Trending Issues

The South Carolina Medical Association is dedicated to keeping up with the latest trends in medicine, but most importantly, keeping you informed. We encourage you to keep up with these trending topics by accessing the resources, FAQs and more under each topic.

End of Life Care

Understanding trends and current end-of-life care options for patients is vital for the health care of our patients and advance care planning continues to be a hot topic in medicine. As our state continues to advance in end-of-life care planning, it is important for physicians to understand the resources available to South Carolinians. The following outlines the forms available to patients in South Carolina:

Health Care Power of Attorney
A durable power of attorney for health care is a document that names a health care agent/proxy/surrogate.  The person named should be someone trusted to make health decisions for you if you are unable to do so. This form also allows one to make health care decisions about treatments intended to sustain life.  A person can accept or refuse medical treatment addressing such issues as CPR, breathing machines, tube feeding, organ donation and comfort care.  Decisions about these treatments are not required for the completion of this form.

South Carolina Living Will or “Declaration of a Desire for a Natural Death” under the SC Death with Dignity Act
A living will tells how a patient feels about treatment intended to sustain life should one be terminally ill or in a state of permanent unconsciousness.  The treatment issues addressed in the living will are tube feeding, hydration and comfort care.  Naming a health care agent/proxy/surrogate is an optional decision on this form.

South Carolina Adult Health Care Consent Act
If you do not have an advance directive, the SC Adult Health Care Consent Act lists the order of priority of persons who may make health care decisions for a patient who is unable to consent.

Isn't It Time We Talked?
The South Carolina Hospital Association joined with the Carolinas Center for Hospice and End of Life Care, the South Carolina Medical Association, and the South Carolina Bar Association to develop two documents on advance care planning to help the public and health care professionals: “Isn’t It Time We Talk” brochure and Frequently Asked Questions about advance directives.

Additional Resources

MACRA

Following years of advocacy by the nation's physicians standing up for their patients and their practices, Congress repealed the sustainable growth rate (SGR) formula. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently eliminates SGR (and its annual threat of physician payment cuts) and provides positive annual payment updates lasting through 2019.

Consistent with the law, MACRA creates two different payment pathways for physicians—alternative payment models (APMs) and the Merit-Based Incentive Payment System (MIPS).

Alternative Payment Models: MACRA supports physicians who choose to adopt new payment and delivery models approved by the Centers for Medicare & Medicaid Services. Participation in these new models is entirely voluntary. Physicians who choose to be paid under eligible APMs are exempt from participating in MIPS.

Merit-Based Incentive Payment System: MACRA also retains a modified fee-for-service model and consolidates former reporting programs (Physician Quality Reporting System, Value-Based Modifier, Meaningful Use) to provide greater flexibility. Initially, most physicians are expected to be participants in MIPS.

Recently, the SCMA and several other physician groups voiced concerns about MACRA and its related deadlines. CMS recently announced that they will allow providers flexibility when it comes to MACRA implementation. This flexibility will ultimately allow physicians  to choose the level and pace at which they comply with the new payment reform model aimed at emphasizing quality patient care over volume.

Next year, eligible physicians and other clinicians will be given four options to comply with new payment schemes such as the Merit-based Incentive Payment System (MIPS) or an alternative payment model such as accountable care organizations. Under MIPS, physician payments will be based on a compilation of quality measures and the use of electronic health records.

 

The Options Include:


Option 1: Will allow providers to avoid a negative payment adjustment for any data reported. The goal is to ease providers into broader participation in the following two years.

Option 2: Will allow providers to submit data for a reduced number of days. This means their first performance period could begin later than January 1, 2017 and that practice could still qualify for a small payment if it submits data on how the practice is using technology and how it's improving.

Option 3: Will allow practices that are ready to hit the ground running to be able to do so. 

Option 4: Gives physicians the ability to participate in an advanced alternative payment model such as a Medicare Shared Savings ACO.

 

Learning Opportunities

AMA Overview Webinar | November 21 @ 7:00 p.m.

AMA Atlanta Regional Webinar | December 1 @ 6:30 p.m.

