Primary Care

September Physician Focus: The Physician-Patient Relationship

Posted in Health, Health Reform, medical homes, Medicine, Physician Focus, Primary Care on August 30th, 2013 by MMS Communications – Comments Off on September Physician Focus: The Physician-Patient Relationship

Since the days of Hippocrates, the physician-patient relationship has been regarded as the foundation of good health care, thus making the selection of a physician one of the most important medical decisions a patient will make.

The September episode of Physician Focus provides an in-depth discussion of this key element of health care with two experienced primary care physicians.

Special guest for this program is MMS Vice President Dennis M. Dimitri, M.D., a board-certified family physician in Worcester, Mass. with more than three decades of primary care experience.

Dr. Dimitri, (photo, seated) Clinical Associate Professor and Vice Chair of the Department of Family Medicine and Community Health at UMass Memorial Medical Center and UMass Medical School in Worcester, joins fellow family physician and program host Mavis Jaworski, M.D. for the conversation.

Focusing on primary care, the physicians examine a range of topics, including what factors patients should consider when seeking a physician, the elements that make up a good physician-patient relationship, the barriers that might negatively affect the relationship, what patients and physicians might do if the relationship doesn’t seem to be working, and the potential impact on the relationship of new models of care such as the patient-centered medical home and accountable care organizations.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at ,  and on iTunes at

The President’s Podium: In the Court of Public Opinion

Posted in patient safety, Primary Care, Tiering on August 22nd, 2013 by MMS Communications – Comments Off on The President’s Podium: In the Court of Public Opinion

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

With the constant push for quality, safety, and transparency, the practice of  rating physician performance is becoming as commonplace as the stethoscope in health care.

Insurers have developed tiers; the federal and state governments and private organizations have launched websites. Local and national magazines rate physicians individually and by group practices. Patients can rate their doctors on any number of websites. The focus on ratings has become so widespread that even organizations best known for reviewing restaurants and home services have joined the club.

Some physicians bristle at the notion of such assessments. A few have filed lawsuits in response to negative reviews, and some, in attempting a preventive strategy, have asked patients to sign documents promising not to use any rating websites. This tactic has backfired and not surprisingly, strained the physician-patient relationship.

Like them or not, ratings are here to stay. Some provide useful information; some not so much, merely allowing disaffected patients to vent about the care they think they should have received, how much time they spent in the waiting room, or why they couldn’t talk to the doctor when they wanted. The methodology used by some organizations and the low sample size may also raise questions. Fortunately, most experts will caution patients about such information, advising them to judge the relevance, accuracy, and reliability of the information with extreme care and to use the information as just one of many factors when judging physicians.

To be sure, physician performance is a critically important and complex issue, and MMS has been ahead of the curve. Back in 1999, MMS first developed our Principles for Profiling Physician Performance, which has since been updated. That was followed by a similar document for health plans, and we’ve even provided guidance for patients.

In the end, each patient individually will determine how well his or her doctor is providing care, and that perhaps is the only rating that truly matters. But reasonable patient input and well-constructed surveys can offer a yardstick for measurement, especially with so many changes taking place in health care.

With that in mind, here’s a look at some responses from the MMS’s recent public opinion poll that relate to physician performance:

  • 84% expressed satisfaction with the care they received over the last year. Notably, that’s comparable to the 88% rate of satisfaction in 2004, when we first asked the question. 51% cited quality of care as the biggest reason for their satisfaction.
  • 74% said they have asked their physician for suggestions when deciding where to go for medical care, signaling that the physician remains the most preferred source of information about care.
  • 67% said they would prefer to receive care from a physician; this despite the proliferation of retail clinics and a new state law allowing nurse practitioners and physician assistants to act as primary care providers.

There’s always room for improvement, and while one hundred percent in every category will remain the target, the judgment from our patients again this year is that Massachusetts physicians and health care providers are living up to their reputation for quality care. That’s good news for physicians, and the high level of satisfaction over a decade, in which huge changes have occurred, is especially gratifying. But let’s remember this: the court of public opinion on health care is always in session. And that’s just as it should be.

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



April Physician Focus: Checkups and Screenings: What Do You Need?

Posted in Health, Health Policy, Health Reform, medical homes, Medicine, Physician Focus, Primary Care on April 1st, 2013 by MMS Communications – 1 Comment

The annual physical exam and other periodic screenings have for years been considered key elements to sound medical health, offering prevention against disease and illness. Yet recent studies have called into question the value of these exams, saying such testing has had no effect on reducing disease or death and in some cases causes harm.

The April episode of Physician Focus, Checkups and Screenings: What do you need?, offers an in-depth discussion of this issue with Michael Barry, M.D., president of the Informed Medical Decisions Foundation in Boston and medical director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital. Hosting the show is primary care physician Mavis Jaworski, M.D.

