AMA Wire® Fri, 27 May 2016 20:51:00 GMT Entire state gets one naloxone prescription Fri, 27 May 2016 20:51:00 GMT <p> There are many steps that need to be taken to end an epidemic—including policy, medication, coverage and treatment expansion—and require physicians to take the lead in fighting for their patients. Leaders in Pennsylvania are on a mission to provide that help to both the people who are suffering in the opioid epidemics and the physicians who treat them.</p> <p> <strong>A standing order for naloxone</strong></p> <p> Through a multiagency effort, Pennsylvania’s physician general Rachel Levine, MD, in October signed a statewide prescription for naloxone, making this lifesaving overdose reversal drug available to the entire population.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> “As we were studying the problem and working on the distribution of naloxone,” Dr. Levine said, “we decided that I would write two standing orders.”</p> <p> The first was a standing order for first responders—state police, municipal police and fire departments—to obtain naloxone. After this was accomplished, Dr. Levine and Department of Drug and Alcohol Programs Secretary Gary Tennis called all the insurance companies in the state and raised money to obtain two forms of naloxone, the nasal spray and auto-injector, for the public.</p> <p> “We wanted to facilitate as much as possible the public obtaining naloxone if they have a friend or family member or a loved one who is at risk of overdosing from prescription opioids or heroin,” Dr. Levine said. “Under Gov. Wolf’s leadership, I signed the standing order prescription for anyone in the public to go to a pharmacy and obtain naloxone.”</p> <p> Dr. Levine, as part of her statewide prescription, recommends that pharmacists take <a href=",%20on%20the%20Dispensing%20of%20Opioids.pdf" rel="nofollow" target="_blank">voluntary training</a> developed by the Pennsylvania Medical Society (PAMED) in consultation with the Pennsylvania Pharmacy Association. “We encourage pharmacists to do whatever teaching is necessary in the dispensing of naloxone,” she said.</p> <p> Now that the standing order for naloxone is in effect, there are three things Dr. Levine said need to happen:</p> <ul> <li> Making sure all the pharmacies are aware of the standing order and carry naloxone</li> <li> Working with insurance companies to ensure it is covered</li> <li> Getting the word out to the public that it is available</li> </ul> <p> The standing order “certainly has been successful in highlighting the importance of this issue, the risk of prescription opioids and heroin and the risk of overdoses,” she said. “It has served a number of purposes.”</p> <p> In March, Gov. Wolf honored hundreds of municipal and state police officers who together have reversed over 600 opioid overdoses in the short time that naloxone has been available.</p> <p> “Particularly with the increase in fast acting fentanyl in the heroin supply," said Alice Bell, the overdose prevention project coordinator of <a href="" rel="nofollow" target="_blank">Prevention Point Pittsburgh</a>, "it is critical that those who are most likely to be already on the scene when someone overdoses—people who are using drugs together, friends, family members and other lay people—have naloxone available on the scene.   While it’s also critical for police and other first responders to carry naloxone, they may arrive too late.”</p> <p> Many states have worked closely with the AMA and state medical societies to <a href="" target="_self">ensure widespread access to naloxone</a> and develop good Samaritan laws to help save lives.</p> <p> <strong>Next steps for Pennsylvania in fighting the opioid overdose epidemic</strong></p> <p> The standing order was not the last step in Pennsylvania’s efforts to end the epidemic, but rather the first. Working with PAMED and several other organizations, Dr. Levine is continuing the multi-agency effort to provide resources and guidance to the physicians and patients in her state.</p> <p> “This is a very collaborative effort under the leadership of Gov. Wolf and with many, if not most, state agencies,” she said. “It’s all hands on deck. The message when we go out and speak … is that addiction is a disease—it is a medical condition—it is not a moral failing. So we want to eliminate this stigma.”</p> <p> Here are five ways Pennsylvania is continuing their efforts:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Educating future physicians.</strong> “We are working on prevention,” Dr. Levine said. “We are working with all the medical school deans [in our state] to define the clinical competency that a medical student should have when they leave school about all these issues—opioid pharmacology, pain treatment, and about addiction referral and treatment.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Educating physicians.</strong> In collaboration with PAMED, the agencies are working on four to five modules that have continuing medical education credit for physicians and other medical professionals who prescribe opioids.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Prescribing guidelines.</strong> “We are working on specialty-specific prescribing guidelines in regards to opioid pain medication,” Dr. Levine said.<br /> <br /> Already published are guidelines for the treatment of and safe prescribing for <a href="" rel="nofollow" target="_blank">chronic non-cancer pain</a>, pain in the <a href="" rel="nofollow" target="_blank">emergency department</a>, pain among <a href="" rel="nofollow" target="_blank">OB-GYN patients</a>, pain among <a href="" rel="nofollow" target="_blank">geriatric patients</a> and pain in <a href="" rel="nofollow" target="_blank">dental practice</a>. The state also has published dispensing guidelines for <a href=",%20on%20the%20Dispensing%20of%20Opioids.pdf" rel="nofollow" target="_blank">pharmacists</a>.<br /> <br /> In the works are guidelines for treatment of pregnant women who are addicted to opioids, use in orthopedics and sports medicine and use for pediatric and adolescent patients. Pennsylvania also is working on guidelines for the emergency department “warm handoff.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>PDMP use.</strong> “We are implementing the prescription drug monitoring program (PDMP) for Pennsylvania,” Dr. Levine said. “We have hired a director … a vendor … and the goal is that the PDMP will be up and running by August.”<br /> <br /> Use of the PDMP will be “required for all first prescriptions,” she said. “[And] strongly recommended for other prescriptions.”</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Expanding treatment.</strong> “We are working to expand treatment options both for abstinence-based treatments,” she said, “as well as a pivot toward emphasizing medication-assisted treatment (MAT) for patients addicted to opioids.”</p> <p> “We need to work on preventing [substance use disorders], diagnosing it and treating it as we do with diabetes or heart disease,” Dr. Levine said. “As physicians we know the pharmacology of this, we know how addiction works neurologically and we need to not treat this any differently than any other medical condition.”</p> <p> <strong>Learn more about physicians’ efforts to end the opioid epidemic:</strong></p> <ul> <li> Read a <a href="" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a>, and watch a <a href="" rel="nofollow" target="_blank">video message</a> from AMA President Steven J. Stack, MD.</li> <li> Find out how a substance use researcher in San Francisco <a href="" target="_self">talks with his patients about substance use disorder</a>.</li> <li> Learn how <a href="">physicians are teaming up to treat addiction in rural areas</a>.</li> <li> Discover the <a href="">3 steps for talking with patients about substance use disorder</a> recommended by an internal medicine physician who is an addiction consultant.</li> <li> Learn what the AMA Task Force to Reduce Opioid Abuse <a href="" target="_self">recommends for physicians to reduce stigma and increase use of MAT</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7c3e704b-3d5b-475e-8a96-0d6a8b20956d What it’s like to be in endocrine surgery: Shadowing Dr. Krishnamurthy Fri, 27 May 2016 20:34:00 GMT <p> As a medical student, do you ever wonder what it’s like to be an endocrine surgeon? Here’s your chance to find out.</p> <p> Meet Vikram D. Krishnamurthy, MD, an endocrine surgeon and featured physician in <em>AMA Wire’s</em>® <a href="">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Read his insights to help determine whether a career in endocrine surgery might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. Krishnamurthy</strong></p> <p> <strong>Specialty:</strong> Endocrine surgery</p> <p> <strong>Practice setting: </strong>Academic group practice in a health system of 10 hospitals and 18 ambulatory centers</p> <p> <strong>Years in practice:</strong> 2</p> <p> <strong>A typical day in my practice</strong>:</p> <p> Life during training is a lot different from life after fellowship. During general surgery residency, workweeks are usually 80 hours per week on rotations involving abdominal, oncologic, cardiovascular, thoracic, pediatric and trauma surgery. Endocrine surgery is focused on surgical conditions of the thyroid, parathyroid glands, adrenals, and neuroendocrine tumors of the pancreas and gastrointestinal tract. Workweeks during fellowship are typically around 50-60 hours per week with very limited night and weekend demands. </p> <p> After training, a typical week for most academic surgeons involves a couple days of surgeries, a couple days of clinic and one day (or half day) of administrative activities (protected time for academic, educational and research interests).</p> <p> For example, my workweek includes two days of OR, two days of clinic and one administrative day. A day in the OR (which can last from 7 a.m. to 4 p.m.) can involve three cases, ranging from thyroidectomies to lateral neck dissections to laparoscopic adrenalectomies. A day in the clinic (which is usually 8:30 a.m. to 3:30 p.m.) involves seeing 12-20 patients and performing ultrasounds, biopsies and laryngoscopies. Administrative days include lecturing students, meeting with residents and conducting research.</p> <p> It should be stated that when you work in academic surgery, you are expected to attend weekly conferences at your home institution and national meetings throughout the year to contribute to the academic community. This can add to the overall time you spend “working.” Fortunately, most endocrine surgeons enjoy these activities, so it feels like a calling rather than an obligation.</p> <p> As endocrine surgery gains recognition as a distinct specialty, an increasing number of fellowship graduates are entering non-academic community practices. This is indubitably beneficial to patients but also provides a new dimension to the field and new opportunities for those interested in becoming endocrine surgeons. These graduates are more likely to continue to perform general surgery procedures, in addition to endocrine operations, in their practices.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in </strong><strong>endocrine surgery</strong>:</p> <p> Endocrine surgeons are specialists who manage both routine and complex pathology. Thus, in addition to common patient presentations, we also treat advanced cases referred by non-fellowship trained surgeons or smaller hospitals. We also see and operate on patients who had aborted or failed operations by other surgeons, which makes patient education and re-operation more difficult. </p> <p> Fortunately, our training prepares us for this challenge, and continued mentorship throughout our career gives us the confidence and support to help these patients. The most rewarding part of our specialty is probably two things: (1) providing excellent oncologic outcomes that preserve functional capacity (e.g., voice) and optimize cosmesis and (2) reversing the debilitating effects of various tumors that produce excessive hormones.</p> <p> <strong>Three phrases that describe the typical physician in </strong><strong>endocrine surgery</strong><strong>:</strong></p> <ul> <li> Detail-oriented, overachievers</li> <li> Inquisitive investigators and educators</li> <li> Friendly and communicative</li> </ul> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> After training, endocrine surgery has allowed me to experience a healthy work-life balance. Most operations take one to four hours, and the majority of patients stay one night in the hospital and are discharged home the next day. This makes for a relatively light inpatient census and little need for clinical work on weekends. </p> <p> True endocrine surgery emergencies are rare; thus, nights and weekends are relatively free to work on academic pursuits and personal interests. My career has allowed me to have a vibrant professional and personal life filled with achievements, travel and time with loved ones. Furthermore, research shows that more than 95 percent of endocrine surgery fellowship graduates are satisfied with their jobs (approximately 50 percent are women and 50 percent men), speaking to ability to successfully balance professional and personal obligations.</p> <p> <strong>One skill every physician in training should have for </strong><strong>endocrine surgery but won’t be tested for on the board exam:</strong></p> <p> Perseverance, stamina, motivation (especially self-motivation), empathy and superb communication skills. Also a lifelong desire to learn and the ability to execute delicate, fine and purposeful movements in the operating room.</p> <p> <strong>One question physicians in training should ask before pursuing endocrine surgery: </strong></p> <p> Am I interested in routine and complex endocrine physiology, oncology and surgery?</p> <p> <strong>Six books every medical student interested in </strong><strong>endocrine surgery should read:  </strong></p> <ul> <li> <em>Essentials of Surgery</em> by Peter Lawrence, MD</li> <li> <em>Lange’s Current Diagnosis and Treatment: Surgery</em> by Gerard Doherty, MD</li> <li> <em>Rush University Medical Center Review of Surgery</em> by Jose Velasco, MD, et al</li> <li> <em>Common Surgical Diseases</em> by Theodore J. Saclarides, MD; Jonathan A. Myers, MD; and Keith W. Millikan, MD</li> <li> <em>Endocrine Surgery: Principles and Practice</em> by Johnathan Hubbard, MD; William B. Inabnet, III, MD;and Chung-Yau Lo, FRCS</li> <li> <em>Textbook of Endocrine Surgery</em> by Orlo Clark, MD; Quan-Yang Duh, MD; Electron Kebebew, MD; Jessica Gosnell, MD; and Wen Shen, MD</li> </ul> <p> <strong>Online resources students interested in my specialty should follow:</strong></p> <ul> <li> The <a href="" rel="nofollow" target="_blank">website of the American Association of Endocrine Surgeons</a></li> <li> The <a href="" rel="nofollow" target="_blank">American Association of Endocrine Surgeons patient education website</a></li> <li> An <a href="" rel="nofollow" target="_blank">explanation of the maturation of the specialty of endocrine surgery</a> from the Cleveland Clinic</li> <li> <a href="" rel="nofollow" target="_blank">The endocrine surgery job market: A survey of fellows, department chairs and surgery recruiters</a></li> <li> <a href="" rel="nofollow" target="_blank">Mapping endocrine surgery: Workforce analysis from the last six decades</a></li> </ul> <p> Also follow the American Association of Endocrine Surgeons on Twitter @AAES1. My Twitter handle is @healthyroidsurg.</p> <p> <strong>A quick insight I’d give students who are considering </strong><strong>endocrine surgery</strong><strong>:</strong></p> <p> Stay open-minded during your general surgery training and also consider surgical oncology, colorectal, hepatobiliary and breast surgery. Seek mentorship and research opportunities early on.</p> <p> <strong>If I had a song or two to describe my life in this specialty, they’d be:</strong></p> <p> “Hall of Fame” by The Script and “Such Great Heights” by the Postal Service</p> <p> <strong>Want to learn more about your specialty options?</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="" target="_self">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="" target="_self">neurology</a>, <a href="" target="_self">nephrology</a>, <a href="" target="_self">otolaryngology</a>, <a href="" target="_self">vascular surgery</a> and <a href="" target="_self">infectious disease</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="" target="_self">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="" target="_self">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:abe88e95-c6e8-4a51-9c3a-6206a08a3eef What it’s like to be in obesity medicine: Shadowing Dr. Lazarus Fri, 27 May 2016 20:30:00 GMT <p> As a medical student, do you ever wonder what it’s like to be an obesity specialist? Here’s your chance to find out.</p> <p> Meet Ethan Lazarus, MD, an obesity specialist and featured physician in <em>AMA Wire’s</em>® <a href="" target="_self">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties. Dr. Lazarus is the secretary treasurer of the Obesity Medicine Association (OMA) and the OMA delegate for the AMA.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Read his insights to help determine whether a career in obesity medicine might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. Lazarus</strong></p> <p> <strong>Specialty:</strong> Obesity medicine</p> <p> <strong>Practice setting:</strong> Solo</p> <p> <strong>Years in practice:</strong> 18</p> <p> <strong>A typical day in my practice:</strong></p> <p> I see patients Tuesday, Wednesday and Thursday from 9 a.m. to 4 p.m. I spend 30 minutes with follow-up patients and 60 minutes with new patients. I teach free classes on obesity and related topics one or two times per week. When not at the office, I speak either at CME conferences or for pharmaceutical companies about once a week. I also serve as an adviser to Novo Nordisk regarding obesity treatment.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in obesity medicine:</strong></p> <p> Patients lose weight, then stop treatment, then they regain the weight and blame themselves. It is hard to get people to accept that obesity is a chronic disease. There is also a lot of bias against treating obesity as a disease, particularly with regards to the use of anti-obesity medications. Further, there is public perception that obesity is primarily a result of eating too much and exercising too little, so most individuals affected by obesity combat it by trying to eat less and move more. Unfortunately, since eating too much and exercising too little are not thought to be the <em>cause</em> of obesity, but perhaps instead the <em>result</em> of obesity, all too often the person ends up even heavier.</p> <p> <strong>Three adjectives that describe the typical obesity specialist:</strong></p> <p> Empathetic. Non-judgmental. Open-minded.</p> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> It is completely different—I thought I’d be a surgeon. Instead, I spend the majority of my time either counseling patients or educating physicians. I never envisioned the speaking part of my career.</p> <p> <strong>One skill every physician in training should have for obesity medicine but won’t be tested for on the board exam:</strong></p> <p> Motivational interviewing.</p> <p> <strong>One question every physician in training should ask themselves before pursuing this specialty:</strong></p> <p> Do I really think that obesity is a disease? If so, am I willing to treat it with the same seriousness, compassion and respect as other diseases?</p> <p> <strong>Books every medical student interested in obesity medicine should read:</strong></p> <ul> <li> <em>Mindless eating: Why We Eat More Than We Think</em> by Brian Wansink, PhD</li> <li> <em>Best Weight: A Practical Guide to Office-based Obesity Management</em> by Yoni Freedhoff, MD, and Arya Sharma, MD, PhD</li> </ul> <p> <strong>Online resources students interested in my specialty should follow:  </strong></p> <ul> <li> <a href="" target="_blank" rel="nofollow">Obesity Medicine Association</a></li> </ul> <p> <strong>If I had a mantra to describe my life in this specialty, it’d be: </strong>Obesity is primarily a <em>physiological</em> phenomenon. This means that obesity is more complex than “eat less, exercise more.”</p> <p> <strong>Want to learn more about your specialty options?</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="" target="_self">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="" target="_self">neurology</a>, <a href="" target="_self">nephrology</a>, <a href="" target="_self">otolaryngology</a>, <a href="" target="_self">vascular surgery</a> and <a href="" target="_self">infectious disease</a>, among others.</li> <li> Review a <em>JAMA®</em> article outlining the <a href="" target="_self" rel="nofollow">biological drivers of weight gain</a>.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="" target="_self">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="" target="_self">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5f9de148-d0c2-42fc-89ab-7d753f5cac0b What you need to do now to secure a firm financial future Thu, 26 May 2016 21:11:00 GMT <p> When it comes to financial planning, one-half of young physicians go it alone. But such independence may cost you dearly in the long run.</p> <p> <strong>Establishing a strong financial foundation</strong></p> <p> A recent study by <a href="mhtml:file://F:\05_16_2016%20DRAFT%20MRD%20financial%20advisers.mht!" rel="nofollow" target="_blank">AMA Insurance</a> found that 71 percent of young physicians feel somewhat or not very knowledgeable about financial planning. At a time when your income climbs from modest to six figures, your biggest mistake could be counting only on yourself to get your arms around your financial future.</p> <p> That future likely includes higher income, increasing taxes and a set of pressing financial priorities, including retirement, your children’s education, and the long-term health of you and your spouse.</p> <p> “Finances are a primary concern among new residents,” said Adam Cantor, who starts his residency in June at Indiana University School of Medicine. “Many of us have not had an income since starting medical school and will have difficulties establishing a budget.”</p> <p> “My key concern is to be able to save enough money to support a family eventually,” said Cantor, who is part of the Young Physicians Financial Advisory Committee, a think tank that helps AMA Insurance address the financial needs of students, residents, fellows and young physicians.</p> <p> AMA Insurance, in collaboration with Jerry Moran, a senior wealth strategist with Millennium Brokerage Group, examined the finances of young physicians in its report, “<a href="" rel="nofollow" target="_blank">2015 report on young physicians’ financial preparedness: Young physicians segment</a>.” The research found that those with financial advisers felt more confident about their finances, were more on track for retirement, had more money saved and had more diversified portfolios.</p> <p> Experts say going without an adviser is a fundamental mistake that can set the stage for others, like basing investment moves on market news and mishandling retirement funds.</p> <p> But the one-half of all young physicians who do not hire an adviser cite a lack of time, the cost and the inability to find someone they they’re comfortable with and trust. And some feel they have the skills to manage their own finances.</p> <p> “With our busy schedules, I think a financial adviser can help save a lot of time and avoid pitfalls,” Cantor said.</p> <p> <strong>How to choose the right financial adviser</strong></p> <p> In his report, Moran offered a few guidelines for finding an adviser who is right for you:</p> <ul> <li> Ask colleagues for at least three referrals.</li> <li> Take time to vet the advisers you’re considering.</li> <li> Do a quick <a href="" rel="nofollow" target="_blank">FINRA check</a> of a prospective adviser’s certifications, employment history, license and complaints.</li> <li> Conduct your own interviews. Ask about your prospective adviser’s credentials, experience working with physician clients and fee structure.</li> <li> If you’d prefer a referral to a financial planner, AMA Insurance offers the <a href="" rel="nofollow" target="_blank">Physicians Financial Partners</a> program.</li> <li> Trust your gut. This is going to be a face-to-face relationship, so choose someone you can see yourself partnering with.</li> </ul> <p> Advisers and established physicians agree that investing some time now can pave the way to financial health and happiness for the long haul.</p> <p> “Get mentorship on investing and financial and business practice now,” one established physician advised. “Don’t wait until you have a good income.”</p> <p> <strong>Gain additional insights on physician finances:</strong></p> <ul> <li> <a href="" target="_self">5 financial planning tips every young physician should know</a></li> <li> <a href="" target="_self">How to partner with a physician-friendly financial adviser</a></li> <li> <a href="" target="_self">How to kick your financial plan into high gear</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:74fd3f97-2638-46be-97d6-f3a4362f0be5 The well-trained MA: One practice’s winning strategy Wed, 25 May 2016 21:44:00 GMT <p> Well-trained medical assistants (MA) can hold fast the front line of patient care, freeing up physicians from some of their routine administrative and clinical tasks. MAs can play an integral role in achieving practice goals, but sometimes inconsistencies in training and expectations can slow down the progression toward physician-led team-based care. Find out how one practice implemented a professional training program to ensure all of their MAs were able to provide high-quality care support.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Giving the MAs in your practice consistent and accurate professional development tools can help increase their knowledge and ability to contribute to the practice team in a meaningful way. A new <a href="" rel="nofollow" target="_self">module</a> in the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice further the training of MAs in a way that suits both the needs of the practice and the MAs—resulting in better care for your patients and a more efficient work day for you.</p> <p> <strong>Finding the source of the problem</strong></p> <p> Vanguard Medical Group in New Jersey, which contributed this STEPS Forward module after <a href="" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge, was in the process of implementing a physician-led team-based care model in 2012 when the practice collected revealing feedback from physicians, patients, clinical and administrative staff and care coordinators. Their feedback indicated that, among MA staff, there were varied levels of performance, making the implementation of the new work flows more difficult and time consuming.</p> <p> Vanguard found that the variation in MA performance was in large part a result of three things:</p> <p style="margin-left:40px;"> 1.  Differences in prior education and experience</p> <p style="margin-left:40px;"> 2.  Lack of opportunity for MAs to access professional development beyond the initial new-hire orientation process</p> <p style="margin-left:40px;"> 3.  Non-formalized communication with MAs about performance expectations beyond the annual review</p> <p> As a result of these obstacles, physicians had to complete administrative tasks left unaddressed or repeat clinical tasks done incorrectly. The MAs felt undervalued and thought that the practice was not invested in supporting their professional growth. Meanwhile, some patients commented that MAs were inconsistent in terms of professionalism, phone skills, accurately relaying information and the rooming process.</p> <p> Vanguard determined that because MA performance was uneven, this essential component of the practice staff was left untapped and underdeveloped. The need for MA training was clear and prompted the implementation of a professional development program.</p> <p> <strong>The solution</strong></p> <p> Using topics selected through a staff survey, the nurse care coordinators lead the initiative at each site. These leaders deliver a monthly MA training session in a modular format. Modules are delivered each month in a “lunch and learn” format and are approximately 45 minutes long. They may include warm-up exercises, short electronic surveys, interactive presentations, handout materials, guest speakers and peer instruction.</p> <p> The professional development cycle begins with the distribution of pocket-sized flashcards (available for <a href="" rel="nofollow">download</a> as tools in the STEPS Forward module) as a pre-session learning exercise. Each flashcard set is divided into general topics, including professionalism in the MA role, diabetes management, hypertension and proper blood pressure measurement technique, hospice and palliative care, chronic kidney disease, cultural diversity in the workplace and stress reduction.</p> <p> After four weeks, cards are collected, and a pre-assessment is given to gauge how much the MAs are learning, which helps determine the content of the curriculum. MAs sign in at each session, and attendance is tracked by their supervisors as a component of their annual performance review.</p> <p> Vanguard does not collect quantitative data on the program, and the practice purposely eliminated the testing that was done in the past. Those who oversaw the training observed that “learning for the test” behavior created anxiety among MAs, rather than encouraging deeper learning and collaboration with peers. Instead, the practice tracks the success of the program by collecting qualitative data, including MA reports of increased confidence, greater pride in their roles and a stronger perception of being valued by the practice.</p> <p> Initial feedback from MAs, clinical supervisors, physicians and care coordinators has been positive. Vanguard learned from previous iterations that an information-dense lecture approach is less useful than the current interactive format, and the practice continues to tweak the program in ways that motivate MAs to learn and use the information from each session.</p> <p> The <a href="" rel="nofollow" target="_self">MA professional development</a> module is one of eight new modules recently added to the AMA’s <a href="" rel="nofollow" target="_self">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p> <strong>Learn more about physician-led team-based care:</strong></p> <ul> <li> <a href="" target="_self">What Stanford added to make MAs key components to team-based care</a></li> <li> <a href="" target="_self">Rethinking team-based care</a></li> <li> <a href="" target="_self">How to coordinate patient visits in a team-based care model</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1de33718-d9e0-4a0d-bf6f-410aea9eede8 Answer revealed to this top-missed USMLE Step 2 question Wed, 25 May 2016 21:29:00 GMT <p> Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="" target="_self">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong><br /> A 42-year-old woman comes to the physician because of a four-month history of intermittent abdominal cramps and diarrhea. She has had episodes of skin flushing lasting from two to 15 minutes, most pronounced in the head and neck area. She denies nausea, vomiting, constipation or blood in her stools. Her medical history is unremarkable, and she takes no medications. A grade 3/6 murmur is heard along the mid left sternal border. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. Laboratory studies show urinary excretion of 5-hydroxyindoleacetic acid of 75 mg/day (normal: 0.5-9.0 mg/day). CT scan of the liver demonstrates a 2-cm lesion. Which of the following is the most likely diagnosis?</p> <p style="margin-left:40px;"> <strong>A. </strong>Carcinoid tumor, metastatic</p> <p style="margin-left:40px;"> <strong>B. </strong>Cholangiocarcinoma, primary</p> <p style="margin-left:40px;"> <strong>C. </strong>Hepatocellular carcinoma, primary</p> <p style="margin-left:40px;"> <strong>D. </strong>Mucinous adenocarcinoma of the colon, metastatic</p> <p style="margin-left:40px;"> <strong>E. </strong>Squamous cell carcinoma of the esophagus, metastatic</p> <p>  </p> <p> <object data="" height="350" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is A.</strong></p> <p>  </p> <p> <strong>Kaplan says, here’s why:</strong></p> <p> Carcinoid syndrome is the term used for the cluster of cutaneous flushing, abdominal cramps, bronchospasm and diarrhea that is seen in patients who have excess amounts of circulating vasoactive substances, including serotonin. The usual cause is an intestinal carcinoid tumor that has metastasized to the liver.</p> <p> Gastrointestinal carcinoids that have not yet metastasized are much less likely to produce carcinoid syndrome, because the liver metabolizes and clears the portal blood of the vasoactive substances. Much less commonly, carcinoids at nongastrointestinal sites, such as lung or ovary (whose venous blood does not pass through the liver before entering the systemic circulation), can cause carcinoid syndrome without metastatic disease.</p> <p> Right-sided endocardial fibrosis, with pulmonary stenosis and tricuspid regurgitation, is common in carcinoid patients and is the result of toxic damage to the heart. 5-hydroxyindoleacetic acid is a urinary metabolite of serotonin that can be used to confirm the clinical impression of carcinoid syndrome. Carcinoid tumors are often indolent, and 10- to 15-year survivals after liver metastasis can occur.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice B:</strong> Cholangiocarcinoma arises from the epithelial cells of the bile duct. Symptoms of cholangiocarcinoma include painless jaundice caused by obstruction of the biliary system, pruritus, abdominal pain, weight loss and fever. This tumor does not secrete hormonally active substances.</p> <p> <strong>Choice C:</strong> Hepatocellular carcinoma usually arises in the setting of cirrhosis or other risk factors, such as hepatitis B, hepatitis C, aflatoxin exposure or hemochromatosis. This tumor does not secrete hormonally active substances.</p> <p> <strong>Choice D:</strong> Mucinous adenocarcinoma of the colon typically causes iron-deficiency anemia caused by blood loss, bowel obstruction or change in bowel habits. This tumor does not secrete hormonally active substances.</p> <p> <strong>Choice E:</strong> Squamous cell carcinoma of the esophagus usually causes symptoms with swallowing; it is unlikely to cause diarrhea. This tumor does not secrete hormonally active substances.</p> <p> <strong>Key tips to remember:</strong></p> <ul> <li> Carcinoid syndrome is described as cutaneous flushing, abdominal cramps and diarrhea caused by excessive circulating serotonin.</li> <li> Metastasis of primary intestinal carcinoid to the liver, or primary lung or ovarian carcinoid tumor, results in symptoms of carcinoid syndrome.</li> <li> The small bowel is the most common site of carcinoid tumor; however, small bowel carcinoid tumors do not cause carcinoid syndrome because the liver metabolizes and clears the portal circulation of the excessive circulating serotonin.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d8f5b3c1-0b41-41c5-af14-79e6630dfd91 6 tips to nurture your family during training Tue, 24 May 2016 23:00:00 GMT <p> Medical school and residency are times of intensive training, so adding a family to the mix can necessitate even greater planning and attention. At the same time, medical trainees with families say the rewards of going through this period with such a support network are well worth the effort. One medical family shares their tips for success.</p> <p> <strong>It’s quite a ride</strong></p> <p> “I’m not exactly sure how to explain what it was like going to medical school as a family of five, but I guess the best way to describe [it] is a rollercoaster,” Angela Kalcec wrote in an article in the <a href="{"issue_id":297297,"page":22}" target="_blank" rel="nofollow">spring 2016 issue</a> of <em>Physician Family</em>, a publication of the AMA Alliance.</p> <p> Kalcec and her husband Everett, a third-year medical student at Michigan State College of Osteopathic Medicine, have three elementary-school-aged children and came to medical school after successful teaching careers. They share their joint insights in the article.</p> <p> “There are highs and lows, and sometimes we just barely hang on, but it is a fun ride,” she said.</p> <p> Here are six tips the Kalcecs recommend for other physicians in training and their families:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Communication is essential to succeeding as a busy family. </strong>“If you and your spouse are not communicating and working as a team, things will be really hard,” Everett Kalcec said.<br /> <br /> “We talk every morning and every night and go through the plans for the day and the next,” Angela Kalcec said.<br /> <br /> And when plans change along the way, the Kalcecs said it’s important to stay in constant contact. “We talk and text often,” she said. “We communicate, and we make it work.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Don’t follow assigned responsibilities. </strong>With the sometimes chaotic schedules that come with the responsibilities of medical training, a partner’s job and the children’s needs and activities, each day may look a little different. That makes it all the more important for everyone to pitch in.<br /> <br /> “If something needs to get done, you just do it,” said Angela Kalcec. “From picking a child up from school to emptying the dishwasher or folding laundry, nothing is beneath either of us.”<br /> <br /> When there are multiple things that need to be done at the same time, that’s when communication and prioritization are most important. The Kalcecs advise that you talk to your spouse if you need more time for essential responsibilities—such as studying for an exam or meeting a work deadline—and rearrange the other priorities accordingly.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Plan carefully, but be ready to improvise. </strong>“We plan just about every minute of the day,” Angela Kalcec said. That includes using organizational tools, such as a shared Google Calendar that includes reminders about upcoming activities.<br /> <br /> But with children, the best of plans can get derailed. “You have to be able to improvise,” she said. “This includes backup and double back-up childcare, friends that can take notes and co-workers who can cover in a pinch.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Make family time a priority. </strong>“When my husband decided to go to medical school, we agreed to do our best to always make time for our family,” Angela Kalcec said. For their family, that means having dinner together and spending time together in the early evening before studies. Whatever family time fits with your schedule, the important part is to make it quality time together.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Follow a budget. </strong>Not only does this mean understanding how to manage your finances but also prioritizing what you will spend on and what you will save on.<br /> <br /> “One sacrifice I couldn’t make was opportunities for our kids,” Angela Kalcec said. Instead, the Kalcecs spend less on clothing, drive older cars, and use coupons and bargain shop.</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>Make the most of your support network. </strong>The Kalcecs recommend connecting as much as possible with built-in support networks. Angela Kalcec said she’s been very active in the local and national physician family groups, where she has met great mentors and friends.<br /> <br /> Everett Kalcec said taking advantage of the school’s resources for students has been invaluable. “Nothing important was ever done alone,” he said. “All medical schools have counselors and advisers to help students.” He said he also has made sure to talk with professors whenever possible.<br /> <br /> “Remember to reach out to each other, other medical student families and get involved,” he said. “We are all in this together!”</p> <p> <strong>Additional insights for physician families:</strong></p> <ul> <li> <a href="" target="_self">Building blocks for a successful medical marriage</a></li> <li> <a href="" target="_self">How to balance a two-physician family</a></li> <li> <a href="" target="_self">6 tips for living on a budget during training</a></li> <li> <a href="" target="_self">Physician-recommended steps to work- and home-life balance</a></li> <li> <a href="" target="_self">5 financial planning tips every young physician should know</a></li> </ul> <p align="right"> <em>By AMA Wire editor</em> <a href="" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ed50c450-ec0f-4040-a68f-5f5f79ab9dc3 4 new ways HHS hopes to simplify, support patient care Tue, 24 May 2016 20:48:00 GMT <p> Physicians and patients could soon have access to tools that will help simplify complicated components of health care, including Medicare payment policies and medical bills. Learn about two new health IT challenges and funding opportunities that should bring greater clarity and simplicity to important administrative functions, from medication management to care coordination.</p> <p> <strong>Making sense of regulations and medical bills</strong></p> <p> “It’s not just a vision for our future,” said U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell as she announced two new challenges at Health Datapalooza in Washington, D.C. “These changes are happening right now. We are getting closer to that better, smarter health care system every day.”</p> <p> The two challenges from HHS focus on clarity for both physicians and patients:</p> <ul> <li> <strong>MIPS Mobile Challenge. </strong>The Medicare Access and CHIP Reauthorization Act (MACRA) proposed rule is complicated, and many physicians are wondering how to make sense of it all. In an effort to help physicians understand the rule when it is finalized this fall, HHS has announced a new challenge to help physicians navigate the Merit-based Incentive Payment System (MIPS).<br /> <br /> The MIPS Mobile Challenge will focus on solving the problem that many physicians and their staff will face—the ability to easily access information that is relevant to improve patient care and enable successful reporting under the new payment system. The winning idea will create a mobile platform that features innovative ways of transmitting educational materials or facilitating collaboration among users.<br /> <br /> Submissions for mobile platforms that accomplish this goal are open through July 15. <a href="" rel="nofollow" target="_blank">Learn more</a> about the MIPS Mobile Challenge.</li> </ul> <ul> <li> <strong>A Bill You Can Understand Challenge. </strong>Medical bills can be difficult to understand, often feeling like a foreign language to patients. HHS recently announced a new challenge that seeks design solutions that result in clearer, less complex and more understandable medical bills that improve the patient financial experience.<br /> <br /> Idea submissions for a medical bill that makes sense are due Aug. 10. The winners will be announced at the Health 2.0 conference in September. <a href="" rel="nofollow" target="_blank">Learn more</a> about the challenge.</li> </ul> <p> <strong>Technology that advances patient care</strong></p> <p> National Coordinator for Health IT Karen DeSalvo, MD, announced two new funding opportunities intended to boost implementation of standards and technology that can improve care delivery, health information exchange and the patient experience.</p> <p> The Office of the National Coordinator for Health IT is asking applicants to select focus areas from a list of categories, including comprehensive medication management, laboratory data exchange and care coordination.</p> <p> Each program differs in award amount and category selection:</p> <ul> <li> <strong>High Impact Pilots (HIP) program.</strong> Applicants select one priority category and a minimum of three impact dimensions that their project will address. Total funding available is $1.25 million. Submissions are welcome until July 8. <a href="" rel="nofollow" target="_blank">Learn more</a> about the HIP program.</li> </ul> <ul> <li> <strong>Standards Exploration Award (SEA) program.</strong> Applicants select one priority category and one specific impact dimension that their project will address. Total funding available is $250,000. Submissions are welcome until July 8. <a href="" rel="nofollow" target="_blank">Learn more</a> about the SEA program.</li> </ul> <p> “We all need to move toward common standards,” Dr. DeSalvo said. “We have to move toward culture change—one in which access to health information is the norm, including addressing information blocking, and we have to build an appropriate business case for interoperability.”</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d4101952-b171-4c88-a060-f54c2328aa8b This USMLE Step 1 question stumped test-takers Mon, 23 May 2016 21:25:00 GMT <p> When it comes to taking exams, not all questions are created equal. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you need this exclusive scoop on one of the most commonly missed USMLE test prep questions. Find out what this month’s challenging question is, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="" target="_self">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> An investigator is evaluating the effects of new synthetic drugs on arteriolar resistance. Drug X maximally increases vascular resistance by 50 percent at a dose of 20 mg/mL. Drug Y maximally increases vascular resistance by 75 percent at a dose of 40 mg/mL. Which of the following conclusions can be drawn from this study?</p> <p> A. Drug X has a smaller volume of distribution than drug Y Angiotensin II</p> <p> B. Drug X has a shorter half-life than drug Y</p> <p> C. Drug X is less efficacious than drug Y</p> <p> D. Drug X is less potent than drug Y</p> <p> E. Drug X has a lower LD<sub>50</sub> than drug Y</p> <p>  </p> <p>  </p> <p> <object data="" height="350" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is C.</strong></p> <p>  </p> <p> <strong>Kaplan says, here’s why: </strong><br /> The only conclusion that can be drawn from these data is that drug X is less efficacious than drug Y. Efficacy is defined as the maximum effect that can be produced by a drug, regardless of dose. Drug X can produce only a 50 percent change in resistance, whereas drug Y can produce a 75 percent change in resistance. Therefore, drug X is less efficacious than drug Y.</p> <p> In the figure below, Drug X has a greater efficacy than Drug Y because it produces a larger effect. Drug A is more potent than Drug B because less drug is required to produce a given response.</p> <p> <a href="" target="_blank"><img src="" style="margin:15px;" /></a></p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> A volume of distribution is a hypothetical volume of body fluid that would be required to dissolve the total amount of drug at the same concentration that is found in the blood.</p> <p> <strong>Choice B:</strong> The half-life is the time it takes for the concentration of a drug to decrease 50 percent from its previous measurement. There is no information given to determine half-life.</p> <p> <strong>Choice D:</strong> The potency is the dose or concentration required to produce 50 percent of the drug’s maximal effect. We cannot determine the potency of drug Y from this question.</p> <p> <strong>Choice E:</strong> The LD<sub>50</sub> is the dose that causes death in 50 percent of a population of subjects. The experiment described does not involve a population study, and it does not give any indication about the toxicity of the drug. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d2e34901-7427-4926-b3f3-47e069a357bb 3 steps for talking with patients about substance use disorder Mon, 23 May 2016 21:00:00 GMT <p> When a patient with a substance use disorder comes in for a visit, talking to them about treating their addiction in a way that avoids the stigma that surrounds these disorders can be difficult. Learn how one physician approaches this conversation during her addiction consultations with patients.</p> <p> Out in New Mexico, physicians and other medical professionals are putting in a lot of work toward ending the opioid overdose epidemic. <a href="" rel="nofollow" target="_blank">Project ECHO</a> (Extension for Community Healthcare Outcomes), a free-of-charge distance education model, connects primary care physicians with specialists to help them develop and share knowledge in the care of a variety of complex health conditions The program also has facilitated medication-assisted treatment (MAT) trainings for more than 375 physicians who are now buprenorphine-waivered.</p> <p> But what about the simple yet critical act of beginning the conversation about treatment with a patient who has a substance use disorder?</p> <p> As associate director of Project ECHO, Miriam Komaromy, MD, an internal medicine specialist and addiction consultant in New Mexico, spends the bulk of her clinical time conducting addiction consultations.</p> <p> <strong>Beginning the conversation that could save a life</strong></p> <p> Primary care physicians refer patients to Dr. Komaromy so that she can talk with them, get to the heart of the disorder and figure out the best way to structure their treatment plans.</p> <p> When a patient comes in for that first visit, Dr. Komaromy focuses on three things to minimize stigma and promote an effective dialogue:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Let the patient tell their story.</strong> Start out broadly, asking open-ended questions to get the patient talking about their story—not their substance use disorder story, but rather their personal story.<br /> <br /> “I usually start by saying, ‘Tell me a little bit about yourself,” Dr. Komaromy said. “If they don’t immediately jump in talking about their substance use disorder, I say, ‘OK, now would you be comfortable telling me a little bit about your history of issues with substance use?’ The story really unfolds from there.”<br /> <br /> “People really want to tell their story, but they often feel constrained in a medical environment,” she said. “But if you allow them to [tell their story,] it can be the most efficient thing of all …. People want to be heard. You can get a lot of relevant information right up front.”<br /> <br /> “Certainly, by the time [a patient] is open to treatment, they’re not having a good time,” Dr. Komaromy said. “They’ve really exported to a phase of substance use disorder that’s miserable in trying to avoid withdrawal and struggling with something that feels like it’s got a stranglehold on them.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Get to the heart of the matter.</strong> Understanding the reason for a patient’s substance use is key to finding the treatment option most suitable for that patient.<br /> <br /> “They’re usually really hurting, and almost always they have some story of trauma that underlies it,” Dr. Komaromy said. “Part of what I try to do is not just help figure out how to address the substance use disorder right here and now, but also how do we start to address the underlying trauma or the possibility of post-traumatic stress disorder.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Convey respect.</strong> Stigma is a big issue in these conversations, and respect is a key ingredient to avoiding it.<br /> “People with substance use disorders, because of the stigma, are used to being treated badly,” Dr. Komaromy said. “It’s so important to convey respect. The message—on a really gut level—is that I’m just another human being like you, and I want to figure out how I can help.”<br /> <br /> She recommends paying attention the following:</p> <ul> <li style="margin-left:40px;"> Never conduct the interview while standing. Try to sit at the same level as the patient.</li> <li style="margin-left:40px;"> Make eye contact.</li> <li style="margin-left:40px;"> Say things that are encouraging, empathetic and simple during their story, “such as, ‘That sounds really difficult,’” she said. “It’s simple, but I think that plays a huge role in developing the start of a therapeutic relationship.”</li> </ul> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="" target="_self">five things physicians can do to prevent opioid abuse</a>, recommended by the <a href="" target="_self">AMA Task Force to Reduce Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> Learn more about physicians’ efforts to end the opioid epidemic:</p> <ul> <li> Find out <a href="" target="_self">how a substance use researcher in San Francisco talks with his patients about substance use disorder</a>.</li> <li> Learn <a href="" target="_self">how President Obama’s opioid initiatives align with the task force’s recommendations</a>.</li> <li> Read a <a href="" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a><u>,</u> and watch a <a href="" rel="nofollow" target="_blank">video message</a><u> </u>from AMA President Steven J. Stack, MD.</li> <li> Find out <a href="" target="_self">what physicians are saying <u> about the new Centers for Disease Control and Prevention’s opioid guidelines</u></a>.</li> <li> Learn what the AMA Task Force <a href="" target="_self">recommends for physicians to reduce stigma and increase use of MAT</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a66bbcec-f472-4287-9d12-a4590787866f 3 barriers keeping data from improving health outcomes Fri, 20 May 2016 21:00:00 GMT <p> Access to actionable, real-time data can create opportunities for physicians to improve the health of their patients, but the current environment often prevents physicians from being able to access and use that data. Find out what three experts think the future holds for data usage and what they say needs to change first.</p> <p> <strong>How health data can—and does—save lives</strong></p> <p> Experts recently spoke to the health IT community about current and future uses of data at Health Datapalooza in Washington, D.C. Though there are issues in the current health system that cause problems for data usage in practice, the panelists were first and foremost optimistic about the future.</p> <p> “We are using data to save people’s lives,” said David T. Feinberg, MD, president and CEO of Geisinger Health Systems. For example, his practice saw a 16-year-old girl, who came to the emergency department for dehydration but volunteered for Geisinger’s population health-based genetics program.</p> <p> “We take a look … and it turns out that she has two of the genes associate with fatal cardiac arrhythmias in young athletes,” he said. “She wasn’t dehydrated; it was the beginning of her cardiac symptoms.”</p> <p> “Our data shows that 30 people in her extended family are treated by us,” he said. Geisinger then brought in her family members and set up monitoring for those at risk.</p> <p> “To me, it’s the first time we looked at this kind of information and [could] anticipate what’s going to happen in people’s lives,” he said, “and completely change the trajectory.”</p> <p> <strong>Barriers standing in the way of progress</strong></p> <p> There are many practices already using data to coordinate care, create better outcomes and focus on population health, but three barriers are still slowing progress and impeding practices’ abilities to use data in a helpful way.</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Time and technology</strong><br /> “We ask people who are driven to spend time with their patients to complete complex cognitive tasks,” said James L. Madara, MD, AMA executive vice president and CEO. “[A lot of] of physicians’ time during the day is on the keyboard [not] face to face with patients, which is why they went into that field. Added onto that … hours in the evening finishing up their keyboard work.”<br /> <br /> “One of the issues is the failure to recognize the variation that occurs regionally and in terms of practice type,” Dr. Madara said. “We often get tools that have this monolithic kind of feel to them. A good place to start is a really well-defined problem, and then the ideas stem from that.”<br /> <br /> “For example, <a href="" target="_self">electronic health records (EHRs)</a>,” he said. “The idea is that we have lots of data—we have to organize it in some digital way. If you would have said that was the problem initially, and the problem is actionable, organized data at the point of care, easy entry, protecting the interface between patient and physician and recognizing that … continuity and interoperability are really important, we would have had a digital approach with a very different set of products than we have today.”<br /> <br /> Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, gave an example of how physicians have worked together to make improvements based on access to meaningful data outside of a handed-down mandate.  <br /> <br /> “We have tended to organize primary care physicians into small teams,” he said. “One of the things we have learned [is that] when they see each other’s data, they see things, do things, act on things in a way no government or regulator or payer ever could cause them to do.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>The wrong incentives</strong><br /> The rapid growth of high-deductible plans has made many patients reluctant to seek the care that they need, Burrell said. “We see people who need care coordination and need certain services but say, ‘I know I need it, but I can’t afford all the out-of-pocket expense.’ I’m worried about the long-term implications of those designs.”<br /> <br /> On the physician side, Burrell said, putting financial risks on physicians doesn’t foster improvements. It’s the current movement toward incentives that has been more effective, he said.<br /> <br /> But perhaps the real incentives U.S. health care needs aren’t financially based.<br /> <br /> “I think we have the incentive systems all wrong,” Dr. Madara said. A nationwide <a href="">study</a> the AMA conducted with the RAND Corporation found that “the primary driver of physicians was time face to face with patients,” he said, “and everything that got in the way of that was a disincentive.”<br /> <br /> “There have been studies that show that if you ask a physician what [they] need to improve [their] practice, they say actionable data in real-time,” he said. “[If] you give it to them, they produce higher quality care than one does with small economic incentives.”<br /> <br /> The incentive isn’t the payment—it’s the patient’s health and the physician’s relationship with him or her.<br /> <br /> “The more we shift toward paying for value, the better,” Dr. Feinberg said. “It will play out differently in different communities and at different levels, but the concept of paying for outcomes, paying for quality, for functionality … however it plays will be better.”<br /> <br /> “The biggest barrier is that we’re completely worried about our own turf,” Dr. Feinberg said. “This is a crisis in America—the type of health care we deliver, who gets it, the quality, who doesn’t get it and the cost.”<br /> <br /> Industry stakeholders are all worried about what’s happening to them, Dr. Feinberg said. “It’s never really been the year of the patient.”<br /> <br /> “Then something happens in your family, and you interact with this system, even as an insider,” he said. “It’s totally a pain. I think if we’re going to fix this, it’s going to take a huge dose of selflessness, and I don’t see the industry talking about that.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Gaps in education</strong><br /> “We’re focused on connecting the data to missing gaps in the health system,” Dr. Madara said. One example is the AMA’s <a href="" target="_self">Accelerating Change in Medical Education Consortium</a>, which consists of 32 medical schools. “We are now populating the consortium with a learning EHR … which [will] allow students to get the rhythm of what an EHR can do and get them ready for the next generation of EHRs.”<br /> <br /> “In terms of the flow of work in physician offices,” Dr. Madara said, “we have created a set of interactive modules—<a href="" rel="nofollow" target="_self">STEPS Forward</a>™—that allow one to use data in a more effective way in practice.”<br /> <br /> It is important that the next generation of physicians is prepared and has the knowledge to make sure the system continues to shift in the right direction, he said. “And that requires changing the structure of medical school.”</p> <p> Explore ways data is changing care and education:</p> <ul> <li> Read what a U.S. senator is saying about <a href="" target="_self">why the health system needs to fix EHRs</a>.</li> <li> Discover how Vice President Biden is <a href="" target="_self">calling for physician input and breaking down the walls that prevent data sharing</a>.</li> <li> Find out how <a href="" target="_self">virtual patients help create the med ed environment of the future</a>.</li> <li> Learn how to <a href="" target="_self">diagnose prediabetes among your patients using a registry</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e2384373-292e-4173-9528-2c96e84f5e92 How new Medicare payment system intends to help small practices Fri, 20 May 2016 21:00:00 GMT <p> Draft regulations released last month outline sweeping changes to the Medicare payment system, and one of those eagerly anticipated changes is the Centers for Medicare & Medicaid Services’ (CMS) stated intent to ease physicians’ administrative burdens—including for those in small or rural practices. A new fact sheet outlines flexibilities the agency is proposing for physicians in the new payment system.</p> <p> <strong>Responding to physician feedback</strong></p> <p> The <a href="" target="_blank" rel="nofollow">proposed rule</a> for implementing key provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) has drawn concerns regarding its regulatory impact analysis, which projected that the quality and resource use components of the new Merit-based Incentive Payment System (MIPS) would have a negative impact on most solo physicians and small practices.</p> <p> CMS has clarified in its new <a href="" target="_blank" rel="nofollow">small practices fact sheet</a> that the projections made in the analysis were “based on 2014 data when many small and solo practice physicians did not report their performance. It also does not reflect the accommodations in the proposed rule that are intended to provide additional flexibility to small practices.”</p> <p> In particular, the impact analysis table in the proposed rule only offers a partial picture of physicians’ potential success in MIPS because it fails to include participation in the categories of “clinical practice improvement” and “advancing care information”—formerly the electronic health record meaningful use program.</p> <p> Another flaw in the analysis was that it did not provide the magnitude of how physicians would be affected. For example, physicians who opted not to participate in quality reporting and meaningful use would be subject to an 11 percent payment cut in 2019 under previous law. Under MACRA, the maximum payment cut would be 4 percent. Unlike MACRA, previous law did not provide any partial credit for efforts that were not 100 percent successful.</p> <p> The analysis looked at successful participation of “eligible clinicians” in the Physician Quality Reporting System (PQRS) and under the value-based modifier. CMS’ definition of “eligible clinicians” includes nonphysician health professionals such as chiropractors. Many of these eligible clinicians could not participate in PQRS or the value-based modifier. Consequently, the subset of the physicians actually reflected in the analysis is relatively small.</p> <p> Andy Slavitt, acting administrator of CMS, <a href="" target="_self">recently testified</a> before a congressional committee, emphasizing that the agency is focused on providing the flexibility required for physicians in smaller practices to be as successful under MIPS as those in larger groups.</p> <p> Here are some of the flexibilities that CMS says were included in the proposed rule to accommodate the unique needs and challenges faced by physicians in small practices: </p> <ul> <li> <strong>Physicians with a low Medicare volume won’t be subject to the MIPS payment adjustment.</strong> To avoid unnecessary reporting burdens, clinicians or groups who have less than or equal to $10,000 in Medicare charges and less than or equal to 100 Medicare patients are excluded from the MIPS payment adjustment.</li> </ul> <ul> <li> <strong>Physicians should not be held accountable to inapplicable categories.</strong> If a MIPS performance category does not have enough measures or activities that are applicable for the practice, then the category would not be included in the practice’s MIPS score.</li> </ul> <ul> <li> <strong>Physicians will have fewer measures on which to report.</strong> The agency is proposing to remove unneeded measures and reduce administrative requirements. For example, CMS proposes to reduce the number of required measures in the quality and advancing care information categories.</li> </ul> <ul> <li> <strong>Physicians can use a single reporting mechanism.</strong> Three of the four categories will require reporting—all of which can be done through the same mechanism, instead of the distinct reporting options required under the current payment system. Physicians also have greater choice regarding which reporting mechanism to use.</li> </ul> <p> <strong>Easing the burden within performance categories</strong></p> <p> CMS has proposed additional flexibilities within MIPS performance categories to account for the unique circumstances of individual clinicians, small groups, and practices in rural or professional shortage areas:</p> <ul> <li> <strong>Quality.</strong> The total possible points would be 80 for a group of nine or fewer, while a group of 10 or more would be 90 points. Also in an effort to reduce physicians’ reporting burden, the quality category would require practices of all sizes to report only on six measures, rather than the nine current measures. In addition, physicians would receive partial credit for measures.</li> </ul> <ul> <li> <strong>Clinical practice improvement activities.</strong> Under this category, physicians and other clinicians would be rewarded for clinical practice improvement activities, such as those focused on care coordination, beneficiary engagement and patient safety. A list of more than 90 options will be available for physicians to select activities that match their practice’s individual goals.<br /> <br /> For physicians in small practices located in rural or professional shortage areas, this category allows them to submit one activity of any weight to receive partial credit or two activities of any weight to receive full credit. Larger practices would be required to submit three to six activities.</li> </ul> <ul> <li> <strong>Cost.</strong> A cost score would not be calculated for physicians who don’t have a high enough patient volume for the cost measures (generally defined as a minimum of 20 cases pertaining to a particular measure). CMS would reweight the cost category to zero and adjust other MIPS performance category scores to make up the difference.</li> </ul> <p> While these proposals are important changes for physicians, the agency will need to make additional improvements during the rulemaking process to best address things that have been getting in the way of physicians focusing on providing high-quality care to their patients. The proposed rule is open for comment through June 27, and CMS has said it welcomes feedback from patients, physicians, caregivers, health care professionals and members of Congress, among others.</p> <p> The AMA is developing recommendations to further ease the burdens on physicians in small or solo practices to enable their success under this new payment system.