September Physician Focus: Breast Cancer

Posted in Health, Physician Focus on August 31st, 2015 by MMS Communications – Be the first to comment

Breast cancer is one of the most common cancers in women, second only to skin cancer. About one in eight women will developBreast Cancer MMS Blog the disease during their lifetime, and three out of four will develop it after age 50.

The good news is that death rates from this disease have been declining for some 25 years, largely due to better treatment.

The standard for preventive care has been the mammogram, yet differing opinions from health professionals about this screening have raised concern and confusion. The advent of genetic testing and the growing acceptance of preventive mastectomies have added to the concerns.

The September edition of Physician Focus discusses these and other topics about breast cancer with medical oncologists from The Cancer Center at Beth Israel Deaconess Medical Center in Boston.

Guests are Nadine Tung, M.D., (photo, right) Director of the Cancer Genetics and Prevention Program, and Gerburg Wulf, M.D., Ph.D., (center) medical oncologist and researcher. Hosting this edition is B. Dale Magee, M.D., (left) a past president of the Massachusetts Medical Society.

Among the topics of conversation are the current thinking and controversy surrounding mammograms and how they differ from MRIs in detecting the disease; risk factors; genetic testing; preventive mastectomies; the relationship between breast cancer, birth control pills, and hormone replacement therapy; and lifestyle issues that can reduce a woman’s risk of breast cancer.

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.

Patient Experience is NOT Patient Satisfaction: Why Focusing on Great Patient Experience Delivers Safe, Quality, High-Value Care

Posted in Uncategorized on August 28th, 2015 by Erica Noonan – Be the first to comment

 

By Katherine Schauer

Do you know the difference between patient experience and patient satisfaction?

If you’re not sure, you’re not alone, according to Adrienne Boissy, MD, chief experience officer at the Cleveland Clinic.

“Patient satisfaction measures if they were satisfied, (i.e. happy) with the results of their stay. To look at it this way makes patients seem like consumers at a store…But health care is more emotional than that,” said Dr. Boissy.

Dr. Boissy is one of the featured speakers at a two-day Patient Experience Summit: A Physician Leadership Certificate Program, focusing on the patient experience. It will be held on September 30 and October 27, and was developed by the Cleveland Clinic in collaboration with the MMS.

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Adrienne Boissy, MD

Dr. Boissy said that patients aren’t really consumers because under most circumstances, they don’t want to be in the hospital. To call them satisfied and treat them like consumers is a mistake, she said. “Our goal isn’t to make them satisfied or leave them feeling happy. Our goal is to help them navigate through the process of getting better or dealing with a lifelong sickness. We want to make that experience a little easier for them. That is patient experience, an emotional journey that we can try to make better.”

Dr. Boissy defines patient experience as delivering “safe, quality, high-value care” and notes that everything a physician does in front of the patient influences their experience. “It matters because the patients choose where they want to be treated based on their past experiences and through the experiences of their friends and family,” she said.  “It also matters because at one point we are all patients. It isn’t “their” experience; it is “our” experience.”

The patient experience has many aspects, cleanliness of room, discharge speed, doctor/nurse attitude and more.  But Dr. Boissy thinks physicians are one of the most important influences on the experience.

“They (physicians) definitely have control over the experience. The problem is that some of them do not see their accountability. The physicians don’t feel as connected to some parts of the patient experience, like the cleanliness of the room. They are accountable for everything they say and the impression they give their patients,” she said.  “A doctor may be a phenomenal heart surgeon but if the patient feels they weren’t listened to then it doesn’t matter how good of a doctor he/she was.”

Health care teams are looking towards physicians to lead the patient experience movement, she said, and physicians must become more engaged with the idea of patient experience to get their teammates on board.  “Health care has shifted from being doctor-centered to relationship-centered care,” she stated.  Hospitals and practices know that patient experience is a key metric and will receive more focus in the future, as hospitals are increasingly reimbursed for quality patient care.

Many physicians believe they are leaving their patients with great impressions, but sometimes they’re mistaken, Boissy said. “Doctors need the transparency of the survey results to see their patient experience blind spots, to become self-aware.”

Dr. Boissy said systems that compare doctor-patient experience evaluations within a group or system can be more effective than traditional private evaluations. Seeing his or her scores in comparison with a colleague can motivate a physician to improve or to seek advice from others.

