Leaving on a Jet Plane - New Hampshire Medical Society

Physicians’ Bi-Monthly
July/August 2015
Leaving on a Jet Plane
By Charles Blitzer, MD
Friday May 1, 2015, at 12:30 pm, I
realized that I would be leaving the
next day to work providing disaster
relief in Nepal. One week earlier
a 7.8 magnitude earthquake had
caused extensive destruction in
Kathmandu and decimated many
remote villages killing approximately 9,000. Initially it appeared
there likely would not be a call to
the disaster responders’ roster
maintained by the American Academy of Orthopaedic Surgeons.
However, Wednesday, April 29,
International Medical Corps (IMC)
sent out request for aid. My practice partners readily picked up my
clinical commitments and my wife
helped procure necessary supplies
from friends, EMS and Kittery
Trading Post. I was on call Friday
Physical Activity
Matters and the
YMCA Can Help
By Rudy Fedrizzi, MD, Director of
Community Health Clinical Integration at Cheshire Medical Center/
Dartmouth-Hitchcock Keene
Leaving, cont. on page 6
Prescribing Naloxone to
Prevent Overdoses
By Seddon R. Savage MD, MS
A recently passed New Hampshire
law HB 2711 means that New Hampshire physicians can now prescribe,
dispense or distribute naloxone not
only to patients at risk for opioid
overdose, but also to family members or friends concerned about risk
of overdose in a loved one who is
not a patient of the physician. This
means, for example, that a physician
may prescribe naloxone to a father
or mother to use in the event of an
1
overdose by a heroin-using daughter
who is not a patient of the physician.
The legislation passed in May also
confers immunity from civil, criminal and professional liability to the
prescriber, dispenser, and/or administrator of naloxone in the event
of adverse outcomes related to use
of the prescribed naloxone. While
naloxone is generally regarded as a
safe drug without any clinically significant effects if given to persons
not using an opioid, it produces
http://www.gencourt.state.nh.us/ legislation/2015/HB0271.html
Naloxone, cont. on page 8
We know that to prevent and
control hypertension and reduce
the risk of cardiovascular disease
people require regular physical
activity. The Centers for Disease
Control and Prevention recommend that adults engage in 150
minutes of moderate-intensity
aerobic activity (e.g., brisk walking) every week, and musclestrengthening activities that
work all major muscle groups
two or more days per week.
But how do busy medical practitioners encourage patients to
develop a regular habit of sufficient activity? Reminding patients about the health benefits
of physical activity is not enough.
Providing a list of area fitness
centers and maps of local trails
is not enough, either. However,
one viable opportunity for medical providers is to develop integrated partnerships with local
fitness providers like the YMCA.
From 2012 to 2014, Cheshire
Medical
Center/DartmouthMillion Hearts, cont. on page 7
Physicians’ Bi-Monthly
New Hamphire Medical Society
7 North State Street
Concord, NH 03301
603 224 1909
603 226 2432 fax
nhmedicalsociety@nhms.org
www.nhms.org
President’s Perspective
Prior Authorization
scalable economies by insurers
and pharmaceutical companies.
They are far larger in scope than
ever before and have grown prior
authorization into a bigger beast,
negatively impacting many more
insured and uninsured lives.
Lukas R. Kolm, MD, FACEP...... President
Janet Monahan.....................Interim EVP
Mary West........................................ Editor
Physicians Recognized as Lifetime
Educators..............................................3
New Hampshire Medical Society
225th Celebration.................................4
EVP Corner.............................................5
Plan Now: Bioterrorism Preparedness,
Recognition and Response for the
Medical Practice.................................12
2015 NHMS Council .............................13
Doctor, can you get me some of that
medical marijuana?............................14
Save the Date: 9/24/15
Don’t Get Caught in the Weeds..........14
NHMS Welcomes New Members...........16
Save the Date! 2015 NHMS Annual
Scientific Conference!........................18
Mission: Our role as an organization in creating the
world we envision.
The mission of the New Hampshire Medical Society
is to bring together physicians to advocate for the wellbeing of our patients, for our profession and for the
betterment of the public health.
Vision: The world we hope to create through our
work together.
The New Hampshire Medical Society envisions
a State in which personal and public health are
high priorities, all people have access to quality
healthcare, and physicians experience deep satisfaction
in the practice of medicine.
Do you or a colleague need help?
The New Hampshire Professionals’ Health
Program (NH PHP) is here to help!
The NH PHP is a confidential resource that
assists with identification, intervention, referral
and case management of NH physicians,
physician
assistants,
pharmacists,
and
veterinarians who may be at risk for or affected
by substance use disorders, behavioral/mental
health conditions or other issues impacting
their health and well-being. NH PHP provides
recovery documentation, education, support
and advocacy – from evaluation through
treatment and recovery.
