Society Reaffirms Opposition to Physician

2 PRESIDENT’S MESSAGE
3 YOUR PRACTICE Medicare Revalidation Update • ACOs & Innovation
4 THE PUBLIC’S HEALTH Physicians Push Tobacco Bans • Effects of Biomass
Combustion • Alliance Charitable Foundation Supports Medically Underserved
5 GOVERNMENT AFFAIRS An Interview with House Majority Leader Ron Mariano
6 PROFESSIONAL MATTERS When Poor Record Keeping Is a Red Flag • Bullies &
Victims: Can You Tell the Difference? • Resources for International Medical Graduates
7 INSIDE MMS Work/Life Balance for Young Physicians • Get LinkedIn to the MMS •
Across the Commonwealth • In Memoriam
volume 17, issue 1, december 2011/january 2012
8 MMS EDUCATION PROGRAMS
Society Reaffirms Opposition to Physician-Assisted Suicide
Vote Comes at 2011 Interim Meeting
By erica noonan
T
he Society voted this
month to reaffirm its
­opposition to physicianassisted suicide, with its House
of Delegates voting by a threequarters margin to maintain a
policy the Society has had in
­effect since 1996.
Opposition to physician-assisted
suicide was part of a larger policy
statement that includes recognition of patient dignity at the end
of life and the physician’s role in
caring for terminally ill patients.
“Physicians of our Society have
clearly declared that physician-­
assisted suicide is inconsistent
with the physician’s role as healer
and health care provider,’’ said
Lynda Young, M.D., president of
the Society. “At the same time,
we recognize the importance of
patient dignity and the critical
role that
Another policy
physicians
adopted by the
have in
Society at its
end-of-life
meeting, held
care.’’
Friday and SaturThe upday, December 2
dated policy
and 3, was one
includes
to maximize
“support
­influenza vaccifor patient
nation among
dignity and
health care workthe alleviaers by supporting
Photo by Doug Bradshaw
tion of pain Members prepare to cast electronic votes.
efforts by the
and sufferMassachusetts
ing at the end of life.” It also inDepartment of Public Health and
cludes the Society’s commitment
other health care ­organizations.
to “provide physicians treating
In the event other means are not
terminally ill patients with the
successful at maximizing rates,
ethical, medical, social, and legal
the MMS determined it would
education, training, and resources
support mandatory immunization
to enable them to contribute to
programs.
the comfort and dignity of the
Delegates also expanded
patient and the patient’s family.”
the extensive Confidentiality
Statement of Principles Policy for
patients to include genetic information, ­including testing and
disclosure.
The Society also voted to develop and implement the MMS
Health Care Access Initiative, a
program to improve recruitment
and retention of primary care
physicians. The policy includes
pursuing fund-raising efforts and
developing a strategy to sustain
the initiative.
Resolutions to convene a task
force to improve communication
between doctors and medical
­examiners and to support advocacy for mental health services
for pregnant and postpartum
­patients were also approved.
For complete coverage of
the Interim Meeting, visit www.
massmed.org/interim2011. VS
Happy 200th Birthday, NEJM
SGR Cuts Loom
2012: Year of Special Articles, Symposia
Focus on Preventing 27.4 Percent Cut
By Vicki Ritterband
On the eve of its 200th birthday,
the New England Journal of Medicine
(NEJM) is looking good for its
age. In fact, it’s thriving as the
most influential and widely read
and cited general medical journal
in the world.
But that wasn’t always the case,
according to Editor-in-Chief
­Jeffrey Drazen, M.D. For nearly
the first two-thirds of its life,
NEJM mostly gathered medical
news that had been reported
elsewhere first. Then, in 1937,
Robert Nason Nye, M.D., took
over NEJM’s reins. As legend has
it, he sent free subscriptions to
­every enlisted physician in World
War II. Many of these new readers
went on to distinguished careers
in medicine, and suddenly NEJM
had the eyes and ears of the most
influential doctors in the country.
“From the 1950s to 1970s, we
­ ecame a place to deposit the
b
most important original research
findings,” said Drazen. “We ­began
to rival Lancet and the Journal of
the American Medical ­Association.”
A list of those deposits reads
like a Who’s Who of modern medical discoveries: the first studies
making the link between DES
daughters and clear cell adenocarcinoma; the earliest descriptions of AIDS — then called gayrelated immune deficiency — and
its treatment; the initial reports
showing the cardiovascular benefits of beta blockers and aspirin
therapy; and the earliest ­papers
on everything from the use of
statins in cardiovascular disease
to new molecular advances in the
treatment of chronic leukemia
and lung ­cancer.
And as the pace of research
has quickened, NEJM has worked
hard to shorten the window between discovery and publication,
especially when the public’s
continued on page 2
With the failure of the Congressional “Super Committee” to
reach agreement last month,
prospects of a quick and permanent repeal of planned cuts to
Medicare’s Sustainable Growth
Rate (SGR) have dimmed.
The White House and Legislative leaders on both sides of the
aisle continue to maintain that
the nation’s physicians will not
see a permanent 27.4 percent
cut in payments.
In a recent statement, U.S.
Health and Human Services Secretary Kathleen Sebelius referred
to physicians as “the backbone of
continued on page 5
President’s Message
Happy 200th Birthday, NEJM
continued from page 1
SGR: Front and Center
We had a very productive Interim
Meeting here in Waltham earlier this
month, and my thanks to all of you
for your engaged and serious debate.
There are few issues so urgent as the proposed cuts of more than 27 percent in Medicare payments to
physicians. Because Congress’ Super
Committee failed to come up with
a proposal for trimming $1.2 trillion
from the budget, our chance of
finally getting rid of the Sustainable
Growth Rate (SGR) payment formula
has sustained a setback.
