The President’s Podium: Doctor’s Day 2015

Posted in Uncategorized on March 27th, 2015 by MMS Communications – 1 Comment

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

This year marks the 25th anniversary of National Doctor’s Day, annually celebrated on March 30 and first proclaimed by  President George Bush in 1991 to honor physician leadership in the “prevention and treatment of illness and injury.”

On this Doctor’s Day, however, physicians of the Massachusetts Medical Society are not calling attention to ourselves, but to the importance of the physician-patient relationship – the relationship that is at the very heart of health care.

The impetus behind this focus is a 2011 Florida law making it illegal for physicians to ask patients if they own a gun or to record information about gun ownership in a patient’s medical record. Pediatricians sued to block the law, but it was eventually upheld by a panel of the U.S. Court of Appeals who declared the law regulates physician conduct “to protect patient privacy and curtail abuses of the physician-patient relationship.” Florida physicians have asked for a rehearing, which is currently pending.

This appears to be growing trend. Similar laws are pending in several other states, and the latest effort to regulate physician behavior is occurring in Texas.

Regarding this as a bold intrusion into the physician-patient relationship, members of our House of Delegates at the Interim Meeting last December passed a two-part resolution that (1) declared our opposition to any attempt by government to interfere with a physician’s right to free speech as a tool to improve the health and wellness of our patients, and (2) dedicated Doctors Day 2015 to the recognition of the basic principles that the doctor-patient relationship is confidential and sacrosanct.

As a result, we have acted to call attention to this issue through news reports and opinion pieces in local publications across the Commonwealth. I invite you to read the press release here and one of the commentaries here. Several district society presidents have joined me in co-authoring the commentaries for papers in their regions.

While gun safety takes center stage in the effort due to the Florida law, the real issue posed here is outside interference in the physician-patient relationship, which physicians should emphatically resist. Our obligation as health care providers drives us to ask about many subjects that affect health. Banning conversation about gun safety is a slippery slope indeed: if that discussion is off limits, what might be the next topic prohibited?

President Bush’s 1991 proclamation establishing Doctors Day said that “More than the application of science and technology, medicine is a special calling, and those who have chosen this vocation in order to serve their fellow man understand the tremendous responsibility it entails.”

That “tremendous responsibility” of our special calling is rooted in the physician-patient relationship, and any intrusion into that relationship hinders our ability to practice medicine and denies patients from getting proper care.

So on this 25th anniversary of Doctors Day in 2015, we are placing the focus not on the physician, but on the patient – and that’s right where it should be.

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

Editor’s Note: Read how Worcester physicians are taking the lead in gun safety by targeting gun “gag laws.” 

 

 

U.S. House Makes History, Votes to Repeal Medicare SGR Payment Formula

Posted in Medicare on March 26th, 2015 by Erica Noonan – Be the first to comment

IPhoto by wallyg, via flickrn a historic move, the U.S. House of Representatives voted overwhelmingly Thursday in favor of repealing the flawed Medicare physician payment formula by a vote of 392-37. All Massachusetts members voted in favor of the bill.

The $200 billion package, widely embraced by both political parties, calls for a permanent repeal of the Sustainable Growth Rate, or SGR, that has threatened physicians with double-digit reimbursement cuts 17 times over the past decade.

MMS President Richard Pieters, MD, applauded the House’s action, calling it critical to re-establishing a stable environment for physicians and more than 1 million Massachusetts seniors who depend on Medicare.

“We thank the lawmakers on both sides of the aisle who came together on behalf of the nation’s seniors and military families who depend on Medicare and their doctors to stay well,” said Dr. Pieters.

“Thank you to the tens of thousands of physicians and patients who heeded our calls to contact their representative in Congress this week. Your voices were heard,” he said.

The Senate will not consider the measure until it returns from its Easter recess in mid-April. If it is successful there, President Obama has indicated he will sign the measure into law.

The most recent Medicare payment patch expires March 31. The next day, a 21 percent cut is scheduled to take effect. However, CMS doesn’t process claims until two weeks after date of service, so if the Senate acts quickly enough, physicians’ first payments for services provided after April 1 will not reflect the 21 percent cut.

The MMS will update its website and social media channels frequently with news of the bill’s continued progress through the Senate.  Read more on the MMS website about the effort to repeal the SGR.

