Society Reaffirms Opposition to Physician
Transcription
Society Reaffirms Opposition to Physician
2 PRESIDENT’S MESSAGE 3 YOUR PRACTICE Medicare Revalidation Update • ACOs & Innovation 4 THE PUBLIC’S HEALTH Physicians Push Tobacco Bans • Effects of Biomass Combustion • Alliance Charitable Foundation Supports Medically Underserved 5 GOVERNMENT AFFAIRS An Interview with House Majority Leader Ron Mariano 6 PROFESSIONAL MATTERS When Poor Record Keeping Is a Red Flag • Bullies & Victims: Can You Tell the Difference? • Resources for International Medical Graduates 7 INSIDE MMS Work/Life Balance for Young Physicians • Get LinkedIn to the MMS • Across the Commonwealth • In Memoriam volume 17, issue 1, december 2011/january 2012 8 MMS EDUCATION PROGRAMS Society Reaffirms Opposition to Physician-Assisted Suicide Vote Comes at 2011 Interim Meeting By erica noonan T he Society voted this month to reaffirm its opposition to physicianassisted suicide, with its House of Delegates voting by a threequarters margin to maintain a policy the Society has had in effect since 1996. Opposition to physician-assisted suicide was part of a larger policy statement that includes recognition of patient dignity at the end of life and the physician’s role in caring for terminally ill patients. “Physicians of our Society have clearly declared that physician- assisted suicide is inconsistent with the physician’s role as healer and health care provider,’’ said Lynda Young, M.D., president of the Society. “At the same time, we recognize the importance of patient dignity and the critical role that Another policy physicians adopted by the have in Society at its end-of-life meeting, held care.’’ Friday and SaturThe upday, December 2 dated policy and 3, was one includes to maximize “support influenza vaccifor patient nation among dignity and health care workthe alleviaers by supporting Photo by Doug Bradshaw tion of pain Members prepare to cast electronic votes. efforts by the and sufferMassachusetts ing at the end of life.” It also inDepartment of Public Health and cludes the Society’s commitment other health care organizations. to “provide physicians treating In the event other means are not terminally ill patients with the successful at maximizing rates, ethical, medical, social, and legal the MMS determined it would education, training, and resources support mandatory immunization to enable them to contribute to programs. the comfort and dignity of the Delegates also expanded patient and the patient’s family.” the extensive Confidentiality Statement of Principles Policy for patients to include genetic information, including testing and disclosure. The Society also voted to develop and implement the MMS Health Care Access Initiative, a program to improve recruitment and retention of primary care physicians. The policy includes pursuing fund-raising efforts and developing a strategy to sustain the initiative. Resolutions to convene a task force to improve communication between doctors and medical examiners and to support advocacy for mental health services for pregnant and postpartum patients were also approved. For complete coverage of the Interim Meeting, visit www. massmed.org/interim2011. VS Happy 200th Birthday, NEJM SGR Cuts Loom 2012: Year of Special Articles, Symposia Focus on Preventing 27.4 Percent Cut By Vicki Ritterband On the eve of its 200th birthday, the New England Journal of Medicine (NEJM) is looking good for its age. In fact, it’s thriving as the most influential and widely read and cited general medical journal in the world. But that wasn’t always the case, according to Editor-in-Chief Jeffrey Drazen, M.D. For nearly the first two-thirds of its life, NEJM mostly gathered medical news that had been reported elsewhere first. Then, in 1937, Robert Nason Nye, M.D., took over NEJM’s reins. As legend has it, he sent free subscriptions to every enlisted physician in World War II. Many of these new readers went on to distinguished careers in medicine, and suddenly NEJM had the eyes and ears of the most influential doctors in the country. “From the 1950s to 1970s, we ecame a place to deposit the b most important original research findings,” said Drazen. “We began to rival Lancet and the Journal of the American Medical Association.” A list of those deposits reads like a Who’s Who of modern medical discoveries: the first studies making the link between DES daughters and clear cell adenocarcinoma; the earliest descriptions of AIDS — then called gayrelated immune deficiency — and its treatment; the initial reports showing the cardiovascular benefits of beta blockers and aspirin therapy; and the earliest papers on everything from the use of statins in cardiovascular disease to new molecular advances in the treatment of chronic leukemia and lung cancer. And as the pace of research has quickened, NEJM has worked hard to shorten the window between discovery and publication, especially when the public’s continued on page 2 With the failure of the Congressional “Super Committee” to reach agreement last month, prospects of a quick and permanent repeal of planned cuts to Medicare’s Sustainable Growth Rate (SGR) have dimmed. The White House and Legislative leaders on both sides of the aisle continue to maintain that the nation’s physicians will not see a permanent 27.4 percent cut in payments. In a recent statement, U.S. Health and Human Services Secretary Kathleen Sebelius referred to physicians as “the backbone of continued on page 5 President’s Message Happy 200th Birthday, NEJM continued from page 1 SGR: Front and Center We had a very productive Interim Meeting here in Waltham earlier this month, and my thanks to all of you for your engaged and serious debate. There are few issues so urgent as the proposed cuts of more than 27 percent in Medicare payments to physicians. Because Congress’ Super Committee failed to come up with a proposal for trimming $1.2 trillion from the budget, our chance of finally getting rid of the Sustainable Growth Rate (SGR) payment formula