INSIDE Reflecting Back and Looking Forward
Transcription
INSIDE Reflecting Back and Looking Forward
Summer 2013 www.pasg.org PSG Pennsylvania Society of Gastroenterology Newsletter I NSIDE President’s Message Reflecting Back and Looking Forward By Louis La Luna, MD Intro to Risk Management Series FIT Corner Hot Topics Louis La Luna, MD Annual Meeting It seems like just yesterday I began my two-year term as president of the PSG, and following our September Annual Scientific Meeting in Hershey in September, Dr. David Sass will take over as your new PSG president. I have worked with him for a number of years and I am confident he will do a great job. I also want to acknowledge the administrative staff and Board Members that have worked with me and thank them for all of their help. Like all aspects of medicine, the PSG has changed with the times and will continue to do so. We have expanded our board to include fellows, we are currently updating our website, we continue to pursue value-added services, and we moved to include a hands-on portion to our Scientific Meeting. The field of gastroenterology is also rapidly evolving, making it difficult to stay upto-date. Add in information technology (report writers and EMR’s) as well as billing and practice regulations (ICD-10, HIPPA, etc.), and things become more complex. The pressures of data collection, quality improvement and pay for performance are everincreasing. Even our national societies seem to want increasing amounts of data from us. If you have not been approached by your local hospital to join a clinical integration network, odds are you will be asked to in the next few years. Gone are the days of practicing medicine without paying attention to the business of medicine. Now more than ever, physicians need to engage. We need to be part of the process. We need to take control rather than be controlled. I appreciate and encourage progress and I am willing to change with the times, but sometimes I feel like saying “enough is enough.” Sometimes I just want to be a doctor without all the distracting hassles. Over the next couple of years we will see significant changes in healthcare and I strongly encourage you to pay close attention. We need to voice our opinions and stick together to maintain the integrity of the field of medicine. Healthcare changes are inevitable; the question is whether we will be a part of the process or victims of apathy. I encourage any feedback or ideas you would like to share. I will end by saying it was my humble pleasure to serve as President these past two years and thank you for the opportunity. I have learned a lot along the way and met some fantastic people. I look forward to seeing you this September at the Annual Scientific Meeting in Hershey. Legislative Update SLC Update PRESIDENT Louis LaLuna, MD 1101 Reed Road Wyomissing, PA 19610 (610) 374-4401, ext. 220 (Phone) (610) 374-7140 (Fax) [email protected] PRESIDENT-ELECT David A. Sass, MD Jefferson Digestive Disease Institute 132 S. 10th Street Main Building, Suite 480 Philadelphia, PA 19107 (215) 955-8900 (Phone) (215) 503-2146 (Fax) [email protected] SECRETARY Ralph D. McKibbin, MD Blair Gastroenterology Associates 810 Valley View Blvd. Altoona, PA 16602-6342 (814) 946-5469 (Phone) (814) 946-4970 (Fax) [email protected] TREASURER James W. Srour, MD Gastroenterology Assoc. of York 2690 Southfield Dr. York, PA 17403 (717) 741-1414 (Phone) (717) 741-4774 (Fax) [email protected] AdmINISTRATIVE OFFICE EXECUTIVE DIRECTOR Maria B. Elias 777 East Park Drive, P.O. Box 8820 Harrisburg, PA 17105-8820 (717) 558-7750 ext. 1584 [email protected] 2 Risk Management Major Areas of Physician Risk Exposure: Quality, Malpractice, and Compliance By Richard E. Moses, DO, JD The Pennsylvania Society of Gastroenterology (PSG) introduced a Risk Management section in the last issue of Rumblings (Spring 2013) to discuss various issues. Feedback from PSG membership was positive. Going forward, we will identify relevant and timely topics to discuss as they relate locally and nationally to medical practice and Gastroenterology. Despite the belief and allegations by Pennsylvania government and the plaintiff’s bar that the Medical Care Availability and Error Reduction (Mcare) Act has made a positive difference in reducing medical malpractice cases throughout Pennsylvania, I have yet to meet and/or work with a medical malpractice defense attorney, or a malpractice insurance company, that has a paucity of work or agrees. Frivolous lawsuits are still common, as are awards in the millions of dollars to plaintiffs. I will briefly call your attention to five major areas of medical malpractice risk for health care providers: Inadequate Informed Consent Failure to provide adequate informed consent and patient education is one of the top ten medical malpractice allegations in all medical specialties nationwide. This is a particularly relevant area