Crotched Mountain: What Physicians Need to Know

Physicians’ Bi-Monthly
June/July 2012
Crotched Mountain:
What Physicians Need to Know
and remain valued, active members
of their communities.
Source: www.crotchedmountain.org
Crotched Mountain in Greenfield,
N.H., is a statewide resource offering extensive services to meet the
needs of some of New Hampshire’s
most vulnerable citizens. Crotched
Mountain is often thought of as a
rehabilitation hospital. However,
the organization provides a unique
combination of rehabilitative, educational, technological, residential
and community-based services that
may help many of your current patients achieve their personal goals
Crotched Mountain Specialty
Hospital
Children and adults with brain injuries, stroke, post-operative needs,
spinal cord injuries and other neurological conditions receive rehabilitative care at multiple levels, from
acute post-hospitalization to acute
rehabilitation, to sub-acute rehabilitation to skilled care in this 62-bed
facility. The interdisciplinary treatment team includes physicians with
specialties in physiatry, psychiatry,
pediatrics and family medicine.
The clinical staff includes certified
Social Media: Are Your Patients
Your “Friends” or Your Patients?
Reminders of your responsibilities in the
new world of social media and ever-increasing communication.
Social media has introduced us all
to a new cadre of vernacular such
as “following,” “liking,” “friending”
and “tweeting.” At its April 2012
House of Delegates, the Federation
of State Medical Boards [“FSMB”]
adopted guidelines for physicians
and social media and social networking.
The guideline – Model Policy Guidelines for the Appropriate Use of Social
Media and Social Networking in Medical Practice – was developed at the
request of FSMB’s chair, Dr. Janelle
Rhyne. In 2011, Dr. Rhyne asked
the FSMB’s Special Committee on
Ethics and Professionalism to develop guidelines around proper
physician use in these areas – social
media and social networking. For
Social Media, cont. on page 9
brain injury specialists, certified
neuroscience registered nurses, certified rehabilitation nurses, certified
wound-care specialists and medicalsurgical credentialed nurses.
The clinical staff at Crotched
Mountain is trained to handle the
most complex conditions and help
patients achieve their maximum
potential. Eighty percent of patients
return to home or community settings with appropriate supports.
• Ventilator Management – Children and adults with diagnoses
requiring short-term or permanent ventilator assistance can
receive vent management, vent
weaning and respite services
Crotched Mountain, cont. on page 8
Physicians’ Bi-Monthly
New Hamphire Medical Society
7 North State Street
Concord, NH 03301
603 224 1909
603 226 2432 fax
[email protected]
www.nhms.org
President’s Perspective
Obesity
prevent about 80% of heart disease, 90% of diabetes and 70% of
stroke. Those are the three pillars.
They really do make a difference.”
Cynthia S. Cooper, MD.............. President
Scott Colby......................................... EVP
Catrina Watson................................ Editor
AMA Practice Tip:
New AMA Resources Help Physicians
Take Charge of Their Data..................3
Lyme Disease Update..............................4
EVP Corner.............................................5
MMIC Practice Tip:
Environmental Safety in the Physician
Office Practice......................................6
Immunization Notice............................. 11
Mission: Our role as an organization in creating the
world we envision.
The mission of the New Hampshire Medical Society
is to bring together physicians to advocate for the wellbeing of our patients, for our profession and for the
betterment of the public health.
Vision: The world we hope to create through our
work together.
The New Hampshire Medical Society envisions
a State in which personal and public health are
high priorities, all people have access to quality
healthcare, and physicians experience deep satisfaction
in the practice of medicine.
Do you or a colleague need help?
The New Hampshire Professionals’ Health
Program (N.H. PHP) is here to help!
The N.H. PHP is a confidential resource that
assists with identification, intervention, referral
and case management of N.H. physicians,
physician assistants, dentists, and dental
hygienists who may be at risk for or affected
by substance use disorders, behavioral/mental
health conditions or other issues impacting
their health and well-being. N.H. PHP provides
recovery documentation, education, support
and advocacy – from evaluation through
treatment and recovery.
For a confidential consultation, please call
Dr. Sally Garhart @ (603) 491-5036.
