Update: AMA Seeks Physician Input on Sunshine Act Portal

Posted in Uncategorized on August 19th, 2014 by Erica Noonan – Be the first to comment

The AMA has extended its deadline until noon on Friday, August 22, for physicians to share their experiences with CMS’ Sunshine Act Open Payments system while trying to register.

The responses will help strengthen AMA’s advocacy on this topic.     calendar_icon

Go to the survey here, or email your comments to OpenPayments@ama-assn.org.

The portal reopened last week after glitches and reports of errors earlier in the month.

CMS still plans to open the system to the general public on Sept. 30, but that the deadline for physician registrations has been extended to Sept. 8.

We’ll keep you updated on any changes to that schedule.

Sunshine Act Portal Reopens for Registration

Posted in sunshine act on August 15th, 2014 by MMS – Be the first to comment

The Centers for Medicare and Medicaid Services says that the physician portal for the Sunshine Act’s Open Payments system has now reopened, and is now accepting registrations.

The portal was shut down for more than a week following reports of significant errors with physician data, and the extreme difficulty some physicians were having when trying to register.

CMS’ last comment was that it still plans to open the system to the general public on Sept. 30, but that the deadline for physician registrations has been extended to Sept. 8. We’ll keep you updated on any changes to that schedule.

Important Note

The AMA is asking physicians to take a brief online survey to report their experiences while trying to register. The responses will help strengthen AMA’s advocacy on this topic.

Go to the survey here, or email your comments to OpenPayments@ama-assn.org. The deadline for responding to the survey is Monday, Aug. 18.

 

With Portal Plagued by Problems, AMA, MMS and Others Urge Sunshine Act Delay

Posted in Pharmaceutical Industry, Regulation, sunshine act on August 5th, 2014 by MMS – Be the first to comment

penThe American Medical Association, Massachusetts Medical Society, and 110 other state and specialty medical societies today asked the federal government to delay the public release of information about payments and other transfers of value to physicians from the pharmaceutical and medical device industries.

In a joint letter to Marilyn Tavenner (.pdf), administrator of the Centers for Medicare and Medicaid Services, the groups said that because of an “overly complex” registration process and a condensed time frame, it is “effectively impossible” for physicians to review and dispute reports by the August 27, 2014 deadline.

The reports are scheduled to be released to the public by Sept. 30, 2014. The letter recommends a release date of March 31, 2015. “This process must be streamlined and physicians must be given adequate time to review and dispute their reports,” the letter states.

The reports are mandated by the Physician Payments Sunshine Act, which was enacted in 2010. The report this year will cover activities from Aug. 1 to Dec. 31, 2013.

The joint letter also asked the CMS to:

  • Explicitly direct industry manufacturers to label as “disputed” any unresolved disputes between physicians and industry, even after the physician’s appeal is rejected by the manufacturer. CMS has no plans to mediate physician-industry disputes, even though physicians are already reporting significant errors in the data.
  • Exempt manufacturers from reporting about funding for continuing education activities when the manufacturer does not know the name of program faculty and other participants before the event. Current regulations require reports if industry learns of the identities before or after the event. “Our organizations are concerned that this would have a significant chilling impact on CE [continuing education], which runs contrary to the public interest,” the letter states.
  • Exempt medical textbooks, journal article supplements and reprints from public reporting. The letter states that these publications “represent the gold standard in evidence-based medical knowledge and provide a direct benefit to patients.”

ABIM Responds to Certification Change Concerns

Posted in MOC on August 4th, 2014 by Erica Noonan – Be the first to comment

Earlier this week, the American Board of Internal Medicine  issued a     written response to all internal medicine physicians, addressing concerns   about recent changes to Maintenance of Certification, or MOC, requirements.

ABIM acknowledged “a palpable level of anger among internists and internal medicine subspecialists” and said it plans to alter some of its policies and processes, as well as its requirements.

Read more on the NEJM Knowledge + blog.