of risk for Gastroenterologists. Issues to consider include: • Who provides the actual informed consent discussion? • What are the roles of the schedulers as to the role of the physician? • Where is the informed consent obtained – in the office during consultation, in the holding area before endoscopy, in the procedure room minutes before the procedure begins? • How is informed consent documented? Is it witnessed? Does it include adequate patient education using a variety of modalities such as printed material, video materials and personal discussion? Missed Abnormal Lab Tests • Who is responsible for identifying abnormal lab tests and pathology results, physicians or support staff? • How are physicians notified? How are patients notified? If a phone call is made, do doctors or staff properly document the transaction? • Are messages left on answering machines (potential HIPAA violation)? Are results mailed to the patient? Is the mailing documented? • If no direct contact is made or if the results show a serious problem that needs expedient follow-up, is a certified letter sent? If the certified letter is mailed and returned, what follow-up steps are taken to document and preserve that effort of communication? Incomplete History and Physical Electronic medical records (EMR/EHR) create a false sense of security on the part of providers in obtaining and documenting the patient’s history and physical exam among other portions of the medical record. This is an extensive topic in and of itself on a number of risk management and healthcare fraud levels. But for the sake of this discussion, be advised that failures to obtain complete medical information are common and are frequently identified allegations in medical malpractice actions. Particular attention needs to be paid to missing a comorbid medical problem, inadequate documentation, errors in medication documentation, and the tendency to “cut and paste” and rely on dropdown menus. 3 PSG’s 2013 Annual Scientific Meeting September 27-29, 2013 The Hotel Hershey Hershey, PA Risk Management continued from page 2 Medication Management Errors Patient medical problems and management have become more complex over the years with more co-morbidities and the use of more medications. The frequent use of anti-platelet and anti-coagulation therapies, with their associated limited reversibility, are just one set of examples in this regard. Errors in medication management may occur on the medicine floor, in endoscopy and surgical suites, during outpatient procedures, and in the office. Physicians must ask: • What systems are in place to obtain information on, and reconcile all medications? • When did the patient allegedly stop medicines as instructed prior to a procedure? • How is this documented? • Are the nurses and other medical staff adequately assessing the various medication orders they are managing? • Are medications being given in the proper dose and as scheduled? Patient Handoff Over the years, the communication between physicians and other health care providers has become increasingly important. This is readily apparent in the hospital setting as primary management of patients has come under the purview of Hospitalists, Intensivists, and other admitting physicians. The same principles hold true for the outpatient setting, and will become increasingly important. Patients are at increasing risk for suffering actual harm due to delays in communication, or because physicians are focused on too many “transactions” at one time. The patient handoff process must be timed, documented with regard to the specific information shared between providers, and must involve immediate and active follow up care by the receiving physician and support staff. 4 FIT Corner Fellows: Don’t Miss New Opportunities at the PSG Annual Meeting By Eva Alsheik, MD and Dustin Wallace, MD, Fellows-in-Training Representatives The PSG Annual Scientific Meeting at The Hotel Hershey will prove to be an exciting one for fellows and residents alike. Similar to previous years, the PSG will offer the Gastroenterology/Hepatology Poster Competition to all GI and Hepatology fellows in PA, as well as Internal Medicine residents. The PSG is currently accepting abstracts online at www. pasg.org and the deadline for submission is July 26, 2013. Research topics as well as clinical vignettes on interesting cases can be submitted at no cost for a chance to win a first prize of $750. All accepted presenters are offered a generous stipend by the PSG to attend the meeting. Welcome NEW Members Lia Kaufman, MD Raman Khehra, MD Benjamin Raile, MD Alexander Schlachterman, MD If you would like to submit a question or story idea, contact Dr. Ravi Ghanta, newsletter editor, at [email protected]. As a new opportunity for trainees, in addition to the high-yield general sessions ranging from talks about celiac sprue to refractory IBD, C. Diff and fecal transplant, and