Announcing “What Works For Me” – An Opportunity to Share, and Learn

Posted in Physician Health on April 18th, 2014 by MMS – Be the first to comment

Steven Adelman, MDBy Steve Adelman, MD

I believe that it is essential for health care professionals to balance the stresses and demands of medical practice with enlivening passions, absorbing pastimes, and effective self-care strategies.

Over the past year, I have spoken with more than a thousand Massachusetts physicians about the everyday challenges of practicing medicine in 2014.  The good news is that many busy doctors have developed passions, pastimes and coping strategies that sustain us and help us to maintain an even keel, even when the weather is stormy.

To that end, Dr. Eddie Phillips, a dynamic leader in the important emerging field of lifestyle medicine, and I have created a community blog, WhatWorks4Me.org to showcase and share personal and professional “best practices.”

What works for you? What do you do at home, at work, and in the community, to keep your personal batteries fully charged? What personal and professional practices keep you engaged and excited, when you are “on duty” and when you are “off duty?”

Our first two posts come from Dr. Jeremy Lazarus, immediate past president of the AMA, and Dr. Mary Ann Rose, a radiation oncologist and equestrian who hails from California.

If you’re interested in contributing to this community, please click here to submit a 300-600 word account of what works for you. Try to dig beneath the surface a bit and reveal the “why” behind your passion. Consider including a patient anecdote (disguised and de-identified) to make your story come alive. Do patients know what works for you? How have they reacted? We review and acknowledge every submission, and we will post those that promise to inspire other health care professionals.

We invite you to stop on by, and hope that you will submit a firsthand account of what works for you.

Steve Adelman, MD, is a psychiatrist and director of Physician Health Services, a corporation of the Massachusetts Medical Society.

Income Tax Scam Is Targeting Some Physicians

Posted in taxes on April 16th, 2014 by MMS – Be the first to comment

Form 1040

Several state medical societies in New England have received reports about an income tax scam directed at physicians. According to the reports, someone is filing fraudulent federal income tax returns using physician names, addresses and Social Security numbers.

To date, we have not received reports of any Massachusetts physicians being targeted. However, this appears to be a national problem, since it has impacted physicians in Maine, Vermont, New Hampshire, Indiana, South Dakota, Iowa, North Carolina and Puerto Rico. (Update 4/18/14 @ 4:30 p.m. - After this notice was posted, some Massachusetts physicians told us that they suspect they were also targeted.)

The IRS has not issued an alert. Rather, the majority of affected physicians are first becoming aware of it when they receive an IRS 5071C letter advising them of possible fraud.

Other physicians are receiving a rejection notification when attempting to electronically file their taxes. It indicates the return cannot be submitted because a return has already been filed under that Social Security number. At least one physician learned of the fraud when he received a large tax refund check before filing a tax return.

Next Steps – Act Quickly

Internal Revenue Service: If you are a victim of this scam, you’ll receive a IRS 5071C letter. It instructs you how to contact the IRS through its identity theft website or by phone at (800) 830-5084, so you can inform officials know you did not file the return referenced in their letter.

If you are a victim, you may not be able to electronically file your return this year since a return with your Social Security number has already been filed. You’ll need to file a paper return and attach an IRS 14039 Identity Theft Affidavit to describe what happened.  Attach copies of any notices you received from the IRS, like the 5071C letter. Be sure to let your tax preparer know if this happens to you. Verify with the IRS and your tax preparer where to mail your paper tax return, based on the type of return you are filing and your geographic area.

If you have not received a notification from the IRS but believe your personal information may have been used fraudulently or are concerned about whether you may have been victimized, call the IRS Identity Protection Specialized Unit at (800) 908-4490. Find more information from the IRS, including forms, at the IRS website.

Federal Trade Commission complaint: File a complaint with the FTC here. This not only helps the FTC identify patterns of abuse, but the printed version becomes your Identity Theft Affidavit. Along with a police report, that affidavit becomes your Identity Theft Report, which you will need. The FTC recommends other immediate steps and provides helpful information here.