 

August Physician Focus: Advance Care Planning

Posted in End of Life Care, Palliative Care, Physician Focus, Uncategorized on July 31st, 2014 by MMS Communications – Be the first to comment

Physicians are increasingly recognizing the importance of advance care planning – preparation for the end-of-life -  and as the subject gains more public attention, more patients are being motivated to talk about the issues.

The August edition of Physician Focus shares the physician’s perspective on this topic with two members of the Massachusetts Medical Society’s Committee on Geriatric Medicine.

Eric Reines, M.D., (photo, center) a geriatrician with Element Care in Lynn and chair of the committee, and Beth Warner, D.O., (right) a consultant geriatrician with Cooley Dickinson Health Care in Northampton and committee member, join host and primary care physician Bruce Karlin, M.D. (left) to discuss the basics of advance care planning.

Among the topics of conversation are the importance and advantages of planning, when it should begin, how to start the process, and the physician’s role in the process. Healthcare proxies, medical orders for life-sustaining treatment, and hospice and palliative care are also included in the discussion.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org,  and on YouTube.

The President’s Podium: Tracking Prescription Drug Abuse

Posted in Department of Public Health, Drug Abuse, opioids, Public Health on July 17th, 2014 by MMS Communications – Comments Off

By Richard S. Pieters, M.D., President, Massachusetts Medical Society

The Centers for Disease Control’s just-released state-by-state report on opiate abuse has cast a bright new light on this serious and potentially deadly problem.

Saying that an “increase in painkiller prescribing is a key driver of the increase in prescription overdoses,” CDC noted that prescribers wrote 259 million prescriptions for painkillers in 2012, and that 46 people die from prescription overdoses every day. That prompted CDC Director Dr. Tom Frieden to capture the paradox: “All too often, and in far too many communities, the treatment is becoming the problem.”

Massachusetts ranked in the top 10 in prescribing long-lasting painkillers, but 41st in overall prescribing of opioids.  Rankings, however, are only a reference point, as volume itself is insufficient to indicate whether overprescribing or under prescribing is occurring.  And rankings matter little when counting the human toll: in Massachusetts alone, 688 residents died from opiate overdoses in 2012, and more than 200 additional lives have been lost since November 2013, according to the Massachusetts Department of Public Health (DPH).

Multiple responses are under way in the Commonwealth: The Governor has formed an Opioid Task Force, the legislature has filed bills, DPH launched Opioid Overdose Education and Naloxone Distribution Program, and police and fire departments are now carrying naloxone.

Regionally, five New England governors agreed to collaborate, and nationally, the U.S. Senate has announced the formation of a Prescription Drug Abuse Working Group.

Physicians are adding their voices as well. MMS immediate past president Dr. Ronald Dunlap offered his perspective in April, and American Medical Association President Dr. Robert M. Wah, following the New England governors’ announcement in June, shared a five-point proposal to combat prescription drug abuse.

The CDC is focusing attention on overprescribing by healthcare providers, and while others continue to see physicians as part of the problem, thefts from pharmacies and diversion from families and friends remain major contributors to the problem, as is the influx of heroin into Massachusetts and New England.

A critical need in responding to this crisis is getting better data. We should know the sources of the drugs – how many come from prescriptions, how many from thefts, how many are diverted from home medicine cabinets – to develop responses.

Better data is available through the state’s Prescription Monitoring Program (PMP), a program MMS helped to establish more than 20 years ago.  It’s one of the best tools we have to track prescription use, and one CDC urges all states to use.  The experiences of New York and Tennessee are testimony to the effectiveness of such programs.

In Massachusetts, however, the program has yet to fulfill its promise.

A well-run PMP has four purposes: (1) identifying patients who get schedule II and III prescriptions from multiple doctors; (2) identifying prescribers who inappropriately write many prescriptions or write prescriptions for high dosages; (3) providing a clinical review of those patients and prescribers, to determine what interventions might be necessary; and (4) facilitating research in discovering trends, practices, and problems.

To achieve the program’s full benefit, two things must occur: (1) the PMP must allow all prescribers and dispensers access to up-to-the-minute data on individual patients, and (2) the state must reform its structure to devote resources to the clinical analysis of data and to streamline outreach to providers.