even updates on the Affordable Care Act, the PSG is piloting the first-ever Fellow-in-Training breakout session. This session will take place immediately following the general session on Saturday, September 28th and has been designed specifically with fellows in mind. Fellows will have the unique opportunity to participate in an informal session with members of the PSG board to discuss absolutely anything they would like, including searching for a job, interviewing, contract negotiations, and general questions about both private and academic practice. A range of board members from both private and university settings will be present to answer questions and provide insight into the world beyond training. Although we are taught a plethora of didactic and clinical knowledge during our three years as GI fellows, we are grossly underprepared on how to approach life after fellowship. By virtue of training in university settings, we are seldom exposed to the world of GI beyond our training center. The PSG affords us with the unique opportunity to engage in discussions with experienced attendings in a very informal, relaxed setting. Speaking with those who have been through the process before and are now in positions to hire for their practice will undoubtedly be useful. Richard Moses, DO, JD, will be there as well to provide his unique legal perspective on contracts and negotiations. This will be particularly helpful for the third year fellows who will be in the midst of contract negotiations this fall. A number of internal medicine residents who are interested in GI frequently come to the annual PSG meeting to present their research. Residents are also invited to the FIT breakout session, where they will not only be able to meet fellows from across the state, but attendings from some of the premier training programs. Fellows will be able to share their application experiences and give their insight as to what they consider important in a training program. The fellows will also be available to answer questions about the common application form, personal statements, interviews, and the match process. We are very excited about the FIT breakout session at the annual PSG meeting this year and look forward to meeting you there! 5 Choose a strong partner. Choose pMsLIC. CheC out K ou Low r er rate s As a top writer of medical professional liability insurance, PMSLIC is renowned for our great “Always With You” customer service. Rated “A” (Excellent) by A.M. Best, we offer industry-leading risk management services and outstanding claims expertise. And now with more competitive rates*, PMSLIC is your clear choice for a strong partner. Contact your agent, or Laurie Bush at PMSLIC at 800-445-1212, ext. 5558 or email [email protected]. Visit pmslic.com/start to request a premium indication. A NorcAl Group compANy * Premium impact varies by factors such as medical specialty and practice location. 6 Hot Topics The Current Trend: Practice Mergers and Consolidations By Richard E. Moses, DO, JD Medical practice across all specialties, and health care in general, is undergoing a major change from solo private practice physicians or small groups toward an employment model of non-physician owned or controlled organizations, such as hospitals and health systems. More than fifty percent of physicians currently in practice are employed by larger practices or health systems, with estimates that this number will increase to almost eighty percent within the next three to five years. The Government’s and third party payers’ efforts over the past few years to change the health system from a fee-for-service model to a quality improvement-based global reimbursement model have fueled these changes. Most recently, the Patient Protection and Affordable Care Act (PPACA) has escalated system changes through its requirements to report data beyond Meaningful Use and Electronic Health/Medical Records (EHR/ EMR) requirements in order to avoid the reimbursement penalties that will begin in 2014. Quality data on physicians already exists and will become the norm. The administrative burden and cost to a medical practice will be enormous. Practice-merging and physician employment is felt by some to be the answer to handling these practice challenges. The theory is that a larger practice or institution is in a better administrative and financial position to absorb the associated costs involved in the system-wide change. These maneuvers continued on page 8 The PSG would like to thank the following corporate sponsor for their support: Janssen Pharmaceutical Companies 7 PSG Hosts 2013 Annual Scientific Meeting in Hershey September 27-29 Physician Breakout Sessions • Refractory IBD By Gary R. Lichtenstein, MD • GI Aspects of Neuroendocrine Tumors By David C. Metz, MD • Minimally Invasive Surgery for Achalasia By Abbas Abbas, MD Physician Hands-On Track • Station 1: Spirus and Balloon