25th anniversary celebrated at best care practices in the … 2017 progress report.pdf ·...

Serving Physicians, Medical Directors, Advanced Practice Nurses, Pharmacists, and Physician AssistantsPracticing in Florida’s Post-Acute and Long-Term Care Continuum

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25th Anniversary Celebrated at Best CarePractices in the Geriatrics Continuum

By Ian Cordes, Executive Director

MDA celebrated its 25th

Anniversary during Best CarePractices in the GeriatricsContinuum Conference, Oct.

13-16, 2016. The educational programprovided its usual stellar review andupdate of major post-acute and long-termcare diseases, illnesses, and risks found innursing home and hospice patients,residents of assisted living facilities, andseniors living at home. Topics varied andincluded a wide range of clinical andadministrative talks and featured anexceptional annual forum with nationalleaders — one of the highlights of theconference each year — which providesan opportunity for industry thought-leaders to discuss challenges anddifficulties facing their organizations in thelong-term care and post-acute (PA/LTC)continuum.

The theme for this year’s conferencewas Navigating Successfully into a New Frontier: PA/LTCand offered many sessions that empowered practitioners tostay ahead of the curve and be prepared for what lies ahead.

The conference offered two preconference workshops. Thefirst, a three-hour workshop titled “New Trends in Hospice,Palliative Care, End-of-Life Decisions, and BundledPayments,” was hosted by a great panel of experts. Thesecond, a four-hour workshop, “Developing Skills for Quality

Assurance Improvement (QAPI) in Long-Term Care for the Interdisciplinary Team,”featured AMDA experts Dallas Nelson,MD, CMD, and Suzanne Gillespie, MD,RD, CMD.

In addition to the interesting workshops,the conference featured a Medicare billingand coding update, management of heartfailure, conflicted surrogate syndrome, aBeers Criteria update, update on diabetestreatment and new medications, antibioticstewardship, regulatory update forclinicians, movement disorders, acuterenal failure, CMS 5-Star SNF Reporting,motivational interviewing, journal articlesreview, and many more dynamic sessionsdesigned for those with an interest in PA/LTC medicine.

FMDA President Leonard Hock, DO,CMD, MACOI, HMDC, was impressedby the number of high-level presentationsand quality speakers.

“Playing on the theme of this year’s conference,Navigating Successfully into a New Frontier: PA/LTC, thereis much change in the world of post-acute and long-termcare medicine, with a lot of focus on CMS’ reimbursementmodels and how practitioners will be compensated in thefuture,” Dr. Hock said.

Volume 24 Number 1February 2017

FMDA President Dr. Leonard Hock

FMDA - The Florida Society for Post-Acute and Long-Term Care Medicine

FMDA Progress Report ✧ February 2017



MDA is excited aboutthe future of thesociety and the stellaryear it enjoyed in

2016. From a major boost inmembership numbers, newcollaborations on importantstatewide initiatives, and asymposium co-sponsorship with FloridaState University’s College of Medicine,there is a lot for us to brag about. Pleasesee pages 8-9 for FMDA’s year in review.

We also wanted to share that our 26th

Annual Conference is Oct. 12-15, 2017, atDisney’s Grand Floridian Resort.

Our CME-Education Committee isalready hard at work building anotherexceptional conference for practitioners inthe post-acute and long-term care (PA/LTC)continuum.

FMDA has developed and will continueto develop powerful leaders and mentorsto improve quality of care and drive betterpatient outcomes. This energy is the forcebehind our society and we will use thismomentum to engage industry thought-leaders as we move forward.

There is a growing need to solve commonchallenges or break barriers with strategicindustry partners. Through collaborationwith other like-minded organizations,FMDA’s Quality Advocacy Coalition, ablyco-chaired by Dr. Steven Selznick and Dr.Rick Foley, launched a statewide qualityinitiative in 2016. The initiative is being ledby FMDA, Agency for Health CareAdministration, Health Services Advisory

From the PresidentFMDA: The Next 25 Years

FFMDA - The Florida Society forPost-Acute and

Long-Term Care MedicineServing Physicians, Medical Directors,

Advanced Practice Nurses, Pharmacists,and Physician Assistants Practicing in

Florida’s PA/LTC Continuumwww.fmda.org

PRESIDENTLeonard Hock Jr., DO, MACOI, CMD

Delray Beach(561) 714-1531

[email protected] OF THE BOARD

John Symeonides, MD, FAAFP, CMDPalm Coast

(386) 283-5654 • Fax: (386) [email protected]

VICE PRESIDENTRhonda L. Randall, DO

Orlando(407) 758-4573 • Fax: (407) 823-8989

[email protected] PAST-PRESIDENT

Robert G. Kaplan, MD, FACP, CMDLongwood

(407) 862-7054 • Fax: (407) [email protected]

SECRETARY/TREASURERMichael G. Foley, MD, CMD

Crestview(850) 682-6143 • Fax: (850) 682-0227

[email protected]

DIRECTORSMarva Edwards-Marshall, DNP, ARBP-BC

Palm BayRick Foley, PharmD, CGP, FASCP

SorrentoElizabeth Hames, DO, CMD

Fort LauderdaleGregory James, DO, MPH, CMD

TampaMichelle Lewis, MSN, ARNP, FNP, GNP

CocoaClaudia Marcelo, DO, CMD

Oakland ParkJohn Potomski Jr., DO, CMD

MelbourneAngel Tafur, MD, CMD

The VillagesFMDA QUALITY ADVISORY COALITIONSteven Selznick, DO, CMD; Chair

Rick Foley, PharmD, CGP; Co-ChairExecutive Director

Ian Cordes, MBA, NHA400 Executive Center Drive, Suite 208

West Palm Beach, FL 33401(561) 689-6321 • Fax: (561) 689-6324

[email protected]

Group, FL ChapterAmerican Society ofConsultant Pharm-acists, Florida HospitalAssociation, Florida Health CareAssociation, Florida College ofEmergency Physicians, RiskManagement Association, hospitals,

hospital systems, nursing home providers, toname a few stakeholder groups.

The purpose of this initiative is to achievea measureable statewide reduction inunnecessary acute episodes and theirassociated burdens on patients and families.While many readmissions are necessary, a lotare avoidable. We have a sizable opportunityfor improvement because most other stateshave lower readmission rates than Florida. Infact, Florida is ranked 53rd out of 54 statesand territories.

We believe the challenges facing health carein Florida require this statewide concertedeffort to help achieve the Triple Aim ofimproving population health, patient careexperience, and affordability of care. Webelieve the goals are attainable if we worktogether to produce significant improvementsby targeting avoidable readmissions.

I would like to take a moment to thank thegenerous sponsors of our 25th AnniversaryConference, whose support is essential to thesociety’s long-term vision. Our sincerest thankyou to OPTUMCare, VITAS Health Care,MorseLife Health Systems, TrustBridge,Consulate Health Care, Greystone HealthNetwork, and MedElite.

FMDA Progress Report has a circulation of more than 1,100physicians, advanced practice nurses, physician assistants,consultant pharmacists, directors of nursing, administrators, andother LTC professionals. Progress Report is a trademark of FMDA.Progress Report Editor Elizabeth Hames, DO, welcomes letters,original articles, and photos. If you would like to contribute tothis newsletter, please email your article to [email protected].

Any statements of fact or opinion expressed here are the soleresponsibility of the authors. Copyright © 2000-2017 FMDA. Allrights reserved. No portion of this newsletter may be reproducedwithout written permission from FMDA.

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Table of Contents

CMS MACRA/Quality Payment Program Update

The Medicare Access & CHIP Reauthor-ization Act (MACRA) legislation author-izes Health and Human Services toimplement a value-based system aimed

at improving care access and quality for Medicareand Children’s Health Insurance Program (CHIP)beneficiaries. MACRA legislation significantlychanges Medicare’s physician reimbursementsystem. CMS has released the Final Rule, which provides adefinitive framework for transition over the next several yearsto the Quality Payment Program (QPP). The QPP, whichstreamlines several quality reporting programs, currently hastwo paths for eligible clinicians: the Merit-based IncentivePayment System (MIPS) and Alter-native Payment Models (APMs).