Police report: Consider filing a report with the local police where you reside. Bring all documentation available, including the state and federal complaints you filed. This will likely be necessary if there is financial account fraud as a result of the identity theft. However, if the only fraud is tax fraud, the police report will be necessary only if requested by the IRS.

Social Security: Call the Social Security Administration’s fraud hotline at (800) 269-0271 to report fraudulent use of your Social Security number. In case your number is being used for fraudulent employment, you can also request your Personal Earnings and Benefit Estimates Statement here or call (800) 772-1213. Check it for accuracy.

MMS: Medical society executives around the country are monitoring the situation. If you have been victimized by this tax scheme, contact the MMS so we can convey the scope of the situation to the proper authorities. Contact Charles T. Alagero, MMS General Counsel, at calagero@mms.org.

We acknowledge the generosity of our colleagues at state medical societies throughout New England for their help in developing this message.

 

Opiate Abuse: The Physician’s Perspective

Posted in Drug Abuse, opioids on April 10th, 2014 by MMS – 1 Comment

DSC_0003 Dunlap 4x6 color 300 ppi_editedBy Ronald W. Dunlap, M.D.
President, Massachusetts Medical Society

Across Massachusetts, lives are being wasted. State Police have recorded nearly 200 deaths from drug overdoses since November, but the actual number could be even higher, as figures from the largest three cities – Boston, Worcester, and Springfield – are not included in the totals.

The Commonwealth is not alone. The Centers for Disease Control states that death from drug overdose is now the leading cause of injury-related death in the U.S. While drugs like heroin remain a prime cause of such deaths, CDC’s most recent figures show that most – 60 percent – of the more than 38,000 annual drug overdose deaths in the U.S. are related to pharmaceuticals. And of those, 75 percent involved opioids or prescription painkillers.

Thus Governor Patrick’s declaration last month of a public health emergency regarding heroin and opioid addiction was appropriate and welcome.  Physicians share the Governor’s concern and support his goal of reducing opiate abuse.

His directive that first responders carry Naloxone is something we have long supported.  The $20 million commitment for treatment is a good initial response to increase help for addicts. His focus on youth is desirable, with teen prescription drug abuse jumping 33 percent since 2008 according to the Partnership at Drugfree.org.

His ban on a new form of hydrocodone should be the subject of legitimate discussion about its use and potential impact in clinical practice and its addiction potential. A balance must be achieved so that patients can truly benefit from its ability to control chronic pain. Opioids are important therapies to treat acute pain after trauma or surgery, as well as to manage chronic pain, including end-of-life care.

Those who follow the drug abuse issue point to physicians as part of the problem. We write too many prescriptions, they say, and are too quick to fulfill patient requests for painkillers. Balancing pain management and potential overprescribing is an area of constant physician concern.  The treatment of pain is complex and individualized for each patient, and the addictive potential of any medicine that could be harmful gives any caring physician pause. And while some physicians have been found to prescribe painkillers for financial gain, these outliers represent a tiny portion of the physician population and should rightfully pay the consequences for violating ethical and clinical standards.

Physicians are not standing on the sidelines. We have had multiple discussions about solutions to the problem with legislators, patient advocates, and other professionals that prescribe pain medications, as well as with representatives of the Department of Public Health and the Board of Registration in Medicine.

Twenty years ago, the Massachusetts Medical Society helped to establish the Prescription Monitoring Program. We have consistently provided input into the program. It remains the best tool we have to combat prescription drug abuse. An accurate and accessible database can provide data on all prescriptions, including prescriber, dispenser, and patient usage. It can alert regulators to physicians who might be overprescribing or patients who might be “doctor shopping” for controlled substances.

We support the automatic enrollment of all prescribers and dispensers and call on them to participate fully in the program.  We also believe improvements to the program, such as establishing real-time information and integrating the program into electronic health records, will enhance monitoring and reduce diversion of drugs.