has sustained a setback. Most people think that these cuts won’t go through, and a freeze on payments will happen for probably a year, punting the issue to after the 2012 elections. So, now we are back to square one — trying to keep the cuts at bay while working towards a permanent fix. The AMA had been working diligently on coming up with innovative ideas that are already in place in various parts of the country. They hope that by sharing new, successful approaches to how doctors deliver care, more physicians can start thinking of ways to change their practices to their goals of even better quality and cost control. The AMA’s Innovator Committee is working on what are the challenges, barriers and solutions that each group has encountered. We are fortunate to have a Massachusetts Medical Society member on this task force, Dr. Philip F. Gaziano, M.D. of Springfield. We applaud his work, and look forward to updating you on the committee’s progress in the months to come. – Lynda M. Young, M.D. health is at stake, as in the 2008 heparin contamination scare. “The article came in on Thursday and it was published on the Web on Tuesday,” said Drazen. “The goal of NEJM is to connect with physicians in practice and research and to get them the best information,” continued Drazen. “That’s been constant for 200 years. The way it’s done and how quickly it’s done has changed as technology has evolved.” Birthday Celebrations NEJM’s legacy is woven throughout this year’s anniversary celebration. “The anniversary is all about connections,” said Christine Lamb, director of marketing for NEJM. “Connecting with younger audiences, connecting younger generations to older, connecting NEJM’s history to the challenges in medicine today and connecting research to practice.” Kicking off the year with its January 5 issue, NEJM will publish 11 specially commissioned articles by the biggest names in medicine today. Elizabeth Nabel, M.D., and Eugene Braunwald, M.D., will debut the series with a survey of 200 years of heart disease — a fitting bookend to the first article that appeared in NEJM in 1812 on angina pectoris by John Warren, the father of one of the founding editors; George Annas will pen a piece about medical malpractice and jurisprudence; Atul Gawande, M.D., will write about surgery; and Paul Farmer, M.D., will contribute an article on tuberculosis, to name a few of the contributors. The authors’ only directive is to write about something that interests them and to highlight how NEJM connects with the topic. Other special content includes a history of NEJM and articles on therapeutics, practice, and disease from a historical perspective. Anniversary Website The special content will be collected on NEJM’s anniversary website, NEJM200.NEJM.org. The website features video interviews with Dr. Drazen and his four predecessors as well as several long-time colleagues, an interactive timeline of medical milestones with tie-ins to NEJM articles, an opportunity for people to vote on their favorite NEJM article of all time, and videos submitted by NEJM readers about important or inspirational moments in their medical careers or the role NEJM has played in their lives. “The anniversary isn’t about how great the journal is, but rather about the NEJM community,” said Pamela Miller, assistant to the editor for special vital signs is the member publication of the Massachusetts edical Society. M Editor: Erica Noonan Staff WriterS: Deb Beaulieu, Vicki Ritterband EDITORIAL STAFF: Charles Alagero, Office of General Counsel; Robyn Alie, Public Health; Lori DiChiara, Government R elations; Kerry Ann Hayon, Managed Care; Stephen Phelan, Membership; Cathy Salas, West Central Regional Office; Jessica Vautour, P hysician Health Services Production and Design: Department of Premedia and Publishing Services; D epartment of Printing Services pRESIDENT: Lynda M. Young, M.D. executive vice president: Corinne Broderick Director of Communications: Frank Fortin 2 • december 2011/january 2012 Vital Signs rojects. “NEJM would be nothing without the people p who read it and contribute. We’re focused on them. The anniversary gives us a more informal way to include a lot of different voices that we normally don’t have room for on the main site.” The anniversary website will also give a taste of things to come, according to Christopher Lynch, MMS vice president of publishing. “There are things we’re doing with the website that may lead to new ways to better communicate with our audience,” said Lynch. “The use of social media, a more graphical interface — we’re using it as a testing ground. Research is changing and practice is changing. We’ve got to change with those changing needs.” VS NEJM Then and Now Even if Dr. Drazen’s father had been a physician instead of a power distribution engineer, it’s doubtful he would have granted his dad the same honor John Collins Warren, M.D., granted his in 1812: publishing his article as the first in the inaugural issue of the New England Journal of Medicine and Surgery, the earliest incarnation of the New England Journal of Medicine (NEJM). In nineteenth century Boston, father and son were local medical superstars. They were part of a small coterie of physicians laying the groundwork for Boston as a future health care capital by founding Harvard Medical School, establishing the Massachusetts General Hospital, and creating the Massachusetts Medical Society (MMS). In 1921, the MMS purchased what was then called the Boston Medical and Surgical Journal for $1; after 100 years of publication under that name, in February 1928, the name was changed to the New England Journal of Medicine. Today, NEJM is a truly international journal, with an estimated 600,000 weekly readers in nearly every country in the world. It strives to ferret out the best research happening anywhere. “We send our editors all over the world to find those investigators who are at the cutting edge of knowledge and discovery,” said Editor-in-Chief Drazen. “We’ve gone to countries such as