During the official commentperiod to CMS, many medicalspecialty groups raised concerns andmade influential recommendations.AMDA – The Society for Post-Acuteand Long-Term Care Medicinecontributed significantly to thisprocess and has continued to provide updates and educationalmaterials for PA/LTC providers. AMDA recently hosted a freewebinar, Overview of MACRA for PA/LTC Practitioners,which is available at http://www.paltc.org/audience/physician.This webinar, featuring presentations from Marjorie Kanof,MD; Rod Baird, MS; Alex Bardakh, MPP; and Charles Crecelius,MD, PhD, CMD, gives an excellent discussion of the transition

process, reporting measures, and how this willimpact providers in PA/LTC. After attending thewebinar on Dec. 14, I wanted to share some of thisupdated information with you:

The QPP consolidates MIPS and APMs, and isa budget-neutral program.

MIPS establishes four physician performancecategories for quality reporting, and consolidates

prior programs, such as PQRS, Medicare HER incentive,meaningful use, and value modifiers (VM). Performancereporting for Jan. 1, 2017, through Dec. 31, 2017 will influencereimbursement adjustments received by clinicians in 2019.Initially, the majority of PA/LTC providers will use MIPS.

MIPS FINAL SCORE =QUALITY PERFORMANCE +

COST PERFORMANCE +CLINICAL PRACTICE

IMPROVEMENTACTIVITIES + ADVANCING

CARE INFORMATION

Performance Categories, Weights, andRequirements for 2017 Include:

1) Quality (60%) – Report up to 6 quality measures includingan outcome measure for a minimum of 90 days (includingcare planning, influenza vaccination, BMI screen, HbA1Ccontrol, appropriate antibiotic prescribing)

2) Cost (Resource use) (0%) – Increasing to 10% in year 2020and 30% in 2021 and beyond. Report per capita costmeasures, spending per beneficiary, episodes of carecost measures*** This category is not added to 2017 MIPS final performance score,not required for 2017

3) Clinical practice improvement (15%) – Report 4improvement activities (94 are currently available) for aminimum of 90 days (only 2 activities if clinician groupsize < 15 or located in rural/HPSA area)*** All medical homes and some APMs (oncology and shared savingstrack 1) given full credit automatically – other APMs are given halfcredit automatically

4) Advancing care information (25%) – remains 25% in year2021 and after

Report required measures for minimum 90 days: patientaccess to EMR, electronic prescribing, send/receive electronicsummaries of care, security risk analysis.


FMDA 25th Anniversary Celebrated ................................................. 1From the President ............................................................................ 3Editor’s Corner ................................................................................. 4Membership Report: Pharmacists Welcomed .................................... 5FMDA News from Around the State ................................................ 6FMDA Highlights from 2016 ........................................................... 8Help Direct the Future of FMDA ................................................... 12Rheumatoid Arthritis Mechanisms May Vary by Joint .................. 13FMDA’s 25th Anniversary Conference Photos .............................. 14Call for Speaker Presentations ....................................................... 16ICD-10 Code Updates and Impact to Eligible Professional Medicare Quality Programs ...................................................... 17Member Spotlight ........................................................................... 18Designer Compound May Untangle Damage Leading to Some Dementias ........................................................................ 19New Payment Models Announced to Improve Cardiac & Joint Care ... 202016 Research Highlights: Clinical Breakthroughs ....................... 22

Editor’s Corner

By Elizabeth Hames, DO, CMD; Assistant Professor, Department of Geriatrics, NSU-COM; AssociateProgram Director, Geriatric Medicine Fellowship, Broward Health; Editor, Progress Report

The QPP consolidates MIPSand APMs, and is a

budget-neutral program.



FMDA has multiple classes of membershipincluding general, honorary, student, retired,lifetime, and affiliate membership.

General voting members: Any physician whoholds the position of medical director, or a physician, advancedpractice nurse, pharmacist, or physician assistant.

At this time, FMDA has 446 members.We added a lifetime member category when the bylaws

were amended in October 2013. As of the end of December,there are 16 lifetime members.

Member dues were increased from $45 in 2007 to $65, andto the current $75 within the last five years. In 2013 we addedmulti-year dues, such as 2 years @ $125, 3 years @ $190, andlifetime @ $750, while student member dues are $25 per year.We are considering a possible dues increase at this time. Thiswill be reviewed at an upcoming strategic planning retreat.

This past October, our members voted unanimously tochange our bylaws and include pharmacists as votingmembers. This reflects the longstanding presence of consultantpharmacists and clinical pharmacists collaborating withmedical directors, attending physicians, advanced practicenurses, and physician assistants in the PA/LTC continuum.

We welcome pharmacists who have an interest in the PA/

LTC continuum, and look forward to FMDA’s first pharmacistsitting on the board of directors.

FMDA has seen a large boost in membership in 2016 withits first corporate membership, Consulate Health Care, Floridaand South East Divisions. The new members consist of morethan 200 administrative support staff from corporate,divisional, and regional offices; medical directors andphysician assistants; executive directors and directors ofclinical services; and Consulate’s therapy partners, GenesisRehabilitation Services.

Consulate Health Care is a national leading provider ofsenior healthcare services, specializing in post-acute care.Operating more than 200 centers nationwide in 21 states, ithas grown to become the sixth-largest provider in the nationand the largest in the Sunshine State.

Welcome Consulate and thank you for your support!In addition, 10 physicians and advanced practice nurses from

Miami Jewish Health Systems also joined FMDA.With this increase in membership, FMDA is becoming the

nucleus for providing advocacy, education, and clinical carein the post-acute and long-term care continuum (PA/LTC). Ithas also become the largest chapter of AMDA in the country.

Membership Report: FMDA Continues to GrowBy Dr. Gregory James, Chair, Membership Committee

MDA members voted unanimously duringits annual meeting to change its bylaws toinclude pharmacists as voting members.This reflects the longstanding presence of

consultant pharmacists and clinical pharmacistscollaborating with medical directors, attendingphysicians, advanced practice nurses, and physicianassistants in the PA/LTC continuum.

FMDA President Dr. Hock applauds this milestone.“Over the years, our pharmacist colleagues have made a hugecontribution to the quality of care of our patients,” he said.“We invite pharmacists to consider FMDA their professionalhome alongside the other practitioners of the inter-professionalteam,” Hock added.

Pharmacists have supported FMDA for many years andhave contributed greatly to its success. One such individual,has just been unanimously appointed by the board of directorsto sit as a director on behalf of its pharmacist members.

Congratulations are extended to Rick Foley, PharmD, CPh,BCGP, FASCP; clinical professor of geriatrics at theUniversity of Florida College of Pharmacy and a full-timeconsultant pharmacist for nine nursing homes in Central

Bylaws Change Embraces Pharmacists as Voting MembersDr. Rick Foley appointed to represent pharmacists on the board of directors.

Florida. A fellow of the American Society of ConsultantPharmacists, Dr. Foley is president of the FloridaChapter of American Society of ConsultantPharmacists, member of FMDA’s CME/EducationCommittee, and co-chair of FMDA’s Quality AdvocacyCoalition. He has practiced as a consultant pharmacistfor Omnicare since 1999.

“Rick has been so supportive that it is no surprisethat he will be the one to welcome pharmacists home

to FMDA,” said Dr. Hock.“We sincerely congratulate Dr. Foley for this appointment

and thank him for his ongoing support of the inter-professionalframework under which FMDA operates,” added Dr. JohnSymeonides, chairman of the board.

FMDA is the largest chapter of AMDA – The Society forPost-Acute and Long-Term Care Medicine, and is comprisedof medical directors, attending physicians, advanced practicenurses, consultant pharmacists, registered pharmacists, nurseadministrators, and nursing home administrators of skillednursing facilities. All of these disciplines make FMDA one ofthe most dynamic and diverse PA/LTC associations in the stateof Florida.

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FMDA News from Around the State25th Anniversary Video

FMDA produced a very special seven-minute videocommemorating the Society’s 25th Anniversary. It premieredat the annual conference this past October and is availableon our home page at www.fmda.org or on YouTube at https://www.you tube.com/watch?v=xkRpopkyq_s&t=5s. Enjoythe memories!