</p> <p> <strong>Resources to help you prepare for the new payment systems</strong></p> <p> The AMA offers a number of resources to help physicians prepare for the coming payment policies, including:</p> <ul> <li> <a href="" target="_self">A summary of the proposed regulations</a></li> <li> <a href="" target="_self">4 steps to prepare for Medicare’s new payment systems</a></li> <li> <a href="" target="_self">A guide to physician-focused payment models</a></li> <li> <a href="" target="_self">Key points of the Merit-based Incentive Payment System</a></li> <li> <a href="" target="_self">What you can do now to prepare</a>  </li> <li> The AMA’s <a href="" target="_self" rel="nofollow">STEPS Forward™ collection</a> of practice improvement strategies, which include advancing team-based care, implementing electronic health records, improving care and practicing value-based care</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fddb8359-730d-431b-b580-e76905780de8 Weigh in on pressing health care issues by June 5 Thu, 19 May 2016 17:21:00 GMT <p> How do you think the practice of medicine should be improved in the United States? Share your thoughts on important health care topics—and have a chance to shape AMA policy—via the AMA <a href="" target="_self">Online Member Forums</a> (log in). They’re now open in advance of the <a href="" target="_self">2016 AMA Annual Meeting</a>, taking place June 11-15 in Chicago.</p> <p> Online forums allow AMA members to weigh in on key policy issues facing medicine at the convenience of their own schedules. By participating in the forums, you can add your voice to the AMA policy discussion from your home, at your office or on the go.</p> <p> Resolutions and reports up for discussion at the 2016 AMA Annual Meeting address such topics as:</p> <ul> <li style="margin-left:0.25in;"> Measuring and improving access to care for patients</li> <li style="margin-left:0.25in;"> Addressing the availability of addiction treatment centers</li> <li style="margin-left:0.25in;"> Reducing gun violence</li> <li style="margin-left:0.25in;"> Improving the safety of drinking water</li> <li style="margin-left:0.25in;"> Increasing the number of residency positions available to train doctors for practice</li> <li style="margin-left:0.25in;"> Reducing barriers to preventive and routine physical and mental health care for physicians in training</li> </ul> <p> All items of business from initial reports and resolutions for this policymaking meeting are posted in the forums, which are sorted by reference committee. Any AMA member can comment on any item of business. While the forums will be open until the start of the meeting, comments posted after June 5 may not be captured in the comment summaries that will be shared with reference committee members and posted on the <a href="" target="_self">2016 AMA Annual Meeting website</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5ea6cf51-5743-492b-848d-3b463f1580b4 4 ways schools are paving a new path to residency Thu, 19 May 2016 16:57:00 GMT <p> Several medical schools are overhauling the way their students make the traditionally stressful leap into graduate medicine education (GME).</p> <p> Schools are implementing these programs as part of their work with the AMA’s <a href="" target="_self">Accelerating Change in Medical Education Consortium</a>, which is working to modernize and reshape the way physicians are trained. The programs are designed to improve competency, leadership and patient care through innovations that bridge the curriculum gap between medical school and internship.</p> <p> <strong>A transition curriculum</strong></p> <p> “Interns in July are expected to hit the ground running and take care of patients,” said Julie Byerley, MD, vice dean for education at the University of North Carolina School of Medicine, a consortium member school. But greater emphasis needs to be placed on preparing students to make that transition.</p> <p> The school has launched its new <a href="" target="_blank" rel="nofollow">Translational Education at Carolina</a> curriculum, which weaves professional development throughout the four years of medical school. It also includes a “transition to internship” component designed to enhance leadership qualities, ethics and humanism with an eye specifically toward making a smoother transition from undergraduate medical education (UME) to GME.</p> <p> The school is on track to see their first class of students take part in the transition to internship aspect of the curriculum beginning in March 2018. This will include:</p> <ul> <li> Monthlong rotations specifically focused on the transition to internship</li> <li> Assessment of core entrustable professional activities (EPA) for entering residents</li> <li> More leadership education, enabling students to take on leadership roles sooner as residents</li> </ul> <p> Dr. Byerley said the updated transition plan promises fewer medical errors, better care and a priceless opportunity to shape the future of medical education.</p> <p> <strong>Focusing on patient safety</strong></p> <p> Michigan State University College of Osteopathic Medicine, also a member of the consortium, is considering the transition to residency through the lens of patient safety.</p> <p> An emphasis on safety education begins in the first year of medical school under its new program and continues into clerkship and residency. The goal is to enable students to use their undergraduate understanding of safety as a springboard to residency research projects on the same topic.</p> <p> “We hope to demonstrate that students can and should be valued elements of the overall goal of patient safety,” said Saroj Misra, DO, associate professor of family and community medicine at Michigan State<em>.</em></p> <p> So far, there is little training on patient safety at the undergraduate level and little effort to use a safety curriculum that bridges the transition from medical school to residency, Michigan State faculty who are leading the school’s curricular innovations say. While there is little evidence to date that longitudinal approaches to safety will have a positive impact, Dr. Misra said, they intend to discover if it does.</p> <p> With the use of a formalized curriculum involving validated modules combined with mock cases, Michigan State is training students to detect and react to medical errors. Students learn to identify errors, identify the stages of treatment most prone to errors, examine causes and communicate with the families of patients. The training involves such elements as how to apologize and how to conduct a root cause analysis.</p> <p> <strong>Embedding students in the care setting</strong></p> <p> At Ohio University Heritage College of Osteopathic Medicine, another consortium member, physician educators are laying the foundation for a seamless transition to internship by embedding students in patient-centered medical homes in Cleveland.</p> <p> “The impetus is, we need to be looking for more efficiency in education, just like we need to look for more efficiency in care,” said Isaac Kirstein, DO, dean of the college.</p> <p> In this model, students continually build skills needed to lead in health systems science, population health, communications, safety and health IT—practical skills that prepare them for their transition to the linked residency.</p> <p> For students who have been embedded in patient care throughout medical school, their first day of residency doesn’t seem very different from their last day of medical school, Dr. Kirstein said.</p> <p> He called leadership a key skill in playing a more meaningful part in a health care team from the first day of residency. “If we don’t produce physicians who can lead within health care teams, other professionals will take that role,” Dr. Kirstein said.</p> <p> <strong>A bridge between UME and GME</strong></p> <p> To usher students through the transition from medical school to residency, the University of California, Davis, School of Medicine and the Kaiser Permanente health care system have collaborated since 2014 as part of the school’s work as a founding member of the AMA’s Accelerating Change in Medical Education Consortium.</p> <p> “Internship is a huge mystery to medical students,” said Tonya Fancher, MD, associate professor of medicine. “If we can tell them, ‘here is what you need to be able to do on Day 1,’ then we’ve made it easier for them.”</p> <p> UC Davis puts students to work in Kaiser clinics throughout medical school, providing them with early experience in teamwork.</p> <p> At graduation, students are offered conditional acceptance to residency at either Kaiser or UC Davis. The project enhances the transition to internship and gets physicians into the workforce sooner, Dr. Fancher said. It also serves another vital purpose, she said—solving the acute shortage of primary care doctors in California.</p> <p> “It seems really important to bridge the gap between UME and GME,” she said. “These two worlds have really lived separately for probably too long.”</p> <p> <strong>More innovations in medical education:</strong></p> <ul> <li> Learn why <a href="" target="_self">one school is relaying student competency to residency programs</a>.</li> <li> See <a href="" target="_self">how a school is training students for rural medicine</a>.</li> <li> Find out <a href="" target="_self">how students are at the forefront of transforming med ed</a>.</li> <li> Discover <a href="" target="_self">why physician educators are going back to school</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e76ac848-377b-4f77-9aa9-02b7d40848fc The impact of parenthood on residency Wed, 18 May 2016 21:21:00 GMT <p> With women comprising one-half of medical school graduates, two recent studies examined the experience that residents have when they decide to become parents during training. Find out how common parenthood is and how it impacts men versus women.<a href=""><img src="" style="width:350px;height:1259px;margin:15px;float:right;" /></a></p> <p> <strong>Deciding when to have children</strong></p> <p> Two recent investigations into parenthood during training found that residents are concerned about how having a child will impact their training and how their skills and work ethic will be perceived. But the studies showed women who become pregnant are more often impacted than men who become fathers during residency.</p> <p> With residents spending the prime of their reproductive years in training and more women going into medicine, a <a href="" rel="nofollow" target="_blank">study</a> in the <em>International Journal of Radiation Oncology</em> looked at how parenthood impacted radiation oncology residents and a <a href="" rel="nofollow" target="_blank">second study</a> published in the <em>Journal of the American College of Surgeons</em> explored general surgery residents’ experiences.</p> <p> Among the 190 radiation oncology trainees who responded to a survey, slightly more than one-half had children. Nearly 45 percent said they or their partner had a pregnancy during residency, while 50.5 percent of respondents said they delayed or were delaying having children because of residency demands.</p> <p> And parental leave is a common occurrence among general surgery residents. In the study published in the <em>Journal of the American College of Surgeons</em>, 41 percent of the 66 general surgery residency program directors who responded to a survey said at least once a year they have a resident who takes maternity or paternity leave.</p> <p> <strong>Workload and training concerns</strong></p> <p> Radiation oncology residents expressed concerns about how a pregnancy would impact their training. One-third of those who were pregnant during residency believed colleagues would have extra work because of their pregnancy. Nearly one-half believed they had less research experience compared to colleagues, and more than one-fifth believed they gained less clinical experience than colleagues who didn’t become pregnant during training.</p> <p> General surgery residents who had become pregnant expressed concerns about “being a burden on colleagues,” “being perceived as ‘lazy’ or not carrying my weight,” and “being treated differently than my peers,” the study found.</p> <p> Similarly, men who became fathers said they felt guilty about leaving their teams shorthanded while on paternity leave and said “the good residents take as little time as possible.”</p> <p> The radiation oncology study showed no significant differences in academic productivity or academic career aspirations between men and women overall. It also found that over the total duration of training, radiation oncology residents who were mothers kept pace academically with male colleagues without children.</p> <p> “That could be due to more efficient use of time and resources,” study authors said. “Alternatively, perhaps hours spent on childcare do not come at the expense of academic pursuits but instead come at the expense of self-care and leisure activities.”</p> <p> General surgery program directors perceptions back that up. They saw children as decreasing female trainees’ well-being more often than male trainees—32 percent versus 9 percent.</p> <p> <strong>More challenging for women than men</strong></p> <p> Women were more often responsible for childcare duties than men. Among radiation oncology residents, 38.1 percent of fathers had non-employed partners to take care of a child. No mothers had a non-employed partner. Also:</p> <ul> <li style="margin-left:0.25in;"> Fathers reported performing a median 25 percent of cumulative familial childcare duties; they said their partner performed a median of 70 percent.</li> <li style="margin-left:0.25in;"> Mothers reported a median of 40 percent of childcare duties, compared to a median partner rate of 35 percent.</li> <li style="margin-left:0.25in;"> Nearly 75 percent of men said their partner “usually” was the caretaker when unexpected childcare needs arose; just 31 percent of women responded that way.</li> </ul> <p> <strong>Read more about work-life balance issues:</strong></p> <ul> <li style="margin-left:0.25in;"> <a href="" target="_self">Physicians rank residency work-life balance by specialty</a></li> <li style="margin-left:0.25in;"> <a href="" target="_self">Four physician-recommended steps for a work- and home-life balance</a></li> <li style="margin-left:0.25in;"> <a href="" target="_self">Residents share 4 tips for assessing specialty lifestyle</a></li> <li style="margin-left:0.25in;"> <a href="" target="_self">Will gender influence your specialty? Physicians offer insights</a></li> </ul> <p align="right">  </p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a9708a3c-4249-4de2-945f-7800333ce266 Why your practice needs a health coach (and how to get one) Wed, 18 May 2016 20:45:00 GMT <p> Engaging patients in behavior changes can improve their overall health and reduce the amount of medical care they need, but it’s often difficult for physicians to find the extra time to collaborate and plan these types of strategies. Trained health coaches can take on a lot of these responsibilities to advance lifestyle changes, prevention and patient health.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Having a health coach involved in a patient’s care can not only increase patient satisfaction and engagement but also reduce physician stress and burnout by freeing up time.</p> <p> In a new <a href="" rel="nofollow" target="_self">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies, primary care physician Thomas Bodenheimer, MD, provides insights into implementing health coaching in your practice. Dr. Bodenheimer is a professor of family community medicine at the University of California San Francisco School of Medicine and contributed this module after <a href="" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge.</p> <p> <strong>You don’t need to look far to find a health coach</strong></p> <p> A health coach can bring an extra boost to your practice’s methods for both prevention and treatment. Health coaches may be registered nurses, licensed practical nurses, medical assistants (MA), health educators or community health workers.</p> <p> You may consider transitioning a current staff member into the health coach role. Or you may consider recruiting pre-medical or pre-nursing student interns to serve as volunteer health coaches if there are not enough resources to support an additional team member. You could also train a current and loyal employee to take on the health coaching role part time.</p> <p> The education of health coaches depends on the role you expect them to play. If your health coaches are going to provide clinical education, a nurse or social worker may be a good option. If they will be reinforcing the physician’s plan of care and using phone calls to keep patients on track, someone without a clinical license could acquire that skill set.</p> <p> In a randomized clinical trial, MAs successfully filled the health coach role and were able to help patients improve HbA1c and LDL levels. Once your health coaching program has been established, you may opt to select patients who have met their health goals to become peer coaches. These types of coaches should have the same illness and similar backgrounds to the patients they coach.</p> <p> <strong>How it’s working in Oakland</strong></p> <p> Asian Health Services is a community health center that serves Asian-American and Asian immigrant patients in Oakland, Calif. After a successful health coaching pilot program, they chose to expand so that each physician is paired with a health coach.</p> <p> With this type of focused teamwork, each patient gets the care they need, understands the management of their treatment and is actively engaged in their own health care. The organization provides care to a high-needs population—approximately two-thirds of their patients are on Medicaid. Many of the remaining patients are uninsured or underinsured and were determined to be especially suited to health coaching.</p> <p> The health coaches at Asian Health Services are MAs who have received additional training in motivational interviewing, such as the “ask-tell-ask” technique (a sample dialogue is available for <a href="" rel="nofollow" target="_self">download</a> as a tool in the STEPS Forward module), <a href="" rel="nofollow" target="_self">pre-visit planning</a>, chronic illness monitoring and electronic health record management. Training is ongoing, and members of the multi-disciplinary team in each clinic lead the educational sessions.</p> <p> The health coaches prep charts the day before a patient visit to see if the patient received care elsewhere between visits, review interval laboratory tests and refresh their memory using notes from the previous visit. The day of the appointment, the health coaches conduct a pre-visit <a href="" target="_self">huddle</a> with the patient’s physician to discuss the upcoming visit.</p> <p> During the patient visit, the coach obtains the blood pressure and performs medication reconciliation, sets the agenda and conducts action planning with the patient. After the visit, the coach meets again with the patient in the exam room to ensure he or she understands the physician’s recommendations.</p> <p> The program is now active in all clinic locations, and Asian Health Services continues to evaluate and evolve their health coaching training and application. They plan to expand the health coaching program to include licensed vocational nurses who will serve patients with diabetes.</p> <p> The <a href="" rel="nofollow" target="_self">implementing health coaching module</a> module is one of eight new modules recently added to the AMA’s <a href="" rel="nofollow" target="_self">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices.</p> <p> Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4c63e5f8-1e0f-4e92-ab12-db3a3d9d7d47 Student wellness: Blueprints for the curriculum of the future Tue, 17 May 2016 22:13:00 GMT <p> The focus on wellness in medical education is growing, and it’s motivating students and faculty to search for the path to the wellness-centered learning environment of the future.</p> <p> Several submissions to the <a href="" target="_self">AMA Medical Education Innovation Challenge</a>, which encouraged students around the nation to upend the traditional medical school curriculum with outside-the-box ideas, and projects within the <a href="" rel="nofollow" target="_self">AMA Accelerating Change in Medical Education Consortium</a> emphasize student wellness.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> The goal is to create physicians who are better equipped to take care of themselves and therefore able to serve patients throughout the course of their medical careers.</p> <p> <strong>Building health for the healer</strong></p> <p> A team of students from the University of Louisville School of Medicine, which placed third in the Innovation Challenge, set out an ambitious goal to forge “an ideal version of medical education.”</p> <p> In their proposal, “Happy healers, healthy humans: A wellness curricular model as a means of effecting cultural change, reducing burnout and improving patient outcomes,” the four team members said the current environment is stressful and self-awareness, empathy and communication skills suffer.</p> <p> Their vision is of a medical school curriculum with an emphasis on student wellness comprised of physical, mental and spiritual health. Under their curriculum, students build coping and self-care skills with goal-setting groups, reflection and cognitive behavioral therapy.</p> <p> This vision even includes redesigning the medical school buildings. If the library is next to a gym, if the school provides stationary bikes, treadmill desks and meditation zones, the school promotes student wellness.</p> <p> “The healthiest choices also become the easiest choices,” said student Matthew Neal, an author of the proposal. “You make it so the path of least resistance leads to wellness, and folks will take care of the rest.”</p> <p> <strong>Fostering idealism</strong></p> <p> A team of Eastern Virginia Medical School (EVMS) students submitted a proposal to the challenge titled, “The medical education manifesto: Training the physician change agent of tomorrow,” and said the current system fails to preserve student idealism and the vision of “changing the world for the better.” Students tend to become more cynical and less idealistic as they move through their education, said Heath Patel, an author of the proposal.</p> <p> “Our work promotes wellness by preventing this phenomenon,” he said.</p> <p> Patel and three other students propose fostering wellness with a curriculum that preserves idealism and humanism, and makes time for what they call gratitude, mindfulness and reflection. The result is a student driven by his or her core values and beliefs and more resistant to burnout.</p> <p> “Intrinsic motivation is armor that protects from the difficulties of life,” Patel said.</p> <p> The medical school administration already has taken steps toward those values. In the fall of 2016 EVMS will debut the school’s CareForward Curriculum, which integrates student wellness as a guiding principal. EVMS is a member of the AMA’s <a href="" target="_self">Accelerating Change in Medical Education Consortium</a>.</p> <p> The four-year longitudinal curriculum promotes student well-being, academic success and resilience, said Allison Knight, PhD, who leads the wellness element of CareForward. Senthil Kumar Rajasekaran, MD, assistant dean for academic affairs, is leading the curriculum reform at EVMS.</p> <p> CareForward builds first-year students’ emotional skills to help deal with the transition to medical school and encourages students to monitor their sleep, nutrition and exercise routines. Throughout the curriculum, there is an emphasis on asking for help when needed and cultivating supportive relationships.</p> <p> The curriculum also features periodic, confidential mental health screenings and weekly protected time for health maintenance and well-being activities.</p> <p> <strong>Supporting medicine’s social mission</strong></p> <p> The Innovation Challenge proposal, “Reaffirming medicine’s social mission,” from a team based at Yale School of Medicine, called for greater emphasis on social responsibility as a way to wellness.</p> <p> “Reinforcing social responsibility as a crucial part of medicine through curricular reform and cultural changes is necessary to promote wellness,” said Tehreem Rehman, an author.</p> <p> Many who go into medicine with the goal of helping underserved populations face obstacles that challenge their own well-being. Those on the front lines of coping with health inequities suffer the most the proposal said.</p> <p> The proposal called for a curriculum that values contemplative practices that can lower burnout, improve joy and foster social responsibility. Rehman said contemplation allows those in the medical community to “process all of the chaos and trauma that medical training and practice inevitably entails.”</p> <p> <strong>Preparing students for the business side of practice</strong></p> <p> A team of students from Ohio University Heritage College of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine and Rowan University School of Osteopathic Medicine in their Innovation Challenge proposal tied burnout and stress to a common lack understanding of the business side of medicine among physicians.</p> <p> According to their proposal, “Training students to be prepared for the modern challenges of health care: Lessons learned in business school,” that lack of understanding has grown in importance as business issues play an ever-larger role in decisions that affect physicians.</p> <p> “Being able to have a say [in] your practice can give you a sense of ownership and lead to less burnout,” said Dan Krajcik, a dual DO and MBA student at Ohio University and lead author of the proposal.</p> <p> A greater understanding of mental health issues among students inspired him to take part in the Medical Education Innovation Challenge, Krajcik said—he helped carry out a survey of 10,000 osteopathic students and found more depression, anxiety and suicide than in the general population.</p> <p> <strong>Addressing the hazards of education</strong></p> <p> These and other proposals are part of ongoing work to foster medical student wellness. Some efforts are as simple as retreats to the mountains or low rates for gym membership, while others are more comprehensive.</p> <p> Mayo Medical School researchers have studied wellness among students for more than 14 years. Lotte Dyrbye, MD, professor of medicine at Mayo, has studied burnout since 2004, and the school is a founding member of the AMA’s Accelerating Change in Medical Education Consortium. Close to one-half of medical students in the United States experience burnout, she has said.</p> <p> “Trying to become a doctor shouldn’t be a hazard,” Dr. Dyrbye said in a recent tweet chat convened by the AMA.</p> <p> She has identified six important ways to prevent future physicians from experiencing what she calls “student distress”—these actions recognize the need for broad changes and involvement by both students and the broader medical community in making them happen.</p> <p> <strong>For more on physician burnout:</strong></p> <ul> <li> <a href="" target="_self">Physician satisfaction: Why leadership qualities matter</a></li> <li> <a href="" target="_self">Preventing resident burnout: Mayo Clinic takes unique approach</a></li> <li> <a href="" target="_self">The role of personal accomplishment in physician burnout</a></li> <li> <a href="" target="_self">Ward off burnout: Your peer network may impact you more than you thin</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:74fda54a-21dc-4017-ae4d-e2c72b3a4b96 Freedom of patient-physician conversations hinges on court case Tue, 17 May 2016 22:08:00 GMT <p> A federal court will be hearing a case about the constitutionality of a state law that represses free discussion between physicians and patients regarding health and safety issues.</p> <p> In a friend-of-the-court brief filed April 26, the AMA and eight other medical societies urged the <a href="" target="_blank" rel="nofollow">Court of Appeals for the 11th Circuit</a> to overturn a Florida law that restricts physicians from discussing firearm safety with patients and their families.</p> <p> The brief argues that the <a href="" target="_blank" rel="nofollow">Firearm Owners’ Privacy Act</a> is unconstitutional and intrudes on the practice of medicine. The law will inevitably affect other aspects of patient care, the brief says.</p> <p> In 2012 the district court had found the 2011 law unconstitutional. In 2014 a court of appeals panel of three judges issued a split decision. While one judge sided strongly with physicians opposing the law, the other two ruled in favor of the state. Physician groups and others sought a rehearing.</p> <p> In a <a href="" target="_self">rare decision</a>, the full court of appeals agreed to rehear the case. The rehearing will be held before the court <em>en banc—</em>all 11 active judges are to hear the case. Oral arguments are scheduled for June 21 in Atlanta.</p> <p> In its April 26 briefing, the AMA and other organizations call the law an example of politics overriding medicine. It has already led Florida physicians to self-censor when talking with patients, the brief says.</p> <p> “It is censorship, imposed for purely political motives,” it says.</p> <p> The law directly clashes with a consensus on care that dates to at least 1989. That year, the AMA enacted a <a href="" target="_self">policy</a> that encourages members to inquire into the presence of firearms in households and to promote the use of safety locks on guns in an effort to reduce injuries to children.</p> <p> “Effective medical care requires unfettered communications between physicians and their patients,” the brief tells the court.</p> <p> <strong>Other recent cases in which the AMA has been involved:</strong></p> <ul> <li> <a href="" target="_self">Court case could extend medical liability</a></li> <li> <a href="" target="_self">Case could leave physicians exposed to large fines</a></li> <li> <a href="" target="_self">Supreme Court case could have major health implications</a></li> <li> <a href="" target="_self">Court case could increase liability exposure, redefine injury</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c9e3064e-6495-45f4-93ad-3009a0ba8379 Harnessing senior physicians’ expertise Mon, 16 May 2016 21:34:00 GMT <p> Older physicians—especially those who are still interested in actively contributing to health care after retirement—have invaluable knowledge to pass on. Find out what one physician has to say about the profession finding new ways for these doctors to impart what they’ve learned.</p> <p> <strong>Creating new opportunities</strong></p> <p> Late-career physicians need pathways that let them pursue professional mentoring, teaching and meaningful community involvement, such as volunteering or working with service agencies or communities that are important to their organizations, a <em>Mayo Clinic Proceedings</em> <a href="" target="_blank" rel="nofollow">commentary</a> urges.</p> <p> Older physicians are less likely to be motivated by financial considerations and more likely to be looking for other rewards. Consequently, alternatives beyond cutting back their hours could help them “rediscover meaning and purpose in medicine and potentially prolong careers,” writes commentary author William M. Spinelli, MD, a researcher at Allina Health’s Division of Applied Research in Minnesota.</p> <p> “In return for this engagement, organizations would reap the benefit of the accumulated institutional wisdom and increased community engagement from senior clinicians as they continue medical practice and bridge the interval before the arrival of new primary care practitioners,” he said.</p> <p> <strong>A different way of thinking: From early exits to new roles</strong></p> <p> Long work hours, productivity demands and professional fatigue are driving a number of physicians out of practice earlier than they expected. Adding to the stress for some physicians is a growing number hospitals and practices requiring older physicians complete evaluations to see if they are still competent to practice.</p> <p> A 2014 Physicians Foundation <a href="" target="_blank" rel="nofollow">study</a> found that 44 percent of physicians surveyed planned to make changes that would ultimately reduce patient access to their services, including cutting back on the number of patients seen, retiring or working part time.</p> <p> Those statistics come at a time when primary care is facing a projected physician shortage. For years, fewer medical graduates have been choosing to go into primary care specialties such as family and internal medicine. At the same time, the U.S. population is living longer, resulting in more people needing care.</p> <p> “A great deal of the health care system is focused on innovative practices and such things as work flow processes and payment reform,” Dr. Spinelli said in a <a href="" target="_blank" rel="nofollow">video</a> accompanying his commentary. “I would suggest that another form of innovation is investing in the people who are responsible in helping with both patient care and implementation of these other new health care system design strategies.”</p> <p> Dr. Spinelli suggests that medicine can learn something from heartwood trees. As the trees age, the older cells at the core of the tree harden when they lose some of their ability to conduct water. As they harden, they perform the essential function of structurally supporting the tree.</p> <p> “Specifically, the question at hand is, ‘How can we leverage the knowledge, wisdom and experience of senior physicians at a time in their career when they are struggling with the pace, demands and changes in health care?’” Dr Spinelli said.</p> <p> He suggests that physicians can explore their commitment and passion for medicine and their communities by asking:</p> <ul> <li style="margin-left:0.25in;"> How did I get to this stage of my career?</li> <li style="margin-left:0.25in;"> What do I want the next stage of my career to look like?</li> <li style="margin-left:0.25in;"> What are the skills needed and the possibilities available for this next stage?</li> <li style="margin-left:0.25in;"> How can I learn from and share these journeys with colleagues?</li> </ul> <p> <strong>Tackling senior physicians’ concerns</strong></p> <p> The AMA earlier this year convened a national group of stakeholders to explore the growing trend of assessing the competency of aging physicians. The group, which included nearly three dozen representatives from organizations such as the Joint Commission and the Council of Medical Specialty Societies, was a recommendation of a recent report from the AMA <a href="" target="_self">Council on Medical Education</a>.</p> <p> The AMA <a href="" target="_self">Senior Physicians Section</a>, which stands more than 55,000 members strong, was the driving force behind the AMA policy that led to the council report and the convening of the stakeholder group.</p> <p> The AMA does not have a policy on whether physicians should be assessed, and the <a href="" target="_self">group began deliberation</a> around key issues and challenges for determining whether national guidelines for assessment should be developed. Considerations include the legal implications of screening physicians based on age and the uncertainty of how to interpret cognitive or motor function tests given to physicians.</p> <p> For those attending the 2016 AMA Annual Meeting in June, the AMA Senior Physicians Section will be hosting an <a href="" target="_self">education session</a> on physician burnout and reconnecting with one’s professional calling at any career stage.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2200672b-ff7f-455b-8093-10d29c162704 Fix EHRs for the patient-physician relationship, senator says Mon, 16 May 2016 21:20:00 GMT <p> Electronic health records (EHR) have caused many problems for the patient-physician relationship, and Sen. Bill Cassidy, MD, R-La., definitely has his fair share of troublesome EHR stories. The current state of EHRs is tearing the patient-physician relationship apart, Sen. Cassidy said. And that’s why he is taking steps in the U.S. Senate to relieve this burden and put physicians in the driver's seat.</p> <p> Sen. Cassidy recently spoke to the health IT community at Health Datapalooza in Washington, D.C.</p> <p> Sen. Cassidy and Sen. Sheldon Whitehouse, D-R.I., who also spoke at the event, introduced the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, also called the TRUST IT Act, which would create a star rating system to assess the interoperability, usability and security of certified health IT. The AMA issued a <a href="" target="_self">letter of support </a>(log in) for this bill.</p> <p> <strong>4 stories: How EHRs are affecting relationships with patients </strong></p> <p> <em>X-ray on a disc:</em> Sen. Cassidy said his mother recently had an injury, and he accompanied her to her physician’s office. All the required steps in the EHR almost led to the wrong test being ordered and a collapsed vertebra being missed.</p> <p> In seeking advice from a fellow physician and friend the next day, Sen. Cassidy asked if he could take a look at the x-ray and offer his opinion. The physician said that the two facilities don’t share data and so the senator would have to put the information on a disc and bring it in himself.</p> <p> “I’m thinking, this is great,” Sen. Cassidy said. “I used to bring films, and now I bring a disc.”</p> <p> <em>The EHR box:</em> Just two weeks ago, Sen. Cassidy received a call from a resident in his home state of Louisiana, who expressed her growing frustrations with her EHR. “She feels as if she is in a box,” he said. “She can’t do what she went to medical school for because she’s always in the EHR.”</p> <p> “She feels frustrated because she grew up with [technology],” the he said. “As a physician, but also as the son of a patient … I think what we should most focus on is the <a href="" target="_self">patient-physician relationship.</a>”</p> <p> But EHRs are tearing it apart, he said. “Whatever the promise and whatever the potential …unless we pay attention to that patient-physician relationship, it will all be for naught.”</p> <p> A recent study <a href="" target="_self">tracking resident EHR usage</a> found that residents in a teaching hospital each spent 112 hours per month on 206 patient encounters.</p> <p> “I think what we want,” Sen. Cassidy said, “is for the physician to have the capability to still focus what he or she needs to do based on that particular patient’s needs—not [be] driven by drop-down boxes.”</p> <p> <em>Interacting with the EHR, not the patient: </em>When recently visiting a physician friend who said he’s required to have 30-minute visits with each patient at the VA clinic, Sen. Cassidy asked if he really needed that full 30 minutes. “He said, ‘<a href="" target="_self">I don’t have time</a> to speak to the patient,’” Sen. Cassidy recalled. “‘I have 30 minutes, but I only have five minutes to actually turn, face the patient and see what his problem is.’”</p> <p> “When you spend so much time on an EHR,” Sen. Cassidy said, “the issue [is] not that you’re not paid for it …. Rather, it is [that] your time is consumed by your EHR.”</p> <p> <em>Pulled away from patients:</em> Sen. Cassidy’s wife is a retired breast cancer surgeon. “She said that when a woman came, and she had breast cancer,” he said, “she would speak to the woman—it was usually the husband who was crying—and she would want to look into their eyes to know that the diagnosis of breast cancer was not a sentence to death, but rather it was the next phase of their life and that there was hope and that they would come through this.”</p> <p> “It was looking into their eyes and reading body language and understanding when to pull back and when to press forward as she gave information that made my wife such an effective clinician,” Sen. Cassidy said. “I can promise you, [you can’t do that] if you’re staring at a drop-down box.”</p> <p> <strong>How the TRUST IT Act can help</strong></p> <p> “In the TRUST IT Act,” Sen. Cassidy said, “we attempt to establish a new paradigm—measure outcomes not processes.” It doesn’t matter how the patient gets to the best possible outcome, as long as they reach that outcome and their health is improved, he said.</p> <p> The act would create a grading system of EHR interoperability used by those who participate in the delivery of care. “Ideally,” he said, “the outcome would not be defined by somebody sitting in Washington but by the creativity of [physicians and developers].”</p> <p> “The focus should be the patient-physician relationship,” Sen. Cassidy said. “We have to start thinking less about what software works for those big institutions, which have every interest in the world in data-blocking, and more as to what works for me, the patient, me, the physician, [and] me, the son of the patient.”</p> <p> “Although many physicians are discouraged by EHRs,” he said, “Most don’t want to go back …. Physicians are dedicated people.”</p> <p> The AMA has taken action on EHRs in several ways:</p> <ul> <li> BreakTheRedTape, the AMA’s grassroots effort, held town halls in <a href="" target="_self">Seattle</a>, <a href="" target="_self">Boston</a> and <a href="" target="_self">Atlanta</a>.</li> <li> JAMA sponsored an event gathering experts to <a href="" target="_self">discuss why EHRs should be a top priority</a></li> <li> The AMA’s STEPS Forward ™ collection of practice transformation initiatives can help you <a href="" target="_self">select and purchase EHR products</a> and <a href="" target="_self">how to address documentation woes</a></li> <li> Find out <a href="" target="_self">eight things physicians said about EHRs</a> in an AMA-RAND study</li> <li> The AMA and MedStar evaluated the <a href="" target="_self">usability of the top 20 EHR products</a> with a new framework</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks </em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d75e20e7-cef1-4a41-a57d-8b197884f267 Biden seeks physician input in global cancer fight Fri, 13 May 2016 20:00:00 GMT <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">U.S. Vice President Joe Biden passionately called for data experts, researchers and physicians to join him in the <a href="" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);">National Cancer Moonshot Initiative</span></a> announced earlier this year by lending their talents and expertise to the global fight against cancer. Breaking down the walls that prevent data sharing will be an essential component to the initiative, as is physician input. <a href="" style="font-family:Arial, Verdana, sans-serif;font-size:12px;" target="_blank"><img src="" style="margin:15px;float:right;" /></a></span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Mr. Biden last week addressed the health IT community at Health Datapalooza in Washington, D.C. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Data and technology—when combined—can have an incredible impact on saving people’s lives and improving the health of people here and around the world,” the vice president said. “Six years ago our administration decided we should open up more of the data that’s held by the federal government to drive progress in medical research and health care delivery.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Since that time the U.S. Department of Health and Human Services has published more than 2,100 data sets. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Imagine what you could do to help in the fight against cancer if you had access to the millions of cancer pathologies and genomic sequences, family histories, and treatment outcomes,” he said. “You know what this significant access to data has enabled you to find out thus far, and I think we’re only scratching the surface.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><b>4 key ways data will play a role</b></span></span><br />  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Cancer-related deaths are down 23 percent over the last 21 years,” Mr. Biden said. “But we haven’t done nearly enough. We have to ask ourselves, ‘Why are we not progressing more rapidly?’” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">It’s expected, he said, that the world will see almost 20 million new cancer cases and 11.4 million more deaths from cancer by the year 2025 without dramatic intervention. “How can we prevent that from happening?” he asked. Mr. Biden cited four things that need to happen next:</span></span><br />  </p> <ul> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Generate large quantities of health data</span></span></li> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Make that data available to share by breaking down silos </span></span></li> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Build a network centered around patients that allows access to privacy-protected data</span></span></li> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Support quality data analysis to turn raw data into knowledge</span></span></li> </ul> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Researchers need to share data in order to move discoveries more rapidly,” he said. “Published research is hidden behind paywalls that lead to unnecessary duplication and failed efforts and wasted time and money.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><b>A personal experience with cancer</b></span></span><br />  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Mr. Biden’s son passed away three years ago from glioblastoma. “When you have someone near and dear to you—and every one of you has experienced this in some form or another,” he said solemnly, “when they’re in trouble you try to learn as much as you can as rapidly as you can, with as much depth as you can to see if you can help.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“It wasn’t until then—now three years ago,” Mr. Biden said, “that I came to realize that if this had been five years earlier, or five years later, the circumstances would have been either more difficult … or maybe I’d be standing here with my boy.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“My son had an exotic and last-ditch treatment for the glioblastoma,” he said. “They injected a virus into the tumor in his brain, but it required MRIs on a regular basis.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">But the location where his son’s MRIs were taken could not share the data with the location where he was receiving his treatment. Mr. Biden had to go to great lengths to put the data on a disc and make sure it was available to the other location on a regular basis. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Most major cancer centers don’t have an easy way … to share data, including patients’ records, test results, family histories and treatment responses,” he said. “We’ve got to change this. We need to break down silos that keep research away from the world and from one another.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“This matters,” Mr. Biden said. “It’s a matter of life and death.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><b>Leading a global effort</b></span></span><br />  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“You all stepped up,” Mr. Biden said. “You developed apps to track your blood pressure and how you sleep. We need this same use of your talents and expertise in the fight against cancer.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“More and more people are working together,” he said. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">During a recent trip to the Middle East to discuss ISIS, the leader of the United Arab Emirates first wanted to discuss how they could take part in the moonshot. And at the recent nuclear security summit, where more than 50 of the world’s leaders assembled, President Obama first had to address the leaders’ interest in talking with the vice president about cancer research. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“A few years ago it took more than a decade and $2.7 billion to sequence a fresh human genome. Now it takes less than a day, and it costs roughly $1,000,” he said. “Big data and computing power together provide the possibility of significant insight into how genomics, family medical history, lifestyles, genetic changes can trigger cancer—and how the cancer should be treated.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“We are on the cusp of significant breakthroughs that will save lives, sooner, to the benefit of all humanity.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Physicians, researchers and developers can go to the <a href="" rel="nofollow" target="_blank">National Cancer Moonshot Initiative </a>website and tell Mr. Biden about their plans to find collaborative solutions to accelerate progress and overcome barriers. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Help in the fight against cancer,” he said. “Please use your talents and tell us how—tell me how—we can do more. Tell me where you disagree. What are the things we should be focusing on?”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;text-align:right;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><i>By AMA staff writer </i><span style="color:rgb(4, 51, 255);"><i><a href="" rel="nofollow" target="_blank">Troy Parks</a></i></span></span></span></p> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d47bcd67-3edc-4733-957e-6554ae14f6ed 4 steps to prepare for Medicare’s new payment systems Fri, 13 May 2016 18:19:00 GMT <p> While the details of the Medicare Access and CHIP Reauthorization Act (MACRA) regulations still are being hammered out, physicians should start preparing for the new payment systems now. Make sure you’re on track by taking four important steps.</p> <p> The lengthy <a href="" rel="nofollow" target="_blank">proposed rule</a> released by the Centers for Medicare & Medicaid Services (CMS) outlines the draft regulations the agency is considering for implementation. This is just the beginning of the official rulemaking process, but what is known for sure is that physicians will have a choice in whether to participate in the <a href="" target="_self">Merit-based Incentive Payment System</a> (MIPS) or meet requirements for an <a href="" target="_self">alternative payment model</a> (APM).</p> <p> Here are the steps you can take to prepare your practice for one of the two new Medicare paths:</p> <p style="margin-left:40px;"> <strong>1.  Review your quality measurement and reporting.</strong> Understanding current quality reporting requirements and how you are scoring across both the Medicare Physician Quality Reporting System (PQRS) and private payers will help your practice be better suited for the upcoming changes.<br /> <br /> You also should try to access and review your Medicare quality and resource use reports (QRUR) to see where you can make improvements related to cost ahead of time. Two particularly important components to identify as you prepare for meeting the care coordination requirements are: (1) your most costly patient population conditions and diagnoses, and (2) targeted care delivery plans for these conditions.<br /> <br /> <strong>Tip:</strong> You can access your 2014 annual PQRS feedback reports and QRURs on the CMS <a href="" rel="nofollow" target="_blank">Enterprise Portal</a> using your Enterprise Identify Data Management account. <a href="" rel="nofollow" target="_blank">Learn more</a> about how to access these reports. If you are part of a large practice or health system, you may need to talk to your administrator about accessing your QRUR.</p> <p style="margin-left:40px;"> <strong>2.  Understand your patient data and benchmarks.</strong> Data registries can streamline reporting and improve performance scores. If you are not already participating in a patient clinical data registry, contact your medical specialty society to discuss how to participate in theirs. There also might be regional registries relevant to your practice.<br /> <br /> <strong>Tip:</strong> You can view a list of 2016 CMS-approved qualified clinical data registries and contact information on the <a href="" rel="nofollow" target="_blank">CMS website</a>.</p> <p style="margin-left:40px;"> <strong>3.  Check on your electronic health record (EHR).</strong> If your practice uses an EHR, contact your vendor to discuss how its product supports adoption of new payment models.<br /> <br /> Make sure your EHR is certified to the Office of the National Coordinator for Health IT’s (ONC) 2014 or 2015 certification requirements. Using a 2014 or 2015 edition EHR is essential for participation in either MIPS or APMs.<br /> <br /> Ask your vendor when they will update your software to the 2015 certified edition and whether reporting quality measures through the EHR is a viable option based on the proposed MIPS quality requirements.<br /> <br /> <strong>Tip:</strong> You can check your product’s certification in a <a href="" rel="nofollow" target="_blank">listing by the ONC</a>.</p> <p style="margin-left:40px;"> <strong>4.  Stay informed.</strong> There are several ways to keep your practice up-to-date on the new regulations:</p> <ul style="margin-left:80px;"> <li> Stay connected with the AMA for tools to assist you in implementation. Watch <em>AMA Wire</em>® to learn about a free online individual practice readiness assessment tool that will launch this summer.</li> <li> Contact your medical specialty society or state medical association to find out if there are APM opportunities for your practice and <a href="" target="_self">how you can get involved in their development</a>.</li> <li> Seek out local support for your quality improvement activities. <a href="" target="_self">Practice transformation networks</a> and regional health improvement collaboratives provide resources and technical support.</li> </ul> <p> For more information on how to prepare for the new Medicare payment systems, review the AMA’s <a href="" target="_self">MACRA checklist</a>, or check out the AMA’s <a href="" rel="nofollow" target="_self">STEPS Forward</a><u>™</u> collection of practice improvement strategies that can help your practice <a href="" rel="nofollow" target="_self">prepare for value-based care</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:27eb626c-6b83-4b2c-bebe-204bd64ff3d7 3 principles driving new Medicare payment systems Thu, 12 May 2016 21:15:00 GMT <p class="p1"> When Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), testified before an influential congressional committee Wednesday about implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the focus was clear: The patient and physician must be at center of the new Medicare payment systems. </p> <p class="p1"> <b>A look at the draft regulations</b></p> <p class="p1"> Rep. Pat Tiberi, chairman of the U.S. House Ways and Means Committee, said the committee called the <a href="" rel="nofollow" target="_blank"><span class="s1">hearing</span></a> to discuss how the <a href="" target="_self"><span class="s1">draft regulations</span></a> released last month match the congressional intent of the law. In particular, the committee was interested in how physicians and other stakeholders have responded to the draft regulations. They also focused many of their questions and remarks on the importance of final regulations that take special care to ensure the success of physicians in small practices, as well as those in larger groups.</p> <p class="p1"> “MACRA streamlined the patchwork of programs that currently measure value and quality into a single framework … where every physician and clinician has the opportunity to be paid more for providing better care for their patients,” Slavitt said. </p> <p class="p1"> He said CMS’ goal is to make the payment pathways under MACRA “flexible, transparent and simple so physicians can focus on patient care, not reporting or scorekeeping. Physicians know best how to provide high-quality care to our beneficiaries.”</p> <p class="p1"> Slavitt said three principles are guiding the agency’s implementation of the new Medicare payment systems:</p> <p class="li1" style="margin-left:40px;"> <b>1.<span class="Apple-tab-span"> </span> Keeping the focus on patient care.</b> “Patients are—and must remain—the key focus,” Slavitt said. “Financial incentives should work in the background to support physician and clinician efforts to provide the highest quality care and create incentives for more coordinated care.”</p> <p class="li1" style="margin-left:40px;"> <b>2.<span class="Apple-tab-span"> </span> Allowing flexibility.</b> The agency is working to ensure that physicians can adopt approaches that work for their practices, rather than forcing a “one-size-fits-all from Washington,” Slavitt said. “It will be important to allow physicians to define the measures of care most fitting with their patients.”</p> <p class="li1" style="margin-left:40px;"> <b>3.<span class="Apple-tab-span"> </span> Aiming for simplicity.</b> “Physician practices are already busy, and we are seeking every opportunity possible to minimize distractions from patient care by reducing, automating and streamlining existing programs,” Slavitt said. “One of the reasons why we don’t have the hearts and minds of physicians is because there’s just too much paperwork in health care.”</p> <p class="p1"> <b>The importance of physician feedback</b></p> <p class="p1"> Slavitt said the agency’s guiding principles were developed based on extensive feedback they received from thousands of physicians. He emphasized that physician feedback as the new Medicare payment systems are rolled out will be essential to their success.</p> <p class="p1"> “It is critical that we receive direct feedback from physicians and others stakeholders and are undertaking significant outreach efforts,” he said. “In the month of May alone, we have 35 scheduled events and listening sessions to hear from a wide range of stakeholders. It will take work and broad participation to get it right.”</p> <p class="p1"> Slavitt said the agency is looking for feedback from physicians—especially those in smaller practices—on how “what we do here in Washington” will impact their practices. He said they want to know what will work and what could have unintended negative consequences.</p> <p class="p1"> “We really do want to get to the best answer,” he said. “And we don’t have a monopoly on that.”</p> <p class="p1"> CMS is hosting a number of listening sessions, webinars and other opportunities for individual physicians to provide their insights. </p> <p class="p1"> A built-in physician feedback mechanism is the <a href="" target="_self"><span class="s1">Physician-Focused Payment Model Technical Advisory Committee</span></a>, which is collecting physician ideas for alternative payment models that can be tested for the new Medicare payment system.</p> <p class="p1"> The AMA and other medical associations also are providing feedback to CMS and will be submitting formal comment letters by the June 27 deadline.</p> <p class="p1"> <b>Resources to help you prepare for the new payment systems</b></p> <p class="p3"> The AMA offers a number of resources to help physicians in their initial preparations for the coming payment policies, including:</p> <ul> <li class="p5"> <span class="s2"><a href="" target="_self">A summary of the proposed regulations</a></span></li> <li class="p6"> <a href="" target="_self"><span class="s2">A guide to physician-focused payment models</span></a></li> <li class="p6"> <span class="s2"><a href="" target="_self">Key points of the Merit-based Incentive Payment System</a></span><span class="s4"> </span></li> <li class="p6"> <span class="s2"><a href="" target="_self">What you can do now to prepare</a></span><span class="s4"> </span><span class="s5"> </span></li> <li class="p6"> The AMA’s <a href="" rel="nofollow" target="_blank"><span class="s6">STEPS Forward™ collection</span></a> of practice improvement strategies, which include advancing team-based care, implementing electronic health records, improving care and <span class="s7">practicing value-based care</span></li> </ul> <p class="p8" style="text-align:right;"> <i>By AMA Wire editor</i> <a href="" rel="nofollow" target="_blank"><span class="s6"><i>Amy Farouk</i></span></a></p> <p class="p9">  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:27901d44-9e1c-4857-ba0b-1d9da5f7818b What successful self-measured BP looks like in practice Wed, 11 May 2016 22:26:00 GMT <p> When a patient is willing to partner with their physician in gaining control of high blood pressure, the results can be rewarding for both parties. That partnership is both important and surprisingly simple. A resident physician gives an inside look at how her medical center implemented self-measured blood pressure (SMBP) monitoring and is engaging patients in the advancement of their own health.</p> <p> At Family Health Center at Medstar Franklin Square in Baltimore, physicians incorporated SMBP monitoring in their practice in a way that has helped patients with high blood pressure take control of their health.</p> <p> The practice implemented SMBP monitoring when it collaborated with the AMA and Johns Hopkins Medicine as part of the <a href="" target="_self">M.A.P. program</a>—measure accurately, act rapidly and partner with patients, families and communities), said Crystal Peralta, MD, a third-year resident physician at Franklin Square.</p> <p> “Our project is a culmination of ideas that we brainstormed together as a team,” Dr. Peralta said. “It also incorporates ideas that we gathered from other family programs who were experiencing success with their own home blood pressure monitoring initiatives.”   </p> <p> Patient engagement was initially very high and has continued to grow at Franklin Square.</p> <p> <strong>How patients are identified for SMBP</strong></p> <p> The practice began incorporating SMBP into its regular routine as an effort to more accurately identify the true blood pressures of its patients. Studies show that patients’ pressures often are elevated when they are in the office and often are not a true reflection of their blood pressure in their daily environment, Dr. Peralta said. </p> <p> “By using our [electronic health records], we’ve identified the patients who have had continued elevated blood pressure” above goal, based on the clinical guidelines the practice follows, she said. “We’ve highlighted every one of those patients on each clinician’s  roster.” The clinicians are then responsible for contacting their patients and encouraging them to follow up in the office. At that point, the clinicians offer the patients an opportunity to participate in SMBP monitoring.  </p> <p> “We’ve included patients with hypertension, patients with white coat hypertension, patients with elevated blood pressure with a confirmed diagnosis, patients who have had a recent history of pre-eclampsia,” she said. “It’s basically open to everybody—and it’s a decision that the physician and the patient make together.”</p> <p> “So far the response has been wonderful,” she said. “We have seen that once patients are actively participating in their care by taking their pressures daily, they are eager and so motivated to improve their health.”</p> <p> It all begins when a patient comes into the office for an office visit. “Our medical assistants know that  when a patient has a blood pressure that is elevated above [goal], they automatically take out a laminated, neon orange card that says ‘140/90: Make a change; follow up in 2-4 weeks,’” Dr. Peralta said. “The card is left right on the keyboard in the room so that the physician sees the card when they sit down and start writing their notes. It’s a really good stop-and-pay-attention sign because it can’t be missed.”</p> <p> After addressing the elevated blood pressure, the physician gives the patient the opportunity to participate in SMBP monitoring. Any patient can participate if they meet three criteria:</p> <ul> <li> Two blood pressure readings above 140/90 during the office visit</li> <li> The patient’s arm circumference is within limits of the blood pressure cuff size</li> <li> The patient exhibits the motivation and willingness to improve their blood pressure</li> </ul> <p> <strong>Getting started</strong></p> <p> “We offer them the opportunity to take home a blood pressure cuff for approximately 14 days,” Dr. Peralta said. “We have 15 automated blood pressure machines at the moment. We started off with only five, but the program became so popular that we had to buy 10 more. Even with the 15 we have, they are always signed out, and there is often a waiting list for a monitor, so we are looking at hopefully buying a few more in the near future.”  </p> <p> The practice’s medical assistants are trained in the protocol and are key to the success of the project, she said. “It really is a team effort. Between the office staff, the medical assistants and clinicians, we all play a huge role.”</p> <p> “We have a package of handouts and other materials that the physicians along with the medical assistants review with the patient,” she said. “First, the physician educates the patient on what high blood pressure means, then discusses effective ways to improve their pressure through things like diet, exercise, medication compliance, etc. We review a handout about the DASH diet and spend a lot of time walking them through step-by-step instructions on how to take their blood pressure properly with the monitor we provide to them.”</p> <p> Before they leave the office, the patient has to demonstrate that they are able to take a proper blood pressure.</p> <p> “The patients are very appreciative when we offer them a monitor to take home,” Dr. Peralta said. “The truth is that many of our patients may not be able to afford a monitor. Some may not even truly understand the importance of having a monitor at home, and so this is a great way for us to educate our patients, increase their awareness, and provide them a resource that they may not have been able to otherwise access.”</p> <p> “Patients who have never taken their own blood pressure before tell me how pleasantly surprised they are at how easy it is to take their blood pressures properly,” she said. “The machines that we have are very user friendly.”</p> <p> Patients must schedule a follow-up visit for two weeks later before they leave the office and begin the 14-day measuring program.</p> <p> <strong>How it works</strong></p> <p> Patients are asked to take their blood pressure readings two times in the morning at least one minute apart and two times in the evening. To encourage active participation, the patient is responsible for recording their readings. There is also a column for comments, where they can list any factors that might have contributed to a high blood pressure reading, such as recent exercise, coffee or fast food consumption, or getting into an argument.</p> <p> “It helps them to be more aware of what they’re doing in a day that might be elevating their pressures,” Dr. Peralta said. “It makes them more aware of their diet. It makes them accountable and aware of what might be contributing to their high blood pressures.”</p> <p> “We advise that after a week they should check in with us. Either the physician will call the patient, or the patient calls us,” she said.</p> <p> “At the two-week visit, if their blood pressures have been within goal, the physician might decide that the patient has completed the program and continue to encourage the patient to stay the course and further improve upon the lifestyle changes they have made,” Dr. Peralta said. If the patient’s pressures continue to remain elevated above goal, then the patient and physician come up with a plan together. This plan may include medication adjustments, additional blood work or nutrition counseling. The patient also might continue on in the monitoring program for another 14 days to see how the changes affect the patient’s blood pressure.</p> <p> “Sometimes patients will come in, and if they haven’t had their blood pressure taken properly, they’ll tell the physician, ‘I was supposed to be sitting down with both feet flat on the ground, and I didn’t get it done that way this time.’ Some people tell us stories of how they are now able to teach other members of their family how to properly take a blood pressure,” she said. “It’s really great when you see your patients grow. They first present understanding very little about what hypertension even means and then transform into advocates for healthier living in their own families and communities.”</p> <p> <strong>Get started in your practice:</strong> Access the AMA-Johns Hopkins Medicine <a href="" target="_self">M.A.P. resources</a> to implement SMBP monitoring in your practice. The resources cover everything from selecting an SMBP device to patient training on how to self-measure correctly to hypertension diagnosis and management.