*Opinions expressed by authors may not
always reflect official N.H. Medical Society
positions. The Society reserves the right to
edit contributed articles based on length and/
or appropriateness of subject matter. Please
send correspondence to “Newsletter Editor,”
7 N. State St., Concord, NH 03301.
2
Cynthia S. Cooper, MD
Have your patients been getting larger over the years? One
of my “themes” during my presidential year will be to address the
growing obesity problem in New
Hampshire and to make sure we,
as physicians, know ways to help
our patients avoid weight gain as
they age. If they already are overweight or obese, we should be able
to advise them regarding the most
successful ways to lose weight and
keep it off. Statistics from 2009
show that 36.5% of New Hampshire residents are overweight
with a BMI of greater than 25,
while 26.3% are obese with a BMI
of greater than 30. That makes
62.8% of our residents either
overweight or obese!
This year, our Annual Scientific
Conference, titled The Obesity Epidemic and Your Practice, will be held
from October 26-28 in Portsmouth
and will address this issue. Save
the date! Dr. Walter Willett, the
chair of the nutrition department
at Harvard Medical School of Public Health in Boston, will be our
keynote speaker. He says, “With
the right food choices, physical activity and not smoking, we could
We have also known for some
time that excess pounds increase
cancer risk. The relationship between obesity and endometrial
cancer has been known since the
1960s. However in the past 15
years, the list of cancers linked
to excess weight has grown. Evidence is strongest for postmenopausal breast cancer, colon cancer,
esophageal, kidney and pancreatic
cancers. There is thought to be a
“probable” association between excessive weight and various cancers,
including ovarian, gallbladder
and liver cancers as well as adult
lukemias, lymphomas and aggressive prostate cancers according to
Alpa Patel, an epidemiologist who
directs the Cancer Prevention
Study-3 at the American Cancer
Society. For some cancers, such as
colon and postmenopausal breast
cancer, there is a linear relationship between increasing weight
and increasing cancer risk. Other
cancers, such as pancreatic cancer,
are increased only by higher levels
of obesity.
While a BMI over 25 is labeled as
unhealthy, it is an arbitrary number chosen by a committee that set
the USDA 2000 Dietary Guidelines for Americans in 2000. Committee members agreed that the
risk of heart disease, diabetes and
high blood pressure begins to
climb at BMIs of 22 or so. However if they had labeled a BMI
of 22 as overweight, there would
have been very few Americans who
President, cont. on page 8
June/July 2012
AMA practice tip:
New AMA Resources Help Physicians Take Charge of Their Data
Increasing importance of
physician data
3)improve the quality and efficiency of their practices; and,
It is often said that knowledge is
power, and in our increasingly
technology-based world of medicine, the primary source for obtaining that knowledge is data.
All-payer claims databases, patient
registries, patient satisfaction survey results, data analytics engines,
electronic health records and a
host of other systems and technologies are revolutionizing the
way in which health care is chosen,
delivered and funded. Physicians
are being publicly rated for the
quality, cost and style of care they
provide to patients, and payment
mechanisms are increasingly being
tied to prospective utilization budgets and measures of performance
in an effort to control the ever-increasing cost of medical care.
4) prepare themselves for the new
budget-based payment models
that depend on the variation
between projected and actual
use and cost of resources, rather than on maximizing volume
of services
As the collection of medical data
is proliferating, it is becoming apparent that physician survival will
be tied to owning, mining and understanding that data. Physicians
must ensure that their information is responsibly reported by
other parties, as well as learn to
use data themselves for improving their practices and remaining
relevant in the changing health
care marketplace. It is critical
that physicians begin to review
and understand their claims and
other data to:
1)reduce health care costs by
eliminating the currently inexplicable variation in treatment
patterns;
2)
ensure that their publiclyreported practice profiles are
accurate;
AMA physician data resources
To support physicians in this new,
data-driven environment, AMA’s
Private Sector Advocacy team has
developed several educational
tools. “Take Charge of Your Data”
is a new guide designed to help
physicians understand and verify
the accuracy of the complex profiling reports provided by public
and private health insurers. Using
practical information and step-bystep instructions, the guide simplifies the review of data reports
and teaches physicians how to use
both quality and cost-of-care data
to identify practice improvement
opportunities.
“Take Charge of Your Data” was
developed to be used in tandem
with the AMA’s “Standardized
Physician Data Report.” The AMA
created the Standardized Report
to encourage payers to adopt a
uniform format for physician
profiling reports. Currently, each
payer uses its own unique format
to report physician performance
data, making it extremely challenging for physicians to decipher
the reports from various insurers.
The Standardized Report offers
a uniform reporting format for
payers’ physician data reports and
includes the patient-specific detail
needed for the reports to be meaningful and actionable for physicians. When used together, the
physician guide and the Standardized Report can help physicians
identify common report features,
interpret quality and cost-of-care
performance results, and use the
information to improve care and/
or increase efficiency.
