SGO Issues Nov. 19, 2015
Late-breaking abstract submissions open Dec. 1 – Jan. 10
SGO submits MACRA comments to CMS
ABOG announces Gilstrap retirement
Medicinal cannabis: The genie is out of the bottle
Next coding webinar Dec. 8
SGO is accepting late-breaking abstract submissions for the Annual Meeting on Women’s Cancer® Dec. 1, 2015, through Jan. 10, 2016. This session will highlight data of the highest scientific impact that has become available since the original 2016 Annual Meeting abstract submission deadline on Sept. 15, 2015. Abstracts already submitted in response to the original Call for Abstracts for the 2016 Annual Meeting are not eligible for resubmission.
On Nov. 17, SGO submitted comments in response to the Request for Information regarding the implementation of the Merit Incentive Payment System (MIPS) and the Eligible Alternative Payment Models program as authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The letter addressed numerous aspects of the MACRA law, its implementation, and how that implementation should be done to positively impact the subspecialty of gynecologic oncology and those Medicare patients for whom SGO members provide care.
SGO specifically commented on the following aspects of the Merit Incentive Payment System: reporting mechanisms available for quality performance, data stratification, barriers to successful quality performance, data accuracy, resource use performance, clinical Performance Improvement Activities (CPIA), development of performance standards, and defining and incorporating improvement and public reporting.
Regarding Physician-Focused Payment Models (PFPM), “SGO believes that it is critical that the MACRA regulations establish a clear pathway for models to be proposed to the Preadmission Screening and Resident Review (PASRR) Technical Assistance Center (PTAC) and for those models that are recommended by the PTAC to HHS to be implemented by CMS as qualified Alternative Payment Models (APMs)…
“The forthcoming regulations should establish an easy pathway for PFPM proposals to be adopted as qualified APMs. CMS should clearly outline the criteria that will be used to evaluate PFPM proposals. CMS and the PTAC should work collaboratively with medical societies and other organizations developing proposals, provide feedback on drafts, and provide data up-front to help in modeling impacts. These regulations should also make it clear that PFPMs recommended by the PTAC will be accepted by CMS. SGO is working very hard on its endometrial cancer APM with the intent of having it accepted as a PFPM.”
On Nov. 17 the American Board of Obstetrics and Gynecology (ABOG) announced the pending retirement of Executive Director Larry C. Gilstrap, III, MD, in January 2017.
Dr. Gilstrap served as ABOG’s Director of Evaluation from 2006-2010 before becoming its Executive Director in 2010. Prior to coming to ABOG he was the Chair of the Department of Obstetrics and Gynecology at The University of Texas Health Science Center at Houston. Earlier in his career he worked as the Associate Professor of Obstetrics and Gynecology and Director of the Maternal-Fetal Medicine Fellowship the University of Texas Southwestern Medical Center in Dallas.
Dr. Gilstrap’s military service includes a 20-year assignment as a medical officer for the United States Air Force, where he retired as a colonel.
He is also a member of the Board of Directors of the American Board of Medical Specialties and on the Executive Board of the American College of Obstetricians and Gynecologists.
“I have witnessed the tremendously positive influence of Dr. Gilstrap’s tenure as Director of Examinations and Executive Director of ABOG,” said SGO Past President Larry Copeland, MD, who also serves as Chair, Board of Directors of ABOG. “While the examination process has advanced, so has ABOG’s relationship with many of our ‘sister’ professional organizations and societies, including the SGO.
“It has been an honor to serve under his leadership,” Dr. Copeland added. “His ‘Texas-size’ boots will be a challenge for ABOG to fill.”
A job posting for the ABOG Executive Director position is currently available on the ABOG website.
By Christopher Lutman, MD
In 1996, Proposition 215 was passed by the citizens of California, which became the first state to legalize the usage of cannabis for medical purposes. Since that historic ballot measure, medicinal cannabis has now become legal in 23 states. It is also legal in the District of Columbia and the overseas territories of Guam and Puerto Rico.