</p> <p> <strong>For more on SMBP:</strong></p> <ul> <li> Learn <a href="" target="_self">4 ways to promote better BP during National High Blood Pressure Education Month</a>.</li> <li> Find out <a href="" target="_self">why you should use SMBP</a>.</li> <li> Learn <a href="" target="_self">what you need to start SMBP in your practice.</a></li> <li> Examine <a href="" target="_self">expert insights</a> into the latest blood pressure trials and guidelines.</li> <li> Use the <a href="" target="_self">one graphic you need for accurate blood pressure reading</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7b39dccb-41d7-4d6c-9a82-1cc0195f7356 Virtual patients help create the med ed environment of the future Wed, 11 May 2016 22:06:00 GMT <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>Medical students can expect virtual patients, those almost-real cases based in cyberspace, to play a larger role in learning and problem-solving as medical education evolves. Educators are looking at ways this technology can help address current issues in medical school education.</p> <p> <strong>A low-risk education tool </strong></p> <p> “Virtual patients allow students to learn without putting real patients at risk,” said Norm Berman, MD, professor of pediatrics at the Geisel School of Medicine at Dartmouth and the lead author of a <a href="" rel="nofollow" target="_blank">perspective piece</a> recently published by the journal <em>Academic Medicine</em>. “No actual patients are harmed in the process of learning from virtual patients.”</p> <p> The authors outlined the role of virtual patients in light of challenges and opportunities facing medical education, including the rapidly expanding body of medical knowledge, the ongoing issue of diagnostic and other cognitive errors, the ability to enhance education through learning preferences, and the need for better assessment.</p> <p> The authors argued that virtual patients have the potential to:</p> <ul> <li> <strong>Deepen learning</strong>. Virtual patients can be used for interactive learning activities that help students grasp expanding medical knowledge. One strategy is to assign virtual patients to students ahead of a seminar so they can practice a particular concept on their own and then attend a seminar or a problem-based learning or team-based learning session—the “flipped classroom” model. Virtual patients with embedded learning analytics can give the instructor insights into students’ preparation that would not otherwise be available.<br />  </li> <li> <strong>Promote clinical reasoning expertise</strong>. Virtual patients offer an opportunity to help students overcome the common difficulty of applying knowledge of foundational scientific and clinical concepts when they are solving or explaining clinical problems. Virtual patients can be integrated into earlier education and provide hands-on experience in clinical reasoning techniques, such as asking open-ended questions, supplying single-sentence summaries of patient problems, probing early for differential diagnoses and comparing diagnostic hypotheses based on real clinical data.<br />  </li> <li> <strong>Foster mastery and lifelong learning</strong>. Virtual patients can incorporate adaptive technologies, matching the cognitive demands of virtual patients with student capabilities. In this way, virtual patients can foster student mastery of the content, rather than simply meeting short-term goals, such as getting a good grade on a test.<br />  </li> <li> <strong>Reduce medical errors</strong>. As training in medical school and residency becomes increasingly focused on achieving competencies, virtual patients can be used to assess students’ competency and facilitate mastery of clinical skills needed for working with real patients.<br />  </li> <li> <strong>Improve learning outcomes</strong>. In addition to assessing individual students, virtual patients can help educators better understand educational outcomes more broadly. Learning data could be collected from virtual patients across a broad group of students and institutions, and analysis of this data can better inform education strategies and curriculum.</li> </ul> <p> <strong>Growing sophistication</strong></p> <p> The authors predicted that ever-more sophisticated virtual patients will play an increasing role in education and supplement case-based and patient-based learning.</p> <p> “Current virtual patients are largely one-size-fits-all,” said Marc Triola, MD, director of the Institute for Innovations in Medical Education, an associate professor at the NYU School of Medicine and one of the authors of the perspective piece. NYU School of Medicine is one of the founding members of the AMA’s <a href="" target="_self">Accelerating Change in Medical Education Consortium</a>.</p> <p> “Future virtual patients will be able to incorporate data from other systems, such as the electronic health record, to tailor the content and level of complexity of the cases to the needs of each specific learner,” Dr. Triola said.</p> <p> Dr. Berman agreed that virtual patients of the future will be vastly smarter. “Virtual patients with embedded learning analytics should be able to discern how much the student knows and how well the learner is able to think through a problem,” he said.</p> <p> <strong>For more information on the changing nature of medical education:</strong></p> <ul> <li> Learn now a <a href="" target="_self">student network</a> sparked a stronger curriculum.</li> <li> Find out how real <a href="" target="_self">clinical data</a> is driving new student perspectives.</li> <li> Discover how one school employed a <a href="" target="_self">student GPS</a> to track educational progress.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bbaa48fa-e85d-4604-883c-bfac7f90268d 5 financial planning tips every young physician should know Tue, 10 May 2016 22:19:00 GMT <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>It’s never too early to start saving for your long-term needs, financial planners say. But if you’re still early in your career and training, how can you build a savings habit in the face of med school debt, day-to-day expenses and the complexity of financial planning?</p> <p> Despite the obstacles, it’s worth investing the time and money. Many put off financial planning for years and live to regret it, financial experts and older physicians say.</p> <p> “I didn’t really start figuring out finances until residency, and that put me years behind,” an established physician said. “Now I’m on the right track, but the catch-up was painful.”</p> <p> A recent study by <a href="" rel="nofollow" target="_blank">AMA Insurance</a> found that more than one-half of young physicians feel they don’t spend enough time on financial planning. Nearly 9 in 10 feel somewhat or not at all protected in the event that a disability would prevent them from practicing, according to the <a href="" rel="nofollow" target="_blank">2015 Report on Young Physicians’ Financial Preparedness: Young Physicians Segment</a>.</p> <p> With those physicians in mind, AMA Insurance asked Jerry Moran, a senior wealth strategist with Millennium Brokerage Group, to offer five strategies for building a strong financial foundation.</p> <p> <strong>1. Pay yourself first. </strong></p> <p> Start saving from Day 1. Put 20 percent of your monthly salary into savings, knowing that just one unanticipated crisis can upend your finances.</p> <p> “Start thinking and planning about finances in residency,” one established physician suggested, “and carve out time on a regular basis thereafter to address it.”</p> <p> <strong>2. Develop a budget beyond debt repayment.</strong></p> <p> Don’t let loan repayment block saving for retirement. Build a realistic budget and adjust it as your income changes. Living with student loan debt—73 percent of physicians graduate with it—means keeping to a budget.<br /> <br /> “Live like a resident for the first three years of your practice,” one experienced physician advised.</p> <p> <strong>3. Understand the financial aspects of your employment contract.</strong></p> <p> Get educated on <a href="" target="_self">contract negotiations</a>, and seek out older physicians for advice. Look beyond salary to things like office expenses, life and disability insurance, and employer-matching retirement funds.</p> <p> <strong>4. Prepare for the unexpected. </strong></p> <p> Protect your family. Only 24 percent of young physicians have an updated will and medical directives. About two-thirds of young physicians have less than $50,000 in emergency funds. “Make sure you have that financial cushion, because you can’t count on things going as planned,” a physician said.</p> <p> <strong>5. Engage a professional financial adviser.</strong></p> <p> Physicians with a financial adviser make smarter investments, have more savings and feel more confident they are making the right choices for their families. Physicians should rely on recommendations and interviews to shop for an adviser that is right for them. “Don’t assume financial matters will take care of themselves once you have an income,” an established physician said.</p> <p> If you’re a physician under 40, Moran said, you are probably weighing these issues. Young physicians tend to begin their savings years behind many other professionals because of a lengthy education. With the transition from austerity to earning a good living comes an obligation to be smart with money, Moran said.</p> <p> That calls for discipline and expert help to lay the foundation of life-long financial security, Moran said.</p> <p> <strong>Learn more about financial security for physicians:</strong></p> <ul> <li> Finding <a href="" target="_self">a financial adviser</a> that’s right for you.</li> <li> The basics of <a href="" target="_self">student loan refinancing</a>.</li> <li> The leading <a href="" target="_self">financial planning mistakes</a> physicians make.</li> <li> Kicking your <a href="" target="_self">financial plan into high gear</a>.</li> <li> <a href="" target="_self">IRA questions</a> you need to answer.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:31835864-e78b-414f-91af-cb87c2034fd9 Finding a model of care for child immigrants Tue, 10 May 2016 22:13:00 GMT <p> A recent surge in minors crossing on their own from Mexico into the United States has brought renewed interest in their health and how physicians can best care for them.</p> <p> U.S. Customs and Border Protection <a href="" target="_blank" rel="nofollow">reports</a> that 23,553 minors were apprehended while crossing the border from Oct. 1, 2015, to March 1, 2016, an increase of 89 percent from the same period a year earlier. Though far smaller than the high tide of crossings in 2014, the surge raises some of the same concerns that surfaced then.</p> <p> <strong>A special set of health needs</strong></p> <p> Unaccompanied alien children—“UACs” in the official jargon—have unique physical and mental health needs, according to a <a href="" target="_blank" rel="nofollow">report by the Pew Charitable Trusts</a> and the experience of physicians working with immigrant children.</p> <p> “Unaccompanied children have often faced trauma prior to, during and/or after arriving to the United States,” said Julie Linton MD, chairperson of the Immigrant Health Special Interest Group of the American Academy of Pediatrics. “Trauma-informed care is essential as they access health services.”</p> <p> Border crossings by unaccompanied minors, most of them from Central America, reached a peak in 2014, when 68,500 were apprehended at the border. The Centers for Disease Control and Prevention <a href="" target="_blank" rel="nofollow">reported</a> clusters of pneumonia and influenza at the time in temporary shelters in the Southwest.</p> <p> <strong>Little public health hazard</strong></p> <p> Yet early warnings of a substantial health threat to the wider community seem to have been unfounded. Infectious diseases are no more common among unaccompanied children than they are among other immigrant children from low-resource nations, said Dr.Linton, who practices in Winston-Salem, N.C.</p> <p> The Office of Refugee Resettlement (ORR), part of the U.S. Department of Health and Human Services, reports that unaccompanied minors pose little health risk to the wider community.</p> <p> Still, meeting these children’s medical needs calls for heightened understanding of their particular experiences.</p> <p> The AMA House of Delegates has characterized unaccompanied minor immigration as “a humanitarian issue” and resolved that the organization would work to identify obstacles to mental and physical care in cooperation with other organizations.</p> <p> “Partnership with community-based organizations is essential when caring for unaccompanied children,” Dr. Linton said. To be effective, health care must work in tandem with the trauma, legal and institutional trust issues that child immigrants experience, she said.</p> <p> <strong>Finding a permanent place</strong></p> <p> While ORR pays for and provides services, including medical care for the children while they are at a shelter, once a child has been placed with a family member or sponsor, the care and well-being of the child becomes the responsibility of that sponsor.</p> <p> ORR has helped large numbers of unaccompanied minors move during the past two years from temporary shelters into long-term housing, arranging places with family members and other sponsors. Pew reports that 97 percent of children apprehended in late 2015 and early 2016 have been placed in housing around the U.S.</p> <p> Policies addressing health care for unaccompanied immigrant children vary by jurisdiction. Several states, including California, Illinois, Washington, Massachusetts and the District of Columbia, have sought a solution by providing child immigrants with Medicaid coverage.</p> <p> “Many of these children struggle to effectively integrate into communities,” Dr. Linton said. “However, having successfully reached a potentially safe new home, they also have tremendous potential to contribute immensely to our community.”</p> <p> <strong>Read more about populations facing barriers to health care:</strong></p> <ul> <li> Learn about <a href="" target="_self">three environmental issues</a> disproportionately affecting Hispanic patients.</li> <li> Find out how a Chicago health network is <a href="" target="_self">improving health for low-income residents</a>.</li> <li> Discover how an inner city care team is <a href="" target="_self">reducing hypertension disparities</a>.</li> </ul> <p align="right" style="margin-left:.25in;"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e6ad82d0-f596-4ca4-aa32-55d345b398be 10 concepts that will help you thrive as an intern Mon, 09 May 2016 21:58:00 GMT <p> The first year of residency can be one of the most physically and emotionally challenging years of your training. A chief resident offers tips for navigating this part of your education.</p> <p> In this second post of a <a href="" target="_self">two-part series</a>, Dr. Faton Bytyci, chief resident at Sacred Heart Hospital’s family medicine residency program in Allentown, Penn., provides insights to help you thrive throughout the challenges of your intern year.</p> <p> <strong>1. Say goodbye to being the best at everything you do.</strong></p> <p> When you start the first year, it’s important to recognize that there’s a lot you don’t know, Dr. Bytyci said. At the same time, don’t let that hold you back from learning everything you can. “It’s OK because you are being watched by every nurse, medical assistant, senior, attending, even the people who empty the trash,” he said.</p> <p> <strong>2. Know that you will make mistakes—and you will hear about them.</strong></p> <p> “You will be paged by a senior resident or attending physician to ask you why you did this thing or that,” Dr. Bytyci said. “Don’t argue. Just say you’re sorry, then cry in the corner for a moment and get over it. You are not a bad person because you made a mistake.”</p> <p> <strong>3. Ask for help.</strong></p> <p> “If you are completely over your head, admit it and ask for help,” he said. “Don’t pretend to be smart. Every residency is different and has specific regulations that you have to learn and follow. So focus on learning.”</p> <p> <strong>4. Be honest.</strong></p> <p> “It’s very important for your senior residents and attendings to trust you,” Dr. Bytyci said. “It’s OK to say ‘I don’t know’ or ‘I forgot.’ Don’t lie. Everything starts with trust and builds from there.”</p> <p> Learn the <a href="" target="_self">key factors</a> that build residents’ trust in interns.</p> <p> <strong>5. Don’t let fear stop you.</strong></p> <p> “Procedures can be scary,” Dr. Bytyci said. “If you understand from the beginning that fear is a normal response to new situations, you’ll expect it and be ready to move through it. You can’t learn without getting outside your comfort zone.”</p> <p> <strong>6. Be nice to everyone.</strong></p> <p> “Strive to be nice to staff, fellow residents, consultant services, patients, families, environmental assistants, clerks and everyone else,” he said. “It’s good for you, good for others and good for patient care.”</p> <p> <strong>7. Respect every team member.</strong></p> <p> “Most nurses are deeply dedicated to their patients,” Dr. Bytyci said. “Every nurse in the hospital has more clinical experience than you. Nurses are your best friends. They can make or break your experience.”</p> <p> <strong>8. Be careful how often you complain</strong>.</p> <p> Dr. Bytyci warns that residency is full of sacrifice. “You will be grumpy. You will be exhausted,” he said. “Complain only to your friends and family. Nobody wants to work with complainers.” In an environment where everyone works hard, others can find it annoying if you repeatedly tell people how hard you’re working, he said.</p> <p> <strong>9. Learn to say yes.</strong></p> <p> Dr. Bytyci recommends taking advantage of every learning opportunity. Say “yes” to participating in procedures and other clinical opportunities, conducting research, <a href="" target="_self">publishing</a> and attending conferences.</p> <p> <strong>10. Keep your eye on the goal: Residency will transform you.</strong></p> <p> “The most awesome thing about being an intern is that at the end of the year, everything that once seemed scary and difficult will become second nature,” Dr. Bytyci said. “You start out lost, scared, having no idea what to do, and in a short period of time, you turn into a well-informed, confident, professional physician.”</p> <p> <strong>Learn more about navigating residency:</strong></p> <ul> <li> Find out how to make it through residency <a href="" target="_self">on a budget</a>.</li> <li> Read about the Mayo Clinic’s <a href="" target="_self">unique approach to preventing resident burnout</a>.</li> <li> Discover the <a href="" target="_self">four building blocks</a> for a successful medical marriage.</li> <li> Learn about an initiative that could bring changes to <a href="" target="_self">the residency environment</a>.</li> <li> Read up on whether more flexible hours can help improve the <a href="" target="_self">residency experience</a>.</li> </ul> <p style="text-align:right;"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8efec448-0c59-4291-b945-fb6c3567b6da Physicians team up to treat addiction in rural areas Mon, 09 May 2016 21:50:00 GMT <p> Physicians in New Mexico have developed a distance learning model to address inadequate access to medical care in rural and traditionally underserved areas. Through a special focus on substance use and behavioral health disorders, the project has bolstered primary care physicians’ ability to care for patients with substance use disorders in the midst of the opioid overdose epidemic.</p> <p> Led by Professor of Medicine Sanjeev Arora, MD, <a href="" rel="nofollow" target="_blank">Project ECHO</a> (Extension for Community Healthcare Outcomes) was created at the University of New Mexico Health Sciences Center in 2003. The project is a free-of-charge distance education model that connects primary care professionals with specialists through simultaneous video conferencing to help them develop and share knowledge in the care of a variety of complex health conditions they may not have felt prepared to treat.</p> <p> <strong>How Project ECHO works</strong></p> <p> The ECHO model connects local clinicians, or “spokes,” with specialist teams at academic medical centers, or “hubs,” in weekly teleconference clinics called teleECHO™ clinics. During these weekly two-hour sessions, participants present patient cases that raise challenging medical and other treatment issues to collect the input of their colleagues and the specialists on the call.</p> <p> TeleECHO clinic sessions typically begin with a brief didactic discussion on an aspect of substance use disorder or behavioral health. Then a participant gives an oral case presentation—cases are submitted by participants in advance of the session. Questions are solicited from other participants, including the specialists at the hub, and then the group has a discussion around the teaching points raised by the case. These recommendations are summarized and sent to participants as a reference.</p> <p> In light of the opioid overdose epidemic, Project ECHO has been ahead of the curve with two focus areas: effective treatment of substance use disorders and supporting medication-assisted treatment (MAT) with buprenorphine. Since 2005, specialists in treatment of substance use and behavioral health disorders at Project ECHO have offered the weekly Integrated Addictions and Psychiatry (IAP) teleECHO Clinic.</p> <p> Miriam Komaromy, MD, associate director of Project ECHO and an internal medicine specialist and addiction consultant, leads the IAP teleECHO Clinic sessions which have been used to recruit physicians to participate in buprenorphine waiver trainings. In 2006, only 36 physicians in New Mexico were buprenorphine-waivered. Since that time, 375 physicians in New Mexico have participated in buprenorphine waiver trainings offered by Project ECHO’s IAP teleECHO Clinic. New Mexico now has more buprenorphine-waivered physicians per capita than all but three other states.</p> <p> <strong>National expansion of the ECHO model</strong></p> <p> Several states, including Connecticut, Montana, Hawaii and upstate New York, have jumped on board and started their own substance use teleECHO clinic sessions in the last year. The ECHO Institute offers a rolling, monthly training that lasts up to three days and shows leaders how to establish the model in their state or region.</p> <p> In addition to individuals trying to connect and wanting to start programs in their own areas, Dr. Komaromy is involved in a national effort in collaboration with the American Society of Addiction Medicine (ASAM), with funding from the Center for Substance Abuse Treatment. “We’re doing a 16-week pilot we’re calling Fundamentals of Addiction Medicine teleECHO Clinic (FAME),” she said. “We recruited participants who had attended a one-day pre-course called “Fundamentals of addiction medicine” at the annual ASAM meeting.”</p> <p> “Every week people are coming into the clinic from all different corners and presenting cases,” she said. “A unique feature is that we’ve recruited a bench of addiction specialists from around the United States and Canada.” Dr. Komaromy facilitates the live conversation, but the guest specialists give didactic presentations and participate in the patient case discussion each week.</p> <p> “It’s been a rich opportunity for people at different levels of knowledge to interact and for the primary care physicians to develop mentorship relationships with the specialists,” she said.</p> <p> Participants ask questions and talk about patient cases to “promote the kind of dialogue that doesn’t happen enough between specialists and primary care physicians,” Dr. Komaromy said. “The specialists also learn from the primary care physicians, so it’s a really collaborative learning environment.”</p> <p> As a result of Project ECHO’s success, Sens. Brian Schatz, D-Hawaii, and Orrin Hatch, R-Utah, recently introduced the Expanding Capacity for Health Outcomes (ECHO) Act in an effort to expand the model to rural health networks throughout the country.</p> <p> <strong>How participants are responding</strong></p> <p> Dr. Komaromy has heard a lot of positive responses from physicians. One physician said he has started to see the Thursday morning clinic session as an anchor to his week. He saves up questions, and when he runs into a challenging case, he wants to bring it to the group for discussion.</p> <p> A nurse practitioner in Alaska said that she just doesn’t have many resources in her area for substance use treatment, and it’s helpful to have a network of people whom she can run cases by and gather advice.</p> <p> Another benefit of the ECHO sessions has been helping participants better understand the patient’s perspective as well as the power of language when talking about substance use and addiction.</p> <p> “We see people change over time,” Dr. Komaromy said. “Stigma is a big issue. It’s huge in the medical profession because it’s huge in society. Sometimes we’ll role play discussions … [and] model bringing compassion to the interaction—trying to understand this patient’s point of view, particularly focusing on trauma, which can help turn the conversation around.”</p> <p> “As physicians our tendency is to think the most helpful thing is to talk about the medication or the biology of the situation,” Dr. Komaromy said. But understanding the relationship component and how to talk with these patients is critical.</p> <p> “I think one of the most important components that we have is an excellent addiction counselor who is part of our faculty,” Dr. Komaromy said. To see medical professionals collaborating with the counselor and learning some very practical techniques for framing the issue with their patients “is very powerful to experience,” she said. “The multidisciplinary nature of the clinic is very helpful.”</p> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="" target="_self">five things physicians can do to prevent opioid abuse</a>, recommended by the <a href="" target="_self">AMA Task Force to Reduce Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> Learn more about what physicians are doing to end the opioid epidemic:</p> <ul> <li> <a href="" target="_self">How to talk about substance use disorders with your patients</a></li> <li> Learn <a href="" target="_self">how President Obama’s opioid initiatives align with the Task Force’s recommendations</a>.</li> <li> Read a <a href="" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a></li> <li> Find out what <a href="" target="_self">physicians are saying about the new Centers for Disease Control and Prevention opioid guidelines</a>.</li> </ul> <p align="right">  </p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e4307885-0d6e-477f-9139-ed66ec2b3757 Burnout driving physicians to cut down work hours Fri, 06 May 2016 21:40:00 GMT <p> A new study found that high levels of burnout and low professional satisfaction scores predict a reduction in work levels. Learn more about which physicians are reducing their work hours and what is being done to improve professional satisfaction.</p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>Who is increasingly cutting hours</strong></p> <p> Full-time physicians who report worsening burnout or show declining job satisfaction are more likely to reduce the hours they work, according to <a href="" rel="nofollow" target="_blank">study</a> published in April’s <em>Mayo Clinic Proceedings</em>.</p> <p> More than 1,800 Mayo Clinic physicians responded to a 2011 survey. For each one-point increase a physician had on a seven-point emotional exhaustion scale, there was a 43 percent higher likelihood that the physician would reduce his or her full-time employment over the next 24 months. Each one-point decrease in the five-point satisfaction score, meanwhile, led to a 34 percent higher likelihood a physician would reduce his or her hours, the study found.</p> <p> A longitudinal analysis at the physician level showed that full-time physicians who reported worsening burnout or declining satisfaction between 2011 and 2013 also were more likely to cut hours in the next 12 months.</p> <p> And it’s not the younger physicians who cut back hours.</p> <p> Between 2008 and 2014, there was a statistically significant increase in the proportion of men older than 55 who worked less than full time, a jump from 12.6 percent at the beginning of the study to 17.7 percent by the end of the study. The change was not statistically significant for men in other age groups, the study showed.</p> <p> Women overall were less likely to work full time than men, but their rate did not increase over the study period. In fact, the proportion of women 35 years old or younger who worked less than full time decreased from 29.2 percent to 11.8 percent during the study period.</p> <p> “These findings suggest that the trends in full-time employment we observed were not attributable to millennials oriented toward better work-life integration but rather reductions in work hours by their older colleagues,” study lead author Tait D. Shanafelt, MD, director of the Mayo Clinic Department of Medicine Program on Physician Well-being, and his colleagues wrote.</p> <p> “Although the reasons for this trend are unknown, several studies have suggested that the interval of 10 to 20 years after entering practice is a particularly stressful time for physicians, and it is possible that many physicians reduce their workload in response to the distress they experience during this period of their career,” Dr. Shanafelt and colleagues wrote.</p> <p> <strong>Could burnout exacerbate physician shortages?</strong></p> <p> The proportion of physicians working less than full time at the Mayo Clinic increased to 16 percent in 2014, up from 13.5 percent in 2008. While working fewer hours may help individual physicians cope with burnout, a better solution needs to be found so physician shortages are not even worse than projected, both the researchers and an <a href="" rel="nofollow" target="_blank">editorial</a> accompanying the study said.</p> <p> “There are many reasons why physicians may choose to decrease their work effort,” Rachel B. Levine, MD, an associate professor of medicine at Johns Hopkins School of Medicine wrote in the editorial. “However, [the study’s] findings provide further compelling evidence that now is the time to address physician burnout and diminished work satisfaction. We are currently facing projected workforce shortages, especially among primary care specialties, at the same time that our population is aging, and there is increased demand to care for newly insured patients.”</p> <p> Study authors said efforts to reduce burnout must recognize the problem is, in large part, a system issue, and efforts need to address the problems that drive burnout, including excessive workloads and inefficiencies in the practice environment.</p> <p> <strong>Improving professional satisfaction</strong></p> <p> The call for changing the practice environment echoes the findings of an AMA <a href="" rel="nofollow" target="_blank">study</a> conducted with RAND as part of the AMA’s Professional Satisfaction and Practice Sustainability <a href="" target="_blank">initiative</a>. That study concluded that key drivers of physician satisfaction were providing high-quality care; having greater control over the pace and content of clinical work; holding similar values to the practice leadership; and working in an environment that fosters collegiality, fairness and respect.</p> <p> These areas are the ones policymakers and health delivery systems should work to change to improve professional satisfaction among physicians.</p> <p> “This may seem an obvious conclusion, but considering the typical tools used to influence physician behavior (regulations, payment rules, financial incentives, public reporting and the threat of legal action), refocusing attention on the targets identified in this study may actually represent a substantial change of orientation for many participants in the U.S. health care system,” the AMA-RAND study found.</p> <p> <strong>Resources to fight burnout </strong></p> <p> The AMA offers several online modules through its <a href="" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of practice improvement strategies to help physicians in practice and physicians in training recognize and address burnout. These modules cover <a href="" rel="nofollow" target="_blank">preventing resident and fellow burnout</a>, <a href="" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="" rel="nofollow" target="_blank">improving physician resiliency</a>.</p> <p> The AMA also is helping physicians to create thriving practices, working with physicians to advance initiatives that enhance their practice through <a href="" target="_blank">leadership principles and efforts.</a> The AMA is collaborating with hospitals, independent physician associations and others to cultivate successful physician leadership that improves the value of care for patients and fosters a more cohesive and integrative decision-making process within hospitals and health care systems.</p> <p> For those attending the <a href="" target="_blank">2016 AMA Annual Meeting</a>, Dr. Shanafelt will be the featured speaker for a continuing medical education activity at noon June 10, during which he’ll discuss physician burnout throughout medical education and practice.</p> <p> <strong>For more on physician burnout:</strong></p> <ul> <li> <a href="" target="_blank">Physician satisfaction: Why leadership qualities matter</a></li> <li> <a href="" target="_blank">Preventing resident burnout: Mayo Clinic takes unique approach</a></li> <li> <a href="" target="_blank">The role of personal accomplishment in physician burnout</a></li> <li> <a href="" target="_blank">Ward off burnout: Your peer network may impact you more than you think</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:df6da955-e310-4d5d-9489-0ad341cc70ab 6 ways to free up time in your practice Fri, 06 May 2016 21:36:00 GMT <p> Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is healthy also can contribute to better outcomes and patient satisfaction. Learn six ways to streamline revenue-related processes to maximize the amount of time available for patient care.</p> <p> <strong>Speed up your processes electronically</strong><a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> A new <a href="" target="_blank" rel="nofollow">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice streamline revenue cycle management processes. The module details several ways for your practice to become more efficient in these processes, which is critical for financial health and sustainability.</p> <p> It is important to have a practice management system (PMS) that works best for your staff and medical personnel before you implement new processes. Your PMS will determine your practice’s ability to take advantage of electronic processes. If you are choosing a new PMS, be sure to gather input from your staff and make a priority checklist to find the PMS that aligns with your needs and requirements—and make sure that system works with your electronic health record (EHR).</p> <p> Once you have a PMS in place that works for your practice, take advantage of these six ways to make your revenue cycle management processes more efficient:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Verify insurance eligibility electronically before visits.</strong><br /> Most health plans allow patient eligibility to be verified by phone or through a Web portal, but these methods are often inefficient and may not provide all the necessary information. Electronic eligibility verification can be a big time-saver.<br /> <br /> When a patient schedules an appointment, the scheduling or registration staff collects their insurance information and submits an electronic eligibility request by entering the patient’s data into the PMS. Federal regulations require health plans to respond within 20 seconds. Patients can then be made aware of any financial responsibility that will be requested at check-in.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Reduce prior authorization burdens through electronic transactions.</strong><br /> Newly available electronic pharmacy prior authorization transactions enable physicians to complete prior authorization requirements as part of the e-prescribing work flow. E-prescribing system vendors are in various stages of implementing the technology for these transactions, so find out your vendor’s timeframe and request this new technology for your practice.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Submit claims electronically to save time and money.</strong><br /> Submitting these health care claim submissions electronically can save time and speed up health plan adjudication and payment. After your PMS generates an electronic claim, your practice can either submit it directly to the health plan or indirectly through a clearinghouse or billing service, which may pre-audit or “scrub” claims prior to submission to check for missing or incorrect information.<br /> <br /> The built-in checks allow any potential issues to be addressed before the claim reaches the health plan’s adjudication system, reducing payment delays and denials.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Determine the status of a submitted claim.</strong><br /> Practices often don’t know if a claim has been received by the health plan until it is paid, pended or rejected. Use an electronic claim status inquiry to confirm receipt and determine status of submitted claims.<br /> <br /> Health plans are required to support real-time claim status processing. Practices can send “batch” transmissions to health plans to check the status of multiple claims at the same time. By law, health plans must respond by the next business morning. Rather than waiting two or more weeks before taking action, the electronic claim status request provides your practice with an immediate status report on the claim.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Use electronic remittance advice (ERA) to simplify processing of payment information.</strong><br /> An ERA is an electronic version of a paper explanation of benefits and holds all of the same details. The standardized ERA can reduce burdens, more quickly identify claims that require reworking and save time for staff to spend on higher-value activities.<br /> <br /> When implementing ERA in your practice, engage all involved trading partners, including health plans, your PMS vendor and any billing service that your practice uses. Determine the ERA capabilities of your PMS software. Taking full advantage of the ERA transaction may require an upgrade to the software. You can use the <a href="" target="_blank" rel="nofollow">Critical conversations with trading partners about ERA tool</a> in the STEPS Forward module to make sure you cover all the bases.</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>Maximize collection of patient payment.</strong><br /> The growing prevalence of high-deductible health plans means many patients bear additional financial responsibility for their treatment. Collecting payments while the patient is still in your office is a vital first step in any effective patient collections strategy. It will increase cash flow, decrease accounts receivable, and reduce billing and back-end collection costs.<br /> <br /> To bill at the time of service, your staff will need to know the correct amount to charge. Completing an electronic eligibility check before the appointment will provide information about the patient cost. Use this information, along with the health plan’s current fee schedule, to calculate the amount the patient owes.<br /> <br /> For tips on point-of-care pricing, download the <a href="" target="_blank" rel="nofollow">Managing patient payments: Calculating POC treatment price tool</a>.</p> <p> More than 25 modules are available in the AMA’s <a href="" target="_blank" rel="nofollow">STEPS Forward </a>collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:47fc57f7-559f-485c-8eb3-b8befcf6eb3c Tobacco products, e-cigarettes come under greater regulation Thu, 05 May 2016 21:01:00 GMT <p> The U.S. Food and Drug Administration (FDA) Thursday took an important step in the national regulation of tobacco products, issuing a new rule that prohibits the sale of a number of tobacco products, including e-cigarettes, to minors. But two provisions in a federal bill could significantly weaken this authority. Find out what the FDA rule says and how it could be already under threat.</p> <p> “Before today, there was no federal law prohibiting retailers from selling e-cigarettes, hookah tobacco or cigars to people under age 18,” the FDA said in a <a href="" rel="nofollow" target="_blank">news release</a>. “Today’s rule changes that with provisions aimed at restricting youth access.”</p> <p> <strong>What’s in the rule</strong></p> <p> The FDA <a href="" rel="nofollow" target="_blank">rule</a> helps implement the Family Smoking Prevention and Tobacco Control Act of 2009 and allows the agency to improve public health through a variety of steps, including restricting the sale of all tobacco products to minors nationally.</p> <p> “The AMA supports the FDA’s new rule and its efforts to ensure the public—–especially young people—is aware of and protected from these harmful products,” said AMA President Steven J. Stack, MD, in a <a href="" target="_blank">news release</a>. “We urge the FDA to issue further regulations addressing marketing of these products and banning flavored e-cigarettes, which are particularly enticing to minors.”</p> <p> “Patients suffer from many chronic and fatal diseases related to tobacco use, including cancer, heart disease and emphysema,” Dr. Stack said. “Smoking and tobacco use remain the No. 1 preventable cause of death in the United States.”</p> <p> The AMA has long called for e-cigarettes to be regulated in the same way the FDA regulates tobacco and nicotine products. The organization also has strongly advocated for the FDA to extend its tobacco regulations and oversight to include e-cigarettes, cigars and other tobacco products.</p> <p> The rule will go into effect in 90 days and establishes restrictions in the following ways:</p> <ul> <li> Not allowing products to be sold to persons under the age of 18 (both in person and online)</li> <li> Requiring age verification by photo ID</li> <li> Not allowing the selling of covered tobacco products in vending machines (unless in an adult-only facility)</li> <li> Not allowing the distribution of free samples</li> </ul> <p> The FDA also released a <a href="" rel="nofollow" target="_blank">fact sheet</a> further detailing the regulations.</p> <p> Also this week, California became the second state after Hawaii to <a href="" target="_blank">raise the tobacco purchasing age</a> when Gov. Jerry Brown signed bills that raise the tobacco and e-cigarette purchasing age from 18 to 21 years, among other measures.</p> <p> “As cigarette smoking among those under 18 has fallen, the use of other nicotine products, including e-cigarettes, has taken a drastic leap,” said U.S. Department of Health and Human Services Secretary Sylvia Burwell. “Today’s announcement is an important step in the fight for a tobacco-free generation.”</p> <p> <strong>A bill that stands in opposition to the FDA rule</strong></p> <p> Though this final rule is an important action for the health of the nation, two provisions in the House Agriculture Appropriations bill could weaken the FDA’s authority over these tobacco products.</p> <p> In alliance with a large group of other national organizations, the AMA recently sent a letter to the Senate committee with jurisdiction over the bill, opposing the provisions.</p> <p> “One provision seeks to completely exempt certain cigars from FDA regulation,” the letter said. “The other exempts e-cigarettes, cigars and other currently unregulated tobacco products from an important product review requirement, taking away a powerful and efficient tool to protect children from the candy and fruit-flavored e-cigarettes and cigars that have flooded the market in recent years.”</p> <p> “We urge the Senate to reject any provisions [that] make it more difficult for FDA to address this public health problem,” the letter said. “The need for FDA oversight of these products could not be clearer.”</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a06a4df4-f2f9-474f-afe4-79c1c511ae53 The need for med ed fellowships and guidelines for success Thu, 05 May 2016 21:00:00 GMT <p> As innovations in medical education continue to advance, training for faculty members often lags, with most training taking place on the job and with very little formal curriculum. A new study provides insights into what medical education fellowships should entail and explains why this training should take place before physicians assume the responsibilities of faculty appointments.</p> <p> Many medical schools offer formal development programs for existing faculty. But the lack of a standard model and curriculum for training academic physicians troubles directors of existing medical education programs, who believe standardization could improve teaching and scholarship.</p> <p> A <a href="" rel="nofollow">research report</a> in the journal <em>Academic Medicine</em> concludes that “medical education fellowships cultivate leaders and communities of trained educators.” The need for rigorous training is especially important amid innovations in teaching methods and training curriculum, researchers said.</p> <p> The report relied on interviews with eight directors of existing faculty education programs.</p> <p> <strong>Creating a core of faculty leaders</strong></p> <p> Directors noted that most faculty learn on the job while balancing competing demands of patient care and other clinical duties. The study also found that few programs are available to allow those who are interested in pursuing a career as an academic physician to undergo formal training in education before assuming faculty duties.</p> <p> Directors of existing programs told researchers they have ambitious hopes for graduates of education fellowship programs. They envision graduates:</p> <ul> <li> Assuming leadership roles</li> <li> Pursuing an academic career</li> <li> Producing scholarship</li> <li> Achieving national prominence in their fields</li> </ul> <p> “The whole idea is to change the culture one person at a time,” one program director told researchers.</p> <p> <strong>Fellows currently face competing demands</strong></p> <p> The most troubling drawback of existing education programs that train physicians who already are faculty members is participants being pulled away from faculty training to tackle other duties, directors said. This happens even when medical schools have promised to allow fellows the freedom to devote a certain amount of their time to their training in education.</p> <p> “People have committed to coming, but people are leaving because they get called back to cover an emergency patient or something has happened,” a director said. “I think that particularly for new faculty, their academic work takes a back seat to their patient care. I think there are times that they haven’t devoted their time and attention to the fellowship due to busy clinic schedules and various issues that come up in patient care activities.”</p> <p> These findings informed the researchers’ recommendation that medical education fellowship training should occur before initial faculty appointment.</p> <p> <strong>Establishing a new training program</strong></p> <p> Program directors promoted the idea of establishing new faculty training fellowships in medical schools that do not have them. After interviewing directors, the researchers identified four guidelines for success in creating new programs:</p> <ul> <li> Define the goals and objectives for the new program</li> <li> Evaluate best practices and choose those that fit local needs</li> <li> Enlist the support of institutional leaders</li> <li> Protect fellows’ time for training by releasing them from some of their clinical demands</li> </ul> <p> The consensus among the eight program directors was that expanded, improved and standardized faculty education could revolutionize teaching and create a generation of skilled, inspired scholars, educators and leaders.</p> <p> “Everybody says when they leave the program, they feel reinvigorated, reenergized and connected with people who love to teach,” the director of an existing program said. “It’s really an antidote to burnout.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bedd4f81-d691-44bb-b85e-c02aee6691da The resident depression endemic--and solutions underway Wed, 04 May 2016 21:03:00 GMT <p> Researchers recently analyzed more than 50 years of peer-reviewed studies on depression and depressive symptoms in residents. The prevalence is high, and rates have risen with each calendar year. Learn how the medical community is working to increase wellness among physicians in training.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>It’s an endemic</strong></p> <p> Roughly one-third of residents suffer from depression or depressive symptoms according to an <a href="" rel="nofollow" target="_blank">original investigation</a> recently published in the <em>Journal of the American Medical Association</em> (<em>JAMA</em>).</p> <p> The rate of physicians in training who screened positive for depression or depressive symptoms ranged from 20.9 percent to 43.2 percent, depending on the instrument used, the investigation showed. Researchers also found that depressive symptoms increased over time, a 0.5 percent increase per calendar year. The rates are at a level that an <a href="" rel="nofollow" target="_blank">editorial</a> accompanying the <em>JAMA</em> study called “endemic.”</p> <p> The <em>JAMA</em> original investigation was a systematic review and meta-analysis of 31 cross-sectional studies and 23 longitudinal studies conducted between January 1963 and September 2015. More than 17,000 residents were involved in the studies analyzed.</p> <p> Study authors say depression is an important problem to address during residency because it has been linked to a higher chance of future depressive episodes and greater long-term morbidity, suggesting that the future health of residents may be impacted. Also, patient health may be affected because depression in physicians has been linked to lower quality of care.</p> <p> “The time is long overdue for a national conversation on the fundamental structure and function of the graduate medical education system, not unlike the discussion that reformed undergraduate medical education after the Flexner report,” Thomas L. Schwenk, MD, dean of the University of Nevada School of Medicine, wrote.</p> <p> <strong>Rethinking training with mental health in mind</strong></p> <p> <em>JAMA</em> study authors call for more studies to identify effective strategies for preventing and treating depression among physicians in training. Dr. Schwenk’s editorial suggests solutions can be classified into three categories:</p> <ul> <li style="margin-left:0.25in;"> Providing more and better mental health care to depressed physicians and those in training</li> <li style="margin-left:0.25in;"> Limiting trainees’ exposure to the training environment and system that are thought to contribute at least in part to poorer mental health and wellness</li> <li style="margin-left:0.25in;"> Considering the possibility that the medical training system needs more fundamental change</li> </ul> <p> “Relieving the burden of depression among physicians in training is an issue of professional performance in addition to one of human compassion,” he wrote.</p> <p> Dr. Schwenk also said the study’s findings are “significant” and an “important marker for deeper and more profound problems in the graduate medical education system that is in need of equally profound change.” He has more to say on solutions in this JAMA Network <a href="" rel="nofollow" target="_blank">video</a>.</p> <p> <strong>Creative approaches emerging</strong></p> <p> A number of organizations are taking the lead in providing resources to help physicians in training who show signs of depression, and a number of residency programs are creating programs to try to ward off depression.</p> <p> The AMA offers several online modules through its <a href="" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of practice transformation strategies to help physicians in practice and physicians in training recognize and address burnout. Although burnout is different from depression, the two are closely related. These resources offer strategies for <a href="" rel="nofollow" target="_blank">preventing resident and fellow burnout</a>, <a href="" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="" rel="nofollow" target="_blank">improving physician resiliency</a>.</p> <p> Included in these resources are <a href="" target="_blank">six ways</a> that physicians in training can improve their personal wellness. The AMA also <a href="" target="_blank">adopted policy</a> in November to support access to potentially life-saving mental health services for physicians in training.</p> <p> The Accreditation Council for Graduate Medical Education (ACGME), meanwhile, also is <a href="" target="_blank">working toward</a> improving resident wellness across training programs. At its first <a href="" rel="nofollow" target="_blank">forum on physician well-being</a> in November, the ACGME identified six areas that could help improve well-being for residents: building awareness, maximizing levers of change (including competency milestones and program requirements), ongoing education and communication, collaboration across the continuum of education, research, and large-scale cultural change.</p> <p> Solutions taking place within residency programs include:</p> <ul> <li style="margin-left:27pt;"> Stanford University School of Medicine’s <a href="" target="_blank">Balance in Life</a> program gives residents access to mentors and a clinical psychologist, healthy food and social gatherings.<br />  </li> <li style="margin-left:27pt;"> The Mayo Clinic’s campus in Florida designates one <a href="" target="_blank">noon conference</a> every month as “Humanities Thursday.” The Fellows’ and Residents’ Health and Wellness Initiative (<a href="" rel="nofollow" target="_blank">FERHAWI</a>) humanities program includes discussions of artwork, guided visual imagery and art projects, such as watercolor painting, screen printing and origami.<br />  </li> <li style="margin-left:27pt;"> A physician created a one-act <a href="" target="_blank">play</a>, <em>Play What’s Not There</em>, to help residents tackle conversations about balancing family, personal identity and practice. Anyone interested in staging the play can <a href="" rel="nofollow" target="_blank">contact</a> the writer Bill Thomas, MD, and request a script.</li> </ul> <p> A wide variety of ideas will be shared at the <a href="" target="_blank">International Conference on Physician Health™</a>, which the AMA will host Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians. </p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f71d00cd-8435-42c9-b2cc-17938f471452 Court case could lead to unlimited awards of punitive damages Wed, 04 May 2016 20:56:00 GMT <p> The Tennessee Supreme Court is weighing the state’s limit on punitive damages in medical and other liability cases. A ruling to lift the ceiling could mean unlimited awards against physicians and other defendants.</p> <p> <strong>From life insurance to medical liability</strong></p> <p> The case, <em>Lindenberg v. Jackson National Life Insurance Co.</em>, originated in a dispute between an insurance company and the beneficiary of a life insurance policy. The company withheld the proceeds of the policy from the ex-wife of the deceased policyholder based on concerns over competing claims.</p> <p> A jury in December 2014 found the insurance company had breached the terms of the policy contract and awarded the ex-wife $350,000 in actual damages, totaling the face amount of the policy. In addition, jurors awarded her $3 million in punitive damages. The insurance company asked a court to overturn the punitive damages award, citing a 2011 state law that caps punitive awards at $500,000 or twice the amount of actual damages, whichever is higher.</p> <p> A federal judge heard the plaintiff’s arguments that the cap violates her right to a jury trial and encroaches on the powers of the courts. The judge in November referred the question to the Tennessee Supreme Court.</p> <p> The case holds broader implications than for the scenario in question because lifting the cap on damages could leave physicians exposed to unlimited awards for punitive damages.</p> <p> <strong>What physicians are saying</strong></p> <p> The limit on awards ensures fairness and predictability in liability cases, the <a href="" target="_blank">Litigation Center of the AMA and State Medical Societies</a>, the <a href="" target="_blank" rel="nofollow">Tennessee Medical Association</a> and 20 other insurers and employers argued in an April 15 <a href="" target="_blank">friend-of-the-court brief</a> (log in).</p> <p> The organizations underscored that the 2011 law should remain in place, citing laws in other states and previous court rulings as evidence that the cap does not violate the right to a jury trial or encroach on the powers of the courts.</p> <p> “Both sound legal and economic public policies support Tennessee’s reasonable limits on punitive damages,” the organizations said in their brief. They also made the case that the cap helps the state compete economically with other states and nations—physicians and others make decisions on where to set up business, in part, on the risk of excessive punitive awards.</p> <p> “If Tennessee’s legal climate is viewed as having excessive, unpredictable and disproportionate liability exposure,” the brief said, “then job-creators, physicians and others will have an incentive to go where they will receive fairer treatment.”</p> <p> The Tennessee law and others like it were enacted to combat a wave of punitive awards that had grown out of all proportion to actual damages, the brief said, and physicians face inflated penalties without the cap.</p> <p> <strong>Additional medical liability cases in which the AMA Litigation Center is involved:</strong></p> <ul> <li> Find out how the AMA is working to uphold a <a href="" target="_blank">statute of limitations</a> on wrongful deaths.</li> <li> Read about how a case in Oregon could <a href="" target="_blank">increase liability exposure and redefine injury</a><u>.</u></li> <li> Learn how one of the nation’s leading <a href="" target="_blank">medical liability reform laws could be undercut in a state supreme court</a><u>.</u></li> <li> Understand the implications of a case that is set to decide on <a href="" target="_blank">censorship in the exam room</a><u>.</u></li> <li> See the outcome of a court’s decision regarding <a href="" target="_blank">protected patient safety information</a><u>.</u></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:91ae6452-1e5b-47ff-9759-86366882037c Ethics committees: Exploring the past, present and future Tue, 03 May 2016 20:47:00 GMT <p> For complex ethical issues in medicine, ethics committees and consultations offer a solutions-oriented approach that is essential to modern health care. Learn about the historical development of these groups, their current roles in the medical community and how educators can prepare future physicians for ethical challenges they will face in practice.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> The <a href="" target="_blank">May issue</a> of the <em>AMA Journal of Ethics®</em> explores the roles of ethics committees in the modern health care system. Articles featured in this issue include:</p> <ul> <li> “<a href="" target="_blank">Consequences for patients and their loved ones when physicians refuse to participate in ethics consultation processes</a>.” When a physician is unwilling to participate in the ethics deliberation process, how is the function and role of an ethics committee affected? Learn about the structural roles in ethics committees and the best approach to navigating these complicated situations.<br />  </li> <li> “<a href="" target="_blank">Roles of student ethics committees in preparing future physicians</a>.” Medical students can experience ethical dilemmas and concerns about professional behavior during their training. Explore the roles of medical educators in preparing future physicians with the skills and knowledge to identify and respond to these challenges.<br />  </li> <li> “<a href="" target="_blank">Why did hospital ethics committees emerge in the U.S.?</a>” Ethics committees are the primary mechanism for dealing with ethical issues in hospitals today. But how did they come to be present in nearly all U.S. hospitals in just a few decades? Learn about the historical emergence of ethics committees and some of the landmark events that contributed to their integration into health care.<br />  </li> <li> “<a href="" target="_blank">International access to clinical ethics consultation via telemedicine</a>.” Clinical ethics consultation is a service provided to enhance patient care by identifying, analyzing and resolving ethics dilemmas in clinical settings, but this service is often not available everywhere. Find out how telemedicine helps international and remote accessibility.</li> </ul> <p> In the journal’s <a href="" target="_blank">May podcast</a>, Joseph J. Fins, MD, professor of medicine at Weill Cornell Medical College, discusses the work of ethics committees and consultants as they pursue professionalization and respond to changes in health care organization and practice.</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="" target="_blank">Give your answer</a> to this month’s poll: What is the most important role of ethics committees and consultation services in health care organizations in the United States?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="" rel="nofollow" target="_blank">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8dc510e7-3fd7-4909-8930-190f20cbe8eb Why the concept of invincibility causes harm Tue, 03 May 2016 20:44:00 GMT <p> In the taxing scramble of daily professional and personal demands, it’s easy to lose sight of the importance of a balanced life. But putting your own needs on the shelf can put you at risk of burnout and even suicide.</p> <p> That’s the message of Maria Lesetz in her article, “<a href="{%22issue_id%22:287407,%22page%22:14}" target="_blank" rel="nofollow">It’s OK not to be OK,”</a> published in the winter 2016 edition of <a href="{"issue_id":287407,"page":0}" target="_blank" rel="nofollow"><em>Physician Family</em></a>.</p> <p> Lesetz, a certified life coach, has spent 10 years exploring how burnout can transform into wellness for physicians and their families. Finding <a href="" target="_blank">life balance</a> is difficult but crucial, she said.</p> <p> <strong>Shedding the idea of invincibility </strong></p> <p> Lesetz’s research into physician <a href="" target="_blank">burnout and suicide</a> has convinced her of the need for open conversations free of stigma. She finds that some of the top contributors to suicide are:</p> <ul> <li> Isolation</li> <li> Lack of support</li> <li> Lack of autonomy</li> <li> Bureaucracy</li> <li> Fatigue</li> <li> Depression</li> </ul> <p> To deal with burnout in all its forms, physicians have to shed the idea that they have to be “invincible,” she said.</p> <p> “Physicians have told me that if they even addressed the topic of burnout, it was seen as a symptom of weakness,” Lesetz said. “Expressing your feelings is one of the most important action steps to take if you want to maintain great health, both physically and emotionally.”</p> <p> She said challenging the culture of invincibility would benefit physicians, their families and the profession as a whole.</p> <p> <strong>Three simple recommendations</strong></p> <p> Lesetz suggests several action items to begin building balance and wellness:</p> <ul> <li> Create a “best year yet” plan to set goals for the road ahead, both personally and professionally. Doing so can support balance and set the tone for your life.</li> </ul> <ul> <li> “Don’t medicate … meditate,” Lesetz said. Bringing mindfulness techniques to your daily routine will combat reliance on such things as prescription drugs and alcohol to deal with stress. A short break is all that is needed to practice meditation and mindfulness, she said.<br /> <br /> “If you build habits of presence into your daily routine, it will profoundly impact how you feel on the inside,” she said.</li> </ul> <ul> <li> For family members, she recommends offering their physician loved one the chance to make a stress-free transition from work to home each day by letting them unwind in their own way. Family members also can help reach out to a life coach if troubling signs, such a burnout or addiction, begin to appear, she said.</li> </ul> <p> “The bottom line is, it’s OK to not be OK,” Lesetz said. “It only takes one courageous action step to turn the course of your life around.”</p> <p> <strong>Ways the medical community is promoting wellness</strong></p> <p> The AMA has made physician wellness and doctors’ ability to thrive a top priority. Part of the AMA’s <a href="" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative, the AMA’s STEPS Forward™ collection of practice improvement strategies offers proven solutions for physicians by physicians.</p> <p> Three modules are specifically focused on physician wellness: One gives <a href="" target="_blank" rel="nofollow">steps for preventing burnout</a>, another module outlines <a href="" target="_blank" rel="nofollow">solutions for enhancing joy in practice and mitigating stress</a>, and a third module focuses on <a href="" target="_blank" rel="nofollow">ways to promote the well-being of physicians in training</a>.</p> <p> Other modules provide ways to improve elements of your practice environment that can be risk factors for burnout, such as improving work flow through <a href="" target="_blank" rel="nofollow">team documentation</a>, <a href="" target="_blank" rel="nofollow">expanded rooming and discharge protocols</a>, <a href="" target="_blank" rel="nofollow">pre-visit planning</a>, and <a href="" target="_blank" rel="nofollow">synchronized prescription renewal</a>.</p> <p> The <a href="" target="_blank">International Conference on Physician Health™</a> will take place Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> <strong>Want more information on achieving and maintaining a healthy work-life balance?</strong></p> <ul> <li> Find out how <a href="" target="_blank">peer networks</a> can help cope with burnout.</li> <li> Hear from a <a href="" target="_blank">physician and rapper</a> about his unique way of confronting burnout.</li> <li> Explore 6 tips for navigating the challenges of a <a href="" target="_blank">two-physician family</a>.</li> <li> See how the <a href="" target="_blank">Mayo Clinic</a> is creating a model for reducing burnout.</li> <li> Learn how accomplishments and <a href="" target="_blank">professional rewards</a> can reduce burnout and exhaustion</li> </ul> <p>  </p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b7730156-4efe-4b34-964a-17c47c40a447 How to talk about substance use disorders with your patients Mon, 02 May 2016 21:53:00 GMT <p> Though it can be difficult, it’s essential for physicians to speak with their patients about substance use disorders, proper use of opioid medications and medication-assisted treatment—doing so can be a key component to both pain management and overdose prevention. Find out how one physician in San Francisco approaches the conversation around preventing and treating substance use disorder with his patients while avoiding stigma in the process.</p> <p> With 78 people dying from prescription opioid and heroin overdoses each day in the United States, having the conversation about the risk of substance use disorders and the need for treatment for those who have one is critical for patient safety.</p> <p> “It’s a challenging conversation to have,” said Phillip O. Coffin, MD, director of substance use research at the San Francisco Department of Public Health and an internal medicine and infectious disease specialist. “I struggle with it myself all the time.” But there are ways to approach the topic with your patients and partner with them in preventing misuse and overdose, or in getting treatment for a substance use disorder.