Enteroscopy By Mitchell I. Conn, MD • Station 2: Solesta Injection By Evangelos Messaris, MD, PhD • Station 3: Radio Frequency Ablation for Barrett’s Esophagus By Robert M. Coben, MD • Station 4: HET/CRH Therapy for Hemorrhoids By Ravi K. Ghanta, MD Nurse Breakout Sessions • A Review of Pre-Endoscopy Imaging and Testing By Dustin Wallace, MD • Scope Processing By Eileen C. Young, RN, BSN, CNOR • Infection Control in the Endoscopy Lab By James Davis, BSN, RN, CCRN, CIC Nurse Hands-On Track • Station 1: Spirus and Balloon Enteroscopy By Mitchell I. Conn, MD • Station 2: Solesta Injection By Evangelos Messaris, MD, PhD • Station 3: Radio Frequency Ablation for Barrett’s Esophagus By Robert M. Coben, MD • Station 4: HET/CRH Therapy for Hemorrhoids By Ravi K. Ghanta, MD Sunday’s General Session Lectures include such topics as: • Understanding the Affordable Care Act: What is it and How Does it Apply to Gastroenterology? C. Richard Schott, MD • Measurements of Quality: Are They Useful or Just a Waste of Time? Lawrence B. Cohen, MD • New Guidelines for Colon Cancer Surveillance and Surveillance for IBD Patients Neilanjan Nandi, MD • HCV: Non Interferon Therapy Santiago Munoz, MD • Endoscopy, Outside the Lumen: Perforations and Other Topics Abraham Mathew, MD • Mind-Gut Connection Paul J. Lebovitz, MD • C. Difficile: Fecal Transplant and Fidaxomicin David G. Binion, MD During breaks between sessions, physicians and nurses can peruse exhibits and poster displays. Attendees and their families will also have the opportunity to sample some of Hershey’s famous attractions. On Saturday evening, guests are invited to enjoy cocktails and food stations with wine and chocolate pairings; this is also a kid-friendly event. Hersheypark will be open throughout the weekend as well. We hope to see you at Hershey in September! Please spread the word to your colleagues, nurses, and FITs to register! Watch your mail for a registration brochure, visit http://www.pasg.org/NewsEvents/AnnualMeeting.aspx for online registration. 8 LEGISLATIVE UPDATE By Richard E. Moses, DO, JD Chair, PSG Legislative Committee The PSG, in cooperation with the Pennsylvania Medical Society and other State Societies, continues to track health care bill legislation introduced into the Pennsylvania Congress. The PSG has made access to select bills available to members through a portal on the PSG website: www.pasg.org. This list of bills is periodically updated. The 2013 Pennsylvania Congress has introduced a number of health care-related bills, with a few pertaining to physicians. Some recently introduced bills that may be of interest include: • HB 540: An act providing for the collection and disposal of leftover and expired medicines and for penalties for violations. • HB 564: An act amending the act of July 19, 1979 (P.L. 130, No. 48), known as the Health Care Facilities Act, reenacting and amending provisions relating to definitions, powers and duties of the Department of Health and State health services plan; reenacting provisions relating to regulations; reenacting and amending provisions relating to certificate of need and issuance of license; prohibiting certain referrals and claims of payment; and repealing sunset provisions. Hot Topic continued from page 6 can strengthen the physicians’ negotiating position with third-party payers, employers, hospitals, and suppliers. However, there is a downside to merging practices or entering a health system employment model: physicians give up control and autonomy. There is also a lot to be said about being an “employee.” These decisions should not be rushed into, and there needs to be a lot of open discussion and forethought. It is wiser not to merge a practice or take a job than to • SB 482: An act requiring health insurers to disclose fee schedules and all rules and algorithms relating thereto; requiring health insurers to provide full payment to physicians when more than one surgical procedure is performed on the patient by the same physician during one continuous operating procedure; and providing for causes of action and for penalties for violations. • SB 568: An act amending the act of March 20, 2002 (P.L. 154, No. 13), known as the Medical Care Availability and Reduction of Error (Mcare) Act, establishing the Mcare Commission. • HR 1427 (NATIONAL LEVEL): This bill intends to eliminate consumer confusion over who is considered a “medical doctor.” Rep. Larry Bucshon, M.D. (R-In.) and Rep. David Scott (D-Ga.) cosponsored the bill. HR 1427 is being named the “Truth in Healthcare Marketing Act of 2013.” The bill would essentially make it illegal for any healthcare professional to make false or deceptive claims in marketing materials and advertisements regarding their credentials or clinical expertise. Marketers of health provider’s services must also clearly state the type of license the provider holds. rush into a situation and later realize there are major incompatibility issues. As a general rule, the larger the organization, the greater the potential is for disagreements and incompatibility. The influence ideas of the physician lessen. For the physician who historically has been the “captain of the ship,” this can be a major problem and a recipe for disaster. Deciding what to do professionally as a physician has never been more challenging. Consulting with an experienced health care attorney is a must prior to entering into any agreement or arrangement, no matter what is decided. 