Other actions should also be considered. As the respected CommonWealth Magazine has noted, no hard data exists on the state’s opiate problem. We need better and updated information. We must learn more about the source of these drugs:  How many are stolen, taken from home medicine cabinets, obtained illegally from street dealers or out-of-state sources, or bought on the internet? Answers to these questions will help target preventive efforts.

Pharmaceutical companies must play a role in assessing any discrepancies between the manufactured supply of medicines and actual patient demand, as their market studies usually include these estimates.

Drug take-back or return measures can be expanded. The Medical Society, for example, has advocated for legislation requiring pharmacies to have a “take back and disposal” policy for unused and expired medications.

We must also recognize the patient’s role. In the final analysis, the drugs are in the patient’s hands, and responsible use, storage, and disposal are absolutely critical. More patient education is a must.

Prescription medications are some of medicine’s best therapies, and yet they’ve become the root of one of today’s biggest public health problems. The Governor’s declaration has properly elevated opiate abuse to a public health priority; his call to action should represent just the beginning of a sustained analysis and long-term effort for solutions.

This article appeared as a commentary in several Massachusetts newspapers this week.

MMS 2014 Public Health Leadership Forum: The Impact of Health Care Reform on Health Care Disparities

Posted in Health Reform, Payment Reform on April 7th, 2014 by Erica Noonan – Be the first to comment

The key to lessening health care disparities lies in better data collection, pay-for-performance systems that properly measure and reward improvement, and technology that engages patients in their own treatments, according to according to a panel of experts featured at the 2014 MMS Public Health Leadership Forum.

The presentation, “The Impact of Health Care Reform on Health Care Disparities,” was hosted by MMS April 4 in collaboration with the national Commission to End Health Care Disparities.

As one of the first states to pioneer universal health coverage, the nation is looking to Massachusetts for ideas and solutions as this year’s implementation of the Affordable Care Act is expected to bring millions of previously uninsured patients into doctors’ offices, said MMS President Ronald Dunlap.

Massachusetts has lower-than-average rates of disparities in key health areas such as infant mortality, hypertension, obesity and adult diabetes.  But access to primary care physicians in certain regions of the state remains a problem, as do Medicaid payment models that dis-incentivize physicians, said Dr. Dunlap.

Dr. Joel Weissman

Joel Weissman, PhD

Can Pay-for-Performance Create Equity?

Among the most promising tools for bridging the gaps are new payment models that measure and reward reductions in disparities, said Joel Weissman, PhD, Deputy Director and Chief Scientific Officer Center for Surgery and Public Health at Brigham and Women’s Hospital.  “No information means no improvement,” he said.

But most current pay-for-performance models are not effectively addressing disparities and creating incentives that could reduce them.  “Not only do we need to know more about measures that are “disparities-sensitive”, but how to select measures that are ready to have an impact on clinical practice, and how to represent differences in a statistically meaningful and policy-relevant way,” Weissman said.

Dr. John Moore

John Moore, MD

Patient Empowerment Through Technology

Grassroots approaches to health, including personalized patient engagement and “navigators,” who help patents cut through red tape to get social services are already helping reduce disparities in some areas.

John Moore, M.D., CEO and co-founder of Twine Health, said the new health models must also include the patient as “an active participant.”  The old-fashioned paternalistic doctor-patient relationship is fading away, he said. Patients of the future will set their own health care goals and meet them using technology and peer support.

The approach has already worked, he said, citing his study published in 2013 in the Journal of Clinical Outcomes Management that found hypertension controlled in a group of patients for less than 30 percent of the average annual Medicare cost for the same outcome.

Sonia Sarkar

Sonia Sarkar, MPH

Making Physician Advice Actionable in the Moment

Another effective disparities-reducing program has been Boston-based Health Leads, which connects patients to advisors who will coordinate the nitty-gritty details of social services and enter the information on a patient’s EMR for physicians to track and follow-up, said Sonia Sarkar, the company’s chief of staff to the CEO.