AMA Overview Webinar | December 6 @ 8:00 p.m.

AQIN LAN Webinar | December 7 @ 12:00 p.m.

LIVE ACTIVITY: Navigating Quality Payment Porgrams by PCMH Alliance | February 3

MACRA Resources from the AMA

Pre-Diabetes Toolkit Launch

The South Carolina Department of Health and Environmental Control (SC DHEC), South Carolina Diabetes Advisory Council (DAC), South Carolina Medical Association (SCMA) joined forces with the American Medical Association (AMA) and the Centers for Disease Control and Prevention (CDC) to develop and implement a state-wide comprehensive diabetes prevention plan.

To accomplish this, a South Carolina provider toolkit was created that can be used as a guide to evaluate, test, treat, and refer patients to in-person or online evidence-based diabetes prevention programs. Through the use of this toolkit and its enclosed materials, we hope to help practices develop a dialogue for talking with their patients about the risks associated with prediabetes and provide strategies to help patients adopt healthier lifestyles.

The Prediabetes toolkit will be available in conjunction with an online continuing medical education (CME) course which will be available here on the SCMA website September 21, 2017.

Prevent Diabetes

As South Carolina embarks on the prevention of diabetes, The Department of Health and Environmental Control (DHEC), The Diabetes Advisory Council of South Carolina (DAC), and the South Carolina Medical Association (SCMA) have joined forces with the American Medical Association (AMA), Centers for Disease Control and Prevention (CDC), and the National Association of Chronic Disease Directors (NACDD) to develop and implement a state-wide Diabetes Prevention Comprehensive Plan to focus on offering resources to individuals that have prediabetes or those who may be at greater risk for developing type 2 diabetes.

In coming together to develop the state-wide Diabetes Prevention Comprehensive Plan, the state is sending a clear Statewide Diabetes Landscape message to decision-makers in South Carolina that expanding access to the National DPP is a vital step in addressing the type 2 diabetes epidemic in South Carolina, and that support for investing resources is critical to carrying out the state-wide Diabetes Prevention Comprehensive Plan.

 

The plan has been developed and includes the following objectives:

Increase clinical screening, testing, and referral (STR) to the National DPP
This dimension focuses on increasing the number of physicians, health care providers, and health care consumers that recognize prediabetes as a disease, but ultimately committing to make steps towards increasing STR to the National DPP. Educating providers, changing their behavior, incorporating the program into their practice.

Increase the availability of National DPPs
This dimension focuses on progressing the resources surrounding National DPP such as educational material, improving accessibility, and ultimately increasing the number of CDC certified National DPP centers. These are the actual providers of the National DPPs.

Increase participation in National DPPs
This dimension is focused on educating and bringing attention to the National DPP from all perspectives; including, consumers, community organizations, health care providers, hospital systems, health plans, legislators, and employers. Related to the actual population at hand, marketing of the program; increasing the demand for service.

Increase health plan and employer coverage of the National DPP
This dimension focuses on the financial component of the National DPP by persuading employers and payers that covering the National DPP for employees/members does impact upfront costs and investment. Also helps with sustainability of the program.

 

Resources

Uninsured in South Carolina

One of the most heavily debated topics at the 2016 House of Delegates was Medicaid Expansion. The House of Delegates passed a resolution that states that a full plan for covering the uninsured will be unveiled at the 2017 House of Delegates. Earlier this year, the SCMA Board established the SCMA Uninsured Patient Care Committee. This committee, chaired by Dr. John Ropp, consists of physicians who have been tasked with developing an action plan for the uninsured in South Carolina and reaching out to appropriate parties for collaboration. The committee’s work is well underway and the committee has been looking at various models for increased access. A plan for the uninsured will be presented at the 2017 House of Delegates.

Further, the SCMA’s position on Medicaid Expansion is: The South Carolina Medical Association will actively work to collaborate with other interested parties to seek solutions for coverage of the uninsured. While this could include variations of Medicaid Expansion as an option, we remain concerned that full Medicaid Expansion under the terms of the Affordable Care Act is a temporary and unsustainable fix that is not the best solution for the long-term health issues facing South Carolina.

 

Resources