Most people think that these cuts
won’t go through, and a freeze on
payments will happen for probably
a year, punting the issue to after the
2012 elections.
So, now we are back to square one —
trying to keep the cuts at bay while
working towards a permanent fix.
The AMA had been working diligently
on coming up with innovative ideas
that are already in place in various
parts of the country.
They hope that by sharing new, successful approaches to how doctors
deliver care, more physicians can
start thinking of ways to change their
practices to their goals of even better
quality and cost control.
The AMA’s Innovator Committee is
working on what are the challenges,
barriers and solutions that each
group has encountered.
We are fortunate to have a Massachusetts Medical Society member on this
task force, Dr. Philip F. Gaziano, M.D.
of Springfield.
We applaud his work, and look forward to updating you on the committee’s progress in the months to come.
– Lynda M. Young, M.D.
health is at stake, as in the 2008 heparin
­contamination scare.
“The article came in on Thursday and it was published on the Web on Tuesday,” said Drazen. “The
goal of NEJM is to connect with physicians in practice and research and to get them the best information,” continued Drazen. “That’s been constant for
200 years. The way it’s done and how quickly it’s
done has changed as technology has evolved.”
Birthday Celebrations
NEJM’s legacy is woven throughout this year’s anniversary celebration. “The anniversary is all about
connections,” said Christine Lamb, director of marketing for NEJM. “Connecting with younger audiences, connecting younger generations to older, connecting NEJM’s history to the challenges in medicine
today and connecting research to practice.”
Kicking off the year with its January 5 issue, NEJM will
publish 11 specially commissioned articles by the biggest names in medicine today. Elizabeth Nabel, M.D.,
and Eugene Braunwald, M.D., will debut the series with
a survey of 200 years of heart disease — a fitting bookend to the first article that appeared in NEJM in 1812
on angina pectoris by John Warren, the father of one
of the founding editors; George Annas will pen a piece
about medical malpractice and jurisprudence; Atul
­Gawande, M.D., will write about surgery; and Paul
­Farmer, M.D., will contribute an article on tuberculosis,
to name a few of the contributors. The authors’ only
­directive is to write about something that interests them
and to highlight how NEJM connects with the topic.
Other ­special content includes a history of NEJM and
articles on therapeutics, practice, and disease from a
­historical perspective.
Anniversary Website
The special content will be collected on NEJM’s anniversary website, NEJM200.NEJM.org. The website features
video interviews with Dr. Drazen and his four predecessors as well as several long-time colleagues, an interactive timeline of medical milestones with tie-ins to
NEJM articles, an opportunity for people to vote on
their favorite NEJM article of all time, and videos submitted by NEJM readers about important or inspirational moments in their medical careers or the role
NEJM has played in their lives.
“The anniversary isn’t about how great the journal
is, but rather about the NEJM community,” said
­Pamela Miller, assistant to the editor for special
vital signs is the member publication of the Massachusetts
­ edical Society.
M
Editor: Erica Noonan
Staff WriterS: Deb Beaulieu, Vicki Ritterband
EDITORIAL STAFF: Charles Alagero, Office of General Counsel;
Robyn Alie, Public Health; Lori DiChiara, Government R
­ elations; Kerry
Ann Hayon, Managed Care; Stephen Phelan, Member­ship; Cathy Salas,
West Central Regional Office; Jessica Vautour, P
­ hysician Health Services
Production and Design: Department of Premedia and
­Publishing Services; D
­ epartment of Printing Services
pRESIDENT: Lynda M. Young, M.D.
executive vice president: Corinne Broderick
Director of Communications: Frank Fortin
2 • december 2011/january 2012 Vital Signs
­ rojects. “NEJM would be nothing without the people
p
who read it and contribute. We’re focused on them.
The anniversary gives us a more informal way to include a lot of different voices that we normally don’t
have room for on the main site.”
The anniversary website will also give a taste of
things to come, according to Christopher Lynch,
MMS vice president of publishing. “There are things
we’re doing with the website that may lead to new
ways to better communicate with our audience,” said
Lynch. “The use of social media, a more graphical
interface — we’re using it as a testing ground. Research is changing and practice is changing. We’ve
got to change with those changing needs.” VS
NEJM Then and Now
Even if Dr. Drazen’s father had been a physician instead
of a power distribution engineer, it’s doubtful he would
have granted his dad the same honor John Collins Warren, M.D., granted his in 1812: publishing his article as the first in the inaugural issue of the New England Journal
of Medicine and Surgery, the earliest incarnation of the
New England Journal of Medicine (NEJM).
In nineteenth century Boston, father and son were local
medical superstars. They were part of a small coterie of
physicians laying the groundwork for Boston as a future
health care capital by founding Harvard Medical School,
establishing the Massachusetts General Hospital, and
­creating the Massachusetts Medical Society (MMS).
In 1921, the MMS purchased what was then called the
Boston Medical and Surgical Journal for $1; after 100 years of
publication under that name, in ­February 1928, the name
was changed to the New England Journal of Medicine.
Today, NEJM is a truly international journal, with an
estimated 600,000 weekly readers in nearly every country
in the world. It strives to ferret out the best research happening anywhere. “We send our editors all over the world
to find those investigators who are at the cutting edge
of knowledge and discovery,” said Editor-in-Chief Drazen.
“We’ve gone to countries such as China, India, ­Ecuador, and
Zambia to help people who are starting research programs,
or seeking to be published, understand how it’s done.”
The outreach is by no means an indication that NEJM
lacks submissions. The odds of having an article accepted
by NEJM are about the same as getting into Harvard: of the approximately 5,000 research manuscripts sent in each year, only 5 percent are published.