The Patient Experience Summit: A Physician Leadership Certificate Program is designed to help physicians improve their practice of patient experience and relationship-centered care. Registration is now open. It will be held on September 30 and October 27 at the Massachusetts Medical Society’s headquarters in Waltham.

 

August Physician Focus: Common Eye Disorders

Posted in Physician Focus on August 1st, 2015 by MMS Communications – Comments Off on August Physician Focus: Common Eye Disorders

Eye injuries and disorders can occur at any time of life, but with age comes a greater incidence of vision impairment. IMG_0685_editedToday, nearly three million people have glaucoma, nearly 25 million have cataracts, and almost 10 million combined have macular degeneration and diabetic retinopathy.

As the U.S. population ages, however, these age-related diseases are expected to increase dramatically. Macular degeneration and diabetic retinopathy, for example, are projected to double and quadruple, respectively, in the next 25 years.

To highlight these disorders, the August episode of Physician Focus with the Massachusetts Medical Society features two ophthalmologists from Eye Health Services of Quincy who are members of the Massachusetts Society of Eye Physicians and Surgeons (MSEPS).

Guests for the program are John T. H. Mandeville, M.D., Ph.D., (photo, center) a specialist in cosmetic and reconstructive eye plastic surgery and president of MSEPS; and Gerri L. Goodman, M.D., (right) a corneal specialist and member of the Boards of Directors of MSEPS and the New England Chapter of the Glaucoma Foundation. They join host B. Dale Magee, M.D., (left) past president of the Massachusetts Medical Society, for the discussion.

Among the topics of conversation are details on the four common conditions of cataracts, macular degeneration, glaucoma, and diabetic retinopathy; the distinctions among different eye care health professionals; the components of the eye and how it is structured; how to use an Amsler grid to check for macular degeneration; descriptions and photographs of what vision is like with the above conditions, and treatment options for the four disorders.  The physicians also discuss steps everyone should take, regardless of age, to practice good eye health and safety.

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: Being Part of the Solution

Posted in Drug Abuse, Health Policy, opioids, Public Health on July 31st, 2015 by MMS Communications – Comments Off on The President’s Podium: Being Part of the Solution

by Dennis M. Dimitri, M.D., President, Massachusetts Medical Society

 In October 2Dr. Dimitri1_edited013, the Trust for America’s Health rated Massachusetts as one of the top six states for developing  strategies to curb prescription drug abuse. Despite that ranking, the Commonwealth recorded more than 1,000 deaths from opioid overdoses in 2014, a jump of 33 percent from 2012.

Today, our state has developed an even firmer resolve in response to this epidemic.

Governor Charlie Baker and Attorney General Maura Healey have made this public health crisis a top priority. The Governor’s Opioid Working Group released an action plan in June that I believe is a smart, comprehensive approach to a complex problem. From the physician’s perspective, the plan has much to like. It reframes addiction as a medical disease, and recognizes the physician’s critical concern: “to ensure access to pain medication for individuals with chronic pain while reducing opportunities for individuals to access and use opioids for nonmedical purposes.”

The plan also supports initiatives that physicians have urged for some time and embrace wholeheartedly: more drug take-back days (an effort the Drug Enforcement Administration is also reviving), increases in the co-prescribing and bulk purchasing of the life-saving drug naloxone, more treatment programs, eliminating insurance barriers to treatment, and improvements in the state’s Prescription Monitoring Program.

The monitoring program is especially significant. The Centers for Disease Control describes such programs as one of “the most promising state-level interventions” to improve prescribing and protect patients at risk.

Changes in the monitoring program will make it easier for physicians to use, and compatible with those in other states. One key improvement: reducing the time for pharmacy reporting of opioid prescriptions from two weeks to 24 hours. This will provide better “real time” information on patient prescriptions and less “doctor shopping” by patients.

Another good sign: government is allotting more resources to fight the epidemic. The new state budget includes $111 million for substance abuse services, and the Governor has requested another $27.8 million in supplemental spending for treatment and prevention. U.S. Health and Human Services has also announced a $100 million effort for medication-assisted treatment, and Massachusetts will share in that program.

Creative new approaches have come from law enforcement as well. Gloucester’s Angels Program has enrolled nearly five dozen people into treatment since it began June 1, and the program has led to similar efforts in other communities.