New Lifetime Members WelcomedDr. Gregory James, chair of the Membership Committee, and

the officers and directors of FMDA welcome the newest Lifetimemembers, Dr. Carl Suchar and Dr. Richard Stefanacci. We salutethe following Lifetime members:Owen A. Barruw, MD; Patches B. Bryan, RN, MHA, LNHA; Ian LevyChua, MD; Marigel Constantiner, RPh; Moustafa Eldick, MD;F. Michael Gloth III, MD, CMD; Jackie Hagman, ARNP; GregoryJames, DO, CMD; Bernard Jasmin, MD, CMD; John Pirrello, MD;Brian Robare, CNHA; George Sabates, MD, CMD; RichardStefanacci, DO, CMD; Carl Suchar, DO, CMD; John Symeonides,MD, CMD; and Hugh Thomas, DO, CMD

FMDA offers two-year, three-year, and lifetimememberships, and we encourage new and renewing membersto join at one of these levels. For more information aboutmembership, please contact Cindi Taylor, Member ServicesManager, at (561) 689-6321.

Journal Club for MembersThe Journal Club is a learner-based community seeking to

improve health care and health through enhanced care in thePA/LTC continuum. It is a forum where people who care canmeet, share, learn, and create change.

FMDA’s Journal Club helps its members stay current withthe latest evidence-based clinical information relevant to PA/LTC medicine. Journal Club participants share in reviewingarticles that are interesting, provide relevant takeaways, andhighlight best practices. It has developed into a very effectiveway to gain new knowledge.

Each Journal Club meeting is scheduledfor 30 minutes, once a month, viaconference call, and is hosted by rotatingclub members with staff assistance.During these meetings the group willcritically analyze recent literature usingevidence-based medicine principles,including: patient preferences, clinicianexpertise, and scientific findings, eachweighted equally. We quickly reviewtwo to three papers and present highlights and takeaways ina concise, high-yield manner and discussion is encouraged.We look forward to your interest and participation.

The co-chairs of the Journal Club are Dr. MarianneNovelli and Dr. Diane Sanders-Cepeda. For moreinformation, contact Dr. Novelli at [email protected].

Strategic Planning CompletedFMDA recently held a strategic planning session, facilitated

by Dr. Rhonda Randall, on Jan. 7. As a result, the leadershipdecided to revise and update both the society’s mission andvision statements, as follows:

Mission – Describes the fundamental purpose of anorganization, why it exists and what it does to reach its vision.

The mission of FMDA – The Society for Post-Acute andLong-Term Care Medicine is to promote the highest qualitycare as patients transition through the post-acute and long-term care continuum. FMDA is dedicated to providingleadership, professional education, and advocacy for the inter-professional team.

Vision – Describes the desired future state of anorganization in terms of its objectives. It is a long term view.

FMDA – The Florida Society for Post-Acute and Long-Term Care Medicine will provide professional leadership todisseminate information and provide access to resources andexperts.

FMDA will further advance as the professional hub foreducation on best care practices, evidence-based medicine,regulatory compliance, and practice management.

FMDA will continue to be the model organization thatcollaborates with related organizations to promote the highestquality patient care and outcomes in the post-acute and long-term care continuum.

Seated (L-R): Dr. Leonard Hock, Dr. Rhonda Randall, and Dr.Elizabeth Hames. Standing (L-R): Dr. Marva Edwards-Marshall,Dr. Robert Kaplan, Dr. Carl Suchar, Ian Cordes, Dr. Rick Foley,Dr. John Symeonides, Dr. Claudia Marcelo, and Dr. Angel Tafur



10 applicants who are accepted by the review committee willreceive complimentary registration to the 2017 conference(only one applicant per poster presentation will be considered).

Poster sessions provide an opportunity for practicingphysicians, pharmacists, and nurse practitioners to share withcolleagues the results of research, best practices, and outcomes.The sessions are visual presentations using diagrams, charts,and figures. Poster presentations may be on any aspect of thefollowing categories: clinical care, pharmacology of medicine,medical education, history of medicine, medical direction,medical care delivery, medical ethics, economics of medicine,and pediatric long-term care — and in any PA/LTC setting.

All poster abstract proposals must be submitted online onour website at www.fmda.org. All submissions that arecomplete and follow the Criteria for Acceptance of Posterswill be considered and reviewed based on the content containedwithin the proposal.

Submission of a proposal is a commitment by at least oneauthor to be present at the designated times to discuss theinformation in the poster with symposium participants. Wehave arranged the schedule so that there is no overlap betweeneducational sessions and poster exhibit times. The primarypresenter listed on the proposal will be informed of its statusno later than Sept. 15, 2017. Guidelines for presentation andpreparation of visual material will be sent to the primarypresenter upon acceptance.

To learn more, or to submit a proposal, go to www.fmda.org,or call Ian Cordes, Executive Director, at (561) 689-6321.

Conference Hotel HeadquartersThe 2017 Conference Hotel Headquarters is Disney’s Grand

Floridian Resort. The group rate is $244 single/doubleoccupancy; complimentary self-parking; complimentary Wi-Fiservice in guest rooms, meeting rooms, and common areas;and no daily resort fee.

To make a reservation, please call Disney’s GroupReservations, (407) 939-4686, and mention you are attendingthe Florida Medical Directors Association’s Best CarePractices conference. To guarantee rate and room availability,you must make your reservations no later than Sept. 9, 2017.

This special group rate will be applicable three (3) daysprior to and three (3) days following the main program dates,subject to availability. You may also reserve your hotel roomat www.bestcarepractices.org/venue.html.

Victorian elegance meets modern sophistication at this lavishbayside resort hotel. Relax in the sumptuous lobby as the liveorchestra plays ragtime, jazz, and popular Disney tunes. Baskon the white-sand beach, indulge in a luxurious massage, andwatch the fireworks light up the sky over Cinderella Castle.Just one stop to Magic Kingdom park on the complimentaryResort Monorail, this timeless Victorian-style marvel evokesPalm Beach’s golden era.

Cordes Joins Board ofArea Agency on Aging

FMDA Executive Director Ian Cordes hasjoined the Board of Directors of The AreaAgency on Aging of Palm Beach/TreasureCoast (AAA). This is a dynamic, non-profitorganization dedicated to serving the needsof all seniors, persons with disabilities, and their caregiversin Palm Beach, Martin, St. Lucie, Indian River, andOkeechobee counties.

Part of a nationwide network, The Area Agency on Agingprovides information on aging issues, advocacy, one-on-oneassistance, and a host of services that help seniors maintaintheir independence, well-being, and dignity in the community.

With 60 dedicated staff members, the AAA is responsiblelocally for the Alzheimer’s Disease Initiative, CommunityCare for The Elderly, Home Care for The Elderly, and hasestablished Centers of Excellence for its Helpline, ConsumerCare & Planning, Elder Rights, Foster Grandparent, HealthyLiving, SHINE, and Strategic Initiatives.

“Their team approach focuses uniquely on four values,including humility, gratitude/appreciation, respect, andresponsibility/accountability,” Cordes said.

“I am honored to have this opportunity to support thismission-driven organization,” added Cordes.

In 1965, the Older Americans Act (OAA) was enacted. Itestablished the Area Agencies on Aging and the NationalAging Network to service every county in the country. TheOAA was a response to congressional concerns about the lackof community social services for senior citizens, especiallythose at risk of losing their independence. The OAA focuseson improving the lives of older people in the areas of income,housing, health, employment, retirement, and communityservices.

The federally funded Older Americans Act provides avariety of in-home and community-based services without costto persons 60+ through the “aging network.” While people60 years and older are eligible for OAA programs, servicesare funded for individuals with the greatest economic andsocial need. Support services for family caregivers are alsoavailable.

The Administration on Aging (AOA) is the principal agencyof the U.S Department of Health and Human Servicesdesignated to carry out the provisions of the Older AmericansAct through approximately 620 AAA organizationsnationwide.

