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September 15, 2021 Renin Angiotensin Aldosterone System Inhibitors (ACE-I and ARB) BACKGROUND: ACE cleaves C-terminal peptides on angiotensin I, converting it to angiotensin II, and thus increases blood pressure in two ways: vasoconstriction and stimulation of the release of aldosterone, which increases the retention of water and sodium. ACE-I, ARB’s and DRI’s block this process. ACE Inhibitors Angiotensin II Receptor Blockers (ARBs) benazepril (Lotensin) candesartan (Atacand) captopril (Capoten) eprosa...

September 1, 2021 "Are your patients struggling with the cost of medications?”   No medication can be the best treatment for a patient if it costs so much that the patient cannot fill the prescription. CAHPS (Consumer Assessment of Healthcare Providers and Systems) is a program of some 26 years designed to understand the patient experience with healthcare. CAHPS surveys asks patients to report on their experiences with a range of health care services and experiences with providers (practice sites a...

August 15, 2021 Meningococcal B Vaccination   The Neisseria meningitides bacteria cause invasive diseases in the form of meningitis and sepsis. There are at least 13 strains of Neisseria meningitides , but the A, B, C, W, and Y serogroups account for the vast majority of invasive disease. 1 Persons aged 16 to 23 are at an increased risk of contracting meningococcal infections. However, the incidence of Meningococcal Type B (Men B) disease is low and seems to be getting lower. It is estimated that a...

August 1, 2021 Adult Morbid (Severe) Obesity For adults 20 years and older, severe obesity has increased from 2.8% in years 1988 – 1994 to 9.2% in years 2017 – 2018 (1). Obesity-related conditions include heart disease, stroke, type 2 diabetes, sleep apnea, osteoarthritis, depression, hypertension and certain cancers like endometrial cancer, gastric cancer, colorectal cancer. The estimated annual health care costs of obesity-related illness are a staggering $190.2 billion, and that is a conservative est...

Appropriate Use of Vitamin D Testing Vitamin D deficiency is common in many populations, particularly in patients at higher latitudes, during winter months and in those with limited sun exposure. Over the counter Vitamin D supplements and increased summer sun exposure are sufficient for most otherwise healthy patients. Laboratory testing for Vitamin D levels with 25-OH Vitamin D testing is appropriate only in higher risk patients when results will be used to institute more aggressive therapy (e.g., oste...

Quality Performance Opportunities Multiple payors are beginning to report on 2021 quality performance. One common trend noted is the decrease in preventive services and gaps in care closure during 2020 and the start of 2021 due to the COVID-19 pandemic. Experts cannot agree whether 2021 will be a catch-up year or continue with decreased services similar to 2020. Ambulatory clinic volumes are slowly returning to pre-pandemic volume as patients are becoming vaccinated and are more comfortable with the “ne...

June 15, 2021 DPP4 Inhibitors vs GLP-1 Agonists There are no guidelines that support the combined use of a GLP‐1 agonist and a DPP‐4 inhibitor. More and more evidence is showing that the use of DPP4 Inhibitors and GLP‐1 Receptor Agonists in combination, is a practice worth changing. Together, this combination does not provide clinical benefit due to similar mechanisms of action (see picture below). More on, ADA and AACE Guidelines prefer GLP1‐RA over DPP4i for patients with established ASCVD or indicato...

June 1, 2021 Appropriate Advanced Imaging in the Emergency Department Focus:   In order to expedite appropriate patient care, minimize patient/provider conflicts, improve patient satisfaction, meet patient expectations and to minimize waste in both cost and imaging in the emergency department with respect to advanced imaging requests from the primary care and consulting base. Basis:   It is a common occurrence for outpatient providers to refer patients to the emergency department to secure adv...

May 15, 2021   Major Depressive Disorder   Major depressive disorder (MDD) is the second leading cause of disability worldwide, affecting an estimated 120 million people. 1 Screening is to be done once per year in the year that the patient is seen for an encounter. HEDIS measures the percentage of members 12 years of age and older who were screened for clinical depression using a standardized tool and, if screened positive, who received follow-up care    A positive screen MUST have a...

Family Practice Management (FPM) Supplement Introduction MPP Medical Leadership is providing the following resource to provide further education on Hierarchical Condition Category (HCC) coding. The referenced supplement provides a review of risk-adjustment and explains how CMS combines HCC and a patient’s Risk adjustment Factor (RAF) to predict future costs. In addition, strategies on how to be successful in the Value-Based Payment environment are included. Please note: a subscription to AAFP/FPM is req...