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>3 core components to the conversation</strong></p> <p> Dr. Coffin’s expertise includes HIV management, viral hepatitis care, and substance use disorder treatment and research. Some of his patients have substance use disorders that involve prescription opioid medications or heroin, and he is working hard to make sure they are provided the best treatment possible.</p> <p> “There is no easy answer,” he said of his approach to the discussion of substance use disorders. “It’s really about exploring it with the individual patient.”</p> <p> Dr. Coffin offered these three elements that should be part of the conversation about substance use disorders to avoid the stigma that could be a roadblock to patients taking the appropriate steps for their health:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Honesty. </strong>“The most important piece of the story is to always be forthright and honest with your patients about the issues you’re addressing,” Dr. Coffin said. “It’s about patient-centered care, [and] it’s quite rare that patients are coming in looking to reduce their opioid dose.”<br /> <br /> “I often speak about the limited role of opioids in management of many chronic pain indications, really focusing on management of their pain and how it affects their function,” he said. “It’s a talk about the first line, second line and third line options for pain management, which are rarely opioids.”<br /> <br /> “The goal of the conversation may be, for example, to get them toward a point where opioids are something they use intermittently … instead of on a daily basis,” Dr. Coffin said.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Medication-assisted treatment</strong>. For patients with a substance use disorder, Dr. Coffin said he will “almost uniformly offer them buprenorphine and try to encourage them. There may be no interest initially, and it may take months or even years of speaking with patients to get them to consider and actually engage in a transition from full agonists or street opioids to buprenorphine.”<br /> <br /> “I have seen remarkable success with this approach, but it can take a long time of working with a patient,” he said. “For example, you may have, or have inherited, a patient on opioid medications for pain who is very high risk for overdose, who has multiple unprescribed opioids and stimulants in urine studies and has raised concerns about medication diversion,” he said. “If you discontinue opioids but are able to keep the patient engaged, you spend time really worrying about the welfare of the patient because they’ve resumed or increased heroin use, and their life is more chaotic.”<br /> <br /> “Every time you see them, you talk about buprenorphine, and each time they come back they have something positive to say about buprenorphine,” he said. “Sometimes what they come back with is what you told them six months ago, and other times what they’ve heard from talking to other people who have taken buprenorphine. Like with other therapies—such as insulin—over time you can eventually help them make a transition.<br /> <br /> “I can’t emphasize enough how transformative buprenorphine maintenance can be,” Dr. Coffin said. “It can be a remarkably powerful intervention, and it also happens to be quite good for pain management. Not to say you do the prescription and then the problem is no longer an issue at all. Insulin for a person with severe diabetes remains a good analogy; Buprenorphine requires ongoing management, but it solves so much of the core problem.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Treat substance use disorder as a disease.</strong> “You can [treat patients with] buprenorphine in the context of other substance use disorder treatment—behavioral or cognitive behavioral psychological therapy,” he said, “but it has also been shown to be highly effective when implemented in a regular medical setting with the counseling that you get from a primary provider.”<br /> <br /> “It is important that you talk with your patient about their substance use on a regular basis when you prescribe them buprenorphine,” Dr. Coffin said. “You don’t just have them come in, renew their prescription, talk to them about their other medical conditions and ignore their substance use. You have to sit down and talk about it.”<br /> <br /> “When I’ve started seeing patients already on opioids for pain who have multiple risks, opioid use disorder or concerning findings on urine toxicology, it’s really hard to do a 15-minute visit and actually address the issue,” he said. “The visits tend to be long and resource heavy, and hard to complete without a strong supportive team approach to care.”<br /> <br /> “When you bring buprenorphine into the picture,” he said, “substance use becomes one of the three or four issues that you talk about in a patient visit and that, frankly, makes it much more like other diseases that a primary care doctor manages.”<br /> <br /> “You want to ask them how they’re doing with their medication,” Dr. Coffin said. “Are they tolerating it, are they having any side effects, are they getting what they need out of the medication? Are they using any heroin? … And if the answer is ‘a little bit,’ then you ask them what you can do together to decrease how often that happens.”<br />  <br /> “Think of it a lot like talking to a patient with diabetes about their sugar intake per day,” he said. “What can we do to try to reduce that and help you keep your disease under control?”</p> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="" target="_blank">five things physicians can do to prevent opioid abuse</a>, recommended by the <a href="" target="_blank">AMA Task Force to Reduce Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> For more on efforts to end the opioid epidemic:</p> <ul> <li> Learn <a href="" target="_blank">how President Obama’s opioid initiatives align with the Task Force’s recommendations</a>.</li> <li> Read a <a href="" target="_blank">call to action for physicians to turn the tide of the opioid epidemic</a></li> <li> Find out what <a href="" target="_blank">physicians are saying about the new Centers for Disease Control and Prevention opioid guidelines</a>.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:33122ac3-7eb4-42e2-9b6c-7b42fc68e98e 7 things you need to know to succeed as a medical intern Mon, 02 May 2016 21:50:00 GMT <p> For graduating medical students preparing to begin their residency this summer, a chief resident offers tips for navigating one of the most challenging years of training.<a href="" target="_blank"><img src="" style="float:right;margin:15px;" /></a></p> <p> In this first post of a<a href="" target="_self"> two-part series</a>, Dr. Faton Bytyci, chief resident at Sacred Heart Hospital’s family medicine residency program in Allentown, Penn., suggests adopting these principles as you begin work in the clinical setting:</p> <p style="margin-left:40px;"> <strong>1. Get organized and get focused.</strong><br /> Dr. Bytyci says planning out your calendar and organizing your residency-related activities will be a big help in keeping you on track. You can start now by finding a place to live and getting to know the shortest way to the hospital, he said.<br /> <br /> Once you’re on site, make sure you know where all the units of the hospital are located, and get your tools of the trade ready. “Get your white coats, scrubs, stethoscopes, pocket books,” he said.<br /> <br /> Digital and old-fashioned methods of organizing your schedule are important. “Download apps on your smartphone,” Dr. Bytyci said. “Get a calendar and mark your important dates, such as presentations and the ITE exam.”</p> <p style="margin-left:40px;"> <strong>2. Ask for help from your support network.</strong><br /> As you go through this first year of residency, you may need to work with your family members or other members of your support network to help you with your personal responsibilities, Dr. Bytyci said.<br /> <br /> If you’re married, you may need to have a conversation with your spouse about how the two of you will manage household responsibilities. “It could mean that your spouse will take on a greater share or that you will need to hire a house cleaner or nanny,” he said. “It could mean ordering groceries online instead of making the trip to the market.”<br /> <br /> The <a href="" target="_blank">AMA Alliance</a> offers networking and information to support medical families throughout training, practice and retirement.</p> <p style="margin-left:40px;"> <strong>3. Participate in outside activities that help keep you healthy and balanced.</strong><br /> “This is the most important part of your year,” Dr. Bytyci said. “Relaxing activities like games, exercising, hiking and yoga help combat chronic fatigue and burnout. Catch up with sleep, or take a weekend escape.”<br /> <br /> These kinds of activities are so important that several residency programs—including <a href="" target="_blank">Stanford University School of Medicine</a> and the <a href="" target="_blank">Mayo Clinic</a>—build them into special resident wellness programs.</p> <p style="margin-left:40px;"> <strong>4. Make time for friends.</strong><br /> “Studies show that people who socialize in general are happier,” Dr. Bytyci said. “This is especially true for residents after long hours and difficult cases. Meeting with old friends and new helps clear your mind from medicine for a while.”<br /> <br /> <a href="" target="_blank">Learn why having a strong peer network</a> is a key to preventing burnout in residency.</p> <p style="margin-left:40px;"> <strong>5. Set realistic expectations.</strong><br /> If you go into your PGY-1 year with the expectation that it will be a singularly challenging year, you won’t be disappointed. “Be prepared to miss birthday parties, family holidays, weddings—that is just the reality of being a resident,” he said. “If you can accept that and move forward, you’ll do well.”</p> <p style="margin-left:40px;"> <strong>6. Get ready to show enthusiasm and take responsibility.</strong><br /> “This is what will get you through,” Dr. Bytyci said, “and what people really expect of you. In the beginning you may not have great clinical judgment and knowledge. But you can compensate for your shortcomings by preparing to show interest and by working hard.”</p> <p style="margin-left:40px;"> <strong>7. Don’t lose confidence.</strong><br /> “Don’t forget that the program interviewed hundreds of candidates and picked you,” he said. “They like you, and they have faith in you.”</p> <p> <strong>Learn more about navigating residency:</strong></p> <ul> <li> Find out how to make it through residency <a href="" target="_blank">on a budget</a>.</li> <li> Discover the <a href="" target="_blank">four building blocks</a> for a successful medical marriage.</li> <li> Learn about an initiative that could bring changes to <a href="" target="_blank">the residency environment</a>.</li> <li> Read about how more flexible hours can influence the <a href="" target="_blank">residency experience</a>.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5e2b0501-92e3-4ce3-8e1c-9f23b95ef56d Why raising the tobacco purchasing age matters Mon, 02 May 2016 02:00:00 GMT <p> More than 140 localities in 10 states have raised the minimum purchasing age for tobacco from 18 years of age to 21—a movement that has been a long time coming. Find out why this is crucial to the health of the nation and which states and cities have such rules in place.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> California became the second state to raise the tobacco purchasing age when Gov. Jerry Brown signed bills to reduce tobacco use by increasing the purchasing age for tobacco products from 18 years of age to 21, adding e-cigarettes to state tobacco regulations and adopting other measures.</p> <p> Hawaii was the first state to raise the minimum age for purchasing tobacco to 21 years old. Cities and counties in California, Illinois, Kansas, Massachusetts, Mississippi, Missouri, New Jersey, New York and Ohio also have enacted legislation bolstering the wave of support for this initiative.</p> <p> Chicago recently took it one step further, not only increasing the tobacco purchasing age to 21 but also eliminating smokeless tobacco use at sporting events, including its professional sports venues, such as Wrigley Field and U.S. Cellular Field.</p> <p> <strong>Keeping cigarettes away from minors</strong></p> <p> Tobacco use remains the No. 1 cause of preventable death in the United States. A <a href="" rel="nofollow" target="_blank">report</a> from the U.S. Surgeon General shows that nearly 90 percent of adults who smoke on a daily basis had their first cigarette by age 18.</p> <p> The National Academy of Medicine, formerly the Institute of Medicine, last year concluded that raising the tobacco age would <a href="" rel="nofollow" target="_blank">significantly reduce smoking</a> among youth and young adults, decrease the number of smoking-caused deaths, and immediately improve the health of youth, young adults and young mothers who would be dissuaded from smoking as a result.</p> <p> The report also predicts that raising the minimum age will reduce the smoking rate over time by about 12 percent and smoking-related deaths by 10 percent. This reduction translates into 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost.</p> <p> The AMA has long-standing <a href="" target="_blank">policy</a> regarding increasing the age of tobacco purchase to 21. In January, the AMA submitted a <a href="" target="_blank">letter</a> (log in) to N.J. Gov. Chris Christie, urging him to sign legislation that would raise the age for purchasing tobacco and electronic smoking devices as well as the age of a person to whom a vendor may sell, offer for sale, distribute, give or furnish such products in the state. Christie vetoed the legislation.</p> <p> If California’s law is enacted, this may provide momentum to the numerous bills pending across the nation. Over the last two years, bills have been filed in more than 16 states, including: Connecticut, Iowa, Kentucky, Maryland, Minnesota, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington and West Virginia.</p> <p> The AMA also submitted a <a href="" target="_blank">letter</a> (log in) to Calif. Gov. Jerry Brown, encouraging him to sign the bills, citing that the “legislation will protect California’s youth from the dangers of tobacco use and improve public health.”</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:83823167-bfc7-46c5-a00a-ef1b441c9612 4 ways to promote better BP in May Fri, 29 Apr 2016 23:00:00 GMT <p> National High Blood Pressure Education Month starts today. Find out how you can participate, educate your patients and learn the latest techniques in self-measured blood pressure monitoring (SMBP) throughout the month of May.</p> <p> One in three U.S. adults has hypertension. With such a high prevalence rate, it is likely that your practice is treating patients with this condition. The AMA’s <a href="" target="_blank">Improving Health Outcomes</a> initiative is taking steps to reduce the rate of uncontrolled hypertension.</p> <p> <a href="" target="_blank"><img src="" style="width:365px;height:174px;margin:15px;float:right;" /></a></p> <p> Here are four ways you can partner with your patients to help get the upper hand on blood pressure control:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Learn how SMBP can work for your patients</strong><br /> According to the Centers for Disease Control and Prevention (CDC), the last decade saw a 66 percent increase in the number of hypertension-related deaths in the United States. SMBP is a great way to engage patients in managing high blood pressure. Learn more about SMBP, and get started in your practice with these resources:</p> <ul> <li style="margin-left:40px;"> Find out <a href="" target="_blank">why you should use SMBP</a>.</li> <li style="margin-left:40px;"> Learn <a href="" target="_blank">what you need to start SMBP in your practice.</a></li> <li style="margin-left:40px;"> Examine <a href="" target="_blank">expert insights</a> into the latest blood pressure trials and guidelines.</li> <li style="margin-left:40px;"> Find out <a href="" target="_blank">how one practice is using SMBP with few resources</a>.</li> <li style="margin-left:40px;"> Check out the Improving Blood Pressure Control <a href="" rel="nofollow" target="_blank">module</a> in the AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward</a>™ collection of practice improvement strategies.</li> <li style="margin-left:40px;"> Use the <a href="" target="_blank">one graphic you need for accurate blood pressure reading</a>.</li> </ul> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Participate in Measure Up/Pressure Down National Day of Action May 5</strong><br /> Motivate your patients to “roll up their sleeves” and get a blood pressure reading May 5 for a special day of action as part of the Million Hearts® and American Medical Group Foundation’s <a href="" rel="nofollow" target="_blank">Measure Up/Pressure Down initiative</a>.<br /> <br /> On May 5, physicians and others will be participating in at least one action to raise awareness of high blood pressure.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Take the World Hypertension Day and BP monitoring challenge</strong><br /> World Hypertension Day will be observed May 17. Supported by the American Heart Association (AHA) in collaboration with the World Hypertension League, this year’s theme is “know your numbers.”<br /> <br /> Throughout the month of May, encourage your patients to visit the AHA’s <a href="" rel="nofollow" target="_blank">Target: BP</a> website and select the “I’ve Checked My Blood Pressure” button each time they get a blood pressure reading. All of the clicks will be counted by May 17 in an effort to reach 3 million blood pressure checks in one month. You can follow along with the action around this initiative on Twitter using the hashtags #BPcheck and #knowyournumbers.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Join the SMBP tweet chat for both physicians and patients May 26</strong><br /> Join #AHealthierNation tweet chat on SMBP hosted by the AMA at 3 p.m. Eastern time May 26. Experts from around the country will convene to discuss the benefits of SMBP and to answer questions from attendees.<br /> <br /> On the physician side, the conversation will focus on the benefits of and the steps to implement SMBP in your practice. Patients also are welcome to join and learn why monitoring their blood pressure can help them better manage their hypertension alongside other techniques for lowering blood pressure.<br /> <br /> Ahead of the chat, tweet any questions using #AHealthierNation to be answered throughout the chat on May 26. Watch the <a href="" target="_blank">#AHealthierNation</a> Web page for more information coming soon.</p> <p> Follow <em>AMA Wire®</em> over the next four weeks for more on SMBP and how it is working for physicians and patients.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a28ce186-da93-4b80-8f5d-f8e2ed0a1049 Better health, costs: One practice’s value-based care outcomes Thu, 28 Apr 2016 23:00:00 GMT <p> As the emphasis of U.S. health care shifts toward quality of care over quantity of services, physicians providing value-based care have been able to renew their focus on patients at the center of care. Find out how a practice in North Carolina successfully implemented and continued a value-based care model that both saved money and resulted in better health outcomes.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>Why value-based care?</strong></p> <p> Grace Terrell, MD, chief executive officer and president of Cornerstone Health Care in North Carolina, authored a <a href="" rel="nofollow" target="_blank">new module</a> for the AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward</a>™ collection of practice improvement strategies to help physicians prepare their practices for the transition to value-based care.</p> <p> “As physicians, our primary focus should be on doing what’s in the best interest of our patients,” Dr. Terrell said. “And quite often the way that fee-for-service is set up, we’re not able to do that because it’s all centered on the visit or individual transaction between the doctor and the patient.”</p> <p> “If we actually have a system where the physician can once again focus on how we can create a relationship with the patient that is completely centered on what’s best for them,” she said, “then I think that it can bring the joy of medicine back for the practicing physician.”</p> <p> <strong>How the new model works</strong></p> <p> At Cornerstone Health Care, Dr. Terrell and her colleagues decided to make the move to value-based care in 2012. Cornerstone transitioned from the traditional fee-for-service model to a patient-centered health care delivery system.</p> <p> They first implemented a value-based care model in a specialized heart clinic designed to address the top 20 percent of their chronic heart failure patients. Primary care physicians referred patients who had an established cardiologist within the organization and had either an ejection fraction under 45 percent or a documented diastolic dysfunction.</p> <p> Team-based care is essential to a value-based care model, Dr. Terrell, an internal medicine physician, said. “If you’ve got a team of people that are part of the care model, you don’t have to be the social worker, and you don’t have to be the clinical pharmacist. You can be the one to have the physician relationship with the patient with a whole group of other resources out there to make sure the patient is getting what they need.”</p> <p> Cornerstone’s heart failure care model team included a cardiologist, a nurse practitioner, an embedded behavioral health provider, pharmacy services, a health navigator and a nutritionist. The nurse practitioner and a health navigator worked closely with the patient’s cardiologist and other members of the health care team to create a treatment plan that was customized to the patient’s individual needs. They closely adjusted medications and taught patients other strategies to control their symptoms. The health navigator made calls between visits and monitored the patient’s progress.</p> <p> One of the challenges faced early was that physicians resisted referring patients to the clinic because they saw referrals as a sign of “giving up” on their patients.</p> <p> “They were so used to the old model, where they were responsible for everything, and everything was centered around them and the office visit with the patient that they initially had a hard time with it,” Dr. Terrell said.</p> <p> “Part of it was that physicians, by and large, want to see their patients with good outcomes,” she said. “As we were able to demonstrate that patients were having better outcomes, there became a cultural acceptance at Cornerstone, and a lot of the concerns went away.”</p> <p> “We’re all on one electronic health record,” Dr. Terrell said. “Having communication with the primary care physician so they can see what’s going on helped them see that they continued to be a part of story under the new model.”</p> <p> <strong>The results of the value-based care model</strong></p> <p> The new care model had a great impact on Cornerstone’s patient population and cost of care. In the three years since implementation, the care model has seen a per-patient cost-of-care savings of $5,500 and an overall cost-of-care savings of $1.7 million for the 321 patients enrolled in the program.</p> <p> Most of these savings are based on comparing the total cost of care for the patients before they entered the program and their total cost of care after enrolling in the program. A reduction in hospital admissions because of improved outpatient management was a critical factor in the overall cost savings.</p> <p> “Within the context of value-based payment,” Dr. Terrell said, “if you’re saving money and improving quality of care, and patients are having better outcomes, then some of the resources can be used to bring in these other things that have not been part of fee-for-service medicine: Clinically integrated networks, nurse navigators, community resources or social work.”</p> <p> “Those have not typically been in the actual fee-for-service bundle that a physician would get,” she said, “but by working together, you can have those resources.”</p> <p> “What is useful about thinking from a value-based care model point of view is that you look at it and ask, ‘What resources do we need to make sure that the patient has the best possible outcome at the best possible price for the best possible quality?’” Dr. Terrell said. “That’s a very different business model [than fee-for-service]. It means you have to collaborate. It means sometimes you spend time doing things that are, on the surface, more expensive, but that’s because it actually provides a better experience for the patient.”</p> <p> Cornerstone now has six specific care models to address their most vulnerable patient populations, and since implementation, they have seen positive outcomes resulting in an overall cost reduction of 12.7 percent and a 30 percent reduction in hospitalizations across all programs. They also have increased satisfaction among patients and health care professionals by 43 percent, and they have a quality score of 94 percent, ranking them sixth in the nation for quality in 2014 in the Medicare Shared Savings Program.</p> <p> “It’s a realignment of the whole system into a new value change,” Dr. Terrell said. “You have primary care practices, hospitals, specialists, home health care, community resources—and they are all really working together.”</p> <p> Dr. Terrell’s module on value-based care is one of eight new modules added this week to the AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p> <strong>Learn more: May 11 webinar</strong></p> <p> Join Dr. Terrell for a webinar at 2 p.m. Eastern time May 11, during which she will share insights into how her practice was able to adopt its value-based care model that has let them focus on keeping patients at the center of care. <a href="" rel="nofollow" target="_blank">Register to participate</a>.</p> <p> <strong>Read more about new payment models underway:</strong></p> <ul> <li> <a href="" target="_blank">Testing new payment models: One pilot program’s success</a></li> <li> <a href="" target="_blank">How doctors are developing new payment models for their specialties</a></li> <li> <a href="" target="_blank">Specialty development key to new payment models’ success</a></li> <li> <a href="" target="_blank">Payment models that can help you better address patients’ needs</a></li> <li> <a href="" target="_blank">3 traits of successful payment models</a></li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="" rel="nofollow" target="_blank">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1f536c4e-9798-4e29-bea1-6b8c2ce8d6bd Do you know the answer to this tough USMLE Step 2 question? Thu, 28 Apr 2016 21:45:00 GMT <p> If you’re gearing up to take the United States Medical Licensing Examination® (USMLE®) Step 2, get this month’s exclusive scoop on the most missed USMLE Step 2 test prep question and expert strategies to help you master it. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="" target="_blank">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong><br /> A 57-year-old female with a history of hypertension comes to the physician because of shortness of breath. She says that she has been experiencing progressively worsening dyspnea while climbing the stairs in her house. She denies both chest pain and dyspnea at rest. She appears comfortable at rest. She is on aspirin and metoprolol. Physical examination shows a regular heart rate and rhythm with absence of murmurs or rubs but does have an S4. Blood pressure is 150/80 mm Hg and pulse 55/min. Pulmonary exam reveals rales at the bases. She has lower extremity edema. Echocardiogram shows increased LV filling pressures with a normal ejection fraction. Which of the following is the next best step?</p> <p style="margin-left:40px;"> <strong>A. </strong>Candesartan</p> <p style="margin-left:40px;"> <strong>B. </strong>Digoxin</p> <p style="margin-left:40px;"> <strong>C. </strong>Reduce the dose of metoprolol</p> <p style="margin-left:40px;"> <strong>D. </strong>Verapamil</p> <p style="margin-left:40px;"> <strong>E. </strong>Transesophageal echocardiography</p> <p> <object data="" height="350" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" quality="best" src="" type="application/x-shockwave-flash" width="450" wmode="transparent"></embed></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is A.</strong></p> <p>  </p> <p> <strong>Kaplan says, here’s why:</strong></p> <p> This patient has been diagnosed with diastolic left ventricular dysfunction as a result of long-standing hypertension. The chronic effects of advanced hypertrophy in response to long-standing hypertension are the most likely cause of diastolic left ventricular dysfunction. Essentially, the concentric hypertrophy leads to a heart that cannot relax during diastole, which manifests clinically as dyspnea on exertion.</p> <p> The left ventricle, thus, is not filling properly because:</p> <ul> <li> The concentric hypertrophy prevents the heart from relaxing during diastole.</li> <li> The relative time spent in diastole is shortened during a tachycardia.</li> </ul> <p> The end diastolic left ventricular volume is reduced, and the end diastole pressure is increased because the LV is stiff and noncompliant, leading to pulmonary congestion as excess preload backs up into the lungs, thus resulting in exertional dyspnea. The best way to counteract the symptoms of diastolic left ventricular dysfunction is to administer a negative inotropic agent in an attempt to relax the heart during diastole, thus improving filling pressures. The goal heart rate is 55–60. If you push the heart rate down, the heart spends more time in diastole and has more time for diastolic filling. Therefore, you would not want to decrease the dose of metoprolol <strong>(Choice C)</strong>. You may also use cardiac calcium channel blockers, such as verapamil or diltiazem <strong>(Choice D)</strong>, but you would not want to push the HR <55.</p> <p> In addition to decreasing the heart rate, reducing the afterload with ACE inhibitors or ARBs is also a target for therapy. Candesartan <strong>(Choice A)</strong> has been shown to improve exercise tolerance but not mortality in patients with diastolic dysfunction.</p> <p> Digoxin <strong>(Choice B)</strong> has not shown benefit in isolated diastolic heart failure and should not be used unless required for the treatment of coexisting atrial arrhythmias.</p> <p> Transesophageal echocardiography <strong>(Choice E)</strong> is not indicated for diastolic left ventricular dysfunction because a transthoracic echo is sufficient to make the diagnosis, which involves documentation of normal or only minimally reduced left ventricular systolic function and evidence of abnormalities of left ventricular relaxation. One of the indications for transesophageal echo is to determine the presence of a thoracic aortic aneurysm.</p> <p> <strong>One key tip to remember:</strong></p> <p> The most common etiology of diastolic heart failure is chronic hypertension leading to left ventricular concentric hypertrophy. Treatment should be aimed at decreasing heart rate through the use of beta-blockers or calcium-channel blockers. A decreased heart rate increases the amount of time for the ventricle to fill. Other medications used in the treatment of heart failure include ACE inhibitors or ARBs (prevent remodeling and act to regress hypertrophy) and aldosterone antagonists (prevents and regresses hypertrophy and fibrosis).</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6ec3cbe7-79bc-4c9e-b20e-52871e36508e Draft regulations outline next phase of Medicare Wed, 27 Apr 2016 23:11:00 GMT <p> A 962-page <a href="" rel="nofollow" target="_blank">proposed rule</a> released Wednesday by the Centers for Medicare & Medicaid Services (CMS) details the draft regulations the agency is considering for implementation of last year’s groundbreaking Medicare reform law.</p> <p> <strong>Goals for improving health care for patients and physicians</strong></p> <p> Ahead of CMS’ release of the rule, <a href="" target="_blank">physician leaders testified</a> to the U.S. House of Energy and Commerce Committee’s Subcommittee on Health during a special hearing last week on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).</p> <p> The physicians all underscored in their <a href="" rel="nofollow" target="_blank">testimony</a> the great potential the law holds for allowing physicians across the country in every specialty and practice setting to focus more on their patients and the innovations that are needed to improve quality, reduce costs and ensure the sustainability of their practices.</p> <p> If implemented in a way that truly achieves these goals, MACRA could positively change the health care environment. “We think it may even bring back the joy of medical practice,” Robert Wergin, MD, board chair of the American Academy of Family Physicians, said in his written testimony.</p> <p> Robert McClean, MD, of the American College of Physicians’ Board of Regents, expressed a similar hope for how the law will be carried out, noting in his testimony, “I truly believe that if MACRA can get rolled out with its best intentions implemented well, it is a remarkable ‘shot in the arm’ Congress can give to physicians and the rest of the clinician community to combat burnout and thereby enable our system to realistically strive for the <a href="" rel="nofollow" target="_blank">Quadruple Aim</a>.”</p> <p> An <a href="" rel="nofollow" target="_blank">AMA study</a> conducted by RAND has shown that professional satisfaction for physicians is directly tied to being able to provide the highest quality care for their patients with the fewest administrative barriers to doing that. A <a href="" rel="nofollow" target="_blank">second study</a> by the two groups found that physicians recognize value in moving to new payment models but need support and guidance to be successful in them and assurance that new models will be sustainable.</p> <p> Implementation of MACRA could address many of these issues. The intent of the law is to streamline the various Medicare reporting programs that have been so burdensome for physician practices, reward high-quality care, and provide opportunities and support for physicians to develop and adopt alternative payment models (APM).</p> <p> “MACRA makes significant improvements over the current system, including the repeal of the flawed sustainable growth rate formula and giving CMS an opportunity to reset and improve performance measurement as well as other requirements,” Barbara McAneny, MD, AMA immediate-past board chair, said. “By increasing the availability of APMs, CMS will spur innovative delivery models focused on enhanced care coordination that can lead to better outcomes for patients.”</p> <p> <strong>The proposed regulations</strong></p> <p> “While we have not yet digested the entire 962-page regulation, it appears on our initial review that CMS Acting Administrator Andy Slavitt and his senior management team have listened,” AMA President Steven J. Stack, MD, said in an <a href="" target="_blank">AMA Viewpoints post</a>.</p> <p> Among other issues, the proposed rule addresses questions about elements of MIPS, including:</p> <ul> <li> <strong>Quality:</strong> In this category, clinicians would choose to report six measures, rather than the current requirement of nine measures, from among a range of options that accommodate differences among specialties and practice settings.</li> <li> <strong>Advancing care information:</strong> For this category, clinicians would choose to report customizable measures that reflect how they use technology in their day-to-day practice. Unlike the existing electronic health record (EHR) meaningful use program, this category would not require all-or-nothing EHR measurement or redundant quality reporting.</li> <li> <strong>Clinical practice improvement activities:</strong> This category would reward physicians for clinical practice improvements, such as activities focused on care coordination, patient engagement and patient safety. Clinicians would select activities that match their practices’ goals from a list of more than 90 options.</li> </ul> <p> <strong>A work in progress</strong></p> <p> The AMA is eager to continue its work with CMS as the agency revises the regulations over the coming months.</p> <p> “The 60-day comment period will provide physicians with an opportunity to offer constructive recommendations to share the final regulations that will be issued in the fall,” Dr. Stack said in a <a href="" target="_blank">statement</a> Wednesday. “The AMA will continue its engagement with CMS during the comment period so that MACRA can live up to its promise.”</p> <p> Since MACRA was passed last spring, the AMA has been providing extensive physician feedback on what should be included in the regulations under development. This has included numerous comment letters on specific aspects of MACRA implementation, as well as <a href="" target="_blank">10 overall principles</a> the AMA and more than 100 other medical associations urged the agency to follow.</p> <p> The AMA also has responded to CMS’ requests for information that provided advice on the agency’s proposal for a quality measure development plan and episode groups. Other activities have included hosting listening sessions with CMS for different medical specialties and other stakeholders.</p> <p> To help physicians succeed under the new Medicare system, the AMA will be offering step-by-step guidance and practical resources for practices that will pursue participation in APMs or MIPS. <a href="" target="_blank">Resources currently available</a> include an expert-authored <a href="" target="_blank">guide to physician-focused payment models</a>, <a href="" target="_blank">key points of MIPS</a> and <a href="" target="_blank">five things you can do now to prepare</a>.</p> <p> The AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of practice improvement strategies also offers a variety of education modules to help physicians take steps toward advancing team-based care, implementing electronic health records, improving care and <a href="" rel="nofollow" target="_blank">practicing value-based care</a>.</p> <p> A physician expert will be the featured speaker for a webinar at 2 p.m. Eastern time May 11, during which she will share how her practice has adopted a value-based care model that has let them focus on keeping patients at the center of care. <a href="" rel="nofollow" target="_blank">Register to participate</a>.</p> <p> Additional resources and insights from practicing physicians and payment model experts will be available over the coming weeks and months.</p> <p> <strong>Read more about MACRA and new payment models underway:</strong></p> <ul> <li> <a href="" target="_blank">Testing new payment models: One pilot program’s success</a></li> <li> <a href="" target="_blank">How doctors are developing new payment models for their specialties</a></li> <li> <a href="" target="_blank">Specialty development key to new payment models’ success</a></li> <li> <a href="" target="_blank">Payment models that can help you better address patients’ needs</a></li> <li> <a href="" target="_blank">3 traits of successful payment models</a></li> </ul> <p align="right"> <em>By AMA Wire editor</em> <a href="" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:81152015-0934-498f-a48d-473dd1d13fd9 Historic Medicare payment policy changes an opportunity for success Wed, 27 Apr 2016 22:40:00 GMT <p> <em>An AMA Viewpoints post by AMA President Steven J. Stack, MD</em></p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:left;" /></a><a href="" rel="nofollow" target="_blank">Proposed rules</a> issued Wednesday by the Centers of Medicare & Medicaid Services (CMS) represent the most sweeping change in physician payment policy in the last 25 years.</p> <p> <strong>Implementing MACRA</strong></p> <p> With overwhelming physician support—including from the AMA and the majority of other medical associations—Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) one year ago. This law repealed the threat of annual payment cuts from the sustainable growth rate formula, and it now offers physicians treating Medicare patients a choice of two payment pathways going forward:</p> <ul> <li> Participating in the <strong>modified fee-for-service model</strong>, which will be subject to a revised set of pay-for-performance metrics under the Merit-based Incentive Payment System (MIPS)</li> <li> Meeting requirements for <strong>alternative payment models</strong> (APM), which offer opportunities to improve care delivery while having more payment flexibility</li> </ul> <p> The rulemaking for this law also provides an opportunity to reduce the physician burden associated with the current Medicare reporting requirements for electronic health record meaningful use and clinical quality. The AMA has been vigorously pressing for needed changes to these programs.</p> <p> While we have not yet digested the entire 962-page regulation, it appears on our initial review that CMS Acting Administrator Andy Slavitt and his senior management team have listened.</p> <p> <strong>Providing physician feedback</strong></p> <p> We are at the beginning of the formal rulemaking process. CMS leadership has asked for feedback on what the agency did well in the proposed rule, what needs to be revised and what else needs to be included.</p> <p> This proposed rule gives us an opportunity to provide thoughtful feedback to CMS in order to secure further improvements in the final regulations. In the coming weeks, the AMA will develop a detailed analysis of the proposed rule and coordinate formal written comments with state and national medical societies.</p> <p> In the fall, CMS will publish a final rule that will set the terms for the initial performance period, which will determine payment bonus and penalty amounts in 2019.</p> <p> <strong>Supporting you throughout the process</strong></p> <p> Navigating changes with substantial financial consequences for our practices and implications for how we deliver care to our patients will require preparation, sound guidance and adaptation. Change is never easy, and most physicians are already overwhelmed with existing demands.</p> <p> The AMA is committed to continued advocacy and support for you, your colleagues and your practice teams through every step of this process in the months and years ahead.</p> <p> To help you in your initial preparations for the coming payment policies, the AMA offers a <a href="" target="_blank">guide to physician-focused payment models</a>, <a href="" target="_blank">key points of MIPS</a> and <a href="" target="_blank">five things you can do now to prepare,</a> among <a href="" target="_blank">other resources</a>. The AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of practice improvement strategies also offers a variety of education modules to help physicians take steps toward advancing team-based care, implementing electronic health records, improving care and <a href="" rel="nofollow" target="_blank">practicing value-based care</a>.</p> <p> You can also learn more about MACRA and the ways physicians are already pursuing alternative payment models and other delivery reforms at <a href="" target="_blank"><em>AMA Wire</em></a>®. And a webinar at 2 p.m. Eastern time May 11 will feature a physician expert who will share how her practice has adopted a value-based care model that has let them focus on keeping patients at the center of care. <a href="" rel="nofollow" target="_blank">Register to participate</a>.</p> <p> I urge you to take the first step of becoming familiar with the core elements that will determine payments for the MIPS and APM tracks. The core policy elements in MACRA are also surfacing in other public and private insurance programs, so understanding these principles will be essential for most physician practices.</p> <p> We’ll make additional tools available later this year to help you assess your options within the new MIPS and APM programs and choose the best course for your practice. We also will offer online educational programs and in-person forums in the coming months.</p> <p> <strong>Navigating the road ahead</strong></p> <p> MACRA both presents opportunities and poses risks. On the opportunity side, we have the potential to fix some misguided reporting programs and implement better rewards for physician-led improvements in care delivery.</p> <p> The risk is that government policymakers may cling to narrow-minded regulatory approaches that are driving the alarming rate of physician burnout. We remain actively engaged in the policymaking process now underway in the hope that we will be better positioned to lower the risk of more excessive regulatory burdens and seize other opportunities to support professional satisfaction and sustainable physician practices.</p> <p> The AMA has been working closely with state and national medical societies to shape the early stages of MACRA implementation and will continue to do so. You can play an important role by providing your input, support and participation in our efforts to shape a better delivery and payment system for patients and physician practices.</p> <p> The road ahead will be bumpy, it will certainly be challenging, and course corrections will need to be made. But the goal is well worth it: Building an environment that fosters greater physician satisfaction and more sustainable practices. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:acd2c52d-a483-4123-81bc-51d6e60bc4c3 What you need to know to negotiate your first employment contract Wed, 27 Apr 2016 22:16:00 GMT <p> An experienced attorney can help you reach an employment contract that will be fair to both you and your employer. An experienced health care attorney offers insights to consider when you enter the job market and consider your first contract.</p> <p> “It’s not something physicians typically look forward to,” said Wes Cleveland, an attorney in the AMA’s Advocacy Resource Center. Physicians are often anxious about contracts and often lack the legal expertise to sort through the right questions to ask, he said. And there are many questions.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>The importance of legal guidance</strong></p> <p> “The idea of negotiations can stress people out, and a lot of people don’t like to talk about money,” Cleveland said. At the same time, many physicians wonder if they really need a lawyer to come to a fair contract. Many physicians associate lawyers with confrontation or other negative experiences, Cleveland said.</p> <p> But the right lawyer knows what issues matter most, can give you market insights regarding pay and other compensation, and may be able to tell you how physician pay and satisfaction vary among specific potential employers in the region.</p> <p> “If they’ve been practicing for 10, 20, 30 years, they’ll know the lay of the land,” Cleveland said. Hiring a lawyer is a modest investment that could pay dividends for years to come, he said.</p> <p> “Relative to what you’re spending on education, having an attorney review the contract is not what I consider a big-ticket item,” he said. “Why get to the 1-yard line and fumble the ball?”</p> <p> <strong>Sorting out critical issues</strong></p> <p> Many residents and fellows, Cleveland said, could fail to spot or give enough attention to issues that turn out to be critical:</p> <ul> <li> How you can get out of a contract and how an employer can end it.</li> <li> When and where you will be required to work. For instance, a contract could require you to work at other employer locations that might significantly increase your commute.</li> <li> How on-call obligations will be shared among physicians.</li> <li> Who will have the responsibility for purchasing your tail coverage (liability insurance coverage that follows you after you leave a hospital or practice) and for how long.</li> <li> What your compensation will be. “Compensation is always really important,” Cleveland said. “You just want to be very clear what that involves.”</li> </ul> <p> An evolving compensation environment might demand more attention than in the past, he said. More and more compensation is based on performance, linked to such issues as patient satisfaction, your ability to keep patients out of the ER and prevent hospital readmissions, and other cost variables.</p> <p> Cleveland urges you to research the compensation market to ensure you get the best deal. There are publicly available sources of information that may help you get a general idea of what the compensation market is where your potential employer is located.   </p> <p> <strong>Learn more: Attend an event in May</strong></p> <p> Cleveland will address the most current issues as well as the age-old fundamentals of contracts in two upcoming AMA events for residents. The program will cover these issues and others:</p> <ul> <li> What you need to know about your employment benefits</li> <li> Why you might want the advice of a health care attorney</li> <li> Which critical resources can help you navigate the employment contract process</li> <li> What you need to understand about non-compete clauses</li> </ul> <p> Seating is limited, so <a href="" rel="nofollow">send an email</a> to the AMA Resident and Fellows Section to register today.</p> <p> The programs are free to AMA members and include a three-course dinner, wine and beer. The charge for non-members is $75. If you’re not yet a member, you can join the AMA for only $45 and gain free access to this event. To do so, call (800) 262-3211. Non-physician guests also are welcome to attend for $50.</p> <p> The two events are scheduled for:</p> <ul> <li> 7–9 p.m. May 5 at McCormick & Schmick’s, 1652 K St. N.W., Washington, D.C.</li> <li> 7–9 p.m. May 19 at Morton’s Steakhouse, 888 W. Big Beaver Road, Troy, Mich.</li> </ul> <p> <strong>Learn more about preparing for employment:</strong></p> <ul> <li> Read about the <a href="" target="_blank">8 benefits to negotiate</a> for your next job offer.</li> <li> Discover <a href="" target="_blank">employment resources</a> you need for starting their job hunt.</li> <li> Find out the <a href="" target="_blank">7 things you must know</a> before signing an employment contract.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2ea23d8e-f7d4-48f8-8dbe-8173095d8da5 Physician satisfaction: Why leadership qualities matter Tue, 26 Apr 2016 21:45:00 GMT <p> Physician leaders have a significant impact on the well-being and satisfaction of the physicians they supervise, according to a new study. Learn which leadership qualities are essential to promote healthy professional environments that reduce the likelihood of physician burnout.</p> <p> <strong>Effective leaders increase physician well-being </strong></p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>Physician leaders who inform, engage, inspire, develop and recognize the physicians they supervise are more likely to have employees who feel professionally satisfied and less likely to show signs of burnout, a <a href="" rel="nofollow" target="_blank">study</a> published in the April issue of <em>Mayo Clinic Proceedings</em> found.</p> <p> Study authors asked Mayo Clinic physicians to rate their immediate physician supervisor on a scale from 1 to 5 for leadership qualities, such a how well the supervisor does in holding development conversations; inspiring them to do their best; treating them with respect and dignity; recognizing them for a job well done; and empowering them to do their jobs.</p> <p> Overall, 38 percent of the nearly 3,900 physicians surveyed reported high emotional exhaustion, 15 percent reported high depersonalization and 40 percent reported at least one symptom of burnout. Nearly 80 percent were satisfied or very satisfied with the organization, while 9 percent were dissatisfied or very dissatisfied.</p> <p> After adjusting for age, sex, duration of employment at Mayo Clinic and specialty, the study authors found that leadership ratings had a strong association with burnout and satisfaction for the individual physicians.</p> <p> “At the work unit level, 11 percent of the variation in burnout and 47 percent of the variation in satisfaction with the organization was explained by the leadership rating of the division/department chairperson,” the authors wrote. “This is remarkable when one considers the extent of other factors that influence satisfaction (e.g., salary, workload expectations, specialty, culture, strategic direction of the organization, personality conflicts and opportunities for professional development).”</p> <p> In contrast, the authors noted, the leaders’ own level of burnout was not related to the prevalence of burnout in the division or department.</p> <p> <strong>More opportunities for leadership training</strong></p> <p> Researchers said organizations need to provide physician leaders with the training they need to be effective. Often physician leaders are selected based on their clinical acumen, scientific expertise or reputation, rather than on the qualities necessary to be an effective leader, the authors noted.</p> <p> “These factors often combine to create a circumstance in which an individual who has not been well prepared to lead is thrust into a very challenging leadership situation,” the authors said. But that can be improved by offering leadership training.</p> <p> “Many of the leadership qualities we evaluated were specific and teachable behaviors, such as keeping people informed, encouraging reports to suggest ideas for improvement, having career development conversations, providing feedback and coaching and recognizing a job well done,” study authors said.</p> <p> <strong>Promoting physician wellness</strong></p> <p> One of the study’s lead authors, Tait Shanafelt, MD, will be a featured speaker at a continuing medical education event at the <a href="" target="_blank">2016 AMA Annual Meeting</a> in Chicago June 11. Dr. Shanafelt is director of the Mayo Clinic Program on Physician Well-being, and he will explore finding meaning, balance and personal satisfaction throughout medical education and in the practice of medicine. His presentation will include a look at successful individual and organizational approaches to promoting physician well-being.</p> <p> Promoting physicians’ wellness and ability to thrive is a <a href="" target="_blank">top priority</a> for the AMA, which will host the <a href="" target="_blank">International Conference on Physician Health™</a> Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> The AMA’s STEPS Forward™ collection of practice solutions also offers resources for physicians on <a href="" rel="nofollow" target="_blank">improving physician resiliency</a>, <a href="" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="" rel="nofollow" target="_blank">preventing resident and fellow burnout</a>.</p> <p> <strong>Check out these stories for more about physician burnout:</strong></p> <ul> <li> <a href="" target="_blank">Seven steps to prevent burnout in your practice</a></li> <li> <a href="" target="_blank">Five things institutions can do to prevent resident burnout</a></li> <li> <a href="" target="_blank">Eight things that can put you at risk of burnout</a></li> <li> <a href="" target="_blank">Burnout busters: How to boost satisfaction in personal life, practice</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:15b80048-5cf9-4092-8b89-3831ea6d7680 How to beat this top-missed USMLE Step 1 question Tue, 26 Apr 2016 21:23:00 GMT <p> If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you need this exclusive scoop on one of the most challenging USMLE test prep questions and expert strategies to help you pass it with flying colors. Find out what this month’s most-missed question is, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, “Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank”: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="" target="_blank">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> <a href="" target="_blank"><img src="" /></a></p> <p> An investigational oral contraceptive causes less weight gain than other oral contraceptives because it contains a unique progestin that blocks mineralocorticoid receptors. One hundred consecutive female participants are instructed to take 21 days of active pills, starting at Day 0, containing the progestin and ethinyl estradiol, followed by seven days of placebo. Based on the data shown, which of the following parameters is most likely being measured?</p> <p style="margin-left:40px;"> <strong>A. </strong>Aldosterone</p> <p style="margin-left:40px;"> <strong>B. </strong>Angiotensin II</p> <p style="margin-left:40px;"> <strong>C. </strong>pH</p> <p style="margin-left:40px;"> <strong>D.</strong> Potassium</p> <p style="margin-left:40px;"> <strong>E. </strong>Sodium</p> <p>  </p> <p> <object data="" height="350" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" quality="best" src="" type="application/x-shockwave-flash" width="450" wmode="transparent"></embed></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is D.</strong></p> <p> <strong>Kaplan says, here’s why: </strong><br /> Since the new investigational combination drug (progestin/ethinyl estradiol) is blocking mineralocorticoid receptors, the actions of aldosterone will be antagonized during the first 21 days of the cycle. Sodium reabsorption and the secretion of potassium and hydrogen ion should be diminished, decreasing potassium and hydrogen ions in the urine. It is important to note that the graph is measuring urine potassium levels, not serum potassium levels. Since many actions of mineralocorticoids are relatively slow and because the progestin will require several days to rise to steady state levels, its effect on urine potassium excretion will not be instantaneous but will gradually increase during the drug treatment.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer to help you prepare with future studying.</em></p> <p> <strong>Choices A and B:</strong> Urinary levels of aldosterone and angiotensin II would be expected to be elevated during the first 21 days because suppression of the response to aldosterone decreases blood pressure. Reduced blood pressure releases the renin-angiotensin-aldosterone system from the normal negative feedback; higher plasma aldosterone causes higher urinary aldosterone excretion.<br /> <br /> The mechanism of the aldosterone response is increased renin secretion, with increased production of angiotensin II. Angiotensin II has a very short plasma half-life (about 30 seconds); normal urinary excretion is very low, about 20 pmol/24 hours. Increased plasma renin activity and the consequent increased production of angiotensin II would increase rather than decrease urinary angiotensin II levels.<br /> <br /> Estrogens increase hepatic production of angiotensinogen, leading to an increase in angiotensin II and aldosterone. Also, increased plasma potassium caused by decreased renal excretion is a potent stimulus for aldosterone secretion.</p> <p> <strong>Choice C:</strong> Since there are less hydrogen ions in the urine, the urinary pH would increase in the first 21 days of the cycle.</p> <p> <strong>Choice E:</strong> Since sodium reabsorption would be impaired, urinary levels of sodium would be expected to increase.</p> <p> <strong>Key points to remember:</strong></p> <ul> <li> An antagonist at mineralocorticoid receptors will block the actions of aldosterone. If administered as a contraceptive, this occurs during the first 21 days of the menstrual cycle.</li> <li> Sodium reabsorption and potassium and hydrogen ion secretion would be diminished, decreasing potassium and hydrogen ions in the urine.</li> <li> Compensatory responses to aldosterone receptor blockers include increased plasma renin activity, angiotensin II production and aldosterone secretion.</li> </ul> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:53addb79-524d-4a66-9c25-601a3fc08d24 Supreme Court case could have major health implications Mon, 25 Apr 2016 21:43:00 GMT <p> Depending on how it reads the Clean Air Act, the Supreme Court of the United States could limit the authority of the Environmental Protection Agency (EPA) to restrict carbon emissions that cause climate change and have been proven to inflict major health problems on the people of the world. Find out how this case could affect your patients.<a href="" target="_blank"><img src="" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> <strong>A case for clean air</strong></p> <p> At stake in <em>West Virginia, et al. v. EPA,</em> is whether that federal agency has the authority to enforce recent regulations known as the Clean Power Plan. The final rule of the plan was released in October. On the same day, 12 state governments, led by West Virginia, sued the EPA in the U.S. Court of Appeals for the District of Columbia Circuit, claiming that the regulations exceeded the EPA’s authority under the Clean Air Act.</p> <p> The states involved moved to prevent the regulations from being enforced until the appeals are resolved. The Court of Appeals denied the stay motions, and the states appealed this denial to the U.S. Supreme Court. By a 5:4 vote, the U.S. Supreme Court stayed these regulations until complete resolution of the case.</p> <p> <strong>How this case affects public health</strong></p> <p> The Clean Air Act empowers the EPA to establish standards for the regulation of pollution from existing stationary sources of emissions. In response to this directive of the Clean Air Act, the EPA adopted the Clean Power Plan, which establishes carbon pollution standards for power plants that will help slow the harmful impacts of carbon pollution on public health. The plan was designed to achieve a 32 percent reduction of the 2005 levels of carbon emissions by 2030.</p> <p> “These regulations are well within [the] EPA’s statutory authority,” the <a href="" target="_blank">Litigation Center of the AMA and State Medical Societies</a> said in an <a href="" target="_blank">amicus brief</a> (log in) submitted to the U.S. Supreme Court. “Failure to uphold the Clean Power Plan would undermine [the] EPA’s ability to carry out its legal obligation to regulate carbon emissions that endanger human health and would negatively impact the health of current and future generations.”</p> <p> Carbon emissions are a significant driver of the anthropogenic greenhouse gas emissions that cause climate change and consequently harm human health. Direct impacts from the changing climate include health-related illness, declining air quality and increased respiratory and cardiovascular illness. Changes in climate also facilitate the migration of mosquito-borne diseases, such as dengue fever, malaria and most recently the <a href="">Zika virus</a>.</p> <p> “In surveys conducted by three separate U.S. medical professional societies,” the brief said, “a significant majority of surveyed physicians concurred that climate change is occurring … is having a direct impact on the health of their patients, and that physicians anticipate even greater climate-driven adverse human health impacts in the future.”</p> <p> The brief highlights three ways that carbon emissions affect climate change and consequently human health:</p> <ul> <li> <strong>Heat:</strong> Increasing concentrations of greenhouse gases trap a higher portion of the sun’s solar energy, leading to an overall rise in global land and ocean temperatures.<br /> <br /> Excess heat has a major impact on human health. The 2003 European heat wave is estimated to have led to approximately 50,000 deaths in August alone. A 2006 heat wave in California resulted in more than 16,000 extra visits to the emergency room and 1,182 extra hospitalizations.</li> </ul> <ul> <li> <strong>Ozone and particulate matter:</strong> Climate change has a number of effects on air quality that are harmful to human health, including higher concentrations of ground level ozone and particulate matter. Air pollution from these sources has been linked to cardiovascular disease and respiratory illness.</li> </ul> <ul> <li> <strong>Pollen and microbial hazards:</strong> Climate change promotes increased exposure to pollen, fungi and other microbial growth. Rising global temperatures are increasing both the duration and intensity of pollen seasons. Higher pollen counts impair the quality of life of at least 16.9 million Americans and impose substantial costs on the health care system.<br /> <br /> Higher pollen levels also are associated with lung inflammations, which can cause upper and lower respiratory tract symptoms, even among those who do not suffer from allergic asthma, allergic rhinitis or hay fever.</li> </ul> <p> “By addressing both carbon emissions responsible for climate change and conventional air pollutants,” the brief said, “[the] EPA’s Clean Power Plan carries out the Clean Air Act’s mandate to protect the public health.”</p> <p> <strong>Other recent cases in which the AMA Litigation Center is involved: </strong></p> <ul> <li> Find out how a case in Oregon could <a href="" target="_blank">increase liability exposure and redefine injury</a>.</li> <li> Learn how one of the nation’s leading <a href="" target="_blank">medical liability reform laws could be undercut in a state supreme court</a>.</li> <li> Understand the implications of a case that is set to decide on <a href="" target="_blank">censorship in the exam room</a>.</li> <li> See the outcome of a court’s decision regarding <a href="" target="_blank">protected patient safety information</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:63eec211-374b-4d7a-8c93-e20afd956e25 A growing divide: Life expectancy for richest, poorest Americans Mon, 25 Apr 2016 21:39:00 GMT <p> The poorest American men at age 40 have a life expectancy similar to men in Pakistan and Sudan, according to a <a href="" rel="nofollow" target="_blank">major study</a> appearing in the <em>Journal of the American Medical Association</em> (<em>JAMA</em>). Meanwhile, the richest Americans continue to add years to their lives.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" style="height:595px;width:360px;" /></a></td> </tr> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" style="height:468px;width:360px;" /></a></td> </tr> </tbody> </table> <p> That widening gap is the subject of a report <em>JAMA</em> published online April 10. Using tax and Social Security records, eight researchers examined how income correlates with longevity—and how that correlation is changing.</p> <p> In addition, researchers uncovered something they said should be a key area for further research: The poor live longer in cities such as San Francisco and New York, <a href="" rel="nofollow" target="_blank">cities that have higher average incomes</a> and levels of education.</p> <p> <strong>The age gap widens</strong></p> <p> The report found that the gap in life expectancy between the richest 1 percent and the poorest 1 percent was 10 years for women and nearly 15 years for men. Men at the age of 40 in the bottom 1 percent of the income distribution had a life expectancy of almost 73 years, women 79 years. Men in the top 1 percent of the income distribution had a life expectancy of 87 years, women 89 years.</p> <p> That gap widened between 2001 and 2014, the period examined in the study. Life expectancy increased by about three years for men and women in the top 5 percent of the income distribution but showed no increase for those in the bottom 5 percent.</p> <p> The researchers put their data in perspective by comparing life expectancies at selected percentiles of the income distribution in the United States with mean life expectancies in other countries. “For example,” the report said, “men in the bottom 1 percent of the income distribution at the age of 40 years in the United States have life expectancies similar to the mean life expectancy for 40-year-old men in Sudan and Pakistan.”</p> <p> <strong>Health behaviors and location</strong></p> <p> The study confirmed that life expectancy follows income and that most of the variation in life expectancy was related to differences in health behaviors, including smoking, exercise and obesity. But those behaviors and corresponding life expectancy for the poorest individuals correlate with the areas in which people live.