For our part, the Massachusetts Medical Society has reached out to all prescribers with our Opioid Therapy and Physician Communication Guidelines, offering evidence of best practices for prescribing.

In May, we made our continuing medical education courses on opioids and pain management free to all prescribers, and since then, nearly 2,500 health professionals have taken one or more courses in the first two months. To meet demand, we have added nine courses since last year, when only 400 completed such courses in a comparable period.

We are reaching out to patients, focusing on the critical areas of proper storage and disposal of medications with a dedicated website and an upcoming radio public service campaign that will continue through the end of the year.

The American Medical Association is also taking action, concentrating on physician education in prescribing opioids, use of monitoring programs, and promoting access to treatment and naloxone.

But physicians – and all prescribers – can do better. More than half of enrolled prescribers don’t routinely use the prescription monitoring program, and most patients say their doctors don’t discuss the risks of addiction when prescribing pain medication. One of the best things prescribers can do is raise patient’s awareness of the risks of addiction and their responsibility to properly store and dispose of their medications.

Let’s also remember the public has a critical role to play. More than 75 percent of those 12 and older who use pain relievers for nonmedical reasons are using drugs prescribed to someone else, whether obtained free, purchased, or stolen. As White House Drug Policy Director Michael Botticelli told our membership, the prescription opioid problem is, in one sense, “an epidemic that starts in the medicine cabinet.”

The Opioid Working Group declared that “strong partnerships” will be required to curb this abuse. Many groups are rising to meet the challenge, and physicians have made the commitment to be part of the solution as well. As those closest to the patients, as the ones who prescribe their medicines and treat their pain, we can do no less.

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

CMS, AMA Announce Help with ICD-10 for Physicians

Posted in Electronic health records, Health IT, Health Policy on July 6th, 2015 by MMS Communications – Comments Off on CMS, AMA Announce Help with ICD-10 for Physicians

With the October 1 deadline for the implementation of ICD-10 looming, The Centers for Medicare & Medicaid Services road 1 icd(CMS) and the American Medical Association (AMA) today jointly announced some good news – and relief – for physicians.

The two organizations have reached agreement on important elements of a “grace period” for the implementation of version 10 of the new International Classification of Diseases that includes some 68,000 codes. The medical codes, used for diagnosis and billing, have not been updated in more than 35 years.

Among the major steps announced by CMS and the AMA:

• For a one-year period beginning October 1, Medicare claims will not be denied or audited solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes.
• To avoid potential problems with mid-year coding changes in CMS quality programs for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed.
• CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
• CMS will also establish an ICD-10 communications and coordination center, to identify and resolve issues arising from the transition.
• CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.

The organizations also said they will reach out to providers across the county, with webinars, on-site training, and educational articles to help them learn about the new codes and prepare for the transition. The free help from CMS also includes the Road to 10, The Small Physician Practice’s Route to ICD-10, a website aimed specifically at smaller physician practices to help them with the transition.

Today’s CMS/AMA joint announcement may be read here. More information on ICD-10 is available at this CMS site and from this post by AMA President Steven J. Stack, M.D., which contains links to additional information and resources.

July Physician Focus: Guns and Public Health

Posted in gun control, Physician Focus, Public Health on July 2nd, 2015 by MMS Communications – Comments Off on July Physician Focus: Guns and Public Health

Deaths and injuries from firearms continue to shine a spotlight on gun violence as a public health issue. The latest mass shooting at a church in South Carolina joins a list that includes tragedies in Newtown, Connecticut, at Virginia Tech, and in the Colorado communities of Columbine and Aurora. These shocking incidents receive great attention because of the numbers of people killed and injured, the young ages of the shooters, and where they take place (schools, a church, a movie theater).

Those incidents, however, are just a few of  the total number, with many of them taking place at schools. Since the Newtown, Connecticut tragedy in 2012 that resulted in the deaths of 20 children and 6 adults, an additional 127 school shootings have occurred in the U.S., 73 of them in grades K-12, according to Everytown for Gun Safety, which tracks such data.

Physicians have since become some of the most vocal advocates for gun safety. In April, seven physician organizations, the American Public Health Association, and the American Bar Association issued a call to action, saying “Deaths and injuries related to firearms constitute a major public health problem in the United States.”