Gov. Baker Releases Budget; Board of Registration in Medicine and MassHealth Affected

Posted in Board of Medicine, Uncategorized on March 6th, 2015 by Erica Noonan – Be the first to comment

 

By William Ryder, Esq

MMS Legislative and Regulatory Counsel

Governor Charlie Baker released his first budget this week. Saddled by deficits from the previous administration, particularly in MassHealth spending due to well-documented problems with the Connector, Gov. Baker was faced with significant challenges.

Overall spending is up in MassHealth for Fiscal Year 2016. This is led by managed care line item increases with fee-for-service appropriations slightly down. Both these amounts are based on anticipated demand and projected to maintain access to covered services and maintain current rates. Chiropractic coverage is eliminated for a projected $300,000 saving.

Gov. Baker’s stated commitment to rein in MassHealth spending by confirming eligibility, rather than through across-the-board cuts to providers and legitimate patients, is a reasonable and fair approach that is also federally mandated. Some physicians have expressed concern about reports  that the state could carry over some payments from this fiscal year in FY16. This is often done in state government late in the fiscal year. It does not mean that there will be no payments until July. The governor’s budget proposal is a proposal which must be acted on by the legislature to become law. Usually final passage occurs in June.  Massachusetts State House

Also in the budget is the prescription monitoring program, funded at approximately $1.2 million, a reduction of about $45,000 from last year. It has only six employees to register prescribers, pharmacists, and delegates. As we try to evolve a better PMP, perhaps more resources should be provided to improve the system, provide support staff to participants with concerns, and strengthen the database.

The governor’s proposed budget also included outside sections that would directly impact the Board of Registration in Medicine by placing it within the Mass. DPH and under the authority of the commissioner. The MMS has always supported a fully funded, independent medical board with oversight by the Division of Administrative Law Appeals, the Supreme Judicial Court and the Commissioner of Public Health with some oversight on new regulations. This change was offered by former Senator Richard Moore and rejected in last year’s budget.  MMS will work to maintain the medical board’s independence.

Physician Focus for March: The Measles Outbreak and The Value of Vaccines

Posted in Physician Focus, Public Health on February 27th, 2015 by MMS Communications – Comments Off

The current measles outbreak, which began last December in Disney World and has since led to more than 150 cases in 17 states, is a stark reminder that diseases once declared eliminated can, without vigilance, return easily and spread quickly.

To remind patients about the benefits of immunization, the March episode of Physician Focus examines the current outbreak, how it came about, and why vaccines merit its place on the list of the top ten greatest public health achievements of the 20th century.

Guests are George Abraham, M.D., (photo, center) a board-certified infectious disease specialist, Associate Chief of Medicine at Saint Vincent Hospital in Worcester, Professor of Medicine at UMass Medical School, and Governor of the Massachusetts Chapter of the American College of Physicians, and Sean Palfrey, M.D., (right) a pediatrician at Boston Medical Center, Clinical Professor of Pediatrics and Public Health at Boston University School of Medicine and the founder and director of the Immunization Initiative of the Massachusetts Chapter of the American Academy of Pediatrics. Hosting this edition is primary care physician Bruce Karlin, M.D. (left).

Among the topics of discussion are how once-eradicated diseases like measles can return and spread, how dangerous childhood diseases can be and why people tend to discount their severity, the risks of not getting vaccinated, how herd immunity to protect the public’s health is determined, how misinformation about medicines can spread quickly, how physicians may deal with patients and their parents who have questions or reservations about vaccines, and the importance of immunization for adults as well as children.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on YouTube.

The President’s Podium: Reducing Opiate Abuse

Posted in Department of Public Health, Health Policy, Medicine, opioids on February 18th, 2015 by MMS Communications – Comments Off

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

Governor Charlie Baker and Attorney General Maura Healey have each made opiate abuse one of their top priorities, and this week they will announce steps they will take to fight this public health crisis. That the state’s top elected official and top law enforcement officer have put this issue at the forefront of their agendas is good news, because even as Massachusetts ranks as one of the top four states in adopting strategies to curb prescription drug abuse by the Trust for America’s Health, prescription and opiate abuse remains a crisis in the Commonwealth.

MMS has reached out to both the Governor and Attorney General to offer our assistance as they address the problem. Their initial responses have been encouraging, and we look forward to hearing the specifics of their plans and working with them.

One of the keys to reducing the abuse, however, is a sustained effort in raising public awareness about the issue, and the Massachusetts Medical Society has long recognized the importance of communicating to both physicians and patients about prescription drug abuse.