</p> <p> The strongest pattern in the data showed that persons in the lowest-income quartile live the longest, and have more healthful behaviors, in cities with high incomes, high education and high levels of government spending, such as New York and San Francisco. In these cities, life expectancy for the bottom 5 percent in income was about 80 years, compared to about 75 in years in cities such as Gary, Ind., and Detroit.</p> <p> Researchers suggested the longer lives of the poor in cities such as San Francisco and New York could be explained by public policy in those cities, such as smoking bans and higher spending for public services. Also, those with lower incomes may benefit from the influence of others who follow healthy behaviors.</p> <p> The variations in cities suggest that reducing gaps in longevity may require local policy changes, the researchers concluded. Health professionals could target low-income communities with interventions intended to change health behaviors, the study found, while taxing and other local polices may play a role in encouraging behavior changes.</p> <p> <strong>Find out more about longevity and other health disparities:</strong></p> <ul> <li> See a <a href="" rel="nofollow" target="_blank">video</a> on the <em>JAMA</em> report.</li> <li> Explore this report, an author interview and related materials on the JAMA Network <a href="" rel="nofollow" target="_blank">health disparities website</a>.</li> <li> Learn about <a href="" target="_blank">three environmental issues</a> disproportionately affecting Hispanic patients.</li> <li> Find out how a Chicago health network is <a href="" target="_blank">improving health for low-income residents</a>.</li> <li> Discover how an inner city care team is <a href="" target="_blank">reducing hypertension disparities</a>.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9584848e-1247-40f0-bc4b-0b88bbda508f How to diagnose prediabetes Mon, 25 Apr 2016 21:00:00 GMT <p> Studies have shown that up to 30 percent of people with prediabetes will develop type 2 diabetes within five years. At a time when one in three U.S. adults has prediabetes, it’s important to identify which of your patients have this condition to help them get the interventions they need right away. Learn the ways to identify patients with prediabetes in your practice.</p> <p> <strong>Two screening options, three tests</strong></p> <p> Prediabetes is a condition in which blood glucose or hemoglobin A1C (HbA1C) levels are higher than normal but not high enough to be classified as type 2 diabetes. There are two different approaches you can take to determine when patients have prediabetes: Identification at the point of care or via an electronic heath record (EHR) query that results in a listing or registry.</p> <p> For point-of-care identification, use a <a href="" target="_blank">simple algorithm</a> (log in) to walk through the steps. The process starts with giving patients a <a href="" target="_blank">diabetes risk assessment</a> (log in). If the patient is at risk and has a body mass index (BMI) of ≥24 kg/m<sup>2</sup> (≥22 kg/m<sup>2</sup>, if Asian*) or a history of gestational diabetes, then you should use the results of a diagnostic test to determine whether the patient has normal blood sugar levels, prediabetes or diabetes.</p> <p> There are three kinds of tests you can order: HbA1C, fasting plasma glucose or oral glucose tolerance test. </p> <p> <a href="" target="_blank"><img src="" style="width:650px;height:104px;margin:15px;" /></a></p> <p> Experts recommend that you have patients complete the risk assessment before their visit and arrange for pre-visit lab testing so you can spend time talking with your patients about their results during the actual visit. (Tip: If you don’t routinely employ pre-visit planning, <a href="" rel="nofollow" target="_blank">check out a module</a> in the AMA’s STEPS Forward™ collection of practice improvement strategies to help you implement that practice.)</p> <p> If you choose to identify patients with prediabetes via a registry, you can do that by querying your EHR and setting up a prediabetes registry.</p> <p> Patients with a BMI of ≥25 kg/m<sup>2</sup> (≥23 kg/m<sup>2</sup> for Asians) and blood glucose or HbA1C levels in the prediabetes range qualify for an evidence-based diabetes prevention program. <a href="" target="_blank">View an algorithm</a> (log in) that lists the inclusion and exclusion criteria for your EHR query.</p> <p> When reporting the tests and diagnoses, refer to the charts below for the appropriate codes.</p> <p> <a href="" target="_blank"><img src="" style="width:650px;height:508px;margin:15px;" /></a></p> <p> <strong>What to do following a diagnosis</strong></p> <p> An effective, evidence-based ways to reduce diabetes risk is to participate in a diabetes prevention program recognized by the CDC. Such programs emphasize healthy eating and increased physical activity, and they can reduce the risk of developing diabetes by more than one-half.</p> <p> The AMA and the CDC jointly offer an easy way for care teams to access practical resources: <a href="" target="_blank">Prevent Diabetes STAT: Screen, Test, Act—Today™</a>. This initiative can help you and your team take three simple steps to improve the health of your patients:</p> <p style="margin-left:36.75pt;"> 1. Screen patients for prediabetes using the CDC Prediabetes Screening Test or the American Diabetes Association (ADA) Diabetes Risk Test</p> <p style="margin-left:36.75pt;"> 2. Test for prediabetes using one of three blood tests</p> <p style="margin-left:36.75pt;"> 3. Act by referring patients with prediabetes to a nearby <a href="" rel="nofollow" target="_blank">diabetes prevention program</a></p> <p> The U.S. Department of Health and Human Services <a href="" target="_blank">recently announced</a> it soon will begin covering diabetes prevention programs for Medicare beneficiaries, making this lifestyle intervention accessible to even more people.</p> <p> <span style="font-size:10px;">*These BMI levels reflect eligibility for the National Diabetes Prevention Program, as noted in the CDC Diabetes Prevention Recognition Program Standards and Operating Procedures. The ADA encourages screening for diabetes at a BMI of ≥23 kg/m<sup>2</sup> for Asian Americans and ≥25 kg/m<sup>2</sup> for non-Asian Americans, and some programs may use the ADA screening criteria for program eligibility. Please check with your diabetes prevention program provider for their specific BMI eligibility requirements.</span></p> <p> <a href="" target="_blank"><img src="" style="margin:15px;" /></a></p> <p align="right"> <em>By AMA Wire editor </em><a href="" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:39143c5b-0f94-44a5-b648-edf713ac547e Financial data going public: Review yours now Fri, 22 Apr 2016 21:21:00 GMT <p> Physicians have three weeks left to review and dispute reports regarding their financial interactions with manufacturers of drugs and medical devices reported under the Physician Payments Sunshine Act, also known as the Open Payments program. Learn the steps you can take to review your data before it is made public.</p> <p> The Centers for Medicare & Medicaid Services (CMS) this month announced the beginning of the program’s 45 day review and dispute period, which concludes on May 15. Disputes filed during this time will be flagged in the Open Payments data before CMS publishes the 2015 payment data and updates to the 2013 and 2014 data June 30.</p> <p> You can still dispute your data after the public release, but any disputes submitted after the May 15 deadline will not be flagged for that initial release.</p> <p> The Open Payments program is CMS’ effort to increase transparency and accountability in health care, but the program has seen significant issues with inaccurate data. Make sure you follow these three steps to register and review so that you can potentially dispute any inaccurate data reported and tied to your name:</p> <p style="margin-left:40px;"> <strong>Step 1: Complete the CMS e-verification process. </strong>Test your login credentials through the <a href="" target="_blank" rel="nofollow">CMS Enterprise Portal (EIDM)</a>. New users will be required to complete a one-time EIDM registration process. Visit CMS’ <a href="" target="_blank" rel="nofollow">frequently asked questions</a> Web page to troubleshoot locked accounts or other issues.</p> <p style="margin-left:40px;"> <strong>Step 2: Register with CMS’ Open Payments system. </strong>Once you are registered within the EIDM, you can then register with CMS’ Open Payments system through the portal to gain access to your data. Registration is rather cumbersome, so make sure to follow the directions closely and allow enough time to complete it in one session.</p> <p style="margin-left:40px;"> <strong>Step 3: Review your data and dispute any inaccuracies. </strong>After logging in to the Open Payments system, you can review and dispute your data. You should be able to follow the process of any disputes from initiation to resolution through the portal.</p> <p> Refer to the <a href="" target="_blank">AMA website</a> for more detailed step-by-step instructions on how to register to review and dispute data. For answers to additional questions, <a href="" rel="nofollow">email Medicare’s Open Payment Help Desk</a>, or call (855) 326-8366.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d91c0fe1-d722-41b1-8524-20d7d27a46e4 In med school, students’ perceptions matter Thu, 21 Apr 2016 22:00:00 GMT <p> One of the keys to student success in medical school is a positive perception of the learning environment—it’s linked to academic performance as well as higher scores on the United States Medical Licensing Exam (USMLE). A new study has found that student perceptions aren’t shaped as much by individual student backgrounds as they are by campus cultures.</p> <p> <strong>Evaluating campus perceptions</strong></p> <p> After just one year of medical school, a student’s perception about his or her learning environment is shaped by the culture at the campus where they are taking classes, according to a recent AMA-authored <a href="" rel="nofollow" target="_blank">study</a> in <em>Academic Medicine</em>.</p> <p> Researchers asked more than 4,000 students from 28 medical schools to report the frequency of 17 aspects of the learning environment from the Medical School Learning Environment Survey (MSLES) on a scale from “never” to “very often” at the end of the first year of medical school. Among the items they ranked:</p> <ul> <li style="margin-left:0.25in;"> Students gather for informal activities.</li> <li style="margin-left:0.25in;"> Competition for grades is intense.</li> <li style="margin-left:0.25in;"> Students in school are distant from each other.</li> <li style="margin-left:0.25in;"> Faculty are reserved and distant with students.</li> <li style="margin-left:0.25in;"> Courses emphasize the interdependence of facts, concepts and principles.</li> </ul> <p> The students’ demographic characteristics accounted for very little of the total variance in student perceptions, according to the paper, which came out of the AMA’s <a href="" target="_blank">Learning</a> Environment Study. The greater variation was between schools, a finding that suggests the campus culture has an impact on students.</p> <p> “The student’s school or campus location, with its inherent local institutional culture, explains 90 percent of the measured variance in student perception and the learning environment,” study authors concluded. “The relationships between the MSLES scores, student demographic and personal attribute measures, although statistically significant, only explained about 2 percent of the variance.”</p> <p> Students’ impressions of the learning environment are important because they have been linked to academic performance. Studies also have shown that students who feel more positive about their learning environment perform better on the USMLE.</p> <p> “Schools have the most influence on students’ perceptions of their learning environment early in their education,” said lead study author Susan E. Skochelak, MD, the AMA’s group vice president for medical education. “Some schools are doing a better job than others. It will be important for schools to look to best practices so that they can support the best learning environment possible for our students.”</p> <p> <strong>More research needed</strong></p> <p> The study results suggest that medical schools can examine their institutional learning environments—such as grading policies, the hidden curriculum, learning communities and curricular change efforts—to enhance student experiences in undergraduate medical education. Study authors said more studies are needed to identify specific factors that may contribute to student perceptions.</p> <p> Some of that research is underway.</p> <p> “We are doing additional analysis of the data that we have collected,” Dr. Skochelak said. “We have papers about learning communities and other implications that will be published. Other organizations are also studying and reporting on these issues, including the Association of American Medical Colleges and individual medical schools.”</p> <p> The study by Dr. Skochelak and colleagues is related to the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education</a> initiative, which is working to transform medical education to meet the evolving needs of physicians and patients.</p> <p> <strong>For more about how medical education is changing:</strong></p> <ul> <li style="margin-left:0.25in;"> <a href="" target="_blank">How students are at the forefront of transforming med ed</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">What med ed and organizational change have in common</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">Med school explores new way to assess millennial learners</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">21 more schools tapped to transform physician training</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">Residency training environments primed for transformation</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:351aa74e-f838-4298-ad96-25e75b79dd4f Practicing at the end of the world: One physician’s encore career Wed, 20 Apr 2016 21:43:00 GMT <p> Right now in the medical facility of McMurdo Station, Antarctica, Kenneth Iserson, MD, is treating patients in one of the harshest environments in the world. Rather than sitting on a warm beach somewhere, Dr. Iserson has spent the first years of his retirement teaching and practicing emergency medicine in extreme environments on all seven continents. Find out what it’s like to practice in these conditions and what advice Dr. Iserson has for physicians looking for ways to continue using their medical skills after retirement.</p> <p> McMurdo Station is located on the southern tip of Ross Island in Antarctica and serves as a research center for many groups, including the National Science Foundation. The station is only accessible by air or by ships, one month a year, after an icebreaker clears the way.</p> <p> “I see this as my encore career,” Dr. Iserson said. “I retired from the University of Arizona Emergency Medicine Department after 30 years, early enough so that I could work around the world. For the last eight years, I’ve worked only in resource-poor settings, where, if we have an emergency, we can’t immediately get [patients] to surgery or to an intensive care unit. We really have to improvise.”<object align="right" data="" height="350" hspace="5" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="5" quality="best" src="" type="application/x-shockwave-flash" vspace="5" width="450" wmode="transparent"></embed></object></p> <p> <strong>What it’s like being the only physician at McMurdo Station</strong></p> <p> McMurdo Station has a population of about 1,200 in the summer, but that number significantly decreases in the winter months when the station is a “closed,” meaning that there is, at best, a flight only every four to eight weeks. As the only physician, Dr. Iserson lives and works with his patients.</p> <p> “It means that I’m trusted by our entire population because I’m their physician,” he said. “And I’m their physician 168 hours a week for the whole time I’m here, which will be about nine months.”</p> <p> “Days are getting very short right now, and while there is still some light here, but it’s going away quickly. We’ll lose it completely on April 24 for four months,” Dr. Iserson said. “Traditionally that increases depression and the likelihood that people could get hurt outside. They can go a little stir crazy because, with the cold weather and harsh conditions, it’s harder to do outside activities.”</p> <p> “We’ll sit and watch movies together,” he said. “They have some bars—I don’t usually attend. Last night we had game night. … We’ll also go on hikes together. We can only work so much of the time, and we have to spend the rest of it interacting.”</p> <p> Confidentiality is crucial to practicing medicine in such an isolated and extreme climate, Dr. Iserson said. “It’s a tricky situation because we have a very close-knit and, right now, closed population. And we interact with each other in all kinds of situations.”</p> <p> “When there’s anything serious that happens, everybody knows everybody else, [and] they’re reasonably upset and concerned about the situation,” he said. “But that’s the thing we have to be very careful about here because we eat with our patients, we shower in the same bathrooms, we walk in the same halls. Confidentiality is paramount.”</p> <p> Dr. Iserson has seen major fractures, bad burns, crush injuries, pneumonias, significant eye problems, cardiac problems, appendicitis and much more. “It runs the entire gamut of what you might see in a serious emergency department, and we have pretty much all of the same equipment too,” he said.</p> <p> “But it’s not meatball medicine,” Dr. Iserson said. “We’re much better equipped than Hawkeye’s MASH unit was. We’re in pretty good shape here. We actually have a regular ambulance with at least one available paramedic,” he said, “but that’s usually only for in-town problems or problems on a road, where it can be accessed.”</p> <p> “We have a lot of rules that protect people, and preventive medicine really is the best thing,” he said. “If something goes wrong, we’re kind of short-handed. Every season, you work up a team of auxiliary people who can help you out if there is a health crisis.”</p> <p> “Usually though, it’s just going to be the physician’s assistant and myself for most things,” he said. “The most common routine thing we see is called the McMurdo Crud—that’s an upper respiratory infection that just gets passed around the station. We’re in close quarters, and right now it’s a closed community. So, once it burns out, it should be done until the next group of outsiders arrives.”</p> <p> <strong>Opportunities after retirement</strong></p> <p> Dr. Iserson’s first stint in Antarctica came in 2009 when he spent six months as the lead physician “during what we call ‘winfly,’ which means coming in at the end of the winter and leaving at the end of the summer,” he said. “I was asked to come back here this time for the winter.”</p> <p> Before coming to Antarctica, everyone has to go through a physical qualification process, Dr. Iserson said. “They all have to be okay to come down here, and that’s a big deal—especially for an old guy like me. The people who are here generally can tolerate the cold, and we all have adequate clothing.”</p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:left;" /></a>“We are each issued what we call ‘Big Red,’ which are giant red coats,” he said. “We say we look like big red penguins. I’ve had some interactions with emperor penguins, and I think that’s what they think we are.”</p> <p> “I’ve worked on all seven continents now, and also the Arctic,” Dr. Iserson said. “It’s an exciting life. People always ask me how they can do what I’m doing, and my answer is what we used to say in the military—check all the right boxes.”</p> <p> “Have the skills [and] the preparation, and do your homework,” he said. “Most organizations want clinical experience, but they prefer people who have experience overseas in developing countries, and there are ways to break into that area.”</p> <p> “There are a lot of volunteer opportunities around,” he said. “Some are paid jobs, but it depends on what specialty you’re in, what you’re willing to do or are interested in doing. You need to get tied into the right groups and know what you’re getting into.”</p> <p> “One of my books is <em>The Global Healthcare Volunteers Handbook</em>,” Dr. Iserson said. “It tells you how to pack, prepare, and find positions around the world, and lists and describes a vetted group of volunteer global health organizations.”</p> <p> “I do these things because they’re of interest or [because] I haven’t done them,” he said, “and because my wife lets me do them. She had to give her permission for me to come, and she thought about it a long time and then finally was gracious enough to let me do it.”</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:600f8ec0-bd44-4aea-b1c2-ab1e03277a9f 4 building blocks for a successful medical marriage Wed, 20 Apr 2016 20:40:00 GMT <p> Physicians and their spouses face obstacles—such as workloads, call hours, stress and household demands—in forming and maintaining healthy relationships. Researchers defined four themes that work for physician families who have found the formula for harmony at home.</p> <p> <strong>The 4 foundations</strong><a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Twenty-five physicians and spouses participated in interviews, discussing the strengths that formed the foundations of their marriages. In their <a href="" rel="nofollow" target="_blank">report</a>, three researchers from the University of Michigan said that these lessons could serve as examples, especially for medical trainees and junior physicians.</p> <p> Their research report appears in the January 2015 issue of <a href="" rel="nofollow" target="_blank"><em>Academic Medicine</em></a>.</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Mutual support. </strong>“He’s just really, really supportive,” a pediatrician told researchers, referring to her nonphysician husband. Researchers listed support first among their four foundations.<br /> <br /> Many participants emphasized the support they gave and received as a key to contentment. That support included encouraging partners to find time for recreation as well as work.<br /> <br /> “Any time he wants to go do something, he can do it,” a surgeon said of her nonphysician domestic partner. “If he ever said to me, ‘I want to go to Italy for a week by myself,’ I would say, ‘Yes.’”<br /> <br /> Support was just as important as career goals. “He is very supportive,” another physician said. “If he wasn’t willing to shoulder a large burden of the primary childcare, picking up, dropping off, taking care of them if I go out of town, I couldn’t do my job.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Roles for family members. </strong>Participants described how they divided up household jobs such as grocery shopping, paying bills, cooking and home repairs. Clearly dividing up roles and assigning responsibilities was a recurring theme among participants.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Shared values. </strong>Having common values and priorities, such as career commitment, child rearing and integrity, pave the way for strong relationships, researchers found.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Benefits of being a physician. </strong>Participants noted that their medical careers provide financial security and skills that can be useful not only at work but also at home.<br /> <br /> “As an emergency physician, at least I’m able to care for a lot of stuff that might otherwise require us to go (to the hospital),” one physician said. “My kid cut his hand, so I stitched it up.”<br /> <br /> Participants said they benefit from being better off financially than most and more immune to layoffs, which shields them from relationship stresses tied to finances.<br /> <br /> “I mean, there is large unemployment in Michigan right now,” a physician said. “(But) neither of us really feels threatened that we are going to lose our jobs.”</p> <p> <strong>A resource for med ed</strong></p> <p> Researchers expressed hope that, given the importance of intimate relationships to physician well-being, physicians would find their four foundations useful in their own lives. They also hoped their research would become part of the informal mentoring that senior physicians provide their younger colleagues, and eventually become part of medical education programs.</p> <p> <strong>More information on medical marriages:</strong></p> <ul> <li> Discover 6 tips for happiness in the <a href="" target="_blank">two-physician family</a>.</li> <li> Strengthen <a href="" target="_blank">your connection</a> to your partner as your relationship grows.</li> <li> Find out why a <a href="" target="_blank">fellow health care professional</a> may be your best match.</li> <li> Learn physician-recommend steps to a <a href="" target="_blank">healthy life</a> at work and at home.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:87e19f4b-ea60-4c15-abd6-3974a111c884 Physicians tell House panel the keys to MACRA implementation Tue, 19 Apr 2016 22:00:00 GMT <p> Physician leaders Tuesday testified before an influential congressional committee, calling attention to the promise of the landmark Medicare reform law and the necessary steps to ensure implementation is optimal for physicians and patients.</p> <p> <strong>A critical opportunity</strong></p> <p> One of the primary goals of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was to <a href="" target="_blank">repeal the sustainable growth rate</a> (SGR) formula that left physicians in a constant state of uncertainty and threatened patients’ access to care. But the law does a lot more than that.</p> <p> “The passage of MACRA now allows physicians an opportunity to focus on our patients,” Barbara McAneny, MD, immediate past-chair of the AMA Board of Trustees, told the panel during her opening remarks.</p> <p> The four physicians spoke at a <a href="" rel="nofollow" target="_blank">hearing</a> of the U.S. House Energy and Commerce Committee’s Subcommittee on Health explained that this law provides a path forward, with important improvements over the current Medicare system. These include:</p> <ul> <li> <strong>Eliminating the SGR formula. </strong>“This change alone allows more time and resources to be spent focusing on care rather than worrying about how to sustain practices,” Dr. McAneny said in her <a href="" target="_blank">written testimony</a> (log in). In place of the SGR formula, MACRA established payment updates of 0.5 percent through 2019.</li> </ul> <ul> <li> <strong>Streamlining reporting programs. </strong>The law enacts a new Merit-based Incentive Payment System (MIPS) that will combine the requirements of the electronic health record meaningful use program, the Physician Quality Reporting System and the Value-based Payment Modifier.<br /> <br /> “By creating a single reporting program known as MIPS, the law gives us opportunity to streamline measures, reduce reporting burden and create flexibility to encourage physicians in every specialty to participate and improve care,” Dr. McAneny said.<br /> <br /> MACRA also reduces the stakes for physicians who do not successfully participate in the programs. Under the current system, physicians could face a financial penalty as high as 11 percent in 2019. The new law limits that maximum penalty to 4 percent.<br /> <br /> And those who meet certain quality benchmarks will receive payment increases. “The law provides strong incentives for physicians to engage in activities to improve quality,” said Robert McLean, MD, of the American College of Physicians’ Board of Regents.</li> </ul> <ul> <li> <strong>Promoting physician innovation. </strong>Physicians who participate in alternative payment models (APM) will be exempt from the MIPS so they can focus on new ways to coordinate care. Physicians also will receive financial support to participate in APMs, equivalent to 5 percent of their prior year’s aggregate Medicare expenditures.<br /> <br /> “APMs can be tailored to specific patient populations to drive care improvement, leverage technology and promote new treatments,” Dr. McAneny said. “Importantly, the law acknowledges physician leadership is needed in developing APMs, which not only promotes participation but protects patients and can drive down costs.”</li> </ul> <p> <strong>Necessary steps for successful implementation</strong></p> <p> As part of the hearing, each of the physician leaders spoke to the importance of careful implementation of this law under regulations being developed by the Centers for Medicare & Medicaid Services (CMS).</p> <p> “As the regulations for MIPS and APMs are developed, it is vital that CMS continues to engage the stakeholder community, including provider groups, patient advocates, specialty societies, medical associations, payers and others,” said Jeffrey Bailet, MD, president of Aurora Health Care Medical Group and a member of the new federal advisory committee on physician payment models.</p> <p> Dr. McAneny pointed to three aspects of implementation that CMS will need to pay careful attention to as it works on regulations coming out of MACRA:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Consolidating performance reporting.</strong> Specifically, the new regulations will need to move away from a pass-fail program design to accommodate the needs of all practices, specialties and patient populations. CMS also will need to improve the timing of feedback reports for physicians. And the agency must minimize unnecessary data collection and the reporting burden.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Broadening APMs. </strong>“MACRA regulations must establish a clear pathway for rapid approval and implementation of physician-focused APMs that establish different approaches to delivering patient care,” Dr. McAneny said.<br /> <br /> “CMS must avoid adding unnecessary and burdensome requirements to APMs that cause resources to be spent on administrative costs rather than helping patients,” she said. Instead, the agency should provide data and assistance to identify models that are relevant for their practices.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Improving measurement. </strong>Dr. McAneny pointed to such needed improvements as suitable methods for attribution and resource use, elimination of the program flaws that make practices with high-risk patients more susceptible to penalties, and timely data reports.</p> <p> The physician testifying at the hearing agreed on the great potential of thoughtful MACRA implementation that is based on physician feedback.</p> <p> “We believe that the work needed to bring about the change in how physicians provide medical care that will make MACRA successful will mean better care for patients, better professional experience for physicians and their medical teams, and better control of health care costs,” said Robert Wergin, MD, board chair of the American Academy of Family Physicians.</p> <p> CMS’ proposed regulations are expected this spring.</p> <p align="right"> <span style="font-size:10px;"><em style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;">By AMA Wire editor </em><a href="" rel="nofollow" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;" target="_blank"><em>Amy Farouk</em></a></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:26b920fc-1869-4de0-a96a-dfe568ac1f5a Testing new payment models: One pilot program’s success Tue, 19 Apr 2016 13:00:00 GMT <p> As physicians await the final rule on the Medicare Access and CHIP Reauthorization Act (MACRA), specialty societies across the country are getting a head start in testing out possibilities for alternative payment models (APM) to shift the health care system toward value-based care and payment. One practice at the University of Colorado recently showed that a new model could reduce frequent emergency department (ED) visits by roughly 40 percent.</p> <p> <strong>How the pilot program reduced ED visits</strong></p> <p> In 2012, the Metro Community Provider Network (MCPN) in Colorado was selected as a site partner to test the replicability of a pilot program funded by the Center for Medicare and Medicaid Innovation (CMMI) to decrease overuse of emergency and inpatient services by patients who frequently visit the ED.</p> <p> Jennifer Wiler, MD, an emergency medicine physician and associate professor and vice-chair of the Department of Emergency Medicine at the University of Colorado, helped create and facilitate the program at MCPN, which they called Bridges to Care. The program is a multidisciplinary team of health coaches, community health workers, care coordinators, behavior health specialists and a primary care physician, she said.</p> <p> The goal was to “provide services to enrolled patients for two months to educate and empower them to become independent and make better choices about health care navigation and utilization,” Dr. Wiler said.</p> <p> From 2012 to 2015, the Bridges to Care program enrolled almost 600 patients through partnerships with community health organizations, such as federally qualified health centers (FQHC) and a community advocacy organization called Together Colorado. The program included patients who had three or more ED visits or two or more hospital admissions within six months.</p> <p> “This program and the services that were provided for home-based care created a financial incentive for emergency care providers and hospitals to partner with community programs,” Dr. Wiler said.</p> <p> Uniquely, the program included mental health patients. “Typically, high-utilizer programs exclude substance abuse and mental health primary or comorbid diagnoses, and we included those diagnoses,” she said.</p> <p> “We found that touching a patient when they’re in acute crisis increases the potential of a successful intervention,” Dr. Wiler said. “If we saw a [patient] in the ED and we tried to call them the next day to enroll them in the program, it was not as successful as having someone talk to them in the middle of the night when they were there for their visit.”</p> <p> Community case workers were on site, embedded in the ED to enroll eligible patients in the program. “We picked our high-volume times, which could go up until midnight,” she said. “The community case worker then had access to the EHR infrastructure in the clinic to make appointments and follow-ups with the clinic notes and also had access to our hospital system information."</p> <p> “Our program intervention was to make an initial assessment of the patient through home visits,” she said. “At least two home visits were provided to the patients after they were enrolled” to determine their specific needs and reasons for frequent visits to the ED.</p> <p> Some of these reasons included social determinants of health. “The No. 1 barrier to accessing care for our patients was a transportation issue,” she said. “The community organizers helped to navigate immigration issues if they existed, transportation, cultural acclimation and education issues.” The program helped patients decide how to leverage available and appropriate community resources.</p> <p> The results of the program show its success. “Overall, there was nearly a 50 percent reduction in ED utilization and a 42 percent reduction in utilization for patients with chronic pain,” she said.</p> <p> “We saw a 45 percent reduction in visits related to ambulatory sensitive conditions,” she said. Patients also self-reported an increase in their number of healthy days and a decrease in their number of unhealthy mental health days.</p> <p> “The total site cost [for the Bridges to Care program] was $1.2 million,” she said, “and our total program savings was $13.5 million.” That breaks down to about $23,000 of savings per participating patient.</p> <p> “We’re excited about our results,” Dr. Wiler said. “[But] it’s a challenge because grants don’t create sustainability.”</p> <p> <strong>Pivoting to an APM</strong></p> <p> The American College of Emergency Physicians (ACEP) has convened a task force that is looking at opportunities for emergency medicine to participate in potential APMs. “The program that I specifically participated in is being discussed as a potential APM or to inform APMs in development,” Dr. Wiler said.</p> <p> As vice-chair of an AMA workgroup on emerging payment issues, she recently presented the program and its results to leading experts in payment reform at the National Value-based Payment and Pay for Performance Summit in San Francisco.</p> <p> “Right now there’s not a financial incentive for us to work together,” she said. “There’s resources in our state, a per-member, per-month case management payment that’s being provided by Medicaid for care coordination, but currently it’s insufficient to support the services that we implemented and does not recognize the value contribution of the hospital or emergency physician.”</p> <p> It’s important that physicians get involved with their specialty societies now to create programs and develop physician-focused APMs that work for their patients as the health care system transitions to MACRA.</p> <p> “What’s challenging is there will be similarities but important differences in each practice and community across the country," Dr. Wiler said. "But there’s a real potential to decrease ED utilization and avoidable costs.”</p> <p> Dr. Wiler said payment models need to be easy to implement and meaningful, and they should create alignment among stakeholders. “But they have to allow for customization based on the needs of the community,” she said.</p> <p> To help physicians and specialty societies in the effort to create these payment models, the AMA worked with Harold Miller to develop the “<a href="" target="_blank">Guide to physician-focused APMs</a>.”</p> <p> <strong>For more information about APMs:</strong></p> <ul> <li> Check out the <a href="" target="_blank">three traits of successful payment models</a> and the <a href="" target="_blank">most common barriers</a> in the current payment system.</li> <li> Find out <a href="" target="_blank">who is using new delivery and payment models</a>. </li> <li> Learn about <a href="" target="_blank">seven payment models that address physician needs</a>.</li> <li> Read more about the importance of <a href="" target="_blank">working with your specialty society to develop APMs</a>.</li> <li> Learn <a href="" target="_blank">what you need to know about MACRA right now</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e1dda469-9349-4e67-9ef2-9c11082bd94f What it’s like to be in neurology: Shadowing Dr. Govindarajan Mon, 18 Apr 2016 22:02:00 GMT <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>As a medical student, do you ever wonder what it’s like to be a neurologist? Here’s your chance to find out.</p> <p> Meet Raghav Govindarajan, MD, a neurologist and featured physician in <em>AMA Wire’s</em>® <a href="" target="_blank">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties.</p> <p> Read his insights to help determine whether a career in neurology might be a good fit for you.</p> <p> <strong>"Shadowing" Dr. Govindarajan</strong></p> <p> <strong>Specialty:</strong> Neurology</p> <p> <strong>Practice setting:</strong> University hospital</p> <p> <strong>Years in practice:</strong> 2</p> <p> <strong>A typical week in my practice:</strong></p> <p> I am a neurologist with specialization in neuromuscular disease. I take care of patients with muscular dystrophies, myasthenia gravis, amyotrophic lateral sclerosis and neuropathies. I also take care of patients with headaches, multiple sclerosis, Parkinson’s disease and many more medical issues. In addition, I do procedures, including BOTOX<sup>®</sup> for a variety of conditions, electromyography, skin and muscle biopsies. A typical day is spent in the clinic and is a mix between taking care of patients and doing procedures. I also teach medical students and residents in the clinic as well give didactic lectures and spend half a day doing research on amyotrophic lateral sclerosis.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in neurology:</strong></p> <p> Neurological care requires time and patience. The challenging part is to find the balance between providing care and keeping up with the expectations of the management in maintaining productivity. The most rewarding part is to see the smiles on the faces of the patients and families when they come to see me.</p> <p> <strong>Three adjectives that describe the typical physician in neurology:</strong></p> <p> Thoughtful. Empathetic. Sincere and responsive.</p> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> Neurology offers more than <a href="" rel="nofollow" target="_blank">11 different fellowships</a>, and the lifestyle depends upon the fellowship and kind of practice one chooses. I was always interested in an outpatient academic career, and my current practice closely reflects that. The only thing I wish is that I had more time to teach. Private practice offers greater flexibility of work hours than being employed by a hospital or hospital system, but each has its advantages and disadvantages. There are some careers in neurology, such as <a href="" rel="nofollow" target="_blank">neurocritical care</a> and <a href="" rel="nofollow" target="_blank">vascular neurology</a>, which are predominantly hospital- and inpatient-based. Further, the <a href="" rel="nofollow" target="_blank">neurohospitalist subspecialty</a> is an up-and-coming career choice for many neurologists and provides the option of one week on and one week off, ideal for raising a family. Finally, many neurologists are choosing administrative careers and other <a href="" rel="nofollow" target="_blank">non-medical careers</a>.</p> <p> The American Academy of Neurology also offers <a href="" rel="nofollow" target="_blank">more details</a> on many of these career options.</p> <p> <strong>One skill every physician in training should have for neurology but won’t be tested for on the board exam:</strong></p> <p> Many neurological conditions are chronic and can affect patients of all ages. One quality we are looking is the ability to provide sincere, empathetic, compassionate care to patients and their families. This is easier said than done. I shudder at the thought of giving a diagnosis of amyotrophic lateral sclerosis (Lou Gehrig’s disease), and these conversations take a lot out of you as a physician. This is not tested in board exams but is a very important quality for a neurologist.</p> <p> <strong>One question physicians in training should ask before pursuing neurology:</strong></p> <p> Neurology is all about history and exam. We have a lot of fancy investigations, but history and exam still forms the core of neurological care. So the question is, are you willing to get your hands dirty and spend the time needed in doing a careful, methodical history and exam?</p> <p> <strong>Three books every medical student interested in neurology should read:</strong></p> <ul> <li> <em>The Man Who Mistook His Wife for a Hat</em> by Oliver Sacks, MD</li> <li> <em>Reaching Down the Rabbit Hole: A Renowned Neurologist Explains the Mystery and Drama of Brain Disease</em> by Allan Ropper, MD, and Brian Burrell</li> <li> <em>Phantoms in the Brain: Probing the Mysteries of the Human Mind</em> by V.S. Ramachandran, MD, PhD, and Sandra Blakeslee</li> </ul> <p> <strong>Online resources students interested in neurology should follow:</strong></p> <p> The <a href="" rel="nofollow" target="_blank">American Academy of Neurology</a> has some great resources about neurology residency, neurology as a career option, awards and scholarships for students, and much more.</p> <p> <strong>Additional advice for students who are considering neurology</strong>:</p> <p> Neurology is a rapidly growing field with lots of new treatment options (did you know that we have more than 10 different treatment options for multiple sclerosis?) and research opportunities. In addition, it offers both <a href="" rel="nofollow" target="_blank">cognitive as well as procedural options</a> with a great lifestyle. Check it out!</p> <p> <strong>If you had a mantra or song to describe your life in this specialty, it’d be:</strong></p> <p> I live my life and career based on 4Ps: Passionate, pragmatic, persistence, partnering with colleagues and patients.</p> <p> <strong>Want to learn more about your specialty options</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="" target="_blank">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="" target="_blank">otolaryngology</a>, <a href="" target="_blank">vascular surgery</a>, <a href="" target="_blank">infectious disease</a>, <a href="" target="_blank">adolescent medicine</a> and <a href="" target="_blank">physical medicine and rehabilitation</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="" target="_blank">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:abace417-8800-4305-87db-9d3928ae0bce What it’s like to be in nephrology: Shadowing Dr. Desai Mon, 18 Apr 2016 21:58:00 GMT <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>As a medical student, do you ever wonder what it’s like to be a nephrologist? Here’s your chance to find out.</p> <p> Meet Tejas Desai, MD, a nephrology specialist and featured physician in <em>AMA Wire’s</em>® <a href="" target="_blank">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties.</p> <p> Read his insights to help determine whether a career in nephrology might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. Desai</strong></p> <p> <strong>Specialty:</strong> Nephrology</p> <p> <strong>Practice setting:</strong> Academic</p> <p> <strong>Years in practice:</strong> 6</p> <p> <strong>A typical day in my practice</strong>:</p> <p> I start my day by seeing clinic patients in the morning. I see anywhere between eight and12 patients before noon. From noon to 1 p.m., we have an academic conference. This conference varies based on the day of the week, but we have journal club, case conference and research conference weekly. In the afternoon I see hospitalized patients with a fellow, resident and medical student. In a week I work approximately 50-60 hours, divided between the office and the hospital.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in nephrology</strong>:</p> <p> Research and development in kidney diseases is growing. This makes nephrology extremely exciting because I believe that the way I practice nephrology today will be dramatically different in the next 10-15 years. However, this also means that I am caring for patients today that need the drugs and therapies of tomorrow. These therapies are on the horizon, but they don’t exist yet for me to use in caring for my patients. This makes research and development of new therapies in kidney diseases both a rewarding and exciting part of my field and a challenge simultaneously.</p> <p> <strong>Three adjectives that describe the typical nephrology physician:</strong></p> <p> Logical. Excited. Professionally satisfied.</p> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> The lifestyle is actually better than what I envisioned in medical school. I never thought I’d be able to balance family obligations with clinical care and research. However, I’ve been very fortunate to have both personal and professional gratification. </p> <p> <strong>One skill every physician in training should have for nephrology but won’t be tested for on the board exam:</strong></p> <p> The main skill is to think logically. Nephrology is very attractive to individuals who prefer logical thinking and deductive reasoning to rote memorization. Board exams are geared more toward testing memorization than logic and deduction. </p> <p> <strong>Three books every medical student interested in nephrology should read:   </strong></p> <ul> <li> <em>National Kidney Foundation’s Primer on Kidney Disease</em> by Scott J. Gilbert, MD; Daniel E. Weiner, MD; Debbie S. Gipson, MD; Mark A. Perazella, MD; and Marcello Tonelli, MD</li> <li> <em>The ICU Book</em> by Paul L. Marino, MD, PhD</li> <li> <em>The Handbook of Dialysis</em> by John T. Daugirdas, MD; Peter G. Blake, MD; and Todd S. Ing, MBBS</li> </ul> <p> <strong>Online resources students interested in my specialty should follow:</strong></p> <ul> <li> <a href="" rel="nofollow" target="_blank">AJKD Blog</a></li> <li> <a href="" rel="nofollow" target="_blank">The International Society of Nephrology</a></li> <li> <a href="" rel="nofollow" target="_blank">National Kidney Foundation</a></li> <li> <a href="" rel="nofollow" target="_blank">Nephrology On-Demand</a></li> <li> <a href="" rel="nofollow" target="_blank">UKidney</a></li> </ul> <p> <strong>A quick insight I’d give students who are considering nephrology:</strong></p> <p> Try to find a mentor in the field as early as you can. It’s really important to have guidance as you approach graduation from medical school and enter residency. A great mentor is invaluable.</p> <p> <strong>If I had a mantra or song to describe my life in this specialty, it’d be:</strong></p> <p> “If you fail, never give up because F.A.I.L. means First Attempt In Learning” by APJ Abdul Kalam</p> <p> <strong>Want to learn more about your specialty options?</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="" target="_blank">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="" target="_blank">otolaryngology</a>, <a href="" target="_blank">vascular surgery</a>, <a href="" target="_blank">infectious disease</a>, <a href="" target="_blank">adolescent medicine</a> and <a href="" target="_blank">physical medicine and rehabilitation</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="" target="_blank">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:126b0e9b-dbbb-4879-9320-7715b96d75f1 Containing Zika: The urgent need for funds, pregnancy guidance Mon, 18 Apr 2016 21:28:00 GMT <p> The Centers for Disease Control and Prevention’s (CDC) <a href="" rel="nofollow" target="_blank">confirmation</a> that the Zika virus causes microcephaly and other congenital brain abnormalities underlines how vital it is for physicians to understand the latest guidelines for conception and pregnancy care. Meanwhile, vector control will play a key role in combating Zika. Learn what experts have to say and why federal funding is so important.</p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>The CDC counts 39 countries and U.S. territories that are reporting <a href="" rel="nofollow" target="_blank">active Zika transmission</a>. The agency reports that as of April 13, 833 people in the United States and its territories have been infected with Zika, including 68 pregnant women. The virus is expected to spread as its leading vector, the mosquito <em>Aedes aegypti</em>, expands <a href="" rel="nofollow" target="_blank">its range</a> during the warm weather months.</p> <p> <strong>Containing Zika’s spread</strong></p> <p> A crucial component of battling Zika is curbing the spread of the mosquitos that carry the virus. The leading vector for the virus is <em>Aedes aegypti,</em> a mosquito that can be recognized by the white markings on its legs. It most often bites at dusk and dawn, and prefers to breed in stagnant water, such as buckets and discarded tires.</p> <p> At an April 1 <a href="" rel="nofollow" target="_blank">summit on Zika</a> in Atlanta, Lyle Petersen, MD, director of the CDC’s Division of Vector-Borne Diseases and Incident Manager for Zika Response, called for coordination among the various state and local agencies and private contractors responsible for mosquito abatement in communities across the nation.</p> <p> In preparation for mosquito season, Dr. Petersen said, communities should develop communications strategies among agencies and engage communities in control plans, which should include removing standing water and using larvicide in water sources that cannot be removed.</p> <p> Genetics might one day provide another tool to fight the spread of Zika. The U.S. Food and Drug Administration (FDA), the CDC and other agencies are considering a plan to fight Zika with genetically engineered mosquitos. The FDA is accepting public comments on the draft <a href="" rel="nofollow" target="_blank">environmental assessment</a> of the plan until May 13.</p> <p> <strong>The urgent need for funds to fuel the Zika fight</strong></p> <p> Meanwhile, the AMA and other organizations are urging Congress to reinforce the fight against Zika by providing more resources. In an April 5 letter to Congress, the AMA and dozens of other organizations committed to public health urged lawmakers “in the strongest terms to immediately provide emergency supplemental funding,” especially considering the approach of summer and mosquito season.</p> <p> President Obama has underlined the urgency of the eradication effort by asking Congress for close to $1.9 billion for the campaign against Zika.</p> <p> Additionally, Congress approved a bill April 12 that calls on the FDA to make Zika a priority, which President Obama signed April 19. The law will add Zika to the list of diseases that qualify for an incentive program designed to spur the development of new drugs and other products. </p> <p> <strong>Guidelines for Zika care</strong></p> <p> In its <a href="" rel="nofollow" target="_blank">updated guidelines</a>, the CDC gives recommendations for physicians caring for women who may have been exposed to the virus and are interested in conceiving:</p> <ul> <li> <strong>Postponing conception after exposure.</strong> Women and men who do not have the Zika virus but live in or have traveled to active-transmission areas should wait eight weeks after exposure to attempt conception. That period is bases on the estimated upper limit of the incubation period for Zika virus disease, 14 days, and the approximate tripling of the longest published period of viremia after symptom onset, which is 11 days.<br />  </li> <li> <strong>Postponing conception after illness.</strong> Women with Zika symptoms should wait eight weeks after the onset of symptoms to attempt conception. Men with symptoms should wait six months after onset. This interval is based on limited information on the persistence of Zika virus in semen.<br />  </li> <li> <strong>Counseling in active transmission areas.</strong> Physicians caring for patients in active-transmission areas should discuss patients’ reproductive plans and counsel them on the best ways to prevent unintended pregnancy.<br />  </li> <li> <strong>Counseling outside active areas.</strong> Physicians should offer preconception counseling to women living outside active areas, including offering information on Zika symptoms.<br />  </li> <li> <strong>Testing for Zika infection.</strong> Testing for Zika should be performed on patients with possible exposure to the virus who have one or more of the <a href="" rel="nofollow" target="_blank">most common symptoms</a>.</li> </ul> <p> The CDC does not recommend routine testing for women or men who are attempting conception and have possible exposure to the Zika virus but have no clinical illness. The performance of routine testing in asymptomatic persons is unknown, and results might be difficult to interpret.</p> <p> The updated guidelines also include recommendations for couples undergoing fertility treatments, including timing guidelines for those attempting conception.</p> <p> <strong>Want more information on the Zika virus?</strong></p> <ul> <li> Learn more about <a href="" target="_blank">how you can respond</a> to the Zika outbreak.</li> <li> Find a wealth of information in the <a href="" target="_blank">AMA Zika Resource Center</a>.</li> <li> See what <a href="" rel="nofollow" target="_blank">advice</a> the CDC has for pregnant women.</li> <li> Check out the CDC map of <a href="" rel="nofollow" target="_blank">active-transmission areas</a>.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8547dd4d-6d29-44b7-9740-23c15560c77f From volume to value: How one health system is making the change Fri, 15 Apr 2016 22:03:00 GMT <p> Across the nation, care models are shifting from volume to value-based care—and this means getting to the heart of every process within a medical practice. Learn how one of the largest federally qualified health centers in the nation is transitioning to a patient-centered, physician-friendly, interoperable health system.</p> <p> <strong>Providing a continuum of care to underserved populations</strong></p> <p> ACCESS Health System operates 36 health centers across Chicago and Cook and DuPage counties. Their mission: “To provide outstanding preventive and primary health care, accessible to all in their own communities,” said Jairo Mejia, MD, chief medical officer at ACCESS.</p> <p> “We serve the medically underserved and the most vulnerable communities,” Dr. Mejia said. “We screen patients for social determinants like food insecurity, housing and behavioral issues.” ACCESS uses a team-based care model rooted in evidence-based practices to coordinate this care across their three dozen health centers.</p> <p> With the Affordable Care Act in place, large numbers of newly insured patients are seeking care. Many patients mention that they haven’t seen a physician since their last pediatric visit, Dr. Mejia said. “[That appointment] was when they were a teen, and now they are 65—and that’s an everyday reality.”</p> <p> To prevent patients from falling into such gaps, ACCESS tries to engage their patients in a continuum of care. “Our interactions with the patients are not limited to the visits,” Dr. Mejia said. “We have a constant, permanent interaction with them through our [patient portal].”</p> <p> Patients now have the ability to schedule appointments, view their records and communicate with physicians. These patients can seek care at any of the 36 health centers with their records fully available to each physician they see. ACCESS now has close to 50,000 patients using the patient portal to communicate with their physicians.</p> <p> “We are [emphasizing] sharing the decisions of care with the patients,” Dr. Mejia said. It’s not the relationship of the past where the physician gives a prescription and says you have to do this and that’s all, he said. “It’s really involving the patients in making their own decisions.”</p> <p> “This is the new model in medicine. Patients come to your office knowing everything because they visited Dr. Google, and Dr. Google gave them a lot of information,” and ACCESS is working hard to make sure patients are more involved, he said.</p> <p> <strong>Changing the organization for value, not volume</strong></p> <p> “There’s been a lot of talk about the paradigm change from volume to value,” Dr. Mejia said. “In the past, it was ‘see as many patients as you can—you have to see one patient every 15 minutes and rush.’ And now it’s ‘Dr. Mejia, we need you to [provide] quality and value.’ … We need to really care for the patient in a holistic way.”</p> <p> “This transition is a struggle,” he said, “and we are working in little baby steps to transition to this model of care.”</p> <p> ACCESS became a patient-centered medical home three years ago. “We started with a self-assessment of our organization to see where we were at,” Dr. Mejia said.</p> <p> They provided comprehensive training for staff and physicians and carefully reviewed every process in the organization. “The [physicians and staff] embraced the process,” he said. ACCESS’ 36 health centers are now level three patient-centered medical homes.</p> <p> “We huddle every day in our clinics,” he said. “We plan and we see the schedules and we see who’s coming to the visit—we plan ahead of the visit.”</p> <p> Learn how to <a href="" rel="nofollow" target="_blank">implement daily huddles</a> in your practice with a module from the AMA’s STEPS Forward™ collection of practice improvement strategies.</p> <p> <strong>What ACCESS is doing for their physicians</strong></p> <p> Like physicians in many practices and systems across the nation, physicians at ACCESS were feeling the heat of burnout. So ACCESS took steps to change this.</p> <p> <strong>Listening:</strong> First, Dr. Mejia said, “listen and get them involved.” Dr. Mejia often holds meetings with physicians to talk about the issues they are facing. “At the end of one meeting,” he said, “I had this wonderful experience where a doctor said, ‘We probably didn’t solve anything today, but you know, we need to vent sometimes, and we need someone to listen to us.’”</p> <p> <strong>Quality:</strong> The quality structure at ACCESS involves many departments. “We used to have a quality department, but we don’t have it anymore [because] it’s ineffective,” Dr. Mejia said. “In order for quality to work, you need to involve everyone in the organization—every single person.” Now, just as patients can view their EHR, ACCESS has a dashboard through which physicians can see their quality metrics in real time.</p> <p> “It is a multidisciplinary approach,” he said. Groups from each department in the health system report every month to a quality advisory committee.</p> <p> <strong>Time:</strong> “Optimizing the processes is important to us,” Dr. Mejia said. “Doctors’ time is gold. We don’t want to waste the time of the doctor.” Their ultimate goal, he said, is that the physicians’ responsibilities are to show up to the exam room, see the patient and complete the charting.</p> <p> For this reason, they are enhancing the medical assistants’ roles to make sure physicians’ time is used in the most valuable way—patient care.</p> <p> <strong>Flexibility:</strong> Leadership at ACCESS also makes sure to be flexible with scheduling. “Many doctors want to work three 12-hour shifts, and that’s fine,” he said. “Or they want to work four 10-hour shifts, and that’s fine too. We need to facilitate things to make the lives of our [physicians] a little bit easier.”</p> <p> <strong>Teamwork:</strong> “When we talk about teamwork,” Dr. Mejia said, “this is our teamwork structure: An MD or DO working in two health centers and collaborating with advanced nurse practitioners. All of them have a panel of patients, and all of them work in the same EHR environment.”</p> <p> <a href="" target="_blank">Read more</a> about ACCESS and their work to improve health outcomes in the communities of patients they serve.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8cdf375d-4e3e-4053-8f60-f11eee1990bc How doctors are developing new payment models for their specialties Fri, 15 Apr 2016 21:52:00 GMT <p> New regulations under the Medicare Access and CHIP Reauthorization Act (MACRA) are on their way, and physicians will have a choice to participate in the new Merit-based Incentive Payment System or alternative payment models (APM). It’s important that physicians are involved and leading the way now in the design of APMs to ensure they work for both their patients and their practices. Learn how one physician got involved with his specialty society to develop new payment models.</p> <p> <strong>Building future payment models</strong></p> <p> As a radiation oncologist in Seattle, Shilpen Patel, MD, saw opportunity in the APM option and began working with his specialty society, the American Society for Radiation Oncology (ASTRO), early. “It’s interesting to figure out how to navigate this because we’re all learning together,” he said.</p> <p> Dr. Patel sits as vice-chair of the payment reform workgroup at ASTRO, which is comprised of 19 members who practice at freestanding community-based and academic medical centers. ASTRO is also represented in the AMA’s MACRA APM Workgroup. Dr. Patel presented his organization’s work to the AMA <a href="" target="_blank">Council on Medical Service</a> last November.</p> <p> “One of the things I like about our group is that it’s a bunch of working physicians who see patients every day, and we’re all kind of in the trenches,” Dr. Patel said. “We have a pretty wide variation in terms of different practices represented to make sure that this is going to work for everybody at the end of the day.”</p> <p> “We have the ability to set the agenda,” Dr. Patel said. “A lot of times people say, ‘Well, we’re just going to wait for something to happen and then react to it.’ Engaging the staff of your specialty societies is key because physicians can’t do these things by themselves.”</p> <p> What’s important is that “physicians are leading the way,” he said. “We are approaching the insurance companies, saying let’s come up with a solution.”</p> <p> <strong>Two alternative payment models</strong></p> <p> Dr. Patel and his colleagues have been working to develop APMs that will be applicable to a wide range of physicians.</p> <p> “Flexibility is important as we get these models through implementation,” he said. “We want this to be applicable to lots of different practices, whether you’re in academics or if you’re in a solo practice and everything in between.”</p> <p> Here are two payment models from the payment reform workgroup at ASTRO:</p> <p> <strong>1.     </strong><strong>Palliative treatment for bone metastases</strong></p> <p> Bone metastases were a good place to start because it covers all cancers that spread to the bones, Dr. Patel said. “With that alternative payment model, the main thing was to demonstrate that radiation therapy was this alternative to debilitating narcotics.” Avoidance of those narcotics can help improve a patient’s quality of life, he said.<br /> <br /> Shared decision-making was an important piece of this model, Dr. Patel said. “Physicians and patients should be able to decide the most appropriate treatment, between the two of them.”<br /> <br /> “It was a focused model in terms of really defining and establishing an episode of care for which there were some evidence-based practices and determining what’s appropriate from the radiation side of things,” Dr. Patel said. “The goals are quality and appropriate utilization—which encompasses not only overutilization but also underutilization—to make sure patients get the most appropriate therapy.”<br /> <br /> “We know that a large fraction of the dollars spent on patients is in the last six months of their life,” Dr. Patel said. “This model applies to lots of different cancers, so it is far reaching and somewhere where we could make a big difference.</p> <p> <strong>2.     </strong><strong>Breast cancer treatment</strong><br /> Dr. Patel and his colleagues then set out to address specific cancers and establish appropriate models for each. “We chose breast [cancer] because it is the most common in women, and there are discreet episodes of care,” he said. Each episode “can help improve quality and make sure patients are still getting choices in their treatment while also getting the most appropriate and up-to-date treatment.”<br /> <br /> “We established a base rate using a weighted average of fee-for-service payments of four different modalities that were suitable for early stage breast cancers,” he said. “By doing this, we have a level set for a cost of care across various modalities.”<br /> <br /> “Ultimately our goal is to incentivize the use of the most appropriate treatment for patients and preserve some flexibility as well in terms of treatment options,” Dr. Patel said.</p> <p> <strong>Physicians leading the way</strong></p> <p> If you want to get involved with your specialty society, Dr. Patel has some advice. “When physicians are trying to take some leadership roles in this, they need to know that it’s a work in progress and we’re in it for the long haul,” he said.</p> <p> “Do a little bit of research in terms of variation in care, cost, value and quality,” Dr. Patel said. “All of those things are relatively easy to prove when we look at the way people practice. Then provide that data to your society.”</p> <p> “It’s easy to look at large population [data] using your databases or Medicare’s databases to prove that not everybody is getting the same level of care,” he said. “And the specialty societies need to lead on that.”</p> <p> The AMA worked closely with Harold Miller, president of the Center for Healthcare Quality and Payment Reform, to develop the “<a href="" target="_blank">Guide to Physician-focused Alternative Payment Models</a>.” The guide describes seven different types of physician-focused APMs that address opportunities to improve care and help physicians overcome payment barriers. Although different specialties are working on models for the patients and conditions that they manage, they are also working together with the AMA to advocate for more physician-focused APMs.