China, India, Ecuador, and Zambia to help people who are starting research programs, or seeking to be published, understand how it’s done.” The outreach is by no means an indication that NEJM lacks submissions. The odds of having an article accepted by NEJM are about the same as getting into Harvard: of the approximately 5,000 research manuscripts sent in each year, only 5 percent are published. Vital Signs is published monthly, with combined issues for June/July/ August and December/January, by the Massachusetts Medical Society, 860 Winter Street, Waltham, MA 02451-1411. Circulation: controlled to MMS members. Address changes to MMS Dept. of Membership Services. Editorial correspondence to MMS Dept. of Communications. Telephone: (781) 434-7110; toll-free outside M assachusetts: (800) 3222303; fax: (781) 642-0976; email: [email protected]. Vital Signs lists external websites for information only. The MMS is not responsible for their content and does not recommend, endorse, or sponsor any product, service, advice, or point of view that may be offered. The MMS expressly disclaims any representations as to the accuracy or suitability for any purpose of the websites’ content. ©2011 Massachusetts Medical Society. All Rights Reserved. www.massmed.org your practice Medicare Revalidation Update: Have You Received a Notice? PPRC PHYSICIAN PRACTICE RESOURCE CENTER medicareprovidersupenroll/11_ revalidations.asp. When you do receive a notification from the CMS, you should take the following steps: • Complete and submit either Since September of this year, the Centers for Medicare and Medicaid Services (CMS) has sent more than 89,000 letters to physicians, non-physician practitioners, and facilities requesting that they revalidate their Medicare enrollment records. The health system reform law states that by March 23, 2013, no physician or other health professional can be enrolled or re-enrolled in Medicare without going through the re validation process. This new standard of screening was designed to prevent fraud in the Medicare system. Just recently, the CMS responded to pressure from physician organizations, including the American Medical Association, and extended the deadline to re-enroll by two years to 2015. However, the extension does not apply to physicians who have already received a revalidation notice. Failure to meet the timeframe designated in the letter of notification will cause a deactivation of your record. If you are not sure if you have received a revalidation notice, you can reference the list the CMS compiled by visiting www.cms.gov/ a paper or online enrollment application within 60 days of notification • Mail a signed certification letter to the contractor within 15 days of submitting an online application. Physicians, nonphysician practitioners and physician group practices are exempt from paying an application fee. • Provider or suppliers using the 855 paper enrollment application will now submit a $505 application fee electronically at https://pecos.cms.hhs.gov/pecos/ feePaymentWelcome.do. Providers and suppliers are strongly encouraged to submit with their application a copy of their receipt of payment. • The CMS has determined that Internet-based PECOS online users can complete their applications and, if necessary, pay the fee without leaving the system. Once the payment transaction is completed, users are automatically returned to the PECOS website to complete the remaining part of the application. VS – Talia Goldsmith For more information on Medicare’s revalidation process, please visit www.cms.gov/medicareprovidersupenroll. For assistance with revalidation, please contact the NHIC Provider Enrollment Help Line at (888) 300-9612. Accountable Care Organizations: One Option for Innovation The highly anticipated October 20 Centers for Medicare and Medicaid Services (CMS) final ruling on the Shared Savings Program spurred a vigorous discussion among physicians, hospitals, and administrators regarding the strategic benefits of joining an accountable care organization (ACO). Many question whether or not the financial return justifies the effort and investment. While there is no easy answer to this question, it is important to note that the Shared Savings Program represents a unique opportunity for enhancing collaborative efforts among stakeholders in the health delivery system. The Shared Savings Program is one of many innovative programs the CMS is investigating through the Center for Medicare and Medicaid Innovation Center (CMMI). If participation in the Shared Savings Program isn’t right for your practice but you have an interest in getting involved, other options exist, such as the CMMI programs that follow: • ACO Advanced Payment odel — This program allows M eligible organizations to www.massmed.org receive an advance on the shared savings they expect to earn in order to help defray the investment necessary to engage in an ACO model. • Pioneer ACO Model — With this program, providers who are already experienced with coordinated care delivery models can test new and innovative payment models. in predetermined regions of the country. • Federally Qualified Health Center Advanced Primary Care Practice Demonstration — This demonstration project seeks to test the patient-centered medical home as a model for improving quality of care, promoting better health, and lowering costs. ACCOUNTABLE CARE SOLUTION CENTER Guiding You Forward • Bundled Payments for Care Improvement — This program is for providers who would like to engage in one of four models, three that involve a retrospective bundled payment arrangement and one that pays prospectively. • Comprehensive Primary Care Initiative — This initiative focuses on breaking through the “historical impasse,” but invites payers to partner with Medicare to invest in primary care • Health Care Innovation Chal- lenge — Medicare is looking to award up to $1 billion to innovative projects across the country that test creative models of delivering high-quality, low-cost health care