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VIDEO: Setting up a telepsychiatry practice
ATLANTA – Telepsychiatry “in some ways is a force multiplier” because it expands the flexibility of when, where, and how physicians can provide integrated care to more patients, Dr. James (Jay) H. Shore said at the annual meeting of the American Psychiatric Association. But psychiatrists thinking about setting up a telepsychiatry practice must learn about regulations, technology, and administrative processes, he added.
In this video, Dr. Shore describes the regulatory landscape that exists for telepsychiatrists, how telepsychiatry fits into a collaborative care model, and reimbursement issues. He also discusses which services telepsychiatrists are not yet paid for and the regulatory landscape. In addition, he mentions specific training resources available to clinicians interested in learning how to incorporate telepsychiatry into their practices.
Dr. Shore, associate professor of psychiatry at the University of Colorado at Denver, is chair of the American Psychiatric Association’s Committee on Telepsychiatry.
On Twitter @whitneymcknight
ATLANTA – Telepsychiatry “in some ways is a force multiplier” because it expands the flexibility of when, where, and how physicians can provide integrated care to more patients, Dr. James (Jay) H. Shore said at the annual meeting of the American Psychiatric Association. But psychiatrists thinking about setting up a telepsychiatry practice must learn about regulations, technology, and administrative processes, he added.
In this video, Dr. Shore describes the regulatory landscape that exists for telepsychiatrists, how telepsychiatry fits into a collaborative care model, and reimbursement issues. He also discusses which services telepsychiatrists are not yet paid for and the regulatory landscape. In addition, he mentions specific training resources available to clinicians interested in learning how to incorporate telepsychiatry into their practices.
Dr. Shore, associate professor of psychiatry at the University of Colorado at Denver, is chair of the American Psychiatric Association’s Committee on Telepsychiatry.
On Twitter @whitneymcknight
ATLANTA – Telepsychiatry “in some ways is a force multiplier” because it expands the flexibility of when, where, and how physicians can provide integrated care to more patients, Dr. James (Jay) H. Shore said at the annual meeting of the American Psychiatric Association. But psychiatrists thinking about setting up a telepsychiatry practice must learn about regulations, technology, and administrative processes, he added.
In this video, Dr. Shore describes the regulatory landscape that exists for telepsychiatrists, how telepsychiatry fits into a collaborative care model, and reimbursement issues. He also discusses which services telepsychiatrists are not yet paid for and the regulatory landscape. In addition, he mentions specific training resources available to clinicians interested in learning how to incorporate telepsychiatry into their practices.
Dr. Shore, associate professor of psychiatry at the University of Colorado at Denver, is chair of the American Psychiatric Association’s Committee on Telepsychiatry.
On Twitter @whitneymcknight
EXPERT ANALYSIS FROM THE APA ANNUAL MEETING
Mental health workers urged to guard against the possibility of patient violence
ATLANTA – About half of all mental health professionals at all levels and in all practice settings can expect to be threatened by a patient at some point in their career, with as many as 40% sustaining a patient-inflicted injury, according to a researcher.
Despite these numbers, there exist few formal protocols for mental health personnel to learn how to protect themselves against the risk of being harmed by a patient.
Why this is, and what can be done to fill this void, has become an area of deep interest for Dr. Michael Knable, the executive director of the Sylvan C. Herman Foundation in Frederick, Md., a major underwriter for Clearview Communities’ residential treatment facilities for persons with mental illness, where Dr. Knable is also the medical director.“I really only got interested in this because of these two friends of mine who were killed [by patients],” Dr. Knable said in an interview at the annual meeting of the American Psychiatric Association.
His two friends were Dr. Wayne Fenton and Dr. Mark Lawrence, two Washington-based psychiatrists killed in their private offices by patients in 2006 and 2011, respectively.
“It’s true that the seriously mentally ill are more likely to be victimized than to be the victimizers, but it’s also true that, especially in acute settings like emergency rooms and hospitals, that they can be very violent,” Dr. Knable said in the interview.
Based on his research, Dr. Knable said the risks to practitioners include being physically threatened, stalked, sued, stabbed, and even shot to death, among other injuries. According to statistics from the Department of Justice, between 2004 and 2009, mental health workers were second only to law enforcement officers in sustaining on-the-job violence: 38 victims per 1,000 mental health workers, compared with 48 per 1,000 law enforcement officers.
Dr. Knable conducted a literature review of all published surveys of mental health professionals ranging from those with 4-year degrees, to social workers, to psychiatrists. He found that the typical profile of a mental health provider murdered by a patient is a female case worker in her 30s who has been shot to death. The typical patient perpetrator is a male, also in his 30s, who has a form of schizophrenia, a history of violence, and non-adherence to medication. More than half of these individuals also have a history of involuntary hospitalization.
“Our field attracts a lot of idealistic people who want to help others,” said Dr. Knable. “But until they’ve experienced [violence], they simply don’t evaluate the risks carefully enough.”
The National Institute of Mental Health’s Clinical Antipsychotic Treatment Intervention Effectiveness (CATIE) trial found that 19.1% of 1,410 patients with schizophrenia had a violent episode in the prior six months.