Physician data case study
Howard has been a patient of Dr.
Werxard for many years, and like
many of his patients, Howard suffers from asthma. Dr. Werxard and
Howard have formed a friendly,
mutually respectful patient/physician relationship. However, when
Howard comes in for a routine office visit, he is upset. “My insurer
says that I’ll have to pay a higher
co-pay to keep seeing you. They’re
saying that you’re not a good doctor!”
Dr. Werxard is distressed by this
news and promises Howard that
he will look into the situation. He
digs through the stack of paperwork on his desk until he finds the
profiling report that he received
from Howard’s insurer a few
months ago. He usually ignores
these reports because he doesn’t
understand them, and he doesn’t
have much time to figure them
out. But he’s heard about AMA’s
“Take Charge of Your Data” and
decides to take another shot at deciphering his performance data.
Howard’s insurer gave Dr. Werxard an excellent quality score, but
his cost-of-care numbers were significantly higher than his peers.
This led to his placement in a netAMA Practice Tip, cont. on page 10
3
Physicians’ Bi-Monthly
Lyme Disease Update
Because of these facts we want to
encourage all clinicians in N.H. to
“think Lyme.” Diagnosis of early
Lyme disease should be based
solely on clinical suspicion since
diagnostic serologies (including
IgM) may not yet be positive. Erythema migrans is not always present, but can be seen in 60% to
80% of the patients. �
4
New Hampshire Department of Health and Human Services
Infectious Disease Surveillance Section
Reported Cases of Lyme Disease in New Hampshire, 2007-2011
NEW HAMPSHIRE COUNTIES WITH EMERGING
LYME DISEASE INCIDENCE
120.0
Rate per 100,000 Persons
100.0
Belknap
80.0
Carroll
Cheshire
60.0
Coos
Grafton
40.0
Sullivan
20.0
0.0
2007
2008
2009
Year
2010
2011
NEW HAMPSHIRE COUNTIES WITH ENDEMIC
LYME DISEASE INCIDENCE
250.0
Rate per 100,000 Persons
Lyme disease continues to be the
most frequently reported vectorborne illness in New Hampshire.
From 2008 when we saw this disease peak at 1,615 cases (for a rate
of 122/100,000 persons), we have
seen it decrease to 1,301 cases in
2011 (98.7/100,000 persons). But
this decrease masks a changing
trend in the geographic distribution of the cases. As shown in the
attached table, there are clear differences in the trends observed
in the different counties in New
Hampshire. The four counties that
encompass the southeast part of
the state, where historically Lyme
disease had the highest rates, are
now eclipsed by those other counties where high incidence rates of
Lyme disease were not the norm.
In addition, more than 50% of
deer ticks sampled in N.H. from
2007 to 2010 were infected with
Borrelia burgdorferi, the bacteria that causes Lyme disease, in
all counties except Belknap, Carroll and Coos. Although ticks have
a two-year life cycle, the greatest
risk for humans to be infected
occurs between May and August
when the nymph stage of the deer
tick is most active.
200.0
Merrimack
Hillsborough
150.0
Rockingham
Strafford
100.0
50.0
0.0
2007
2008
2009
Year
2010
2011
Note: All the data in this report are based upon information provided to the New Hampshire Department of Health and
Human Services under specific legislative authority. The numbers reported may represent an underestimate of the
true absolute number and incidence rate of cases in the state. The department is not responsible for any duplication or
misrepresentation of surveillance data released in this report. Case counts by year are based on morbidity date, which
is the date closest to onset of illness and may represent date of onset, date of diagnosis, or date of report, whichever
is earliest. Case counts may not exactly match data published yearly by the Centers for Disease Control and
Prevention. Population data used in this report comes from the U.S. Census Bureau. Data are complete as of May 3,
2012. Data prepared by Elizabeth R. Daly, MPH, 603-271-4927, [email protected].
June/July 2012
EVP Corner
An Eye-Opening Experience
lyn was able to interact with these
patients as they continued their
journey of recovery and rehabilitation. To say the least, she was
moved.
Scott G. Colby
During my seventeen-year-old
daughter’s recent school vacation,
I had the chance to accompany
her on a tour and job-shadowing
experience at Crotched Mountain
Rehabilitation Center in Greenfield, N.H. – a special thank you
goes to Carl Cooley, MD, for arranging the visit.