FMDA Call for Poster Submissions— Submissions from physicians, pharmacists, PAs, andadvanced practice nurses accepted online.

FMDA is hosting its 14th Annual Poster Session during theBest Care Practices Conference, Oct. 12-15, 2017. The first Continued on page 16



Celebrate FMDA’s 25th AnniversaryFMDA celebrated this milestone a number of ways, includ-ing the production of a video montage shown during theAnnual Awards Luncheon and a Wine & Cheese Celebrationsponsored by Consulate Health Care during the annualconference.The video is a celebration of the rich history of FMDA – TheFlorida Society for Post-Acute and Long-Term Care as itcelebrated its 25th Anniversary on Oct. 15, 2016, at Disney’sGrand Floridian Resort. To view the video, visit our website’shome page at www.fmda.org.Launching our conference on the first morning, attendees werewelcomed by a video greeting from Molly McKinstry, AssistantSecretary, Florida’s Agency for Health Care Administration.Sec. McKinstry saluted the attendees and congratulated FMDAon its anniversary. To view the video, please visit: https://www.youtube.com/watch?v=tpI7RebHMlQ&t=1s.

FMDA Highlights from 2016New Virtual Journal Club Launched

The Journal Club is designed to develop a learner-based com-munity of those seeking to improve health care and healththrough enhanced care in the PA/LTC continuum. It is aforum where people who care can meet, share, learn, andcreate change.FMDA’s Journal Club helps you stay current with the latestevidence-based clinical information relevant to post-acute andlong-term care medicine. Journal Club participants will sharein reviewing articles that are interesting, provide relevanttakeaways, and highlight best practices. It will be an effectiveway to gain new knowledge.It normally meets monthly telephonically, but there was anin-person meeting as well during the annual conference.

Industry Advisory Board Renamed FMDA’sQuality Advocacy Coalition, or FQAC

After 15 successful years, the Industry Advisory Board has anew name and mission. It held a yearly event that broughtpost-acute and long-term care industry leaders together todiscuss ways to provide a greater focus on delivering qualitycare in the new age of health care reform. The new name isFMDA’s Quality Advocacy Coalition, or FQAC.

FMDA’s Quality Advocacy Coalition held a Summit in Apriland a second in October, when we launched a new statewideinitiative to reduce avoidable hospital readmissions. Floridais ranked 53rd out of 54 states and territories in the country.

On Dec. 1, FMDA co-sponsored a stakeholders meeting withFlorida Hospital Association at the Florida College of Emer-gency Physicians’ training center. The focus of this effort wasto develop strategies to reduce avoidable hospital readmis-sions. More than 40 representatives attended from around thestate. Three workgroups were formed with results to be dis-cussed when we met again on April 4, 2017.

Organized the Council of PresidentsThe council is composed of past presidents of FMDA, withDr. Robert Kaplan as chair. Past presidents have the advan-tage of past experience and wisdom. The council acts as anindependent advisory panel to dialogue with the current boardand be available to the sitting president when requested. Theboard will be encouraged to solicit the council’s collectivewisdom about important issues and on pressing mattersfacing the association.

FMDA Member Advises TrumpHealthcare Team

As the Trump healthcare team goes about developingits plan for reform, they reached out to asmall handful of policy experts. Dr. RichardStefanacci, DO, MGH, MBA, AGSF,CMD, practicing geriatrician, CMS HealthPolicy Scholar under President GeorgeBush, and faculty at the Thomas JeffersonCollege of Population Health, recently

spent time with the team to present opportunities andchallenges in post-acute and long-term care.

Dr. Stefanacci used PACE (program for all-inclusivecare for the elderly) to illustrate the benefits of shiftingfrom acute care volume-based reimbursement to bundledpayments, which allow for investment in interdisciplinarycare teams, coordinated care, and ability to focus resourceswell beyond what Medicare and Medicaid fee-for-serviceprovide. In addition, he had the chance to learn aboutpriorities in front of the new administration, which he haswritten about in the current issues of Annals of LTC andGeriatric Nursing.

“As a proud FMDA lifetime member, I promise to keepus not only informed, but educated on the likely impact ofthese changes to our patients and practices...much moreto come to be sure,” Dr. Stefanacci said.



Congratulations, Dr. David LeVine!Congratulations to FMDA member Dr. David LeVine,winner of AMDA’s 2016 Medical Director of the Year Award.

Two FMDA Members Appointed toStatewide Telehealth Advisory Council

Florida’s Agency for Health Care Administration Secretaryand State Surgeon General and Department of Healthannounced the appointments of 13 to the Telehealth AdvisoryCouncil. Two of the 13 are members of FMDA. Ourcongratulations to Dr. Steven Selznick and Dr. Kevin O’Neil.

New Bylaws Changes EmbracePharmacists as Voting Members

On Oct. 14, our members voted unanimously to change ourbylaws and include pharmacists as voting members. Thisreflects the longstanding presence of consultant pharmacistsand clinical pharmacists collaborating with medical directors,attending physicians, advanced practice nurses, and physicianassistants in the PA/LTC continuum.

FMDA Appointed to FloridaHealthcare Workforce Initiative

At the recommendation of then-AHCA Sec. Liz Dudek,FMDA joined Florida Healthcare Workforce, a statewideinitiative. FMDA President Dr. Leonard Hock joined the Lead-ership Council and Executive Director Ian Cordes joined theProfessional Advisory Resource Group.Its purpose is for Florida’s health care providers to serve asthe primary point of contact for statewide health careworkforce data and predictive trends to facilitate policy andstrategy development. Its mission is to identify current andfuture demand, supply, and gaps for a quality workforce inthe state in order to meet the needs of health care employers.

Consulate Health Care Joins asCorporate Members

FMDA has seen a large boost in membership in 2016with a new corporate membership from Consulate Health Care,Florida and South East Divisions. The new members consistof administrative support staff from corporate, divisional, andregional offices; medical directors and physician assistants;executive directors; and directors of clinical services, and theirtherapy partners, Genesis Rehabilitation Services.Consulate Health Care is a national leading provider ofsenior health care services, specializing in post-acute care.Operating more than 200 centers nationwide in 21 states, it

FMDA Highlights from 2016has grown to become the sixth-largest provider in the nationand the largest in the Sunshine State. With the increase inmembership, FMDA is becoming the nucleus for providingadvocacy, education, and clinical care in the post-acute andlong-term care continuum.

FMDA Is the Largest Chapter of AMDAFMDA is composed of medical directors, attending physicians,advanced practice nurses, physician assistants, consultantpharmacists, nurse administrators, and nursing home adminis-trators in the PA/LTC continuum. All of these disciplines makeFMDA one of the most diverse and dynamic PA/LTC asso-ciations in the state of Florida. With the inclusion of ConsulateHealth Care, FMDA has grown into the largest chapter ofAMDA in the country.

First AMDA President from FL in Nearly 20 YearsIn March 2015, FMDA Director Dr. Naushira Pandya assumedthe presidency of AMDA – The Society for Post-Acute andLong-Term Care Medicine at its Annual Conference inLouisville. The last AMDA president from Florida was Dr.Roman Hendrickson.FMDA salutes Dr. Pandya for her leadership and dedication.Her term expired in March of 2016, and she is now the imme-diate past-president of AMDA. Dr. Pandya is professor andchair, Department of Geriatrics; and Project Director, Geriat-ric Education Center, Nova Southeastern University Collegeof Osteopathic Medicine in Fort Lauderdale.

FMDA Expanding Special Interest GroupsFMDA has had a Hospice Section for many years. Now, wehave introduced separate special interest groups (SIGs) duringthe annual conference for assisted living, rehab. medicine,hospital medicine, home care, etc.

President’s ReportContinued from page 3

FMDA has become the premier organization for providingleadership and education for best care practices, evidence-based medicine, regulatory compliance, and practicemanagement. FMDA’s goal is to become a model organizationthat collaborates with related organizations and promotes thehighest quality of care to patients in the post-acute and long-term care continuum. We invite our members to get involved,become energized, and stay connected to the society.Respectfully yours,

Leonard Hock Jr., DO, CMD, HMDC, MACOI



F M D A T h a n k s T h e s e S u p p o r t e r s o



f t h e 2 5 t h A n n i v e r s a r y C o n f e r e n c e



AT A GLANCE• An epigenomic analysis of rheumatoid arthritis in knee and hip joints

revealed unique patterns that suggest disease mechanisms may differfrom joint to joint.