A meta-analysis of 110 studies of more than 45,000 patients with schizophrenia also found that nearly 20% had a history of violence, and review of registry data from Sweden showed that in 82,647 patients with schizophrenia, 6.5% of men and 1.4% of women had been convicted of a violent crime when not taking their medication. When they were taking their prescribed medications, crime rates fell by 45% in the cohort taking antipsychotics and 24% in those taking mood stabilizers.
Given these data, when asked why there are not more mandatory personal security training programs for mental health personnel, Dr. Knable said it comes down to a mix of naiveté and politics.
“The perception is that if you worry about this, you are stigmatizing the patient, and, to a certain extent, you are. But my desire is to be factual and to know what we’re really dealing with,” Dr. Knable said. Those in his profession most likely to underestimate the seriousness are those in private practice who “aren’t on the front lines” treating persons with serious mental illnesses like schizophrenia.
The national debate over gun control in the context of persons with mental illness also clouds the issue, he said. “People are afraid it will be stigmatizing and keep people out of treatment to say it, but if you have had an involuntary hospitalization, you should not be allowed to have a gun.”
In addition to taking a danger assessment of a patient in the pre-screening interview, Dr. Knable recommended clinicians set up their office so that there is a desk between them and the patient, and more importantly, that the patient is not between the clinician and the exit. Have an established escape route and consider installing cameras in the waiting area so you can see patients before they enter your office. Be aware of solo meetings such as after hours or on weekends. Above all, he said it was best to see potentially violent patients only in tandem with a member of that person’s family, a colleague, or even a security officer.“Before my friends were killed, I was just like everybody else. I just went to work and thought, ‘Well, you just have to be careful.’ I thought I had good instincts. But now, I think there is a lot of room for study and training on this issue.”
On Twitter @whitneymcknight
This article was updated May 17, 2016.
ATLANTA – About half of all mental health professionals at all levels and in all practice settings can expect to be threatened by a patient at some point in their career, with as many as 40% sustaining a patient-inflicted injury, according to a researcher.
Despite these numbers, there exist few formal protocols for mental health personnel to learn how to protect themselves against the risk of being harmed by a patient.
Why this is, and what can be done to fill this void, has become an area of deep interest for Dr. Michael Knable, the executive director of the Sylvan C. Herman Foundation in Frederick, Md., a major underwriter for Clearview Communities’ residential treatment facilities for persons with mental illness, where Dr. Knable is also the medical director.“I really only got interested in this because of these two friends of mine who were killed [by patients],” Dr. Knable said in an interview at the annual meeting of the American Psychiatric Association.
His two friends were Dr. Wayne Fenton and Dr. Mark Lawrence, two Washington-based psychiatrists killed in their private offices by patients in 2006 and 2011, respectively.
“It’s true that the seriously mentally ill are more likely to be victimized than to be the victimizers, but it’s also true that, especially in acute settings like emergency rooms and hospitals, that they can be very violent,” Dr. Knable said in the interview.
Based on his research, Dr. Knable said the risks to practitioners include being physically threatened, stalked, sued, stabbed, and even shot to death, among other injuries. According to statistics from the Department of Justice, between 2004 and 2009, mental health workers were second only to law enforcement officers in sustaining on-the-job violence: 38 victims per 1,000 mental health workers, compared with 48 per 1,000 law enforcement officers.
Dr. Knable conducted a literature review of all published surveys of mental health professionals ranging from those with 4-year degrees, to social workers, to psychiatrists. He found that the typical profile of a mental health provider murdered by a patient is a female case worker in her 30s who has been shot to death. The typical patient perpetrator is a male, also in his 30s, who has a form of schizophrenia, a history of violence, and non-adherence to medication. More than half of these individuals also have a history of involuntary hospitalization.
“Our field attracts a lot of idealistic people who want to help others,” said Dr. Knable. “But until they’ve experienced [violence], they simply don’t evaluate the risks carefully enough.”
The National Institute of Mental Health’s Clinical Antipsychotic Treatment Intervention Effectiveness (CATIE) trial found that 19.1% of 1,410 patients with schizophrenia had a violent episode in the prior six months.
A meta-analysis of 110 studies of more than 45,000 patients with schizophrenia also found that nearly 20% had a history of violence, and review of registry data from Sweden showed that in 82,647 patients with schizophrenia, 6.5% of men and 1.4% of women had been convicted of a violent crime when not taking their medication. When they were taking their prescribed medications, crime rates fell by 45% in the cohort taking antipsychotics and 24% in those taking mood stabilizers.
Given these data, when asked why there are not more mandatory personal security training programs for mental health personnel, Dr. Knable said it comes down to a mix of naiveté and politics.
“The perception is that if you worry about this, you are stigmatizing the patient, and, to a certain extent, you are. But my desire is to be factual and to know what we’re really dealing with,” Dr. Knable said. Those in his profession most likely to underestimate the seriousness are those in private practice who “aren’t on the front lines” treating persons with serious mental illnesses like schizophrenia.
The national debate over gun control in the context of persons with mental illness also clouds the issue, he said. “People are afraid it will be stigmatizing and keep people out of treatment to say it, but if you have had an involuntary hospitalization, you should not be allowed to have a gun.”