As with many young adults, Kaitlyn is considering her path to her
future and what she might do as
an adult that will provide her a
fulfilling, yet sustaining career.
After several discussions about
her future, passions and what
motivates her, Kaitlyn has decided
to pursue a career in healthcare as
an occupational therapist.
During our trip to Crotched
Mountain, Kaitlyn had the opportunity to job shadow with the
director of clinical and rehabilitation services as well as several
therapists. She saw firsthand how
these professionals made a real
difference in the lives of these
patients. With the appropriate
HIPAA safeguards in place, Kait-
What was especially meaningful for Kaitlyn was the context in
which she could place this experience. You see, she is involved
in a program at her high school
that allows her to work one-onone with fellow students who have
serious physical, mental and/or
emotional conditions. As she has
been working with these students,
she has come to realize two things.
First, she derives great satisfaction
in helping people achieve their
greatest potential; and second, this
experience has allowed her deepseated compassion to flourish.
During her day at Crotched Mountain, she met several patients suffering from brain injuries and was
very impressed with the autism
program and how well the therapists connect with the students. In
a remarkable parallel, Kaitlyn met
a student who was described by
the staff as being very withdrawn
and who had difficulty interact-
ing with others. To the pleasant
surprise of staff and Kaitlyn, this
student came up to her and “highfived” her and asked for Kaitlyn’s
name – staff described this as a
break-through moment for this
student! It was at this point that
Kaitlyn knew a career in occupational therapy was right for her.
While at Crotched Mountain,
even for only a few hours, she felt,
for lack of a better term, a calling
when working with the students.
Seeing the therapists interact and
make a real difference “sealed the
deal” for her.
I believe this calling is similar
to that which you must have felt
when you were deciding to pursue
a career in medicine. Please never
underestimate the importance of
what you do and the impact you
have on your patients.
On the ride home, Kaitlyn shared
the details of her experience with
such passion and sense of purpose. It was one of those daddaughter moments I will forever
cherish, and the entire day was an
eye-opening experience for both
of us. �
Do You Want To:
• Serve others?
• Receive free training?
• Assist in Public Health
Initiatives?
• Help during times of crisis?
• Learn how to be prepared
during an emergency?
Join the Medical Reserve Corps!
Volunteer your professional skills a few hours a month
Register online at: NHResponds.org
5
Physicians’ Bi-Monthly
Medical Mutual Insurance Company of Maine
Environmental Safety in the Physician Office Practice
Proactive safety management
helps to ensure a safe environment
in the physician office practice.
Use the following recommendations as a guide in the development of an environmental safety
program.
I. Environmental Safety Plan
Operational
√ Encourage physicians and employees to report unsafe or potentially hazardous conditions.
Immediately remedy high-risk
situations.
√ Maintain stairwells with firmly
attached handrails, adequate
lighting.
√ Identify glass doors with emblems.
√Cleary mark all exits. Post
evacuation routes.
II. Plan Elements
Life Safety: Office Setting
√ Arrange furniture away from
traffic areas.
√ Develop a safety plan that describes how to maintain a safe
environment. Include the role
of the physicians and employees.
√Remedy sharp table corners
and worn carpeting.
√ Conduct walk-around inspections on a regular basis to
identify potential risks. Correct identified risks.
√Remove clutter, equipment
and obstacles from walkways.
√ Install call bells, safety bars in
patient restrooms.
√ Limit height of stacked materials to prevent collapse.
√Check emergency exit signs
for visibility and lighting.
√ Test emergency lighting.
Life Safety: Grounds and Parking
Areas
√Remove snow from parking
areas and walkways as needed.
√Frequently sand/treat icy areas.
Environmental Safety, cont. on page 7
FAMILY MEDICINE
Southern New Hampshire
Elliot Health System is seeking family medicine physicians for practice
locations in Southern New Hampshire. Join our team and you will enjoy a
fantastic call schedule (approximately 18 days of call per year) ; access to
a hospitalist service as well as electronic medical records. This practice is
located within 10 miles of Elliot Hospital in Manchester, New Hampshire,
The Elliot Hospital is a 296-bed, JCAHO-accredited acute care facility and
Level II Regional Trauma Center. EHS is distinguished by an extensive
Primary Care Physician Network, Women’s Health Program, Geriatrics
Programs, a Regional Cancer Center, and a Level III NICU.
We are proud to offer an exceptional compensation and benefits
package!