Vital Signs is published monthly, with combined issues for June/July/
August and December/January, by the Massachusetts Medical Society,
860 Winter Street, Waltham, MA 02451-1411. Circulation: controlled
to MMS members. Address changes to MMS Dept. of Membership
­Services. Editorial correspondence to MMS Dept. of Communications.
Telephone: (781) 434-7110; toll-free outside M
­ assachusetts: (800) 3222303; fax: (781) 642-0976; email: vitalsigns@mms.org.
Vital Signs lists external websites for information only. The MMS is not
responsible for their content and does not recommend, endorse, or
sponsor any product, service, advice, or point of view that may be
offered. The MMS expressly disclaims any representations as to the
accuracy or suitability for any purpose of the websites’ content.
©2011 Massachusetts Medical Society. All Rights Reserved.
www.massmed.org
your practice
Medicare Revalidation Update: Have You Received a Notice?
PPRC
PHYSICIAN PRACTICE RESOURCE CENTER
medicareprovidersupenroll/11_
­revalidations.asp. When you do
­receive a notification from
the CMS, you should take the
following steps:
• Complete and submit either
Since September of this year, the
Centers for Medicare and Medicaid Services (CMS) has sent more
than 89,000 letters to physicians,
non-physician practitioners, and
facilities requesting that they revalidate their Medicare enrollment records. The health system
reform law states that by March
23, 2013, no physician or other
health professional can be enrolled or re-enrolled in Medicare
without going through the re­
validation process. This new standard of screening was designed
to prevent fraud in the Medicare
system.
Just recently, the CMS responded to pressure from physician organizations, including the
American Medical Association,
and extended the deadline to
­re-enroll by two years to 2015.
However, the extension does
not apply to physicians who have
already received a revalidation
notice. Failure to meet the timeframe designated in the letter of
notification will cause a deactivation of your record. If you are
not sure if you have received
a re­validation notice, you can
ref­erence the list the CMS compiled by ­visiting www.cms.gov/
a paper or online enrollment
application within 60 days of
notification
• Mail a signed certification
l­etter to the contractor within
15 days of submitting an online
application. Physicians, nonphysician practitioners and
physician group practices
are exempt from ­paying an
­application fee.
• Provider or suppliers using the
855 paper enrollment application will now submit a $505
­application fee electronically
at https://pecos.cms.hhs.gov/pecos/
feePaymentWelcome.do.
Providers and suppliers are
strongly encouraged to submit
with their application a copy
of their receipt of payment.
• The CMS has determined that
Internet-based PECOS online
users can complete their applications and, if necessary, pay
the fee without leaving the system. Once the payment transaction is completed, users are
automatically returned to the
PECOS website to complete
the remaining part of the
­application. VS
– Talia Goldsmith
For more information on Medicare’s
revalidation process, please visit www.cms.gov/medicareprovidersupenroll.
For assistance with revalidation, please
contact the NHIC Provider Enrollment
Help Line at (888) 300-9612.
Accountable Care Organizations: One Option for Innovation
The highly anticipated October
20 Centers for Medicare and
Medicaid Services (CMS) final
ruling on the Shared Savings Program spurred a vigorous discussion among physicians, hospitals,
and administrators regarding the
strategic benefits of joining an
­accountable care organization
(ACO).
Many question whether or not
the financial return justifies the
effort and investment. While
there is no easy answer to this
question, it is important to note
that the Shared Savings Program
represents a unique opportunity
for enhancing collaborative efforts among stakeholders in the
health delivery system.
The Shared Savings Program is
one of many innovative programs
the CMS is investigating through
the Center for Medicare and Medicaid Innovation Center (CMMI).
If participation in the Shared Savings Program isn’t right for your
practice but you have an interest
in getting involved, other options
exist, such as the CMMI programs
that follow:
• ACO Advanced Payment
­ odel — This program allows
M
eligible organizations to ­
www.massmed.org
receive an advance on the
shared savings they expect to
earn in order to help defray
the investment necessary to
­engage in an ACO model.
• Pioneer ACO Model — With
this program, providers who
are already experienced with
coordinated care delivery models can test new and innovative
payment models.
in predetermined regions of
the country.
• Federally Qualified Health
Center Advanced Primary Care
Practice Demonstration — This
demonstration project seeks to
test the patient-centered medical home as a model for improving quality of care, promoting better health, and
lowering costs.
ACCOUNTABLE CARE SOLUTION CENTER
Guiding You Forward
• Bundled Payments for Care
Improvement — This program
is for providers who would like
to engage in one of four models, three that involve a retrospective bundled payment arrangement and one that pays
prospectively.
• Comprehensive Primary Care
Initiative — This initiative focuses on breaking through the
“historical impasse,” but invites
payers to partner with Medicare to invest in primary care
• Health Care Innovation Chal-
lenge — Medicare is looking to
award up to $1 billion to innovative projects across the country that test creative models of
delivering high-quality, low-cost
health care services.
• Innovation Advisors Program —
This program seeks to create
a network of experts trained,
­supported, and charged by the
CMS to improve the health care
delivery system.
• Partnership for Patients —
This initiative works to engage
providers in improving the
quality of care available to CMS
beneficiaries with the dual goal
of preventing patients from
getting injured or sicker and
helping them heal without
complication.
• State Demonstrations to Inte-
grate Care for Dual Eligible
­Individuals — This program
seeks to partner with states to
test new payment and delivery
system models for dual-eligible
individuals.