services. • Innovation Advisors Program — This program seeks to create a network of experts trained, supported, and charged by the CMS to improve the health care delivery system. • Partnership for Patients — This initiative works to engage providers in improving the quality of care available to CMS beneficiaries with the dual goal of preventing patients from getting injured or sicker and helping them heal without complication. • State Demonstrations to Inte- grate Care for Dual Eligible Individuals — This program seeks to partner with states to test new payment and delivery system models for dual-eligible individuals. There are a variety of opportunities to consider if you have an interest in testing out a concept of your own design or one described above. To learn more about these programs, visit www.innovations.cms.gov/initiatives or www.massmed.org/acsc. VS – Kerry Ann Hayon Source: Center for Medicare and Medicaid Innovation Center. What We’re Doing. www.innovations.cms.gov/initiatives (accessed November 14, 2011). Vital Signs december 2011/january 2012 • 3 the public’s health Public Health Impacts of Wood Biomass Combustion MMS Spurs Policy Recommendations On November 7, the MMS hosted a symposium for the Lowell Center for Sustainable Production at UMass Lowell on the public health impacts of wood combustion. A panel of health and science experts presented the current science on wood as a source of heat and power, associated public health impacts, and the opportunities to mitigate those impacts. Participants, including physicians and agency decision makers from the New England states, Pennsylvania, and New York, discussed how to protect the public health in the context of the proliferation of wood combustion units for commercial, industrial, and institutional use. Schools, hospitals, and energy companies are turning to wood biomass as an alternative to more expensive fossil fuels. But, said David Deitz, chair of the MMS Committee on Environmental and Occupational Health who represented the MMS on the symposium’s advisory committee, “The science clearly shows that, like emissions from coal and oil-fired power plants, biomass emissions include particulates and other substances that have pulmonary, cardiovascular, and potentially carcinogenic effects.’’ “This supports the MMS position that these health impacts must be considered as part of any policy decisions to use biomass as part of regional or national energy strategies,” Dr. Deitz added. Since 2009, the MMS has advocated for policies that protect the public from the harmful health effects of emissions from biomass plants. Other organizations collaborating on the symposium included the American Lung Association, the Asthma Regional Council of New England, the New England College of Occupational and Environmental Medicine, the Northeast States for Coordinated Air Use Management, the New York State Energy Research and Development Authority (NYSERDA), and the University of British Columbia. The Heinz Endowments and the NYSERDA provided funding. VS Mass. Physicians Help Ban Tobacco Sales in Pharmacies Nineteen Massachusetts cities and towns have successfully enacted regulations banning the sale of tobacco and related products in health care institutions, including pharmacies. In these communities, retail pharmacies — as well as grocery and retail stores housing pharmacies — are banned from selling tobacco products. Alex White, M.D., president of the Massachusetts Thoracic Society and chief of pulmonary medicine at New England Sinai Medical Center in Stoughton, was instrumental in spearheading the ban in Newton, a city of approximately 80,000 people with 8 pharmacies that formerly sold tobacco. The Thoracic Society had written to some of the large pharmacy chains in Massachusetts asking them to stop selling tobacco products, said Dr. White, but the pharmacies refused. “The pharmacies’ mission is to provide health care to our patients,” said Dr. White. “They should not be taking advantage of that by selling them tobacco products.” Boston and Needham had already enacted bans, so Dr. White went to his hometown of Newton. He asked an alderman there to put the issue on the docket and testified at the meeting to make a case for the ban. Within a few months, the city had enacted the ban. Dr. White encourages physicians to raise awareness of the issue and to become advocates for minimizing or eliminating the sale of tobacco in their own communities. “We need to protect our younger generations and make it more difficult for children to start smoking,” he said. Dr. White provides the following tips for physicians who want to help enact a local pharmacy tobacco sales ban: • Find sympathetic city or town representatives and enlist their support. They know the ropes and how to get things done — whether by a city ordinance or board of health regulation. • Ask other physicians in town to lend their support by contacting local officials before the final vote. • Speak at hearings to highlight the health perspective. You can find resources for physicians on the MMS website to help you enact a similar ban in your own town. The MMS supports local and statewide efforts to ban the sale of tobacco products in health care facilities, including pharmacies. VS For more information, visit www. massmed.org/tobacco. Cities and Towns with Bans on Tobacco Sales in Pharmacies* MunicipalityAffected (Population Establishments Rank) Boston (1) Needham (56) Newton (11) Everett (39) Walpole (79) Lancaster (215) Southboro (107) Oxford (142) Fall River (9) Wakefield (73) Westford (83) Worcester (2) Wellesley (65) Somerville (12) Westwood (134) Chatham (227) Hatfield (269) Lowell (4) New Bedford (6) Brookline (18) Wareham (87) TOTAL 88 4 8 5 5 0 4 3 22 4 3 34 4 10 2 1 0 12 20 8 5 242 Source: Massachusetts Municipal Association *As of 12/2/11 MMS Foundation Supports Medically Underserved As the global recession continues, the MMS and Alliance Charitable Foundation remains committed to supporting medically underserved