For a confidential consultation, please call
Dr. Sally Garhart @ (603) 491-5036 or email
sgarhart@nhphp.org.
*Opinions expressed by authors may not
always reflect official NH Medical Society
positions. The Society reserves the right to
edit contributed articles based on length and/
or appropriateness of subject matter. Please
send correspondence to “Newsletter Editor,”
7 N. State St., Concord, NH 03301.
2
Lukas Kolm, MD, MPH, MBA, FACEP
With the recent flurry of emails
regarding the concern of prior
authorization, it only makes sense
to acknowledge it further. It is
a highly germane issue that is a
real barrier to virtually all clinical
practices. The emails from several New Hampshire physicians,
share a deep-seated concern regarding this moving target. Providers and patients look forward
to more transparency regarding
drug pricing along with sensible
turnaround times to have prescriptions filled. Querying as to
whom, how and why prior authorization terms are arranged may
not be as significant as focusing
on a larger provider representation to confront and redirect this
nemesis. After all, it is not a new
animal. The process, premised
on cost control mechanisms and
market manipulation, has been
around for a really long time.
What has occurred over the past
few years is the infusion of anabolic steroids, under the guise of
________________________________________________
1
“Cost control methods in prescription drug programs can be
categorized as being targeted to
or intending to affect pharmacies
or pharmacists, drug manufacturers, prescribers, and/or consumers. Strategies directed toward
pharmacies/pharmacists or manufacturers generally are price or
discounting oriented, consistent
with a theme of volume purchasing that serves as a basic tenet
throughout managed care. Strategies directed toward consumers
or prescribers can be more complex and with utilization goals
in mind, sometimes achieved by
manipulating the cost (monetary
or non-monetary) incurred when
choosing to use (prescribe) a given drug.”1
With so many more lives covered
by the largest insurers, along with
acquisitions of pharmaceutical
companies, the competition and
negotiating powers have shifted
dramatically. Very few providers or pharmacists have a clear
understanding of how to effectively move forward with the
constant changes being put upon
them and the health care organizations that employ them. “The
five biggest [prescription benefit
manager] PBMs operating in the
President’s Perspective, cont. on page 3
Kreling, PhD, RPh, D. (2000, August). Cost Control for Prescription Drug Programs:
Pharmacy Benefit Manager (PBM) Efforts, Effects, and Implications. Background
report prepared for the Department of Health and Human Services Conference on
Pharmaceutical Pricing Practices, Utilization and Costs, Washington, D.C.
July/August 2015
Physicians Recognized as Lifetime Educators
Dr. Oge Young, a past president of NHMS, was recently awarded one of the first Geisel Academy of
Master Educators Lifetime Educator Awards. The peer-selected award recognizes master educators
whose past contributions and dedication have greatly impacted the Geisel School of Medicine
at Dartmouth and who have helped to further its educational mission. Pictured, from left, are
recipients, Dr. Peter A. Mason, Dr. Harold Swartz, and Dr. Oge Young. Photo by Jon Gilbert Fox.
President’s Perspective, cont. from page 2
United States are very large, covering more than 50% of patients
with pharmacy benefits [Express
Scripts, Inc. being one of the industry leaders along with CVS
Caremark, who just recently acquired all of Target’s in store
pharmacies]. These rankings and
numbers come from a survey of
PBM performance during the
second quarter of 2011 conducted by Atlantic Information Services.”2 The yield and impact to
make needed changes may be low
in pursuing the details regarding
________________________________________________
hospitals’ arranged prior authorization agreements. However,
sharing the legislative efforts of
other states could be far more
helpful in focusing on key areas
where a bit of collective reasoning
could redirect segments of prior
authorization in the best interest of our practices and patients.
Refer to the “New Uniform Prescription Drug Prior Authorization Request Form and Notification Requirements for Health
Plans in California”3 illustrating
one of several states that have
and are moving toward legislative
measures to draft uniform regulations.
Having insight as to who the largest pharmacy benefit managers
are and how they may be impacting relationships in New Hampshire is key. Moving forward with
streamlined efforts to bring this
information to providers could
expedite welcome change, rather
than polling providers as to what
their respective awareness is regarding their institutions’ PMB
contracts. �
Lamb, Edward. Top 5 Pharmacy Benefits Managers Retrieved June 16, 2015, from http://pharmacy.about.com/od/Insurance/a/Top-5Pharmacy-Benefits-Managers.htm.
3
Johnson & Johnson Health Care Systems Inc. (September 2014). New Uniform Prescription Drug Prior Authorization Request
Form and Notification Requirements for Health Plans in California. Retrieved from https://www.janssenaccessone.com/assets/CAPrescription-Drug-Prior-Authorization-Form.pdf.