• The findings could open the door to development of more effective,personalized therapies for rheumatoid arthritis.

heumatoid arthritis is an autoimmune disease inwhich the immune system mistakenly attacks thebody’s own tissue, such as the membranes that linejoints. This can cause pain, swelling, stiffness, and

loss of function in joints throughout the body. For unknownreasons, different joints are affected differently in people withrheumatoid arthritis.

The causes of rheumatoidarthritis aren’t completelyunderstood. Several genesinvolved in the immune systemhave been associated with atendency to develop rheumatoidarthritis. Environmental factors— such as cigarette smoking,diet, and stress — may alsoplay a role in triggering thedisease. A better understandingof the molecular mechanisms atwork in the disease may leadto more effective approaches totreatment.

A research team led by Drs.Gary S. Firestein and WeiWang at the University ofCalifornia, San Diego, has beenstudying fibroblast-like synoviocytes (FLS), a type of cell thatlines joints and contributes to joint destruction in rheumatoidarthritis. In past work, the team gained insights into how thesecells function using epigenetics — the study of factors thatchange the way genes are read, or expressed, without changingthe DNA sequence itself. They identified patterns of DNAmethylation — a common epigenetic modification that affectsgene expression — in FLS that differ between rheumatoidarthritis and osteoarthritis.

In their new study, the team studied FLS obtained fromtotal joint replacement surgeries in 30 people with rheumatoidarthritis and 16 with osteoarthritis. Their work was funded inpart by NIH’s National Institute of Arthritis and

Rheumatoid Arthritis MechanismsMay Vary by JointBy Harrison Wein, PhD; NIH Research Matters

Musculoskeletal and Skin Diseases (NIAMS) and NationalInstitute of Allergy and Infectious Diseases (NIAID). Thestudy appeared on June 10, 2016, in Nature Communications.

The scientists used computer analyses to group the samplesaccording to the thousands of methylation differences theyfound across the genome. As expected, methylation patternsdiffered between rheumatoid arthritis FLS and osteoarthritisFLS. The team found the patterns also differed betweenrheumatoid arthritis FLS isolated from knees and hips.

The researchers next examined the biological pathwaysaffected and identified several in FLS that were differentiallymethylated between rheumatoid arthritis knees and hips.Gene expression analysis confirmed that genes and pathways

differ between the jointlocations. Many of thesepathways are related toimmune function andinflammation.

The team next examineddrugs developed for use inrheumatoid arthritis. Theycompared the drugs’ targets tothe joint-specific biologicalpathways they uncovered.This analysis suggested thatseveral promising drugs mighthave been assessed differentlyif these pathways had beentaken into account. Thisanalytical method could formthe basis for developingprecision medicine approaches

to rheumatoid arthritis.“We showed that the epigenetic marks vary from joint to

joint in rheumatoid arthritis,” Firestein says. “Even moreimportantly, the differences involved key genes and pathwaysthat are designed to be blocked by new rheumatoid arthritistreatments. This might provide an explanation as to why somejoints improve while others do not, even though they areexposed to the same drug.”

NIH Research Matters is a weekly update of NIH research highlightsreviewed by NIH’s experts. It is published by the Office of Communicationsand Public Liaison in the NIH Office of the Director and published in FMDA’sProgress Report with permission from NIH.

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“Even more importantly, thedifferences involved key genes

and pathways that are designed tobe blocked by new rheumatoidarthritis treatments. This might

provide an explanation as to whysome joints improve while others

do not, even though they areexposed to the same drug.”

— Dr. Gary S. Firestein



Dr. Kenya Rivas, Dr. Elizabeth Hames, Dr. Leonard Hock,Dr. Naushira Pandya, Dr. John Potomski, and Dr. Rick Foley

25th Anniversary Conference Remembered

Dr. Rhonda Randall, Dr. John Symeonides, Dr. Michael Foley,and Dr. Robert Kaplan at the Annual Membership Meeting

Ian Cordes and Dr. Leonard Hock with25th Anniversary cake provided by Disney

Ian Cordes, Dr. Paul Katz, Dr. Niharika Suchak,Debra Allan Danforth, and Dr. Leonard Hock

Dr. Leonard Hock, Dr. Jason Gundersen, Dr. Susan Levy,Dr. Katherine Abraham Evans, and Christopher Laxton

Poster presentations during the annual conference

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25th Anniversary Conference Remembered

Dr. Leonard Hock with special guestDr. Nicole Bixler, president, FloridaOsteopathic Medical Association Dr. Elizabeth Hames (L) and Dr. Leonard Hock (R) with the poster presenters

Moderator Dr. Rick Foley with speakers Todd Semla, MS,PharmD, BCPS, FCCP, AGSF; and Peter A. Hollmann, MD

National Leaders Forum: Dr. Susan Levy, Dr. Jason Gundersen,Dr. Katherine Abraham Evans, and Moderator Dr. Leonard Hock

Dr. Gregory James (R) with the OPTUMCare teamat the Annual Trade Show

Dr. Leonard Hock (second from left) and Ian Cordes (R) withConsulate Health Care’s Carrie Condon, Robin Baschnagel,

Todd Mehaffey, and Richard Murphy



FMDA Activities at AMDA’s AnnualConference, March 16-19, in PhoenixFMDA Board Meeting: Members are invited to attend the

board meeting from 11:30 a.m. to 1 p.m., Friday, March17, in Remington, on the second floor of the Hyatt RegencyPhoenix. Lunch will be serviced, however, space is limited.Please RSVP by March 1 to Ian Cordes at [email protected].

AMDA House of Delegates: Chairing this year’s delegationis Dr. John Potomski. The Florida delegation will meet 5:30-6:30 p.m., Friday, March 17, just before the Florida ChapterReception in Sundance, on the first floor of the Hyatt.

The Florida Chapter Reception: 6:30-7:30 p.m., Friday,March 17. Our thanks to OPTUMCare for sponsoring thereception. This is always a really nice gathering. Plus, we willpresent the AMDA Foundation with a $3,000 check from FMDA.

Progress Report Newsletter is DigitalWe have transitioned to a digital-only edition and we are

asking our members if they prefer that a printed version bemailed to them instead of a digital version via email. Pleasesend your request for a printed newsletter to Cindi Taylor atcindicorecare @bellsouth.net.

Best Care Practices Logo RevisedIn line with FMDA’s name

change in 2015, the conferencename has been revised to reflectthe new emphasis on post-acuteand long-term care.

FMDA News from Around the StateContinued from page 7

Quality of Care Measure Scores ofMedicare-certified Hospices AvailableNational averages of the quality of care measure scores of

Medicare-certified hospices are now available ondata.medicare.gov. National average data are available for twoquality of care datasets — the Hospice Item Set (HIS) and theConsumer Assessment of Healthcare Providers and Systems(CAHPS®) Hospice Survey. The HIS information reflectsprovider performance on the seven National Quality Forum(NQF)-endorsed HIS measures (https://www.cms.gov/Medicare/Quality-Init iatives-Patient-Assessment-Instruments/Hospice-Qual i ty-Report ing/Current-Measures.html) from Quarter 3 of 2015 through Quarter 2 of2016 (July 2015 through June 2016).

The CAHPS® Hospice Survey information contains thenational average “top-box” scores of Medicare-certifiedhospices on the eight NQF-endorsed CAHPS® Hospice Surveymeasures. Top-box scores reflect the proportion ofrespondents who gave the most favorable response orresponses for each measure. Scores are calculated fromCAHPS® Hospice Survey responses that reflect careexperiences of informal caregivers (i.e., family members orfriends) of patients who died while receiving hospice care inQuarter 2 of 2015 through Quarter 1 of 2016 (April 2015through March 2016).

To access the HIS and CAHPS® Hospice Survey files, visit:https://data.medicare.gov/.