We highlighted the topic in 2011 with our patient education television program that reaches communities across the state, and in subsequent shows addressed the topic of substance abuse in young people and how they can be treated.

Our current program revisits the subject of prescription abuse with experts in addiction medicine. Additionally, we have distributed articles to local media, to outline what both physicians and patients can do to prevent prescription abuse. This is especially important, as more than three out of four people who misuse prescription pain medicines use drugs prescribed to someone else.

My predecessor Dr. Ronald Dunlap last year outlined the physician’s perspective on prescription drug abuse and recommended additional steps that can be taken to reduce the abuse.

I have since provided my views and recommended improvements in the state’s prescription monitoring program, which the Society helped to create more than 20 years ago. We believe a well-run, real-time, robust monitoring program is a key element in the fight against prescription abuse and one in which every physician should participate.

MMS will continue its educational effort on opioids and prescription abuse on April 8 with our Annual Public Health Leadership Forum for physicians and health care providers. The Opioid Epidemic: Policy and Public Health, featuring local and national leaders in substance abuse and addiction medicine, will discuss a range of issues, including the basics of pain management, alternatives to opioids, communicating with patients about pain management and treatment, and advocacy for treatment programs for those with addictions. This forum will offer important information for those who prescribed opioids and treat pain and addiction, and I urge those who do so to attend.  Also, the MMS Ethics Forum at our annual meeting in May will explore the ethical and legal considerations in pain management by physicians.

As government and public health officials seek remedies to the opiate crisis, we urge them to recognize that physicians and their patients – the ones who treat the pain and take the medicines – can play critical roles in reducing the abuse.

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

Interoperability is New Focus for Health IT

Posted in Electronic health records, Electronic Medical Records, meaningful use on February 13th, 2015 by Erica Noonan – Comments Off

By Leon Barzin

MMS Director of Health Information Technologykeyboard 1

Barriers to interoperability continue to be main challenges to moving the nation’s health care system beyond simply making electronic silos of information from paper ones, according to experts at the recent annual meeting of the eHealth Initiative.

The recent Meaningful Use Program started with three goals for the identified stages: Stage 1: data capture and sharing; Stage 2: advance clinical processes; and Stage 3: improve outcomes.

Stage 1 of Meaningful Use, as painful as it has been to some independent practices, is generally considered quite successful in fostering electronic data capture.  It has moved the use of electronic medical records from single digits in the pre-Meaningful Use period to an estimated 70 percent nationwide today.

Unfortunately, it appears that both Stages 1 and 2 have largely failed in the primary objective of “sharing,” moving health data security to the right place at the right time – especially among dissimilar systems.

In January 2015, the U.S. Department of Health and Human Services released the document, A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.

If improved interoperability can be achieved via this federal roadmap, such a system would support more efficient and effective healthcare and lead to a continuously improving health system that empowers individuals, customizes treatment, and accelerates cure of disease.

On the heels of the release of the government’s document, the eHealth Initiative held its yearly meeting last week, bringing together physicians, administrators and other national experts to focus on how this plan could be implemented in real clinical environments.

Several consensus items among attendees were clear:

  • EHR vendors and providers can no longer ignore interoperability.
  • New secure interoperability software is on the near horizon and mobile devices will be the focus.
  • Patients will soon be included as active partners in their healthcare and possess some or all of their records on their smartphones.
  • Wearable sensor devices like Fitbit will become more clinically connected and able to provide useful clinical information.
  • Early pilots in telemedicine are moving toward standard operation, especially chronic disease management, benefiting from advances in sharing technology.

Although there seems to be little impetus for additional “checkbox” Meaningful Use requirements, it appears efforts will shift throughout the industry, within provider communities, and at CMS to push forward with interoperability improvements.

MMS Building Status for Tuesday, Feb. 10

Posted in MMS Building Information, Weather Alert on February 9th, 2015 by MMS – Comments Off

Because of the winter weather, MMS facilities will be operating at reduced levels on Tuesday, Feb. 10.

Some meetings are still being held as scheduled. If you have an event scheduled at an MMS facility, please check with your meeting or event coordinator for the status of your event.

February Physician Focus: The Physician’s Perspective on Prescription Drug Abuse

Posted in Drug Abuse, Health, opioids, Physician Focus, Public Health on January 30th, 2015 by MMS Communications – Comments Off

Health and governmental officials at all levels are struggling with solutions to what has become one of the nation’s most pressing public health problems: prescription drug and opiate abuse.

