CMS plans to give MIPS an overhaul
By Gregory Twachtman

CMS Administrator Seema Verma said the changes are designed to make measures more relevant and reporting less burdensome.

Other top stories:

1. Endocrine Society advises on diabetes care for older adults
A clinical practice guideline from the Endocrine Society addresses the impact of aging on patients with diabetes aged 65 years and older.

2. U.S. infant mortality continued slow decline in 2017
Massachusetts had the nation’s lowest rate; Mississippi had the highest.

3. HHS proposes pathways for drug importation
The new plan would lay the foundation for safe importation of certain medications.

4. Short-course azithromycin no benefit in pediatric asthma admissions
Clinicians should consider these data before prescribing azithromycin to children hospitalized with asthma.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

What's up in the osteoarthritis drug pipeline
By Bruce Jancin

Few drugs. Limited resources. But change is in the air. Reporting from the 2019 annual OARSI World Congress in Toronto.

Other top stories:

1. Hypothyroidism may have more impact on cardiac health than hyperthyroidism
   Evaluate thyroid function in patients with a fast resting heart rate, new-onset AFib, idiopathic heart failure, bradycardia, resistant hypertension, and statin-resistant hyperlipidemia. 
2. Acid-suppressing drug use associated with increased antiallergy drug use
   People taking acid-suppressing medications such as proton pump inhibitors are subsequently more likely to use anti-allergy drugs.
3. MMR vaccine maintains effectiveness after 10 years
   The responses obtained after receipt of one or two doses of MMR-containing vaccines remain above the seropositivity thresholds up to 10 years later.
4. No increase in UTI risk with SGLT-2 inhibitors
   SGLT-2 inhibitors are not associated with an increased risk of severe urinary tract infections.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

CMS proposes improved E/M payments, additional price transparency for hospitals
by Gregory Twachtman 

The proposal would overhaul the Merit-based Incentive Payment System.

Other top stories::

1. FDA approvals permit double-immunoassay approach to Lyme disease diagnosis
   The streamlined approach to diagnosis may speed treatment of Lyme disease.
2. Clopidogrel matched aspirin for reducing risk of colorectal cancer
   Aspirin's chemoprotective effect may be mediated mostly through the permanent inactivation of platelet COX-1.
3. Prescriptions for cough, cold medicine dropping for children
   Meanwhile, physicians increased their recommendations for antihistamines from 2002 to 2015.
4. Most patients with new hypertension under revised BP guidelines won't need pharmacotherapy
   In terms of nonpharmacotherapies for these patients, the largest benefit is in getting them to lose weight. 

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

What's hot in knee OA rehab research
by Bruce Jancin

Other top stories today:

1. As patients, physicians fare nearly the same as everyone else
   Physicians do only slightly better than nonphysicians in adhering to guidelines.
2. Trained interpreters essential for treating non-English-speaking patients
   Even in a private office setting, failure to engage a trained translator is discouraged.
3. U.S. fertility rate, teen births are on the decline
   The report from the Centers for Disease Control and Prevention also found an increase in vaginal births after previous cesarean delivery.
4. Can sunscreens cause frontal fibrosing alopecia? The jury's out
   Some studies have found an association, but the causation link hasn't been established.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Meeting just 2 of 7 'simple' goals lowers HF risk

American Heart Association recommendations seem to lower risk even when only a couple of the 'Simple 7' are mastered.

Other top stories in medicine:

1. The FDA finds increased blood clot, death risk associated with Xeljanz
   The agency announced newly approved warnings and a new limitation on the approved indication for ulcerative colitis.
2. Best inhaler for COPD is the one the patient will use
   COPD patients should bring their inhalers back and demonstrate their use on every visit.
3. AGA issues guideline for watery diarrhea
   Recommended tests rule out potential causes.
4. How common is aclerated knee OA?ce
   More than one in seven women who developed knee OA in a large, prospective population-based U.K. study had the more severe accelerated version.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Today's featured story:

Two-drug integrase inhibitor-based regimen noninferior to standard in HIV-infected adults
by Andrew D. Bowser

The price tags on these drugs are the biggest barrier to their use.

Source: Data presented at the 2019 International AIDS Society Conference on HIV Science. 