2
3
Physicians’ Bi-Monthly
New Hampshire Medical
Society 225th Celebration
On May 4, 1791, ten of the nineteen charter members of the
New Hampshire Medical Society (even then, quorums were
hard to achieve and coverage hard to obtain!) met at Lamson’s
Tavern in Exeter, the first meeting of our historic organization.
And so, on Friday evening, May 6, 2016, we expect that a
much larger number of New Hampshire physicians will
gather to celebrate the quasquibicentennial (yes, that’s what
they call the 225th anniversary!) of our New Hampshire
Medical Society. Lamson’s has closed, but the newly
renovated Manchester Country Club will provide a suitable
alternative for this gala celebration. And we expect that most
of you will have an easier trip than Dr. John Roberts of
Plymouth, New Hampshire, who traversed on horseback
“many miles of rough terrain” to attend the 1791 gathering.
So mark your calendars and electronic devices to “save the
date” a year from now. Stories will be told; awards and
recognitions presented; entertainment and oratory elicited.
Please plan to join us as we celebrate our honorable
profession in a manner that those post-Revolutionary
doctors could only have imagined was possible!
Gary Sobelson, MD
for the 225th Anniversary Celebration Committee
4
July/August 2015
EVP Corner
New Hampshire Leader
By Janet Monahan
Interim Executive Vice President
For four days in June, I had the
honor and privilege to escort
NHMS past president and former AMA delegate, Dr. Georgia
Tuttle, in her successful campaign for reelection to the AMA
Board of Trustees. Watching Dr.
Tuttle interact with her physician
colleagues whether in a casual
press-the-flesh reception, at the
21 formal scheduled candidate
interviews or in front of the full
AMA House of Delegates, made
me realize two things. First, I was
so glad that it was Georgia and
not me, and second, I was genuinely proud that this impressive
and well-respected physician was
from the New Hampshire Medical
Society. Georgia stood head and
shoulders above her competition
because of her remarkable background and because of her pas-
sion and dedication to organized
medicine. For those of you who
don’t know a lot about Georgia …
•She is a solo, private practice
dermatologist who, several
years ago, also worked parttime for Dartmouth-Hitchcock.
•Georgia grew up in a military
family and as a result is very
familiar with the VA health
system and TRICARE.
•She was the first female president of NHMS.
•In her seventh, unpaid term
as Mayor of Lebanon, New
Hampshire, Georgia is seeing
the heroin and drug abuse
epidemic from a unique perspective.
•Georgia is a former medical
staff president, where she has
experience rewriting hospital
bylaws.
NHMS AMA delegate, Dr. Bill Kassler and AMA Board of Trustees member,
Dr. Georgia Tuttle, at the 2015 AMA Annual Meeting in Chicago, June 6-10.
•Extensive legislative experience is another attribute she
possesses, starting back in the
1990’s with limiting laser use
in New Hampshire to only
physicians, enactment of the
medical malpractice panel law
(RSA 519-B), protection of
physician malpractice insurance funds (JUA), repeal of
the Medicare SGR cuts and
most recently, the ban on indoor tanning for minors.
•She is also the Tuttle of Georgia Tuttle vs the NH Medical
Malpractice Joint Underwriters
Association.
The Tuttle case was noteworthy in
Georgia’s AMA campaign because
it demonstrated her persistence
when faced with an injustice that
affected her physician colleagues.
In 2009, Georgia took a personal, professional and financial risk
when she joined Lakes Region
General Hospital and Derry Medical Center in a lawsuit to prevent
the state of New Hampshire from
taking $110 million in JUA policy holder excess surplus premiums to balance the state budget.
That successful legal challenge
returned $109 million to physician policyholders in 45 states and
seven countries. Georgia personally spent a year and a half on her
computer and telephone locating
hundreds of “lost” physicians or
their heirs. Nationally the Tuttle
case has significance because it
was cited in successful legal challenges in Wisconsin and Pennsylvania when physicians were facing similar battles.
EVP Corner, cont. on page 15
5
Physicians’ Bi-Monthly
Leaving, cont. from page 1
and in the OR until after 8:00 pm, so there was little
time to dwell on packing.
On arrival in Kathmandu Monday morning I joined
the IMC team, initially working to arrange hospital
space to provide care for earthquake victims. Politically this turned out to be a challenge, but allowed me
the opportunity to join a mobile medical unit (MMU).
The MMU visited remote (two-day arduous hike in
good times) villages to assess damage and needs. We
traveled by helicopter, camped in small tents and ran
clinics (mostly primary care) and helped move stones
from collapsed houses. It was remarkable to be in my
Somersworth office with no travel plans on Friday
morning and to be looking out upon a decimated village in the shadow of
8,000 meter mountains on Tuesday! I
have volunteered in
various parts of the
developing
world
mostly on an elective basis with Health
Volunteers Overseas.