Call for Articles for Progress ReportFMDA is currently accepting articles for future issues of

its award-winning publication, Progress Report. If you wouldlike to submit an article, or get more information, pleasecontact Ian Cordes at [email protected].

he CME-Education Committee for Best Care Practicesin the Post-Acute and Long-Term Care Continuum 2017invites you to submit educational program proposalsand abstracts for the annual conference. The meeting

will be held Oct. 12-15, 2017, at Disney’s Grand Floridian Resortin Lake Buena Vista, FL.

Submissions should be based on current trends and best practicesin post-acute, long-term care, and geriatric topics. Of special interestis emerging clinical information, research, innovations in non-pharmaceutical modification of challenging behaviors, emergingconcepts in management and medical direction, and updates onapproaches to regulatory compliance.

The committee also seeks proposals that emphasize strategiesfor successful cooperation with advanced practice nurses,pharmacists, physician assistants, directors of nursing, andadministrators, as well as the entire interdisciplinary team.

Year after year, conference evaluations show that a majority of

Call for Speaker Presentationsattendees come for the educational programs and the associatedcontinuing-education credits. Our attendees expect clinical topicsto be evidence-based with cited references, and management topics tobe relevant to their setting and grounded in best practices. For theirlearning experience, attendees seek opportunities to network withcolleagues and engage in interactive presentations through variousformats such as point-counterpoint, case-based discussion (Q&A),small groups and/or role play, and practical information for valuabletake-home tools such as handouts, key points, guides, or quick tips.

If you have an interest in presenting at the 2017 conference, orknow some knowledgeable and excellent speakers, please bedirected to our proposal submission page at www.bestcarepractices.org.

The Oral Presentation Submission deadline has been extendeduntil March 24, 2017.

For information, contact the business office at (561) 689-6321.

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n Oct. 1, 2016, new International Classificationof Diseases (ICD)-10-CM and ICD-10-PCS codesets went into effect. Updating of these codestraditionally occurs on an annual basis, however,

during the immediate years leading up to the ICD-9 to ICD-10 transition there was an extended freeze to code updates tosupport a smooth transition. Therefore, for fiscal year (FY)2017, updates and revisions include changes since the lastcompleted update (October 1, 2013).

As a result of the consolidated coding updates, a largenumber of new codes was added or removed from the ICD-10 code set. The Centers for Medicare & Medicaid Services(CMS) is acutely aware of the relationship between the ICD-10 update and quality reporting. Under the Physician QualityReporting System (PQRS), calendar year (CY) 2016 is theperformance period for (1) the 2018 PQRS and Value Modifierpayment adjustments and (2) eligible professionals (EPs) whowere part of a Shared Savings Program ACO participant TINin 2015 and are reporting outside their accountable careorganization (ACO) for the special secondary reportingperiod, because their ACO failed to report on their behalf forthe 2015 PQRS performance period.

CMS has examined impact to quality measures and hasdetermined that the ICD-10 code updates will impact CMS’sability to process data reported on certain quality measuresfor the 4th quarter of CY 2016. Therefore, CMS will not applythe 2017 or 2018 PQRS payment adjustments, as applicable,to any EP or group practice that fails to satisfactorily reportfor CY 2016 solely as a result of the impact of ICD-10 codeupdates on quality data reported for the fourth quarter of CY2016. The Value Modifier program will consider solopractitioners and groups, as identified by their taxpayeridentification number (TIN), who meet reporting requirementsin order to avoid the PQRS payment adjustment (either as agroup or by having at least 50% of the individual eligibleprofessionals in the TIN avoid the PQRS adjustment) to be“Category 1,” meaning they will not incur the automaticdownward adjustment under the Value Modifier program.

ICD-10 Code Updates and Impact to EligibleProfessional Medicare Quality Programs

Consistent with previously communicated eCQM reportingrequirements, eligible professionals must submit eCQM datacorresponding to the 2015 versions of the measurespecifications and value sets (2015 Annual Update) for fourthquarter 2016 reporting.

For the 2017 performance period, CMS will publish anaddendum containing updates relevant to the ICD-10 valuesets for eCQMs in the Merit-based Incentive Payment SystemProgram (MIPS). CMS will provide additional informationon the addendum later this year.

CCCCCAREERAREERAREERAREERAREER-----ORIENTEDORIENTEDORIENTEDORIENTEDORIENTED P P P P PROGRAMMINGROGRAMMINGROGRAMMINGROGRAMMINGROGRAMMING:::::What do practitioners see as valuable? They can findclinical talks anywhere, but should they come to BestCare Practices for career guidance information,regulatory, and administrative talks? Why shouldphysicians, NPs, pharmacists, PAs, nurse admini-stratrors, and nursing home administrators join FMDAand attend our conference? Answer = CareerCompetitive Advancement. What topics or burningquestions would you like to see featured at futureeducational programs? Become a member today!

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CMS is acutely aware of therelationship between the

ICD-10 update andquality reporting.



moved to Florida in 2001 to escape the coldweather and be closer to the warm waters.I was happy to realize there were manynursing homes and a significant elderly

population. Geriatrics and nursing home care becamea substantial part of my practice.

Then I discovered FMDA, an organization of like-minded professionals, whose members have tremendousknowledge and experience that they are willing to share. Iattended a Town Hall meeting in Sarasota and met FMDA’sofficers and members. They were welcoming, friendly, andwarm and I felt among family and old friends! I was soonlooking forward to meetings and functions, and Best CarePractices was the epic event ofthe year, where I could absorbknowledge and years ofexperience.

During the time I waspresident of FMDA, we heldthe first strategic planningsummit at Safety Harbor,expertly coordinated by Dr.Rhonda Randall, where weestablished our mission andvision statement. We alsoformally moved to expand thespectrum of FMDA membership to include physicianassistants and nurse practitioners.

I am grateful to those individuals and this organization fortheir willingness to serve and assist. I was honored when Iwas asked to become involved with FMDA, following thesteps of FMDA’s great leaders and mentors. I was promotedthrough the ranks to become president from 2011 to 2013,and now chairman of the board of this great organization. Iknow I couldn’t have done it without the guidance of thepresidents who preceded me and the presidents who follow.Each one of us is a link in a chain towards improved care inthe post-acute and long-term care continuum (PA/LTC).

FMDA is evolving and growing and is now FMDA – TheFlorida Society for Post-Acute and Long-Term Care. At thecore, FMDA remains inviting and welcoming new individualsand organizations that have the best interest of this populationat heart and provide care and services to those individuals.

FMDA is literally the go-to organization for best carepractices having in mind patient- and family-centered care.It is where every professional in PA/LTC can turn for advice andsolutions for these ever-complicated and challenging times.

FMDA will continue to lead and shape the future of PA/LTC and become the go-to organization when issues surface.

Also, FMDA will be at the crossroad wheregovernmental, advisory, insurance, and all otherorganizations pass through for best services,opportunities, and care.

I foresee FMDA to be the:• Leader and driving force, guide, and advisor for

PA/LTC• Pertinent player and central hub that leads to best care

practices and patient/family-centered individual care• Leader in advocacy, care, and standards• Go-to for governmental or non-governmental organizations

initiatives’ in long-term care• Relevant and engaging medical society

I share AMDA’s vision: aworld in which all PA/LTCcare patients and residentsreceive the highest-quality,compassionate care foroptimum health, function, andquality of life

It is a great pleasure torepresent such a wonderfulorganization. At FMDA, thereare challenges that need to beaddressed from a political,organizational, and financial

aspect. These challenges have to be addressed in order for usto proceed in the future in a profitable and successful manner.

Extreme pressures are being placed at national, state, andlocal levels to improve the quality of health care and reducethe number of hospital readmissions. We, as PA/LTC partners,must organize our operations so that we can achieve morepreventative care on the front end and reduce the high cost ofreadmissions.

In addition, there is a movement at the nursing home levelto limit the medication burden placed upon our patients.Presently, multiple prescriptions are being written by primarycare, hospitalists, specialists, and attending physicians.Frequently, there is a lack of coordination and communication.By analyzing the complete picture of each patient, we shouldimprove quality of care by reducing medication and limitingunnecessary spending. We should maximize and increase theefficiency of services provided in a skilled facility withoutthe need for avoidable, unnecessary, and expensive transfersto hospitals.