There are a variety of opportunities to consider if you have an
interest in testing out a concept
of your own design or one described above. To learn more
about these programs, visit
www.innovations.cms.gov/initiatives or
www.massmed.org/acsc. VS
– Kerry Ann Hayon
Source: Center for Medicare and Medicaid Innovation Center. What We’re Doing. www.innovations.cms.gov/initiatives
(accessed November 14, 2011).
Vital Signs december 2011/january 2012 • 3
the public’s health
Public Health
Impacts of
Wood Biomass
Combustion
MMS Spurs Policy
Recommendations
On November 7, the MMS hosted
a symposium for the Lowell Center
for Sustainable Production at UMass
Lowell on the public health impacts
of wood combustion. A panel of
health and science experts presented
the current science on wood as a
source of heat and power, associated
public health impacts, and the opportunities to mitigate those impacts.
Participants, including physicians
and agency decision makers from the
New England states, Pennsylvania,
and New York, discussed how to protect the public health in the context
of the proliferation of wood combustion units for commercial, industrial,
and institutional use.
Schools, hospitals, and energy companies are turning to wood biomass
as an alternative to more expensive
fossil fuels. But, said David Deitz, chair
of the MMS Committee on Environmental and Occupational Health who
represented the MMS on the symposium’s advisory committee, “The
science clearly shows that, like emissions from coal and oil-fired power
plants, biomass emissions include
particulates and other substances
that have pulmonary, cardiovascular,
and potentially carcinogenic effects.’’
“This supports the MMS position that
these health impacts must be considered as part of any policy decisions to
use biomass as part of regional or national energy strategies,” Dr. Deitz added.
Since 2009, the MMS has advocated
for policies that protect the public
from the harmful health effects of
emissions from biomass plants.
Other organizations collaborating on
the symposium included the American
Lung Association, the Asthma Regional
Council of New England, the New England College of Occupational and
Environmental Medicine, the Northeast
States for Coordinated Air Use Management, the New York State Energy
Research and Development Authority
(NYSERDA), and the University of British
Columbia. The Heinz Endowments and
the NYSERDA provided funding. VS
Mass. Physicians Help Ban Tobacco Sales in Pharmacies
Nineteen Massachusetts cities and
towns have successfully ­enacted
regulations banning the sale of
tobacco and related products in
health care institutions, including
pharmacies.
In these communities, retail
pharmacies — as well as grocery
and retail stores housing pharmacies — are banned from selling
tobacco products.
Alex White, M.D., president
of the Massachusetts Thoracic
­Society and chief of pulmonary
medicine at New England Sinai
Medical Center in Stoughton, was
instrumental in spearheading the
ban in Newton, a city of approximately 80,000 people with 8 pharmacies that formerly sold ­tobacco.
The Thoracic Society had written to some of the large pharmacy chains in Massachusetts asking
them to stop selling tobacco
products, said Dr. White, but the
pharmacies refused.
“The pharmacies’ mission is
to provide health care to our
­patients,” said Dr. White. “They
should not be taking advantage
of that by selling them tobacco
products.”
Boston and Needham had already enacted bans, so Dr. White
went to his hometown of Newton.
He asked an alderman there to
put the issue on the docket and
testified at the meeting to make
a case for the ban. Within a few
months, the city had enacted
the ban.
Dr. White encourages physicians to raise awareness of the
­issue and to become advocates
for minimizing or eliminating
the sale of tobacco in their own
communities.
“We need to protect our younger generations and make it more
difficult for children to start
smoking,” he said.
Dr. White provides the following tips for physicians who want
to help enact a local pharmacy
tobacco sales ban:
• Find sympathetic city or town
representatives and enlist their
support. They know the ropes
and how to get things done —
whether by a city ordinance or
board of health regulation.
• Ask other physicians in town to
lend their support by contacting local officials before the
­final vote.
• Speak at hearings to highlight
the health perspective.
You can find resources for physicians on the MMS website to
help you enact a similar ban in
your own town. The MMS supports local and statewide efforts
to ban the sale of tobacco ­
products in health care facilities,
­including pharmacies. VS
For more information, visit www.
massmed.org/tobacco.
Cities and Towns with Bans on Tobacco Sales in Pharmacies*
MunicipalityAffected
(Population Establishments Rank)
Boston (1)
Needham (56)
Newton (11)
Everett (39)
Walpole (79)
Lancaster (215)
Southboro (107)
Oxford (142)
Fall River (9)
Wakefield (73)
Westford (83)
Worcester (2)
Wellesley (65)
Somerville (12)
Westwood (134)
Chatham (227)
Hatfield (269)
Lowell (4)
New Bedford (6)
Brookline (18)
Wareham (87)
TOTAL
88
4
8
5
5
0
4
3
22
4
3
34
4
10
2
1
0
12
20
8
5
242
Source: Massachusetts Municipal Association
*As of 12/2/11
MMS Foundation Supports Medically Underserved
As the global recession continues, the MMS and Alliance Charitable Foundation remains committed to supporting medically
underserved populations.
“Requests for funding continue
to grow,” said Vanessa Kenealy,
chair of the Foundation’s board
of directors. “This economy has
made fundraising more difficult,
but this pales in comparison to
the hardship and adversity many
of our fellow citizens have had to
face. Job loss, budget cuts, and
gas prices have made life more
difficult, leaving more people
hungry, homeless, and without
adequate health care.”
Physician-led volunteer initiatives that increase access to care
4 • december 2011/january 2012 Vital Signs
for the uninsured and medically
underserved remain Foundation
priorities. One such program is
the Metro West Free Medical
­Program, which provides health
care services to nearly 2,000 un­
insured or underinsured indivi­
duals each year. The Society’s
­Committee on Senior Volunteer
Physicians helps the program
identify new physician volunteers
and assures that malpractice
­coverage is available to them.