In addition to taking a danger assessment of a patient in the pre-screening interview, Dr. Knable recommended clinicians set up their office so that there is a desk between them and the patient, and more importantly, that the patient is not between the clinician and the exit. Have an established escape route and consider installing cameras in the waiting area so you can see patients before they enter your office. Be aware of solo meetings such as after hours or on weekends. Above all, he said it was best to see potentially violent patients only in tandem with a member of that person’s family, a colleague, or even a security officer.“Before my friends were killed, I was just like everybody else. I just went to work and thought, ‘Well, you just have to be careful.’ I thought I had good instincts. But now, I think there is a lot of room for study and training on this issue.”
On Twitter @whitneymcknight
This article was updated May 17, 2016.
ATLANTA – About half of all mental health professionals at all levels and in all practice settings can expect to be threatened by a patient at some point in their career, with as many as 40% sustaining a patient-inflicted injury, according to a researcher.
Despite these numbers, there exist few formal protocols for mental health personnel to learn how to protect themselves against the risk of being harmed by a patient.
Why this is, and what can be done to fill this void, has become an area of deep interest for Dr. Michael Knable, the executive director of the Sylvan C. Herman Foundation in Frederick, Md., a major underwriter for Clearview Communities’ residential treatment facilities for persons with mental illness, where Dr. Knable is also the medical director.“I really only got interested in this because of these two friends of mine who were killed [by patients],” Dr. Knable said in an interview at the annual meeting of the American Psychiatric Association.
His two friends were Dr. Wayne Fenton and Dr. Mark Lawrence, two Washington-based psychiatrists killed in their private offices by patients in 2006 and 2011, respectively.
“It’s true that the seriously mentally ill are more likely to be victimized than to be the victimizers, but it’s also true that, especially in acute settings like emergency rooms and hospitals, that they can be very violent,” Dr. Knable said in the interview.
Based on his research, Dr. Knable said the risks to practitioners include being physically threatened, stalked, sued, stabbed, and even shot to death, among other injuries. According to statistics from the Department of Justice, between 2004 and 2009, mental health workers were second only to law enforcement officers in sustaining on-the-job violence: 38 victims per 1,000 mental health workers, compared with 48 per 1,000 law enforcement officers.
Dr. Knable conducted a literature review of all published surveys of mental health professionals ranging from those with 4-year degrees, to social workers, to psychiatrists. He found that the typical profile of a mental health provider murdered by a patient is a female case worker in her 30s who has been shot to death. The typical patient perpetrator is a male, also in his 30s, who has a form of schizophrenia, a history of violence, and non-adherence to medication. More than half of these individuals also have a history of involuntary hospitalization.
“Our field attracts a lot of idealistic people who want to help others,” said Dr. Knable. “But until they’ve experienced [violence], they simply don’t evaluate the risks carefully enough.”
The National Institute of Mental Health’s Clinical Antipsychotic Treatment Intervention Effectiveness (CATIE) trial found that 19.1% of 1,410 patients with schizophrenia had a violent episode in the prior six months.
A meta-analysis of 110 studies of more than 45,000 patients with schizophrenia also found that nearly 20% had a history of violence, and review of registry data from Sweden showed that in 82,647 patients with schizophrenia, 6.5% of men and 1.4% of women had been convicted of a violent crime when not taking their medication. When they were taking their prescribed medications, crime rates fell by 45% in the cohort taking antipsychotics and 24% in those taking mood stabilizers.
Given these data, when asked why there are not more mandatory personal security training programs for mental health personnel, Dr. Knable said it comes down to a mix of naiveté and politics.
“The perception is that if you worry about this, you are stigmatizing the patient, and, to a certain extent, you are. But my desire is to be factual and to know what we’re really dealing with,” Dr. Knable said. Those in his profession most likely to underestimate the seriousness are those in private practice who “aren’t on the front lines” treating persons with serious mental illnesses like schizophrenia.
The national debate over gun control in the context of persons with mental illness also clouds the issue, he said. “People are afraid it will be stigmatizing and keep people out of treatment to say it, but if you have had an involuntary hospitalization, you should not be allowed to have a gun.”
In addition to taking a danger assessment of a patient in the pre-screening interview, Dr. Knable recommended clinicians set up their office so that there is a desk between them and the patient, and more importantly, that the patient is not between the clinician and the exit. Have an established escape route and consider installing cameras in the waiting area so you can see patients before they enter your office. Be aware of solo meetings such as after hours or on weekends. Above all, he said it was best to see potentially violent patients only in tandem with a member of that person’s family, a colleague, or even a security officer.“Before my friends were killed, I was just like everybody else. I just went to work and thought, ‘Well, you just have to be careful.’ I thought I had good instincts. But now, I think there is a lot of room for study and training on this issue.”
On Twitter @whitneymcknight
This article was updated May 17, 2016.
EXPERT ANALYSIS FROM THE APA ANNUAL MEETING
Some improvements seen in neurocognition post-bariatric surgery
ATLANTA – Some patients experienced improvement in at least one neurocognitive domain up to 3 years after having bariatric surgery, a small, systematic review has shown.
The most significant improvements were reported in memory, with nine studies showing some statistically significant improvement in a post-bariatric surgery cohort. Four studies showed statistically significant improvement in attention and executive function, and two did so in language.
