Match Day 2019 was another record breaker, and psychiatry helped play a big role by offering nearly 200 more residency slots and matches than in 2018, according to the National Resident Matching Program (NRMP).

There were a total of 1,740 PGY-1 psychiatry slots offered in 2019, up from 1,556 in 2018, for an increase of 11.8%. The 184-position increase was the fourth-largest overall increase among all measured specialties, behind only internal medicine, family medicine, and emergency medicine.

“Since 2015, the number of psychiatry positions has increased by 387, or 28.6%,” the NRMP said in a press release. However, while the fill rate increased slightly to 99%, leaving only 20 slots unfilled, the fill rate by U.S. graduates dropped from 63.1% to 60.6%.

Overall, a total of 32,194 PGY-1 slots were offered, a new record, and 94.9% were filled, with U.S. graduates filling 55.2%, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (33,426; up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

lfranki@mdedge.com

Match Day 2019 was another record breaker, and psychiatry helped play a big role by offering nearly 200 more residency slots and matches than in 2018, according to the National Resident Matching Program (NRMP).

There were a total of 1,740 PGY-1 psychiatry slots offered in 2019, up from 1,556 in 2018, for an increase of 11.8%. The 184-position increase was the fourth-largest overall increase among all measured specialties, behind only internal medicine, family medicine, and emergency medicine.

“Since 2015, the number of psychiatry positions has increased by 387, or 28.6%,” the NRMP said in a press release. However, while the fill rate increased slightly to 99%, leaving only 20 slots unfilled, the fill rate by U.S. graduates dropped from 63.1% to 60.6%.

Overall, a total of 32,194 PGY-1 slots were offered, a new record, and 94.9% were filled, with U.S. graduates filling 55.2%, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (33,426; up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

lfranki@mdedge.com

Match Day 2019 was another record breaker, and psychiatry helped play a big role by offering nearly 200 more residency slots and matches than in 2018, according to the National Resident Matching Program (NRMP).

There were a total of 1,740 PGY-1 psychiatry slots offered in 2019, up from 1,556 in 2018, for an increase of 11.8%. The 184-position increase was the fourth-largest overall increase among all measured specialties, behind only internal medicine, family medicine, and emergency medicine.

“Since 2015, the number of psychiatry positions has increased by 387, or 28.6%,” the NRMP said in a press release. However, while the fill rate increased slightly to 99%, leaving only 20 slots unfilled, the fill rate by U.S. graduates dropped from 63.1% to 60.6%.

Overall, a total of 32,194 PGY-1 slots were offered, a new record, and 94.9% were filled, with U.S. graduates filling 55.2%, the NRMP said in its 2019 Main Residency Match report.

The 2019 Match set a record for most positions offered (35,185; up 6.1%), most positions filled (33,426; up 4.8%), most PGY-1 positions offered (32,194; up 6.5%), and total applicants (38,376; up 3.4%).

“The results of the Match are closely watched because they can be predictors of future physician workforce supply. There also is significant interest in the competitiveness of specialties, as measured by the percentage of positions filled overall and the percentage filled by senior students in U.S. allopathic medical schools,” the NRMP said.

lfranki@mdedge.com

SEATTLE – At the 2018 Conference on Retroviruses and Opportunistic Infections, investigators reported that the rate of adverse pregnancy outcomes was 23% among HIV-positive women who took isoniazid to prevent tuberculosis during pregnancy, but just 17% among women who waited until after delivery.

It was an international, randomized trial that included 156 women, and outcomes included in utero demise and low birth weight. The investigators concluded that the World Health Organization needed to reconsider its recommendation for isoniazid preventative treatment (IPT) during HIV pregnancy in areas where tuberculosis (TB) is common.

The news was in the exact opposite direction at this year’s conference: An observational study of 151 pregnant HIV-positive women in Soweto, South Africa, found no evidence of poor maternal or infant outcomes with isoniazid prophylaxis, according to investigators led by Nicole Salazar-Austin, MD, a pediatric instructor at Johns Hopkins University, Baltimore.

The team was alarmed by the 2018 findings, so it decided to take a closer look with their own data. They compared outcomes in 69 HIV-positive women (46%) who reported initiating IPT during pregnancy with 82 who did not from January 2011 through January 2014. There was higher use of combination antiretroviral therapy in the IPT group, and viral loads below 400 copies/mL were more common.

The proportion of neonates born prematurely was lower in the IPT group than in the group not using it, but this did not reach significance (10% vs. 22%; P = 0.06). There was no difference in fetal demise (1% in both groups); low birth weight (9% vs. 12%; P = 0.51); or congenital anomalies (1% vs. 2%, P = 1.0).

A composite of the four outcomes actually showed fewer events among infants exposed to IPT (16% vs. 28%; P = 0.08). The outcomes held when stratified by viral load suppression and when other causes of poor infant outcomes – advanced HIV disease, advanced maternal age, and low weight gain during pregnancy – were taken into account.

As an observational study based on self-report, the new work was much less rigorous than the 2018 randomized trial, Dr. Salazar-Austin noted. Also, the work was part of a larger project that was not designed specifically to study pregnancy outcomes. IPT was initiated by public antenatal and HIV clinics, not by the study team.

Still, “we hope that these results provide some reassurance that IPT can be used in the second or third trimester among pregnant women with HIV,” Dr. Salazar-Austin said.

So, how to mesh the two studies? Like everything in medicine, it comes down to a risk/benefit analysis.

“For pregnant women living in a household with an active TB case, maybe the benefit outweighs the risk, especially if they are living with HIV. Whether all women living with HIV in a high [TB] burden [area] should receive isoniazid is still somewhat in question. I think we need to weigh” IPT during HIV pregnancy on an “individual basis moving forward,” she said.

Women in the observational trial were a median of about 30 years old. The median CD4 T-cell count at enrollment was about 370 cells/mm³.

The work was funded by the National Institutes of Health. Dr. Salazar-Austin didn’t have any disclosures.

aotto@mdedge.com

SOURCE: Salazar-Austin NM et al. CROI 2019, Abstract 77.

SEATTLE – At the 2018 Conference on Retroviruses and Opportunistic Infections, investigators reported that the rate of adverse pregnancy outcomes was 23% among HIV-positive women who took isoniazid to prevent tuberculosis during pregnancy, but just 17% among women who waited until after delivery.

It was an international, randomized trial that included 156 women, and outcomes included in utero demise and low birth weight. The investigators concluded that the World Health Organization needed to reconsider its recommendation for isoniazid preventative treatment (IPT) during HIV pregnancy in areas where tuberculosis (TB) is common.

The news was in the exact opposite direction at this year’s conference: An observational study of 151 pregnant HIV-positive women in Soweto, South Africa, found no evidence of poor maternal or infant outcomes with isoniazid prophylaxis, according to investigators led by Nicole Salazar-Austin, MD, a pediatric instructor at Johns Hopkins University, Baltimore.

The team was alarmed by the 2018 findings, so it decided to take a closer look with their own data. They compared outcomes in 69 HIV-positive women (46%) who reported initiating IPT during pregnancy with 82 who did not from January 2011 through January 2014. There was higher use of combination antiretroviral therapy in the IPT group, and viral loads below 400 copies/mL were more common.