populations. “Requests for funding continue to grow,” said Vanessa Kenealy, chair of the Foundation’s board of directors. “This economy has made fundraising more difficult, but this pales in comparison to the hardship and adversity many of our fellow citizens have had to face. Job loss, budget cuts, and gas prices have made life more difficult, leaving more people hungry, homeless, and without adequate health care.” Physician-led volunteer initiatives that increase access to care 4 • december 2011/january 2012 Vital Signs for the uninsured and medically underserved remain Foundation priorities. One such program is the Metro West Free Medical Program, which provides health care services to nearly 2,000 un insured or underinsured indivi duals each year. The Society’s Committee on Senior Volunteer Physicians helps the program identify new physician volunteers and assures that malpractice coverage is available to them. “With financial support from the MMS and Alliance Charitable Foundation, we can assure that the volunteer clinicians have the medical supplies, coordination, and access to diagnostic services that they need to provide quality care,’’ said Kim Prendergast, the program’s executive director. VS Foundation Grant Deadline January 15 The Foundation awards grants once each year to area nonprofit organizations. To apply, visit www.mmsfoundation.org and submit a letter of inquiry by January 15, 2012. For more information on the Foundation and its activities or to make a year-end tax-deductible contribution, contact Jennifer Day at (781) 434-7044 or at jday@ mms.org. www.massmed.org government affairs state update No Simple Solution to Cost Crisis, Says House Leader Mariano: Massachusetts Should Do More to Retain Physicians House Majority Leader Ronald Mariano made headlines this fall when he filed a bill proposing Massachusetts health insurers be required to lower rates paid to some of the state’s most expensive hospitals, while boosting rates for the smaller, lowest-paid systems. The bill, which Mariano (DQuincy) said would address the biggest issue driving up health care costs in the state, was one of many cost-containment proposals put forth on Beacon Hill in 2011. He said he expects the debate to intensify in 2012. “It’s certainly not a new issue in Massachusetts, but we’ve really moved it to the forefront of the greater debate,” said Mariano in an interview last month with Vital Signs. Massachusetts has so many providers, insurance carriers, and other stakeholders, “a onesize-fits all solution is not going to work,” said Mariano. “Even the idea of rate-setting is a ‘temporary fix’,” he said. “I’ve never seen it as a long-term solution.” Looming SGR Cuts continued from page 1 our health care system” and said the “Obama Administration is 100 percent committed to fixing the flawed Medicare payment system and protecting Medicare beneficiaries’ access to doctors.” Sebelius called on Congress to continue working on legislation permanently reforming the SGR. “The pattern of threatened SGR cuts and last-minute Congressional rescues is in itself not a sustainable solution and must be remedied,” she said. Last month, the Centers for Medicare and Medicaid Services published its annual Medicare physician payment rule for 2012. Key provisions include: • Sustainable Growth Rate (SGR). Absent congressional action, Medicare physician payments will be cut by 27.4 www.massmed.org House Majority Leader Ronald Mariano “We have to let providers know how they can flourish in this new system. Doctors need to know where they fit in and how they’ll benefit,” he said. Keeping the field of providers and services balanced and informed is an ongoing challenge as accountable care organizations prepare to enter the market. percent on January 1, 2012, instead of 29.5 percent as stated in the proposed rule. • E-prescribing. The CMS final- ized its proposal for the 2012 and 2013 incentive and 2013 and 2014 penalty programs. Despite continued AMA and MMS opposition, participating physicians will need to report 10 times during the first 6 months of 2012 and 2013 to avoid application of e-prescribing penalties in subsequent years. Improvements to the program (CMS) the AMA and MMS supported include allowing the use of a certified electronic health record (EHR) to e-prescribe and making it easier to avoid the penalties by not requiring physicians to link the e-prescribing codes to qualifying visits and allowing physicians to apply for hardship exemptions online. More should be done to prepare the state’s physicians for payment reform, Mariano said. “We have to let providers know how they can flourish in this new system. Doctors need to know where they fit in and how they’ll benefit,” he said. Legislative priorities in the new year should include insuring the viability of community hospitals and smaller providers and reforms aimed at connecting costs to quality of care, said Mariano. More discussion is needed about Medicaid reimbursements to the state and the role Medicaid costs will play in any possible tiered system, he said. In the meantime, as the 2012 presidential race heats up, the national spotlight will shine even brighter on Massachusetts’ approach to health care reform. “We are a national leader and we have to keep moving forward,” said Mariano. He predicted the coming year may bring some intense debates over health care coverage that many • RUC Recommendations. The RUC panel persuaded the CMS that the resources involved in hospital observation care visits and hospital inpatient visits are equivalent. The CMS also accepted 87 percent of the RUC’s 252 recommendations for the 2012 Medicare payment schedule for new and revised codes and those that had been considered potentially misvalued. • Physician Quality Reporting System. In response to AMA advocacy, the CMS finalized its proposal to provide interim feedback reports for physicians reporting individual measures and measure groups through claims-based reporting for 2012 and beyond. These reports will