1 vaccine. This fall, the federal government will provide states with H1N1 vaccine and supplies (needles, syringes, sharps containers, alcohol swabs, H1N1 immunization cards) at no cost. DPH is responsible for directing the vaccine and supplies in Massachusetts. Providers (including private providers, hospitals, local health departments, regional public health coalitions, visiting nurses associations, clinics, pharmacists and commercial community vaccinators) wishing to receive and administer H1N1 vaccine must register with the DPH. The deadline for registering is October 9, 2009. Click here to be directed to more information and the online registration, or visit http://www.mass.gov/dph/h1n1registration.

Statewide H1N1 Conference

On September 30, DPH will host the Massachusetts Statewide Conference on H1N1 Influenza Response for public health, health care, school and community leaders at the DCU Center in Worcester. For information and to register, click here. The conference will present the latest situation update regarding the flu in Massachusetts, and elsewhere and what the outlook is for the coming months. And will provide the latest information on guidance and planning for flu vaccination, both seasonal and H1N1.
 

Seasonal Influenza Vaccine Still Available for Purchase

For information about vaccine distributors with seasonal influenza vaccine available for purchase, go to the National Influenza Vaccine Summit website at: http://www.preventinfluenza.org/ivats/ivats_09_10.xls

Source: Massachusetts Department of Public Health (September 8, 2009).