The proportion of neonates born prematurely was lower in the IPT group than in the group not using it, but this did not reach significance (10% vs. 22%; P = 0.06). There was no difference in fetal demise (1% in both groups); low birth weight (9% vs. 12%; P = 0.51); or congenital anomalies (1% vs. 2%, P = 1.0).

A composite of the four outcomes actually showed fewer events among infants exposed to IPT (16% vs. 28%; P = 0.08). The outcomes held when stratified by viral load suppression and when other causes of poor infant outcomes – advanced HIV disease, advanced maternal age, and low weight gain during pregnancy – were taken into account.

As an observational study based on self-report, the new work was much less rigorous than the 2018 randomized trial, Dr. Salazar-Austin noted. Also, the work was part of a larger project that was not designed specifically to study pregnancy outcomes. IPT was initiated by public antenatal and HIV clinics, not by the study team.

Still, “we hope that these results provide some reassurance that IPT can be used in the second or third trimester among pregnant women with HIV,” Dr. Salazar-Austin said.

So, how to mesh the two studies? Like everything in medicine, it comes down to a risk/benefit analysis.

“For pregnant women living in a household with an active TB case, maybe the benefit outweighs the risk, especially if they are living with HIV. Whether all women living with HIV in a high [TB] burden [area] should receive isoniazid is still somewhat in question. I think we need to weigh” IPT during HIV pregnancy on an “individual basis moving forward,” she said.

Women in the observational trial were a median of about 30 years old. The median CD4 T-cell count at enrollment was about 370 cells/mm³.

The work was funded by the National Institutes of Health. Dr. Salazar-Austin didn’t have any disclosures.

aotto@mdedge.com

SOURCE: Salazar-Austin NM et al. CROI 2019, Abstract 77.

SEATTLE – At the 2018 Conference on Retroviruses and Opportunistic Infections, investigators reported that the rate of adverse pregnancy outcomes was 23% among HIV-positive women who took isoniazid to prevent tuberculosis during pregnancy, but just 17% among women who waited until after delivery.

It was an international, randomized trial that included 156 women, and outcomes included in utero demise and low birth weight. The investigators concluded that the World Health Organization needed to reconsider its recommendation for isoniazid preventative treatment (IPT) during HIV pregnancy in areas where tuberculosis (TB) is common.

The news was in the exact opposite direction at this year’s conference: An observational study of 151 pregnant HIV-positive women in Soweto, South Africa, found no evidence of poor maternal or infant outcomes with isoniazid prophylaxis, according to investigators led by Nicole Salazar-Austin, MD, a pediatric instructor at Johns Hopkins University, Baltimore.

The team was alarmed by the 2018 findings, so it decided to take a closer look with their own data. They compared outcomes in 69 HIV-positive women (46%) who reported initiating IPT during pregnancy with 82 who did not from January 2011 through January 2014. There was higher use of combination antiretroviral therapy in the IPT group, and viral loads below 400 copies/mL were more common.

The proportion of neonates born prematurely was lower in the IPT group than in the group not using it, but this did not reach significance (10% vs. 22%; P = 0.06). There was no difference in fetal demise (1% in both groups); low birth weight (9% vs. 12%; P = 0.51); or congenital anomalies (1% vs. 2%, P = 1.0).

A composite of the four outcomes actually showed fewer events among infants exposed to IPT (16% vs. 28%; P = 0.08). The outcomes held when stratified by viral load suppression and when other causes of poor infant outcomes – advanced HIV disease, advanced maternal age, and low weight gain during pregnancy – were taken into account.

As an observational study based on self-report, the new work was much less rigorous than the 2018 randomized trial, Dr. Salazar-Austin noted. Also, the work was part of a larger project that was not designed specifically to study pregnancy outcomes. IPT was initiated by public antenatal and HIV clinics, not by the study team.

Still, “we hope that these results provide some reassurance that IPT can be used in the second or third trimester among pregnant women with HIV,” Dr. Salazar-Austin said.

So, how to mesh the two studies? Like everything in medicine, it comes down to a risk/benefit analysis.

“For pregnant women living in a household with an active TB case, maybe the benefit outweighs the risk, especially if they are living with HIV. Whether all women living with HIV in a high [TB] burden [area] should receive isoniazid is still somewhat in question. I think we need to weigh” IPT during HIV pregnancy on an “individual basis moving forward,” she said.

Women in the observational trial were a median of about 30 years old. The median CD4 T-cell count at enrollment was about 370 cells/mm³.

The work was funded by the National Institutes of Health. Dr. Salazar-Austin didn’t have any disclosures.

aotto@mdedge.com

SOURCE: Salazar-Austin NM et al. CROI 2019, Abstract 77.

SEATTLE – HIV infection is associated with increased risk of recurrent venous thromboembolism, especially within 1 year of the initial episode. The finding, presented during a poster session at the Conference on Retroviruses & Opportunistic Infections, follows up on an earlier study that found that first-time VTE risk also is higher among HIV-positive individuals than in the general population.

Jim Kling/MDedge News

The conclusion about first-time VTE risk, published earlier this year in Lancet HIV, came from a comparison between the ATHENA (AIDS Therapy Evaluation in the Netherlands) cohort and European population-level of studies of VTE. It found a crude incidence of 2.33 VTE events per 1,000 person-years In HIV patients, with heightened odds when CD4 cell counts were below 200 cells/mcL (adjusted hazard ratio, 3.40).

The new work represents a follow-up and compared results from ATHENA (153 patients with HIV and first VTE) and the Dutch MEGA cohort (4,005 patients without HIV, with first VTE), which includes the general population. Overall, 26% of patients in the ATHENA cohort experienced a second VTE event, compared with 16% of the general population. At 1 year after anticoagulation withdrawal, HIV-positive individuals were at 67% increased risk (HR, 1.67). At 6-years after withdrawal, the relationship was not statistically significant (HR, 1.22).

Researchers also found that CD4 cell-count recovery was associated with lowered risk, with every 100 cell-count increase between initial VTE diagnosis and anticoagulant withdrawal linked to a 20% reduction in risk (HR, 0.80).

“The clinical question is: If it’s true you have an increased risk of recurrence, should you be continuing anticoagulant therapy longer in people with HIV? This poster doesn’t answer that question and you probably need a randomized, controlled trial to look at that,” Peter Reiss, MD, professor of medicine at Amsterdam University Medical Center, said in an interview during the conference.

In the absence of a clear answer, it’s sensible for clinicians to be aware of the potential increased risk, much as clinicians have internalized the increased risk of atherosclerotic vascular disease in HIV patients. “I think the publication [in Lancet HIV] as well as this poster suggest that on the venous side of things there may also be an accentuated risk,” said Dr. Reiss.

Heidi Crane, MD, a professor of medicine at the University of Washington, Seattle, presented a poster examining the underlying factors that may predispose HIV patients to first-time VTE events. Her team performed an adjudicated review of VTE cases among HIV patients at six institutions and found that the risk factors appeared to be distinct from those seen in the general population.

The traditional long plane ride was less common in this population, while factors such as injected drug use and pneumonia were more common. The VTE events occurred at a median age of 49 years; 30% of the patients had a detectable viral load. “We’re seeing a little more (VTE) than you might expect, and in a younger population than you might have guessed,” said Dr. Crane in an interview.