</p> <p> “If we’re not all going to propose APMs, we all need to at least have an understanding,” he said, “before we get caught with insurance companies saying this is the way it’s going to be.”</p> <p> <strong>More on alternative payment models</strong></p> <ul> <li> Learn why <a href="" target="_blank">specialty development is key to new payment models’ success</a>.</li> <li> Get the details on <a href="" target="_blank">payment models that can help you better address patients’ needs</a>.</li> <li> Find out <a href="" target="_blank">what you need to know about the transition from meaningful use to MACRA</a>.</li> <li> Understand <a href="" target="_blank">why MACRA matters for your practice</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bf24c066-0f48-4335-9ac7-d65c9e8082c8 AMA members appointed to med ed leadership roles Fri, 15 Apr 2016 15:00:00 GMT <div> Seven AMA members were recently appointed by medical education organizations to their leadership. These physicians were nominated by the AMA, and each organization made the final appointment decision from among the candidates it received.</div> <ul> <li> <strong>Aditee P. Ambardekar, MD, </strong>of Plano, Texas, has been appointed to the <strong>Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Anesthesiology</strong>, effective July 2016. Dr. Ambardekar has been an AMA member for two years.</li> </ul> <ul> <li> <strong>Toni Ganzel, MD,</strong> of Louisville, Ky., has been appointed to the <strong>Liaison Committee on Medical Education (LCME)</strong>, effective July 2016. Dr. Ganzel has been an AMA member for 33 years.</li> </ul> <ul> <li> <strong>David C. Han, MD,</strong> of Hershey, Pa., has been appointed to the <strong>ACGME Review Committee for General Surgery</strong>, effective July 2016. Dr. Han has been an AMA member for nine years.</li> </ul> <ul> <li> <strong>Bruce E. Herman, MD, </strong>of Park City, Utah, has been appointed to the <strong>ACGME Review Committee for Pediatrics</strong>, effective July 2016. Dr. Herman has been an AMA member for two years.</li> </ul> <ul> <li> <strong>Jeffrey I. Hunt, MD, </strong>of Cumberland, R.I., has been appointed to the <strong>ACGME Review Committee for Psychiatry</strong>, effective July 2016. Dr. Hunt has been an AMA member for 20 years.</li> </ul> <ul> <li> <strong>Suzanne J. Sampang, MD,</strong> of Cincinnati has been appointed to the <strong>ACGME Review Committee for Psychiatry</strong>, effective July 2016. Dr. Sampang has been an AMA member for 16 years.</li> </ul> <ul> <li> <strong>George A. Sarosi, Jr., MD,</strong> of Gainesville, Fla., has been appointed to the <strong>American Board of Surgery</strong>, effective July 2016. Dr. Sarosi has been an AMA member for four years.</li> </ul> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:98f609cf-b048-4c1b-ba47-8c87261d412f Your idea could shape medicine’s future: Participate today Thu, 14 Apr 2016 14:45:00 GMT <p> Do you have an idea that could help shape 21<sup>st</sup>-century medicine? The AMA is offering the opportunity for three winning teams to receive a total of $50,000 and access to a support network to accelerate their solutions. <object align="right" data="" height="350" hspace="5" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="5" quality="best" src="" type="application/x-shockwave-flash" vspace="5" width="450" wmode="transparent"></embed></object></p> <p> The AMA <a href="" rel="nofollow" target="_blank">Healthier Nation Innovation Challenge</a> gives medical students, residents and physicians the chance to have their most original ideas heard by the medical community. All entries must answer one of the following questions:</p> <ul> <li> Making technology work for learning: What innovation would help transform physician education?</li> <li> Advancing digital health: What innovation would help patients live longer, healthier lives?</li> <li> Evolving digital medicine: What innovation would help physicians improve their practice?</li> </ul> <p> Idea submissions must come from teams that include at least one physician, resident or student. Ideas can come from anywhere in the United States, but the finalists must attend and pitch their ideas on stage at a live pitch event in Chicago, which will be held June 11 during the 2016 AMA Annual Meeting.</p> <p> The deadline for all submissions is 11:59 p.m. Eastern time May 16.</p> <p> “New ideas for better care emerge every day,” AMA President Steven J. Stack, MD, said in a <a href="" target="_blank">press release</a>. “The AMA wants to support these health care innovators and help them succeed in moving their new ideas from the concept phase into day-to-day practice.”</p> <p> <strong>Other ways to get involved in the challenge</strong></p> <p> Whether or not you submit an idea, be sure to provide feedback for the solutions and ideas you like best. Votes received by 11:59 p.m. Eastern time May 20 will help to determine the finalists.</p> <p> In addition, members of the health care community can follow-up directly with the applicants if you have interest to mentor or advise, partner or pilot a solution in your health care setting.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:70a39fa2-a87d-4fad-9745-24ee1de1dcae Push is on for transparency of clinical trials Wed, 13 Apr 2016 20:14:00 GMT <p> For physicians to make the best decisions on how to treat patients, they need information from <em>all</em> the clinical trials on drug treatments and preventive services. All too often, though, only select results are reported, and physicians don’t get the full picture. The <a href="" target="_blank" rel="nofollow">AllTrials</a> campaign, which the AMA joined in March, is aiming to change that.</p> <p> <strong>Knowledge is power</strong></p> <p> Although all clinical trial results should be reported to <a href="" target="_blank" rel="nofollow"></a>, a U.S. National Institutes of Health website that serves as a registry and results database for public and private clinical studies involving human participants, that doesn’t always happen. And to date, fines haven’t been levied against researchers who don’t comply.</p> <p> AllTrials USA, a project of <a href="" target="_blank" rel="nofollow">Sense About Science USA</a>, in July set out to unite patient groups, professional societies, researchers, academic centers, publishers, investor groups and pharmaceutical companies to change the culture and create an atmosphere where reporting always happens. The movement started in the United Kingdom in 2013 and is calling for all past and present clinical trials to be registered and their results reported.</p> <p> So far, nearly 650 patient advocacy groups, professional societies and medical organizations have supported the campaign. It’s an important movement for physicians in the exam room because they need to be able to pick the right drug for a patient and give it at the right time, Director of AllTrials USA Lauren Quattrochi, PhD, said.</p> <p> “How are they expected to make the best decisions for patients without all the information?” she asked. “Physicians are ultimately the consumers of the pharmaceutical companies. They are the ones who decide if and when to use the product. Physicians have an incredible amount of skin in the game.”</p> <p> Researchers also have a stake, said Quattrochi, previously a researcher at Pfizer.</p> <p> If clinical trials aren’t reported, researchers do not know if they are unnecessarily duplicating efforts, Quattrochi said. They also could miss a new application for a drug. Or a study could deem a medication as not effective when it had only been tested for efficacy at the highest and lowest doses. No one may have ever tested for efficacy at the middle dose.</p> <p> “That’s why transparency is so important,” Quattrochi said. “We don’t want to leave anything on the cutting room floor.”</p> <p> Helping physicians and patients is what prompted the AMA to join the AllTrials effort.</p> <p> “The AMA strongly supports improving the timeliness and accessibility of clinical trial data to reduce the duplication of research and help inform future research—ultimately improving health outcomes for patients,” AMA President Steven J. Stack, MD, said.</p> <p> <strong>What needs to be shared</strong></p> <p> AllTrials wants three kinds of information to be made available: knowledge that a trial has been conducted, from the clinical trials register; a brief summary of the trial’s results; and full details about the trial’s methods and results.</p> <p> “With the AMA’s support and support from others, we foresee huge strides,” Quattrochi said. More reporting will lead to better care for patients, more information for physicians trying to provide the best care for patients and more information for researchers to build upon, she said.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:616fa872-91d8-424b-89fc-a00060920328 Preventing resident burnout: Mayo Clinic takes unique approach Wed, 13 Apr 2016 20:12:00 GMT <p> A cardiology fellow at the Mayo School of Graduate Medical Education at Mayo Clinic in Jacksonville, Fla., launched a program-wide wellness initiative that helps physicians in training reduce stress and prevent burnout through activities not usually associated with medicine.<a href="" rel="nofollow" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>It started with one fellow’s idea</strong></p> <p> When cardiology fellow Olufunso Odunukan, MBBS, took a year off between residency and fellowship, he signed up for ballroom dancing classes once a week while working as a hospitalist. He found it was a great way to reduce stress.</p> <p> When he jumped back into the learning environment for his fellowship at the Mayo School of Graduate Medical Education at Mayo Clinic in Jacksonville, Fla., Dr. Odunukan looked at the medical literature to find ways to combat burnout during training. While he found plenty of research on the extent of burnout, there was frustratingly little written about how to intervene and prevent burnout.</p> <p> “Then an epiphany came when I volunteered with a heart failure support group,” Dr. Odunukan said. “It wasn’t all lectures. … They had an instructor who taught people how to paint or make origami boxes. I had no background in either, but in 10 minutes I made the most beautiful box, and I had a sense of accomplishment.”</p> <p> It left Dr. Odunukan wondering if this approach would help physicians in training lower their stress as well. So he tested his theory.</p> <p> <strong>Can arts and meditation reduce stress?</strong></p> <p> Dr. Odunukan created a pilot project that revealed that internal medicine residents who participated in one hour of art class were less fatigued and had improved work-related motivation when compared to their colleagues who participated in the usual noon conference.</p> <p> He then followed up with a three-month study that included arts and humanities activities every two weeks, which replicated his initial finding. Afterward, he ran a randomized, crossover study that compared the impact of art and meditation on reducing stress and fatigue.</p> <p> The results showed that group participation in arts led to improved bonding with colleagues, while meditation was more effective for lowering stress and fatigue.</p> <p> “They were complimentary to each other,” Dr. Odunukan said.</p> <p> Today, the internal medicine program at Mayo Clinic’s campus in Florida designates one noon conference every month as “Humanities Thursday.” The Fellows’ and Residents’ Health and Wellness Initiative (<a href="" rel="nofollow" target="_blank">FERHAWI</a>) humanities program includes discussions of artwork, guided visual imagery and art projects, such as watercolor painting, screen printing and origami.</p> <p> The initiative has received rave reviews, leading Mayo Clinic to earmark funds for resident wellness programs on all three of their campuses, Dr. Odunukan said. The Mayo Fellows Association also began a quarterly Wellness Fair at the Florida campus, where residents and fellows have a three-hour period to come and go and participate in arts, chair massages, yoga and pilates, among other things. And physicians in training can visit vendors to gather information, such as healthy eating tips.</p> <p> “It is a strong message that we don’t just care for patients but we have to care for ourselves,” Dr. Odunukan said. “It is just very reassuring to see an institution placing value on the wellness and well-being of residents.”</p> <p> <strong>Improving residents’ well-being</strong></p> <p> The program, which won the <a href="" rel="nofollow" target="_blank">David C. Leach Award</a> of the Accreditation Council for Graduate Medical Education in February, is one that could be replicated in resident programs nationwide. FERHAWI is featured in the AMA’s STEPS Forward™ collection of practice improvement strategies. The collection contains an <a href="" rel="nofollow" target="_blank">online module</a> that explains what is needed to prevent burnout among physician trainees, based on lessons learned by successful residency wellness programs.</p> <p> Studies have shown there are six key factors in fostering residents’ <a href="" target="_blank">personal wellness</a>, including practicing good nutrition and fitness, meeting emotional needs, and participating in preventive care. Through the AMA STEPS Forward™ collection, the AMA is helping physicians and physicians in training take those steps.</p> <p> A wide variety of ideas will be shared at the <a href="" target="_blank">International Conference on Physician Health™</a>, which the AMA will host Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> <strong>Explore other wellness solutions for residents and fellows:</strong></p> <ul> <li> <a href="" target="_blank">Residents are beating burnout with help from the theatre</a></li> <li> <a href="" target="_blank">How one program achieved resident wellness, work-life balance</a></li> <li> <a href="" target="_blank">Ways residents have found to conquer burnout</a></li> <li> <a href="" target="_blank">Ward off burnout: Your peer network may impact more than you think</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:12ba91bf-59c1-49bc-a290-60e8311bffef What Stanford added to take team-based care a step further Tue, 12 Apr 2016 21:03:00 GMT <p> In many practices, physicians take on administrative responsibilities that may distract them from patient care—the physician-led team-based care model can help. As health care continues the shift toward value-based care, this new model of care has increased in popularity. Find out how Stanford Coordinated Care pushed their team-based care model a little bit further.</p> <p> <strong>Making more time for patients</strong></p> <p> Stanford Coordinated Care took their team-based care model one step further than traditional models by making medical assistant (MA) care coordinators a central part of the team.</p> <p> These MAs work closely with patients to resolve many inquiries based on protocol or knowledge of the patients’ individual cases. Out-of-scope issues are forwarded to the nurses and finally, the physician handles any complex inquiries.</p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> The Stanford MA care coordinators are each responsible for their own panel of patients and complete several vital tasks for the clinic’s work flow, including:</p> <ul> <li> Refilling medications</li> <li> Performing routine health maintenance and chronic disease monitoring tests</li> <li> Answering initial patient phone calls and emails</li> <li> Scribing patient visits</li> <li> Advising patients on action plans</li> <li> Acquiring authorizations</li> <li> Facilitating referrals</li> </ul> <p> All of these expanded activities are completed by standing orders and protocols under the close supervision of the physicians on the team. Incorporating these simple tasks into the clinic’s already successful team-based work flow streamlines unnecessary work so physicians have more time to interact with their patients.</p> <p> By shifting the majority of the administrative responsibilities from physicians to other team members, Stanford’s physicians are able to use their time more efficiently.</p> <p> <strong>Get team-based care started in your practice</strong></p> <p> A new <a href="" rel="nofollow" target="_blank">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice implement team-based care. The module details the individual elements of a team-based care model and shows you how to bring all of those elements together.</p> <p> More than 25 modules are available in the AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward </a>collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5b626e66-ea84-4be6-8351-2fc95102d2b5 Find out who made list of most influential physicians Tue, 12 Apr 2016 20:58:00 GMT <p> Hospital and health system CEOs, federal officials, medical educators, and quality experts were voted to <em>Modern Healthcare</em>’s annual list of the 50 most influential physician executives and leaders in health care. More than one-half of this year’s honorees are AMA members.</p> <p> Three of the top five honorees are AMA members. The No. 2 slot went to John Noseworthy, MD, president and CEO of the Mayo Clinic. Coming in at No. 4 was Robert Wachter, MD, professor and interim chairman of the Department of Medicine at the University of California at San Francisco. And voted in at No. 5 was Toby Cosgrove, president and CEO of the Cleveland Clinic.</p> <p> These physician leaders joined other such notables as Thomas Frieden, MD, director of the Centers for Disease Control and Prevention; Robert Califf, MD, commissioner of the U.S. Food and Drug Administration; and Patrick Conway, MD, deputy administrator for innovation and quality and chief medical officer for the Centers for Medicare & Medicaid Services.</p> <p> The honorees were nominated by their peers and voted on by both readers and senior editors of the publication.</p> <p> Other AMA members who made the list include:</p> <ul> <li> Richard Migliori, MD, executive vice president of medical affairs and chief medical officer of UnitedHealth Group: No. 6</li> <li> Jonathan Perlin, MD, president of clinical services and chief medical officer of HCA: No. 10</li> <li> Gary Kaplan, MD, chairman and CEO of Virginia Mason Health System: No. 11</li> <li> David Shulkin, MD, undersecretary for health at the Veterans Affairs Department: No. 12</li> <li> Roy Beveridge, MD, chief medical officer of Humana: No. 16</li> <li> Atul Gawande, MD, surgeon, professor, writer and researcher at Harvard Medical School and Harvard School of Public Health: No. 17</li> <li> Charles Sorenson, MD, president and CEO of Intermountain Healthcare: No. 18</li> <li> Mark Chassin, MD, president and CEO of the Joint Commission: No. 20</li> <li> Eric Topol, MD, chief academic officer of Scripps Health and director of Scripps Translational Science Institute: No. 21</li> <li> Peter Pronovost, MD, director of the Armstrong Institute for Patient Safety and Quality and senior vice president for patient safety and quality at Johns Hopkins Medicine: No. 23</li> <li> Francis Collins, MD, director of the National Institutes of Health: No. 27</li> <li> Humayun Chaudhry, DO, president and CEO of the Federation of State Medical Boards: No. 28</li> <li> Tejal Gandhi, MD, president and CEO of the National Patient Safety Foundation: No. 30</li> <li> J. Mario Molina, MD, president and CEO of Molina Healthcare: No. 32</li> <li> David Pryor, MD, executive vice president and chief clinical officer of Ascension: No. 34</li> <li> Victor Dzau, MD, president of the National Academy of Medicine: No. 36</li> <li> Troyen Brennan, MD, executive vice president and chief health officer of CVS Health: No. 37</li> <li> Lynn Simon, MD, president of clinical services and chief quality officer of Community Health Systems: No. 40</li> <li> William Roper, MD, CEO of UNC Health Care, University of North Carolina at Chapel Hill: No. 42</li> <li> Susan Turney, MD, CEO of Marshfield Clinic Health System: No. 43</li> <li> James Madara, MD, executive vice president and CEO of the AMA: No. 44</li> <li> William Conway, MD, executive vice president and chief quality officer of Henry Ford Health System and CEO of Henry Ford Medical Group: No. 46</li> <li> Lynn Massingale, MD, co-founder and executive chairman of TeamHealth: No. 47</li> </ul> <p> <a href="" rel="nofollow" target="_blank">Read about</a> this year’s top physician leaders and <a href="" rel="nofollow" target="_blank">see the full list</a> at <em>Modern Healthcare</em>.</p> <p style="text-align:right;"> <span style="font-size:11px;"><em style="color:rgb(26, 20, 20);font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;text-align:-webkit-right;">By AMA Wire editor </em><a href="" rel="nofollow" style="color:rgb(0, 102, 204);cursor:pointer;word-wrap:break-word;overflow:hidden;font-family:Gotham, 'Helvetica Neue', Helvetica, Arial, sans-serif;font-size:13px;line-height:18.2px;text-align:-webkit-right;" target="_blank"><em>Amy Farouk</em></a></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:67a50fe9-1835-4925-989d-c019e53d5de2 2016 Match by the numbers Mon, 11 Apr 2016 22:00:00 GMT <p> The 2016 Match was the largest ever recorded by the National Resident Matching Program (NRMP) and resulted in a higher overall match rate than the year prior.</p> <p> With 42,370 total registrants, this year’s Match eclipsed the record set in 2015 by 1,036 registrants, according to <a href="" rel="nofollow" target="_blank">2016 Match data</a> released by the NRMP.</p> <p> A total of 30,750 positions were available, an increase of 538 positions from 2015, which was another record. Available first-year (PGY-1) positions reached 27,860, a year-over-year increase of 567.</p> <p> The overall match rate hit 96.2 percent in 2016, with 96.3 percent of first-year positions filled. Both those rates were up from last year.</p> <p> The number of active U.S. allopathic seniors participating in the Match increased this year by 162, reaching 18,187. And while the percent of U.S. allopathic seniors matching to PGY-1 positions dropped slightly, from 93.9 percent to 93.8 percent, 125 more seniors matched into PGY-1 positions compared to 2015.</p> <p> Other highlights included:</p> <ul> <li> <strong>5,323:</strong> New record for participation by U.S. citizens who are seniors/graduates of foreign medical schools. Their match rate went up about 1 percentage point, reaching 53.9 percent for U.S. citizen international medical graduates and 50.5 percent for non-citizen international medical graduates (50.5 percent).</li> </ul> <ul> <li> <strong>53.0 percent: </strong>Percentage of U.S. allopathic seniors who obtained their first choice for training. 79.2 percent obtained one of their top three choices for training.</li> </ul> <ul> <li> <strong>1,046:</strong> Highest-ever number of active couples navigating the Match together.</li> </ul> <ul> <li> <strong>95.7 percent: </strong>Best-ever match rate for couples.</li> </ul> <ul> <li> <strong>2,982:</strong> Most U.S. osteopathic seniors/graduates ever to submit preferences.</li> </ul> <ul> <li> <strong>80.3 percent:</strong> Record-high match rate for U.S. osteopathic seniors/graduates.</li> </ul> <p> The NRMP Match Week Supplemental Offer and Acceptance Program® (SOAP®) enables applicants who did not match to apply for unfilled positions. Of 1,178 unfilled positions this year, 1,097 were offered during SOAP.</p> <p> <strong>Physician shortage looms large</strong></p> <p> Concerns remain that residency training programs may not be able to address the estimated shortage of physicians, which could range from 61,700 to 94,700 over the next decade, according to newly released study <a href="" rel="nofollow" target="_blank">findings</a> from the Association of American Medical Colleges (AAMC).</p> <p> The study updates a report from 2015, with findings remaining largely consistent. The latest report includes a new section on underserved populations, showing that the physician shortage would be even more severe if barriers to health care were removed and more people in need could access services.</p> <p> In fact, the country would need up to an additional 96,000 physicians today to meet these needs, the study found.</p> <p> <strong>Advocating for new solutions</strong></p> <p> The AMA has been calling for expanded graduate medical education (GME) programs and funding for many years.</p> <p> At the federal level, the AMA recently submitted a <a href="" target="_blank">letter</a> (log in) on key GME reforms to the House of Representatives Committee on Energy and Commerce, and is pushing for legislation such as the <a href="" target="_blank">Creating Access to Residency Education (CARE) Act</a><u>.</u></p> <p> At the 2015 AMA Interim Meeting, the AMA also adopted a <a href="" target="_blank">report</a> on alternative funding mechanisms for GME.</p> <p> State funding opportunities and working with philanthropic organizations, local hospitals and employers all are among the options the report outlined for programs looking to expand their residency slots.</p> <p> Going forward, the AMA will continue to explore various models of all-payer funding for GME. It also will encourage insurance payers and foundations to forge partnerships with academic medical centers and other organizations to expand training opportunities.</p> <p> Other ongoing efforts include the <a href="" rel="nofollow" target="_blank">SaveGME</a> campaign to protect federal funding and the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education</a> initiative, which is addressing some of these issues by supporting medical school projects that accelerate student progress through medical school, allowing them to enter residency sooner and contribute more rapidly to expanding the physician workforce.</p> <p align="right"> <em>By contributing writer Tim Mullaney</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:161c3e54-d23e-4935-ac4e-e9f7e77e388b How Michigan is relaying student competency to residency programs Mon, 11 Apr 2016 21:56:00 GMT <p> A <a href="" rel="nofollow" target="_blank">new study</a> proposes that following the Match, medical school faculty should evaluate individual students and send residency program directors accurate, competency-based assessments for each graduate moving to the next level of physician training. This would ensure program directors have more detailed information on interns’ abilities and would help to identify areas where trainees need extra help, the University of Michigan Medical School authors said.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>Improving the system</strong></p> <p> The current medical student performance evaluation (MSPE) allows medical schools to pass on information about a student’s general competency, but it doesn’t give a high level of detail and is sent nearly a year before a graduate starts his or her residency.</p> <p> Schools within the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education Consortium</a> have been working on flexible, <a href="" target="_blank">competency-based</a> pathways for students in recent years, and a group at the University of Michigan—one of the 11 founding schools of the consortium—saw room for improvement.</p> <p> “For this movement to succeed, medical schools must take an active role in using competency-based assessment and reliably communicating the information they garner to residency programs as part of a standardized educational handover,” noted study authors from the University of Michigan.</p> <p> Members of a committee formed at the University of Michigan saw that much of the groundwork already existed to provide more detailed information. The Accreditation Council for Graduate Medical Education (ACGME) has assessments of specialty-specific milestones in place. But the competency evaluations aren’t clearly documented during the transition from undergraduate to graduate medical education, and there isn’t a clear understanding of who is supposed to ensure graduates’ level 1 competency.</p> <p> To try to create a meaningful system, committee members in the spring of 2013 evaluated seven University of Michigan medical students who matched into emergency medicine residencies. The committee determined each student’s competency for the 23 emergency medicine milestones. They based their conclusions on assessments from the mandatory emergency medicine clerkship, the multi-station standardized patient exam completed at the end of the student’s third year, the emergency medicine boot camp elective and other medical school data already available.</p> <p> Committee members then created a letter—a post-Match, milestone-based mMSPE—for each student. When students received a copy of the letter to review, they “reacted favorably” and made “no changes,” study authors said. The letters went to the students’ six residency program directors in July 2013 (two students headed to the same residency program). The directors also reacted positively.</p> <p> Five of the six residency program directors completed a survey after they received the letter, and all of them believed the proposed assessment would be useful for all incoming interns, the study found. And four of the five responding directors said they believed the assessment provided information not available on the traditional MSPE; one director concluded the letter would allow for early intervention for areas of weakness.</p> <p> <strong>Next steps</strong></p> <p> Study authors said the next steps include determining the widespread usefulness of an mMSPE and gauging interest in it as a tool for all emergency medicine program directors, as well as program directors in other specialties.</p> <p> “Although this ‘second dean’s letter’ does not affect residency placement … it does provide [program directors] with a more accurate and up-to-date view of the capacities of the new interns,” the authors concluded. “This information allows the [program directors] to tailor training to the strengths and weaknesses of their incoming class, which, in turn, affords the opportunity to address any weaknesses before problems arise.”</p> <p> The University of Michigan will provide specialty milestone competency “handover letters” for students in pediatrics, obstetrics & gynecology, surgery and emergency medicine this year. Faculty at the University of Michigan also are working with other schools as well on the development of educational handovers. </p> <p> <strong>Learn how other med schools are advancing competency-based education:</strong></p> <ul> <li style="margin-left:0.25in;"> More medical schools are <a href="" target="_blank">moving their learning models</a> toward competency-based assessment, requiring greater collaboration and information-sharing.</li> <li style="margin-left:0.25in;"> Vanderbilt University School of Medicine <a href="" target="_blank">uses e-portfolios</a> to transform students’ assessments, strengthen partnerships with faculty and track students’ progress.</li> <li style="margin-left:0.25in;"> University of California, Davis, School of Medicine and Kaiser Permanente Northern California recently developed the <a href="" target="_blank">Accelerated Competency-based Education in Primary Care (ACE-PC) Program</a>, a three-year medical school pathway for students committed to primary care careers.</li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:516c8c50-150b-4087-b609-fca33495ae49 Medical community inspires next generation of minority doctors Fri, 08 Apr 2016 22:07:00 GMT <p> Psychiatrist Frank Clark, MD, remembers a Chicago summer spent at an <a href="" rel="nofollow" target="_blank">Illinois Institute of Technology</a> program that sparked his interest in science and a program at <a href="" rel="nofollow" target="_blank">Northwestern University</a> that ignited his passion for medicine. For Gricelda Gomez, the path to Harvard Medical School started at Los Angeles’ <a href="" rel="nofollow" target="_blank">Bravo Medical Magnet High School</a>, which gave her the opportunity to volunteer in a hospital and see medicine first hand in a cardiovascular lab.</p> <p> Now Dr. Clark and medical student Gomez are headed into their communities to get kids thinking about the possibility of becoming a physician. On May 3 they will take part in the AMA’s <a href="" target="_blank">National Doctors Back to School Day</a>, a day for physicians and physicians in training to head back to high school, middle school and elementary school classrooms to inspire minorities to go into medicine, and ultimately work toward eliminating racial and ethnic health disparities.</p> <p> “It allows me and many others to share our testimonies of how we became physicians,” said Dr. Clark, who practices in Christiansburg, Va., and is the vice chair of the AMA Minority Affairs Section Governing Council. “Some students may never encounter a doctor who looks like them. To see someone in a white coat that symbolizes compassion, integrity and resilience sends a powerful message and instills a beacon of hope for our future leaders. We want them to know that they have every opportunity to pursue their dreams.”</p> <p> <strong>Paying it forward</strong></p> <p> Gomez said she wouldn’t be where she is today if others had not taken the time to mentor her through the years.</p> <p> “I have a responsibility to pay it forward,” said Gomez, who is in her fourth year of an MD-MPH program at Harvard and is the medical school representative on the AMA Minority Affairs Section Governing Council. “As physicians and as medical students, we have trust and weight in the community, and we should use that leverage to better our community and to make medicine better.”</p> <p> Many minorities are underrepresented in medicine. While African-Americans, Hispanic Americans and Native Americans comprise nearly 25 percent of the U.S. population, just 9 percent of the nation’s doctors have that heritage. Over the next 30 years, minorities are expected to comprise one-third of the population.</p> <p> <strong>Being the change you want to see</strong></p> <p> Dr. Clark encourages his colleagues to take the time from their schedules to reach out to children who are at impressionable ages and help them understand the steps they need to take in high school and college to become a physician.</p> <p> “If we are strongly dedicated to the mission to eliminate health care disparities, then that starts with us,” Dr. Clark said. “If we want to increase the number of under-represented minorities in medicine, then we as individuals need to practice beyond the bedside and sow seeds of advocacy and leadership in our communities. If we are not seen by our youth, then it is a missed opportunity to engage them.”</p> <p> Gomez noted that physicians and physicians in training shouldn’t underestimate just how influential a classroom visit could be: “It might be something that is an hour or two out of our day,” she said, “but for the kids, those hours could influence the trajectory of their lives.”</p> <p> Doctors Back to School can take place any day of the year if you’re not able to join in the national day May 3. To help prepare for a visit, the AMA offers a <a href="" target="_blank">Doctors Back to School kit</a> (log in) for members that includes presentation ideas, handouts and checklists. <a href="" target="_blank">Learn more</a> about National Doctors Back to School Day and how to register your event.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:56c9c50e-8c68-4eff-a29e-08991b1b3e19 Test your HIPAA knowledge: 3 data sharing situations Fri, 08 Apr 2016 21:11:00 GMT <p> Now that you know the Health Insurance Portability and Accountability Act (HIPAA) <a href="" target="_blank">allows data sharing</a> without patient authorization for certain health care operations activities, take a closer look at the range of situations in which your practice can use technology to obtain and share patient information. Test your HIPAA knowledge in three data sharing situations and determine whether or not they are HIPAA-compliant.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Experts at the Office of the National Coordinator for Health IT (ONC) recently published a <a href="" target="_blank" rel="nofollow">series of blog posts</a> on permitted uses and disclosures of protected health information (PHI) under HIPAA. The series provides reference materials and offers clarification to physicians and patients on when they can use and disclose PHI.</p> <p> The blog posts offer several examples of when physicians or hospitals can disclose PHI without patient authorization. Here are three data sharing situations to test your HIPAA knowledge:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Sharing data for care coordination.<br /> <br /> The situation:</strong> You work in a hospital. As you prepare to discharge a patient who will need ongoing rehabilitation, you also need to find a rehabilitation facility that provides the type of care this specific patient needs.<br /> <br /> In order to find out which rehabilitation facility will accept this patient, you will need to share PHI about the patient with each facility. Can you release this PHI to these facilities to find the best place for your patient to continue care?<br /> <br /> <strong>The answer:</strong> Yes, your hospital may use certified electronic health record (EHR) technology to disclose the relevant PHI to the rehabilitation facilities without obtaining the patient’s written authorization as long as the disclosure is done in a manner that complies with the HIPAA Security Rule.<br /> <br /> This is a treatment disclosure made in anticipation of future treatment by one of the prospective rehabilitation facilities and is allowed under HIPAA.<br /> <br /> <strong>A concern:</strong> If you disclose this information to the rehabilitation facilities, will your hospital be held responsible for what they do with that information after the fact?<br /> <br /> No. Under HIPAA, your hospital is responsible only for complying with HIPAA when you disclose the information. After the rehabilitation facilities have received the PHI, they, as covered entities, are responsible for safeguarding that PHI.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Sharing data for quality assessment and improvement.<br /> <br /> The situation:</strong> You are conducting a quality review and need to know the health outcome of a patient that you treated but are no longer in contact with. Does HIPAA allow you to query a health information exchange (HIE) for the relevant information about that patient?<br /> <br /> <strong>The answer:</strong> Yes, you can query an HIE or even ask the patient’s new physician directly (if you know who it is) without obtaining the patient’s written permission because this qualifies as a quality assessment activity.<br /> <br /> <strong>The other side:</strong> If you are the physician responding to this query, you may use certified EHR technology to send the PHI directly to the requesting physician or to the HIE.<br /> <br /> Other hospitals that have treated or are treating this patient also may use certified EHR technology to share relevant PHI to determine the cause or source of an infection if one has occurred. This determination may aid in preventing infections for future patients as long as the information is shared in compliance with HIPAA.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Sharing data for care planning.<br /> <br /> The situation:</strong> When you discharge patients from your hospital, you want to make sure they have a comprehensive care plan after they leave. You hire a care planning company to develop these plans for your patients on your behalf. The care planning company requests relevant PHI about each patient from your hospital and the patient’s other health care providers. Does HIPAA allow your hospital and the other providers to disclose this information to the care planning company?<br /> <br /> <strong>The answer:</strong> Yes, your hospital and each of the other providers may disclose relevant PHI for purposes of care planning without obtaining written authorization from the patients using certified EHR technology as long that the sharing is done in compliance with HIPAA.<br /> <br /> <strong>A precaution:</strong> In a situation such as this, your hospital should enter into a business associate agreement with the care planning company. All of the other health care providers may share PHI with the care planning company as if they are sharing it with your hospital. They are not required to execute a business associate agreement.<br /> <br /> Once the others have shared patients’ PHI with the care planning company in compliance with HIPAA, they are no longer responsible for what the care planning company does with that PHI.</p> <p> For an even more detailed look into data sharing under HIPAA, read the <a href="" target="_blank" rel="nofollow">full series</a> on the ONC’s health blog.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f4452dc9-0b16-423e-b00f-69d72c6e2b0e Register now for 2016 AMA-IMG Section Annual Meeting Fri, 08 Apr 2016 16:00:00 GMT <p> Join your peers at the 2016 AMA International Medical Graduates (IMG) Section Annual Meeting, June 10-13 in Chicago. Invite a colleague or friend to attend and share in the AMA-IMG Section’s valuable information sessions. </p> <p> Meeting highlights include:</p> <ul> <li> <strong>AMA-IMG Section candidates forum: 3 p.m. June 10</strong><br /> Meet the candidates who are running for an AMA Board of Trustees position. This candidate’s forum will be cosponsored by the AMA Minority Affairs Section.</li> </ul> <ul> <li> <strong>AMA-IMG Section reception and congress: 5:30–7:30 p.m. June 10</strong><br /> Come hear Mahek Shah, MD, from the Harvard Business School Institute for Strategy and Competitiveness and Ami Shah, MD, founder of Face2Face Health, discuss health care innovation in the medical practice. Additional discussions will include organizational reports and resolutions being considered at the 2016 AMA Annual Meeting. You also can share your comments on resolutions being considered for the 2016 AMA Interim Meeting.</li> </ul> <ul> <li> <strong>10th annual “Desserts From Around the World” reception: 9:30–11 p.m. June 11 </strong><br /> Each year this event gets bigger and tastier! Come try new and exciting ethnic desserts and view the live entertainment. You also are welcome to be a sponsor for this event.</li> </ul> <ul> <li> <strong>AMA-IMG Section delegate caucus: 8:30-9:30 a.m. June 13</strong><br /> Meet your IMG Section delegate, and discuss the strategies for deliberations on reference committee reports and resolutions.</li> </ul> <ul> <li> <strong>Busharat Ahmad, MD, Leadership Development Program: 10:30–11:30 a.m. June 13</strong><br /> This program, “Why physician leaders fail and how to ensure success” featuring speaker Sunil Wimalawansa, MD, PhD, is designed to develop individuals who want to become dynamic physician leaders.</li> </ul> <p> <a href="" target="_self">Register today</a>. Send an <a href="" rel="nofollow">email</a> to the AMA-IMG Section or call (312) 464-5397 for more information.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fd8a1cc6-3725-42f3-b0e9-ed800c8b78c3 AMA-SPS Governing Council election results are in Fri, 08 Apr 2016 15:00:00 GMT <p> The AMA Senior Physicians Section (SPS) Governing Council recently held its 2016-2017 elections. The officers who were selected will begin their terms at the conclusion of the 2016 AMA Annual Meeting in June.</p> <ul> <li> <strong>Delegate:</strong> Claire V. Wolfe, MD, of Dublin, Ohio.</li> <li> <strong>Alternate delegate:</strong> John A. Knote, MD, of West Lafayette, Ind.</li> <li> <strong>Officer at large (two-year position):</strong> Paul H. Wick, MD, of Tyler, Texas</li> <li> <strong>Officer at large (two-year position):</strong> Richard Allen, MD, of Happy Valley, Ore.</li> </ul> <p> They will join the current <a href="" target="_self">AMA-SPS Governing Council officers</a>:</p> <ul> <li> <strong>Chair:</strong> Barbara A. Hummel, MD, of Muskego, Wis.</li> <li> <strong>Chair-elect:</strong> Barbara S. Schneidman, MD, of Seattle, Wash.</li> <li> <strong>Officer at large:</strong> Angus M. McBryde, Jr., MD, of Mobile, Ala.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fb3163aa-539e-4447-8565-d3d8b33f0b38 How a Minnesota practice is preventing diabetes--and you can too Thu, 07 Apr 2016 22:09:00 GMT <p> Nine out of 10 people who have prediabetes, the precursor to type 2 diabetes, don’t know they have it. Fortunately, evidence-based diabetes prevention programs are available to support physicians who treat these patients—and recently, groundbreaking steps were taken to soon cover these costs under Medicare. Find out how a practice in Minnesota used a local diabetes prevention program to help their patients stop the onset of type 2 diabetes.</p> <p> A three-year demonstration project funded by the Center for Medicare and Medicaid Innovation allowed the YMCA of the USA (Y-USA) to deliver its Diabetes Prevention Program, modeled after the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program, through local YMCAs at no cost to nearly 8,000 Medicare beneficiaries at a high risk of developing type 2 diabetes.</p> <p> As part of its <a href="" target="_blank">Improving Health Outcomes</a> initiative, the AMA teamed up with the Y-USA and <a href="" target="_blank">26 physician practice pilot sites</a> (log in) in eight states to develop tools and resources to increase physician screening and testing for prediabetes and to help them refer those patients to local programs</p> <p> <strong>Getting involved in diabetes prevention</strong></p> <p> One of those sites was Park Nicollet’s clinic in Brookdale, Minn. Steven Reed, MD, a primary care physician at the Brookdale location, said that for years he’s seen patients who are overweight who have all the signs of prediabetes, but “you sort of sound like a broken record after awhile saying you need to lose weight and exercise and eat right.”</p> <p> “To have a <a href="" rel="nofollow" target="_blank">program that’s been proven</a> in studies to be effective in the ultimate goal to reduce risk of developing diabetes is exciting,” he said. “There is data that shows that this, for most patients, marks a change in their lifestyle that is lasting … so it’s not a quick-fix diet where you lose the weight and it comes back.”</p> <p> The program is 12 months long and focuses on behavior such as diet and exercise, but “they cover a lot of practical things,” Dr. Reed said. “It’s not just what to eat, but it’s how you get through the holidays, how to shop at the grocery store and what to do when you go out to eat. They cover how to deal with stress and keep your motivation up to keep doing these things.”</p> <p> <strong>How Park Nicollet did it</strong></p> <p> Park Nicollet became part of the demonstration project with only a few months left to participate in the program, so they had to work quickly. “We had a limited window of time where we could do this,” Dr. Reed said. “We wanted to get as many people into this program as we could.”</p> <p> “The impressive thing to me is that we were able to use the power of the electronic health record (EHR) to find the patients who would be eligible for this,” Dr. Reed said. “It cut down on a lot of man hours that would be required to do it as patients came in.”</p> <p> “I think the program was a success in that way,” he said. “We worked with the IT folks to build a work list that scoured our patient database.”</p> <p> The search was for patients who met three criteria:</p> <ul> <li> Aged 65 or older and on Medicare</li> <li> Had a body mass index of 25 or greater</li> <li> Had a diagnosis of prediabetes (met the hemoglobin A1c and glucose criteria)</li> </ul> <p> Dr. Reed noted that EHRs can have their share of frustrations but said that “this is a case where it can be good to be able to easily identify these patients who could benefit from the program.”</p> <p> Using the list produced by their EHR, Park Nicollet sent referral letters to each patient, notifying them of their prediabetes condition and eligibility for the diabetes prevention program at the YMCA.</p> <p> “We went through several versions of that letter,” Dr. Reed said. “We had a couple patients who said they were surprised by it, [but] no one was really upset or didn’t like the way we communicated it.”</p> <p> “The YMCA did a nice job of giving us updates when the patients were going through the program to let us know if it was working for them or whether they had completed it or not and how many sessions they went to.”</p> <p> For physicians contemplating referring their patients to a diabetes prevention program, Dr. Reed suggested “be aware of the program, promote it to patients and know where it’s available in your community. For us it was the YMCA, but there are a lot of other places it’s available.”</p> <p> <strong>Diabetes prevention programs soon to be covered by Medicare</strong></p> <p> The U.S. Department of Health and Human Services (HHS) <a href="" target="_blank">recently announced</a> it soon will begin covering diabetes prevention programs for Medicare beneficiaries as the result of the Y-USA’s demonstration project. The announcement highlights the project’s success.</p> <p> It is the first time a preventive service model from the Center for Medicare and Medicaid Innovation has been expanded into the Medicare program, and the agency said the model holds promise for employers, private insurers and patients.</p> <p> “That is exciting,” Dr. Reed said. “If it’s covered by Medicare, at least in the area where I work, that alleviates a huge barrier to care, which is the cost of the program—400 plus dollars—which is a lot of money for a lot of patients that I see. To have that barrier removed is a major step forward.”</p> <p> “The solutions really are lifestyle changes,” he said, “and this program has been proven to work and can make it available to more people—I think it’s fantastic.”</p> <p> Learn how your practice can start helping patients with prediabetes reduce their risk for developing type 2 diabetes. The AMA and the CDC offer practical resources through the joint <a href="" target="_blank">Prevent Diabetes STAT: Screen, Test, Act–Today™</a> initiative. The resources center on three important steps to take with your patients:</p> <p style="margin-left:36.75pt;"> 1.   Screen patients for prediabetes risk using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test</p> <p style="margin-left:36.75pt;"> 2.   Test patients to confirm prediabetes using one of three blood tests, which may already be recorded in your EHR</p> <p style="margin-left:36.75pt;"> 3.   Act by referring patients with prediabetes to a nearby CDC recognized <a href="" rel="nofollow" target="_blank">diabetes prevention program</a></p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a04ff218-bfb0-4aeb-974e-5547cda94eaa Attend the 2016 AMA-SPS Annual Meeting June 11 Thu, 07 Apr 2016 14:00:00 GMT <p> Members of the AMA Senior Physicians Section (SPS) are invited to attend the 2016 AMA-SPS Annual Meeting June 11 at the Hyatt Regency Chicago. Those present may introduce new items of business related to the section’s mission and review items in the House of Delegates Handbook related to senior physician issues.</p> <p> The assembly meeting is scheduled from 11:30 a.m. to noon June 11 in Columbus K/L (East Tower, Gold Level). Come enjoy the fellowship of your senior physician colleagues. A luncheon will be served at 11:30 a.m. on a first-come, first-served basis. If you have questions about the meeting, please contact Alice Reed at <a href="" rel="nofollow"></a> or call (312) 464-5523.</p> <p> The AMA-SPS also is sponsoring an education program titled “Burning up, burning out or burning brightly<em>.</em>” The program is scheduled from noon to 1:30 p.m. June 11 in Columbus K/L. Many physicians today are experiencing increasingly high levels of dissatisfaction with their profession as a result of more intense work environments, more time spent on less meaningful activities, and the introduction of new quality standards and electronic health records, among other stressors.  </p> <p> While aging can bring declines in some areas of performance, senior physicians also are particularly well-equipped to contribute in ways that enhance work experience. What should senior physicians—and physicians at all stages of development—focus on in order to reconnect with their calling, find professional fulfillment and offer their patients high-quality care? This educational session will explore how senior physicians who are confronting challenges can thrive and continue to make a difference.</p> <p> <strong>Objectives: </strong></p> <p> Upon completion of this session, attendees will be able to:</p> <ul> <li style="margin-left:0.5in;"> Describe the risk factors for professional burnout</li> <li style="margin-left:0.5in;"> Identify approaches that promote professional fulfillment</li> <li style="margin-left:0.5in;"> Develop strategies to reduce burnout and promote fulfillment for self and colleagues</li> </ul> <p> The featured speaker is Richard B. Gunderman, MD, PhD, chancellor’s professor at Indiana University. The moderator is Barbara A. Hummel, MD, Chair, AMA-SPS Governing Council.  </p> <p> This program is approved for 1.5 <em>AMA PRA Category 1 Credits™.</em></p> <p> Advance <a href="" target="_self">registration</a> is appreciated. If you have questions about the meeting or registering, please contact Alice Reed of the AMA via <a href="" rel="nofollow">email</a> or at (312) 464-5523.</p> <p> <em>The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.  The American Medical Association designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e874c015-8dec-4b2b-83c0-a9c59b204b2b Focus on training: Treating patients with intellectual disabilities Wed, 06 Apr 2016 20:45:00 GMT <p class="p1"> Seeing patients with intellectual disabilities can raise significant ethical questions for physicians. Learn how early training for providing compassionate care to patients with disabilities can result in more ethically informed medical decisions.</p> <p class="p1"> The <a href="" target="_blank"><span class="s1">April issue</span></a> of the <i>AMA Journal of Ethics</i> explores key ethical concepts regarding how medical professionals treat patients with intellectual disabilities. Articles featured in this issue include:</p> <ul> <li class="p4"> “<a href="" target="_blank"><span class="s1">An open letter to medical students: Down syndrome, paradox and medicine.</span></a>” Clinical encounters involving people with intellectual disabilities can be both charged and complex. How can you understand these complexities in a way that will help to improve patient encounters? Learn how a focus on ethics can help you, as a future clinician, see your patients more clearly.</li> </ul> <ul> <li class="p4"> “<a href="" target="_blank"><span class="s1">The curriculum of caring: Fostering compassionate, person-centered health care.</span></a>” Person-centered care is high<span class="s2">-</span>quality health care that respects an individual’s preferences, needs and values in a compassionate way, but what is required to make this model of training effective? Find out how personal encounters with patients, modeling by mentors and reflective activities can foster caring qualities during medical training.</li> </ul> <ul> <li class="p4"> “<a href="" target="_blank"><span class="s1">Is proxy consent for an invasive procedure on a patient with intellectual disabilities ethically sufficient?</span></a>”<b> </b>Reproductive health care is an important part of each person’s overall health. Learn how to draw upon ethical principles to navigate conversations regarding reproductive health care for women whose disabilities compromise their decision-making capacity.</li> </ul> <ul> <li class="p4"> “<a href="" target="_blank"><span class="s1">Considering decision making and sexuality in menstrual suppression of teens and young adults with intellectual disabilities.</span></a>” Distinguishing caregiver convenience from patient benefit can be critical in sexual health decision-making for young adults with intellectual disabilities. Learn strategies for providing appropriate counseling regarding sexuality and how to consider the sexual health treatment of your patients with intellectual disabilities<span class="s2">.</span></li> </ul> <p class="p1"> In the journal’s <a href="" target="_blank"><span class="s1">April podcast</span></a>, Susan Mizner, disability counsel for the American Civil Liberties Union, discusses some merits, drawbacks and alternatives to guardianship for persons with disabilities. </p> <p class="p1"> <b>Take the ethics poll</b></p> <p class="p1"> <span class="s1"><a href="" target="_blank">Give your answer</a></span> to this month’s poll: Numerous factors determine whether and when women with disabilities have equitable access to reproductive health care services. What do you think interferes most prominently with clinicians’ capacities to care well for the reproductive health needs of women with disabilities?</p> <p class="p1"> <b>Submit an article</b></p> <p class="p1"> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="" rel="nofollow" target="_blank"><span class="s1">Submit your work</span></a> for publication.</p> <p class="p5" style="text-align:right;"> <i>By AMA staff writer </i><a href="" rel="nofollow" target="_blank"><span class="s1"><i>Troy Parks</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e2ef33ca-23c8-4a37-8155-89fad831e58b 6 tips for living on a budget during training Wed, 06 Apr 2016 20:39:00 GMT <p class="p1"> Making it through medical school and residency on a very limited income is one of the many challenges of life as a physician in training. But careful planning and following advice from physicians who have successfully completed that phase of their careers can help turn personal finances during training into less of a worry. </p> <p class="p1"> Laura Ditkofsky, the wife of a physician who recently completed residency, offered insights from their years in training in a <a href="" rel="nofollow" target="_blank"><span class="s1">post</span></a> for <a href="" rel="nofollow" target="_blank"><span class="s1">AMA Alliance</span></a> publication <i>Physician Family</i>:</p> <ul> <li class="p3"> <b>Know your prices.</b> Groceries can eat up a significant part of your monthly budget if you aren’t careful about what you buy and where you buy it. Ditkofsky recommends memorizing or writing down prices for every item you buy. That way, you can compare prices between stores for the best buys and stock up on particular items when they go on sale.</li> </ul> <ul> <li class="p3"> <b>Plan your meals. </b>It may sound like more work, but thinking ahead about what you’ll eat for the week can save you from last-minute scrambles and drive down your grocery bill. Meal planning around foods that are on sale that week can ensure you get the best deals. It also will keep you from purchasing things you don’t need or having food you don’t get to prepare go bad, Ditkofsky said.<br /> <br /> If you’ve never done meal planning before, you can easily find recommendations to suit your tastes and needs. There are plenty of mobile apps and weekly recommendations from online sources that focus on healthy menus, special diets and kid-friendly options.</li> </ul> <ul> <li class="p3"> <b>Use coupons.</b> Couponing can be as basic as using your store’s weekly ads, but there are also plenty of opportunities to print, clip or download manufacturers’ ads. Ditkofsky also recommends checking out Groupon and Amazon Local for deals on date night dining.</li> </ul> <ul> <li class="p3"> <b>Prioritize little splurges. </b>“Most of us, no matter how poor, will splurge on something,” Ditkofsky said. The key is to make sure your splurges aren’t routine and that you realistically prioritize those things that you want versus the things that you need. If you have a spouse or partner, also be sure to talk about and agree upon what those things are.</li> </ul> <ul> <li class="p3"> <b>Live off your current income, not your earning potential. </b>Although you may be working toward practicing in a field that could offer a very comfortable income, it’s wise not to accrue more debt than necessary. Once you’re in practice, you’ll have med school loans to pay off, retirement and children’s educations to save for, not to mention higher income taxes and other practice expenses.</li> </ul> <ul> <li class="p3"> <b>Share your car. </b>If you have a spouse or partner, Ditkofsky recommends working your way through training as a one-car household. “We live in a very car-oriented society, and we often assume that we need our own car,” she said. “But sometimes we need to stand back and reassess whether two cars is a necessity or merely a convenience.” In addition to the cost of buying your car, savings include insurance, registration and maintenance.<b> </b></li> </ul> <p class="p1"> “Being frugal is hard work, but if you communicate with your spouse, set realistic expectations and develop healthy habits, living frugally will eventually become second nature,” Ditkofsky said.</p> <p class="p1"> <b>Looking for additional financial insights?</b></p> <ul> <li class="p4"> <span class="s2"><a href="" target="_blank">5 student-friendly tips for eating healthy on a budget</a></span></li> <li class="p4"> <span class="s2"><a href="" target="_blank">How to finish residency without falling further into debt</a></span></li> <li class="p4"> <span class="s2"><a href="" target="_blank">Top tips for your financial life after residency</a></span></li> </ul> <p class="p5" style="text-align:right;"> <i>By AMA Wire editor </i><a href="" rel="nofollow" target="_blank"><span class="s1"><i>Amy Farouk</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a865cef1-9cf3-4da2-af84-1659edf0a805 What single GME accreditation could mean for residency matches Tue, 05 Apr 2016 22:05:00 GMT <p class="p1"> The transition is underway to a single accreditation system for graduate medical education (GME), which will allow osteopathic and allopathic medical school graduates to train in residency and fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). GME experts shared several things medical students need to know as they navigate the new system.</p> <p class="p1"> Physician leaders at the ACGME, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine (AACOM) are two years into the effort to align all GME programs under one accreditation system within the ACGME. The <a href="" target="_blank"><span class="s1">transition</span></a> is slated for completion by July 2020. </p> <p class="p2"> <b>Will there be a single match?</b></p> <p class="p1"> All programs ultimately will be ACGME-accredited programs, and all physicians in training will meet a common set of milestones and competencies. However, students will continue to participate in a variety of matches, depending on the specialty they are pursuing or if they are in the military, said Lorenzo L. Pence, DO, ACGME senior vice president of osteopathic accreditation. The ACGME does not administer any of the matches. </p> <p class="p1"> The National Resident Matching Program (NRMP) is the largest Match program. It will expand further as AOA programs gain ACGME initial accreditation and become listed as part of the NRMP. To date, 15 programs have received initial accreditation. Osteopathic programs that have not started the ACGME accreditation process or have not yet received initial accreditation will still be part of the National Matching Service (NMS) Match.</p> <p class="p1"> “All AOA programs are going through ACGME accreditation, and by 2020, all GME programs will need to be ACGME-accredited,” said Stephen C. Shannon, DO, AACOM’s president and CEO.</p> <p class="p2"> In addition to the NRMP Match, the Military Match (students from the Uniformed Services University of the Health Sciences and Health Professions Scholarship Program), San Francisco Match and Urology Match are other matches that students will continue to use to pursue their residencies. Programs associated with any of these matches are already ACGME-accredited programs and will continue as they always have, Dr. Pence said.</p> <p class="p1"> <b>If I am studying for my MD, how will single accreditation impact me?</b></p> <p class="p1"> As an allopathic student, you will have more options than previous allopathic students. </p> <p class="p1"> Traditionally, students with MDs could not participate in the NMS Match and receive osteopathic training. Under the single accreditation system, the ACGME has created a new designation called osteopathic recognition, Dr. Shannon said. Allopathic students that have met prerequisites that relate to osteopathic medicine will have an opportunity to match, via the NRMP, with a program that contains osteopathic training.</p> <p class="p1"> “It will make for a more diverse opportunity for everyone,” Dr. Shannon said.</p> <p class="p1"> All ACGME-accredited programs are eligible to apply for osteopathic recognition, Dr. Pence said. To date, 18 programs have achieved that recognition. Some were already dually accredited programs; others were previously only AOA-accredited; and some were ACGME programs that had no prior osteopathic designation, he said.</p> <p class="p1"> “We hope all AOA-accredited residencies as they achieve ACGME initial accreditation will pursue osteopathic recognition,” said Dr. Pence. “In addition, we hope to see more ACGME programs apply and achieve osteopathic recognition. MDs who would enter residencies that have achieved osteopathic recognition would have an opportunity to learn about osteopathic medicine, and that would be a good thing for everyone.”</p> <p class="p1"> <b>If I am studying for my DO, how will I be impacted?</b></p> <p class="p1"> It will be important for you to talk to your clinical advisor to determine which match will be best for you to enter, Dr. Shannon said.</p> <p class="p1"> “Going through the transition (to Single Accreditation) may mean that the best residency program is in the NMS match this year and the NRMP Match next year,” Dr. Shannon said. “Stay aware and ask questions if you have them. And keep an interactive dialogue going with those of us helping put the new system in place. If there are roadblocks, we want to know about it.” </p> <p class="p1"> Members of the medical community can email the <a href="" rel="nofollow"><span class="s1">AACOM</span></a>, <a href="" rel="nofollow"><span class="s1">ACGME</span></a> or <a href="" rel="nofollow"><span class="s1">AOA</span></a>. </p> <p class="p1"> <b>As a DO or a MD student, how can I best keep on top of the changes underway?</b></p> <p class="p1"> The best thing medical students can do is make sure they are getting their information from the most accurate source, Dr. Shannon said. Information from blogs, forums and social media may not be the best sources. Instead visit the ACGME <a href="" rel="nofollow" target="_blank"><span class="s1">website</span></a><span class="s1">,</span> the <a href="" rel="nofollow" target="_blank"><span class="s1">AACOM Single GME Accreditation System</span></a> Web page or the <a href="" rel="nofollow" target="_blank"><span class="s1">AOA</span></a> website.</p> <p class="p1"> The ACGME answers <a href="" rel="nofollow" target="_blank"><span class="s1">frequently asked questions</span></a> about the Single GME Accreditation System on its website, and the AACOM also breaks out <a href="" rel="nofollow" target="_blank"><span class="s1">frequently asked questions</span></a> about the new system on its website.</p> <p class="p1"> In addition, <a href="" target="_blank"><span class="s1">FREIDA</span></a><span class="s1"> Online®</span>, the AMA Residency and Fellowship Database™, posts information about programs that have osteopathic recognition or are newly ACGME accredited. Use the term “AOA” in the keyword search, and the search results will include programs that are dually accredited, ones that have osteopathic recognition and ones that are newly accredited by the ACGME that had been AOA-accredited only.</p> <p class="p1"> <b>Why the move to single accreditation?</b></p> <p class="p1"> “Single accreditation makes it fair and equitable for everyone,” Dr. Pence said. “We have made some great strides, and I believe we are moving in the right direction.”</p> <p class="p1"> Dr. Shannon added that “we have a lot to learn from each other.”