Among the topics of conversation are the pros and cons of medical tests and treatments, how to decide which ones to have, why patients should have a greater voice in their health care decisions, and the concept of shared decision-making – physicians and patients working together so that, in Dr. Barry’s words, “good medical decisions are made with the full participation of an informed patient.”

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at and on iTunes at


MMS Urges Parents: Learn More About Child Sexual Abuse

Posted in Primary Care, Public Health, Uncategorized, violence on February 27th, 2013 by MMS Communications – Comments Off on MMS Urges Parents: Learn More About Child Sexual Abuse

As reports of child sexual abuse increase at Massachusetts schools and with the Penn State and church pedophile scandals still in memory and making headlines, the Massachusetts Medical Society is encouraging parents and guardians to learn more about child sexual abuse with the publication of Protecting Your Child from Sexual Abuse, a collaborative effort with Massachusetts Citizens for Children.

This free 12-page brochure includes basic information on child sexual abuse; tips to help protect children; potential signs and changes in behavior to look for; what to do if abuse is suspected; and resources on reporting, preventing, and treatment of child sexual abuse.

Authored by Jetta Bernier, executive director of MCC, Protecting Your Child from Sexual Abuse is the result of a cooperative effort between the MMS Committee on Violence Intervention and Prevention and MCC, a nonprofit, independent advocacy group for the state’s most vulnerable children. It is one of a series of ten brochures focusing on various aspects of violence and children originated by Robert Sege, M.D., Director of the Division of Family and Child Advocacy at Boston Medical Center and a member of the American Academy of Pediatrics Committee on Child Abuse and Neglect.

The series of brochures is part of the Massachusetts Medical Society’s Campaign Against Violence and includes individual descriptions of such topics as dating and street violence, violence in the media, bullying, violence in the home, and myths and facts about violence.

Protecting Your Child from Sexual Abuse and the other brochures in the series are available free via download from the Massachusetts Medical Society at Printed copies may be ordered individually or in sets from the Medical Society by writing to or calling 1-800-322-2303, Ext. 7373.



MMS Issues Q&A on Stroke

Posted in Health, Primary Care, Public Health on February 8th, 2013 by MMS Communications – Comments Off on MMS Issues Q&A on Stroke

Following the release of new research indicating that more strokes occur during the winter months and that the public’s knowledge of warnings signs is low and that people aren’t calling for help soon enough when symptoms appear, the Massachusetts Medical Society (MMS) has distributed a Q&A on stroke to local media across Massachusetts to increase awareness and educate patients about this condition.

Statistics from the American Heart Association indicate that nearly 800,000 people suffer a stroke each year, or an average of one person every forty seconds. One of every 18 deaths in the U.S. is attributed to stroke.

In the release, MMS notes that many strokes can be prevented and for those that do occur, knowing what to do and doing it quickly can reduce the risk of permanent damage. The Q&A provides a basic primer about strokes, including risk factors, symptoms, and what steps to take when the signs of a stroke appear. It contains information from the National Stroke Association, American Stroke Association, and the Centers for Disease Control and Prevention. The release/Q&A may be read here.

Consumer Reports Rates Mass. Physicians

Posted in Health, Health Policy, Medicine, Primary Care, Uncategorized on May 31st, 2012 by MMS Communications – Comments Off on Consumer Reports Rates Mass. Physicians

Richard V. Aghababian, MDFrom magazines featuring “top doctors” to multiple websites of state agencies, nonprofit organizations, and commercial enterprises, physicians have been graded and rated on a host of criteria, in the interests of increasing transparency and improving care. But few offer comprehensive  or scientifically-based data.

Consumer Reports magazine, perhaps the biggest and most widely known judge of all, in creating its own Health Ratings Center, has set out to change that. In April, CR published ratings on heart surgeons in collaboration with the Society of Thoracic Surgeons.

Now, in concert with Massachusetts Health Quality Partners, CR has focused on the Bay State, delivering a special 24-page report in its July issue for its Massachusetts readers rating the state’s primary care physician practices.

The ratings are based on MHQP’s patient experience survey, which asked questions of more than 47,000 adults and 16,000 parents about their experiences with their physicians.  Nearly 500 physician practices with three or more doctors are ranked.

Among the areas examined were how well physicians communicate with their patients, coordinate care, and know their patients, as well as the patient’s experience with other staff in the practice. In publishing the ratings, CR recognized the difficulty in rating an area like healthcare:  “…medical care is complex, and patient experience is only one measure of quality” but the magazine suggests that patient experience can affect clinical measures like managing conditions such as arthritis, high blood pressure, or high cholesterol.

So how did Massachusetts primary care doctors rate?