Dr. Gurneet S. Thiara, a psychiatry resident at the University of Toronto, presented the findings during a scientific session at this year’s annual meeting of the American Psychiatric Association.
Because the studies that form the basis of the analysis did not follow a standard pre-surgery neurocognitive assessment, the actual scope of bariatric surgery’s impact on neurocognition is hard to determine. This shortcoming provides evidence that instituting a standardized method of psychiatric assessment pre-bariatric surgery could help clinicians better anticipate overall neurocognitive outcomes, he said.
“It’s hard to pinpoint the one domain that affects [this cohort] most,” said Dr. Thiara.
One study included in the analysis showed no neurocognitive improvement, although Dr. Thiara noted this was possibly due to the under- or non-reporting of negative outcomes by researchers who conducted studies that might have met his inclusion criteria.
Dr. Thiara and his colleagues were not able to draw conclusions as to which patients would be affected in which domains and by what mechanism of action. Their analysis did suggest possible relationships between gastric bypass and changes in metabolism, levels of leptin and ghrelin, vascular function, hypoperfusion in the brain, and even shifts in the gut microbiome.
Dr. Thiara sought studies with bariatric surgery patients whose neurocognitive and psychological outcomes were followed anywhere from one to three years post-surgery. After analyzing 422 studies published between January 1990 and August 2015, only ten studies, with patient sample sizes ranging from 10 to 156, met the criteria.
The study was not intended to determine a relationship between neurocognitive outcomes and type of bypass surgery performed, but Dr. Thiara said the majority of the procedures analyzed tended to be Roux-en-Y rather than the gastric bypass sleeve.
On Twitter @whitneymcknight
ATLANTA – Some patients experienced improvement in at least one neurocognitive domain up to 3 years after having bariatric surgery, a small, systematic review has shown.
The most significant improvements were reported in memory, with nine studies showing some statistically significant improvement in a post-bariatric surgery cohort. Four studies showed statistically significant improvement in attention and executive function, and two did so in language.
Dr. Gurneet S. Thiara, a psychiatry resident at the University of Toronto, presented the findings during a scientific session at this year’s annual meeting of the American Psychiatric Association.
Because the studies that form the basis of the analysis did not follow a standard pre-surgery neurocognitive assessment, the actual scope of bariatric surgery’s impact on neurocognition is hard to determine. This shortcoming provides evidence that instituting a standardized method of psychiatric assessment pre-bariatric surgery could help clinicians better anticipate overall neurocognitive outcomes, he said.
“It’s hard to pinpoint the one domain that affects [this cohort] most,” said Dr. Thiara.
One study included in the analysis showed no neurocognitive improvement, although Dr. Thiara noted this was possibly due to the under- or non-reporting of negative outcomes by researchers who conducted studies that might have met his inclusion criteria.
Dr. Thiara and his colleagues were not able to draw conclusions as to which patients would be affected in which domains and by what mechanism of action. Their analysis did suggest possible relationships between gastric bypass and changes in metabolism, levels of leptin and ghrelin, vascular function, hypoperfusion in the brain, and even shifts in the gut microbiome.
Dr. Thiara sought studies with bariatric surgery patients whose neurocognitive and psychological outcomes were followed anywhere from one to three years post-surgery. After analyzing 422 studies published between January 1990 and August 2015, only ten studies, with patient sample sizes ranging from 10 to 156, met the criteria.
The study was not intended to determine a relationship between neurocognitive outcomes and type of bypass surgery performed, but Dr. Thiara said the majority of the procedures analyzed tended to be Roux-en-Y rather than the gastric bypass sleeve.
On Twitter @whitneymcknight
ATLANTA – Some patients experienced improvement in at least one neurocognitive domain up to 3 years after having bariatric surgery, a small, systematic review has shown.
The most significant improvements were reported in memory, with nine studies showing some statistically significant improvement in a post-bariatric surgery cohort. Four studies showed statistically significant improvement in attention and executive function, and two did so in language.
Dr. Gurneet S. Thiara, a psychiatry resident at the University of Toronto, presented the findings during a scientific session at this year’s annual meeting of the American Psychiatric Association.
Because the studies that form the basis of the analysis did not follow a standard pre-surgery neurocognitive assessment, the actual scope of bariatric surgery’s impact on neurocognition is hard to determine. This shortcoming provides evidence that instituting a standardized method of psychiatric assessment pre-bariatric surgery could help clinicians better anticipate overall neurocognitive outcomes, he said.
“It’s hard to pinpoint the one domain that affects [this cohort] most,” said Dr. Thiara.
One study included in the analysis showed no neurocognitive improvement, although Dr. Thiara noted this was possibly due to the under- or non-reporting of negative outcomes by researchers who conducted studies that might have met his inclusion criteria.
Dr. Thiara and his colleagues were not able to draw conclusions as to which patients would be affected in which domains and by what mechanism of action. Their analysis did suggest possible relationships between gastric bypass and changes in metabolism, levels of leptin and ghrelin, vascular function, hypoperfusion in the brain, and even shifts in the gut microbiome.