The program has partnered with major medical centers in Boston, Providence, Baltimore, Chicago, New York and Washington D.C. and helps them close disparity gaps for patients without resources to get or remain healthy. Connecting patients at risk of disparities to needed food, heat, child care, transportation or other services makes “the doctor’s advice actionable in the moment,” Sarkar said.  “It insures health care delivery is centered around health.”

See the full forum agenda and download the presentations here.

–Erica Noonan

Why Your Windows XP Computer Could Become a HIPAA Security Risk

Posted in Health IT, HIPAA, practice management on April 3rd, 2014 by MMS – 1 Comment

photo by stevendepolo via flickr.comIs your practice using computers that run Microsoft Windows XP? If so, you could be exposing your practice to security risks in the near future.

After April 8, Microsoft will stop supporting Windows XP, its venerable but aged operating system. This means that Microsoft will no longer send you regular software updates to correct new security holes and software bugs.

Will your XP computers suddenly become non-compliant? Not simply because Microsoft is withdrawing technical support. But without software regular patches, your computers may be increasingly vulnerable to the hackers and trolls who scour the internet. Usually they’re seeking credit card and bank account information, but if your system has security holes, they could access your patients’ protected health information more easily.

Will your computers continue to run on XP? If they’re functioning today, they probably will continue to function for a while. But many computer consultants are advising their clients to assess their risk and determine how they will modernize their systems.

Can I upgrade myself? Many computer users have tried upgrading to Windows 7 or 8 on their existing machines, but some have reported the process to be difficult, and sometimes a failure altogether. Many older machines simply don’t have the processing power or memory to run the newer versions of Windows. Sometimes the best solution is to get new hardware. Microsoft does offer brave, intrepid do-it-yourselfers  free data-transfer software.

Our advice? Talk to your computer vendor or consultant, and develop an upgrade plan. Granted, Microsoft derives commercial benefit from this decision, but security-sensitive users are left with little choice.You don’t necessarily have to upgrade today, but it’s not wise to delay the process indefinitely.

Senate Extends Medicare Payment “Patch” for One Year

Posted in Medicare on March 31st, 2014 by MMS – Be the first to comment

gavel

The Senate today approved a one-year extension of the current Medicare payment formula, rejecting a last-ditch effort by Sen. Ron Wyden (D-Ore.) to replace it with a permanent repeal of the entire payment formula.

The legislation averts a 24 percent cut in Medicare payments, which was scheduled to take effect on April 1.  For the rest of the calendar year, physicians will get a 0.5% increase. Rates will be flat for the first three months of 2015, at which time another cut is scheduled to take effect.

The legislation also delays the implementation of the new ICD-10 diagnosis code set until Oct. 1, 2015.

The final tally on the so-called “patch” bill was 64 to 35. Sixty votes were needed for passage. Both Massachusetts senators voted reluctantly in favor of the patch, and would have supported a permanent repeal if it were up for a vote today.

The MMS and AMA have opposed the patch bill (the 17th in the last 11 years), preferring a complete repeal of the payment formula.

MMS President, Ronald W. Dunlap, MD, said, “We’re very disappointed that Congress has again failed to fix the deeply flawed Sustainable Growth Rate Medicare payment formula. The legislation is sound policy that was supported by both parties, in both chambers of Congress. Yet, because its leaders were unable to overcome partisan differences over how to pay for it, we now have the 17th SGR patch in the last 11 years.

“The bitter irony is that every patch makes the problem worse. Congress could have solved the problem years ago by enacting a permanent repeal, and would have saved taxpayers tens of billions of dollars.

“The campaign to fix Medicare must continue, for the sake of the millions of seniors and military families who depend on the program for their health care. We’re deeply grateful to the members of the Massachusetts congressional delegation for their steadfast support for true Medicare payment reform, and pledge to work with them to achieve this goal – once and for all.”

We would like to thank the many physicians who contacted our congressional delegation to urge rejection of the measure.