To continue to highlight this important topic, the July episode of Physician Focus features a discussion with Michael Hirsh, M.D., (photo, right) Surgeon-in-Chief of UMass Memorial Children’s Medical Center and Medical Director of the Public Health Department in Worcester, Mass., and Robert Sege, M.D., (center) Vice President of Health Resources in Action in Boston and a member of the American Academy of Pediatrics Committee on Child Abuse and Neglect. Hosting this edition is primary care physician Bruce Karlin, M.D. (left).

Among the topics of conversation: what parents can and should do to make a home with guns safer for children, how guns in the home can lead to homicide or suicide, how technology can help to make firearms safer, the physician perspective on ‘gag laws’ preventing doctors from discussing gun safety with their patients, and gun buyback programs as a way to reduce the violence.

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.

MMS Statement on Today’s Supreme Court Decision Upholding ACA Subsidies

Posted in Uncategorized on June 25th, 2015 by Erica Noonan – Comments Off on MMS Statement on Today’s Supreme Court Decision Upholding ACA Subsidies

 

Statement from Massachusetts Medical Society President Dennis M. Dimitri, MD, on King v. Burwell:

The Massachusetts Medical Society welcomes today’s Supreme Court decision safeguarding access to crucial health care service for millions of patients, said Massachusetts Medical Society President Dennis M. Dimitri, MD.

“The physicians of the Massachusetts Medical Society applaud the decision to uphold Affordable Care Act subsidies in states that do not have their own health care exchanges,” said Dr. Dimitri. “Patients across the United States will not lose access to the care they need and deserve.”

 

Sports Medicine: Emerging Technologies and Procedures

Posted in Uncategorized on June 24th, 2015 by Erica Noonan – Comments Off on Sports Medicine: Emerging Technologies and Procedures

 

By Nicholas Sargent, MMS Communications Staff

 Brian McKeon, MD, the Chief Medical Officer and Head Team Physician for the Boston Celtics opened his presentation at the 2015 MMS Men’s Health Symposium last week by discussing how rapidly the technology of medicine has advanced.

“This is a totally different talk than I would have given in January,” said Dr. McKeon. Still, even with medical technologies advancing as quickly as they are, he did not see an end to the simple problem of human aging and wearing out the body anytime soon. Because of modern medicine, people are living longer than ever before, instead of “struggling to 42, then getting eaten by a bear.”

People are lasting longer, but we’re still wearing out our bodies, and because of this the need for orthopedic surgery has skyrocketed in recent years, and it won’t slow down anytime soon, he said. The demand for knee arthroplasties is expected to grow 673% by 2030, and modern medicine can’t do much to stop the decay and loss of cartilage, especially the meniscus cartilage in the knee.

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Surgery, Dr. McKeon said, can only do so much. Patient dissatisfaction with meniscus surgery reaches 100% after 10 years, and repeat surgeries can’t do much to help if the tissue is completely worn away.  He said the most attractive prospect is a new implant, invented by a team in Israel, which imitates the meniscus and can be inserted with a very simple procedure.

He said another problematic surgery is patching up rips in the rotator cuff. Clinical studies show that there is a 30 to 50% chance of a rotator cuff repair failure, either from the patient re-opening the tear or from lack of blood flow to the affected tissue, which slows the healing  process.

Dr. McKeon has begun using stem cells to promote tissue growth at the site of the surgery, with great success. While the cells can be harvested from the patient’s own bone marrow and mixed with graft material, the best results are had with amniotic stem cells.

Amniotic cells are currently expensive due to the limited number of companies that provide them, but Dr. McKeon was confident that this will change within a decade. “They’ll be popping up all over the place.”

See slides From Dr. McKeon’s presentation here.

Governor’s Opioid Task Force: A Smart, Comprehensive Approach

Posted in Drug Abuse, opioids on June 22nd, 2015 by MMS – Comments Off on Governor’s Opioid Task Force: A Smart, Comprehensive Approach

By Dennis M. Dimitri, MD
MMS President

Dr. Dennis Dimitri 300 ppiWe welcome today’s report from the Governor’s Opioid Working Group. It is a smart, comprehensive approach to an extremely complex problem, and we pledge to pledged to continue to work with public and private officials to combat the opioid overdose epidemic.