Dr. Thiara sought studies with bariatric surgery patients whose neurocognitive and psychological outcomes were followed anywhere from one to three years post-surgery. After analyzing 422 studies published between January 1990 and August 2015, only ten studies, with patient sample sizes ranging from 10 to 156, met the criteria.
The study was not intended to determine a relationship between neurocognitive outcomes and type of bypass surgery performed, but Dr. Thiara said the majority of the procedures analyzed tended to be Roux-en-Y rather than the gastric bypass sleeve.
On Twitter @whitneymcknight
AT APA 2016
Key clinical point: Neurocognitive testing in patients before bariatric surgery could be a useful tool for tracking overall psychosocial outcomes.
Major finding: Improvements in neurocognitive function were found across several domains in some patients in the years after bariatric surgery.
Data source: Systematic review of neurocognitive outcomes in post-bariatric surgery patients followed for at least 1 year in 10 studies of between 10 and 156 patients.
Disclosures: Dr. Thiara had no relevant disclosures. This study was sponsored in part by the Toronto Western Hospital Bariatric Psychosocial Surgery Program, part of the University Health Network, Toronto, Ont.
ACP advises using 2016 as test for reimbursement under new law
WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.
For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.
“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.
Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.
“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.
Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.
Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.
Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.
But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.
On Twitter @whitneymcknight
WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.
For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.
“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.
Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.
“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.
Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.
Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.
Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.
But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.
On Twitter @whitneymcknight
WASHINGTON – Simple steps can be taken now in fee-for-service practices that can help predict performance in 2019, when the Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect. The first key is to complete all necessary metrics for 2016, according to an American College of Physicians official.
For example, although meaningful use will no longer exist after this year, many aspects of it will continue to be applied and reported under the MACRA rules, Shari Erickson, vice president of governmental and medical practice at the American College of Physicians, said during the Hot Topics session at the annual meeting of the American College of Physicians.
“It will take some time for how things are measured to be reimagined, so we are advising members to try to test meaningful use, because what you’ve learned by doing that will be very helpful as you move” into the Merit-Based Incentive Payment System (MIPS), Ms. Erickson said.
Another way reporting can help is to participate in the Physician Quality Reporting System (PQRS) this year. The measures in this program will be streamlined under the new law, but the flavor will be the same, according to Ms. Erickson. Additionally, not taking the time to report this year not only will set physicians back in their ability to gauge readiness for what’s to come but also could cost considerable money.
“The 2018 adjustments based on 2016 reporting can be as much as [negative] 9% if you’re not doing any reporting at all,” she said in an interview.
Another step is to begin implementing quality improvement programs now. Doing so not only will improve PQRS measures while the program still exists, but also could help earn credit for clinical practice improvement activities that will account for 15% of MIPS scores in the first year under the new law.
Because the new law requires the Centers for Medicare & Medicaid Services to provide feedback to physicians on overall performance on MIPS scores, Ms. Erickson said that reviewing physician feedback reports as they already exist can help determine current ratings. Another way to determine performance ratings is to survey patients directly, she said.
Under the new law, practices have the option each year of choosing to be paid under the MIPS program or an alternative payment model, Ms. Erickson said, so even gradual shifts toward putting in place patient-centered-medical-home sorts of protocols will help MIPS-based performance ratings and increase the chances of earning more under an alternative model in the future.To facilitate those efforts, physicians can conduct a risk stratification of current patient panels and access how care is being delivered by learning about what the ACP calls “high value care.” The ACP has developed a resource center featuring documents addressing these questions for members.
But most importantly, Ms. Erickson said, is to learn about the law and to contribute to the comments section on the proposed rule before the comment period closes at 5 p.m. on June 27, 2016.
On Twitter @whitneymcknight
AT ACP INTERNAL MEDICINE 2016
Mental health care delivery emerges as top concern for internists
WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.
“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.
As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.
He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.
Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.
Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.
On Twitter @whitneymcknight
WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.
“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.
As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.
He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.
Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.
Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.
On Twitter @whitneymcknight
WASHINGTON – Determining how to integrate and deliver quality mental and behavioral health care has emerged as a top priority for internists, American College of Physicians officials have announced.
“We’re making our presence known in this field,” Richard Trachtman, director of legislative affairs at the ACP, said at a Hot Topics session at the annual meeting of the American College of Physicians.
As part of its focus on mental health, the ACP is recommending that Congress approve a grant program that would fully fund the integration of primary, mental, and behavioral health care. “We would like to see it specifically stated that the team would include a primary care physician, and [that] the population treated would include patients with mental illness and co-occuring primary care conditions with chronic illness,” Mr. Trachtman said.
He cited a provision in the Senate’s Mental Health Reform Act calling for a chief medical officer to preside over the Substance Abuse and Mental Health Services Administration to facilitate the creation and dissemination of evidence-based practices that integrate mental health care services into primary care. Under the legislation, the chief medical officer also would provide guidance to insurers to comply with laws that mandate payment for such services. Mr. Trachtman said that he also expected similar legislation to be approved by the House of Representatives.
Among the concerns raised by several audience members during the question-and-answer period at the meeting were the growing workforce shortage of those trained to treat mental and behavioral illness, and best practices for coding and billing for those services. Some audience members also expressed concerns about what the recent proposed rule for value-based care assessment would mean in practical terms for integrating mental health care into practice, and how legal complications could be avoided should mental health outcomes turn out badly.