“With financial support from
the MMS and Alliance Charitable
Foundation, we can assure that
the volunteer clinicians have the
medical supplies, coordination,
and access to diagnostic services
that they need to provide quality
care,’’ said Kim Prendergast, the
program’s executive director. VS
Foundation Grant Deadline January 15 The Foundation awards grants
once each year to area nonprofit
organizations. To apply, visit www.mmsfoundation.org and submit
a letter of inquiry by January 15,
2012.
For more information on the
Foundation and its activities or to
make a year-end tax-deductible
contribution, contact Jennifer
Day at (781) 434-7044 or at jday@
mms.org.
www.massmed.org
government affairs
state update
No Simple Solution to Cost Crisis, Says House Leader
Mariano: Massachusetts Should Do More to Retain Physicians
House Majority Leader Ronald
Mariano made headlines this fall
when he filed a bill proposing
Massachusetts health insurers be
required to lower rates paid to
some of the state’s most expensive hospitals, while boosting
rates for the smaller, lowest-paid
systems.
The bill, which Mariano (DQuincy) said would address the
biggest issue driving up health
care costs in the state, was one
of many cost-containment proposals put forth on Beacon Hill
in 2011. He said he expects
the ­debate to intensify in 2012.
“It’s certainly not a new issue
in Massachusetts, but we’ve really moved it to the forefront of
the greater debate,” said Mariano
in an interview last month with
Vital Signs.
Massachusetts has so many
providers, insurance carriers,
and other stakeholders, “a onesize-fits all solution is not going
to work,” said Mariano.
“Even the idea of rate-setting
is a ‘temporary fix’,” he said.
“I’ve never seen it as a long-term
solution.”
Looming SGR Cuts
continued from page 1
our health care system” and said
the “Obama Administration is
100 percent committed to fixing
the flawed Medicare payment
system and protecting Medicare
beneficiaries’ access to doctors.”
Sebelius called on Congress to
continue working on legislation
permanently reforming the
SGR. “The pattern of threatened SGR cuts and last-minute
Congressional rescues is in itself
not a sustainable solution and
must be remedied,” she said.
Last month, the Centers for
Medicare and Medicaid Services
published its annual Medicare
physician payment rule for 2012.
Key provisions include:
• Sustainable Growth Rate
(SGR). Absent congressional
­action, Medicare physician
­payments will be cut by 27.4
www.massmed.org
House Majority Leader Ronald Mariano
“We have to let providers know
how they can flourish in this
new system. Doctors need to
know where they fit in and
how they’ll benefit,” he said.
Keeping the field of providers
and services balanced and
i­nformed is an ongoing challenge as accountable care
­organizations prepare to enter
the market.
percent on January 1, 2012,
­instead of 29.5 percent as
­stated in the proposed rule.
• E-prescribing. The CMS final-
ized its proposal for the 2012
and 2013 incentive and 2013
and 2014 penalty programs.
­Despite continued AMA and
MMS opposition, participating
physicians will need to report 10
times during the first 6 months
of 2012 and 2013 to avoid application of e-prescribing penalties
in ­subsequent years.
Improvements to the program
(CMS) the AMA and MMS supported include allowing the use
of a certified electronic health
record (EHR) to e-prescribe
and making it easier to avoid the
penalties by not requiring physicians to link the e-prescribing
codes to qualifying visits and
­allowing physicians to apply for
hardship exemptions online.
More should be done to prepare the state’s physicians for
payment reform, Mariano said.
“We have to let providers know
how they can flourish in this
new system. Doctors need
to know where they fit in and
how they’ll benefit,” he said.
Legislative priorities in the new
year should include insuring the
viability of community hospitals
and smaller providers and reforms aimed at connecting costs
to quality of care, said Mariano.
More discussion is needed
about Medicaid reimbursements
to the state and the role Medicaid costs will play in any possible
tiered system, he said.
In the meantime, as the 2012
presidential race heats up, the
national spotlight will shine
even brighter on Massachusetts’
approach to health care reform.
“We are a national leader
and we have to keep moving
­forward,” said Mariano. He
­predicted the coming year may
bring some intense debates over
health care coverage that many
• RUC Recommendations. The
RUC panel persuaded the CMS
that the resources involved in
hospital observation care visits
and hospital inpatient visits are
equivalent. The CMS also accepted 87 percent of the RUC’s
252 recommendations for the
2012 Medicare payment schedule for new and revised codes
and those that had been considered potentially misvalued.
• Physician Quality Reporting
System. In response to AMA
advocacy, the CMS finalized its
proposal to provide interim
feedback reports for physicians
reporting individual measures
and measure groups through
claims-based reporting for 2012
and beyond. These reports will
be a simplified version of annual
feedback reports the CMS currently provides and will be based
Massachusetts residents now
take for granted.
“We have high expectations
of treatment in this state,” he
said. “Essential benefits are
­defined radically differently in
Massachusetts than in other
places. We may have to change
our ­expectations to some degree
to ­insure everyone can have
­coverage.”
He also said the Legislature
must do its part in making
­Massachusetts an attractive
place for physicians to practice
medicine, especially for primary
care physicians who are in great
demand. “We have to do a better
job (of retaining doctors),”
Mariano said.
Convincing young doctors
to settle locally after training
­requires affordable real estate,
high-quality public schools,
and other cost-of-living issues
all industries are struggling
with. “We want doctors who
come here to study medicine to
want to stay here,” he said. VS
– Erica Noonan
on claims for the first three
months of each program year.