be a simplified version of annual feedback reports the CMS currently provides and will be based Massachusetts residents now take for granted. “We have high expectations of treatment in this state,” he said. “Essential benefits are defined radically differently in Massachusetts than in other places. We may have to change our expectations to some degree to insure everyone can have coverage.” He also said the Legislature must do its part in making Massachusetts an attractive place for physicians to practice medicine, especially for primary care physicians who are in great demand. “We have to do a better job (of retaining doctors),” Mariano said. Convincing young doctors to settle locally after training requires affordable real estate, high-quality public schools, and other cost-of-living issues all industries are struggling with. “We want doctors who come here to study medicine to want to stay here,” he said. VS – Erica Noonan on claims for the first three months of each program year. • Multiple Procedure Cuts. In r esponse to comments from the AMA, the RUC, and many specialties, the CMS scaled back its proposal to apply a 50 percent reduction to the professional component of all but the highest valued code when more than one procedure on a list of 119 imaging services is performed on the same patient on the same day. • Annual Wellness Visit (AWV). The CMS increased the relative values for the AWV codes to recognize additional resources associated with adding a health risk assessment to the service’s requirements. But it is continuing its policy of not covering a physical exam as part of these services. VS Vital Signs december 2011/january 2012 • 5 professional matters Student Conference on Global and Community Health: Building a Life Around Service This full-day conference is designed for medical and dental students in New England interested in global and community health. Workshops, panel discussions, and program speakers will focus on subjects such as finding volunteer opportunities, performing disaster relief both locally and abroad, administering refugee work, conducting research, designing sustainable projects, obtaining funding, and maintaining work/life balance. Speakers will include students, residents, fellows, and seasoned clinicians with a wealth of global and community service experience and interests. Networking will be a major focus of the program. VS For more information about this program, go to www.massmed.org/ globalhealth2012 or email Lisa_[email protected]. Building a Life Around Service January 28, 2012 9:30 a.m. to 4:00 p.m. MMS Headquarters 860 Winter Street, Waltham Sponsored by the Massachusetts Medical Society and its Committee on Global Health physician health matters Medical Record Challenges — A Subtle Sign of a Potentially Impairing Condition? Doctors learn early in their training that one important and unavoidable part of their job is to complete medical records in a timely fashion. As house staff, their paycheck may be withheld for failing to do so; as attending doctors, they may lose admitting privileges. Complete, accurate, and upto-date records are critical to patient care, especially since now adays nearly all records are kept electronically. Complete records are also an integral part of hospital accreditation and are important medical-legal documents. When something so necessary is not getting done, it is prudent to explore what else might be going on. Newly manifested problems could indicate other serious issues: • Depression. The physician may be feeling fatigue or a sense of worthlessness, or just be unable to get much done except the most crucial patient care tasks. • Anxiety. As charts pile up, a physician can become paralyzed by anxiety so that they are unable to even begin work on them. • Stress. Almost any issue can preclude the completion of Essential Facts for International Medical Graduates Resource Booklet The MMS periodically receives calls from international medical graduates (IMGs) who are new to Massachusetts and are struggling with how to initiate the process of obtaining a limited or permanent medical license or gain acceptance into a residency program. IMGs often voice their frustration to the Society about finding accurate and consistent information on these processes. In response, the MMS International Medical Graduates Section Executive Committee developed an informational booklet to serve as a basic reference for IMGs striving toward obtaining medical licensure in Massachusetts. The resource booklet includes logistical information regarding the following issues: • Immigration (including VISA requirements) • Obtaining a limited and/or permanent license • Obtaining a residency appointment • Discrimination The guide also contains a comprehensive resource directory. The second edition of Essential Facts for International Medical Graduates is free to MMS members. If you would like a copy of the booklet, please contact Erin Tally at (800) 322-2303, ext. 7413, or [email protected]. VS 6 • december 2011/january 2012 Vital Signs work. Personal issues such as divorce, illness, financial problems, a malpractice suit, or workplace conflicts can interfere with work. Many doctors are not willing to openly discuss such issues with colleagues. • Medical issues. The physician may be struggling with memory issues such as those caused by early dementia or a condition such as multiple sclerosis, diabetes, or other chronic illness that can diminish strength. To make matters worse, the physician may try to cover it up. • Substance abuse issues. Anoth- er possibility is impairment due to drugs or alcohol or the anxiety that comes with hiding such a problem. • Overwork. During a shift, a physician sees patients, orders tests, and prescribes medication, but often what is left for later is the chart work. If the pace of a practice is ill suited for a physician, lack of record keeping may be the first sign. A physician might be reluctant to admit that they just can’t keep up. Dr. John Wolfe, associate