The Elliot Health System invites you to explore the rich heritage,
breathtaking beauty and four-season attractions of (tax-free) New
Hampshire. Enjoy close-knit communities known for their unique blend
of city and country living. Come see why Money Magazine annually ranks
the area one of the nation’s ‘best places to live.’ We are located within
an hour of New Hampshire’s beautiful Seacoast, Lakes Region and the
panoramic White Mountains as well as Boston, Massachusetts.
ID#140867C89
6
New Hampshire Medical Society Newsletter
May 2012
½ page
KRM 140867 FM
For more information, please contact:
Molly Alderson
800-678-7858 x64507
[email protected]
Visit us online at www.ElliotHospital.com
www.elliothospital.org
June/July 2012
Environmental Safety, cont. from page 6
√Repair uneven surfaces, potholes, cracks.
√ Follow manufacturer requirements for safe usage.
√ Remove debris.
√ Secure oxygen cylinders.
√Maintain adequate lighting
to minimize shadows; replace
burned-out bulbs.
√Install signage to identify
parking entrances and exits.
Fall Prevention
√ Closely monitor occupants of
waiting areas.
√ Clearly identify wet floors and
steps with a warning sign.
√ Seat the patient in a chair in
the exam room, not on the
exam table, while awaiting the
physician. Do not leave a patient alone if they are at risk
for a fall.
Fire Safety
√Check for signage warning
that elevators are not to be
used in a fire emergency.
√ Place fire alarms and fire extinguishers in an accessible
area.
√ Service fire extinguishers annually.
√Install “no smoking” signage
in designated areas.
√Routinely
system.
inspect
√Assist unstable patients with
accessing the exam table,
opening doors or maneuvering through corridors.
√Provide personal protective
equipment.
√Store electrical cords appropriately to prevent tripping
hazards.
√ To maintain child safety, utilize
plugs for electrical outlets or
install child-safe outlets.
Medical Mutual’s “Practice Tips”
are offered as reference information only and are not intended
to establish practice standards or
serve as legal advice. MMIC recommends you obtain a legal opinion from a qualified attorney for
any specific application to your
practice. �
Hazardous Materials
√Label and store hazardous
products in appropriate containers in a locked storeroom.
√ Keep electrical outlets in good
condition.
√ Train physicians and staff on
the proper use of equipment
and recognition of product
hazards.
sprinkler
√
Use chairs and examination tables appropriate to the
needs of the patient.
Electrical Hazards
tion to physicians and employees.
Emergency Preparedness
√ Ensure federal, state and local
standards have been met regarding disaster preparations.
Medical Emergency
√ Inspect emergency equipment
for accessibility, proper functioning. Resupply at designated intervals and after each
use.
Trusted Advisors for Changing Times
III. Education
Equipment Safety
√ Properly ground equipment.
√Inspect office equipment for
functionality and integrity.
√Educate new physicians and
staff on safety practices and
expectations.
√ Provide annual safety educa-
New Hampshire’s health-care community
has placed its confidence in our attorneys
for decades.
Headquarters: Concord NH
Offices in: Gorham NH and Portland ME
603.224.2341 | www.sulloway.com
7
Physicians’ Bi-Monthly
Crotched Mountain, cont. from page 1
at the Specialty Hospital. The
hospital’s medical team and
respiratory therapists work
closely with the pulmonologists, neurologists and other specialists of Dartmouth
Hitchcock Medical Center
who provide patient consultation through high-definition
video conferencing and onsite clinical rounding.
• Cognitive Rehabilitation – The
hospital provides inpatient
Cognitive Rehabilitation Therapy (CRT) in both individual
and group settings for peer
learning and support. The
team includes professionals
in neuropsychology, physiatry,
social work, speech-language
pathology, physical and occupational therapy and recreation therapy.
Outpatient Services
Located in Greenfield, this service
provides specialized and traditional outpatient therapies including
a stroke and brain injury rehabilitation program; a developmental
pediatric clinic for diagnostic evaluations, medication management
and developmental monitoring;
sensory integration therapy for
children and adults with autism;
wheelchair seating; and assistive
technology. Traditional therapies
include sports medicine, aquatic
therapy, audiology, physical and
occupational therapy, speech language pathology and others.
ATECH Services
Located in Concord, ATECH is
the state’s premier accessible technology provider. ATECH professionals can provide your patients
who have complex medical, physical, sensory, cognitive and communication needs with consultation
and assistive technology solutions
that address mobility, communication and accessibility. Their services help people achieve their personal goals at work, school, home
or play.
