Update of JCAAI Activities
I appreciate the opportunity to update your readers about recent activities of the Joint Council of Allergy, Asthma, & Immunology (JCAAI). The Mission of the JCAAI is to act on behalf of the specialty of allergy-immunology and the patients it serves; and to provide a unified voice in medical socio-economics that will enable patients to receive the highest quality allergy-immunology care. Our Board of Directors is made up of nineteen members with equal representation from both the ACAAI & AAAAI. It includes the Presidents & Presidents-Elect of both organizations, two Fellows-in-Training/Young Physicians, and two Training Program Representative’s from each. The leadership is also made up of an equal number of representatives from both the College and the Academy. In addition to me our current leadership include Dick Honsinger MD, President-Elect (2 yr. term), Steve Imbeau MD, Past-President, J. Allen Meadows MD, Secretary, and Stan Goldstein MD, Treasurer. I originally joined the board after being nominated to it as the College representative. Our staff is made up of Don Aaronson MD, JD, MPH, Exec. Dir. (Part-time), Gary Gross MD, MBA, Exec. VP (Part-time) and Sue Grupe, Director of Operations. Most importantly the JCAAI’s structure and consensus approach, allows us to impartially represent the interests of all stakeholders in our field, including the practicing allergists and academicians.
I am sometimes asked about the decision making process the JCAAI follows in vetting which of the many issues to tackle. What I term the “JCAAI Advocacy Process Continuum” is as follows:
- Identify an issue that may or has had a socioeconomic effect on “Allergy”.
- Does it fall within the mission of the JCAAI?
- Analyze the potential impact of the JCAAI acting upon the issue and determine whether it could make a difference.
- Act on the issue
Recent and current JCAAI initiatives include:
- USP 797/Allergy Extract Preparation Guidelines
These are free to JCAAI members on the JCAAI website and provide both guideline and a competency quiz for immunotherapy vial preparation. We were able to substitute Allergy developed standards for preparation of sterile solutions which reflected allergy practice instead of being held to USP standards which were not created with the preparation of allergy extract vials and which included standards which did not make scientific sense if applied to allergy vials.
The JCAAI works continuously on tracking changes on coding and potential impacts on reimbursement. We recently were able to successfully defend 95165 (allergy vials) and 95004, 95024 and with some modification 95010 and 95015 when the AMA committee, which recommends pricing of CPT, codes reviewed these codes under the direction of Congress. Overall, in 2011 allergy had an increase in reimbursement as the result of the addition of physician work into the skin testing codes. In addition, the recent CMS Medicare Economic Index rebasing/revising of the Relative Value Units resulted in an estimated positive 4% expected impact for allergy/immunology. The weekly eNewNews keeps our member apprised of these issues.
The JCAAI is frequently contacted by both individual members and our local and state societies related to reimbursement issues. This year we have been able to help straighten out several errors in reimbursement with a range of payors. Sometimes these impact multiple states. The JCAAI has developed a Business Associate Agreement that allows members to supply individual claims information within HIPPA guidelines. This is available to members by contacting Sue Gruppe at the JCAAI office.
- Monitoring impact of Health Care Reform on Allergy
The JCAAI has identified several issues of concern for the allergy/immunologist in the Affordable Care Act. We continue to monitor the implementation of the bill. The formation of Accountable Care Organizations (ACOs) as mandated by the bill, has been the subject of several New News You Can Use (archives available to JCAAI members at www.jcaai.org). We recommend that allergists stay appraised of ACOs but take no action because of the many unanswered questions. In late June, CMS Administrator Don Berwick responded to concerns of hospital and physician groups related to ACO implementation in that it creates too many bureaucratic and legal hurdles and that the number of quality standards will require excessive data management. Berwick said that CMS is attempting to respond to the many questions, especially related to the charge that it will not result in cost-savings, but gave no specifics. We do not expect a final rule until late this year at which time we will have recommendations for our members.
- Comparative Effectiveness Research
The JCAAI Board, along with the ACAAI and the AAAAI, has supported the funding of comparative research on sub-cutaneous immunotherapy (SCIT) provided to large numbers of Medicaid patients in Florida.. Cheryl Hankin, PhD, Linda Cox MD et al have now published several peer reviewed articles and abstracts confirming what our specialty has known all along, that SCIT is not only clinically effective, but also provides health care savings. [1, 2] This information has already impacted decisions for state Medicaid programs and MCOs to cover SCIT as a cost-effective treatment.
- Remote Practice of Allergy
Several commercial companies are offering “remote” allergy testing and immunotherapy services through primary care offices. The typical scheme is that an “allergy technician” (in some cases a nurse) is employed and imbedded in a PCP office with the purpose of performing allergy skin testing and subsequent vials provided through a remote site for treatment. If you have specific information about the remote practice of allergy in your area, please forward it directly to the JCAAI office.
The Regional Advocacy Discussion and Response" (RADAR) network has been established in cooperation with the ACAAI House of Delegates, the AAAAI Regional, State, and Local Allergy Societies (RSLS) and the JCAAI. The vision is to have a ‘grass roots’ network of 200-300 allergists to respond to various issues that are best dealt with at a local level.
I hope this brief overview of some, but certainly not all, of the recent JCAAI activities will be informative to your readers and encourage more of them to become involved, including membership in this very important endeavor.
James L. Sublett MD, FACAAI