All my experiences
have reinforced the
often given advice
that it is important to
be flexible when you
work in the developing world, but certainly much more so
with disaster relief.
Part of my time was
spent at remote villages, part at a large
Kathmandu teaching
hospital, then out to
a 15-bed community
hospital, then back
to Kathmandu. I am
extremely impressed
with the quality of
care and commitment demonstrated
by the Nepalese orthopaedic surgeons.
My closest contact
spent seven consecutive days at the hospital, leaving only to
have one meal at home with his wife and two
young children. He operated through major
aftershocks and also the second major (7.3)
earthquake keeping his team highly functional throughout. IMC did excellent work
with logistics as well as large scope of needs:
sanitation, food, and shelter as well as medical. IMEC, a local organization, mobilized
to get much needed equipment to Nepal
promptly. I would certainly consider further
work in the developing world – elective or
disaster related. For those with interest in
working in the developing world consider:
https://hvousa.org/ourwork/programs/
https://careers.internationalmedicalcorps.
org/volunteer.html
http://imecamerica.org/ �
6
July/August 2015
Million Hearts, cont. from page 1
Hitchcock Keene (CMC/DHK)
and the Keene Family YMCA
collaborated on several pilots of
an evidence-supported program
called “Activity is Good Medicine”
(AGM). AGM is loosely based
on the Exercise is Medicine® program that was developed by the
American College of Sports Medicine. Primary care provider offices screened patients for their
level of activity using a simple tool
(i.e., the Stanford Brief Activity
Survey) as a routine assessment
during the intake process for appointments. Patients who demonstrated an insufficient level of
physical activity were referred to
a three-month individualized program at the Keene Family YMCA
to establish a lasting activity habit.
Once referred, an exercise regimen was designed for participants
in a supportive, welcoming, nonjudgmental environment. Realistic fitness improvements were
achieved through cardiovascular
activities, strength training, and
attention to flexibility and balance.
All participants received one-onone consultation with a YMCA
health coach for orientation to the
YMCA facilities, exercise equipment and pool. The health coach
also completed an exercise history
and current health intake screening, performed simple baseline
fitness testing, reviewed
attainable goals and made
a recommendation for the
best exercise routine to get
started. The Keene Family YMCA created a peer
support group for motivation and social connection.
In addition, a nutritionist,
in partnership with the
Keene State College Dietetic Internship Program,
was available to participants for group education.
This program was available at a
nominal cost to the patient. The
YMCA waived its customary membership fee and discounted its typical monthly charges. CMC/DHK
used community benefit funds to
offset remaining costs through
a HIPAA-compliant contractual
agreement with the YMCA. At
the end of the three-month period, patients were encouraged
to continue their YMCA membership at the standard monthly
rate. Participants with financial
concerns after the initial program
could apply for YMCA scholarship assistance to help reduce the
burden of cost.
Currently, plans for the next iteration of AGM are underway and
will likely include access to other
fitness centers in addition to the
YMCA.
Data from the three AGM pilots
revealed positive participant outcomes, including improvements
in biometric and fitness screening and qualitative measures of
engagement, activation and satisfaction. Results showed 90 day
weight losses of between 4.4-6.7%
of body weight and an 8-11% increase in fitness measures (e.g.,
six-minute walk test).
Another example of clinicalcommunity collaboration stems
from the Assn. of State Technical Health Officials (ASTHO)/
Million Hearts Project in Manchester, New Hampshire. The
Manchester Department of Public
Health (MDPH) partnered with
the Granite YMCA - Downtown
Manchester branch to increase
access to affordable places for
recreation. The Granite YMCA
generously provided a low-cost
membership to all Million Hearts
Project patients of Manchester Community Health Center
(MCHC) and their family members. This membership could be
used to access YMCA facilities
without any restrictions, at a cost
of only $10 per month. Additionally, the YMCA provided MDPH
and MCHC with five no-cost family memberships to distribute as
they saw fit. The Granite YMCA
also provided a report of facility
usage to the providers to track the
engagement of referred patients
and families.
The YMCA of Greater Nashua
offers “Prescribe the Y” which is
a free youth wellness program for
children ages 6 to 13 that is linked
to the child’s pediatric provider and is one of the many other
examples of ways in which New
Hampshire YMCAs are collaborating with medical providers to
help patients incorporate and sustain more physical activity
into their lives.