9 10 SLC Update By Ralph D. McKibbin, MD, FACP, SLC Representative The Pennsylvania Medical Society (PAMED) Specialty Leadership Cabinet (SLC) met on May 21, 2013. The SLC discussed legislative and regulatory items of interest to physician specialists. The PSG actively represents the specific interests of gastroenterologists in Pennsylvania. Recommendations are made to the Board of Trustees to the Pennsylvania Medical Society. Discussed below are May agenda items of particular interest. Governance restructuring was again reviewed for input. Further progress in the form of workgroup proposals was detailed. PAMED is actively working to redesign its governance structures and processes. It is anticipated that the SLC will continue to represent specialty interests. All specialty societies have been asked by the Pennsylvania Academy of Dermatology and Dermatologic Surgery to write a letter of support for House Bill 1259, The Tanning Regulation Bill. This bill would require registration with the state of all tanning salons, payment of a reasonable annual fee, inspections and safety standards, as well as limits of teen access to tanning beds. The PAMPAC “Got Names Campaign” was reviewed. In these times of rapid change, it is imperative that our voices be heard. The “Got Names” campaign is an opportunity to detail relationships with Pennsylvania legislative representatives. By detailing any relationships that exist between physicians and legislators, a network will be constructed that can effectively reach decision makers. This will 11 enhance our ability to be heard on key issues. Look for information in the near future from PAMPAC. We encourage gastroenterologists to participate. Thirty five specialty societies have joined the campaign entitled “Choosing Wisely.” It encourages health care stakeholders to talk about the necessity of medical tests and procedures. The societies have created list of “Things Physicians and Patients should Question.” These are evidence-based recommendations to help make wise decisions about the appropriate care for a particular patient’s individual situation. Members of the Cabinet are asked to increase awareness of the program. The American Gastroenterological Association has compiled five recommendations for “Choosing Wisely.” In summary they are: 1. Limit long term use of anti-reflux therapy to the lowest effective dosage. 2. Do not repeat colorectal cancer screening for ten years in average-risk individuals after a normal high quality colonoscopy. 3. Do not repeat colonoscopy for five years if only one or two small adenomas are found. 4. Barrett’s esophagus surveillance intervals are three years if there is no dysplasia. 5. Individuals with functional abdominal pain should not have CT examinations repeated without significant change. Specific details can be found at www. choosingwisely.org. Look for national media coverage on this campaign. Promoting the high-quality procedures performed by trained endoscopists couple with appropriate use of healthcare resources is important in presenting our case to the public. The PA Department of Health is investigating accreditation from the Public Health Accreditation Board. A Pennsylvania State Health Assessment (PA SHA) project is required and under construction. The project will provide state-specific information on a variety of health issues, including health status, risks, and healthcare services in Pennsylvania. The document will be a ready source of information for answering public and legislative questions and a source of scientifically accurate information for grant writers and policy-makers involved in decision making and planning. Academic-based practitioners should keep watch on this key document. The PSG is committed to representing the interests of Pennsylvania gastroenterologists. Your feedback, comments, and concerns are needed. Please contact your PSG representative or email me directly at ralphmckibbin@ hotmail.com. Please include PSG/SLC in the subject line. PSG PRSRT STD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO. 922 777 East Park Drive PO Box 8820 Harrisburg, PA 17105-8820 2013 PSG Annual Scientific Meeting The Hotel Hershey Sept. 27–29 Plan a family weekend getaway in Hershey while joining us for education, fellowship, food, and fun! Watch your mail in July for the registration brochure. www.pasg.org