“Most practices in the state earn one of the top two ratings across multiple measures in the survey,” CR wrote. “But nearly every practice has room for improvement.  Overall, scores for physician practices in Massachusetts have been on the upswing since the first patient experience survey in 2005” [the year MHQP began its patient experience surveys].

In reacting to the report, MMS President Richard Aghababian (photo, right) told the Associated Press that patient experience can be valuable as one piece of information for patients to use in selecting a physician.  But he echoed CR’s caveat — that patients should consider many other factors, such as recommendations from family or friends, treatment outcomes, doctor safety, and a doctor’s access to particular hospitals.

“It might be helpful to scan what other people have thought about this physician,” Dr. Aghababian said, “but it’s a very personal thing.  It’s not like you’re rating a motor vehicle. It’s a little bit hard to analyze human interaction.”

Dr. Aghababian also agreed with Consumer Reports that such ratings can be helpful to physicians. “If we can glean information from data like this, along with all the new data that’s flowing from medical research, if that will lead to better patient care, then we should take advantage of the information.”

To review the ratings, visit Massachusetts Health Quality Partners at

January Physician Focus: Wound Care

Posted in Physician Focus, Primary Care on December 30th, 2011 by MMS Communications – Comments Off on January Physician Focus: Wound Care

While the human body has a natural and wonderful ability to heal from  wounds or injuries, an estimated eight million Americans suffer from chronic or non-healing wounds. Many of those are patients with diabetes, injuries from radiation, venous disease, and spinal cord injuries, and in many cases these patients require specialized care.

The January edition of the Massachusetts Medical Society’s Physician Focus television program takes an inside look at this specialized care with health care professionals from The Wound Care Center at Harrington, part of Harrington HealthCare System, headquartered in Southbridge, Massachusetts.

Guests for the show are Evan Provisor, M.D. (photo, center), Medical Director of The Wound Care Center, and Susan Proulx, B.S.N., R.N. (right), Program Director.  Led in discussion by primary care physician Bruce Karlin, M.D. (left), Dr. Provisor and Nurse Proulx describe the varied conditions that can lead to chronic wounds, how healing is measured, state-of-the-art treatments, and how a wound care center offers a comprehensive approach to the care of chronic wounds.

Physician Focus, entering its eighth year of health care programming in 2012, is available for viewing on public access television stations throughout Massachusetts. To view online, visit Physician Focus is also available on iTunes at

Despite Travails, Internist’s Practice Stays Open to New Patients

Posted in Global Payments, Primary Care, workforce on June 8th, 2011 by MMS Communications – Comments Off on Despite Travails, Internist’s Practice Stays Open to New Patients

Richard Dupee, M.D., a Wellesley-based internist and geriatrician whose practice has about 10,000 patients, is among a dwindling segment of primary care physicians accepting new patients.

“It’s a matter of business survival,” explained Dr. Dupee, whose practice accepts several new patients every week, including MassHealth enrollees. “I need to keep [patient] volume up to stay in practice.”

Dr. Dupee also thinks closing a practice to new patients sends the wrong message to existing ones. “If you close a practice to new patients, some existing patients might wonder if you’re too busy to see them,” he said.

Of the many primary care physicians who have closed their practices to new patients (see the 2011 Patient Access to Health Care Study), Dr. Dupee said, “I think they’re interested in maintaining a more 9-to-5 lifestyle.” The same preferences motivate young physicians coming out of residency, “so they become employees, with guaranteed salaries, no nights, and no weekends,” he said.

Dr. Dupee is also an associate professor at Tufts University School of Medicine, where he teaches, among other courses, a small medical ethics seminar. “Most of those students are interested in primary care, but they get discouraged by the attitudes of the primary care doctors they work with who don’t love what they do…I love what I do.”

Having said that, Dr. Dupee is quick to itemize the daily travails of a small primary care practice: time wasted on paperwork and prior authorizations and low reimbursements. Increased pay for primary care may eventually come from savings due to better-coordinated care and stricter adherence to clinical guidelines. But in the short term, Dr. Dupee sees no solution to the pay disparity other than to rob Peter to pay Paul. “At some point, subspecialists may have to realize that some of those dollars will be maneuvered to primary care,” he said.

Dr. Dupee’s practice belongs to the New England Quality Care Alliance, a network of autonomous solo and group practices, IPAs, and academic physicians affiliated with Tufts Medical Center. His experience with payers as part of that alliance has convinced him that “global pay for Medicare patients makes sense.” What about the rationing that global-payment critics warn against? Dr. Dupee said that no matter what the payment or delivery system is, “doctors do not and will not deny appropriate care.”