For more information
about collaborating with
your local YMCA and
other fitness providers
or other Million Heartsrelated activities taking
place in New Hampshire,
please contact Rudy Fedrizzi, MD 603.354.5400
or
rfedrizzi@cheshiremed.com. �
7
Physicians’ Bi-Monthly
Naloxone, cont. from page 1
opioid withdrawal in persons using opioids. Withdrawal is usually uncomfortable, but medically
benign. However, relatively rare
complications of withdrawal can
include combativeness related to
anxiety and disorientation, tachycardia/hypertension creating risk in
persons with serious cardiovascular
disease, and unmasking of hypoxic
seizures. The risks associated with
these must be understood against
the likelihood of death if naloxone
is not administered.
Context
Naloxone has been routinely used
for decades to reverse opioid overdoses in hospital emergency rooms
and by some EMTs in the field.
With rising opioid overdose deaths
across the country, its use in diverse
community settings has rapidly expanded and families and friends of
persons at risk for overdose have
understandably sought access to
naloxone for use in an overdose
emergency with a loved one.
In New Hampshire all levels of
EMT personnel now carry naloxone for use in opioid overdose
emergencies.
Recent legislation
authorizes training and use by law
enforcement as well, but actual implementation will be elective by different jurisdictions.
An FDA study and report published in April 2012, suggests that
over-the-counter (OTC) availability
of naloxone may occur in the future
but is not likely for at least several
years. In the meantime, in some
states, such as Rhode Island, naloxone is available OTC at some chain
pharmacies including RiteAid and
CVS, through collaborative practice
agreement between state physicians
and pharmacists. The new New
Hampshire law stipulates that prescribers may make naloxone available through standing orders, but
at press time for this article, NHMS
was still communicating with the
8
Attorney General’s office to fully
understand what this can mean in
practice.
Considerations in prescribing
There are a few issues to be considered in prescribing naloxone to
opioid users and/or their families
or loved ones. Detailed and reliable information for prescribers
and pharmacists is available on all
of these at the excellent website:
www.prescribetoprevent.org
•Who should receive prescriptions for naloxone? There are
two schools of thought, both of
which are supported by the new
law so physicians can determine
what is right in their judgment:
оOne perspective suggests it
should be given to persons
identified as being at high
risk of overdose. Some risk
factors include:
•Current or past opioid use
disorder including use of
heroin or misuse of prescription medications.
•Patients prescribed opioids
for pain who have:
wMisused their opioids,
wCurrent or past history of
any substance disorder,
w
Presence of significant
psychiatric disorder,
wOpioid dose greater than
50-100mg
morphine
equivalents, or
wCo-occurring medical risk
factors: pulmonary dysfunction, renal or hepatic
disease, central nervous
system compromise or
others.
оThe other perspective suggests it should be routinely
provided along with all opioid
prescriptions, similar to providing glucose tablets to persons on insulin, as well as to
persons known to use street
opioids. Arguments are:
• What constitutes “high risk”
is not certain; and
•The ability of clinicians to
accurately identify risk is
limited.
• A number of forms of naloxone
are currently available. Each
may or may not be covered by
different insurances.
о
Injectable vial and syringe
form is cheap but perhaps
challenging for stressed lay
persons to use in an emergency and risk of needle stick.
о
Intranasal naloxone, inexpensive and available in kits
that can be ordered by pharmacies, no risk of needle
stick, not FDA approved but
widely used and studies support nearly similar efficacy to
intramuscular.
оFDA approved auto-injector,
Evzio, is relatively expensive
but with long shelf-life, no
needle stick risk, user friendly
audio instructions.
•Pharmacy availability may be
limited.
оHave someone in your office
identify a pharmacy that carries naloxone and/or
оProvide information to your
local pharmacy regarding options available for ordering
(see www.prescribeto prevent.org).
•Patient/family/friend
education.
Key inclusions which
are available at www.prescribe
toprevent.org as prepared
handouts:
оNeed to call 911 for help and/
or transport to hospital due to
short acting nature of naloxone,
Naloxone, cont. on page 13
July/August 2015
9
Physicians’ Bi-Monthly
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July/August 2015
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11
Physicians’ Bi-Monthly
Plan Now: Bioterrorism Preparedness, Recognition and
Response for the Medical Practice
By Lisa R. Anthony, MPH Loss Prevention Specialist
A bioterrorism attack is the deliberate release of viruses, bacteria or other germs used to cause illness
or death in people, animals or plants. Bioterrorism
agents are typically found in nature, but it is possible
that they could be changed to increase their ability to
cause disease, make them resistant to current medicines, or to increase their ability to be spread in the
environment. It is believed that terrorists may use biological agents because they are difficult to detect and
do not cause illness for several hours to several days.