The most frequent predisposing risk factors were recent hospitalization (40%), infection (40%), or immobilization/bed rest (24%) within the past 90 days, and injectable drug use (22%). “It’s not just the traditional risk factors. Some HIV-specific risk factors are driving this,” said Dr. Crane.

She also aims to learn more about the specifics of risk factors, such as catheter-associated thromboses. The team is working to increase the sample size in order to parse out the relationships with specific outcomes.

In the meantime, the data further characterize the health challenges facing people living with HIV. “This is another example demonstrating that comorbid conditions among patients with HIV that are often considered age related occur at much younger ages in our population,” said Dr. Crane.

SOURCE: Rokx C et al. CROI 2019, Abstract 636; and Tenforde MW et al. CROI 2019, Abstract 637.

.

SEATTLE – HIV infection is associated with increased risk of recurrent venous thromboembolism, especially within 1 year of the initial episode. The finding, presented during a poster session at the Conference on Retroviruses & Opportunistic Infections, follows up on an earlier study that found that first-time VTE risk also is higher among HIV-positive individuals than in the general population.

Jim Kling/MDedge News

The conclusion about first-time VTE risk, published earlier this year in Lancet HIV, came from a comparison between the ATHENA (AIDS Therapy Evaluation in the Netherlands) cohort and European population-level of studies of VTE. It found a crude incidence of 2.33 VTE events per 1,000 person-years In HIV patients, with heightened odds when CD4 cell counts were below 200 cells/mcL (adjusted hazard ratio, 3.40).

The new work represents a follow-up and compared results from ATHENA (153 patients with HIV and first VTE) and the Dutch MEGA cohort (4,005 patients without HIV, with first VTE), which includes the general population. Overall, 26% of patients in the ATHENA cohort experienced a second VTE event, compared with 16% of the general population. At 1 year after anticoagulation withdrawal, HIV-positive individuals were at 67% increased risk (HR, 1.67). At 6-years after withdrawal, the relationship was not statistically significant (HR, 1.22).

Researchers also found that CD4 cell-count recovery was associated with lowered risk, with every 100 cell-count increase between initial VTE diagnosis and anticoagulant withdrawal linked to a 20% reduction in risk (HR, 0.80).

“The clinical question is: If it’s true you have an increased risk of recurrence, should you be continuing anticoagulant therapy longer in people with HIV? This poster doesn’t answer that question and you probably need a randomized, controlled trial to look at that,” Peter Reiss, MD, professor of medicine at Amsterdam University Medical Center, said in an interview during the conference.

In the absence of a clear answer, it’s sensible for clinicians to be aware of the potential increased risk, much as clinicians have internalized the increased risk of atherosclerotic vascular disease in HIV patients. “I think the publication [in Lancet HIV] as well as this poster suggest that on the venous side of things there may also be an accentuated risk,” said Dr. Reiss.

Heidi Crane, MD, a professor of medicine at the University of Washington, Seattle, presented a poster examining the underlying factors that may predispose HIV patients to first-time VTE events. Her team performed an adjudicated review of VTE cases among HIV patients at six institutions and found that the risk factors appeared to be distinct from those seen in the general population.

The traditional long plane ride was less common in this population, while factors such as injected drug use and pneumonia were more common. The VTE events occurred at a median age of 49 years; 30% of the patients had a detectable viral load. “We’re seeing a little more (VTE) than you might expect, and in a younger population than you might have guessed,” said Dr. Crane in an interview.

The most frequent predisposing risk factors were recent hospitalization (40%), infection (40%), or immobilization/bed rest (24%) within the past 90 days, and injectable drug use (22%). “It’s not just the traditional risk factors. Some HIV-specific risk factors are driving this,” said Dr. Crane.

She also aims to learn more about the specifics of risk factors, such as catheter-associated thromboses. The team is working to increase the sample size in order to parse out the relationships with specific outcomes.

In the meantime, the data further characterize the health challenges facing people living with HIV. “This is another example demonstrating that comorbid conditions among patients with HIV that are often considered age related occur at much younger ages in our population,” said Dr. Crane.

SOURCE: Rokx C et al. CROI 2019, Abstract 636; and Tenforde MW et al. CROI 2019, Abstract 637.

.

SEATTLE – HIV infection is associated with increased risk of recurrent venous thromboembolism, especially within 1 year of the initial episode. The finding, presented during a poster session at the Conference on Retroviruses & Opportunistic Infections, follows up on an earlier study that found that first-time VTE risk also is higher among HIV-positive individuals than in the general population.

Jim Kling/MDedge News

The conclusion about first-time VTE risk, published earlier this year in Lancet HIV, came from a comparison between the ATHENA (AIDS Therapy Evaluation in the Netherlands) cohort and European population-level of studies of VTE. It found a crude incidence of 2.33 VTE events per 1,000 person-years In HIV patients, with heightened odds when CD4 cell counts were below 200 cells/mcL (adjusted hazard ratio, 3.40).

The new work represents a follow-up and compared results from ATHENA (153 patients with HIV and first VTE) and the Dutch MEGA cohort (4,005 patients without HIV, with first VTE), which includes the general population. Overall, 26% of patients in the ATHENA cohort experienced a second VTE event, compared with 16% of the general population. At 1 year after anticoagulation withdrawal, HIV-positive individuals were at 67% increased risk (HR, 1.67). At 6-years after withdrawal, the relationship was not statistically significant (HR, 1.22).

Researchers also found that CD4 cell-count recovery was associated with lowered risk, with every 100 cell-count increase between initial VTE diagnosis and anticoagulant withdrawal linked to a 20% reduction in risk (HR, 0.80).

“The clinical question is: If it’s true you have an increased risk of recurrence, should you be continuing anticoagulant therapy longer in people with HIV? This poster doesn’t answer that question and you probably need a randomized, controlled trial to look at that,” Peter Reiss, MD, professor of medicine at Amsterdam University Medical Center, said in an interview during the conference.

In the absence of a clear answer, it’s sensible for clinicians to be aware of the potential increased risk, much as clinicians have internalized the increased risk of atherosclerotic vascular disease in HIV patients. “I think the publication [in Lancet HIV] as well as this poster suggest that on the venous side of things there may also be an accentuated risk,” said Dr. Reiss.

Heidi Crane, MD, a professor of medicine at the University of Washington, Seattle, presented a poster examining the underlying factors that may predispose HIV patients to first-time VTE events. Her team performed an adjudicated review of VTE cases among HIV patients at six institutions and found that the risk factors appeared to be distinct from those seen in the general population.

The traditional long plane ride was less common in this population, while factors such as injected drug use and pneumonia were more common. The VTE events occurred at a median age of 49 years; 30% of the patients had a detectable viral load. “We’re seeing a little more (VTE) than you might expect, and in a younger population than you might have guessed,” said Dr. Crane in an interview.

The most frequent predisposing risk factors were recent hospitalization (40%), infection (40%), or immobilization/bed rest (24%) within the past 90 days, and injectable drug use (22%). “It’s not just the traditional risk factors. Some HIV-specific risk factors are driving this,” said Dr. Crane.

She also aims to learn more about the specifics of risk factors, such as catheter-associated thromboses. The team is working to increase the sample size in order to parse out the relationships with specific outcomes.