</p> <p class="p3" style="text-align:right;"> <i>By contributing writer Tanya Albert Henry</i></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:dfbe455f-1ae7-41d3-af72-3f7360aae4fa From meaningful use to MACRA: What you need to know now Tue, 05 Apr 2016 22:00:00 GMT <p class="p1"> <span class="s1"><i>An </i><a href="" target="_blank"><span class="s2"><i>AMA Viewpoints</i></span></a><i> post by AMA Board Chair </i><span class="s2"><i><a href="" target="_blank">Stephen R. Permut, MD</a></i></span></span></p> <p class="p3"> <a href="" target="_blank"><img src="" style="margin:15px;float:left;" /></a>A new quality reporting and payment system for Medicare is on its way. As physicians we need to understand the choices we will make about participation. This change has been a long time coming, and it will take physicians leading the way to make sure it is a step in the right direction.</p> <p class="p3"> <b>How we got to this point</b></p> <p class="p3"> Thanks to years of advocacy efforts and physician voices on the matter, we were able to secure passage of the Medicare Access and CHIP Reauthorization Act (MACRA) early in 2015. This legislation repealed the sustainable growth rate (SGR) formula and creates the opportunity for making significant changes to the meaningful use program. </p> <p class="p3"> And through our <a href="" rel="nofollow" target="_blank"><span class="s3">Break the Red Tape</span></a> grassroots campaign—which to date has featured three town halls on electronic health records (EHR) and meaningful use and collected thousands of physicians’ testimonies—the AMA was able to secure several <a href="" target="_blank"><span class="s3">key regulatory changes</span></a> after the defeat of SGR.</p> <p class="p3"> The important thing about these changes is that all were physician-led. The implementation of MACRA must also be physician-led if we want to secure a future that is designed for physicians and patients, rather than by insurance companies.</p> <p class="p3"> <b>The choices we have to make for our future</b></p> <p class="p3"> As a result of our efforts, <span class="s1">CMS Acting Administrator Andy Slavitt in January </span>said that the agency is <a href="" target="_blank"><span class="s3">changing its culture</span></a> to focus on physician and patient needs. Then in February, Slavitt took this <a href="" target="_blank"><span class="s3">one step further</span></a><span class="s3">,</span> pledging that CMS would partner with physicians to create a system that is patient-centered, focused on reducing the administrative burdens on physicians and designed to support changes in care delivery. </p> <p class="p3"> This partnership with CMS is critical to the future of medicine. As physicians we should not be spending our time on the computer clicking our way through the day. We are healers; our energy should be focused on spending time at the bedside listening to patients. The fact that CMS has vowed to work with physicians on this new program is a significant turning point. </p> <p class="p3"> As we move forward, it is important for physicians to understand what our choices are: Do you want to <span class="s1">participate in the fee-for-service model under the new merit-based incentive payment system (MIPS) or participate in alternative payment models (APM)</span>? The important thing is that we have a choice. Physicians from all specialties and practice types will have choices in the kinds of models in which they participate. </p> <p class="p5"> If you elect to participate in the MIPS, the composite MIPS score will take into account four categories:  quality, resource use, EHR meaningful use and clinical practice improvement. </p> <p class="p5"> Under the MIPS, the aggregate financial risk is less than under the previous Medicare quality and reporting programs. The old pass-fail approach to all these programs will be eliminated, and physicians will have the chance to earn bonuses if they score above average performance thresholds. Physicians who meet the threshold requirements but don’t exceed them still will avoid penalties. The MIPS also will give physicians the chance to score better and receive more credit for additional quality improvement efforts—including a new category of clinical practice improvement activities—than under the current programs.</p> <p class="p5"> Should they choose the APM option, <a href="" target="_blank"><span class="s3">physicians can take the lead</span></a> by working with their specialty societies to develop payment models appropriate to their specialty. By participating in a qualified APM, physicians will be subject only to quality reporting requirements for their specific payment model and will not be subject to the MIPS.</p> <p class="p5"> <span class="s4">Well-designed APMs</span> can allow physicians to provide better care to their patients, lower health care costs and improve their financial bottom line. </p> <p class="p3"> I am optimistic that we are going to end up in a better place, but securing these options means that we can direct our future—we can design payment models that work for us and our patients and always have fee-for-service under the MIPS as our safety net. In the end, both options really need to be user friendly, which is why it’s so important that the AMA is continuing to get the physician voice in front of key policymakers. </p> <p class="p3"> What is important for physicians now is that we understand these options as more information becomes available. We will know the material and know our options because these changes will determine the course of the future for our practices and our patients.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:78bc87dd-896c-4cb6-b934-7a2aad1726b0 What you can do now to help address a U.S. Zika outbreak Mon, 04 Apr 2016 22:00:00 GMT <p> In preparation for the warmer weather just around the corner, more than 300 local, state and federal government officials and health experts gathered Friday for a special Zika summit to develop action plans for preventing and addressing mosquito-borne transmission of the virus in certain regions of the United States.</p> <p> For a disease that experts know so little about, one of the most important elements of minimizing the effects of an outbreak will be careful surveillance, public health and infectious disease leaders agreed at the Centers for Disease Control and Prevention (CDC)-led <a href="" rel="nofollow" target="_blank">summit</a>. That means physicians need to know when to test for Zika, how to test for the virus and where to report cases.</p> <p> “The mosquitoes that carry Zika virus are already active in U.S. territories, hundreds of travelers with Zika have already returned to the continental United States, and we could well see clusters of Zika virus in the continental United States in the coming months,” CDC Director Tom Frieden, MD, said in a news release Friday. “Urgent action is needed, especially to minimize the risk of exposure during pregnancy. Everyone has a role to play.”</p> <p> Here are the main points physicians need to know:</p> <p> <strong>When should I test my patients for Zika virus?</strong></p> <p> Make sure you and the members of your practice team <a href="" rel="nofollow" target="_blank">know the symptoms</a> of Zika virus, and ask your patients about their travel histories. Both pregnant women and other patients who have symptoms of the virus and have traveled to an <a href="" rel="nofollow" target="_blank">area with Zika</a> should be tested.</p> <p> <strong>How should I test for Zika virus?</strong></p> <p> The CDC offers information about <a href="" rel="nofollow" target="_blank">diagnostic testing</a>, including specimen collection and submission. But all testing must be done through your state and local health departments. You should work directly with these departments when your patients require testing.</p> <p> <strong>Where should I report Zika cases?</strong></p> <p> You should report suspected cases of Zika virus to your state or local health departments to facilitate diagnosis and mitigate the risk of local transmission. If you have a pregnant patient with laboratory evidence of Zika virus, be sure to report this case to your state, tribal, local or territorial health department for inclusion in the <a href="" rel="nofollow" target="_blank">U.S. Zika Pregnancy Registry</a>.</p> <p> <strong>How can I encourage prevention?</strong></p> <p> The most effective way you can help ease the effects of a Zika virus outbreak is to educate pregnant women and their partners on how to prevent Zika transmission. The CDC offers <a href="" rel="nofollow" target="_blank">educational materials</a> that cover where not to travel, the best ways to prevent mosquito bites and how to prevent sexual transmission of the virus.</p> <p> A new <a href="" rel="nofollow" target="_blank">Vital Signs report</a> gives guidance for protecting against the spread of Zika and other mosquito-borne illnesses. These measures can help prevent transmission among your community at large and better protect pregnant women and other vulnerable patients among the community.</p> <p> The AMA continues to regularly update its <a href="" target="_blank">Zika Resource Center</a> to provide the latest information to the public, physicians and other health care workers.</p> <p align="right"> <em>By AMA Wire editor </em><a href="" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f0e0bb01-0c80-4f01-b2b4-73bca73670a3 Court case could extend medical liability Mon, 04 Apr 2016 21:00:00 GMT <p> A state supreme court is set to decide whether the two-year statute of limitations for filing a wrongful death lawsuit should start, as it does now, from the time of death or from the moment the plaintiff learns of the circumstances that may have contributed to or caused death. The distinction is the difference between a finite period in which liability claims can be filed and an undetermined longer period.<a href="" target="_blank"><img src="" style="height:243px;width:365px;margin:15px;float:right;" /></a></p> <p> <strong>What happened</strong></p> <p> At stake in <em>Moon v. Rhode </em>is whether a complaint brought against a radiologist in a wrongful death lawsuit was filed within the two-year timeline allowed under the Illinois statute of limitations.</p> <p> After complications following surgery at Proctor Hospital in Peoria, Ill., Kathryn Moon died on May 29, 2009. In Feb. 2013, Moon’s estate sent CT radiographs to a diagnostic radiologist who concluded that Clarissa Rhode, MD, had negligently misread the scans which caused or contributed to Moon’s death. Moon’s estate sued Dr. Rhode and her employer in a wrongful death action on March 18, 2013.</p> <p> Relying on Illinois’ Wrongful Death Act, which provides that wrongful death suits must be filed within two years of death, the defendants moved to dismiss. The estate, however, argued that the limitation period should start from the time of discovery of the negligence.</p> <p> The story hasn’t stopped there. The trial court granted the dismissal, which the estate appealed. The Illinois Appellate Court affirmed the dismissal but in a split decision. On a second appeal, the case now has moved to the Supreme Court of Illinois.</p> <p> <strong>Why this case matters</strong></p> <p> The statute of limitations is in place to not only allow a significant amount of time for review of the cause of death but also to protect physicians from uncertain liabilities that could hang over them for indeterminate periods of time. If the limitation is extended to the time of discovery—which could occur several years down the road—physicians would be left uncertain over whether something long-past will resurface.</p> <p> “This ruling affects not only Dr. Rhode and her associates but all physicians and licensed health care providers in the state of Illinois,” the <a href="" target="_blank">Litigation Center of the AMA and State Medical Societies</a> said in an <a href="" target="_blank">amicus brief</a> (log in). “This court should give effect to the intent of the General Assembly, which created a fair and just process for tort claims.”</p> <p> “The General Assembly intended to provide the citizens of this state with a limitations period fair to both plaintiffs and defendants,” the brief said. “It balances the need for plaintiffs to bring lawsuits with the defendants’ need to know when their potential liability is extinguished.”</p> <p> “To expand the discovery rule as drafted by the General Assembly,” the brief said, “would contradict the laudable purpose of the legislation. The limitations period language is clear and unambiguous.”</p> <p> <strong>Additional medical liability cases in which the Litigation Center is involved:</strong></p> <ul> <li> Learn how a case in New Jersey <a href="" target="_blank">could leave physicians exposed to large fines</a></li> <li> Read about how physicians are planning to tackle <a href="" target="_blank">liability reform challenges in 2016</a></li> <li> Find out how a case in Oregon could <a href="" target="_blank">increase liability exposure and redefine injury</a></li> <li> Learn how one of the nation’s leading <a href="" target="_blank">medical liability reform laws could be undercut in a state supreme court</a></li> <li> Understand the implications of a case that is set to decide on <a href="" target="_blank">censorship in the exam room</a></li> <li> See the outcome of a court’s decision regarding <a href="" target="_blank">protected patient safety information</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bbaeaa4d-926e-44cc-b10e-1aece4d33e3d Experts take a stand against insurance mergers Fri, 01 Apr 2016 19:00:00 GMT <p> Leading economists and experts representing the physician community last week delivered testimony against the proposed merger of Anthem and Cigna at a hearing of the California Department of Insurance. Find out what they had to say about how the merger would affect patients and physicians.</p> <p> <strong>More competition needed, not less</strong></p> <p> “California should act to block the harmful merger and foster a more competitive market place that will operate in patients’ best interests,” said Henry Allen, the AMA’s top antitrust attorney, in testimony before the California Department of Insurance.</p> <p> “The state’s fragile health care system should not be left vulnerable to a giant health insurance company with anticompetitive market power,” Allen said. “The consequences of the proposed merger would have negative long-term consequences for health care access, quality and affordability in California.”</p> <p> Testimonies opposed Anthem’s bid to dominate the California health insurance market by purchasing Cigna—the state’s sixth largest insurer.</p> <p> “Anthem and Cigna are two of the largest five health insurers in the United States,” said Brent Fulton, associate director of the Global Center for Health Economics and Policy Research. “We are not aware of any peer-reviewed studies that have found that higher insurance market concentration has led to lower health insurance premiums.”</p> <p> The AMA presented state regulators with an <a href="" target="_blank">analysis</a> (log in) that found the proposed Anthem-Cigna merger would run afoul of federal antitrust guidelines in highly-populated metropolitan areas across California.</p> <p> If this health insurer consolidation is allowed, it would compromise the ability of physicians to advocate for their patients, Allen said. In practice, market power allows insurers to exert control over clinical decisions, which undermines the patient-physician relationship and eliminates crucial safeguards of patient care.</p> <p> On the other hand, competition among health insurers can lower premiums, enhance customer service and spur inventive ways to improve quality and lower costs. Patients benefit when they can choose from an array of insurers who compete for their business by offering desirable coverage at competitive prices.</p> <p> The health of the state’s patients is at stake, Allen said. “Conditions in most markets are now heavily tilted toward insurers, giving them an unprecedented advantage in determining the scope, coverage and quality of health care."</p> <p> <strong>Physicians show their opposition</strong></p> <p> 85 percent of California’s physicians are opposed to the merger of health insurance giants Anthem and Cigna, according to a recent <a href="" rel="nofollow">survey</a> conducted by the California Medical Association (CMA) in collaboration with the AMA to gauge physician’s opinion on the mergers.</p> <p> Results of the survey detailed three specific concerns physicians have over the consequences of this consolidation:</p> <ul> <li style="margin-left:0.25in;"> 82.2 percent said it would create narrower networks that make it more difficult for patients to find care from in-network physicians.</li> <li style="margin-left:0.25in;"> 81.9 percent said it would reduce the ability for physicians to advocate on behalf of their patients.</li> <li style="margin-left:0.25in;"> 88.8 percent said it would result in a reduction in the quantity or quality of services that physicians can offer their patients.</li> </ul> <p> In California, where Anthem dominates most markets, high barriers exist for new competitors entering these markets. Potential competitors are typically unable to challenge Anthem’s market dominance due to the insurer’s entrenched position. Allowing Anthem to enhance its market power through the Cigna acquisition would represent an insurmountable barrier for new insurers to expand to California markets and offer competitive choices for patients.</p> <p> “Anthem has been unable to produce evidence to support its claim that the merger will guarantee greater efficiency and lower health care costs,” Allen said. “To the contrary, economic studies have shown that rather than passing any benefits from efficiencies to consumers, health insurer mergers actually result in higher premiums.”</p> <p> More on the proposed mergers:</p> <ul> <li style="margin-left:0.25in;"> <a href="" target="_blank">Physicians stand up against mergers of powerful insurers</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">States where health insurers are squeezing out competition</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0be3e35b-0a8b-4124-9c31-4d568d86aaf7 Rethinking team-based care Fri, 01 Apr 2016 18:53:00 GMT <p> A greater number of technologies, increasingly burdensome regulations and a higher volume of patients have caused physicians to rethink the distribution of work in their practices to spend more time with their patients. Learn about what an expert calls the “hero model” and why the culture of medicine should shift toward physician-led team-based care.</p> <p> “We need to move away from the hero model, where doctors do everything they can and then ask for help afterwards,” said Bruce Bagley, MD, senior advisor for professional satisfaction and practice sustainability at the AMA. “Team-based care is about rethinking how we get our work done and what parts need to be done by the physician versus what parts could be done by other members of the team.”</p> <p> <strong>Changing the culture of medicine</strong></p> <p> Dr. Bagley, who previously served as president and CEO of TransferMED, a subsidiary of the American Academy of Family Physicians, is an expert in team-based care and travels the country helping practices implement this new model of care.</p> <p> “The team-based idea is to redistribute the work strategically,” Dr. Bagley said. “Instead of sending all the work to the most highly trained person to distribute, real team-based care is to think about how the work can be distributed before it gets to the most highly trained person.”</p> <p> Team-based care often is seen as a way for every team member to work at the top of their license or skill level. “I know that’s been a catch phrase, and to me that doesn’t say enough,” Dr. Bagley said. “We’re not talking about traditional roles. Physicians, nurses and pharmacists weren’t trained to use registries to manage chronic illness,” he said. “They weren’t trained in patient engagement, motivational interviewing, shared goal setting—this is all new material. The work is no longer defined by the plaques on the wall.”</p> <p> <strong>How to get started in your practice</strong></p> <p> When approaching team-based care in your practice, Dr. Bagley said you have to “reorganize how you’re doing your work and acknowledge that to be successful you need to be more integrated. This is a team sport.”</p> <p> Ask yourself these three questions:</p> <ul> <li> What can you change about yourself?</li> <li> What can you change about your work environment?</li> <li> What can you change about the system?</li> </ul> <p> “I think there’s an awful lot of energy going into complaining about the system,” Dr. Bagley said, “when the best way to change that is to support your specialty chapter or the AMA—the people that can really make some systematic changes that you can’t quite do as an individual.”</p> <p> “Take that energy and use it to change the things you have control over, like the workings of your local health system or your attitude toward your work,” he said.</p> <p> “If I’m running a one or two doctor office,” Dr. Bagley said, “I’m going to take a loyal employee and send her out to a training session on how to use a registry or how to do motivational interviewing or other things.”</p> <p> “There is no official list of team members that you need for team-based care,” he said. “The focus should be on the tasks that need to be done and how to distribute them among the players that you already have.”</p> <p> <strong>Resources for practice improvement</strong></p> <p> A new <a href="" rel="nofollow" target="_blank">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice implement team-based care. The module details the individual elements of a team-based care model and shows you how to bring all of those elements together.</p> <p> Dr. Bagley recently spoke to the Alaska Chapter of the American College of Physicians and the Alaska Osteopathic Medical Association at an event in Anchorage and also will be speaking in Washington, D.C., April 12. Visit the STEPS Forward <a href="" rel="nofollow">live events</a> page for more information on these and other scheduled events focusing on practice improvement strategies.</p> <p> More than 25 modules are available in the AMA’s <a href="" rel="nofollow" target="_blank">STEPS Forward </a>collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:541efe27-eee7-4d75-831a-591c262d0e50 Get the new ICD-10 chronic disease coding cards Fri, 01 Apr 2016 14:17:00 GMT <p> The ICD-10 code set update for 2017 is on its way. Get ready with five new chronic disease coding cards from the AMA Store.</p> <p> Created for the 2017 edition of the ICD-10 code set, the new <a href="" target="_blank">ICD-10-CM 2017 Chronic Disease Coding Cards: Multiple Specialties</a> provide a unique methodology for selecting the correct diagnosis code for commonly reported chronic diseases. They are available for a number of conditions, including diabetes, hypertension, asthma, arthritis, dysrhythmia, substance abuse and more.</p> <p> With these new coding cards, you can build a code in a compliant and efficient manner by navigating through a series of color-coded choices. Once you arrive at a green box, your code is complete.</p> <p> Some of the key features of the chronic disease coding cards include:</p> <ul> <li> Methodology that ensures specificity and helps avoid incomplete codes and rejected claims</li> <li> Common risk-adjusted diagnoses, which includes codes commonly used incorrectly</li> <li> Unique visual design that clarifies the documentation requirements for coding specific diagnoses</li> </ul> <p> Visit the <a href="" target="_blank">AMA Store</a> to select the correct version for your coding purposes. AMA members receive a 20 percent discount on this product and others from the AMA Store. If you’re not a member, <a href="" target="_blank">join today</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:db07e475-c729-4256-81cf-3fed8f16bbeb How Obama’s opioid initiatives align with physician recommendations Thu, 31 Mar 2016 17:00:00 GMT <p> <em>An</em> <a href="" target="_blank"><em>AMA Viewpoints</em></a> <em>post by Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees</em></p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:left;" /></a>As a nation, we are working incredibly hard to turn the course of the opioid epidemic in a new direction. This week I had the great pleasure to be part of an event that focused on hope, possibilities and action. President Obama announced new initiatives that would expand access to treatment for substance use disorder, among other important actions that align with measures we physicians have recommended.</p> <p> The president’s initiatives, announced Tuesday at the National Rx Drug and Heroin Abuse Summit in Atlanta, combined with the progress of related legislation in Congress, make it clear that addressing this epidemic is a national priority. The administration has taken the next step to expand access to treatment, prevent overdose deaths and increase community prevention strategies. So how do these actions fall in line with the recommendations of the AMA <a href="" target="_blank">Task Force to Reduce Opioid Abuse</a>?</p> <p> <strong>The steps that we need to take</strong></p> <p> We are seeing that physicians have become more judicious in our prescribing practices as the number of prescriptions for opioids has fallen in recent years, according to new data from IMS Health. From 2013 to 2014, the number of opioid prescriptions decreased 2.9 percent nationally. From 2014 to 2015, the number of prescriptions decreased another 6.8 percent, and every state saw a decrease in the number of opioid prescriptions.</p> <p> This is a good sign, but we need many solutions working together to end the nation’s opioid epidemic.</p> <p> Reducing the stigma that surrounds substance use disorders and expanding access to treatment are two such essential solutions. The AMA task force has called for these actions, and the initiatives the president announced also aim to achieve these goals. Stigma has no place in medicine or society, yet its prevalence is clear. Patients with pain deserve care and compassion—not judgment.</p> <p> Several components of the proposal include measures that will help increase treatment for patients with substance use disorders. The Department of Health and Human Services (HHS) is issuing a proposed rule to increase the patient limit for qualified physicians who prescribe buprenorphine to treat opioid use disorders from 100 to 200 patients. This measure aims to increase access to medication-assisted treatment (MAT) combined with behavioral health support for people with opioid use disorders.</p> <p> We are pleased with the extension of the patient limit, but it should not stop there. Treatment with buprenorphine should not be limited to a certain number of patients if the physician is qualified to deliver this kind of care. The benefits have been proven to enhance recovery, so every patient with opioid use disorder should have access.</p> <p> HHS has released $94 million to expand MAT training, which will help increase the number of physicians qualified to prescribe buprenorphine in nearly 300 community health centers that treat underserved communities.</p> <p> Increased patient access to buprenorphine can be further bolstered when physicians take advantage of education to better recognize substance use disorders. We will be better equipped to help our patients on the front lines of this epidemic by doing all we can to help our patients get into treatment, which also includes helping them understand that substance use disorders can be successfully treated. We strongly agree with the president that it is important that we treat opioid use disorder as a disease and not a flaw in the patient who is suffering.</p> <p> HHS also has finalized a rule to enhance access to mental health and substance use services for Medicaid and CHIP plans by treating these conditions in the same way as medical and surgical benefits. According to the White House, these protections are expected to benefit more than 23 million people within these programs.</p> <p> Requiring that substance use disorder be treated and paid for in the same way as other medical conditions is a giant step toward reducing stigma. Patients will feel more comfortable seeking treatment, preventing them from hiding their substance use disorders.</p> <p> Another focus of the task force is to increase access to the lifesaving overdose reversal drug naloxone. As part of the president’s proposal, the Substance Abuse and Mental Health Services Administration is releasing $11 million in funding for states to purchase and distribute naloxone and train first responders in its use. The task force also recommends that physicians co-prescribe naloxone to patients who are at risk of overdose. Learn more about co-prescribing by <a href="" target="_blank">downloading an AMA guide on naloxone</a>.</p> <p> Other important solutions the task force has identified include <a href="" target="_blank">enhanced physician education</a> on managing pain and promoting safe, responsible opioid prescribing and use of state <a href="" target="_blank">prescription drug monitoring programs</a> (PDMP) to check patients prescription histories.</p> <p> <strong>These are significant signs of progress, but action does not end here</strong></p> <p> There is a large and growing gap between the number of patients who need treatment for substance use disorders and the availability of MAT. These initiatives will help to close that gap. Additional details about the <a href="" rel="nofollow" target="_blank">proposal</a> are available on the White House website.</p> <p> Even as we call on Congress to act, we physicians must continue to do everything in our power to end this tragic epidemic. From making sure we have the latest education on safe prescribing practices and are using our state PDMPs to co-prescribing naloxone and reducing stigma, we each can play an important role. Together, we’ll save the lives of tens of thousands of patients.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cc05aa4c-63cb-43dc-b975-a0f4f0f542b3 Physicians among victims of tax fraud Thu, 31 Mar 2016 00:00:00 GMT <p> In the midst of tax season, some physicians are receiving notice that they are victims of identity theft in the form of fraudulent tax filings. Learn the steps to take if this happens to you.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> While the exact number of physicians affected by tax return fraud is uncertain, hundreds of cases have been confirmed in a number of states across the country. According to a report from the Department of Justice, about 7 percent of persons age 16 or older were victims of identity theft in 2014, which is similar to 2012 data and shows that the problem is not going away.</p> <p> But physicians are not the only victims. Thousands of Americans have been impacted by a surge in refund fraud, possibly due to data stolen through an application on the Internal Revenue Service’s (IRS) website last year.</p> <p> <strong>The scheme and how to handle it</strong></p> <p> The thieves are filing false tax returns under stolen Social Security Numbers so they can collect the refunds. When the victims have attempted to file their legitimate tax returns, those returns have been rejected because the fraudsters already filed using the victims’ identity and collected funds based on the false returns.</p> <p> The IRS “<a href="" rel="nofollow">Taxpayer guide to identity theft</a>” offers additional information about tax-related identity theft, including these three warning signs:</p> <ul> <li> You are notified that more than one tax return was filed using your Social Security Number</li> <li> You owe additional tax, refund offset or have had collection actions taken against you for a year in which you did not file a tax return</li> <li> IRS records indicate you received wages or other income from an employer for whom you did not work</li> </ul> <p> If you are a victim of this scam, you should receive a 5071C letter from the IRS with instructions for providing information via the <a href="" target="_blank" rel="nofollow">IRS identity theft website</a>. You also can call the IRS at (800) 830-5084 to let agency officials know that you did not file the return referred to in the IRS’ letter. </p> <p> The next step is to file a paper return if you have not done so already, attaching a Form 14039 Identity Theft Affidavit to explain what happened. You also should attach copies of the 5071C letter and any other notices from the IRS on this issue. </p> <p> If you did not receive a 5071C letter or already have received confirmation that your legitimate tax return was accepted, you most likely are not among this year’s victims. </p> <p>  </p> <p align="right"> <em>By AMA staff writer</em> <a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:49a0b492-9528-42eb-ba29-c5457a618b4e Master the publishing process Wed, 30 Mar 2016 21:50:00 GMT <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>Working toward getting your research published? Physician publishing experts—including two editors in chief—offer practical advice, from conceptualizing your research to writing your paper, targeting the best publications and overcoming rejection.</p> <p> <strong>Start at the very beginning</strong></p> <p> Your success in getting published shouldn’t start with a complete paper. It should start right when you conceptualize your research.</p> <p> Edward Livingston, MD, deputy editor of clinical content for the <em>Journal of the American Medical Association</em> (<em>JAMA</em>), said it all begins with asking the right questions. “Re-examine what’s in front of you,” Dr. Livingston told physicians in training at a recent AMA meeting. “It’s not necessary to find something new [to research]. … You can do more to help patient care if you start thinking in smaller terms.”</p> <p> Dr. Livingston also said residents shouldn’t be deterred by a lack of funding. “Some major science advances were accomplished with minimal funding,” he said. </p> <p> Read <a href="" target="_blank">additional advice</a> about setting yourself up for successful research.</p> <p> <strong>Writing the paper is just as important as conducting the research</strong></p> <p> “You need to be thinking about the paper from the get-go,” said Susan Bates, MD, senior clinical investigator and head of the Molecular Therapeutics Section in the Developmental Therapeutics Branch and Coronary Vector of Columbia University’s BA Cancer Initiative.</p> <p> “It’s not cheap science to think about the paper,” Dr. Bates told residents at a recent AMA meeting. “It’s a way of executing what you do …. You need to have an idea about the point of your paper and the story you’re going to tell.”</p> <p> <a href="" target="_blank">Read more</a> about Dr. Bates’ key tips for researching and writing your paper for publication.</p> <p> Howard Bauchner, MD, <em>JAMA</em> editor in chief, <a href="" target="_blank">offers five tips</a> for residents who are presenting their research in a paper for publication.</p> <p> “Only … a select number of people will read your whole paper,” Dr. Bauchner said. “I can’t emphasize enough how important the abstract is.”</p> <p> <strong>Target your submissions, and don’t be deterred by rejection</strong></p> <p> Knowing where to submit your research is half the battle of breaking into medical publishing. When you’re considering where to send your work, take time to research publication guidelines and special opportunities that fit your level of training.</p> <p> View <a href="" target="_blank">this list of peer-reviewed publications</a> to help you get started on the road to successful publication.</p> <p> Dr. Bates says both targeting publications that fit the scope of your research and tailoring your submissions to the publications are essential. One commonly overlooked step is following the journal’s specific author instructions. “Sometimes you’ll prepare a paper, and it’ll be just perfect, but it’ll [have] three times too many figures and twice as many words” as the required author guidelines, she said.</p> <p> Read <a href="" target="_blank">additional common pitfalls</a> Dr. Bates says residents should avoid.  </p> <p> And if at first you don’t succeed, try, try again. Gail M. Sullivan, MD, editor in chief for the <em>Journal of Graduate Medical Education </em>suggests following <a href="" target="_blank">six steps</a> to overcome rejection. She covers issues from what to do with the rejection letter to evaluating why your paper was turned down to the decision of whether and where to resubmit your paper.</p> <p align="right"> <em>By AMA Wire editor </em><a href="" rel="nofollow" target="_blank">Amy Farouk</a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:41118aef-36b8-4cd7-9473-61a3df3a4de2 The role of personal accomplishment in physician burnout Tue, 29 Mar 2016 20:54:00 GMT <p> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>Physician burnout is on the rise, but providing an environment that boosts doctors’ sense of personal accomplishment and increases professional rewards could help them feel less emotionally exhausted and more energized about their daily work. Experts say it is one of a number of areas that need to be addressed to reverse the burnout trend.</p> <p> <strong>Less personal satisfaction</strong></p> <p> Nearly 55 percent of physicians who responded to a Mayo Clinic survey in 2014 were professionally burned out, up from nearly 46 percent just three years earlier, according to the <a href="" rel="nofollow">study</a> in the <em>Mayo Clinic Proceedings</em>. When asked specifically about their sense of personal accomplishment, 16.3 percent of physicians had a low sense of personal accomplishment in 2014; just 12.4 percent felt that way in 2011.</p> <p> A major driver of physician satisfaction, study authors said, comes from a sense of providing excellent care for patients.</p> <p> “That is why we went to medical school,” said one of the study’s authors, Christine Sinsky, MD, vice president of professional satisfaction at the AMA. “So anything that gets in the way of taking care of patients takes away from a sense of personal satisfaction.”</p> <p> And there’s a lot that gets in physicians’ way of taking care of patients these days: chaotic work environments, lack of control in their work environment and time pressures, to name a few.</p> <p> Transferring administrative tasks away from physicians helps doctors’ sense of satisfaction, Dr. Sinsky said: “This allows physicians to do the job they were trained for instead of spending half their day doing clerical tasks—work that doesn’t require 11 years of education.”</p> <p> Improving work flow also helps. “When you make things more efficient, physicians have more time to listen to their patients, to connect with their patients and to think more deeply about their patients,” Dr. Sinsky said.</p> <p> Helping physicians determine what drives their professional satisfaction and giving them the time to pursue that passion also could go a long way in helping combat burnout, too, said Lotte N. Dyrbye, MD, one of the study’s authors and a professor of medicine and medical education and associate chair for faculty development in the Department of Medicine at the Mayo Clinic. For example, some physicians’ passion is helping patients, for others it is teaching the next generation of physicians and still others may find that professional satisfaction from being on the cutting edge of developing new treatments.</p> <p> “If a physician can spend 20 percent of the week—one of five work days—doing something that is most meaningful, it can help increase their sense of professional satisfaction and lower their risk of burnout,” said Dr. Dyrbye, whose research focuses on physician well-being.</p> <p> Organizations should also look at what their leadership is doing to encourage physicians they manage. Dr. Dyrbye said “if a division chair or department chair holds career development conversations with physicians underneath them and inspires them to do their best, it makes a difference.”</p> <p> <strong>Celebrating success</strong></p> <p> Medicine as a profession takes a hard look at the things that go wrong and spends little time celebrating successes—more so than in other professions, according to an <a href="" rel="nofollow" target="_blank">editorial</a> that accompanied the <em>Mayo Clinic Proceedings</em> burnout study.</p> <p> “Correct diagnosis or successful surgery outcomes quickly disappear into the background, whereas mistakes become a point of discussion among colleagues, perhaps a focus of dissection at the weekly grand round conference or in a published journal article or potentially the basis of a lawsuit,” the editorial notes. It concludes that “focusing on potential mistakes is a poor recipe for encouraging the highest levels of performance.”</p> <p> Dr. Dyrbye said physicians work hard and are critical of themselves, and they have a constant drive to do better.</p> <p> “We sell ourselves short by not celebrating our successes,” she said, noting that recognizing hard work could help physicians feel a sense of personal accomplishment.</p> <p> For example, Dr. Dyrbye recalls being promoted to professor and the accomplishment being recognized by receiving a piece of paper in the mail. It was a missed opportunity to celebrate the hard work and success into achieving that goal, she said.</p> <p> “Now in the Department of Medicine, we send notes to faculty when they are promoted, and we frame the certificate,” Dr. Dyrbye said. “It’s a small way to say we recognize the huge amount of work that goes into this.”</p> <p> <strong>What next?</strong></p> <p> Drs. Dyrbye and Sinsky and their colleagues concluded that meaningful change in physician burnout will require a response at the personal and organization levels. Factors such as struggles with work-life balance, work overload and inefficiency, and loss of autonomy contribute to physician burnout. And they need to be addressed, along with systems factors such as sufficient staffing and efficient work flows.</p> <p> “It is multifactorial; there is not one single culprit or one single magic bullet,” Dr. Sinsky said. Reducing burnout requires interventions at multiple levels.”</p> <p> Promoting physicians’ wellness and ability thrive is a <a href="" target="_blank">top priority</a> for the AMA, which will host the <a href="" target="_blank">International Conference on Physician Health™</a> Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> The AMA’s STEPS Forward™ collection of practice solutions also offers resources for physicians on <a href="" rel="nofollow" target="_blank">improving physician resiliency</a>, <a href="" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="" rel="nofollow" target="_blank">preventing resident and fellow burnout</a>.</p> <p> <strong>Learn more about physician burnout and solutions:</strong></p> <ul> <li style="margin-left:0.25in;"> <a href="" target="_blank">How the Mayo Clinic is battling burnout</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">Ward off burnout: Your peer network may impact more than you think</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">4 physician-recommended steps to work- and home-life balance</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">6 key aspects residents need for well-being</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">How physician burnout compares to general working population</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0eeadde5-eae8-4ada-b873-23b45847e465 Raw data not enough to determine physician competency Tue, 29 Mar 2016 18:36:00 GMT <p> <em>An AMA Viewpoints post by AMA President Steven J. Stack, MD</em></p> <p> <a href="" target="_blank"><img src="" style="float:left;margin:15px;" /></a>Our relationship with patients is a partnership—just as we gather information about our patients for their health care, patients should have access to information about us as well. But, the information provided to patients should be accurate, complete and support their ability to make informed decisions. Without these safeguards, patients will be encouraged to make ill-informed decisions about their physicians based on misleading and incomplete data.</p> <p> <strong>A state-held responsibility</strong></p> <p> Currently, states are vested with the authority to evaluate the impact of medical liability settlements on physician competency. A recent proposal, from <em>Consumer Reports</em>, wants to place this responsibility in the hands of the federal government by allowing patients’ access to the flawed National Practitioner Data Bank which holds unanalyzed, raw data on physicians.</p> <p> Patients should have access to reliable information about physicians, and state regulatory agencies—not the federal government–are best positioned to offer well-balanced information to help patients make informed decisions regarding physicians—for two reasons.</p> <p> <strong>An inaccurate data bank</strong></p> <p> First, judicious and complete information that many states are working to give patients stands in stark contrast to information contained in the inherently flawed National Practitioner Data Bank. The Government Accountability Office (GAO) has said that its “detailed tests raise serious concerns about the integrity of National Practitioner Data Bank information.” The GAO found that the data bank is riddled with duplicate entries, inaccurate data and incomplete and inappropriate information.</p> <p> This responsibility should rest with state regulatory agencies which already provide patients with reliable, well-balanced and complete information on physicians. State regulators are best suited to evaluate and determine how liability settlements reflect a physician’s competency. Failing to provide this important investigative safeguard distorts the true picture of the quality of health care we deliver.</p> <p> <strong>Physicians take on risk to help their patients</strong></p> <p> Second, a vast majority of reports in the National Practitioner Data Bank are based on legal settlements that were never adjudicated by a court, never proven to involve negligence or never settled with the consent of a physician. Consequently, settlement information offers an incomplete and often misleading indicator of physician quality and competence.</p> <p> Sometimes, a hospital or a physician determines that they will take less of a financial hit by settling as opposed to litigating a claim, even when no negligence has occurred.</p> <p> The nation's best physicians who practice cutting-edge medicine take on the riskiest cases, yet the National Practitioner Data Bank information does not acknowledge their high-level of competence, but rather focuses only on the fact that they are involved in settlements. </p> <p> Information on truly negligent practitioners absolutely should be disclosed to the public. However, the relationship of medical liability claims to physician skill is ambiguous. State governments have recognized this and require their regulatory agencies to provide an investigative review of medical liability records rather than simply disseminating unreliable legal data to patients. The information provided to our patients must be based on the true competency of a physician with much weight put on the risks they were willing to take for their patients. </p> <p> As physician representatives, the AMA agrees with the conclusions of Congress, prominent commissions, institutes and other health care leaders who have found that opening the National Practitioner Data Bank would not help patients. We must ensure that our patients are accurately informed and to ensure this, the best approach is to enhance the state-based investigative and reporting systems already in place.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8098fb15-3113-455b-b957-ea619f763d3a 6 key factors that build residents’ trust in interns Tue, 29 Mar 2016 00:00:00 GMT <p> For medical students who are looking ahead to their first year of residency, understanding what forms the foundation of senior residents’ trust in junior colleagues can be an important part of that transition. A new study reveals factors that help build trust and maximize autonomy of interns under resident supervision.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> While many factors go into the formation of trust, six in particular stood out from interviews with residents, as explained in new <a href="" rel="nofollow" target="_blank">research findings</a> in <em>Academic Medicine</em>. The authors of the study conducted interviews between January and March 2015 with 478 residents from five internal medicine programs. The interviews were rooted in a model for how residents develop trust in interns, which was created through preliminary interviews with residents at the University of California, San Francisco.</p> <p> Residents rated three intern characteristics highest in terms of their importance for building trust: Reliability, competence and propensity to make errors. Three contextual factors also emerged as highly important: access to an electronic health record (EHR), duty hours and patient characteristics.</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Reliability:</strong> Residents reported higher trust of interns who were able to prioritize tasks, follow through and seek help as needed.</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Competence:</strong> Residents said that interns show their competence by devising and implementing plans of care, responding to new and acute issues, and demonstrating knowledge.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Propensity to make errors:</strong> Overlooking a lab value or ordering a wrong medication obviously can erode residents’ trust in an intern, but interviewees also indicated that interns build trust by responding to feedback and cutting down on errors.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Access to an EHR:</strong> An important aspect of an EHR is that it allows residents to remotely monitor interns as they complete critical tasks. This enables greater intern autonomy while allowing residents to fulfill supervisory duties.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Duty hours:</strong> Residents report that they get a clearer picture of interns’ competence and thoroughness when they handle more tasks themselves on the interns’ days off.</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>Patient characteristics:</strong> An environment in which there are many patients fosters greater trust, as residents are not able to provide the same level of supervision for every patient. Sicker patients are associated with less trust-building between interns and residents because these patients require more attention from all team members, which limits intern autonomy.</p> <p> Residents also described how they had a harder time trusting interns when they themselves were new to the supervisory role, but over time they became more confident in building trust and relinquishing responsibilities to interns.</p> <p> “Residents appear to consider trust in a way that prioritizes interns’ execution of essential patient care tasks safely within the complexities and constraints of the hospital environment,” the authors wrote.</p> <p> The study’s findings could help medical students understand how to build professional relationships during residency and suggests that environmental, routine and curriculum changes could better foster the formation of trust, authors noted.</p> <p align="right"> <em>By contributing writer Tim Mullaney</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4c9f343e-ae3f-473b-9e4e-58ba8ba26fe7 Ways a Chicago health network is improving community health Mon, 28 Mar 2016 21:00:00 GMT <p> True wellness encompasses treatment of current conditions as well as prevention and improved quality of life. But what happens when communities face overwhelming social determinants of health that interfere with their health care opportunities? Find out how a community health network in Chicago is overcoming these barriers to provide comprehensive care for its patients.</p> <p> <strong>A number of factors prevent true wellness</strong></p> <p> “There are a lot of barriers out there that prevent someone from having true wellness,” said Donna Thompson, chief executive officer of ACCESS Community Health Network in Illinois. “The need to access affordable, quality, comprehensive health care continues.”</p> <p> Thompson has been leading ACCESS for more than a decade and also has been a nurse for more than 40 years. “My journey really started at the bedside … in central Illinois taking care of patients,” she said. “As I made my way to Chicago … I had a curiosity about why there are people who enter the health care arena and get better while others, in a very episodic way, still continue to have challenges with their health [that] many times [are] generational.”</p> <p> <a href="" target="_blank"><img src="" style="margin:15px;float:left;" /></a></p> <p> Her work with ACCESS began at a clinic on Chicago’s South Side near the Robert Taylor homes, known at one time to be the largest concentration of public housing in the nation. It was there that she saw the real effect of social determinants on the health of the community. People were struggling with housing, “and even if they did have housing, we’d see asthmatics because there were rodents or lead in the buildings,” she said.</p> <p> Patients struggled to pay for their prescriptions, find adequate food or secure a place to sleep. Patients would come in without appointments and wait for hours to be seen. At that time, the health centers only had the ability to treat patients’ immediate needs without much long-term health planning.</p> <p> Over one-half of patients who come to community health centers live below the poverty level and are enrolled in some type of Medicaid. But now ACCESS is equipped to address both the health needs of their patients as well as the social determinants that affect their outcomes.</p> <p> “Within the health center you have teams … working in a coordinated way to manage the health care needs of many,” Thompson said. “But when you get [some] patients in the exam room, they quietly tell their provider, ‘I’m hungry; I don’t know about my housing; my son is incarcerated again; I can’t take my medication because it says ‘take with food,’ and I don’t have food.’”</p> <p> “I often say that many of our patients [feel] invisible,” she said. “The best way we can give [them] a voice is to really make sure that we are consistently questioning and pushing the needle around quality.”</p> <p> <strong>Putting a stake in the ground for change</strong></p> <p> For all the reasons above, ACCESS asked themselves these questions: How can health care be more than just an episodic intervention? How do you really create true partnerships?</p> <p> “Two years ago, we put a stake in the ground on how we’re going to make those efficiencies possible,” Thompson said. A few of the changes they wanted to make were reduced waiting time for patients, same-day access to services, more consistent care over longer periods of time, extended hours for patients who work during the day and extended reach into the community through social agencies.</p> <p> “The great thing about community health centers is that they’ve never been a medical-only model,” she said. “You might have people in the lobby helping patients register to vote … people who work on the outside of the health center infused in the community who ... work to partner with other social service agencies to get people to understand why it’s important to manage their diabetes or how to prevent heart disease.”</p> <p> “As physicians are getting patients to engage in trust,” she said, “they can’t dismiss the social issues that it comes with in these areas.”</p> <p> Four of the many ways that ACCESS has addressed patient and community needs include:</p> <ul> <li> <strong>Extended hours.</strong> ACCESS implemented extended hours at its health centers and is planning to open one health center on Sundays. “A lot of our patients are working every day,” Thompson said. Now they can come in as early as 7 a.m. to access care before work.</li> </ul> <ul> <li> <strong>Scheduling freedom.</strong> Patients now can go through a portal that allows them to schedule appointments on their own all day every day. ACCESS has seen no-shows drop from about 40 percent to about 10 percent since beginning use of the patient portal.</li> </ul> <ul> <li> <strong>Smaller waiting rooms.</strong> Waiting rooms were reduced in size as a result of decreased wait times and no-shows, which opened up that extra real estate for other resources and services.</li> </ul> <ul> <li> <strong>Partnerships with other organizations.</strong> Through community relationships, such as with the Greater Food Depository, the health care teams at ACCESS learn more about the socioeconomic needs of their patient population to understand how they can provide more comprehensive care in these communities.<br /> <br /> For example, ACCESS found that in Chicago Heights, “there are plenty of grocery stores,” Thompson said, “but not everyone can afford to shop at those grocery stores.”</li> </ul> <p> “There’s not a one size fits all,” she said. “Every community is unique, and part of what we do is go into the community, look at the assets and really figure out as a collaborative member of a team of individuals who care about health, how to best deliver a service.”</p> <p> Watch <em>AMA Wire®</em> for more details from Chief Medical Officer Jairo Mieja, MD, on how ACCESS coordinates care.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:439ae0f4-f57d-4eca-8530-bd909b445c3a Test your USMLE Step 2 readiness with this most missed question Sat, 26 Mar 2016 00:00:00 GMT <p> If you’re gearing up to take the United States Medical Licensing Examination® (USMLE®) Step 2, <a href="" target="_blank">this series</a> is for you. Each month, we’re giving you an exclusive scoop on the most missed USMLE Step 2 test prep questions and expert strategies to help you beat them. Check out this month’s most challenging question, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong><br /> A 22-year-old African immigrant presents to the hospital with acute abdominal pain. The pain is worst in the left upper quadrant and is described as sharp. She has had this pain for the past several days. She has noticed these episodes frequently in the past but has chosen to ignore them until now. She has not seen a physician in many years, and her past medical history is unknown. She is not taking any medications. On physical examination, vital signs are: temperature 98°F (36.7°C), heart rate 102/min, BP 120/72 mm Hg, RR 18/min. Head and neck examination shows pale mucosa. Chest is clear to auscultation. Heart is tachycardic to auscultation, and a loud systolic murmur is heard throughout the precordium. Pain is elicited upon palpation of the left upper quadrant.</p> <p> Laboratory data are:</p> <ul> <li> WBC: 5,700/mm<sup>3</sup></li> <li> Hct: 25 percent</li> <li> Hb: 8 g/dL</li> <li> Platelets: 250.000/mm<sup>3</sup></li> <li> Creatinine: 1.1 mg/dL</li> <li> Total bilirubin: 4.9 mg/dL</li> <li> Conjugated bilirubin: 1.0 mg/dL</li> </ul> <p> Chest radiography demonstrates no consolidation; however, the vertebrae are noted to be H-shaped. An ultrasound of her abdomen is performed, demonstrating a shrunken spleen and several gallstones without evidence of cholecystitis. Which of the following is the most likely composition of these gallstones?</p> <p style="margin-left:40px;"> A.  Black pigment</p> <p style="margin-left:40px;"> B.  Brown pigment</p> <p style="margin-left:40px;"> C.  Calcium oxalate</p> <p style="margin-left:40px;"> D.  Cholesterol</p> <p style="margin-left:40px;"> E.  Uric acid</p> <p> <object data="" height="350" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is A.</strong></p> <p> <strong>Kaplan says, here’s why:</strong> The correct answer is A. This patient has sickle-cell anemia and is having an acute pain crisis. The clues in the vignette are the H-shaped vertebrae (caused by bone infarctions), the shrunken spleen, and the unconjugated hyperbilirubinemia. Gallstone disease is common in patients with sickle-cell anemia, and the type of stones is black pigment stones composed of calcium bilirubinate. This is a consequence of excessive hemoglobin breakdown and incorporation into the bile. Precipitation of the breakdown pigments with calcium leads to black pigment stone formation. Most sickle-cell patients are asymptomatic, and while cholecystectomy can be considered, these patients are at increased risk for postoperative complications.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer to help you prepare with studying.</em></p> <p> <strong>Choice B:</strong> Brown pigment stones are caused by chronic infection, often parasitic, of the biliary tree. These stones are composed of calcium salts of unconjugated bilirubin with small amounts of cholesterol and protein.</p> <p> <strong>Choices C and E:</strong> Calcium oxalate and uric acid stones are most often associated with nephrolithiasis, not cholelithiasis.</p> <p> <strong>Choice D:</strong> Cholesterol stones are the most common type of gallstones, accounting for approximately 80-85 percent of all gallstones. Women and obese individuals are predisposed to cholesterol gallstone formation.</p> <p> <strong>One key tip to remember:</strong></p> <p> Conditions that cause chronic hemolysis, including sickle-cell anemia, predispose patients to the formation of black pigment gallstones secondary to the biliary precipitation of excess hemoglobin breakdown products.<br />  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:102ab8cc-5391-475c-ab4d-408b8a154d18 Health system makes cutting-edge telemedicine affordable Fri, 25 Mar 2016 20:04:00 GMT <p> With the right kind of equipment, can a video conference between an ambulance and an on-call neurologist deliver the same stroke assessment results as at the bedside in the emergency room? The University of Virginia Health System, after over one year of research, is poised to find out.</p> <p> Previously, <em>AMA Wire®</em> brought you the theory behind the University of Virginia (UVA) Health System’s research efforts to <a href="" target="_blank">bring telemedicine to the ambulance</a> so they can improve care for patients who are experiencing a stroke. We recently caught up with the UVA team to find out that their telestroke model iTreat is now in action.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> Andrew M. Southerland, MD, a neurologist with UVA, and his team already have provided this advanced telemedicine service to patients. “We have enrolled seven patients thus far, so it’s very preliminary,” he said. “We would like to see that number increase, and our goal for this initial phase is roughly 50 patients.”</p> <p> “The ultimate goal,” Dr. Southerland said, “is to take this preliminary data and use it to inform a larger multicenter trial to test this across a variety of different health care settings. We’re trying to capture whether we can get the same accuracy of the neurological exam during ambulance transport via video that we would normally get at the bedside in our emergency room.”</p> <p> <strong>The set up</strong></p> <p> Currently, UVA has mobile telestroke kits installed in six different ambulances from rural-based agencies that triage to UVA Medical Center. “We have several additional [ambulances] on the launch pad and ultimately hope to encompass our entire regional triage network,” Dr. Southerland said.</p> <p> “Each ambulance is equipped with our iTREAT kit, which is a custom set up using low-cost components,” he said. The team can build a kit and outfit an ambulance right now for around $1,800. The goal is to keep it less than $2,000 per ambulance to make it widely accessible.</p> <p> “Our [other] goal is to keep it portable,” Dr. Southerland said, “so that it can be taken on and off the ambulance, depending on if they’re in service or out of service, [and] keep it simple for any emergency provider to use.”</p> <p> The video connection is channeled through a cellular network, securely encrypted to comply with Health Insurance Portability and Accountability Act (HIPAA) requirements. An antenna channels into a high-powered modem in the kit, which makes the ambulance a Wi-Fi environment. The video call occurs across a secure teleconferencing platform.</p> <p> <strong>The protocol</strong></p> <p> Because the telestroke model is currently considered a research study, it’s not intended to interfere with normal treatment for patients. A clinical protocol has been set up to enroll the patients if they are eligible and then get the video conference underway:</p> <p style="margin-left:40px;"> 1.  A patient has a stroke in a rural or regional community, and an ambulance agency responds to the patient.</p> <p style="margin-left:40px;"> 2.  EMS providers evaluate the patient on the scene using the Cincinnati Pre-hospital Stroke Scale—a three-point standard preliminary screening. If anything is abnormal, they call in a stroke alert.</p> <p style="margin-left:40px;"> 3.  The ambulance begins to transport the patient and calls the medical communications system to alert them that they are on their way. If the patient is eligible for the research study, the neurology team gets a study call from the medical communications center.</p> <p style="margin-left:40px;"> 4.  The on-call neurologist then calls the iPad that is part of the iTreat kit in the ambulance. A neurological assessment begins over a video call.</p> <p style="margin-left:40px;"> 5.  The neurologist takes an acute stroke history and performs the NIH Stroke Scale with the emergency provider as tele-presenter. The data is recorded and the patient is then transferred to the specified emergency department.</p> <p> <strong>4 steps for adopting telemedicine in your practice</strong></p> <p> A <a href="" target="_blank" rel="nofollow">new module</a> from the AMA’s <a href="" target="_blank" rel="nofollow">STEPS Forward</a>™ collection of practice improvement strategies can help you use telemedicine in your practice. In the module, you will find these four steps to adopt telemedicine:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Familiarize yourself with federal and state laws and regulations.</strong><br /> Physicians around the country are working to pass federal legislation to allow for expanded use of telemedicine in all aspects of practice. The CONNECT for Health Act and the FAST Act both seek to open the doors for telemedicine.<br /> <br /> Look to your state medical association for information on telemedicine legislation at the state level.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Identify a service model that best meets your goals and the needs of your patients.</strong><br /> There are numerous service models that you could adopt in your practice. These could include: Providing direct care for your patients using videoconferencing; serving as an originating site to connect patients to other physicians; serving as a distant site by consulting with other physicians or advance practice nurses; or remotely monitoring chronic illness patients to help prevent hospital readmissions.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Determine the technology and support needed while following all applicable privacy laws.</strong><br /> It is important to select the right technology, keeping in mind relevant technical requirements, interoperability, sufficient bandwidth and other factors.<br /> <br /> UVA’s model uses HIPAA-encrypted data sharing lines to conduct their calls. Select HIPAA-compliant technologies (both hardware and software), and enter appropriate business agreements when implementing your own telemedicine models.<br /> <br /> You can find more technology guidance from the <a href="" rel="nofollow">HRSA-funded Telehealth Resource Centers</a>.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Understand appropriate practice guidelines to initiate a telemedicine service model.</strong><br /> Be sure to follow appropriate specialty clinical practice guidelines. Contact your medical specialty society for information about any clinical practice guidelines it may have related to telemedicine.<br /> <br /> Also, be sure to adhere to all state and federal regulations that impact telemedicine practice. <a href="" target="_blank">State medical board websites</a> are a good resource for consulting policies and regulations in your state.