Further, a re-energized medical review board, created as part of the original PMP but subsequently reduced in its role, will give an added boost to the effort.  The board can determine patterns of abuse, propose needed interventions, and should be charged with responsibility for referral of such activity to licensing boards or law enforcement authorities.

For the individual clinician, the monitoring program should be a tool seamlessly incorporated into clinical decision making, but it should never impede appropriate patient care.  One of the most difficult tasks for physicians in patient care is balancing the alleviation of pain and the risks of addiction, and we must recognize that patients who experience severe pain will always require treatment and should be able to get relief.

An improved PMP, with real-time data, with all prescribers participating, and with accurate and timely data analysis, should be regarded as the cornerstone of our collective efforts to address prescription drug abuse.  It’s time for that to happen, and physicians stand ready to help.

Addiction is a major public health problem that needs prevention and treatment. Prevention requires the use of all pain management tools, including such methods as physical therapy and acupuncture. We should use the PMP as a starting point to engage other stakeholders to develop a comprehensive strategy for chronic pain management, with the hope of less need for opioids and thus less addiction. Such actions should also lead to more compassionate and enlightened treatment of addiction.

The President’s Podium appears periodically on the MMS Blog, offering Dr. Pieters’ commentary on a range of issues in health and medicine. 

 

Beware of Insurers’ Shift to Credit Card Payments

Posted in practice management on July 10th, 2014 by MMS – Comments Off

Credit cardSome health plans have been issuing physician practices consumer credit cards or virtual credit cards as payment for their services instead of depositing funds directly to bank accounts. According to the AMA, this relatively new trend can cut physician pay by as much as 5 percent after transaction fees.

What can practices do?

If a practice receives a virtual credit card payment, the practice can call the payer and ask them to remit payment through a more traditional mechanism. Practices can demand that payers issue payments via EFTs deposited directly into their bank account. Other suggestions for practices include:

  • Review and evaluate payer contracts to determine whether your practice is required to accept credit cards as a method of payment.
  • Understand merchant card agreements and associated fees if your practice decides to accept credit cards. You also may want to ask if payers are using credit card reward programs that give cash back.
  • Request payment using the health care EFT standard known as ACH CCD+. This transaction, approved by the Health Insurance Portability and Accountability Act, is less costly to payees than credit card transactions.

More information

Physician Focus for July: Boards of Health

Posted in Health, Physician Focus, Public Health on July 1st, 2014 by MMS Communications – Comments Off

In 1799, Paul Revere was appointed chairman of the Commonwealth’s first Board of Health in Boston and was given broad authority to control deadly epidemics and environmental contamination. More than 200 years later, today’s health boards, while charged with many more responsibilities, have much the same purpose: to provide for the public’s health and safety.  They have been given the obligation and authority by the state legislature to protect the public health and welfare, similar to powers given to local police and fire departments.

The July episode of Physician Focus examines how public health efforts are conducted at the community level with senior executives of the Massachusetts Association of Health Boards (MAHB).  The program discusses the responsibilities of the boards, their enforcement powers, how they’re managed and operated, the challenges they face in performing their duties, how they balance individual rights and behaviors while maintaining standards of health and safety for the entire community, and how they relate to other local and state agencies.

Guests are Christopher Quinn, M.D. (photo, center) and Ms. Cheryl Sbarra (right).  Dr. Quinn is Director of Occupational Health Services at Sturdy Memorial Hospital in Attleboro, Mass., a physician with the Attleboro Health Department, and President of MAHB. Ms. Sbarra is the staff attorney for MAHB and provides legal consultation, policy guidance and technical assistance to boards of health and municipal governments throughout the Commonwealth.  Hosting this edition is B. Dale Magee, M.D. (left), MMS past president.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org and on YouTube. 

Physician-Experts on Medical Marijuana: Not a First-Line Therapy

Posted in Medical Marijuana on June 20th, 2014 by Erica Noonan – Comments Off

More than 100 physicians gathered recently at MMS headquarters to take part in a history-making discussion about what the legalization of medical marijuana in the Commonwealth means to them as healthcare providers.