We appreciate that the working group addressed many of the issues we have discussed with the Governor Baker, Attorney General Healey, Secretary Sudders and their staffs. We agree that because of the opioid crisis, we need a different approach to the prescribing and management of opioid medications. That is why we’ve taken a proactive approach to the issues, and launched a comprehensive program to educate physicians, other prescribers and the public last month.

We especially support the recommendations to improve the state’s online prescription monitoring program; increasing access to naloxone by encouraging it to be co-prescribed with opioid medications; allowing the partial filling of opioid prescriptions without additional co-payments; expanding education for prescribers and the public; expanding access to intervention and treatment; and taking steps to destigmatize addiction.

Our program to fight opioid overdoes, called “Smart Scripts MA,” was launched in May 2015. It has three components:

Prescribing Guidelines: The guidelines are designed to help physicians make the right decisions for their patients. They were developed by a task force of physicians from a broad range of specialties, and derived from similar work conducted in other states and by several state and national medical specialties.

The guidelines first emphasize that physicians and patients should discuss family and personal histories of substance abuse disorders and behavioral health concerns, before the prescription is written. The guidelines also encourage patients and physicians to mutually develop agreements that outline the expectations and goals of the treatment, along with the conditions for continuing opioid therapy after initial treatment.

Free Education in Pain Management: The MMS has made its online medical education courses in pain management available free to all prescribers until further notice. Five courses are currently available; several more courses will be published later this week, and more courses are planned for later this year. These courses are available for Continuing Medical Education credit. Physicians have been required to obtain CME credits on this topic as a condition of licensure and re-licensure since January 2012.

Public Education Program: The MMS has also launched a public education program to inform patients and their families about the safe storage and proper disposal of their opioid medications, in an effort to reduce the supply of medications in the community. According to the CDC, more than 80% of people who abuse prescription drugs are using medications that were prescribed for someone else. Safe storage and disposal will reduce or eliminate this source of misused prescription medications.

 

MMS Talks to Dr. Andrew Kowal: Addiction and Men’s Health

Posted in Uncategorized on June 16th, 2015 by Erica Noonan – Comments Off on MMS Talks to Dr. Andrew Kowal: Addiction and Men’s Health

In advance of the 13th Annual Symposium on Men’s Health on June 18 from 8:00 a.m. to 4:00 p.m. at the Massachusetts Medical Society in Waltham, we reached out to several of the panelists and faculty who will be attending for interviews about their areas of expertise. Here is the fourth of a series of short interviews with the event’s presenters.

Dr.  Andrew G. Kowal, director of Pain Management Center, Lahey Hospital & Medical Center, will present a panel on pain management and addiction.

 

By Katherine Schauer

MMS Communications Staff

 

MMS: Pain management is not usually seen as a gender-specific condition, are there any complications or issues that only arise in men? Are men more likely to suffer from chronic pain?

Dr. Kowal:  Men are not more likely to suffer chronic pain; however it can be more difficult to diagnose chronic pain syndromes in men; for example fibromyalgia. Also high dose chronic opiates affect them {men} even more negatively than women secondary to their effect on hormones such as testosterone.

 

MMS: What is your stance on medical marijuana regarding pain management?    Kowal

Dr. Kowal:  Medical marijuana with pain management is not a good idea. We will go into great detail and review this at the symposium.

 

MMS: What do you hope to achieve at the symposium?

Dr. Kowal: I will highlight THC and opiates in the context of chronic pain management and recent evidence about both, or lack thereof! I will also briefly cover new opioid guidelines.

 

MMS: Is there any message you want to be sure everyone attending the symposium hears?

Dr. Kowal: The message I want everyone to hear is that opioids do not help chronic pain; they cause more problems and dangers with escalating chronic use.

 

MMS: What’s the next frontier in the field of pain management?

Dr. Kowal: The next frontier is using functional imaging studies of the central nervous system to diagnose/guide therapies. Also there are new non-opiate pain medications on horizon.

 

Dr. Kowal is clinical assistant professor of anesthesiology at the Tufts School of Medicine in Boston and director of the Interventional Pain Management Center at Lahey Clinic. Dr. Kowal spent 10 years in active duty for the United States Army Medical Corps where he was involved in leading the development and implementation of Department of Defense clinical practice guidelines for pain management.

Read more about the event’s program and panelists.

Register here to attend the 13th Annual MMS Symposium on Men’s Health on June 18.