Refurbished Equipment
Marketplace (REM)
When the cost of new durable
medical equipment is out of reach,
your patients can purchase highquality, gently used and reconditioned bath equipment, walkers, wheelchairs, patient lifts and
other items at reasonable prices
at www.shopREM.com or at the
showroom at ATECH in Concord.
ABA for Preschoolers with
Autism
Children ages 2 to 6 with autism
can build communication, social,
play, motor and self-care skills
through Ready, Set, Connect!,
Crotched Mountain’s Applied Be-
havioral Analysis (ABA) treatment
program at ATECH in Concord.
Led by board-certified behavior analysts, children participate
in full and half-day programs of
intensive one-to-one ABA treatments and learning in a caring
and engaging environment.
Crotched Mountain School
The school is located in Greenfield and specializes in providing
educational services and therapies to children ages 5-21 with
autism, behavioral and emotional
disorders, developmental disabilities and complex medical conditions. Residential students may
receive 24-hour skilled care in
our Specialty Hospital or receive
daily medications and lab testing
through our licensed health center while living in group homes or
apartments on campus.
Physician Take-Away
As you treat patients with autism,
stroke, brain injuries, spinal cord
injuries and other neurological
and developmental disorders, contemplate the resources available at
Crotched Mountain. Many of its
services can support you in developing long-term, clinically effective
treatment plans so your patients
can live healthy, active lives. To inquire about services for your patients, call 603-547-3311 or email
[email protected]. �
President, cont. from page 2
would not have been considered
overweight! Thus, the guideline
was set that a BMI over 25 was unhealthy. According to Dr. Willett,
while the occasional bodybuilder
with a BMI over 25 is healthy, the
rest of us would do much better
8
with a lower BMI, and he feels it
is important to understand that
many people with a BMI of 23-25
are not at their healthiest weight. It
appears the bottom line is to keep
your BMI low!
I hope to see all of you at this very
clinically relevant Annual Scientific Conference in October. Further
details about the meeting will be
mailed out to you soon. �
June/July 2012
Social Media, cont. from page 1
some, social media may seem like
an irrelevant topic; however, the
FSMB’s guidelines cite a 2011 survey of 4,000 physicians and found
that 87% of respondents use a
social media website for personal
use and an astonishing 67% use
one for professional purposes.
The issue of social media in the
practice of medicine is gaining
attention regionally and nationally – even before the release of
these guidelines. The American
Medical Association, for example, adopted a policy in the fall
of 2010 on physicians and the
use of social media (http://www.
ama-assn.org/ama/pub/meeting/
professionalism-social-media.
shtml) and a recent search of the
AMA website found over 15 articles on social media.
In all of these publications, policies and guidelines there is a
common theme: Be careful to
maintain professional boundaries,
confidentiality may be compromised through the use of social
media and, most importantly, you
can never be 100% certain that
the person you are communicating with is actually who you think
it is. Section 4 of the FSMB policy provides guidance in key areas
for physicians who use social media. Below is a summary (for the
full set of guidelines go to www.
nhms.org and see Hot Topics on
the homepage):
Interacting with Patients – The
guidelines discourage physicians
from interacting with current or
former patients on personal, social networking sites.
Discussion of Medicine Online –
Peer-to-peer sites where physicians
can exchange information are useful. Physicians should ensure that
such networks are secure. The
guidelines cite physician networking sites where HIPAA-compliant
messages can be shared.
Privacy/Confidentiality – Breaches of privacy and confidentially
may be in violation of privacy laws
such as HIPAA. Physicians should
never post patient-identifiable information on such sites.
Disclosure – When posting comments online as a healthcare practitioner, it is important to post
your credentials as a physician
and highlight any conflicts of interest you may have.
Professionalism – Among the key
suggestions was establishing separate personal and professional
social network sites for yourself
to ensure that the appropriate
professional boundaries are not
crossed.
Additional resources have been
made available by medical liability insurers. In a recent practice management tip (run in the
NHMS eNews Update on May 23,
2012), Medical Mutual Insurance
Company of Maine offered many
tips, including the reminder that
anything you post is permanent –
even if it is later pulled but “stored
in a search engine or cache.” In addition to addressing permanence,
MMICM offered information on:
Developing a Plan, Offering Medical Advice, Privacy, Education and
Personal Social Networking.
We strongly recommend that you
take a few minutes to read some
of the resources identified in this
article to familiarize yourself with
the potential “dangers” of social
media. While social media can be
enjoyable and relaxing, there are
some potential risks for you as a
physician.