Shari Erickson, the ACP’s vice president for governmental and medical practice, said in an interview that she heard the concerns expressed by members about how they will be expected to deliver these services in a value-based care environment. “Based on the feedback I just heard here, I will be looking very closely at what [the Medicare Access and CHIP Reauthorization Act] means for them in terms of mental health care delivery,” Ms. Erickson said.
On Twitter @whitneymcknight
AT ACP INTERNAL MEDICINE 2016
ABIM announces shorter MOC assessment
WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.
The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.
“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.
“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.
Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.
“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.
The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.
Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.
A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.
“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”
The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.
Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.
On Twitter @whitneymcknight
WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.
The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.
“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.
“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.
Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.
“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.
The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.
Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.
A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.
“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”
The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.
Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.
On Twitter @whitneymcknight
WASHINGTON – Shorter, more frequent MOC assessments are coming to an office or home computer near you under a new American Board of Internal Medicine certification option announced May 5 at the annual meeting of the American College of Physicians.
The new option comes in response to outrage expressed in meetings and online by physicians affected by ABIM recertification protocols that many said were redundant and impractical.
“We know there has been a lot of frustration, and anger and concern,” said Dr. Yul Ejnes, who serves on the ABIM’s internal medicine specialty board.
“Already more than 9,000 ABIM board-certified physicians have shared their opinions with us through a survey and hundreds more are helping ABIM by participating in our [maintenance of certification] blueprint review and open book study,” said Dr. Richard J. Baron, president and CEO of ABIM.
Starting January 2018, the new option will mean that physicians who take shorter assessments on their personal or office computer – with properly authenticated security measures – can do so more frequently than every 10 years, but no more than annually. Physicians also will be able to participate in crafting assessments based on their actual practice experience, and eventually, if they perform well, test out of the longer assessments currently mandated every 10 years.
“By offering shorter assessments, that [can be taken] at home or at the office, we hope to lower the stress and burden that many physicians have told us the current 10-year exam generates,” Dr. Baron said. However, since 20% of diplomates surveyed said they preferred the 10-year exam, it will continue to be an option.
The shorter assessment may be available to some internal medicine subspecialties in 2018, Dr. Baron said.
Physicians maintaining certification in internal medicine whose certification expires before January 2018 will need to pass the current exam, although they will not need to assess again for 10 years.
A blueprint for a new exam has been created based on feedback from dozens of internal medicine professional organizations. The blueprint focuses on the most important things to know in daily practice, as well as the important things to know that aren’t encountered in daily practice, according to ABIM officials.
“The feedback we have so far on the new blueprint is that it is more relevant,” said Dr. Patricia M. Conolly, ABIM chair-elect. “We know it isn’t perfect, and we know we’ll never get it exactly right, but we will have an ongoing process to ensure the exam reflects what internists are doing.”
The ABIM is currently accepting comments on the proposed assessment, and expects to announce more specific details before the end of 2016.
Dr. Baron said ABIM is testing an “open book” assessment as well as ways to provide secure assessments at a physician’s home or office. ABIM also seeks to determine how to provide immediate feedback on assessments and learning activities and will work with societies to expand the number of continuing medical education activities available for MOC credit.
On Twitter @whitneymcknight
AT ACP 2016
VIDEO: Secrets of success in a MACRA-based world
WASHINGTON – Are you ready for the way you are paid for seeing patients to change, and not just change, but change dramatically?
The value-based care system of reimbursement for primary care physicians under the Medicare Access and CHIP Reauthorization Act (MACRA) is expected to take effect beginning in 2019, but how those payments will be made will be based on measurements of your overall performance in 2017. Will you be ready?
“Times are changing, and we need to change with them,” says Dr. Nitin Damle, the incoming president of the American College of Physicians, and an internist with South County Internal Medicine, Wakefield, R.I.
In this video, part of a series of roundtable discussions with leading health policy analysts and academic primary care physicians and mental health specialists, Dr. Damle and Dr. Lee Beers, the medical director for municipal and regional affairs at Children’s National Health System, Washington, discuss the essential steps physician practices must take in order to survive – and thrive – in a value-based care environment.
These steps include: team-based care, inclusion of mental health services, flexible IT electronic health record systems, quality measures tailored to your practice’s competencies and patient panel, and adequate funding.
Whether you’ve already begun the transition to a value-based system, or have yet to begin, this video will help focus your efforts and expectations of what’s to come.
“Don’t let perfect be the enemy of good. Start with incremental steps so you can get momentum going so that you end up where you want to be,” says Dr. Beers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
WASHINGTON – Are you ready for the way you are paid for seeing patients to change, and not just change, but change dramatically?
The value-based care system of reimbursement for primary care physicians under the Medicare Access and CHIP Reauthorization Act (MACRA) is expected to take effect beginning in 2019, but how those payments will be made will be based on measurements of your overall performance in 2017. Will you be ready?
“Times are changing, and we need to change with them,” says Dr. Nitin Damle, the incoming president of the American College of Physicians, and an internist with South County Internal Medicine, Wakefield, R.I.