April Physician Focus: Health Care Disparities

Posted in Health, Health Policy, Medicine, Physician Focus, Primary Care on March 31st, 2014 by MMS Communications – Be the first to comment

A dozen years ago, the Institute of Medicine released its groundbreaking report on health care disparities, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. That report concluded that wide differences exist between racial and ethnic minorities and whites in access to health, availability of insurance, and the quality of care they received.

The IOM report made public a topic that today still commands the attention of the medical community, and it’s the subject of the April episode of Physician Focus.

Guests for the show are Ronald Dunlap, M.D. (photo, center), President of the Massachusetts Medical Society, and Milagros Abreu, M.D., M.P.H. (right), Vice Chair of the MMS Committee on Diversity in Medicine and Founder and President of the Latino Health Insurance Program in Framingham. Alice Coombs, M.D., (left) past president of MMS and a member of the American Medical Association’s Commission to End Health Care Disparities, serves as host.

Among the topics of conversation by the physicians are the causes of health care disparities, their consequences on the health outcomes of patients, and the steps both physicians and patients can take to reduce these differences and improve care.

April’s Physician Focus is part of a renewed attention to the issue of health care disparities by the Medical Society, as outlined by Dr. Dunlap in his blog post of March 28 (below).

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 www.massmed.org/itunes.

The President’s Podium: It’s Time for Equal Treatment

Posted in Health, Medicine, Physician Focus, Primary Care on March 28th, 2014 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

When the Institute of Medicine published its groundbreaking report on DSC_0003 Dunlap 4x6 color 300 ppi_editedhealth care disparities in March of 2002, the topic touched a raw nerve in the medical community. Almost overnight, health care disparities became a top priority for medical professionals and policymakers alike.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care disclosed what all of us consider to be a distressing and unacceptable aspect of health care in America: that racial and ethnic minorities receive poorer quality medical care than whites, even when such factors as insurance coverage, ability to pay, and access to care were equal among the groups.  It is also quite clear that socioeconomic status and poverty contribute to health care disparities.

More than a decade after the IOM’s report, health care disparities still commands our attention, a topic increasing in importance, as our population continues to undergo demographic changes.

For years, the Massachusetts Medical Society has been one of the leading voices in the effort to reduce health care disparities in the Commonwealth. Our members have worked to educate our colleagues about the issue. We have testified before the state legislature in support of bills to reduce disparities in care. We have examined the ethical aspects of disparities, and our patient education efforts have focused on the subject.

I am proud to say we are continuing our efforts.

Our 2014 Public Health Leadership Forum, The Impact of Health Care Reform on Health Care Disparities (occurring Friday, April 4 from 9 a.m. to 1 p.m.) brings together some of the nation’s best health care experts to discuss how reform efforts may affect disparities in care. This forum, moderated by Lenny Lopez, M.D., Chair of the MMS Committee on Diversity in Medicine, adds a new dimension to our efforts on health care disparities, as it is being conducted in collaboration with the Commission to End Health Care Disparities.

The Commission was formed in 2004 by the American Medical Association and the National Medical Association, with the National Hispanic Medical Association joining soon thereafter, to respond to the IOM’s report. It has become the nation’s leading advocate to reduce disparities in care.  The MMS has had and continues to have a seat at the table: Alice Coombs, M.D., MMS past president and past chair of the Committee on Diversity in Medicine, has represented MMS on this committee for several years.

Among the scheduled participants in our Leadership Forum are Commission Co-Chairs Jeremy Lazarus, M.D., immediate past president of the American Medical Association, and Lawrence Sanders, M.D., president-elect of the National Medical Association. Besides looking at the effect of reform on disparities in care, participants will also address how changes in policy and practice and such areas as pay for performance and technology can reduce disparities in care.

Our continuing efforts also include a new dedicated web page on health care disparities that provides research and reports on the topic, resources and activities to identify and reduce disparities, strategies and tools to help eliminate them in the physician’s office, and information on the role of a diverse physician workforce in addressing differences in care.