director of PHS, encourages referral to PHS, explaining that “getting behind on medical records is an objective measure of possible trouble.” With the new era of hospitalists, doctors, especially PCPs, are more likely to be isolated, with problems going unnoticed until the problem is larger, he said. Dr. Jacquelyn Starer, PHS Clinical Advisory Committee member, said, “A doctor’s response, behavior, and attitude when approached about medical record completion may be useful in suggesting whether other issues are involved, such as depression, anxiety, substance abuse, personality disorders, or personal circumstances.” Most hospitals and practices have internal mechanisms for addressing incomplete records. When the problem persists, administrators may begin to “confront or sanction” the physician. Often this does not produce results, and it may even make the problem worse. A referral to Physician Health Services, Inc. (PHS) might help sort out the issues. If you or a colleague need assistance, call PHS at (781) 434-7404. For more information, visit the PHS website at www.physicianhealth.org. VS – Judith Eaton, M.D. Bullies and Victims: Can You Tell the Difference? Stories about bullying have become common in the news today. Government statistics show that roughly one-third of middle and high school students report being bullied. Research indicates that bullying can adversely affect children’s mental and physical health as well as their academic success. Patients and families are increasingly turning to their physicians for advice. On January 25, the MMS will host the webinar “Bullies and Victims: Can You Tell the Difference?” to help physicians make informed decisions about how to handle the challenges of caring for a bully or bullying victim, including how to identify victims and bullies and determine which patients are at high risk for being bullied. Bullying is a particular concern for lesbian, gay, bisexual, and transgender youth and those who are questioning their sexual orientation. This webinar will specifically address the special health care needs of these patients. VS Bullies and Victims: Can You Tell the Difference? Wednesday, January 25, 2012 5:30 p.m. (Live Webinar) For more information, call (800) 843 -6356 or visit www.massmed.org. www.massmed.org inside mms Young Physicians Academic Medicine and Life Management Workshop January 21, 2012 • 8:30 a.m. to 2:00 p.m. MMS Headquarters • 860 Winter Street, Waltham As the largest physician advocate in the state, we educate and advocate on behalf of physicians and their patients. Building on the success of two previous professional development programs designed specifically for early career physicians, the Committee on Young Physicians developed a new workshop that will explore career opportunities in academic medicine and work/life balance. The program features a primary track of four sessions that focus on academic medicine and a secondary track of two sessions that focus on life management. • Group discounts up to 30% • Accountable Care Solution Center — consulting and online services • Updates on meaningful use and EHR stimulus funding • All the benefits of regular membership, such as NEJM and more (800) 322-2303, ext. 7311 [email protected] www.massmed.org Across the Commonwealth District News and Events Berkshire — Annual District Meeting. Wed., Mar. 7, 6 p.m. Location: Spice, Pittsfield. Speaker: Lynda Young, M.D., MMS president. For more information, contact the West Central Regional Office. Charles River — Winter/Scientific Meeting. Thurs. Jan. 12, 6 p.m. Guest speaker: John Gallo, Ph.D., director of special projects, Woods Hole Oceanographic Institution. Topic: Neptune’s Garden: A Voyage of Exploration in the Deep Undersea. Location: Wellesley Country Club. For more information, contact the Northeast R egional Office. The primary track will feature experienced presenters in grant writing, conducting clinical research, teaching, and becoming published. The secondary track will focus on successful balance in all areas of a physician’s life, including marriage, family, personal, and professional endeavors. For full program details, including the agenda, session descriptions, speaker information, and online registration, please go to www.massmed.org/careerworkshop2012 or contact Colleen Hennessey at [email protected] or (781) 434-7315. This workshop is sponsored by the Massachusetts Medical Society Committee on Young Physicians and Resident and Fellow Section. VS Link In with the MMS Join the members-only LinkedIn group at www.massmed.org/linkedin. 7 p.m. Location: Max’s Tavern, Basketball Hall of Fame, Springfield. Members: No charge. Nonmembers: $37.50. For more information, contact Suzanne Skibinski at (413) 736-0661 or [email protected]. Middlesex Central — Executive Committee eeting. Thurs., Jan. 19, 7:45 a.m. Location: M Emerson Hospital, Concord. 5th Tuesday Meeting. Tues., Jan. 31, 11:45 a.m. Location: Emerson Hospital, Concord. For more information, contact Carol Marshall at [email protected]. Plymouth — Executive Committee Meeting. Tues., Jan. 31, 6 p.m. Location: Fireside Restaurant, Middleboro. For more information, contact the Southeast Regional Office. Essex South — Membership Meeting. Wed., Feb. 1, 6 p.m. Guest speaker: Jeffrey Drazen, M.D., editor-in-chief, New England Journal of Medicine. Location: Boston Marriott, Peabody. For more information, contact the Northeast Regional Office. Worcester North — Executive Committee Meeting. Tues., Jan. 26, 6 p.m. Location: Sonoma, Princeton. For more information, contact West Central Regional Office. Franklin — Social Event. Thurs., January 26, Statewide News and Events 6 p.m. Location: Magpie, Greenfield. For more information, contact the West Central Regional Office. Hampden — Medical Legal Forum. Topic: Medical/Legal Ramifications of EMR. Tues., Jan. 24, registration 5:30 p.m., dinner 6:30 p.m., program www.massmed.org If you have news for Across the Commonwealth, contact Michele Jussaume, Northeast Regional