In the meantime, the data further characterize the health challenges facing people living with HIV. “This is another example demonstrating that comorbid conditions among patients with HIV that are often considered age related occur at much younger ages in our population,” said Dr. Crane.

SOURCE: Rokx C et al. CROI 2019, Abstract 636; and Tenforde MW et al. CROI 2019, Abstract 637.

.

Persons with migraine show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while others show accumulations of their attacks on other days of the week. This according to a recent analysis of migraine attacks collected online within the project Migraine Radar in respect to the distribution of migraine attacks throughout the week on a single‐participant level. Researchers recorded data using a web app as well as smartphone apps in order to collect data of 44,639 migraine attacks of 1085 participants who reported 7 or more attacks during a period of at least 90 days. They found:

• For 15.9% of the participants, the attacks were not distributed equally throughout the days of the week.
• Instead, participants show different individual patterns for the distribution of their migraine attacks.
• Furthermore, the modes of the individual distributions are not distributed equally throughout the week.
• Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085).

Drescher J, Wogenstein F, Gaul C, et al. Distribution of migraine attacks over the days of the week: Preliminary results from a web‐based questionnaire. [Published online ahead of print January 12, 2019]. Acta Neurol Scand. doi:10.1111/ane.13065.

Persons with migraine show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while others show accumulations of their attacks on other days of the week. This according to a recent analysis of migraine attacks collected online within the project Migraine Radar in respect to the distribution of migraine attacks throughout the week on a single‐participant level. Researchers recorded data using a web app as well as smartphone apps in order to collect data of 44,639 migraine attacks of 1085 participants who reported 7 or more attacks during a period of at least 90 days. They found:

• For 15.9% of the participants, the attacks were not distributed equally throughout the days of the week.
• Instead, participants show different individual patterns for the distribution of their migraine attacks.
• Furthermore, the modes of the individual distributions are not distributed equally throughout the week.
• Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085).

Drescher J, Wogenstein F, Gaul C, et al. Distribution of migraine attacks over the days of the week: Preliminary results from a web‐based questionnaire. [Published online ahead of print January 12, 2019]. Acta Neurol Scand. doi:10.1111/ane.13065.

Persons with migraine show individual attack patterns and weekend migraine can be determined for a subgroup of participants, while others show accumulations of their attacks on other days of the week. This according to a recent analysis of migraine attacks collected online within the project Migraine Radar in respect to the distribution of migraine attacks throughout the week on a single‐participant level. Researchers recorded data using a web app as well as smartphone apps in order to collect data of 44,639 migraine attacks of 1085 participants who reported 7 or more attacks during a period of at least 90 days. They found:

• For 15.9% of the participants, the attacks were not distributed equally throughout the days of the week.
• Instead, participants show different individual patterns for the distribution of their migraine attacks.
• Furthermore, the modes of the individual distributions are not distributed equally throughout the week.
• Saturday seems to be the predominant day for migraine attacks for a greater proportion of participants (195 of 1085).

Drescher J, Wogenstein F, Gaul C, et al. Distribution of migraine attacks over the days of the week: Preliminary results from a web‐based questionnaire. [Published online ahead of print January 12, 2019]. Acta Neurol Scand. doi:10.1111/ane.13065.

Raising awareness among clinicians that many of the potential variables contributing to the presence of migraine are modifiable (eg, psychological problems and lifestyle behaviors) might intensify resources dedicated to assessing and impacting these factors in order to potentially prevent the frequency and severity of migraine. This according to a recent study that aimed to identify the modifiable and non-modifiable variables that are associated with, and might moderate, the presence of migraine in the general population. Using a nationally representative cross-sectional survey, researchers evaluated responses from individuals aged 15 years and older (n=22,842). There was a secondary analysis of data from the second wave of a health interview survey conducted from 2014 to 2015. They found:

• The 1-year prevalence of migraine was 8%.
• The final multivariate model (Wald χ²=693.00, df=15) retained depression severity, chronic anxiety, exercising several times a month or week, and alcohol use as predictors of migraine (odds ratios=2.1–3.5 for positive associations, odds ratios=0.4–0.9 for negative associations).

Roy R, Sánchez-Rodriguez E, Galán S, et al. Factors associated with migraine in the general population of Spain: Results from the European Health Survey 2014. Pain Med. 2019;20(3):555-563. doi:10.1093/pm/pny093.

Raising awareness among clinicians that many of the potential variables contributing to the presence of migraine are modifiable (eg, psychological problems and lifestyle behaviors) might intensify resources dedicated to assessing and impacting these factors in order to potentially prevent the frequency and severity of migraine. This according to a recent study that aimed to identify the modifiable and non-modifiable variables that are associated with, and might moderate, the presence of migraine in the general population. Using a nationally representative cross-sectional survey, researchers evaluated responses from individuals aged 15 years and older (n=22,842). There was a secondary analysis of data from the second wave of a health interview survey conducted from 2014 to 2015. They found:

• The 1-year prevalence of migraine was 8%.
• The final multivariate model (Wald χ²=693.00, df=15) retained depression severity, chronic anxiety, exercising several times a month or week, and alcohol use as predictors of migraine (odds ratios=2.1–3.5 for positive associations, odds ratios=0.4–0.9 for negative associations).

Roy R, Sánchez-Rodriguez E, Galán S, et al. Factors associated with migraine in the general population of Spain: Results from the European Health Survey 2014. Pain Med. 2019;20(3):555-563. doi:10.1093/pm/pny093.

Raising awareness among clinicians that many of the potential variables contributing to the presence of migraine are modifiable (eg, psychological problems and lifestyle behaviors) might intensify resources dedicated to assessing and impacting these factors in order to potentially prevent the frequency and severity of migraine. This according to a recent study that aimed to identify the modifiable and non-modifiable variables that are associated with, and might moderate, the presence of migraine in the general population. Using a nationally representative cross-sectional survey, researchers evaluated responses from individuals aged 15 years and older (n=22,842). There was a secondary analysis of data from the second wave of a health interview survey conducted from 2014 to 2015. They found:

• The 1-year prevalence of migraine was 8%.
• The final multivariate model (Wald χ²=693.00, df=15) retained depression severity, chronic anxiety, exercising several times a month or week, and alcohol use as predictors of migraine (odds ratios=2.1–3.5 for positive associations, odds ratios=0.4–0.9 for negative associations).

Roy R, Sánchez-Rodriguez E, Galán S, et al. Factors associated with migraine in the general population of Spain: Results from the European Health Survey 2014. Pain Med. 2019;20(3):555-563. doi:10.1093/pm/pny093.

Non-persistence to prophylactic treatment was frequent among migraine patients, a recent study found. Furthermore, opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments. This study used the IBM MarketScan databases from 2005 through 2014 to evaluate migraine patients initiating prophylactic medication. In total, 147,832 patients were analyzed. Outcome measures included persistence with prophylactic migraine medications throughout 2 to 5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Researchers found:

• Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment.
• Throughout the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines.
• Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea.
• Opioid abuse was reported in <1% of opioid users.
• Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids.

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. [Published online ahead of print February 28, 2019]. Cephalalgia. doi:10.1177%2F0333102419835465.