In this video, part of a series of roundtable discussions with leading health policy analysts and academic primary care physicians and mental health specialists, Dr. Damle and Dr. Lee Beers, the medical director for municipal and regional affairs at Children’s National Health System, Washington, discuss the essential steps physician practices must take in order to survive – and thrive – in a value-based care environment.
These steps include: team-based care, inclusion of mental health services, flexible IT electronic health record systems, quality measures tailored to your practice’s competencies and patient panel, and adequate funding.
Whether you’ve already begun the transition to a value-based system, or have yet to begin, this video will help focus your efforts and expectations of what’s to come.
“Don’t let perfect be the enemy of good. Start with incremental steps so you can get momentum going so that you end up where you want to be,” says Dr. Beers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
WASHINGTON – Are you ready for the way you are paid for seeing patients to change, and not just change, but change dramatically?
The value-based care system of reimbursement for primary care physicians under the Medicare Access and CHIP Reauthorization Act (MACRA) is expected to take effect beginning in 2019, but how those payments will be made will be based on measurements of your overall performance in 2017. Will you be ready?
“Times are changing, and we need to change with them,” says Dr. Nitin Damle, the incoming president of the American College of Physicians, and an internist with South County Internal Medicine, Wakefield, R.I.
In this video, part of a series of roundtable discussions with leading health policy analysts and academic primary care physicians and mental health specialists, Dr. Damle and Dr. Lee Beers, the medical director for municipal and regional affairs at Children’s National Health System, Washington, discuss the essential steps physician practices must take in order to survive – and thrive – in a value-based care environment.
These steps include: team-based care, inclusion of mental health services, flexible IT electronic health record systems, quality measures tailored to your practice’s competencies and patient panel, and adequate funding.
Whether you’ve already begun the transition to a value-based system, or have yet to begin, this video will help focus your efforts and expectations of what’s to come.
“Don’t let perfect be the enemy of good. Start with incremental steps so you can get momentum going so that you end up where you want to be,” says Dr. Beers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @whitneymcknight
VIDEO: Value-based care 101
WASHINGTON – Feel free to continue operating under a fee-for-service system, but according to Neil Kirschner, Ph.D., the senior associate for regulatory and insurer affairs at the American College of Physicians, “It’ll slowly be bled. The updates will be less, and will be linked to quality and efficiency.”
But just what is “value-based care” and why is it now, literally, the law of the land?
In this video interview, Dr. Kirschner explains how and why practice is being transformed and what this means in practical terms, and he lists resources for what you can do to ensure your practice is not left behind.
“I think many doctors still are not seeing the change, or not seeing how quickly it’s coming,” says Dr. Kirschner. “Once it comes, it’s going to hit physicians in the face if they’re not prepared.”
On Twitter @whitneymcknight
WASHINGTON – Feel free to continue operating under a fee-for-service system, but according to Neil Kirschner, Ph.D., the senior associate for regulatory and insurer affairs at the American College of Physicians, “It’ll slowly be bled. The updates will be less, and will be linked to quality and efficiency.”
But just what is “value-based care” and why is it now, literally, the law of the land?
In this video interview, Dr. Kirschner explains how and why practice is being transformed and what this means in practical terms, and he lists resources for what you can do to ensure your practice is not left behind.
“I think many doctors still are not seeing the change, or not seeing how quickly it’s coming,” says Dr. Kirschner. “Once it comes, it’s going to hit physicians in the face if they’re not prepared.”
On Twitter @whitneymcknight
WASHINGTON – Feel free to continue operating under a fee-for-service system, but according to Neil Kirschner, Ph.D., the senior associate for regulatory and insurer affairs at the American College of Physicians, “It’ll slowly be bled. The updates will be less, and will be linked to quality and efficiency.”
But just what is “value-based care” and why is it now, literally, the law of the land?
In this video interview, Dr. Kirschner explains how and why practice is being transformed and what this means in practical terms, and he lists resources for what you can do to ensure your practice is not left behind.
“I think many doctors still are not seeing the change, or not seeing how quickly it’s coming,” says Dr. Kirschner. “Once it comes, it’s going to hit physicians in the face if they’re not prepared.”
On Twitter @whitneymcknight
US Official Raises Concerns Over Zika Readiness
The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.
“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.
As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.
In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.
Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.
In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.
A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.
Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.
As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.
Vaccine progress
In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.
Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.
“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.
Research gaps
Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.
“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”
Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.
“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.
Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.
Communicating risk
Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”
The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.
How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”
Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.
On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.
The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.
“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.
As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.
In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.
Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.
In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.
A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.
Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.
As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.
Vaccine progress
In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.
Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.
“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.
Research gaps
Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.
“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”
Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.
“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.
Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.
Communicating risk
Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”
The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.
How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”
Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.
On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.
The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.
“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.
As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.
In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.
Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.
In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.
A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.
Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.
As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.
Vaccine progress
In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.
Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.
“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.
Research gaps
Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.
“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”
Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.
“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.
Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.
Communicating risk
Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”
The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.
How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”
Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.
On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.
U.S. official raises concerns over Zika readiness
The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.
“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.
As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.
In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.
Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.
In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.
A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.
Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.
As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.
Vaccine progress
In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.
Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.
“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.
Research gaps
Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.
“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”
Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.
“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.
Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.
Communicating risk
Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”
The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.
How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”
Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.
On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.