Physician practices and healthcare facilities are advised to look out for unusual diseases not typically
seen in the area. Other potential clues that raise suspicion for a bioterrorism attack include new types of
antibiotic resistance in bacteria, unusual numbers of
cases of a disease, and atypical presentation of diseases. The general public should also be on the watch
for bioterrorism. Events that might suggest an attack
include mass fatalities or a spike in illness in a small
geographic area, mass fatalities spanning a variety of
animal species, or patients with multiple diseases, indicating a mixed attack.
The CDC has developed a classification system for
biological terror agents. The categories are based on
how easily the agents can be disseminated and the
severity of patient illness or deaths they cause. The
agents can be spread through air, water, or in food.
Some bioterrorism agents can be spread from person
to person and some cannot.
Physicians, clinical staff and medical practice staff
need to develop competency in the clinical aspects
of bioterrorism. This includes how to recognize and
report early signs and symptoms of unusual sickness
and how to diagnose and treat conditions that may be
caused by a bioterror attack. Also, all clinicians must
be aware of post exposure management requirements for staff and patients.
Since the future possibility of an event is high, it is
best practice to develop a comprehensive medical office emergency preparedness plan as soon as feasible.
Preparations for a bioterrorism attack are similar to
preparations for many emergencies that can disrupt
a practice flow, such as natural events, practice emergencies and public health outbreaks. A plan will reduce uncertainty in both physicians and staff in the
event of a local, national or international event. �
12
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July/August 2015
2015 NHMS Council
President Lukas R. Kolm, MD
President-Elect John R. Butterly, MD
Immediate Past President Stuart J. Glassman, MD
Penultimate Past President P. Travis Harker, MD, MPH
Vice President Deborah A. Harrigan, MD
Secretary Seddon R. Savage, MD
Treasurer
Gary A. Sobelson, MD
Speaker Richard P. Lafleur, MD
Vice Speaker Tessa J. Lafortune-Greenberg, MD
AMA Delegate
William J. Kassler, MD, MPH
AMA Alternate Delegate Cynthia S. Cooper, MD
Chair, Board of Trustees David C. Charlesworth, MD
Medical Student Vivienne Meljen
Physician Assistant Mark H. Rescino, PA-C
NH Osteopathic Assn. Rep. Robert G. Soucy, Jr., DO
Young Physician Rep.
Vladimir Sinkov, MD
Young Physician Rep. Jeffrey C. Fetter, MD
Member-at-large Tina C. Foster, MD
Member-at-large Gregory Kaupp, MD
Member-at-large John L. Klunk, MD
Member-at-large Edmund Schiavoni, Jr., MD
Member-at-large Anthony V. Mollano, MD
Member-at-large Everett J. Lamm, MD
Physician Member of
NH Board of Medicine
Nicholas Perencevich, MD
Sarah Blodgett, Esq.
Lay Person
Martin Honigberg, Esq.
Physician Rep. of the
NH Dept. Health Human Services
Doris H. Lotz, MD, MPH
Specialty Society Reps.:
·NH ACOG Oglesby H. Young, III, MD
·NH Academy of Family Physicians Gary A. Sobelson, MD
·NH Chapter of the
American College of Physicians Richard P. Lafleur, MD
·NH Chapter of the
American College of Cardiology
Daniel Philbin, MD
·NH Chapter of Emergency Physicians Michelle S. Nathan, MD
·NH Orthopaedic Society
Robert J. Heaps, MD
·NH Pediatric Society
Tessa J. Lafortune-Greenberg, MD
·NH Psychiatric Society
Leonard Korn, MD
·NH Society of Anesthesiologists
Steven J. Hattamer, MD
·NH Society of Eye Physicians & Surgeons Sonalee M. Desai-Bartoli, MD
·NH Society of Pathologists
Jeoffry B. Brennick, MD
Trustee
David C. Charlesworth, MD
Trustee Charles M. Blitzer, MD
Trustee Cynthia S. Cooper, MD
Invited Guest: MGMA Rep. Dave Hutton
Naloxone, cont. from page 8
оIdentification of opioid overdose,
о
Rescue
positioning
breathing,
and
оWhen and how to use naloxone, and
оPossible side effects of naloxone and how to manage.
•Will increased naloxone availability have the unintended
consequence of giving a sense
of safety and encouraging more
opioid use?
оThere are no studies directly
assessing this concern.
о
However, overdoses may
occur for diverse reasons
most of which would not be
changed by the presence of
naloxone.
wAddicted persons are compulsively driven to use and
will not likely hold off in the
absence of naloxone.
wPersons with co-occurring
medical problems experience overdose as a result of
medical issues, not intentional overuse.
wPersons with psychiatric issues may experience overdose in desperation to be
relieved of symptoms.