I encourage each and every one to work together andcommunicate as to the best practices that can be implementedat our facilities to maximize patient care.

Member SpotlightJohn Symeonides, MD, FAAFP, CMD; Chairman of the Board; President from 2011 to 2013

I

Also, FMDA will be at thecrossroad where governmental,

advisory, insurance, andall other organizations passthrough for best services,opportunities, and care.



n Feb. 8, the National Institutes of Health reportedthat a NIH-funded preclinical study suggests apossible treatment for Alzheimer’s disease andother neurodegenerative disorders.

In a study of mice and monkeys, National Institutes ofHealth-funded researchers showed that they could preventand reverse some of the brain injury caused by the toxic formof a protein called tau. The results, published in Science Trans-lational Medicine, suggest that the study of compounds, calledtau antisense oligonucleotides, that are genetically engineeredto block a cell’s assembly line production of tau, might bepursued as an effective treatment for a variety of disorders.

Cells throughout the body normally manufacture tauproteins. In several disorders, toxic forms of tau clumptogether inside dying brain cells and form neurofibrillaryangles, including Alzheimer’s disease, tau-associatedfrontotemporal dementia, chronic traumatic encephalopathy,and progressive supranuclearpalsy. Currently there are noeffective treatments forcombating toxic tau.

“This compound mayliterally help untangle thebrain damage caused by tau,”said Timothy Miller, MD,PhD, the David ClaysonProfessor of Neurology atWashington University, St.Louis, and the study’s seniorauthor.

Antisense oligonucleotidesare short sequences of DNAor RNA programmed to turngenes on or off. Led by Sarah L. DeVos, a graduate studentin Dr. Miller’s lab, the researchers tested sequences designedto turn tau genes off in mice that are genetically engineeredto produce abnormally high levels of a mutant form of thehuman protein. Tau clusters begin to appear in the brains of6-month-old mice and accumulate with age. The mice developneurologic problems and die earlier than control mice.

Injections of the compound into the fluid-filled spaces ofthe mice brains prevented tau clustering in 6-9-month-oldmice and appeared to reverse clustering in older mice. Thecompound also caused older mice to live longer and havehealthier brains than mice that received a placebo. In addition,the compound prevented the older mice from losing theirability to build nests.

“These results open a promising new door,” said Margaret

Designer Compound May UntangleDamage Leading to Some Dementias

Sutherland, PhD, program director at NIH’s National Instituteof Neurological Disorders and Stroke (NINDS). “Theysuggest that antisense oligonucleotides may be effective toolsfor tackling tau-associated disorders.”

Currently, researchers are conducting early-phase clinicaltrials on the safety and effectiveness of antisense oligo-nucleotides designed to treat several neurological disorders,including Huntington’s disease and amyotrophic lateralsclerosis. The U.S. Food and Drug Administration recentlyapproved the use of an antisense oligonucleotide for thetreatment of spinal muscular atrophy, a hereditary disorderthat weakens the muscles of infants and children.

Further experiments on non-human primates suggested thatthe antisense oligonucleotides tested in mice could reachimportant areas of larger brains and turn off tau. In comparisonwith placebo, two spinal tap injections of the compoundappeared to reduce tau protein levels in the brains and spinal

cords of Cynomologusmonkeys. As the researcherssaw with the mice, injectionsof the compound causedalmost no side effects.

Nevertheless, the researchersconcluded that the compoundneeds to be fully tested forsafety before it can be tried inhumans. They are taking thenext steps toward translatingit into a possible treatment fora var ie ty of tau-re la teddisorders.

This study was supportedby grants from NINDS

(NS078398, NS074194, NS057105) and National Institute onAging (AG05681, AG044719), the Tau Consortium and CurePSP. Ionis Pharmaceuticals supplied the authors with all ofthe antisense oligonucleotides in the described work.

NINDS is the nation’s leading funder of research on thebrain and nervous system. The mission of NINDS is to seekfundamental knowledge about the brain and nervous system andto use that knowledge to reduce the burden of neurological disease.

About the National Institute on Aging: The NIA leads thefederal government effort conducting and supporting researchon aging and the health and well-being of older people. Itprovides information on age-related cognitive change andneurodegenerative disease specifically at its Alzheimer’s

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“These results open a promisingnew door... They suggest that

antisense oligonucleotides maybe effective tools for tackling

tau-associated disorders.”— Margaret Sutherland, PhD, program

director, National Institute of NeurologicalDisorders and Stroke




n Dec. 20, 2016, the Centers for Medicare & MedicaidServices (CMS) finalized new Innovation Center modelsthat continue the progress to shift Medicare paymentsfrom rewarding quantity to rewarding quality by creating

strong incentives for hospitals to deliver better care to patients at alower cost. These models will reward hospitals that work togetherwith physicians and other providers to avoid complications, preventhospital readmissions, and speed recovery.

The announcement finalizessignificant new policies that:

• Improve cardiac care: Threenew payment models will supportclinicians in providing care topatients who receive treatment forheart attacks, heart surgery tobypass blocked coronary arteries,or cardiac rehabilitation followinga heart attack or heart surgery.

• Improve orthopedic care: Onenew payment model will supportclinicians in providing care topatients who receive surgery aftera hip fracture, other than hipreplacement. In addition, CMS is finalizing updates to theComprehensive Care for Joint Replacement Model, which began inApril 2016.

• Provide an Accountable Care Organization opportunity for smallpractices: The new Medicare ACO Track 1+ Model will have morelimited downside risk than in Tracks 2 or 3 of the Medicare SharedSavings Program in order to encourage more practices, especiallysmall practices, to advance to performance-based risk.

These new payment models and the updated Comprehensive Carefor Joint Replacement Model give clinicians additional opportunitiesto qualify for a five percent incentive payment through the AdvancedAlternative Payment Model (APM) path under the Medicare Accessand CHIP Reauthorization Act of 2015 (MACRA) and the QualityPayment Program. For the new cardiac and orthopedic paymentmodels, clinicians may potentially earn the incentive paymentbeginning in performance year 2019 or potentially as early asperformance year 2018 if they collaborate with participant hospitalsthat choose the Advanced APM path. For the Comprehensive Carefor Joint Replacement model, clinicians may potentially earn theincentive payment beginning in performance year 2017. For the Track1+ Model, clinicians may potentially earn the incentive paymentbeginning in performance year 2018, and the application cycle willalign with the other Shared Savings Program tracks.

These models are being implemented by the CMS InnovationCenter (https://innovation.cms.gov/index.html) under section1115A of the Social Security Act, with participation by all hospitalsin selected geographic areas in order to yield more generalizableresults, and additional protections for small and rural providers. Themodels will be referred to as:

New Payment Models Announced toImprove Cardiac and Joint Care

• The Acute Myocardial Infarction (AMI) Model;• The Coronary Artery Bypass Graft (CABG) Model;• The Surgical Hip and Femur Fracture Treatment (SHFFT)

Model; and• The Cardiac Rehabilitation (CR) Incentive Payment Model.CMS is also announcing the new Medicare ACO Track 1+

Model. This new opportunity, beginning in 2018, will allowclinicians to join Advanced Alternative Payment Models to improve

care and potentially earn anincentive payment under theQuality Payment Program,created by the Medicare Accessand CHIP Reauthorization Act of2015 (MACRA). The newMedicare ACO Track 1+ Modelwill test a payment model thatincorporates more limiteddownside risk than is currentlypresent in Tracks 2 or 3 of theMedicare Shared SavingsProgram in order to encouragemore rapid progression toperformance-based risk.

For more information about the individual models finalizedthrough this rule, visit the CMS Innovation Center website at https://innovation.cms.gov/initiatives/epm.

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These models will rewardhospitals that work together

with physicians and otherproviders to avoid complications,

prevent hospital readmissions,and speed recovery.

Disease Education and Referral (ADEAR) Center atwww.nia.nih.gov/alzheimers.