• Multiple Procedure Cuts. In
r­ esponse to comments from
the AMA, the RUC, and many
specialties, the CMS scaled
back its proposal to apply a
50 percent reduction to the
professional component of all
but the highest valued code
when more than one procedure on a list of 119 imaging
services is ­performed on the
same patient on the same day.
• Annual Wellness Visit (AWV).
The CMS increased the relative
­values for the AWV codes to
recognize additional resources
associated with adding a health
risk assessment to the service’s
requirements. But it is continuing its policy of not covering a
physical exam as part of these
services. VS
Vital Signs december 2011/january 2012 • 5
professional matters
Student Conference
on Global and
Community Health:
Building a Life
Around Service
This full-day conference is designed
for medical and dental students in
New England interested in global and
community health. Workshops, panel
discussions, and program speakers
will focus on subjects such as finding
volunteer opportunities, performing disaster relief both locally and
abroad, administering refugee work,
conducting research, designing sustainable projects, obtaining funding,
and maintaining work/life balance.
Speakers will include students,
residents, fellows, and seasoned
clinicians with a wealth of global and
community service experience and
interests. Networking will be a major
focus of the program. VS
For more information about this
­program, go to www.massmed.org/­
globalhealth2012 or email
Lisa_­Gruenberg@hms.harvard.edu.
Building a Life Around Service
January 28, 2012 9:30 a.m. to 4:00 p.m. MMS Headquarters 860 Winter Street, Waltham
Sponsored by the Massachusetts Medical Society
and its Committee on Global Health
physician health matters
Medical Record Challenges — A Subtle Sign of
a Potentially Impairing Condition?
Doctors learn early in their training that one important and unavoidable part of their job is to
complete medical records in a
timely fashion. As house staff, their
paycheck may be withheld for failing to do so; as attending doctors,
they may lose admitting privileges.
Complete, accurate, and upto-date records are critical to patient care, especially since now­
adays nearly all records are kept
electronically. Complete records
are also an integral part of hospital accreditation and are important medical-legal documents.
When something so necessary
is not getting done, it is prudent
to explore what else might be
­going on.
Newly manifested problems
could indicate other serious
­issues:
• Depression. The physician may
be feeling fatigue or a sense of
worthlessness, or just be unable
to get much done except the
most crucial patient care tasks.
• Anxiety. As charts pile up, a physician can become paralyzed by
anxiety so that they are unable
to even begin work on them.
• Stress. Almost any issue can
preclude the completion of
Essential Facts for International
Medical Graduates Resource Booklet
The MMS periodically receives
calls from international medical
graduates (IMGs) who are new to
Massachusetts and are struggling
with how to initiate the process of
obtaining a limited or permanent
medical license or gain acceptance into a residency program.
IMGs often voice their frustration
to the Society about finding accurate and consistent information
on these processes.
In response, the MMS International Medical Graduates Section
Executive Committee developed
an informational booklet to serve
as a basic reference for IMGs striving toward obtaining medical licensure in Massachusetts. The resource booklet includes logistical
information regarding the following issues:
• Immigration (including VISA
­requirements)
• Obtaining a limited and/or
­permanent license
• Obtaining a residency
­appointment
• Discrimination
The guide also contains a comprehensive resource directory.
The second edition of Essential
Facts for International Medical Graduates is free to MMS members. If
you would like a copy of the booklet, please contact Erin Tally at
(800) 322-2303, ext. 7413, or
­etally@mms.org. VS
6 • december 2011/january 2012 Vital Signs
work. Personal issues such as
­divorce, illness, financial problems, a malpractice suit, or
workplace conflicts can interfere with work. Many doctors
are not willing to openly discuss
such issues with colleagues.
• Medical issues. The physician
may be struggling with memory
issues such as those caused by
early dementia or a condition
such as multiple sclerosis, diabetes, or other chronic illness that
can diminish strength. To make
matters worse, the physician
may try to cover it up.
• Substance abuse issues. Anoth-
er possibility is impairment due
to drugs or alcohol or the anxiety that comes with hiding such
a problem.
• Overwork. During a shift, a physician sees patients, orders tests,
and prescribes medication, but
often what is left for later is the
chart work. If the pace of a practice is ill suited for a physician,
lack of record keeping may be
the first sign. A physician might
be reluctant to admit that they
just can’t keep up.
Dr. John Wolfe, associate director of PHS, encourages referral
to PHS, explaining that “getting
behind on medical records is an
objective measure of possible trouble.” With the new era of hospitalists, doctors, especially PCPs, are
more likely to be isolated, with
problems going unnoticed until
the problem is larger, he said.
Dr. Jacquelyn Starer, PHS Clinical Advisory Committee member,
said, “A doctor’s response, behavior, and attitude when approached
about medical record completion
may be useful in suggesting whether other issues are involved, such
as depression, anxiety, substance
abuse, personality disorders, or
personal circumstances.”
Most hospitals and practices
have internal mechanisms for addressing incomplete records.
When the problem persists, administrators may begin to “confront or sanction” the physician.
Often this does not produce results, and it may even make the
problem worse. A referral to Physician Health Services, Inc. (PHS)
might help sort out the ­issues. If
you or a colleague need assistance,
call PHS at (781) 434-7404. For
more information, visit the PHS
website at www.physicianhealth.org. VS
– Judith Eaton, M.D.
Bullies and Victims:
Can You Tell the Difference?
Stories about bullying have become common in the news today.
Government statistics show that
roughly one-third of middle and
high school students report being
bullied. Research indicates that
bullying can adversely affect children’s mental and physical health
as well as their academic success.