оOn the other hand, some persons conceivably might experiment with opioids they might
not otherwise misuse due to a
sense of safety in the presence
of naloxone.
As with all medical care, prescribing
of naloxone requires assessment of
the potential risks and benefits; in
most contexts, the availability of
naloxone is expected to reduce risk
and save lives. �
13
Physicians’ Bi-Monthly
Doctor, can you get me some of that
medical marijuana?
By Travis Harker, MD, MPH
If you haven’t been asked about
medical marijuana yet, you soon
will be. RSA 126-X, the therapeutic cannabis law, passed in 2013
and created a process for people
in New Hampshire to obtain and
use marijuana for therapeutic
purposes for a limited number
of conditions and symptoms. Recently four Alternative Treatment
Centers (ATCs) or marijuana dispensaries were selected, and once
the locations are finalized, they
will open their doors for business
in about 8-9 months. So you have
a little time to prepare for how
you will address requests in your
office.
In New Hampshire, physicians
won’t prescribe therapeutic cannabis but rather will certify that a
patient has both a qualifying con-
dition AND has a set of qualifying symptoms. You are under no
obligation to certify a patient for
therapeutic cannabis and should
only do so if you feel that they will
benefit from it. After being certified, a patient will be issued a card
by the state that they will present
to their designated ATC to purchase therapeutic cannabis.
The Medical Society surveyed
physicians and nurse practitioners licensed in New Hampshire
about their knowledge and attitudes toward medical marijuana
and found that 64% of respondents rated their knowledge of
clinical cannabis as low but that
68% would be willing to certify
patients to use marijuana therapeutically. If we are to recommend marijuana as a therapeutic
option for our patients, we need
to increase our knowledge about
its risks and benefits.
To help prepare us for this new
law, the Medical Society has organized a half-day CME program
on September 24, 2015, entitled
“Don’t Get Caught in the Weeds:
Therapeutic Cannabis in Clinical
Care.” There you will learn the
current science behind therapeutic marijuana, clinical management of patients using cannabis
for symptom control, and more
about the New Hampshire rules.
Regardless of how we feel individually about marijuana, it is coming
soon and we will be best served by
learning about the drug and the
New Hampshire therapeutic cannabis program, so that when a patient asks, we will be ready with an
answer. �
Save the Date: 9/24/15
Don’t Get Caught in the Weeds
Therapeutic Cannabis in Clinical Care
September 24, 2015,
SERESC, Bedford, NH, 1-5:15pm
Pharmacology & Biology - Evidence Based Benefits
Health Effects - Patient Counseling
Dispensary Experience - Legal Implications
14
July/August 2015
EVP Corner, cont. from page 5
This spring, Georgia helped
NHMS and her physician colleagues when she took time from
her practice, AMA Trustee duties
and her mayoral responsibilities,
to testify and educate state legislators regarding HB 508, another
potential state grab for $85 million
of JUA excess surplus premium.
Trusted Advisors for Changing Times
New Hampshire’s health-care community has
placed its confidence in our attorneys for decades
For assistance with your legal issues, please
contact our Director of
Business Development, Rob Lanney
Headquarters: Concord NH
Offices in: Gorham NH and Portland ME
603.224.2341 | www.sulloway.com
Dr. Georgia Tuttle, with newly elected
AMA president, Dr. Stephen Stack.
Dedicated
NHMS works with CGI Business Solutions for your
health, life and disability insurance needs.
CGI Business Solutions (CGI) is one of the region’s fastest growing, most innovative benefit
brokerage and consulting firms. Whether needs involve benefit design, compliance, or administration solutions, CGI has the resources to help NHMS and its members prepare for a quickly
evolving marketplace.
CGI is proud to have been named the exclusive broker for the NHMS insurance products. Please
contact our NHMS Dedicated Service Team at:
Contact: NHMS Dedicated Service Team
CGI Business Solutions
171 Londonderry Turnpike
Hooksett, NH 03106
Telephone: 888-383-0058
Facsimile: 603-232-9330
Email: nhms@cgibenefitsgroup.com
NHMS members and nonmembers benefit from leaders like
Georgia and from NHMS Council members. Whether at the state
or national level, organized medicine is your vehicle to support
the practice of medicine and improve public health. Organized
medicine is also a place to hone
your leadership skills. To enable
the AMA and NHMS to work for
physicians and patients, please remind your nonmember colleagues
that they are reaping the benefits
and to please consider joining organized medicine. Direct them to
www.NHMS.org today! �
Business Solutions
Business Simplified
15
Physicians’ Bi-Monthly
NHMS
Welcomes
New Members
The Professionals Health Program provides
a range of direct services to support health,
well-being and resilience of New Hampshire
physicians, physician assistants, pharmacists, and
veterinarians. We work with individuals who are
experiencing difficulties with substance abuse and
addiction, psychiatric and mental health concerns,
stress, burnout, work-related conflict and a variety
of marital or family life issues.