Recently, Sen. Rand Paul, a physician, submitted bipartisan legislation (the CARERS Act of 2015) in the U.S. Congress for rescheduling marijuana and reforming cannabis laws at the federal level. Clearly, the proverbial genie is “out of the bottle” when it comes to cannabis legalization in the United States.
My home state (Ohio) does not have legalized medicinal cannabis. Earlier this month the citizens of Ohio soundly voted down Issue 3. This ballot measure was a first of its kind in that it proposed to legalize both recreational and medicinal cannabis in our state with one vote. This was unprecedented. Previous legalization efforts in other states have followed a gradual pattern of decriminalization followed by progress toward legalization of medicinal, and ultimately, recreational pot.
According to pundits and polls, the major reason Issue 3 failed in Ohio was because of the “monopoly style system” that would have been established here. Opinion polls have clearly shown that most Ohioans overwhelmingly support the legalization of medicinal cannabis.
As I watched the media circus surrounding Issue 3 unfold in Ohio over the past few months, I was struck by a simple fact: Most doctors do not appear to be involved in this important debate. Other than a few Ohio pediatricians speaking out on television about the perils of increased cannabis usage by teenagers; there has been no sensible evidence-based debate about cannabis as medicine “by physicians, for physicians.”
In my opinion, it is unfortunate that the only “medical opinion” about medicinal cannabis given to my fellow citizens recently was a widely distributed television endorsement of the “vote NO on Issue 3” campaign by the Ohio State Medical Association–a non-scientific, political lobbying organization.
In 1999, the Institute of Medicine issued a thoughtful and provocative report on medicinal cannabis. I would encourage all of my colleagues to review this document. In my opinion, it serves as a good starting point and a late wake-up call (published 16 years ago) for physicians now actively engaged in caring for seriously ill patients.
At this point in time, I am generally ambivalent on the usage of medicinal cannabis by my patients. I am trying to learn what I can, but solid data and firm conclusions about medicinal cannabis are sparse due to restrictive federal cannabis policies.
Unfortunately, much of the knowledge that our patients are receiving about medicinal cannabis at the local level is anecdotal and non-scientific. At best, in places like Colorado, non-medical “Budtenders” at cannabis dispensaries serve as “doctor-pharmacists” compassionately helping patients choose the right cannabis strains for their ailments. At its worst, in places like Ohio, drug dealers might be making recommendations to my patients on the usage of cannabis for a variety of symptoms and illnesses.
I am not ambivalent (nor naive) about the political and social realities of the age in which we practice. Physicians should become more aware and socially engaged on the issues surrounding medicinal cannabis. As a cancer doctor and palliative medicine specialist, I will continue to encourage myself and my colleagues to get engaged–scientifically and politically about medicinal cannabis.
If physicians continue to be sidelined by politicians and “ganjapeneurs” in the national debate on medicinal cannabis, then we risk losing yet more ground in our role as the primary drivers of best practices, patient advocacy and patient care. In my opinion, the sanctity of the doctor-patient relationship deserves more from us on the issue of medicinal cannabis.
The National Hospice and Palliative Care Organization (NHPCO) has proclaimed November as National Hospice and Palliative Care Month, to encourage citizens to increase their understanding and awareness of care at the end of life. The 2015 theme is “Hospice. Helps. Everyone.” Outreach materials are available through the NHPCO website and related articles have been posted on the organization’s Facebook page.
The next SGO Connect coding webinar will be held Tuesday, Dec. 8, at 7:00 p.m. EST/6 p.m. CST. The topic will be “An Introduction to Evaluation and Management (E&M) Coding in the Outpatient and Inpatient Setting for Gynecologic Oncologists.” Course directors David O. Holtz, MD, FACOG, and Barbara A. Goff, MD, will review the three areas of E&M coding (history, physical exam, medical decision making) and demonstrate how the physician’s notes are translated by coding experts into billing codes. There will also be case-based examples to walk participants through the process. For more information, contact SGO Education at email@example.com.