Patients and families are increasingly turning to their physicians
for advice. On January 25, the
MMS will host the webinar “Bullies
and Victims: Can You Tell the Difference?” to help physicians make
informed decisions about how to
handle the challenges of caring
for a bully or bullying victim, including how to identify victims
and bullies and determine which
patients are at high risk for being
bullied. Bullying is a particular
concern for lesbian, gay, bisexual,
and transgender youth and those
who are questioning their sexual
orientation. This webinar will
­specifically address the special
health care needs of these
­patients. VS
Bullies and Victims: Can You Tell the Difference?
Wednesday, January 25, 2012
5:30 p.m. (Live Webinar)
For more information, call (800) 843 -6356 or visit www.massmed.org.
www.massmed.org
inside mms
Young Physicians Academic Medicine and Life Management Workshop
January 21, 2012 • 8:30 a.m. to 2:00 p.m. MMS Headquarters • 860 Winter Street, Waltham
As the largest physician advocate in the state,
we educate and advocate on behalf of
physicians and their patients.
Building on the success of two previous professional development programs designed specifically for early career
physicians, the Committee on Young Physicians developed
a new workshop that will explore career opportunities in
academic medicine and work/life balance.
The program features a primary track of four sessions that
focus on academic medicine and a secondary track of two
sessions that focus on life management.
• Group discounts up to 30%
• Accountable Care Solution Center —
consulting and online services
• Updates on meaningful use and EHR stimulus funding
• All the benefits of regular membership, such as NEJM and more
(800) 322-2303, ext. 7311
info@massmed.org
www.massmed.org
Across the Commonwealth
District News and Events
Berkshire — Annual District Meeting. Wed., Mar. 7,
6 p.m. Location: Spice, Pittsfield. Speaker: Lynda
Young, M.D., MMS president. For more information, contact the West Central Regional Office.
Charles River — Winter/Scientific Meeting. Thurs.
Jan. 12, 6 p.m. Guest speaker: John Gallo, Ph.D.,
­director of special projects, Woods Hole Oceanographic Institution. Topic: Neptune’s ­Garden:
A Voyage of Exploration in the Deep ­Undersea.
Location: Wellesley Country Club. For more information, contact the Northeast R
­ egional Office.
The primary track will feature experienced presenters in
grant writing, conducting clinical research, teaching, and
becoming published. The secondary track will focus on
successful balance in all areas of a physician’s life, including
marriage, family, personal, and professional endeavors.
For full program details, including the agenda, session descriptions, speaker information, and online registration, please
go to www.massmed.org/careerworkshop2012 or contact Colleen
Hennessey at chennessey@mms.org or (781) 434-7315.
This workshop is sponsored by the Massachusetts Medical
Society Committee on Young Physicians and Resident and
Fellow Section. VS
Link In with the MMS
Join the members-only LinkedIn group at www.massmed.org/linkedin.
7 p.m. Location: Max’s Tavern, Basketball Hall
of Fame, Springfield. Members: No charge.
­Nonmembers: $37.50. For more information,
­contact Suzanne Skibinski at (413) 736-0661
or hdms@masmed.org.
Middlesex Central — Executive Committee
­ eeting. Thurs., Jan. 19, 7:45 a.m. Location:
M
­Emerson Hospital, Concord. 5th Tuesday Meeting.
Tues., Jan. 31, 11:45 a.m. Location: Emerson
­Hospital, Concord. For more information, contact
Carol Marshall at cmarshall@emersonhosp.org.
Plymouth — Executive Committee Meeting. Tues.,
Jan. 31, 6 p.m. Location: Fireside Restaurant,
­Middleboro. For more information, contact the
Southeast Regional Office.
Essex South — Membership Meeting. Wed.,
Feb. 1, 6 p.m. Guest speaker: Jeffrey Drazen, M.D.,
editor-in-chief, New England Journal of Medicine.
­Location: Boston Marriott, Peabody. For more information, contact the Northeast Regional Office.
Worcester North — Executive Committee Meeting.
Tues., Jan. 26, 6 p.m. Location: Sonoma, Princeton.
For more information, contact West Central Regional Office.
Franklin — Social Event. Thurs., January 26,
Statewide News and Events
6 p.m. Location: Magpie, Greenfield. For more
­information, contact the West Central ­Regional
­Office.
Hampden — Medical Legal Forum. Topic: Medical/Legal Ramifications of EMR. Tues., Jan. 24,
registration 5:30 p.m., dinner 6:30 p.m., program
www.massmed.org
If you have news for Across the Commonwealth, contact
Michele Jussaume, Northeast Regional Office, at (800)
944-5562 or mjussaume@mms.org; Sheila Kozlowski,
Southeast Regional Office, at (800) 322-3301 or skozlowski@
mms.org; or Cathy Salas, West Central Regional Office, at
(800) 522-3112 or csalas@mms.org.
in memoriam
The following deaths of MMS members
were reported to the Society in October
and November. We also note member
deaths on the MMS website at www.
massmed.org/memoriam.
John F. Burke, M.D., 89; Lexington, MA;
Harvard Medical School, 1951; died
­November 2, 2011.
Harriet S. Carey, M.D., 59; Wellesley Hills,
MA; New York University School of
­Medicine, 1979; died May 7, 2011.
Edward L. Cashman Jr., M.D., 87;
Swampscott, MA; Tufts University School of Medicine, 1949; died September 3, 2011.
Sharad R. Chitre, M.D., 75; South Hamilton, MA; Medical College Baroda University, India, 1961; died September 20, 2010.
Martin A. Compton, M.D., 97; Bloomington, IL; Washington University School of
Medicine, 1937; died August 27, 2011.
Ricardo A. Cordon, M.D., 69; Pittsfield,
MA; University De San Carlos, Guatemala,
1968; died August 14, 2011.
W. Philip Giddings, M.D., 96; Shelburne,
VT; Harvard Medical School, 1938; died
October 23, 2009.