Are your patients your “friends”
or your patients? �
Multispecialty Approaches to Patients with Comorbid
Chronic Kidney Disease and Cardiovascular Disease
Target Audiences: Internal Medicine, Cardiologists, and Nephrologists involved
in the treatment of patients with cardiovascular disease, Dyslipidemia, Renal
Impairment, and Chronic Kidney Disease
Live: November 14, 2011 – November 14, 2012
www.cvdckdcme.com
9
Physicians’ Bi-Monthly
New AMA Resources, cont. from page 3
work tier with a higher patient copay. After reviewing “Take Charge
of Your Data,” Dr. Werxard knows
that he should focus his attention
on his cost-of-care performance.
He delves into his report and sees
that the cost of care for his patients
with asthma is a major contributor
to his higher overall costs. Following the step-by-step instructions
in “Take Charge of Your Data,” he
learns how to drill down deeper
into his data and notes some significant variation in the service
utilization rates of his asthma patients and those of his peers. Specifically, his patients’ professional
services costs are lower than his
peers’ patients, while his patients
show considerably higher costs for
emergency room visits.
He digs even deeper into patient
level data to see if there is any significance to these variations. After
analyzing his data, Dr. Werxard decides that some of his patients with
asthma may require closer monitoring, and he begins to schedule
more office visits with appropriate patients. When he receives his
next report from this insurer, he
is encouraged to see that, while
his professional services costs have
increased, there have been significant drops in his patients’ use
of emergency room services. This
has resulted in a lower cost-of-care
score, which in turn has led to his
placement in a more favorable net-
work tier. Howard is happy to see
Dr. Werxard when he arrives for his
next office visit, and Dr. Werxard is
pleased to know that his asthma
patients are living healthier.
Improving physician data
reports
The AMA has also created a set
of best practices for payers to use
in their data reporting efforts. In
April 2011, the AMA presented
the “Standardized Physician Data
Report” to representatives from
national insurers in the hopes that
they would adopt this uniform reporting format. Although payers
were generally supportive of the
concept, they indicated that the
significant investments of both
time and money in their existing
profiling systems made it infeasible to adopt the standardized format in the near future. Instead,
the payers recommended that the
AMA developed a set of best practices for reporting physician data.
AMA’s “Guidelines for Reporting
Physician Data (Reporting Guidelines)” were created in conjunction
with many physicians, Federation
of Medicine staff, national health
insurers, accreditation bodies, and
other organizations with an interest in health care. The Reporting
Guidelines were designed to increase the uniformity of data reports so that these reports can be
more easily understood by physi-
cians. The Reporting Guidelines
also promote the use of sufficient
detail (i.e., patient-level information) in data reports so that physicians can verify the accuracy
of the information and use the
data for practice improvement.
The AMA is urging all interested
stakeholders, including health
plans, to attest their support for
the Reporting Guidelines. The
AMA hopes that payers will incrementally adopt the principles outlined in the Reporting Guidelines,
which will in turn facilitate better
physician understanding and use
of data reports.
Access AMA resources online
“Take Charge of Your Data,” the
“Standardized Physician Data
Report,” and the “Guidelines for
Reporting Physician Data” are all
available on the AMA’s website.
Visit www.ama-assn.org/go/physiciandata to access these resources
and a webinar about the guidebook with physician data expert
Dr. Howard Beckman. And, if you
haven’t already done so, sign up to
receive the AMA Practice Management Alerts emails at www.amaassn.org/go/pmalerts to stay up to
date with information on unfair
payer practices, ways to counter
these practices and practice management resources and tools. �
HPV – Beyond Cervical Cancer
Target Audiences: Internal Medicine, Family Medicine, Primary Care
Live: November 14, 2011 – November 14, 2012
www.hpvcme.com
10
June/July 2012
Immunization Notice
State of New Hampshire Department of Health and Human Services
On June 6, 2012, a report was released by the U.S. Department of
Health and Human Services, Office of Inspector General (OIG),
entitled “Vaccines for Children
Program: Vulnerabilities in Vaccine Management.” This study
was conducted in four large states
and one large city. The OIG visited 45 vaccine provider sites and
interviewed the immunization
program staff in the five areas.
The Centers for Disease Control
and Prevention (CDC) manages
all of the federal funds for the national immunization program, including purchase of vaccines, at a
total cost of $3.6 billion. The OIG
has recommended that “CDC continue to work with grantees and
providers to ensure that (1) VFC
vaccines are stored according to
requirements, (2) expired vaccines
are identified and separated from
non-expired vaccines, (3) grantees
better manage providers’ vaccine
inventories, and (4) grantees meet
oversight requirements.”