Non-persistence to prophylactic treatment was frequent among migraine patients, a recent study found. Furthermore, opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments. This study used the IBM MarketScan databases from 2005 through 2014 to evaluate migraine patients initiating prophylactic medication. In total, 147,832 patients were analyzed. Outcome measures included persistence with prophylactic migraine medications throughout 2 to 5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Researchers found:

• Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment.
• Throughout the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines.
• Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea.
• Opioid abuse was reported in <1% of opioid users.
• Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids.

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. [Published online ahead of print February 28, 2019]. Cephalalgia. doi:10.1177%2F0333102419835465.

Non-persistence to prophylactic treatment was frequent among migraine patients, a recent study found. Furthermore, opioid use was common in migraine patients and the risk of gastrointestinal-related adverse events and opioid abuse increased with long-term use of opioids. These results suggest a need for more effective prophylactic migraine treatments. This study used the IBM MarketScan databases from 2005 through 2014 to evaluate migraine patients initiating prophylactic medication. In total, 147,832 patients were analyzed. Outcome measures included persistence with prophylactic migraine medications throughout 2 to 5 years. Acute medication use and gastrointestinal-related adverse events and opioid abuse following opioid use were evaluated. Researchers found:

• Non-persistence was observed in 90% of patients; 39% switched, 30% restarted, and 31% discontinued treatment.
• Throughout the follow-up, 59.9% of patients received triptans, 66.6% non-steroidal anti-inflammatory drugs, 77.4% opioids, and 2.6% ergotamines.
• Among opioid users, 16.6% experienced nausea/vomiting, 12.2% had constipation, and 10.4% had diarrhea.
• Opioid abuse was reported in <1% of opioid users.
• Gastrointestinal-related adverse events increased with increasing number of days’ supply of opioids.

Bonafede M, Wilson K, Xue F. Long-term treatment patterns of prophylactic and acute migraine medications and incidence of opioid-related adverse events in patients with migraine. [Published online ahead of print February 28, 2019]. Cephalalgia. doi:10.1177%2F0333102419835465.

Influenza activity measures declined for a third consecutive week, but levels are higher than usual at this point in the flu season, according to the Centers for Disease Control and Prevention.

For the week ending March 9, an estimated 4.5% of outpatient visits were for influenza-like illness (ILI), which was down from 4.6% the previous week, the CDC’s influenza division reported March 15, but that is higher than the comparable week for any year since 1998-1999. During last year’s very severe flu season, the outpatient visit rate was just under 3.2% for the week ending March 10.

Although the number of states at level 10 on the CDC’s 1-10 scale remained at 21, the activity map actually looks more red than last week since Rhode Island and West Virgina were replaced by the much larger states of Iowa and Washington. The number of states in the high range (8-10), did go down from 32 to 30, data from the CDC’s Outpatient ILI Surveillance Network show.

ILI-related deaths among children were down considerably, with four reported during the week ending March 9, compared with nine the week before. Of those four deaths, only one occurred during the most recent reporting week, the CDC said.

rfranki@mdedge.com

Influenza activity measures declined for a third consecutive week, but levels are higher than usual at this point in the flu season, according to the Centers for Disease Control and Prevention.

For the week ending March 9, an estimated 4.5% of outpatient visits were for influenza-like illness (ILI), which was down from 4.6% the previous week, the CDC’s influenza division reported March 15, but that is higher than the comparable week for any year since 1998-1999. During last year’s very severe flu season, the outpatient visit rate was just under 3.2% for the week ending March 10.

Although the number of states at level 10 on the CDC’s 1-10 scale remained at 21, the activity map actually looks more red than last week since Rhode Island and West Virgina were replaced by the much larger states of Iowa and Washington. The number of states in the high range (8-10), did go down from 32 to 30, data from the CDC’s Outpatient ILI Surveillance Network show.

ILI-related deaths among children were down considerably, with four reported during the week ending March 9, compared with nine the week before. Of those four deaths, only one occurred during the most recent reporting week, the CDC said.

rfranki@mdedge.com

Influenza activity measures declined for a third consecutive week, but levels are higher than usual at this point in the flu season, according to the Centers for Disease Control and Prevention.

For the week ending March 9, an estimated 4.5% of outpatient visits were for influenza-like illness (ILI), which was down from 4.6% the previous week, the CDC’s influenza division reported March 15, but that is higher than the comparable week for any year since 1998-1999. During last year’s very severe flu season, the outpatient visit rate was just under 3.2% for the week ending March 10.

Although the number of states at level 10 on the CDC’s 1-10 scale remained at 21, the activity map actually looks more red than last week since Rhode Island and West Virgina were replaced by the much larger states of Iowa and Washington. The number of states in the high range (8-10), did go down from 32 to 30, data from the CDC’s Outpatient ILI Surveillance Network show.

ILI-related deaths among children were down considerably, with four reported during the week ending March 9, compared with nine the week before. Of those four deaths, only one occurred during the most recent reporting week, the CDC said.

rfranki@mdedge.com

In 1973, the Supreme Court of the United States recognized a constitutional right to abortion in the landmark case of Roe v Wade. The Court held that states may regulate, but not ban, abortion after the first trimester, for the purpose of protecting the woman’s health. The Court further indicated that states’ interest in “potential life” could be the basis for abortion regulations only after the point of viability, at which point states may ban abortion except when necessary to preserve the life or health of the woman.¹ In 1992, the Court decided Planned Parenthood v Casey and eliminated the trimester framework while upholding women’s right to abortion.² As with Roe v Wade, the Casey decision held that there must be an exception for the woman’s health and life.

Fast forward to 2019

New York passed a law in 2019,³ and Virginia had a proposed law that was recently tabled by the House of Delegates,⁴ both related to abortions performed past the first trimester.

New York. The New York law supports legal abortion by a licensed practitioner within 24 weeks of pregnancy commencement. After 24 weeks’ gestation, if there is “an absence of fetal viability, or the abortion is necessary to protect the patient’s life or health” then termination is permissible.³

Virginia. Previously, Virginia had abortion laws that required significant measures to approve a third-trimester abortion, including certification by 3 physicians that the procedure is necessary to “save mother’s life or [prevent] substantial and irremediable impairment of mental or physical health of the mother.”⁵ Violation included potential for jail time and a significant monetary fine.

The proposed bill, now tabled, was introduced by delegate Kathy Tran (House Bill 2491) and would have rolled back many requirements of the old law, including the 24-hour waiting period and mandate for second-trimester abortions to occur in a hospital.

The controversy centered on a provision concerning third-trimester abortions. Specifically, the proposed bill would only have required 1 doctor to deem the abortion necessary and would have removed the “substantially and irremediably” qualifier. Thus, abortions would be allowed in cases in which the woman’s mental or physical health was threatened, even in cases in which the potential damage may be reversible.⁵
 

The facts

Misconceptions about abortion care can be dangerous and work to further stigmatize our patients who may need an abortion or who have had an abortion in the past. The American College of Obstetricians and Gynecologists (ACOG) recently published a document discussing facts regarding abortion care later in pregnancy. The document (aptly named “Facts are Important”) enforces that policy be based on medical science and facts, and not simply driven by political beliefs.⁶

Fact. The majority of abortions occur prior to 21 weeks, before viability:

• 91.1% of abortions occur at or before 13 weeks’ gestation⁷
• only 1.3% of abortions occur at or after 21 weeks’ gestation⁷
• abortions occurring later in the second trimester or in the third trimester are very uncommon.