Throughout the half-day CME event, Medical Marijuana: Regulations, Responsibilities, and Communication, physician panelists presented various clinical scenarios in which marijuana certification could be considered. One of the experts, Alan Ehrlich, MD, an assistant professor of family medicine at University of Massachusetts Medical School, polled the audience about whether they’d certify patients in given circumstances. Though physicians’ opinions varied as to how they’d approach each circumstance, two consistent themes emerged.

Medical Marijuana is Not  a First-Line Therapy

 “Marijuana does not fix MS,” emphasized Ehrlich. “Make sure they’re getting treated for the underlying disease.” Multiple sclerosis is not the only qualifying condition in which this notion applies. Whether a patient is suffering from cancer, glaucoma, ALS, MS, or chronic pain, physicians must determine whether patients are undergoing treatments to manage their disease before turning to marijuana to help manage symptoms of their disease, or in some cases side effects of other treatments.

When it comes to marijuana several panelists noted, people often hold biases at extreme ends of a spectrum: that it’s either completely harmless or a drug that sends users on the road to ruin.

Neither of those absolutes hold true, but there are real risks to certain patients that physicians need to take into account, according to Kevin P. Hill, MD, MHS, director of Substance Abuse Consultation Service, Division of Alcohol and Drug Abuse at McLean Hospital and an assistant professor of Psychiatry at Harvard Medical School.

For example, an estimated nine  percent of adults who use marijuana become addicted, which translates to about 2.7 million people out of current users. In addition, patients predisposed to mental-health problems may be prone to marijuana use triggering a worsening of those issues.

MDs Must Consider the Context and “Whole” Patient

Ultimately, the question isn’t whether marijuana use is risky, noted Ehrlich, but how dangerous it may be when compared to other risks, such as a patient not being able to stick with therapy due to intolerable side effects. Alternatively, if a patient drives for a living and has a condition that would call for using marijuana during the day, the relative risks increase.

As with recommending any treatment for patients, physicians have to look at it in the full context of patients’ lives, noted Riley M. Bove, MD, a neurologist with Partners Multiple Sclerosis Center at Brigham and Women’s Hospital. “We always have to look at the patient as a whole person,” she said.

 –Debra Beaulieu-Volk

Links to videos:

 

Alan Ehrlich, MD, assistant professor of family medicine at the University of Massachusetts Medical School, discusses the evidence of the efficacy and harms of medical marijuana.

 

Kevin P. Hill, MD, MHS, director of the Substance Abuse Consultation Service at McLean Hospital in Belmont, Mass., discusses substance abuse, addiction, and other adverse effects of marijuana.

 

Riley M. Bove, MD, neurologist and faculty member of the Partners Multiple Sclerosis Center, discusses the evidence regarding the use of marijuana for patients with multiple sclerosis.

See all videos and slide slows from the half-day MMS CME event, Medical Marijuana: Regulations, Responsibilities, and Communication

 

AMA President: A Prescription for Opiate Abuse

Posted in Drug Abuse, opioids, Public Health, Uncategorized on June 20th, 2014 by MMS Communications – Comments Off

Attention and activity directed at the persistent problem of opiate abuse are continuing to increase in the Commonwealth, as policymakers, regulators, legislators, and public health officials propose solutions and programs to address the epidemic.

The latest effort is a collaboration of five New England Governors, who announced on June 17 a unique agreement to work together across state borders to address the problem of opiate abuse, focusing on the monitoring of prescriptions and increasing addiction treatment.

The agreement prompted a thoughtful piece from American Medical Association President Robert M. Wah, M.D. Published online in The Boston Globe on June 18,  Dr. Wah offered a five-point prescription to fight prescription drug abuse, emphasizing treatment and prevention.

The piece adds to the perspective of Massachusetts physicians, previously expressed by MMS Immediate Past President Ronald Dunlap, M.D.  in April in newspapers across the Commonwealth.

Most important, Dr. Wah’s commentary raises the physician’s voice on a critical national issue, offers the assistance of the nation’s leading physician organization in working with governors and legislatures to reduce prescription drug abuse, and demonstrates that physicians seek to be part of the solution.