CDC
concurred with all four of the OIG
recommendations and noted that
vaccination is one of the most successful public health tools in preventing and controlling disease.
In the State of New Hampshire,
the immunization program is
proud to partner with over 300
vaccine providers that work diligently to manage, store, and administer their vaccines according
to CDC standards. In 2011, the
N.H. Immunization Program staff
conducted 177 assessment visits.
For example, of the 177 healthcare practice visits only five had
expired vaccine in the refrigerator. Each practice received appropriate follow-up and was required
to provide a corrective education
plan. In calendar year 2011, wasted vaccine totaled 0.8% of the total number of vaccines provided
to New Hampshire offices to immunize all children birth through
18 years.
handling, and accountability standards. These efforts all contribute
to New Hampshire’s high vaccination rates. The Immunization
Program staff will continue to
work with you to ensure the highest standards of vaccine administration and management. We will
continue to offer educational conferences, one-on-one training for
vaccine managers, monthly conference calls and telephone assistance for all medical staff. �
Marcella Bobinsky, Program Manager
29 Hazen Drive
Concord, NH 03301-6527
603-271-4482
1-800-852-3345 Ext. 4482
Fax: 603-271-3850
TDD Access: 1-800-735-2964
www.dhhs.nh.gov
The N.H. Immunization Program
and N.H. healthcare providers
adhere to strict vaccine storage,
The New Hampshire Medical Society Corporate Affiliates
Anthem BCBS
Merrill Lynch, Pierce, Fenner & Smith
Shaheen & Gordon, P.A.
Cigna Healthcare
Northeast Delta Dental
Software Advice
Crown Healthcare Apparel Service
Northeast Health Care Quality Foundation
Sulloway and Hollis, P.L.L.C.
Coverys
Pfizer
Sunovian
I.C. Systems
Professional Office Services
The Foundry Financial Group, Inc.
Kilbride & Harris, LLC
Rath Young and Pignatelli, PC
Workplace Benefit Solutions
Medical Mutual Insurance Company of
Maine
Risk Transfer Alliance, LLC
NHMS CAP is a paid membership program whose members meet criteria as posted at www.nhms.org
11
Physicians’ Bi-Monthly
Go Paperless
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Register NOW for CMS Electronic
Health Record Incentives
The Centers for Medicare & Medicaid Services (CMS) is giving incentive
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that demonstrate meaningful use of certified electronic health record
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Incentive payments will include:
• Upto$44,000foreligibleprofessionalsintheMedicareEHRIncentiveProgram
• Upto$63,750foreligibleprofessionalsintheMedicaidEHRIncentiveProgram
• Abasepaymentof$2millionforeligiblehospitalsandcriticalaccesshospitals,
dependingoncertainfactors
Get started today! TomaximizeyourMedicareEHRincentivepaymentyouneedto
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Sign up for
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For additional resources and support in adopting certified
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EHR_Ad_Couple_V1.indd 1
12
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Page 1
June/July 2012
IT’S TIME YOU LOOKED
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Your patient filed a claim. Will your carrier conduct a
peer review on your behalf, or a cost-benefit analysis?
T
here are insurance carriers that have shown themselves
to be more than happy to settle a medical professional
liability claim when it’s deemed a less expensive alternative
to defending it — sometimes even when the case is without merit. We’ve even heard of cases where the decision to
settle was made without consulting the physician who had
been sued. Is that the kind of “coverage” you have?
With Medical Mutual you can be sure that if you’re ever
the subject of a significant claim, our Claims Committee,
comprised of practicing physicians like you, will review
the details of your case. Then they — not businesspeople
— determine whether it’s best to settle or defend, based on
the medical facts. And in the end, we believe that since it’s
your reputation and record that are on the line, the decision
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If you prefer that kind of respectful, peer-directed coverage,
make it your call to say so. Talk to your practice or hospital
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Prsrt Std.
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Permit No. 1584
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Address Service Requested
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Sports Trauma and Medical Emergency Conference
September 11, 2012
Grappone Conference Center, Concord, N.H.
Topics include: Head Injury On-field Management, Sudden Cardiac Death,
Heat Stroke, Hypothermia, Concussions, Disabled Military Athletes and
Medical/Legal Aspects of Concussion and Sports Injury
Watch your mail for more information