Addiction experts, public officials, and even some physicians, have pointed to the medical profession as one cause of the problem. Physicians write too many prescriptions, they say.  But the fact that more than three out of four people who misuse prescription pain medicines use drugs that are prescribed to someone else is one indication that the problem arises from more than a single cause.

The February edition of Physician Focus, with a discussion among three physicians knowledgeable about the treatment of pain, pain medications, and opioid abuse, offers the perspectives of physicians on prescription drug and opioid abuse.

Participating in this conversation are Richard Pieters, M.D., (center, photo) President of the Massachusetts Medical Society and Professor of Radiation Oncology and Pediatrics at the University of Massachusetts Memorial Medical Center in Worcester; Daniel Alford, M.D., (right) Director of the Safe and Competent Opioid Prescribing Education program at Boston University School of Medicine and the Director of the Clinical Addiction Research and Education Unit at Boston Medical Center; and Barbara Herbert, M.D., (left) Medical Director of Addiction Service at Commonwealth Care Alliance and President-Elect of the Massachusetts Chapter of the American Society of Addiction Medicine, who serves as host for this program.

All three physicians bring their personal experiences in treating patients with pain to the discussion. Among the topics they address are the physicians’ viewpoints on the causes of opiate abuse; the prevalence of pain as a medical condition; the elements of effective and safe pain management; the distinctions among different kinds of pain; what steps physicians and patients can take, both individually and collectively, to reduce the abuse of pain medicines; and how physicians view the use of the prescription drug Narcan to prevent deaths from overdoses.

Physician Focus, now in its 11th consecutive year of production, is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus, and on  YouTube.

New Medical Marijuana Registration Rules Take Effect Feb. 1

Posted in Department of Public Health, Medical Marijuana on January 30th, 2015 by MMS – Comments Off

marijuanaEffective February 1, 2015, patient certifications from physicians for the medical use of marijuana must be submitted electronically. Paper certifications are no longer sufficient to comply with state law or regulations.

Patients must now obtain their certifications electronically and be registered with the Medical Use of Marijuana Program to possess marijuana for medical use. Paper certifications will no longer be valid. Patients who previously had a paper certification must get a new electronic certification from their physician.

Physicians who wish to certify patients for medical marijuana must now do so electronically. Paper certifications will no longer be valid. Before certifying patients electronically, physicians must register with the state, after earning at least 2 CME credits relating to medical marijuana.

 Additional Resources

What Mattered Most to Physicians Last Year? Top MMS Website Content in 2014

Posted in website on January 2nd, 2015 by MMS – Comments Off

What mattered most to Massachusetts physicians in 2014? The most heavily visited pages on the MMS website may offer some hints.

This list is not a complete traffic report; it covers only individual articles. It doesn’t include transaction pages, or the pages that list individual article pages.

The top 25 are listed here, ranked by the number of page views. Perhaps you will find it of some interest.

  1. Health Care Proxy Information and Forms
  2. Continuing Medical Education Requirements for Physician License Renewal in Massachusetts
  3. Choosing a Specialty
  4. Find a Physician
  5. MMS Careers
  6. End-of-Life Care Series (Online CME course)
  7. MMS Leadership
  8. Health Care Proxies and End of Life Care
  9. Opioid Prescribing Series (Online CME course)
  10. Physician Health Services
  11. Medical Marijuana
  12. Important Differences Between Health Care Proxies and Living Wills
  13. Managing Risk When Prescribing Narcotics Painkillers (Online CME course)
  14. House of Delegates
  15. Legal Advisor: Advance Directives (Online CME course)
  16. The Importance of Discussing End of Life Care (Online CME course)
  17. Medical Price Transparency Law Rolls Out: Physicians Must Help Patients Estimate Costs
  18. MMS Study Shows Patient Wait Times for Primary Care Still Long
  19. Proposed EHR/Meaningful Use Regulations
  20. Medical Marijuana CME (Online CME course)
  21. Physician Health Services: Success Story – An Amazing Journey to Sobriety
  22. Avoiding Failure-to-Diagnose Suits (Online CME course)
  23. Legal Advisor: Identifying Drug Dependence (Online CME course)
  24. Medical Mistakes: Learning to Steer Clear of the Common Ones (Online CME course)
  25. Massachusetts Medical Marijuana Law: Considerations for Physicians