For a confidential consultation,
please call Dr. Sally Garhart at
603.491.5036 or email sgarhart@nhphp.org.
For more information visit http://www.nhphp.org/.
16
Pankaj Bharati, MD
Wilhelmina D. Cabalona, MD
Thomas M. Dodds, MD
William J. Gessner, MD
Matthew J. Hawkins, MD
Kimberly L. MacDonald, MD
Artemio John Mendoza, MD
Anthony J. Ramirez, MD
Amit K. Sharma, MD
Jennifer N. Sirois, MD
Regan N. Theiler, MD
Stephen M. Wiener, MD
Andrew S. Wu, MD
July/August 2015
Practicing medicine has enough risks;
compliance shouldn’t be one of them.
WANTED
New Hampshire Medical Society is pleased to
introduce a new corporate affiliate,
First Healthcare Compliance.
First Healthcare Compliance provides a comprehensive, turnkey
compliance program management solution proven to save time
and money while addressing the compliance needs and challenges
of physicians in private practice, and those in hospital networks and
health systems, skilled nursing facilities and healthcare billing
companies.
The First Healthcare Compliance Solution helps you comply with
every federal regulation including HIPAA/HITECH, OSHA, the False
Claims Act, the Anti-Kickback Statute and Stark, all in one place.
Our members receive a 10% lifetime discount.
Learn more
Contact First Healthcare Compliance at:
Email: info@1sthcc.com
Call: 888-54-FIRST
Visit: http://1sthcc.com/nhms
Don’t put your business at risk,
start complying today!
Internal Medicine, Orthopedic, Neurologic,
General or Family Practice Physicians
interested in providing part-time or fulltime staff medical consultant services or
are interested in performing consultative
examinations in your office for the Social
Security Disability program, under contract
at the state Disability Determination
Services office in Concord, NH, should
email a current CV to Anne.Prehemo@
ssa.gov to begin the process. The medical
contractor must be licensed in the state
of New Hampshire. Staff work involves
performing medical reviews of disability
claims and requires no patient contact.
Anthem BCBS
First Healthcare Compliance, LLC
Northeast Delta Dental
AutoFair
Foundry Financial Group, Inc.
ProAssurance
Baystate Financial
Freedom Energy Logistics, LLC
Professional Office Services, Inc.
Bridge & Byron Printers/Speedy
Printing & Copying
HUB Healthcare Solutions
Rath, Young and Pignatelli
I.C. System
Shaheen & Gordon, PA
Kilbride & Harris Insurance
Services, LLC
Software Advice
CGI Business Solutions
CMIC RRG
Coverys
Sulloway & Hollis, P.L.L.C.
Crown Healthcare Apparel Service
Medical Mutual Insurance Company
of Maine
Sunovion Pharmaceuticals, Inc.
Eaton & Berube Insurance Agency
Minuteman Health, Inc.
Wadleigh, Starr & Peters, PLLC
NHMS CAP is a paid membership program whose members meet criteria as posted at www.nhms.org
17
Physicians’ Bi-Monthly
SAVE the DATE
New Hampshire Medical Society
Annual Scientific Conference
November 6-8, 2015, Sheraton Harborside, Portsmouth, NH
THE MANY FACES OF
ADDICTION
The Journey of Prevention: from Awareness to Best Practices







Recognizing the addicted patient
Treatment and availability of services
Knowledge gaps regarding drug treatment programs
Appropriate use of opioid agreements
Provider to provider communications
Methadone maintenance – the NYC Model
Global solutions/strategies for public health care, providers and communities
For families …
Seacoast Science Center
Kittery Outlets
Prescott Park
Portsmouth Harbor Trail
Lots of History!
18
MAJOR SPONSOR
July/August 2015
When you need it.
Medical professional liability insurance specialists
providing a single-source solution
ProAssurance.com
19
Prsrt Std.
U.S. Postage
PAID
Concord, NH
Permit No. 1584
7 North State Street
Concord, NH 03301
603 224 1909
603 226 2432 fax
nhmedicalsociety@nhms.org
www.nhms.org
ADDRESS SERVICE REQUESTED
Printed on recycled stock using soy-based inks.
2015 AMA Annual Meeting in Chicago a Success*
Dr. Tuttle addressed the AMA House after her Board of
Trustees re-election and suggested that for future campaigns
there should be an official comfortable shoe for candidates.
* For more details and photos, see page 5
NHMS president, Dr. Lukas Kolm
(right), with Dr. Stephen Stack, the
first emergency medicine physician to
serve as president of the AMA