Through the Lens: PBS Looks at Mass. Health Reform, Four Years Later

Posted in Health Reform, Primary Care on November 16th, 2010 by MMS Communications – Comments Off on Through the Lens: PBS Looks at Mass. Health Reform, Four Years Later

Public Broadcasting television’s PBS NewsHour returned to Massachusetts last week to examine how the state, physicians, and residents are faring under the state’s health reform law, four years after it was established in the Commonwealth, and to see what lessons it may offer for national reform.  PBS reporters visited Franklin County, a rural area in Western Massachusetts, and spoke with patients, families, and small business owners to gauge the effects of the state’s landmark health care reform act of 2006.

Among those interviewed were two primary care physicians in Franklin County who offered varying perspectives of doctoring in a rural area: Dr. Joseph Viadero of Connecticut River Internists and Dr. Sarah Kemble of the Community Health Center of Franklin County.

See the physicians’ interviews here.  View the PBS news report here.

A Day in the Life of a Physician: Part 4

Posted in A day in the life of a physician, Primary Care on August 23rd, 2010 by MMS – 2 Comments

By Robin Dasilva and Therese Fitzgerald

This is the final in a series of four posts about a day in the life of Barry Izenstein, MD, an endocrinologist and internal medicine physician who practices in Springfield and Holyoke, Mass.

Read Part 1, Part 2 and Part 3.

Devotion to Patients – From Physician and Staff

Mid Afternoon

DSCN0688Dr. Izenstein’s office staff manages the front office as he continues seeing patients. The office staff is very dedicated to the practice. It is readily apparent that they enjoy their jobs and love working with the physicians and patients in the practice. The atmosphere is more like a family than a workplace.

The office transcends its designation as a place for medical care to a place of caring, similar to a home for patients. For example, one of Dr. Izenstein’s patients, who is mentally challenged, came in for a scheduled appointment. The staff was very attentive to her needs and made sure she was comfortable during her stay. They also ensured that she had her medication and a ride home. The staff often arranges rides for her and takes the saying “give you the shirt off your back” to a new level, with one staff member giving the patient her own coat when the woman arrived in inclement weather without one. On her way home that night, the staffer stopped by to retrieve the coat and check on the patient.

The familial feelings of home fall away and we’re brought back to reality when we ask the office staff about their typical day’s activities. We discover that staff spends most of its time dealing with administrative procedures pertaining to insurance companies. Most of the issues involved prior authorizations, lack of reimbursement, and billing issues related to coding.

According to Dr. Izenstein, insurance companies are not adequately covering medications and turning down prior authorizations. Dr. Izenstein was frustrated that as a physician he was spending so much time getting a prior authorization for patient care. He noted that insurance companies continue to add many hours to both the physician and staff’s days due to administrative burdens.

According to the staff, prior authorizations, referrals, and billing issues take up much of their time. Prior authorizations seem to be needed for everything, especially for primary care. Staff spends numerous hours getting prior authorizations. Nine out of ten times they are approved after phone calls to the insurance companies and nearly 100 percent of the time they are approved after peer conferences. When billing, staff estimates receiving only 50 percent of reimbursements. Billing issues mainly are due to coding errors, adding additional time on the phone with insurance companies.

Even when he successfully navigates the system of administrative procedures to provide the prescribed care, Dr. Izenstein faces further barriers of an administrative nature. Specifically, due to the high costs of prescriptions, many of Dr. Izenstein’s patients can’t afford their prescribed medications.

Late Afternoon

As the afternoon wears on, Dr. Izenstein continues to tend to his patients and return phone calls. As he works, we learn from the staff that Dr. Izenstein was greatly influenced by his father, a man who is also seen as an inspiration to many people in Springfield.

The staff was excited to tell us about the upcoming annual grand rounds at the Bay State Medical Center dedicated to the elder Dr. Izenstein’s memory. The Dr. Louis A. Izenstein Visiting Professorship and Lectures in Diabetes, Obesity and Metabolism was started by Dr. Izenstein and his siblings upon the death of their father in 1996. The lectures were developed by the Division of Endocrinology, Diabetes and Metabolism to honor the memory of Dr. Izenstein “who is considered a pioneer and visionary in his native Springfield”.

Dr. Izenstein’s father returned to the Springfield area upon finishing his training to develop an Academic Department of Medicine with a special focus on the development of high-level faculty and to bring the “state of the art” to the management of diabetes. From all accounts, the younger Dr. Izenstein is following in his father’s well-regarded footsteps and is beloved by his patients and staff for his dedication to his patients.


It is 5:00 p.m. and Dr. Izenstein is still working, seeing patients. He’ll be there late into the evening catching up on the paperwork and phone calls that are necessary but time-consuming to his practice.

Anyone spending the day with Dr. Izenstein can see how dedicated he is to taking care of his patients. And although Dr. Izenstein’s practice may not fit all of the criteria for the “medical home” models being piloted across the state and the nation, this physician’s warmth and caring embodies the true spirit of that model by providing a place where patients are welcomed, supported, and cared for in a nurturing environment.

End of series.