And to bring the message beyond the medical profession, our April episode of Physician Focus, the MMS’s monthly patient education television program, discusses the issue in depth, describing the causes and consequences of health care disparities and what physicians and patients can do to reduce these differences and improve care. Hosting this show is Dr. Coombs, with Milagros Abreu, M.D., Vice Chair of the Committee on Diversity in Medicine, joining me as a guest. An accompanying print article is also being distributed to media across the state.

Twelve years after the Institute of Medicine’s report, we are making progress in reducing disparities, certainly more slowly than we would like, but making progress nonetheless. It is clear that reducing disparities will involve the efforts of everyone in health care – all physicians, providers, payers, and policymakers, and, yes, even patients.

My hope is that our upcoming efforts will signify a renewed commitment to equal treatment. It is a goal worth pursuing and achieving, and it’s time is long overdue.

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

  

 

Over Protests, House Passes One-Year Extension to Medicare Payment Formula

Posted in Medicare on March 27th, 2014 by MMS – Be the first to comment

us-capitol-building-2Despite strong protests from much of organized medicine, the U.S. House today approved – without a roll call –  a one-year extension of the current Medicare payment formula.

The Senate is expected to vote on the bill on Monday at approximately 5:00 p.m.

The “patch” legislation – as it is called – averts a 24% cut at least until April 1, 2015. It would give physicians a 0.5% raise through the end of calendar 2014, and no increase for the first three months of 2015.

The MMS, the American Medical Association and many other physician organizations bitterly opposed the bill, saying they preferred pending legislation that would completely repeal of the payment formula, known as the Sustainable Growth Rate (SGR).

The patch would also delay the implementation of ICD-10 for one full year, to October 2015. That prospect might ordinarily delight the AMA, which opposes ICD-10, but it wasn’t enough to soften the AMA’s opposition to the patch bill. Hospitals and technology groups that have heavily invested in ICD-10 criticized the delay.

This is the 17th time in 11 years that Congress has extended the current payment formula. The AMA’s opposition to this patch was rooted in its contention that it would force a fresh restart of the debate in the new Congress next year. It also protested that the patch legislation appropriates money that would have been used to pay for the repeal, making full repeal even more difficult in the next session of Congress.

The legislation fully repealing the SGR has been supported by both parties, in both chambers of Congress – a very rare phenomenon. But that bipartisan consensus crumbled over a rancorous debate over how to pay for it. Republicans wanted to fund it by delaying the Affordable Care Act’s individual mandate, while Democrats wanted to apply unused military funds. Neither party’s solution was even remotely palatable to the other.

For a brief period of time, the fervent protests of organized medicine seemed to be derailing the patch bill. After some debate on the House floor Thursday morning, there was no quorum to take a vote, and it was taken off the House calendar. But the bill returned to the podium about 90 minutes later, where it was gavelled through a voice vote in about 30 seconds (see video clip below).

House Schedules a Thursday Vote on Another Medicare Patch; AMA Urges No Vote

Posted in Medicare on March 26th, 2014 by MMS – Be the first to comment

39With the debate about how to fund a bipartisan bill repealing the Medicare physician payment formula stalled, the House is set to vote Thursday morning on a bill to extend the current payment formula for 12 months. For parliamentary reasons, a two-thirds majority is needed for passage.

The MMS, the American Medical Association, the American College of Surgeons, American College of Physicians, the American Osteopathic Association, the American Academy of Family Physicians, and many other physician organizations are strongly opposing the bill. They’re calling on the House and Senate to continue working on permanent repeal instead.

The House measure includes a surprise: A 12-month delay in the implementation of the ICD-10 coding system until October 2015. The American Health Information Management Association quickly opposed the delay, saying it would be costly to health care providers. The AMA opposes the implementation of ICD-10 outright, but this provision has not changed the AMA’s mind about the overall bill.

The 16th and most recent extension of the current payment formula is scheduled to expire on March 31. Without further action, a 24 percent cut in Medicare payments is scheduled to take effect on April 1.