June 2018 Newsletter
A Letter from the NPAA President...
Dear NPAA Members,

As you probably know, access to care is Alabama’s number one health concern. The primary reason is that Alabama is faced with a severe shortage of primary and mental health care providers, especially in rural areas. I am thrilled to report that during the first half of this year, a significant milestone was reached in paving the way to increase access to care for Alabamians through the passage of the signature authority bill. This milestone was reached only through the unceasing efforts of the Nurse Practitioner Alliance of Alabama (NPAA) members and officers engaging in activities such as collaborating with healthcare community partners, educating legislatures, and advocating for passage of the bill. Another important breakthrough in improving healthcare was reached with the approval of several critical care procedures. This breakthrough was made possible through the tireless efforts of Dr. Eileen Meyer, our Vice President of Policy, and her collaboration with hospital administrators, the Alabama Board of Nursing, and the Alabama Board of Medical Examiners. Another huge accomplishment was the formation of NPAA’s much needed Political Action Committee (PAC), which was spearheaded by Dr. Joy Deupree, our Senior Advisor for Policy. I am excited about what the next half of the year has in store as NPAA continues to work with our community healthcare partners in meeting the needs of Alabama residents. 

I encourage you to make plans now to attend the 12 th Annual NPAA Conference in September. This event is one you will not want to miss! Dr. Susan Appel and the conference planning committee has been hard at work lining up speakers who will deliver a variety of important legislative, regulatory, and clinical topics. NPAA will also recognize outstanding nurse practitioners, students, educators, and healthcare advocates in Alabama during the Awards Ceremony, which will be held during the luncheon on the first day of the conference. Please review the award categories and submit your nomination(s) now, so NPAA can recognize deserving individuals for their accomplishments. 
Thank you for helping to meet the healthcare needs of Alabama residents and your continued engagement with NPAA. I look forward to seeing you at the conference!

Robin Lawson
NPAA President
12th Annual NPAA Conference Updates!
  • Check out the updated conference agenda. This year's agenda features several breakout sessions! Be sure to sign up for the IUD Insertion Lab after you register for the conference. Space is limited.
  • Nominate an Alabama NP for one of the prestigious awards given out during the Awards Ceremony on September 14th.
  • We have a great list of exhibitors that will be at the conference ready to inform you of their latest products. If you would like to learn about a specific product, please inform Denise Williams, NPAA Administrative Director.
  • Register now to take advantage of the Early Bird Discount. NPAA Members also receive a discounted conference registration. Save now and JOIN NPAA!
Conference Spotlight on Franklin Harrington, Esq.
Mr. Harrington is the Director of Reimbursement and Regulatory Affairs for the American Association of Nurse Practitioners (AANP)
The Reimbursement Landscape:
Nurse Practitioner Reimbursement in a Changing Healthcare System. 

He will provide an overview of national and local issues and changes related to reimbursement and ways for nurse practitioners to optimize their reimbursement in an evolving healthcare system. 

According to Frank, the major barrier to reimbursement is a historical system in which nurse practitioners have been reimbursed at a lower rate than physicians. Many insurers will cite the Medicare payment rate as the rationale for their own, and without a system to enforce payment parity they do not feel incentivized to equalize those rates. What tends to be the case is that nurse practitioners are reimbursed at lower rates than physicians in all states, but full practice authority states tend to have less issues with nurse practitioners being empaneled than in more restrictive states. A healthcare system that is changing its trend from reimbursing for volume to reimbursing for value is a great opportunity for nurse practitioners to optimize reimbursement. Nurse practitioners are well positioned to continue to provide high-quality cost-effective care to their patients, and be better rewarded for this care by a system that pays clinicians based on their quality of care instead of off of a fee schedule.

Frank also asked that NPs who feel they been inappropriately denied payment to email him documentation and he will follow up:  fharrington@AANP.org

Franklin Harrington currently serves as Director of Reimbursement and Regulatory Affairs for the American Association of Nurse Practitioners (AANP). In his position, Franklin reviews, interprets, and analyzes regulations at the State and Federal levels, with a specific focus on issues that affect nurse practitioner reimbursement. Franklin also represents AANP at meetings with insurers and other stakeholders regarding issues that impact nurse practitioners.
Quality Payment Program Look-Up Tool Now Includes 2018 MIPS Eligibility & Predictive Qualifying APM Participant Data
Today, the Centers for Medicare & Medicaid Services (CMS) updated its  Quality Payment Program Look-Up Tool  to allow clinicians to view 2018 Merit-based Incentive Payment System (MIPS) eligibility and Alternative Payment Model (APM) Qualifying APM Participant (QP) data in one place. This tool was previously called the MIPS Participation Status Tool and has been renamed the Quality Payment Program Participation Status Tool.
Practice Brief:
Characterization of Type 2 Diabetes
Submitted by
Susan J. Appel & Theresa M. Wadas
Doctor sitting at office desk and working on his laptop with medical equipment all around top view
Findings from a study by Ahlqvist et al. (2018) were recently published in The Lancet Diabetes & Endocrinology. The findings revealed that type 2 diabetes could further characterize into five subtypes. Participants with type 2 diabetes from Scandinavia were stratified by clusters using common clinical measures (e.g., age of onset, body mass index, A1c, glutamate acid decarboxylase antibodies, homeostatic model assessment2-insulin resistance and beta cell function). Each of the five subtypes had unique but homogeneous presentations, similar responses to specific medications and developed comparable complications by classification. 

Although time will determine how this more detailed characterization of type 2 diabetes will be used clinically. It has be theorized sub-typing of diabetes will allow providers to tailor patient education and to prepare the patient as to what to expect with outcomes of therapy. For example, in clusters 1 and 2 the patient may benefit from being educated that due to their specific sub-type they may require additional oral medications and/or insulin earlier versus later. The intensification of medication therapy should not be blamed on the patient’s lack of diabetes self-management. Likewise, knowing the patients subtype may ultimately avoid the provider being blamed for clinical inertia from untreated diseases versus the diseaseprogress expected especially in clusters 1 and 2. As clusters 1 and 2 require the most aggressive pharmacological management. Perhaps the most important aspect will be knowing to screen for the highest prevalence of complications by sub-type. An examples of complications by subtypes are: Clusters 1 & 2 have highest frequency of retinopathy, while cluster 3 has propensity for developing chronic kidney disease and/or nonalcoholic fatty liver disease. Cluster 4 the most insulin resistant and will need to have metformin optimized.  In short, the level of detailed information gained by sub-typing will not only assist providers in focusing on screening for most common complication, it will no doubt assist in choosing first line pharmacological interventions. This clinically useful classifications of type 2 diabetes management has been recognized as a major step toward precision medicine.

Join the Nurse Practitioner Alliance of Alabama!
The Nurse Practitioner Alliance of Alabama (NPAA) is the professional organization that represents the State’s nurse practitioners (NPs) and students enrolled in NP programs. The mission of NPAA is to promote high quality healthcare for Alabama’s citizens. All NPs and NP students in Alabama are urged to join NPAA. For more information, visit  http://www.npalliancealabama.org.