Practice & Policy Division Works to Represent the Specialty

As one of the three Divisions of the AAAAI Board of Directors, Practice & Policy represents the AAAAI and allergy/immunology on a number of socioeconomic issues. AAAAI members are supported by its endeavors in several areas, which include the understanding of issues pertaining to allergy and asthma diagnosis and treatment, strategic relationships, practice management and quality.

Understanding of Issues Pertaining to Allergy and Asthma Diagnosis and Treatment
We receive and respond to requests from third parties for our scientific, clinical and medical expertise in connection with these issues and share results of our published research, studies and related materials.

Strategic Relationships
The AAAAI participates in the larger context of advocacy for medicine through its involvement with the Subspecialty Advisory Group on Socioeconomic Affairs and Council of Specialty Societies of the American College of Physicians.

The AAAAI is also part of the Cognitive Specialties Coalition. This coalition, which the AAAAI was invited to join two years ago, discusses and works collaboratively on legislative and regulatory outreach on issues including but not limited to:

Overarching Issues

• Emphasize early cognitive specialty care access to decrease overall care costs
• End payment preference based on physician specialty designation
• Improve fairness in Resource-Based Relative Value Scale and Relative Value Scale Update Committee and methodology
• Protect and increase payment on E&M codes
• Overall funding for the Department of Health and Human Services; avoid sequestration cuts to Medicare/Medicaid programs
• Increase access for specialist-provided primary care services for relevant chronic condition patients
• Workforce issues

Alternative Payment Models

• Value-based payment methodology (specifically, payment structure concerns)
• Cognitive specialties access to complex chronic care codes without having to meet the structural requirements under patient-centered medical home (PCMH) certification
• Impact of attribution restraints in PCMH on small practices tied to more than one system

CMS Payment Programs

• Sustainable Growth Rate and future automatic cuts related to it
• Specialty designation concerns in Medicaid primary care parity program
• Medicare bonus program specialty designations (10% for 60% E&M codes)
• Penalties tied to existing reporting programs (Physician Quality Reporting System and E-Prescribing)
• Quality Clinical Data Registries, the new option to facilitate reporting specialty-developed measures

While the coalition works predominantly on issues of mutual interest, member societies may lobby each other for support on particular issues. The coalition also reviews and discusses pertinent resolutions before the American Medical Association (AMA) House of Delegates.

Practice Management
The Practice & Policy Division assists members with practice management issues by coordinating AAAAI educational resources such as the Practice Management Workshop and the Practice Management Resource Guide. Registration opens soon for the 2014 Practice Management Workshop, which takes place July 18-20 in Atlanta. There is more information in eNews. AAAAI members can also obtain guidance on topics such as office operations, allergy immunotherapy extract preparation, coding and promoting your practice with the Practice Management Resource Guide. An updated 2014 edition will soon be available within the Practice Resources area of the AAAAI website.

The AAAAI’s online Practice Resources area contains a library of practice-related information. Members can download and personalize the AAAAI’s skin test and immunotherapy forms, find the most up-to-date guidance on a variety of allergy/immunology topics in the statements and practice parameters section, refer to information in the consultation and referral guidelines to assist patients and healthcare professionals in determining when referral to an allergist/immunologist is needed—and much more.

Quality
The AAAAI is developing an A/I Quality Clinical Data Registry (QCDR), which will facilitate Physician Quality Reporting System (PQRS) reporting with meaningful measures for the specialty.

The QCDR is a new PQRS reporting option that was introduced in the 2014 Physician Fee Schedule. It is designed to provide a mechanism for eligible professionals to report specialty-designed, meaningful quality measures without being limited to existing PQRS measures. The same 2014 PQRS requirements of reporting on nine measures to cover three National Priorities Partnership priorities, including one outcomes measure, will apply when using the QCDR.

Allergy immunotherapy and asthma measures will be built into the A/I QCDR. The allergy immunotherapy measures were developed by the Joint Task Force on Quality Performance Measures and approved by the AAAAI and ACAAI in 2012. The asthma measures built in will include Bridges to Excellence measures, which are used by private payers to facilitate data collection for quality improvement in chronic care. Finally, current PQRS measures will be included but without the existing upper age limits in order to provide data to work toward changing nationally endorsed asthma measures.

The Centers for Medicare & Medicaid Services (CMS) will determine qualification for QCDRs for PQRS reporting later in 2014.

The AAAAI is also helping to move quality into practice in other ways. The AMA-convened Physician Consortium for Performance Improvement® (PCPI™) approached the AAAAI to assume responsibility as maintenance steward for PCPI measures related to the A/I specialty, specifically the PCPI asthma measures that are used in CMS programs. In addition, the American Academy of Dermatology has asked the AAAAI to co-steward PCPI measures on atopic dermatitis.