Fact. The language “late-term abortion” has no medical definition, is not used in a clinical setting or to describe the delivery of abortion care later in pregnancy in any medical institution.⁶

Fact. Many of the abortions occurring later in pregnancy are due to fetal anomalies incompatible with life. Anomalies can include lack of a major portion of the brain (anencephaly), bilateral renal agenesis, some skeletal dysplasias, and other chromosomal abnormalities. These are cases in which death is likely before or shortly after birth, with great potential for suffering of both the fetus and the family.

Fact. The need for abortion also may be due to serious complications that will likely cause significant morbidity or mortality to the woman. These complications, in turn, reduce the likelihood of survival of the fetus.

It is thus vital for women to have the freedom to evaluate their medical circumstance with their provider and, using evidence, make informed health care decisions—which may include abortion, induction of labor, or cesarean delivery in some circumstances. Access to accurate, complete information and care is a right bestowed amongst all women and “must never be constrained by politicians.”⁶ We must focus on medically appropriate and compassionate care for both the family and the fetus.

Use your voice

As clinicians, we are trusted members of our communities. The New York law and the prior proposed Virginia law emphasize important access to care for women and their families. Abortions at a later gestational age are a rare event but are most often performed when the health or life of the mother is at risk or the fetus has an anomaly incompatible with life.

We urge you to use your voice to correct misconceptions, whether in your office with your patients or colleagues or in your communities, locally and nationally. Email your friends and colleagues about ACOG’s “Facts are Important” document, organize a grand rounds on the topic, and utilize social media to share facts about abortion care. These actions support our patients and can make an impact by spreading factual information.

For more facts and figures about abortion laws, visit the website of the Guttmacher Institute.

In 1973, the Supreme Court of the United States recognized a constitutional right to abortion in the landmark case of Roe v Wade. The Court held that states may regulate, but not ban, abortion after the first trimester, for the purpose of protecting the woman’s health. The Court further indicated that states’ interest in “potential life” could be the basis for abortion regulations only after the point of viability, at which point states may ban abortion except when necessary to preserve the life or health of the woman.¹ In 1992, the Court decided Planned Parenthood v Casey and eliminated the trimester framework while upholding women’s right to abortion.² As with Roe v Wade, the Casey decision held that there must be an exception for the woman’s health and life.

Fast forward to 2019

New York passed a law in 2019,³ and Virginia had a proposed law that was recently tabled by the House of Delegates,⁴ both related to abortions performed past the first trimester.

New York. The New York law supports legal abortion by a licensed practitioner within 24 weeks of pregnancy commencement. After 24 weeks’ gestation, if there is “an absence of fetal viability, or the abortion is necessary to protect the patient’s life or health” then termination is permissible.³

Virginia. Previously, Virginia had abortion laws that required significant measures to approve a third-trimester abortion, including certification by 3 physicians that the procedure is necessary to “save mother’s life or [prevent] substantial and irremediable impairment of mental or physical health of the mother.”⁵ Violation included potential for jail time and a significant monetary fine.

The proposed bill, now tabled, was introduced by delegate Kathy Tran (House Bill 2491) and would have rolled back many requirements of the old law, including the 24-hour waiting period and mandate for second-trimester abortions to occur in a hospital.

The controversy centered on a provision concerning third-trimester abortions. Specifically, the proposed bill would only have required 1 doctor to deem the abortion necessary and would have removed the “substantially and irremediably” qualifier. Thus, abortions would be allowed in cases in which the woman’s mental or physical health was threatened, even in cases in which the potential damage may be reversible.⁵
 

The facts

Misconceptions about abortion care can be dangerous and work to further stigmatize our patients who may need an abortion or who have had an abortion in the past. The American College of Obstetricians and Gynecologists (ACOG) recently published a document discussing facts regarding abortion care later in pregnancy. The document (aptly named “Facts are Important”) enforces that policy be based on medical science and facts, and not simply driven by political beliefs.⁶

Fact. The majority of abortions occur prior to 21 weeks, before viability:

• 91.1% of abortions occur at or before 13 weeks’ gestation⁷
• only 1.3% of abortions occur at or after 21 weeks’ gestation⁷
• abortions occurring later in the second trimester or in the third trimester are very uncommon.

Fact. The language “late-term abortion” has no medical definition, is not used in a clinical setting or to describe the delivery of abortion care later in pregnancy in any medical institution.⁶

Fact. Many of the abortions occurring later in pregnancy are due to fetal anomalies incompatible with life. Anomalies can include lack of a major portion of the brain (anencephaly), bilateral renal agenesis, some skeletal dysplasias, and other chromosomal abnormalities. These are cases in which death is likely before or shortly after birth, with great potential for suffering of both the fetus and the family.

Fact. The need for abortion also may be due to serious complications that will likely cause significant morbidity or mortality to the woman. These complications, in turn, reduce the likelihood of survival of the fetus.

It is thus vital for women to have the freedom to evaluate their medical circumstance with their provider and, using evidence, make informed health care decisions—which may include abortion, induction of labor, or cesarean delivery in some circumstances. Access to accurate, complete information and care is a right bestowed amongst all women and “must never be constrained by politicians.”⁶ We must focus on medically appropriate and compassionate care for both the family and the fetus.

Use your voice

As clinicians, we are trusted members of our communities. The New York law and the prior proposed Virginia law emphasize important access to care for women and their families. Abortions at a later gestational age are a rare event but are most often performed when the health or life of the mother is at risk or the fetus has an anomaly incompatible with life.

We urge you to use your voice to correct misconceptions, whether in your office with your patients or colleagues or in your communities, locally and nationally. Email your friends and colleagues about ACOG’s “Facts are Important” document, organize a grand rounds on the topic, and utilize social media to share facts about abortion care. These actions support our patients and can make an impact by spreading factual information.

For more facts and figures about abortion laws, visit the website of the Guttmacher Institute.

In 1973, the Supreme Court of the United States recognized a constitutional right to abortion in the landmark case of Roe v Wade. The Court held that states may regulate, but not ban, abortion after the first trimester, for the purpose of protecting the woman’s health. The Court further indicated that states’ interest in “potential life” could be the basis for abortion regulations only after the point of viability, at which point states may ban abortion except when necessary to preserve the life or health of the woman.¹ In 1992, the Court decided Planned Parenthood v Casey and eliminated the trimester framework while upholding women’s right to abortion.² As with Roe v Wade, the Casey decision held that there must be an exception for the woman’s health and life.

Fast forward to 2019

New York passed a law in 2019,³ and Virginia had a proposed law that was recently tabled by the House of Delegates,⁴ both related to abortions performed past the first trimester.

New York. The New York law supports legal abortion by a licensed practitioner within 24 weeks of pregnancy commencement. After 24 weeks’ gestation, if there is “an absence of fetal viability, or the abortion is necessary to protect the patient’s life or health” then termination is permissible.³

Virginia. Previously, Virginia had abortion laws that required significant measures to approve a third-trimester abortion, including certification by 3 physicians that the procedure is necessary to “save mother’s life or [prevent] substantial and irremediable impairment of mental or physical health of the mother.”⁵ Violation included potential for jail time and a significant monetary fine.