• TANGO study
• GEMINI-1 study
• GEMINI-2 study

Other top news in medicine:

1. Increased cardiovascular risk seen early on with testosterone replacement therapy
   Testosterone replacement therapy for low testosterone is associated with an early increase in the risk of cardiovascular and cerebrovascular events.
2. Moderately high dietary riboflavin linked to fewer migraines
   U.S. NHANES data showed a significant link between moderately high dietary vitamin B2 and fewer severe or migraine headaches.
3. Inadequate glycemic control in type 1 diabetes leads to increased fracture risk
   Each percentage increase in hemoglobin level was associated with a 7% increase in fracture risk.
4. Pharmacist stigma a barrier to rural buprenorphine access
   The role of pharmacists in access to medication-assisted treatment for opioid use disorder has been neglected but remains an important potential barrier.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Air pollution levels correlated with cardiorespiratory mortality, reduced life expectancy
by Bianca Nogrady

Exposure to air pollution may be shortening life expectancy in the United States, with the heaviest burden falling on lower-income populations.

Other top stories:

1. Follow-up after mental illness admission: State scorecard
   Follow-up rates after hospitalization for mental illness vary considerably across the U.S.
2. MIPS: Nearly all eligible clinicians got a bonus for 2018
   In 2018, more than 97% of clinicians scored above the performance threshold required to earn a bonus payment.
3. USPSTF updates, reaffirms recommendation for HBV screening in pregnant women
   The task force gave HBV screening a grade of A, which is the strongest it offers.
4. Most preschoolers with signs of ADHD aren't ready for primary school
   Nearly half of children aged 4-5 years with ADHD received no behavioral therapy from 2009 to 2010.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Clinics get more time on Title X changes
by Alicia Gallegos

Family planning clinics will have more time to comply with a Trump administration rule that prohibits physicians from counseling patients about abortions.

Other top headlines:

1. Atherosclerotic disease risk persists after smoking cessation
   Clinicians should reinforce smoking cessation, with awareness that risk for several atherosclerotic diseases remains significant for decades.
2. New measles outbreaks reported in Los Angeles and El Paso
   Measles cases now have occurred in 30 states this year.
3. FDA approves first generics of pregabalin
   The first generic approvals of the drug were granted to nine companies.
4. Colorectal cancer diagnoses still moving up in younger adults, with no sign of plateau
   Incidence increased from 10% to 12% over a decade of analysis of a large U.S. cancer registry.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Medication overuse prevalent among U.S. migraine patients
by Mitchel L. Zoler

Results from a U.S. survey showed an 18% prevalence of medication overuse among people with self-reported migraine symptoms.

Other top stories in medicine:

1. Plant-based foods could keep type 2 diabetes at bay
   A meta-analysis suggests diets high in nonanimal foods may significantly lower risk
2. Recognize and assess RA fatigue routinely, rheumatology experts say
   Fatigue is a common and persistent problem affecting up to 80% of patients with rheumatoid arthritis and is severe in half of cases.
3. Filgotinib fares well in RA trial of inadequate methotrexate responders
   The investigational oral Janus kinase 1 inhibitor filgotinib helped more patients achieve an ACR20 response at 12 weeks than did placebo.
4. Adjuvant influenza vaccine appears safe for at-risk children
   Side effects are comparable in adjuvanted and traditional vaccines.

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.

Today's top story in medicine:

Transdermal estradiol may modulate the relationship between sleep, cognition
by Michele G. Sullivan

Women using the patch fared better in all measures than did those taking oral conjugated estrogen.

Other top news:

1. Surprise medical billing legislation advances to the House floor
   The bill was amended to include an arbitration process allowing physicians and hospitals to seek higher payments.
2. Smoking-cessation attempts changed little over 7-year span
   The majority of adult cigarette smokers in the United States try to quit each year.
3. Exercise counter astronaut's dizziness after space flight
   Two hours of daily activity during space flight eliminated hypotension after landing.
4. Alopecia areata: Study finds racial disparities
   AA diagnosis is most common among Afircan Americans least common in Asians.
   

You can contact the MDedge Daily Medical News by emailing us at [email protected] or following us on Twitter at @MDedgeTweets.