Office, at (800) 944-5562 or [email protected]; Sheila Kozlowski, Southeast Regional Office, at (800) 322-3301 or skozlowski@ mms.org; or Cathy Salas, West Central Regional Office, at (800) 522-3112 or [email protected]. in memoriam The following deaths of MMS members were reported to the Society in October and November. We also note member deaths on the MMS website at www. massmed.org/memoriam. John F. Burke, M.D., 89; Lexington, MA; Harvard Medical School, 1951; died November 2, 2011. Harriet S. Carey, M.D., 59; Wellesley Hills, MA; New York University School of Medicine, 1979; died May 7, 2011. Edward L. Cashman Jr., M.D., 87; Swampscott, MA; Tufts University School of Medicine, 1949; died September 3, 2011. Sharad R. Chitre, M.D., 75; South Hamilton, MA; Medical College Baroda University, India, 1961; died September 20, 2010. Martin A. Compton, M.D., 97; Bloomington, IL; Washington University School of Medicine, 1937; died August 27, 2011. Ricardo A. Cordon, M.D., 69; Pittsfield, MA; University De San Carlos, Guatemala, 1968; died August 14, 2011. W. Philip Giddings, M.D., 96; Shelburne, VT; Harvard Medical School, 1938; died October 23, 2009. Herbert C. Hagele Jr., M.D., 77; Lynnfield, MA; Creighton University School of Medicine, 1960; died October 30, 2011. Charles P. LeRoyer Jr., M.D., 94; Arlington, MA; Tufts University School of Medicine, 1942; died March 24, 2009. Charles Lieber, M.D., 78; Englewood Cliffs, NJ; Universite Libre De Bruxelles, Belgium, 1955; died March 1, 2009. Gwilym S. Lodwick, M.D., 94; Fort Lauderdale, FL; University of Iowa College of Medicine, 1943; died September 25, 2011. Florentino P. Pina, M.D., 92; Fort Lauderdale, FL; Columbia University College of Physicians and Surgeons, 1946; died October 25, 2011. Warwick Potter Jr., M.D., 82; Wellesley, MA; Yale University School of Medicine, 1953; died August 5, 2009. Edmund P. Quinn, M.D., 93; Hanover, MA; Tufts University School of Medicine, 1943; died November 16, 2010. Edwin W. Salzman, M.D., 82; Cambridge, MA; Washington University School of Medicine, 1953; died October 3, 2011. Benjamin Spelfogel, M.D., 95; Newton, MA; Middlesex University School of Medicine, 1941; died August 11, 2010. David D. Swenson, M.D., 76; Danvers, MA; Harvard Medical School, 1963; died July 28, 2011. Elton R. Yasuna, M.D., 96; Harwich Port, MA; New York University School of Medicine, 1938; died October 18, 2011. Vital Signs december 2011/january 2012 • 7 The Secret Sauce Population Health as a Recipe for Transforming Health care SAVE THE DATE! inside ▶ NEJM Celebrates 200 Years Page 1 ▶ No “Simple Solution” to Cost Crisis Page 5 ▶ Poor Record Keeping Page 6 2012 MMS Annual Meeting — May 17 to 19 MMS Headquarters, Waltham, and the Seaport Hotel, Boston Thursday, May 17 • House of Delegates Opening Session • Ethics Forum • NEJM 200th Anniversary Celebration Reception • IMG Annual Reception Friday, May 18 • Annual Education Program • Shattuck Luncheon & Lecture • Presidential Reception & Member Art Exhibit/Silent Auction • Presidential Inauguration volume 17, issue 1, dec. 2011/jan. 2012 860 Winter Street, Waltham, MA 02451-1411 Nonprofit U.S. postage paid boston, ma permit 59673 & Awards Dinner Saturday, May 19 • House of Delegates Second Session • Alliance Annual Meeting & Fashion Show • Annual Meeting of the Society Luncheon MMS Sponsored and Jointly Sponsored CME Activities Live CME Activities Go to www.massmed.org/cme/events or call (800) 8436356. Unless otherwise noted, event location is MMS headquarters, 860 Winter Street, Waltham. Medical Legal Ramifications of EMR, jointly sponsored by the MMS and the Hampden District Medical Society, will be held on Tuesday, January 24, 2012, from 7:00–9:00 p.m. in Springfield, MA. 7th Annual Women’s Cardiac Health Conference: Medical Management of Heart Disease, sponsored by the MMS and its Committee on Women in Medicine in collaboration with the American Heart Association, will be held on Friday, February, 3, 2012, from 8:00 a.m.–12:30 p.m. Massachusetts Medical Society’s 2012 Leadership Institute — Changing Paradigms in Healthcare: What Does the Future Hold?, sponsored by the MMS, will be held on Wednesday, February 1, 2012, from 8:00 a.m.–2:00 p.m. Seating is limited. To register for any of these activities, call (800) 843-6356. CME CREDIT: These activities have been approved for AMA PRA Category 1 Credit™. SAVE THE DATE Webinar — Bullies and Victims: Can You Tell the Difference? sponsored by the MMS and its Committees on Violence Intervention and Prevention, Medical Education, LGBT Matters, and Student Health and Sports Medicine, will be held on Wednesday, January 25, 2012, from 5:30–6:30 p.m. ONLINE CME ACTIVITIES Go to www.massmed.org/cme. Massachusetts Medical Law Report Risk Management CME Series •Seven Steps to Better Health •Literacy with Diverse Patients* •Medical Mistakes: Learning to Steer Clear of the Common Ones* •Managing Risk When Prescribing Narcotic Painkillers for Patients* •Protecting Your Patients’ Data* •The Importance of Discussing End-of-Life Care with Patients* •A Primer for Accountable Care Organizations* •Avoiding Failure to Diagnose Suits •Getting It on Record and Getting It Right For additional information, contact the Department of Continuing Education and Certification at (800) 322-2303, ext. 7306, or go to www.massmed.org/cmecenter. •Physician Practices Scramble to Comply with New Privacy Reg. •Dealing with the Changing Dynamic of the Medical Staff •Health Providers Facing Stiff HIPAA Regulations •Health Care Providers Brace for Medicare Audits •Social Networking 101 for Physicians *Also available in print. Call (800) 322-2303, ext. 7306. Public Health Risk Management CME Series •MA Responds Orientation Course •Violence — Implications for Health The Legal Advisor Risk Management CME Series •Terminating the Doctor-Patient Relationship •Mandated Reporting •Limited English •Advance Directives •Boundary Issues in the Physician-Patient Relationship Risk Management massmed.org/cme 100% Relevant Content