Herbert C. Hagele Jr., M.D., 77; Lynnfield, MA; Creighton University School of Medicine, 1960; died October 30, 2011.
Charles P. LeRoyer Jr., M.D., 94; Arlington, MA; Tufts University School of
­Medicine, 1942; died March 24, 2009.
Charles Lieber, M.D., 78; Englewood
Cliffs, NJ; Universite Libre De Bruxelles,
Belgium, 1955; died March 1, 2009.
Gwilym S. Lodwick, M.D., 94; Fort Lauderdale, FL; University of Iowa College of
Medicine, 1943; died September 25, 2011.
Florentino P. Pina, M.D., 92; Fort Lauderdale, FL; Columbia University College of
Physicians and Surgeons, 1946; died
­October 25, 2011.
Warwick Potter Jr., M.D., 82; Wellesley,
MA; Yale University School of Medicine,
1953; died August 5, 2009.
Edmund P. Quinn, M.D., 93; Hanover,
MA; Tufts ­University School of Medicine,
1943; died November 16, 2010.
Edwin W. Salzman, M.D., 82; Cambridge,
MA; Washington University School of
Medicine, 1953; died October 3, 2011.
Benjamin Spelfogel, M.D., 95; Newton,
MA; Middlesex University School of
­Medicine, 1941; died August 11, 2010.
David D. Swenson, M.D., 76; Danvers,
MA; Harvard Medical School, 1963; died
July 28, 2011.
Elton R. Yasuna, M.D., 96; Harwich Port,
MA; New York University School of
­Medicine, 1938; died October 18, 2011.
Vital Signs december 2011/january 2012 • 7
The Secret Sauce
Population Health as a Recipe
for Transforming Health care
SAVE THE DATE!
inside
▶
NEJM Celebrates 200 Years Page 1
▶
No “Simple Solution” to Cost Crisis Page 5
▶
Poor Record Keeping Page 6
2012 MMS Annual Meeting ­— May 17 to 19 MMS Headquarters, Waltham, and the Seaport Hotel, Boston
Thursday, May 17
• House of Delegates Opening Session
• Ethics Forum
• NEJM 200th Anniversary ­Celebration Reception
• IMG Annual Reception
Friday, May 18
• Annual Education Program
• Shattuck Luncheon & Lecture
• Presidential Reception & Member Art Exhibit/Silent Auction
• Presidential Inauguration
volume 17, issue 1, dec. 2011/jan. 2012
860 Winter Street, Waltham, MA 02451-1411
Nonprofit U.S.
postage paid boston, ma permit 59673
& Awards Dinner
Saturday, May 19
• House of Delegates Second Session
• Alliance Annual Meeting
& Fashion Show
• Annual Meeting of the
Society Luncheon
MMS Sponsored and Jointly Sponsored CME Activities
Live CME Activities
Go to www.massmed.org/cme/events or call (800) 8436356. Unless otherwise noted, event location is MMS
headquarters, 860 Winter Street, Waltham.
Medical Legal Ramifications of EMR,
jointly sponsored by the MMS and the Hampden District
Medical Society, will be held on Tuesday, January 24,
2012, from 7:00–9:00 p.m. in Springfield, MA.
7th Annual Women’s Cardiac Health Conference:
Medical Management of Heart Disease, sponsored
by the MMS and its Committee on Women in Medicine
in collaboration with the American Heart Association,
will be held on Friday, February, 3, 2012, from
8:00 a.m.–12:30 p.m.
Massachusetts Medical Society’s 2012
Leadership Institute — Changing Paradigms
in Healthcare: What Does the Future Hold?,
sponsored by the MMS, will be held on Wednesday,
February 1, 2012, from 8:00 a.m.–2:00 p.m.
Seating is limited.
To register for any of these activities,
call (800) 843-6356.
CME CREDIT: These activities have been approved for
AMA PRA Category 1 Credit™.
SAVE THE DATE
Webinar — Bullies and Victims: Can You Tell the
Difference? sponsored by the MMS and its Committees
on Violence Intervention and Prevention, Medical
Education, LGBT Matters, and Student Health
and Sports Medicine, will be held on Wednesday,
January 25, 2012, from 5:30–6:30 p.m.
ONLINE CME ACTIVITIES
Go to www.massmed.org/cme.
Massachusetts Medical Law Report
Risk Management CME Series
•Seven Steps to Better Health
•Literacy with Diverse Patients*
•Medical Mistakes: Learning to Steer Clear of the
Common Ones*
•Managing Risk When Prescribing Narcotic Painkillers
for Patients*
•Protecting Your Patients’ Data*
•The Importance of Discussing End-of-Life Care with
Patients*
•A Primer for Accountable Care Organizations*
•Avoiding Failure to Diagnose Suits
•Getting It on Record and Getting It Right
For additional information, contact the Department of
Continuing Education and ­Certification at (800) 322-2303,
ext. 7306, or go to www.massmed.org/cmecenter.
•Physician Practices Scramble to Comply with New
Privacy Reg.
•Dealing with the Changing Dynamic of the
Medical Staff
•Health Providers Facing Stiff HIPAA Regulations
•Health Care Providers Brace for Medicare Audits
•Social Networking 101 for Physicians
*Also available in print. Call (800) 322-2303, ext. 7306.
Public Health Risk Management CME Series
•MA Responds Orientation Course
•Violence — Implications for Health
The Legal Advisor Risk Management CME Series
•Terminating the Doctor-Patient Relationship
•Mandated Reporting
•Limited English
•Advance Directives
•Boundary Issues in the Physician-Patient Relationship
Risk Management
massmed.org/cme
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