The proposed bill, now tabled, was introduced by delegate Kathy Tran (House Bill 2491) and would have rolled back many requirements of the old law, including the 24-hour waiting period and mandate for second-trimester abortions to occur in a hospital.

The controversy centered on a provision concerning third-trimester abortions. Specifically, the proposed bill would only have required 1 doctor to deem the abortion necessary and would have removed the “substantially and irremediably” qualifier. Thus, abortions would be allowed in cases in which the woman’s mental or physical health was threatened, even in cases in which the potential damage may be reversible.⁵
 

The facts

Misconceptions about abortion care can be dangerous and work to further stigmatize our patients who may need an abortion or who have had an abortion in the past. The American College of Obstetricians and Gynecologists (ACOG) recently published a document discussing facts regarding abortion care later in pregnancy. The document (aptly named “Facts are Important”) enforces that policy be based on medical science and facts, and not simply driven by political beliefs.⁶

Fact. The majority of abortions occur prior to 21 weeks, before viability:

• 91.1% of abortions occur at or before 13 weeks’ gestation⁷
• only 1.3% of abortions occur at or after 21 weeks’ gestation⁷
• abortions occurring later in the second trimester or in the third trimester are very uncommon.

Fact. The language “late-term abortion” has no medical definition, is not used in a clinical setting or to describe the delivery of abortion care later in pregnancy in any medical institution.⁶

Fact. Many of the abortions occurring later in pregnancy are due to fetal anomalies incompatible with life. Anomalies can include lack of a major portion of the brain (anencephaly), bilateral renal agenesis, some skeletal dysplasias, and other chromosomal abnormalities. These are cases in which death is likely before or shortly after birth, with great potential for suffering of both the fetus and the family.

Fact. The need for abortion also may be due to serious complications that will likely cause significant morbidity or mortality to the woman. These complications, in turn, reduce the likelihood of survival of the fetus.

It is thus vital for women to have the freedom to evaluate their medical circumstance with their provider and, using evidence, make informed health care decisions—which may include abortion, induction of labor, or cesarean delivery in some circumstances. Access to accurate, complete information and care is a right bestowed amongst all women and “must never be constrained by politicians.”⁶ We must focus on medically appropriate and compassionate care for both the family and the fetus.

Use your voice

As clinicians, we are trusted members of our communities. The New York law and the prior proposed Virginia law emphasize important access to care for women and their families. Abortions at a later gestational age are a rare event but are most often performed when the health or life of the mother is at risk or the fetus has an anomaly incompatible with life.

We urge you to use your voice to correct misconceptions, whether in your office with your patients or colleagues or in your communities, locally and nationally. Email your friends and colleagues about ACOG’s “Facts are Important” document, organize a grand rounds on the topic, and utilize social media to share facts about abortion care. These actions support our patients and can make an impact by spreading factual information.

For more facts and figures about abortion laws, visit the website of the Guttmacher Institute.

Due to the steadily growing interest of SHM members in health care policy and advocacy issues, the 2019 Annual Conference will include a mini-track dedicated to policy issues.

To be held on Monday, March 25th at HM19 in Orlando, the health care policy mini-track will update conference attendees on some of the Washington developments that affect hospitalists, said Josh Boswell, director of government relations at SHM.

“Many of the policy developments in D.C. are directly impacting our members’ practices,” he said. “A couple of years ago, it was decided to add a specific track at the annual conference to cover some of these policy issues, and we’ve generally had positive feedback on the sessions.”

This year, the mini-track will consist of two separate sessions, held back to back. “Both sessions are designed to give attendees an entrée into health policy and explain developments that are happening right now in Washington that impact their practice,” said Joshua Lapps, government relations manager at SHM.

The first session – “CMS Policy Update: An Overview of Meaningful Measures and the Quality Payment Program” – will take place from 2:00 to 3:30 p.m., and will feature Reena Duseja, MD, MS, the acting director for Quality Measurement and Value-Based Incentives Group in the Centers for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services. Dr. Duseja oversees the development of measures and analyses for a variety of CMS quality reporting and value-based purchasing programs. She is also an emergency medicine physician and was an associate professor at the University of California, San Francisco, in the department of emergency medicine, where she led quality improvement activities.

“The session with Dr. Duseja will be an inside look into the approach that CMS is taking for quality measurement and pay-for-performance programs, specifically looking at the quality payment program which came out of the Medicare Access and Chip Reauthorization Act,” Mr. Lapps said. “It will be a high-level discussion about how the programs affect hospitalists, and how hospitalists participate in the programs. It’s also a chance for attendees to hear some of the thinking inside CMS.”

Dr. Duseja is also hoping to get feedback from HM19 attendees. “She wants the session to be educational for our members, as well as an opportunity for her to learn from hospitalists,” Mr. Lapps said.

According to Dr. Duseja, her presentation will provide attendees with an overview of the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), specifically highlighting policy changes from 2018 to 2019 to the Merit-based Incentive Payment System (MIPS) and Meaningful Measures Initiative. Attendees will learn more about CMS’s approach to quality and quality measurement, as well as the future of quality reporting programs.

Following Dr. Duseja’s presentation, the second mini-track session will take place from 3:40 to 4:25 p.m. It will focus more intently on the processes around health care policy making.

“We heard from our members who attended this mini-track at the past two annual conferences that they would like us to explain how policy making works: the play-by-play in D.C. on how we get to where we are,” Mr. Boswell said.

The second session will feature a presentation by Jennifer Bell, founding partner at Chamber Hill Strategies, who represents SHM in Washington. “Jennifer will be discussing how Washington works, the policy process and the pressure points at which SHM and its members can exert influence,” Mr. Lapps said.

Attendees can expect to learn a lot from either session, Mr. Lapps said. “Attendees will learn about the basic contours of the Quality Payment Program that Medicare oversees, and some of the specific new elements of that program this year that were designed with hospitalists in mind. For example, Dr. Duseja will be talking about a facility-based reporting option under the Merit-Based Incentive Payment System. I think our members should gain a concrete understanding of some of the new directions that CMS is heading this year. Overall, they’ll have a better sense of the vision behind quality measures and quality measurement. This is a really exciting opportunity to hear from someone who is both a clinician and works on policy at CMS.”

The policy mini-track offers hospitalists a chance to get a look “behind the curtain” at policy making from someone who is helping to write the rules.

“Attendees will gain insight on where they fit in these programs – and also have the opportunity to tell Dr. Duseja if they don’t feel these programs are a good fit for them,” Mr. Boswell said. “Oftentimes these programs are not structured ideally for hospitalists. So, hearing directly from hospitalists who are experiencing problems would be extraordinarily helpful to a CMS official. I think attendees should view the policy track not only as an opportunity to learn from CMS, but as an opportunity to educate CMS about our issues.”

Due to the steadily growing interest of SHM members in health care policy and advocacy issues, the 2019 Annual Conference will include a mini-track dedicated to policy issues.

To be held on Monday, March 25th at HM19 in Orlando, the health care policy mini-track will update conference attendees on some of the Washington developments that affect hospitalists, said Josh Boswell, director of government relations at SHM.

“Many of the policy developments in D.C. are directly impacting our members’ practices,” he said. “A couple of years ago, it was decided to add a specific track at the annual conference to cover some of these policy issues, and we’ve generally had positive feedback on the sessions.”