About the National Institutes of Health (NIH): NIH, thenation’s medical research agency, includes 27 institutes andcenters and is a component of the U.S. Department of Healthand Human Services. NIH is the primary federal agencyconducting and supporting basic, clinical, and translationalmedical research, and is investigating the causes, treatments,and cures for both common and rare diseases. For moreinformation about NIH and its programs, visit www.nih.gov.— DeVos et al. Tau Reduction Prevents Neuronal Loss and ReversesPathological Tau Deposition and Seeding in Mice with Tauopathy. ScienceTranslational Medicine, Jan. 25, 2017 DOI: 10.1126/scitranslmed.aah7029

NIH Research Matters is a weekly update of NIH research highlightsreviewed by NIH’s experts. It is published by the Office of Communicationsand Public Liaison in the NIH Office of the Director and published in FMDA’sProgress Report with permission from NIH.

Designer Compound May Untangle DamageLeading to Some DementiasContinued from page 19



“A lot of uncertainty lies with the bundled payments forcare improvement initiative (BPCI) in which organizationswill enter into payment arrangements that includefinancial and performance accountability forepisodes of care. We are entering a new frontierin PA/LTC medicine and we must be preparedwith the requisite knowledge to handle thesechanges and provide the best care for ourresidents,” he added.

Best Care Practices in the GeriatricsContinuum 2016 was joint-provided by FMDA– The Florida Society for Post-Acute and Long-Term Care Medicine and AMDA – The Society forPost-Acute and Long-Term Care Medicine, and held incollaboration with the Florida Chapters of GerontologicalAdvanced Practice Nurses Association, the National

FMDA Celebrates 25th AnniversaryContinued from page 1

revention, diagnosis, andtreatment of human disease

With NIH support, scientists across the UnitedStates and the world conduct wide-ranging research to improvethe health of our nation. Groundbreaking NIH-funded researchoften receives top scientific honors.

In 2016, these honors included one NIH-supported NobelPrize winner and five NIH-funded recipients of top awards fromthe Lasker Foundation. Here’s just a small sampling of theresearch accomplishments made by NIH-supported scientistsin 2016. For more health and medical research findings fromNIH, visit NIH Research Matters (https://www.nih.gov/news-events/nih-research-matters).

Islet transplantation restores blood sugarcontrol in type 1 diabetes

Diabetes is a disorder in the regulation and use of glucose.In type 1 diabetes, the body’s own immune system attacksand destroys pancreatic beta cells that make insulin.Researchers used pancreatic islet cell transplantation tosuccessfully treat people with difficult cases of type 1 diabetes.

The procedure and the use of antirejection drugs wereassociated with some side effects. Researchers continue tomonitor participants to assess the experimental procedure.

2016 Research Highlights: Clinical BreakthroughsNIH Research Matters – Dec. 21, 2016

Blood pressure management for seniorsHigh blood pressure, or hypertension, affects one in three

American adults. In a large clinical study, researchers foundthat seniors who aimed for a target systolic blood pressurelevel lower than commonly recommended (less than 120 mmHg compared to 140 mm Hg) had a reduced risk ofcardiovascular disease and death. The findings will help olderadults with hypertension and their doctors make moreinformed decisions about blood pressure goals.

Long-term benefits of age-relatedmacular degeneration treatments

Age-related macular degeneration (AMD) is the leadingcause of vision loss among older Americans. AMD often hasfew symptoms in its early stages, but causes loss of centralvision in later stages. Researchers examined the five-yearoutcomes of using the drugs Avastin and Lucentis to treatAMD. The results showed that almost half of the participantshad 20/40 vision or better, confirming the long-term benefitsof the therapy.

For the full 2016 NIH Research Highlights List visit: https://www.nih.gov/sites/default/files/news-events/research-matters/2016/20161221-nihrm-fill-list.pdf

NIH Research Matters is a weekly update of NIH research highlights reviewedby NIH’s experts. It is published by the Office of Communications and Public Liaisonin the NIH Office of the Director and published in FMDA’s Progress Report withpermission from NIH.

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Association of Directors of Nursing Administration, andFlorida Geriatrics Society.

The conference educated and enlightenedphysicians, consultant pharmacists, advanced

practice nurses, physician assistants, directorsof nursing in LTC, registered nurses and long-term care administrators, as well asgeriatricians, hospice physicians, primary careand home care physicians, physiciansconsidering becoming long-term care or home

care medical directors, and others with aninterest in PA/LTC medicine.Each year, the faculty includes national and

regional authorities in the fields of PA/LTC and geriatricmedicine, medical direction, as well as senior carepharmacology.



Alternative Payment ModelsThese alternative payment models (APMs) offer a fixed

5% bonus for eligible clinicians, and include both ACOs and

medical home models of care. Eligible clinicians in advancedAPMs are exempt from MIPS reporting, and all providerswithin an APM receive the same final APM score. Cliniciansin standard APMs may still have to report in MIPS, generallya small amount of data. For 2017, APMs include:

1) Shared savings (tracks 1,2,3) — an advanced APM2) Next generation ACO model — an advanced APM3) Comprehensive ESRD — an advanced APM4) Oncology care models5) Comprehensive primary care plus — an advanced APMAccording to AMDA’s webinar, possible additional APMs

for 2018 include the joint replacement model, cardiac carecoordination, and a new ACO track I model.

Future Directions for PA/LTC ProvidersAMDA’s Policy Committee is continuing to communicate

and work with CMS on behalf of PA/LTC providers. TheCommittee has asked for automatic hardship exemptions inthe MIPS Advancing Care Information category for clinicianswho practice primarily in SNFs. It was noted during theAMDA webinar that currently only one reportable qualityoutcome measure includes SNF as a denominator — thespeakers stressed the need for additional reportableimprovement activities that reflect QAPI, National Partnershipto Improve Dementia Care, etc. The need for additionaladvanced APMs that include the PA/LTC environment wasdiscussed — some very preliminary ideas from AMDAworkgroups include a dementia APM, neurologic diseaseAPM, and an acute illness APM (focus on in-house treatmentof acute change of condition in the PA/LC facility whenappropriate). PA/LTC clinicians have a unique and specializedskill set which will be extremely valuable for current andfuture quality reporting, ACOs, and APMs.

Follow continued updates through AMDA and CMS!

*** Hardship applications are available for this category — it may bere-weighted to 0% for clinicians with > 50% of their practice in long-termcare facilities where they are not in control of the EHR, and for hospital-based clinicians

For MIPS applications and information, go to:https://qpp.cms.gov

MIPS Timeline and Exclusions:Some clinicians are excluded from MIPS reporting and

scoring. These include:1) Advanced APM participants2) Clinicians newly enrolled as Medicare providers

(during first year)3) Clinicians who see fewer than 100 part B beneficiaries

annually or bill less than $30,000 in part B chargesannually

The timeline is designed for reporting that begins Jan. 1,2017, through Dec. 31, 2017, to be submitted by the deadlineof March 31, 2018. A review and feedback period by CMSwill then occur, with payment adjustments to providersbeginning Jan. 1, 2019. Overall, the 2017 performance yearwill be affecting physician reimbursements in 2019.

Of note, there are flexible paths for clinicians to beginparticipation:

1) Test Pace: After Jan. 1, 2017 report 1 quality measureor one improvement activity or 4-5 of the requiredadvancing care information (EHR) activities — can gainneutral or small positive payment adjustment

2) Partial Year: Report for a 90-day period (any timebetween Jan. 1, 2017 and Oct. 2, 2017) — can gain asmall positive payment adjustment

3) Full Year: Report for the entire year beginning Jan. 1,2017 — can gain a small positive payment adjustment

4) Participate in an APM: This will exclude a clinicianfrom MIPS reporting

***NOTE*** CLINICIANS WHO AREELIGIBLE FOR MIPS REPORTING MUSTREPORT ON AT LEAST A MINIMUM AMOUNTOF DATA (TEST PACE CATEGORY) TO AVOID A4% PAYMENT LOSS IN 2019

Editor’s Corner: CMS MACRA/Quality Payment Program UpdateContinued from page 4

FMDA’s Progress Report February 2017

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