On Twitter @whitneymcknight
The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.
“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.
As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.
In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.
Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.
In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.
A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.
Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.
As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.
Vaccine progress
In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.
Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.
“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.
Research gaps
Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.
“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”
Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.
“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.
Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.
Communicating risk
Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”
The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.
How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”
Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.
On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.
On Twitter @whitneymcknight
The ability of the United States to respond to a potential spike in Zika virus infection rates is a cause for concern, according to a top federal health official.
“The big question is will we get local transmission, and my response to that is very likely we will,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters during a joint media briefing with the Pan American Health Organization (PAHO) on May 3.
As many as 500 million people in the Americas are at risk for being infected by the Zika virus, PAHO’s Zika incident manager, Dr. Sylvain Aldighieri, said during the briefing.
In the continental United States to date, there have been about 400 travel-related cases of infection. In Puerto Rico, there have been nearly 700 locally reported cases, and one Zika-related death.
Countries at highest risk for Zika include those that have experienced any outbreaks of dengue fever or chikungunya in the past 15 years, Dr. Aldighieri said. Hawaii and U.S. territories in the Caribbean have experienced local dengue outbreaks during that time. Florida has had local outbreaks of both illnesses.
In the United States, Zika is poised to gain a stronger foothold even as funding for the study and prevention of the virus remains stalled in Congress, and a lack of cohesive public health messaging leaves the public vulnerable to misunderstanding the potential threat of the disease, according to Dr. Fauci.
A vaccine to fight Zika virus is currently under development. “Don’t confuse that with readiness,” Dr. Fauci cautioned.
Dr. Fauci said he believes the disbursement by Congress of President Obama’s requested $1.9 billion in Zika-related funds would facilitate a more comprehensive approach to preventing and treating the virus’s spread, but so far, the funding remains stalled.
As a result, Dr. Fauci said he has reallocated funds intended for other infectious disease research needs to cover Zika-related costs, but is concerned that continued congressional inaction could mean he is left with holes across many budgets. “That 1.9 billion dollars is essential,” he said.
Vaccine progress
In April, $589 millionin funds primarily earmarked for the Ebola crisis were redirected by the Obama administration to fight the Zika virus. That money is now being used in part to fund development of a vaccine that is expected to be ready for a phase I study of 80 people by September 2016. If successful, a phase II-b efficacy study of the vaccine would be conducted in the first quarter of 2017 in a country or region that has a high rate of infection.
Dr. Fauci said that although the study is not be as high-powered as would be ideal, researchers might be able to determine the vaccine’s efficacy with several thousand volunteers, taking into consideration that during the 1-3 years needed to gather conclusive data, herd immunity could skew rates of infection downward, bringing into question the vaccine’s actual efficacy.
“That’s just something we have to deal with,” Dr. Fauci said, saying that fewer people being infected is a good thing, either way.
Research gaps
Other pressing Zika research needs to include learning more about the virus’s impact on a developing fetus.
“We don’t know exactly what the percentage is of [infants born with] microcephaly,” Dr. Fauci said. “We don’t know beyond microcephaly what the long-range effects are on babies that look like they were born [without microcephaly] but might have other defects that are more subtle.”
Dr. Fauci said current data are unhelpful in that they show anywhere from 1% to 29% of infected mothers will give birth to children with congenital defects. However, he said that a coalition of nations affected by the virus is currently enrolling thousands of pregnant women in a cohort study to determine risk ratios.
“When we get the data from that study, we will be able to answer precisely what the percentage is, but today in May 2016, we don’t know the answer,” he said.
Predicting which infants are most susceptible, and at what point in utero abnormalities develop, are questions still under investigation, although a study published earlier this year supports the theory that infection during the first trimester poses the highest risk to a developing fetus.
Communicating risk
Another problem facing health officials is how to communicate the potential seriousness of an illness that, if it presents at all, does so only mildly, Dr. Fauci said. “In general, it’s a disease in which 80% of people don’t have any symptoms.”
The World Health Organization advises physicians to suspect Zika – particularly if a person has been in Zika-affected regions – if clinical symptoms include rash, fever, or both, plus at least one of these: arthralgia, arthritis, or conjunctivitis. Aside from bed rest, hydration, and over-the-counter analgesics, there are no specific treatments for the virus.
How to counsel women about avoiding pregnancy where Zika is a concern also poses challenges, particularly if the pregnancy is unintended, as about half of all American pregnancies are, or if, as Dr. Fauci told reporters, pregnancy is “guided by laws and religion.”
Although federal policy has not been to advise persons about whether to delay pregnancy, Dr. Fauci said U.S. officials are unwilling to contradict authorities in local regions such as Puerto Rico where such statements have been issued.
On April 28, the Food and Drug Administration authorized the emergency use of a commercial in vitro diagnostic test for use in individuals with symptoms of the virus, or those who have traveled to affected regions. Earlier this year, the FDA granted emergency authorization for use of a single test that can detect Zika, dengue, and chikungunya. Still, serology tests for Zika are often inconclusive, since the virus can mimic dengue or chikungunya, according to Dr. Aldighieri. “It can be complex to know if there is a Zika or dengue or chikungunya outbreak,” he said.
On Twitter @whitneymcknight