This year, the mini-track will consist of two separate sessions, held back to back. “Both sessions are designed to give attendees an entrée into health policy and explain developments that are happening right now in Washington that impact their practice,” said Joshua Lapps, government relations manager at SHM.

The first session – “CMS Policy Update: An Overview of Meaningful Measures and the Quality Payment Program” – will take place from 2:00 to 3:30 p.m., and will feature Reena Duseja, MD, MS, the acting director for Quality Measurement and Value-Based Incentives Group in the Centers for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services. Dr. Duseja oversees the development of measures and analyses for a variety of CMS quality reporting and value-based purchasing programs. She is also an emergency medicine physician and was an associate professor at the University of California, San Francisco, in the department of emergency medicine, where she led quality improvement activities.

“The session with Dr. Duseja will be an inside look into the approach that CMS is taking for quality measurement and pay-for-performance programs, specifically looking at the quality payment program which came out of the Medicare Access and Chip Reauthorization Act,” Mr. Lapps said. “It will be a high-level discussion about how the programs affect hospitalists, and how hospitalists participate in the programs. It’s also a chance for attendees to hear some of the thinking inside CMS.”

Dr. Duseja is also hoping to get feedback from HM19 attendees. “She wants the session to be educational for our members, as well as an opportunity for her to learn from hospitalists,” Mr. Lapps said.

According to Dr. Duseja, her presentation will provide attendees with an overview of the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), specifically highlighting policy changes from 2018 to 2019 to the Merit-based Incentive Payment System (MIPS) and Meaningful Measures Initiative. Attendees will learn more about CMS’s approach to quality and quality measurement, as well as the future of quality reporting programs.

Following Dr. Duseja’s presentation, the second mini-track session will take place from 3:40 to 4:25 p.m. It will focus more intently on the processes around health care policy making.

“We heard from our members who attended this mini-track at the past two annual conferences that they would like us to explain how policy making works: the play-by-play in D.C. on how we get to where we are,” Mr. Boswell said.

The second session will feature a presentation by Jennifer Bell, founding partner at Chamber Hill Strategies, who represents SHM in Washington. “Jennifer will be discussing how Washington works, the policy process and the pressure points at which SHM and its members can exert influence,” Mr. Lapps said.

Attendees can expect to learn a lot from either session, Mr. Lapps said. “Attendees will learn about the basic contours of the Quality Payment Program that Medicare oversees, and some of the specific new elements of that program this year that were designed with hospitalists in mind. For example, Dr. Duseja will be talking about a facility-based reporting option under the Merit-Based Incentive Payment System. I think our members should gain a concrete understanding of some of the new directions that CMS is heading this year. Overall, they’ll have a better sense of the vision behind quality measures and quality measurement. This is a really exciting opportunity to hear from someone who is both a clinician and works on policy at CMS.”

The policy mini-track offers hospitalists a chance to get a look “behind the curtain” at policy making from someone who is helping to write the rules.

“Attendees will gain insight on where they fit in these programs – and also have the opportunity to tell Dr. Duseja if they don’t feel these programs are a good fit for them,” Mr. Boswell said. “Oftentimes these programs are not structured ideally for hospitalists. So, hearing directly from hospitalists who are experiencing problems would be extraordinarily helpful to a CMS official. I think attendees should view the policy track not only as an opportunity to learn from CMS, but as an opportunity to educate CMS about our issues.”

Due to the steadily growing interest of SHM members in health care policy and advocacy issues, the 2019 Annual Conference will include a mini-track dedicated to policy issues.

To be held on Monday, March 25th at HM19 in Orlando, the health care policy mini-track will update conference attendees on some of the Washington developments that affect hospitalists, said Josh Boswell, director of government relations at SHM.

“Many of the policy developments in D.C. are directly impacting our members’ practices,” he said. “A couple of years ago, it was decided to add a specific track at the annual conference to cover some of these policy issues, and we’ve generally had positive feedback on the sessions.”

This year, the mini-track will consist of two separate sessions, held back to back. “Both sessions are designed to give attendees an entrée into health policy and explain developments that are happening right now in Washington that impact their practice,” said Joshua Lapps, government relations manager at SHM.

The first session – “CMS Policy Update: An Overview of Meaningful Measures and the Quality Payment Program” – will take place from 2:00 to 3:30 p.m., and will feature Reena Duseja, MD, MS, the acting director for Quality Measurement and Value-Based Incentives Group in the Centers for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services. Dr. Duseja oversees the development of measures and analyses for a variety of CMS quality reporting and value-based purchasing programs. She is also an emergency medicine physician and was an associate professor at the University of California, San Francisco, in the department of emergency medicine, where she led quality improvement activities.

“The session with Dr. Duseja will be an inside look into the approach that CMS is taking for quality measurement and pay-for-performance programs, specifically looking at the quality payment program which came out of the Medicare Access and Chip Reauthorization Act,” Mr. Lapps said. “It will be a high-level discussion about how the programs affect hospitalists, and how hospitalists participate in the programs. It’s also a chance for attendees to hear some of the thinking inside CMS.”

Dr. Duseja is also hoping to get feedback from HM19 attendees. “She wants the session to be educational for our members, as well as an opportunity for her to learn from hospitalists,” Mr. Lapps said.

According to Dr. Duseja, her presentation will provide attendees with an overview of the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), specifically highlighting policy changes from 2018 to 2019 to the Merit-based Incentive Payment System (MIPS) and Meaningful Measures Initiative. Attendees will learn more about CMS’s approach to quality and quality measurement, as well as the future of quality reporting programs.

Following Dr. Duseja’s presentation, the second mini-track session will take place from 3:40 to 4:25 p.m. It will focus more intently on the processes around health care policy making.

“We heard from our members who attended this mini-track at the past two annual conferences that they would like us to explain how policy making works: the play-by-play in D.C. on how we get to where we are,” Mr. Boswell said.

The second session will feature a presentation by Jennifer Bell, founding partner at Chamber Hill Strategies, who represents SHM in Washington. “Jennifer will be discussing how Washington works, the policy process and the pressure points at which SHM and its members can exert influence,” Mr. Lapps said.

Attendees can expect to learn a lot from either session, Mr. Lapps said. “Attendees will learn about the basic contours of the Quality Payment Program that Medicare oversees, and some of the specific new elements of that program this year that were designed with hospitalists in mind. For example, Dr. Duseja will be talking about a facility-based reporting option under the Merit-Based Incentive Payment System. I think our members should gain a concrete understanding of some of the new directions that CMS is heading this year. Overall, they’ll have a better sense of the vision behind quality measures and quality measurement. This is a really exciting opportunity to hear from someone who is both a clinician and works on policy at CMS.”

The policy mini-track offers hospitalists a chance to get a look “behind the curtain” at policy making from someone who is helping to write the rules.

“Attendees will gain insight on where they fit in these programs – and also have the opportunity to tell Dr. Duseja if they don’t feel these programs are a good fit for them,” Mr. Boswell said. “Oftentimes these programs are not structured ideally for hospitalists. So, hearing directly from hospitalists who are experiencing problems would be extraordinarily helpful to a CMS official. I think attendees should view the policy track not only as an opportunity to learn from CMS, but as an opportunity to educate CMS about our issues.”