</p> <p> In addition, Dr. Southerland suggests that if you’re looking to implement telemedicine in your practice, “Consider reaching out to local telecom providers and wireless vendors to better understand connectivity and broadband capability in your area.”</p> <p> For further reading:</p> <ul> <li> Get <a href="" target="_blank">answers to your telemedicine questions</a></li> <li> See how the AMA is <a href="" target="_blank">addressing the top telemedicine issues</a></li> <li> Learn the <a href="" target="_blank">three ways physicians are prepping for telemedicine’s success</a></li> <li> Find out <a href="" target="_blank">why one health insurer is embracing telemedicine</a></li> </ul> <p> More than 25 modules are available in the AMA’s STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5b14ffe6-acf6-4a5f-8686-2fb651b0f61b What med ed and organizational change have in common Thu, 24 Mar 2016 21:00:00 GMT <p> The AMA’s Accelerating Change in Medical Education Consortium, which includes 32 medical schools, is working to create the medical school of the future by developing and spreading innovative ideas and practices. But making major curriculum revisions is no easy feat. Learn how the ideas of leading thinkers on business innovation can be applied by medical schools embarking on radical change.</p> <p> <strong>Honest self-assessment</strong></p> <p> Rajesh Mangrulkar, MD, associate dean for medical student education at the University of Michigan Medical School, recently spoke at the AMA’s ChangeMedEd 2015 conference about his institution’s journey in transforming its med school curriculum as a founding member of the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education Consortium</a>.</p> <p> “What we envisioned needing our curriculum structure and project to go through was big and very different than what we had had at Michigan,” Dr. Mangrulkar said. “Honestly, when I would give ... presentations on what we were envisioning, some people said this is the biggest change at Michigan in 50 years. Some people said 100 years.”</p> <p> A recent attempt at curricular innovation did not inspire confidence that such an ambitious project could succeed. In 2008, Dr. Mangrulkar led a project to create a more competency-based and time-independent curriculum. That ended in a “public, fiery death,” he told the audience comprised primarily of academic physicians.</p> <p> This time around, he and his colleagues turned to the business literature for ideas on how to achieve a different outcome. Specifically, they needed to rally enough support for the curriculum change to win over a majority of the medical school faculty, who vote on any major structural change.<object align="right" data="" height="350" hspace="15" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> The Disruptive Innovation model created by Harvard Business School’s Clayton Christensen provided a useful framework for how the transformation project could be structured within the University of Michigan Medical School’s existing organization.</p> <p> Dr. Mangrulkar and his team began with a self-assessment.</p> <p> “We needed to understand what our own processes were and [what] our own values were, and so we did an honest, authentic assessment of Michigan’s culture of innovation, our processes and procedures for curricular management, and who we had on the team,” he said.</p> <p> The existing values of the main power brokers at the University of Michigan Medical School—the department heads—were good advocates for education but not strongly aligned with major, transformational change, they determined. In addition, the analysis revealed that the school had strong processes rooted in good deliberative governance and that the leaders who would spearhead the innovation efforts were skilled but still weary and affected by the failed effort in 2008.</p> <p> Based on these findings, they decided to embed the project within the existing governance structure—a different plan than in 2008, when a separate think tank had been established, akin to the “crazy people in the garage” doing innovative things, Dr. Mangrulkar said.This time, he and his colleagues adopted what in the parlance of Disruptive Innovation was a “heavyweight team within the organization.”</p> <p> A steering committee and operational committee, with several work groups and teams, were established for the curriculum strategic planning process. But they all would report to the school’s existing curriculum policy committee, which directly reported to the executive committee representing the faculty and chaired by the dean.</p> <p> <strong>8 steps for success</strong></p> <p> An eight-step process for leading change from another Harvard Business School professor, John Kotter, formed the backbone of the efforts to facilitate the more recent curricular transformation. In particular, the first six steps propelled the project from its earliest stages through the necessary faculty vote, taking a full two and one-half years of groundwork.</p> <p style="margin-left:.5in;"> <strong>1. </strong> <strong>Establish a sense of urgency.</strong> This is crucial so that stakeholders understand why such sweeping changes are needed, even when immediate results in the form of graduation and residency matching rates are good. The dean needed to own this message, which ultimately took the form of five talking points developed from stakeholder surveys, dialogues and similar efforts. The fifth was broad: “Society needs us to change.” But the others all were focused internally and were understandable within the context of the school.</p> <p style="margin-left:.5in;"> <strong>2. </strong> <strong>Establish a powerful guiding coalition.</strong> Those leading the innovation project enlisted the support of a wide variety of stakeholders, including from the health system owned by the University of Michigan. The steering committee included the hospital CEO and representatives from the Veterans Affairs hospital. Dr. Mangrulkar also emphasized that “getting the AMA to support our ideas was very powerful.”</p> <p style="margin-left:.5in;"> <strong>3.  Create a vision.</strong> The curriculum structure itself was not the vision, but rather it was how that curriculum would result in a new type of graduate who would posess additional skills and abilities. The vision that was developed during a three-hour retreat centered around the idea that every Michigan graduate must be able to lead change in health, health care and health care science.</p> <p style="margin-left:.5in;"> <strong>4.  Communicate that vision.</strong> Inspired by other schools in the AMA’s Accelerating Change in Medical Education Consortium, Michigan hired an outside marketing and branding firm—the same one that worked with the school’s athletic department. The firm developed the “Michigan Medicine: Transforming, Creating, Leading” branding, with messaging that resonated with students, faculty and staff.</p> <p style="margin-left:.5in;"> <strong>5.  Empower others to act on the vision.</strong> Student involvement was a key part of this step. The student body was engaged from the beginning of the process, taking part in the operations and steering committees, the work groups, and a new student advisory committee for the curriculum transformation. This “powerful group” has included upward of 100 students, which is a “stunning” proportion of the school’s total 780-student enrollment, Dr. Mangrulkar said.</p> <p style="margin-left:.5in;"> <strong>6.  </strong><strong>Planning for and creating short-term wins.</strong> About 300 people led the charge for the curriculum overhaul. They developed pilots and experiments and disseminated their work through multiple venues, including retreats and conferences with poster presentations. An important aspect here was to share information not only about successes but also about the results that were not positive to convey that the team genuinely was interested in the nuances that would go toward enacting a successful transformation and that the model would always continue to evolve based on experience.</p> <p> When the faculty vote occurred in June, they approved the curricular innovation by a 4:1 margin, with a record turnout of nearly 800 medical school faculty.</p> <p> Steps seven and eight of Kotter’s process call for institutionalizing the changes that have begun. This will be a new and challenging endeavor, but Dr. Mangrulkar is fully optimistic and hopes that this process has helped establish a culture at Michigan that is more nimble and able to embrace and work through large-scale transformations going forward.</p> <p> “We’ve had a successful vote, but change is a process that is never over,” he said.</p> <p align="right"> <em>By contributing writer Tim Mullaney</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b79b8353-5080-4369-ad53-77b3b5f27c09 Why medical trips abroad are invaluable for residents Wed, 23 Mar 2016 22:00:00 GMT <p> OB-GYN resident Stacy M. Lenger, MD, recently spent a week of her vacation helping patients in Central America as part of a surgical mission trip. She reflected on her experience in a February <a href="" rel="nofollow" target="_blank">observations piece</a> in the <em>Journal of Graduate Medical Education</em> and said that in the short time she was there, she gained valuable insight and experience she might not otherwise have acquired.</p> <p> Dr. Lenger, a third-year resident at the University of Tennessee Graduate School of Medicine, said she participated in repeated vaginal and abdominal hysterectomies and provided primary medical care at remote clinics that didn’t have the access to diagnostic testing and labs that physicians are accustomed to in the United States.</p> <p> She recently shared a little more about her experience with <em>AMA Wire</em>.</p> <p> <strong><em>AMA Wire</em></strong><strong>: One lesson you said was constantly emphasized during the trip was “don’t forget your basic assessment skills.” How did you use these skills abroad?</strong></p> <p> <strong>Dr. Lenger:</strong> We had many gynecology patients who would show up to clinic with a chief complaint of pelvic mass. Occasionally, they would bring a paper copy of an ultrasound performed three months prior at the “city hospital” a couple of hours away. The report was written in Spanish, and the images were of such poor quality that you could not decipher characteristics of the mass. We would have to rely on our physical exam to characterize the mass size and location to determine if surgery was necessary. We had no access to ultrasound or other imaging modalities at our facility to assist in making decisions.</p> <p> Also, instead of obtaining a hemoglobin or hematocrit on each patient that had a chief complaint of menorrhagia, we would use physical exam findings—such as lower palpebral conjunctiva pallor—to assist in determining if our limited access to labs should be used on a particular patient.<br /> <br /> <strong><em>AMA Wire</em>: Now that you are back in the states, will you use your basic assessment skills more often or use them in a different way, thanks to your experience in Central America?</strong></p> <p> <strong>Dr. Lenger:</strong> I use the experiences gained to add to my medical decision-making in patient care. I still order imaging when I believe it will add to my decision-making, but I am reminded that you don’t have to order every lab or diagnostic test just because it is available.</p> <p> <strong><em>AMA Wire</em></strong><strong>: In the piece you mentioned cultural awareness and cost awareness—are these areas that you approach or think about differently now?</strong></p> <p> <strong>Dr. Lenger:</strong> After the trip I have found myself more frequently thinking: “Will this test change my decision-making?” Although medicine should always be practiced with mindfulness, I think it is brought to the forefront more when you have been in places with very limited resources.</p> <p> In residency, I see a number of patients who are from the country I traveled to. I now feel as if I can appreciate their cultural background more. For example, had I not taken the trip, I wouldn’t understand [that] there are many people who are from where I was in Central America who believe in a negative connotation associated with Rh negative blood.<br /> <br /> <strong><em>AMA Wire</em>: What advice would you have for others thinking of using their medical skills internationally?</strong></p> <p> <strong>Dr. Lenger:</strong> Keep your mind, arms and heart open at all times. Learn about your patients and their culture. They will help you even more in your education than you are able to help them.<br /> <br /> <strong><em>AMA Wire</em>: Do you believe this is an experience that every physician in training should have?</strong></p> <p> <strong>Dr. Lenger:</strong> Every resident should have this opportunity if they so desire. It is not something everyone should be required to do, because not everyone may want the experience. However, I think there needs to be more centralized support of this type of experience to allow each resident access to the medical, cultural and surgical training benefits if he or she desires.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:201e1e95-8f92-48c3-9ab4-3d19e80c20c5 “Groundbreaking effort” to prevent diabetes announced Wed, 23 Mar 2016 19:20:00 GMT <p> The U.S. Department of Health and Human Services (HHS) Wednesday announced it soon will begin covering diabetes prevention programs for Medicare beneficiaries as the result of a successful demonstration project. It is the first time a preventive service model from the Center for Medicare and Medicaid Innovation (CMMI) has been expanded into the Medicare program, and the agency said the model holds promise for employers, private insurers and patients.</p> <p> <strong>Success in preventing type 2 diabetes</strong></p> <p> The <a href="" rel="nofollow" target="_blank">announcement</a> highlights the success of a three-year demonstration project, funded by CMMI, that allowed the YMCA of the USA to deliver its Diabetes Prevention Program through local YMCAs to nearly 8,000 Medicare beneficiaries at a high risk of developing type 2 diabetes at no cost.</p> <p> As part of its <a href="" target="_blank">Improving Health Outcomes</a> initiative, the AMA teamed up with the Y-USA and <a href="" target="_blank">26 physician practice pilot sites</a> (log in) in eight states to develop tools and resources to increase physician screening, testing and referral for prediabetes.</p> <p> The practices referred their patients with prediabetes to diabetes prevention programs offered by local YMCAs. Medicare beneficiaries were able to participate in this program at no cost as a result of the award from the Center for Medicare and Medicaid Innovation.</p> <p> The Y-USA’s Diabetes Prevention Program is modeled after the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (DPP), which is a proven, evidence-based lifestyle change program. This 12-month lifestyle behavior intervention program helps patients adopt and maintain healthy lifestyles by eating healthier, increasing physical activity and losing a modest amount of weight in order to reduce their chances of developing the disease.</p> <p> At a time when more than 11 million seniors have diabetes and another 26 million seniors (about one-half of all Americans over the age of 65) have prediabetes, the results of the demonstration project speak for themselves:</p> <ul> <li> The estimated savings for Medicare per enrollee in the diabetes prevention program was $2,650 over a 15-month period, <a href="" rel="nofollow" target="_blank">according</a> to the HHS Office of the Actuary. The savings more than recoups the cost of participating in the program.</li> <li> Patients who enrolled in the diabetes prevention program lost about 5 percent of their body weight, which is enough to substantially reduce the risk of developing type 2 diabetes.</li> <li> More than 80 percent of participants attended at least four weekly sessions.</li> </ul> <p> <a href="" rel="nofollow" target="_blank">Research</a> by the National Institutes of Health has shown that diabetes prevention programs can reduce the incidence of new cases of type 2 diabetes by 58 percent. The reduction in incidence increases to 71 percent for adults over the age of 60.</p> <p> “This program has been shown to reduce health care costs and help prevent diabetes, and is one that Medicare, employers and private insurers can use to help 86 million Americans live healthier,” HHS Secretary Sylvia M. Burwell said in a news release. “The Affordable Care Act gave Medicare the tools to support this groundbreaking effort and to expand this program more broadly. Today’s announcement is a milestone for prevention and America’s health.”</p> <p> <strong>A time for action</strong></p> <p> A <a href="" rel="nofollow" target="_blank">study</a> released in 2014 that used methods similar to those of the Congressional Budget Office estimated that Medicare coverage of diabetes prevention programs would reduce federal spending by $1.3 billion over a 10-year budget window. The research was conducted by Avalere Health and released by the American Diabetes Association, the Y-USA and the AMA.</p> <p> The study estimated that the cumulative rate of diabetes in the Medicare population would be reduced by an estimated 37 percent after a decade, resulting in nearly 1 million fewer cases of diabetes among seniors.</p> <p> Risk of developing type 2 diabetes extends to a major portion of the U.S. population beyond Medicare beneficiaries. More than 86 million adults currently are living with prediabetes, but only 10 percent of them know that they have prediabetes and are at risk of developing type 2 diabetes.</p> <p> “Today’s announcement signifies an important step toward ensuring all Americans at risk for type 2 diabetes have access to the resources they need to prevent this debilitating disease,” AMA President-Elect Andrew Gurman, MD, said in a <a href="" target="_blank">statement</a> Wednesday. “Research shows that up to one-third of these individuals will develop type 2 diabetes within five years unless they lose weight through healthy eating and increased physical activity.”</p> <p> The AMA sent a letter to the Centers for Medicare & Medicaid Services last month, calling for coverage of prediabetes screening, referrals to diabetes prevention programs and participation in diabetes prevention programs. These services recently received a Grade B from the U.S. Preventive Services Task Force.</p> <p> Under the Affordable Care Act, private health plans participating in the health insurance marketplaces and the Medicaid program are required to cover preventive services that are recommended with a grade of A or B by the task force.</p> <p> For patients who have insurance through private plans, the AMA is encouraging employers and health insurance companies to cover participation in diabetes prevention programs as well. The entities can use the AMA’s <a href="" rel="nofollow" target="_blank">diabetes prevention cost-savings calculator</a> to better understand why they should offer this coverage, including the potential benefits for improving health outcomes while reducing health care costs.</p> <p> <strong>What you can do </strong></p> <p> Now is the perfect time to start talking to your patients about prediabetes and referring them to diabetes prevention programs that are part of the National DPP. National efforts are underway to prevent the onset of type 2 diabetes. Earlier this year, the AMA, the CDC, the American Diabetes Association and the Ad Council launched a highly visible <a href="" target="_blank">public service ad campaign</a> that clearly delivers an important message: Everyone needs to know whether they have prediabetes or not.</p> <p> The ads use humor to grab people’s attention and ensure they know that there’s no excuse not to find out their prediabetes risk, which they can do through a simple risk assessment at <a href="" rel="nofollow" target="_blank"></a>.</p> <p> For physicians, the AMA and the CDC offer practical resources through the joint <a href="" target="_blank">Prevent Diabetes STAT: Screen, Test, Act–Today™</a> initiative. The resources center on three important steps to take with your patients:</p> <ol> <li> Screen patients for prediabetes risk using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test</li> <li> Test patients to confirm prediabetes using one of three blood tests</li> <li> Act by referring patients with prediabetes to a nearby <a href="" rel="nofollow" target="_blank">diabetes prevention program</a></li> </ol> <p> Depending on what makes the most sense for your practice, there are two different options for how your practice team can identify patients with prediabetes and refer them to the prevention program they need. Members of your practice team can either screen and test patients at the point of care, or they can do so by generating a registry of at-risk patients via your electronic health record system and referring them.</p> <p> The Prevent Diabetes STAT toolkit offers everything you need for either approach, including patient handouts, risk assessments, prediabetes identification algorithm and patient flow process for engaging patients at the point of care, retrospective diabetes identification algorithm, sample patient letters and phone scripts.</p> <p align="right"> <em>By AMA Wire editor</em> <a href="" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9d00ba22-c00c-4a5d-a221-be60ec1d2dbf Key stakeholders explore assessment of aging physicians Wed, 23 Mar 2016 01:00:00 GMT <p> Representatives from key physician, hospital and patient safety organizations met last week to discuss the growing trend of assessing the competence of aging physicians and explore the question of whether national guidelines need to be developed.</p> <p> <strong>Why now</strong></p> <p> The number of physicians 65 years and older has more than quadrupled since 1975, reaching more than 241,000 in 2013, according to a recent report of the AMA <a href="">Council on Medical Education</a>. Senior physicians make up 23 percent of the nation’s physician population, and roughly 40 percent of them are actively engaged in patient care.</p> <p> “It is the opinion of the Council on Medical Education that physicians should be allowed to remain in practice as long as patient safety is not endangered and that, if needed, remediation should be a supportive, ongoing and proactive process,” the report states.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Darlyne Menscer, MD, chair of the AMA Council on Medical Education</em></span></td> </tr> </tbody> </table> <p> “Self-regulation is an important aspect of medical professionalism, and helping colleagues recognize their declining skills is an important part of self-regulation,” the report states. “Therefore, physicians must develop guidelines/standards for monitoring and assessing both their own and their colleagues’ competency.”</p> <p> One of the primary recommendations of the report was to convene national stakeholders to further explore this issue.</p> <p> <strong>Bringing together the key players</strong></p> <p> As the group prepared to meet Wednesday, Darlyne Menscer, MD, chair of the AMA Council on Medical Education, said the initial goal was to look at the available evidence around physician assessment and competence.</p> <p> “Many people have presupposed that the AMA has taken a position on whether physicians should be assessed and how that should be done,” she said. “The truth is that we have not.”</p> <p> The meeting brought together nearly three dozen representatives from such organizations as the Joint Commission, the American Hospital Association, the Coalition for Physician Enhancement, the Council of Medical Specialty Societies, the National Board of Medical Examiners, the National Board of Osteopathic Medical Examiners and the National Patient Safety Foundation.</p> <p> Experts who research physician competence, run assessment programs and deal with related legal issues also participated, sharing their insights.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Barbara Hummel, MD, chair of the AMA Senior Physicians Section</em></span></td> </tr> </tbody> </table> <p> The group began deliberation around key issues and challenges for determining whether guidelines should be developed, including:</p> <ul> <li style="margin-left:0.25in;"> Legal implications of screening physicians based on age</li> <li style="margin-left:0.25in;"> Variability of how age impacts individual physicians’ competence</li> <li style="margin-left:0.25in;"> Uncertainty of how to interpret tests of cognitive or motor function in physicians</li> <li style="margin-left:0.25in;"> Confounding effects of other variables on physician competence and performance</li> </ul> <p> “How do we keep our patients safe and yet be fair to both the physicians and the patients?” said Barbara Hummel, MD, chair of the AMA <a href="">Senior Physicians Section</a>. This is an essential question that stakeholders will continue to explore.</p> <p> Dr. Menscer said it’s particularly appropriate that the AMA Council on Medical Education is spearheading this effort alongside the AMA Senior Physicians Section.</p> <p> “The AMA Council on Medical Education has historically been involved in many issues concerning continuing professional competency and is well-positioned to convene this conversation,” she said. “Who better than us?”</p> <p> The AMA Senior Physicians Section, meanwhile, was the driving force behind the AMA policy that led to the council report and Wednesday’s stakeholder meeting.</p> <p> Watch <em>AMA Wire</em>® for additional information as the group continues to explore the issues surrounding physician assessment and potential solutions.</p> <p>  </p> <p align="right"> <em>By AMA Wire editor </em><a href="" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:98718209-46df-4a84-8e56-6281dce3f295 How to coordinate patient visits in a team-based care model Tue, 22 Mar 2016 20:33:00 GMT <p> Practices across the country have been implementing team-based care models to make better use of the skills and training of the care team and streamline office procedures, but what does this type of care model entail? Find out what a highly-functional team-based patient visit could look like from before the patient arrives through checkout.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> A new <a href="" target="_blank" rel="nofollow">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice implement team-based care. The module details the individual elements of a team-based care model and shows you how to bring all of those elements together.</p> <p> <strong>Effective pre-visit activities </strong></p> <p> One of the cornerstones of team-based care is making sure that your patients and team are prepared for patient visits ahead of time. The most efficient method is to plan ahead for the next visit at the conclusion of the present visit—remember: The next appointment starts today. In addition, a designated nurse, medical assistant (MA) or other team member can complete the pre-visit planning activities just prior to the appointment.</p> <p> Conduct pre-visit planning two to three days prior to the patient visit:</p> <ul> <li> <strong>Review notes from the previous visit.</strong> The designated team member ensures that follow-up results are available for physician review.</li> </ul> <ul> <li> <strong>Use a registry or visit-prep checklist.</strong> The checklist helps to identify any care gaps or upcoming preventive and chronic care needs.</li> </ul> <ul> <li> <strong>Identify whether any further information is required for the visit.</strong> This could include hospital discharge notes, emergency department notes or operative notes from a recent surgery.</li> </ul> <ul> <li> <strong>Send automated appointment reminders to patients.</strong> This could include accurate check-in time and accounting for the additional time it will take to complete any necessary paperwork. Use the <a href="" target="_blank" rel="nofollow">pre-visit questionnaire</a> to streamline the information gathering process.</li> </ul> <ul> <li> <strong>Order pre-visit labs at the end of each appointment.</strong> Ordering the labs ahead of time allows them to be completed prior to the next appointment using the <a href="" target="_blank" rel="nofollow">visit planner checklist</a>.</li> </ul> <ul> <li> <strong>Start the day with a </strong><a href="" target="_blank"><strong>team huddle</strong></a><strong>.</strong> Gathering together at the beginning of the day can prepare the team by reviewing the schedule and discussing important items that are pertinent to all team members.</li> </ul> <p> <strong>The patient visit</strong></p> <p> In team-based care, the patient visit follows a structure that uses the expertise of individuals on the team to streamline the process. First, the nurse or MA updates the medical record, closes care gaps and obtains an initial history. When the physician joins the appointment, the nurse, MA or documentation specialist helps document the visit. At the end of the visit, that team member then emphasizes the plan of care and conducts motivational interviewing and education with the patient.</p> <p> Using this care model, the nurses or MAs become more knowledgeable about the treatment plan, can more effectively coordinate care between visits, and develop closer independent relationships with patients and their families.</p> <p> To aid in this process, practices can:</p> <ul> <li> <strong>Expand rooming and discharge protocols.</strong> This can leverage the skills and training of staff to perform additional tasks and responsibilities associated with a patient visit to allow physicians <a href="" target="_blank">more time to interact with patients</a>. You can use the <a href="" target="_blank" rel="nofollow">rooming checklist</a> to guide this process.</li> </ul> <ul> <li> <strong>Implement team documentation to further streamline the patient visit.</strong> A clinical or clerical assistant accompanies the physician in the exam room with the patient and helps document all patient visits, expanding the time the physician has to connect with patients and easing <a href="" target="_blank">electronic health record woes</a>.</li> </ul> <ul> <li> <strong>Use the annual visit to synchronize prescription renewals.</strong> The physician can indicate which chronic medications may be refilled for the entire year and which to modify or discontinue. This can reduce the number of calls and amount of work that comes with frequent renewal requests.<br /> <br /> Once the physician portion of the visit is complete, the physician can exit the room, review the notes, make any modifications and sign the note. Now, the physician is ready to transition to the next patient’s room.</li> </ul> <ul> <li> <strong>Use the end of the visit to plan the next visit.</strong> Planning for the next visit should occur at the conclusion of each visit. The <a href="" target="_blank" rel="nofollow">visit planner checklist</a> can help by clarifying the upcoming appointments and the laboratory and diagnostic work that should be completed before the patient returns. The patient should leave the visit with a sense of commitment and support from the care team.</li> </ul> <p> More than 25 modules are available in the AMA’s <a href="" target="_blank" rel="nofollow">STEPS Forward </a>collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d43c87c6-49b3-488e-87b9-189df4ac5e5a 3 simple steps to address prediabetes in your practice Tue, 22 Mar 2016 10:00:00 GMT <p> Today is Diabetes Alert Day, and many of your patients will be encouraged over social media to take an online prediabetes test. Make sure you know the signs of this disease and the three steps you should take to prevent or treat it.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> About 86 million Americans have prediabetes and don’t know it. That’s why the AMA has partnered with the Centers for Disease Control and Prevention (CDC), the American Diabetes Association (ADA) and the Ad Council in a highly visible public service ad campaign that clearly delivers an important message: Everyone needs to know whether they have prediabetes or not.</p> <p> The campaign got underway earlier this year, and you may have already seen many of the ads on your daily commutes, watching your favorite TV programs, online or maybe even on your local radio station. Using humor, the ads were created to grab people’s attention and ensure they know that there’s no excuse not to find out their prediabetes risk, which they can do through a simple risk assessment at <a href="" rel="nofollow" target="_blank"></a>.</p> <p> In observance of Diabetes Alert Day, the AMA, CDC and the ADA are using social media to encourage more adults to take the risk assessment today.</p> <p> <strong>What you can do to reduce risk</strong></p> <p> The high visibility of the campaign will likely spur questions from your patients who have taken the risk assessment or have seen the ad campaign.</p> <p> So how do you incorporate into your busy practice new steps you can take to help?</p> <p> One of the best, evidence-based ways to reduce diabetes risk is to participate in a CDC-recognized diabetes prevention program. Such programs emphasize healthy eating and increased physical activity, and they can reduce the risk of developing diabetes by more than one-half.</p> <p> In partnership, the AMA and the CDC created an easy way for care teams to access practical resources to <a href="" target="_blank">Prevent Diabetes STAT: Screen, Test, Act—Today™</a> by taking three simple steps:</p> <p style="margin-left:36.75pt;"> 1.   Screen patients for prediabetes using the CDC Prediabetes Screening Test or the American Diabetes Association Diabetes Risk Test</p> <p style="margin-left:36.75pt;"> 2.   Test for prediabetes using one of three blood tests</p> <p style="margin-left:36.75pt;"> 3.   Act by referring patients with prediabetes to a nearby <a href="" rel="nofollow" target="_blank">diabetes prevention program</a></p> <p> Adding one more thing to an already heavy workload can be an overwhelming prospect. But this initiative provides the <a href="" target="_blank">tools and information you need</a> to easily incorporate these steps into your practice.</p> <p> There are two different approaches to help your practice identify patients with prediabetes and refer them to a prevention program in your community or online.</p> <p> The <a href="" target="_blank">Prevent Diabetes STAT toolkit</a> offers everything you need for either approach, including:</p> <ul> <li style="margin-left:36.75pt;"> Patient handouts</li> <li style="margin-left:36.75pt;"> Risk assessments</li> <li style="margin-left:36.75pt;"> Prediabetes identification algorithm and patient flow process for engaging patients at the point of care</li> <li style="margin-left:36.75pt;"> Retrospective diabetes identification algorithm</li> <li style="margin-left:36.75pt;"> Sample patient letters and phone scripts</li> </ul> <p> If you want to learn even more about prediabetes and other steps you can take to help, check out a <a href="" rel="nofollow" target="_blank">free module</a> in the AMA’s STEPS Forward™ collection of practice improvement strategies. The module is approved for <em>AMA PRA Category 1 Credit</em> ™. The AMA also offers a more extensive <a href="" target="_blank">performance improvement continuing medical education activity</a> that is approved by the American Board of Family Medicine for Maintenance of Certification for Family Physicians Part IV credit.</p> <p> Be sure to follow <a href="" rel="nofollow" target="_blank">#DiabetesAlertDay</a> on Twitter for more information.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:04850ffe-2913-449e-93a5-8c8e6b21eefd Can you ace this tough USMLE question? Mon, 21 Mar 2016 19:29:00 GMT <p> As you study for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, take time to hone your skills with this exclusive scoop on one of the most challenging USMLE test prep questions and expert strategies to help you pass with flying colors. Find out what this month’s toughest question is, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, “Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank”: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="" target="_blank">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 32-year-old woman comes to the physician because of amenorrhea for the past 15 months after delivering a baby. She says that she has also had fatigue, facial swelling, cold intolerance and has gained an additional 4.5 kg (10 lb) since her baby was born. A review of her records shows that the delivery was complicated by severe hemorrhage. Laboratory studies of serum show:</p> <p> LH                    <1 IU/L</p> <p> Estradiol           5 pg/mL (normal 20–100 pg/mL)</p> <p> TSH                  0.1 µU/mL</p> <p> Injection of 500 µg of TRH fails to produce an increase in either serum TSH or prolactin. Assay of other hormones is most likely to show normal levels of which of the following hormones?</p> <p style="margin-left:40px;"> A. Aldosterone</p> <p style="margin-left:40px;"> B. Cortisol</p> <p style="margin-left:40px;"> C. Follicle-stimulating hormone (FSH)</p> <p style="margin-left:40px;"> D. Gonadotropin-releasing hormone (GnRH)</p> <p style="margin-left:40px;"> E. Growth hormone</p> <p> <object align="middle" data="" height="350" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" quality="best" src="" type="application/x-shockwave-flash" width="450" wmode="transparent"></embed></object></p> <p>  </p> <p> <strong>The correct answer is A.</strong></p> <p> <strong>Kaplan says, here’s why: </strong>Sheehan syndrome is hypopituitarism caused by ischemic damage to the pituitary resulting from excessive hemorrhage during parturition. The pituitary is enlarged during pregnancy; it is more metabolically active and more susceptible to hypoxemia. The blood vessels in the pituitary may be more susceptible to vasospasm because of high estrogen levels. In about 30 percent of women who have excessive hemorrhage during parturition, some degree of hypopituitarism eventually manifests.<br /> <br /> The symptoms depend on how much of the pituitary is damaged and what cell types are destroyed. Although some pituitary hormones may be unaffected, even in severe hypopituitarism, pituitary hormones and the hormones controlled by them are more likely to be reduced than hormones that are not primarily controlled by anterior pituitary function. Our patient has amenorrhea (decreased LH) and symptoms of hypothryoidism (decreased TSH). Aldosterone secretion is relatively independent of adrenocorticotropic hormone; it is controlled mainly by angiotensin II and plasma potassium concentration. Aldosterone is least likely to be reduced by hypopituitarism. Treatment is replacement of thyroid hormone and cortisol.<br /> <br /> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer to help you prepare with future studying.</em></p> <p> <strong>Choice B:</strong> Cortisol is controlled by pituitary production of ACTH; because ACTH is often impaired in Sheehan syndrome, reduced secretion of cortisol is likely.<br /> <br /> <strong>Choice C:</strong> The pituitary necrosis that is the root cause of Sheehan syndrome is highly likely to reduce secretion of follicle-stimulating hormone (FSH). The observation of reduced estradiol in this patient strongly suggests that FSH is low because estradiol increases as follicular development occurs.<br /> <br /> <strong>Choice D:</strong> The presence of the depressed levels of estradiol and leuteinizing hormone (LH) in this patient releases hypothalamic secretion of GnRH from its normal feedback control. GnRH levels are likely to increase above normal.<br /> <br /> <strong>Choice E:</strong> Growth hormone is very likely to be reduced by the pituitary necrosis.</p> <p> <strong>Key points to remember:</strong></p> <ul> <li> Suspect Sheehan syndrome (pituitary infarction) in a patient with a complicated delivery with significant hemorrhage who develops hypopituitarism.</li> <li> Depending on the severity of hypopituitarism, patients with Sheehan syndrome may develop low ACTH and low cortisol.</li> <li> Aldosterone is relatively independent of ACTH because it is controlled by angiotensin II and plasma potassium levels. </li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:349f7906-cc57-4737-b7ac-6254aab0da24 When patient satisfaction is bad medicine Fri, 18 Mar 2016 22:15:00 GMT <p> <em>Editor’s note: The complexities of the opioid epidemic demand a comprehensive approach response. This practice perspective provides physician insights into one course of action that could contribute to the solution.</em></p> <p> <em>By Joan Papp, MD, Case Western Reserve University and Metro Health Medical Center in Cleveland, and Jason Jerry, MD, Cleveland Clinic Foundation</em></p> <p> <strong>Pain management and the opioid epidemic</strong></p> <p> The United States is confronting a tragic opioid epidemic—and the situation is getting worse. More American lives were lost in 2014 from drug overdose than during any previous year on record. According to the <a href="" rel="nofollow" target="_blank">most recent data</a> from the Centers for Disease Control and Prevention, the drug overdose death rate from opioids increased by 200 percent between the years 2000 and 2014. To put this in perspective, during the 10-year period spanning 2004-2013, a total of <a href="" rel="nofollow" target="_blank">181,000 people</a> in this country lost their lives to prescription pain medication or heroin overdoses.</p> <p> In the treatment world, we tend to view prescription narcotics and heroin as sides of the same coin because they affect the brain in the same way. In working with patients who are addicted to heroin, we have noted that our patients most often report <a href="" rel="nofollow" target="_blank">developing an addiction to prescription narcotics</a> before transitioning to heroin.</p> <p> The motivation to switch from pain relievers to heroin is often driven by economics, as heroin is about 10 percent of the cost of an equivalent dose of a prescription narcotic. Armed with this knowledge and <a href="" rel="nofollow" target="_blank">the fact</a> that the United States consumes 75 percent of the world’s narcotic pain medication—despite only comprising 5 percent of the world’s population—it would be easy for people to blame the doctors for our narcotic woes.</p> <p> It wasn’t until the mid-1990s that doctors began writing prescriptions for narcotics to manage chronic musculoskeletal pain. Previously, narcotics were largely reserved for treating the pain associated with surgery and end-stage cancer.</p> <p> But then the culture of medical practice surrounding pain management changed drastically. There was a perception that doctors were undertreating pain, and the development of the “fifth vital sign”—the 10-point pain scale—was added to the medical charts of hospitals throughout the country. That meant that doctors had to address pain as a critical function of care.</p> <p> <strong>Patient satisfaction surveys</strong></p> <p> Fast forward two decades, and patient satisfaction surveys became an integral part of Medicare and Medicaid payments to hospitals. Many of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions inquire about important metrics, such as communication between doctors and their patients.</p> <p> Consider, however, the following questions pertaining to pain management taken from the HCAHPS questionnaire: (1) “During this hospital stay, did you need medicine for pain?” Patients can answer “yes” or “no.” (2) “During this hospital stay, how often was your pain well controlled?” Patients can answer “never,” “sometimes,” “usually” or “always.” (3) “During this hospital stay, how often did hospital staff do everything they could to help you with your pain?” Patients can answer “never,” “sometimes,” “usually” or “always.”</p> <p> It is easy to see how problematic this can be.</p> <p> <strong>First:</strong> When it comes to reimbursement for the current HCAHPS questions, the Centers for Medicare & Medicaid Services (CMS) doesn’t give partial credit. This means that unless the patient answers “always” to questions 2 and 3, the hospital is considered an underperformer and is financially penalized. The simplest way for physicians to improve their scores, then, is to be more liberal with opioid pain medications.</p> <p> <strong>Second:</strong> There are no questions asking if other pain control options, such as ice packs, improved positioning, physical therapy or surgical interventions were discussed, which undervalues the discretion of the doctor and the integrity of the doctor-patient relationship.</p> <p> <strong>Third:</strong> The questions do not describe other unpleasant states that a patient may experience. If we exchanged the word “pain” for “discomfort,” the question would encompass a far more comprehensive patient experience that would include other uncomfortable sensations, such as itching or burning.</p> <p> If we were to make these simple changes, we would be able to more broadly evaluate how we treat pain and take the focus off of receiving <em>only</em> opiates.</p> <p> <strong>Pressure to overprescribe</strong></p> <p> We are not alone in feeling the pressures of this misguided policy. Recently, the Ohio State Medical Association (OSMA), in partnership with the Cleveland Clinic Foundation, surveyed 1,100 Ohio physicians. In this survey, 98 percent of the physicians who participated reported that they felt increased pressure to treat pain, and 74 percent reported that they felt an increased pressure to prescribe opioids because of the perverse pain management incentives in the patient satisfaction surveys.</p> <p> An additional 67 percent of respondents agreed that, in general, physicians in the United States over-prescribe controlled substances to treat pain. One physician stated: “I have faced consequences from my hospital for not prescribing narcotics even if [the] patient had a huge, multi-page [Ohio Automated Rx Reporting System] report.” In fact, 24 percent of physician respondents indicated that asking patients about pain control might have the unintended consequence of driving opioid addiction.</p> <p> <strong>What we can do</strong></p> <p> Clearly, the cultural paradigm of overly aggressive pain management still exists and will continue to be a barrier to efforts to address the opioid epidemic.</p> <p> Here in Ohio, we’re advocating for the adoption of a <a href="" rel="nofollow" target="_blank">resolution</a> under consideration by our state legislature. This resolution would both call on CMS to revise the HCAHPS survey measures to better address the topic of pain management and support drug abuse research, education, community outreach and prevention. Both the OSMA and the AMA have officially supported this measure.</p> <p> On a national level, it is time for all physicians to let CMS know our concerns and demand that the pain questions be revised in HCAHPS and other future patient satisfaction surveys. Our patients’ lives hang in the balance.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c34d77e2-d89e-4675-a962-600b20dda5d2 Sharing health data: HIPAA may allow more freedom than you think Fri, 18 Mar 2016 22:05:00 GMT <p> Confusion about the Health Insurance Portability and Accountability Act (HIPAA) often prevents physicians from sharing electronic protected health information (PHI) without a patient’s authorization. Experts at the Office of the National Coordinator for Health Information Technology (ONC), however, say this is a common misconception and are seeking to provide clarification to both patients and physicians.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> ONC recently published a <a href="" target="_blank" rel="nofollow">four-part series</a> of blog posts on permitted uses and disclosures of PHI under HIPAA. The series provides reference materials and offers clarification to physicians and patients on when they can use and disclose PHI without patient authorization.</p> <p> <strong>HIPAA promotes interoperability</strong></p> <p> “What many people don’t realize is that HIPAA not only protects personal health information from misuse,” <a href="" target="_blank" rel="nofollow">one post</a> said, “but also enables PHI to be accessed, used or disclosed interoperably, when and where it is needed for patient care.” The experts note that HIPAA gives health care professionals permission to share PHI for patient care, quality improvement, population health and more.</p> <p> “HIPAA provides many pathways for permissibly exchanging PHI,” the authors said. Working with the Office for Civil Rights (OCR), the ONC has developed two fact sheets incorporating practical, real-life scenarios that demonstrate how HIPAA supports interoperability:</p> <ul> <li> “<a href="" target="_blank" rel="nofollow">Permitted uses and disclosures: Exchange for treatment</a>”</li> <li> “<a href="" target="_blank" rel="nofollow">Permitted uses and disclosures: Exchange for health care operations</a>”</li> </ul> <p> <strong>Permitted disclosure of PHI</strong><br /> The first fact sheet states that under HIPAA, physicians may disclose PHI (whether orally, on paper, by fax or electronically) to another provider for the treatment activities of that provider, without needing patient consent or authorization. HIPAA broadly defines “treatment” as the provision, coordination or management of health care and related services by one or more providers. This includes the coordination or management of health care by a provider with a third party; consultation between providers relating to a patient; or the referral of a patient for care from one provider to another.</p> <p> According to the second fact sheet, physicians and other covered entities must meet three requirements to share PHI for purposes of health care operations:</p> <p style="margin-left:40px;"> 1.   Both covered entities must have or have had a relationship with the patient</p> <p style="margin-left:40px;"> 2.   The PHI requested must pertain to the relationship</p> <p style="margin-left:40px;"> 3.   The discloser must disclose only the minimum information necessary for the health care operation at hand</p> <p> If those criteria are met, a covered entity can disclose PHI to another covered entity or business associate for the following health care operations activities without patient consent or authorization:</p> <ul> <li> Conducting quality assessment and improvement activities</li> <li> Developing clinical guidelines</li> <li> Conducting patient safety activities as defined in applicable regulations</li> <li> Conducting population-based activities relating to improving health or reducing health care cost</li> <li> Developing protocols</li> <li> Conducting case management and care coordination (including care planning)</li> <li> Contacting health care providers and patients with information about treatment alternatives</li> <li> Reviewing qualifications of health care professionals</li> <li> Evaluating performance of health care providers and/or health plans</li> <li> Conducting training programs or credentialing activities</li> <li> Supporting fraud and abuse detection and compliance programs</li> </ul> <p> Watch <em>AMA Wire®</em> in the coming weeks for a closer look into some of these circumstances and how you can take advantage of HIPAA’s capacity for interoperability and data sharing.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1288950b-dc09-4bd4-9782-ab998cea9ebf A lighter look at the Match: Finding that perfect residency Thu, 17 Mar 2016 18:00:00 GMT <p> If you’re a graduating medical student, you likely have experienced the entire gamut of human emotions from stress to elation this week. But Match Day is here. Take a break from the day’s activities for a lighthearted look at the Match through the lens of four new student-produced videos.</p> <p> <strong>The perfect match</strong></p> <p> <object align="right" data="" height="350" hspace="15" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> The Match is the medical world’s version of the dating game—it’s hard to find the perfect fit, but when you do, you know. In celebration of the culmination of your many efforts leading up to today, the AMA Medical Student Section (MSS) has produced four parody videos that present a new perspective on the Match:</p> <ul> <li> One of the telltale signs that you’ve met your perfect match is being able to picture your future together. Watch "Meeting 'the one'" at right.<br />  </li> <li> Did you know that the Match produces more happy residency placements than any other algorithm on the Internet? Watch "<a href="" rel="nofollow" target="_blank">The most successful algorithm</a>."<br />  </li> <li> Sick of trying to find your perfect job through mutual friends? Try something different—the Match. Watch "<a href="" rel="nofollow">Finding your perfect job.</a>"<br />  </li> <li> You can’t deny chemistry. When you find that perfect program you click with, sometimes you just know. Watch "<a href="" rel="nofollow">Undeniable chemistry</a>."</li> </ul> <p> Be sure to follow <a href="" rel="nofollow" target="_blank">#Match2016</a> on Twitter to see where other students matched and check out <a href="" rel="nofollow" target="_blank">#MatchThrowback</a> for pictures submitted by residents, showing their Match Day celebrations.<br /> <br /> Also, be sure to share where you match for a chance to win one a prize in the AMA’s <a href="" target="_blank">Match Day 2016-Survive Your First Week of Residency Sweepstakes</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ca3dd844-11c6-44b3-a4a2-d52123a37e70 Get the CPT® print and digital bundle Thu, 17 Mar 2016 15:00:00 GMT <p> Combining three sources of information, the <em>CPT® Professional 2017 Print and Digital Bundle</em> includes the tools you need to always access the correct code—even when you can’t get to the codebook.</p> <p> This new bundle includes three platforms to assist you in your coding needs: A spiral bound copy of the <em>CPT® Professional 2017 Edition</em>, the <em>CPT® Assistant Digital Archive</em> and the <em>CPT® Professional App</em> for your mobile device.</p> <ul> <li> <strong>CPT Assistant Digital Archive:</strong> Allows you to access every <em>CPT® Assistant</em> article on your mobile device.</li> <li> <strong>CPT Professional App:</strong> Allow you to use your mobile device to look up CPT codes and E/M codes on the spot. The app includes code descriptions, vignettes, clinical examples, RVUs and <em>CPT® Assistant</em> references.</li> </ul> <p> Other features include easy navigation between the 2016 and 2017 code sets, simple illustrations that bring clarity and understanding to complex procedures, and a searchable database.</p> <p> AMA members receive a $35 discount on their <a href="" target="_self">order</a>. Not an AMA member? <a href="" target="_self">Join today</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c5eb72f8-e844-4854-a285-dfdd5532349d What physicians are saying about the new CDC opioid guidelines Thu, 17 Mar 2016 00:00:00 GMT <p class="p1"> Officials at the Centers for Disease Control and Prevention (CDC) Tuesday released clinical guidelines for prescribing opioids to help combat the nation’s overdose epidemic, and physicians were swift to respond. Physicians are embracing the concepts for reducing harm but simultaneously are pointing out serious shortcomings that will need to be addressed.</p> <p class="p1"> <b>What’s in the guidelines</b></p> <p class="p1"> The guidelines, which were <a href="" rel="nofollow" target="_blank"><span class="s1">published in <i>JAMA</i></span></a> and on the <a href="" rel="nofollow" target="_blank"><span class="s1">CDC website</span></a>, are intended for primary care clinicians who treat adult patients for chronic pain in outpatient settings. Their main goals are to help physicians improve communication with their patients about the benefits and risks of using prescription opioids for chronic pain, provide safer and more effective care for chronic pain, and reduce opioid use disorder and overdose among their patients.</p> <p class="p1"> The guidelines are intended to be a “flexible tool” to support informed decision-making, improve physicians’ confidence about how to manage chronic pain, and promote safer and more effective options for pain management, CDC Director Tom Frieden, MD, said on a media call Tuesday.</p> <p class="p1"> The guidelines include 12 clinical recommendations, which are centered on three principles for improving patient care and safety:</p> <ul> <li class="p3"> Nonopioid therapy—including physical therapy, exercise, nonopioid medications and cognitive behavioral therapy—is preferred for chronic pain management (excluding active cancer, palliative and end-of-life care).</li> <li class="p3"> If opioids are prescribed, they should be at the lowest possible effective dosage to reduce the risks of opioid use disorder and overdose.</li> <li class="p3"> If opioids are prescribed, physicians should exercise caution and monitor the patient closely. Steps include consulting their state’s prescription drug monitoring program and tapering opioids if the desired effect is not achieved.</li> </ul> <p class="p1"> Three of the recommendations cover how to determine when to initiate or continue opioids for chronic pain. Four recommendations help physicians make decisions about opioid selection, dosage, duration, follow up and discontinuation. And five recommendations deal with assessing risk and addressing harms.</p> <p class="p1"> <b>Physicians’ responses</b></p> <p class="p1"> Following release of the guidelines, Patrice A. Harris, MD, the AMA board chair-elect and chair of the <a href="" target="_blank"><span class="s1">AMA Task Force to Reduce Opioid Abuse</span></a>, noted that the AMA was “largely supportive of the guidelines” and noted the AMA’s shared goal of reducing harm from opioid abuse and seeking solutions to end the public health epidemic. </p> <p class="p1"> But Dr. Harris highlighted several concerns that remained from the draft guidelines on which the AMA submitted comments. “We remain concerned about the evidence base informing some of the recommendations; conflicts with existing state laws and product labeling; and possible unintended consequences associated with implementation, which includes access and insurance coverage limitations for non-pharmacologic treatments, especially comprehensive care; and the potential effects of strict dosage and duration limits on patient care,” she said.</p> <p class="p1"> “We know this is a difficult issue and doesn’t have easy solutions,” Dr. Harris said. “If these guidelines help reduce the deaths resulting from opioids, they will prove to be valuable. If they produce unintended consequences, we will need to mitigate them. They are not the final word. More needs to be done, and we plan to continue working at the state and federal level to engage policy makers to take steps that will help end this epidemic.”</p> <p class="p1"> In conjunction with release of the guidelines, the JAMA Network published several perspectives from prominent physicians. </p> <p class="p1"> “The CDC guideline for prescribing opioids for chronic pain is an important and essential step forward,” Yngvild Olsen, MD, of the Institutes for Behavior Resources Inc., wrote in a <i>JAMA</i> <a href="" rel="nofollow" target="_blank"><span class="s1">editorial</span></a>. “With support from physicians across the country, as well as from policymakers at all levels, implementation of the recommendations in this guideline has the potential to improve and save many, many lives.” </p> <p class="p1"> But Dr. Olsen underscored that “success depends on simultaneously addressing significant gaps in the health care system.” These include “enormous gaps in reimbursement, both for chronic pain and for addiction treatment” and “few available care models that give primary care practitioners the time, resources and support to care for patients with complex chronic pain at risk for or with addiction.”</p> <p class="p1"> Noting a lack of evidence for the benefit of long-term use of opioids, Mitchell Katz, MD, of the Los Angeles County Department of Health Services, wrote in an <a href="" rel="nofollow" target="_blank"><span class="s1">editorial</span></a> in <i>JAMA Internal Medicine </i>that the guidelines “have done an admirable job of summarizing our ignorance and putting forth 12 sensible recommendations, none of which meets a rigorous standard of evidence but all of which, if implemented, would reduce harm and likely improve chronic pain control in the United States.” Dr. Katz was a member of the Opioid Guideline Workgroup that reviewed the recommendation categories and level of evidence for these guidelines. </p> <p class="p1"> William Renthal, MD, of the Department of Neurology at Brigham and Women’s Hospital of Harvard Medical School, also highlighted the lack of clinical evidence in an <a href="" rel="nofollow" target="_blank"><span class="s1">editorial</span></a> in <i>JAMA Neurology</i>: “[T]here are few well-controlled clinical studies on opioid-prescribing methods for chronic pain. While the guidelines will be updated as new data become available, concerns may be raised that appropriate access to opioids could be negatively affected by federal guidelines based on admittedly weak data.”</p> <p class="p1"> But Dr. Renthal noted the prudent principles of the guidelines. “It is important to note that the CDC guidelines are in this respect, an iteration of well-accepted medical principles of drug prescribing: to use the lowest effective dose for the shortest possible duration,” he wrote. </p> <p class="p1"> An <a href="" rel="nofollow" target="_blank"><span class="s1">editorial</span></a> in <i>JAMA Pediatrics</i> by Neil L. Schechter, MD, of Boston Children’s Hospital, and Gary A. Walco, PhD, of Seattle Children’s Hospital, highlights the exclusion of children from the guidelines. “The CDC guideline is now published, without regard for pediatric patients,” they wrote. They called for greater clarification that the guidelines should not be applied to those younger than 18 years of age and recommended the development of future guidelines specifically for addressing indications and safety concerns for pediatric patients. </p> <p class="p1"> Thomas Lee, MD, of Press Ganey, reflected on the overall opioids situation in his <i>JAMA</i> <a href="" rel="nofollow" target="_blank"><span class="s1">editorial</span></a>: “The data will never be perfect. The measures will never be perfect. The guidelines will never be perfect. And neither will clinicians and their performance. But by acknowledging these imperfections and trying to get better with the tools available, physicians can more effectively reduce the suffering of patients.”<br />  </p> <p class="p4" style="text-align:right;"> <i>By AMA Wire editor </i><a href="" rel="nofollow" target="_blank"><span class="s1"><i>Amy Farouk</i></span></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:599d9cff-1154-461b-91d9-20db86d91482 How physicians can identify, assist trafficking victims Wed, 16 Mar 2016 21:01:00 GMT <p class="p1"> Physicians may encounter human trafficking victims more often than they realize and are in a unique position to help put these children, women and men’s lives on a path to recovery. Learn the warning signs, ways to help patients you’ve identified as possible victims and resources available.</p> <p class="p1"> <b>The problem</b></p> <p class="p1"> The U.S. Department of State estimates hundreds of thousands of people may be trafficked annually worldwide, the majority being women and children. One U.S. <a href="" rel="nofollow" target="_blank"><span class="s1">study</span></a> found that more than 85 percent of survivors had contact with a health care professional while being trafficked. </p> <p class="p1"> Among survivors, more than 60 percent reported going to a hospital or emergency department at some point. Survivors also reported visiting family physicians, internists and obstetrician-gynecologists in traditional physician offices, urgent care clinics, neighborhood clinics and women’s health clinics. </p> <p class="p1"> Yet a <a href="" rel="nofollow" target="_blank"><span class="s1">survey</span></a> of nearly 500 resident physicians showed that fewer than 10 percent suspected that they had encountered a human trafficking victim, and only 20 percent said they would know what to do if they encountered a victim.</p> <p class="p1"> <b>Warning signs</b></p> <p class="p1"> Physicians who are raising awareness about human trafficking say identifying someone who is being trafficked can be complicated. </p> <p class="p1"> “There is not one straightforward answer,” said Suzanne Harrison, MD, a family physician in Tallahassee, Fla., who has spent her career advocating for victims of violence. She is co-chair of <a href="" rel="nofollow" target="_blank"><span class="s1">Physicians Against the Trafficking of Humans (PATH)</span></a>, an anti-trafficking committee of the <span class="s2">American Medical Women’s Association</span>.</p> <p class="p1"> Some red flags may be that the patient:</p> <ul> <li class="p3"> Experiences repeated STDs and/or pregnancies </li> <li class="p3"> Has bruises, scars, burns and cuts—especially ones that are hidden</li> <li class="p3"> Appears fearful, anxious or depressed</li> <li class="p3"> Pays cash and has no health insurance</li> <li class="p3"> Looks malnourished</li> <li class="p3"> Brings a third party who speaks for them</li> <li class="p3"> Shows signs of substance addiction or withdrawal</li> <li class="p3"> Lies about his or her age, or says they are visiting or passing through</li> <li class="p3"> Is tattooed with what may be the mark of a pimp or trafficker</li> </ul> <p class="p1"> Body language also may be a tip-off, said PATH’s creator and Executive Director Kanani Titchen, MD, an adolescent medicine fellow in New York City. Victims may give short answers to questions or seem confused. “Some of this can be normal, but it may be a clue to delve deeper with the patient,” she said. “We need to have our eyes and ears open.”</p> <p class="p1"> <b>What to do once you’ve identified someone</b></p> <p class="p1"> Physicians shouldn’t be shocked at answers from patients and shouldn’t give a judgmental look, experts say. Instead, have an open manner, and remember trafficking victims often are not in control of their bodies or their lives.</p> <p class="p1"> “If our encounters are compassionate, we have a huge opportunity to make a difference in someone’s life,” said Dr. Harrison, who also is AMWA’s president-elect.</p> <p class="p1"> A few questions to open the dialogue include:</p> <ul> <li class="p4"> Are you comfortable? Are you hungry?</li> <li class="p4"> Where are you living? Who are you living with?</li> <li class="p4"> Do you feel safe?</li> <li class="p4"> Has anyone ever hit you or forced you to do something you didn’t want to do?</li> <li class="p4"> Do you live, work and sleep in the same place?</li> <li class="p4"> Have you ever traded anything for sex?</li> </ul> <p class="p1"> “Don’t be afraid of offending a patient,” Dr. Titchen said. “If they are not trafficked, they won’t be offended. If they are trafficked, they will be glad you asked.” </p> <p class="p1"> Find a way to separate the patient from the people who brought them in so they may be more comfortable talking, Dr. Harrison said. Physicians also need to remember that patient privacy can be a matter of life or death for many trafficking victims. And Drs. Harrison and Titchen said writing a patient a prescription for a follow-up medical visit is key. While a trafficking victim may not seek help on a first visit, they may open up at a later visit.</p> <p class="p1"> “This is … about helping them connect the dots,” Dr. Titchen said. “Usually we are going to be one little stone on a long path.”</p> <p class="p1"> <b>Resources</b></p> <p class="p1"> Physicians can help get information to trafficking victims by putting pamphlets and posters in waiting and exam rooms. Face-to-face, physicians can give out a 24-hour hotline number in a way that’s easy to remember, such as this one offered by the National Human Trafficking Resource Center: (888) 3737-888. If a physician is going to write something down, it is best to put a phone number on a health card or write that the number is for a health service, such as the phone number to an x-ray facility.</p> <p class="p1"> In addition to <a href="" rel="nofollow" target="_blank"><span class="s1">PATH’s tools</span></a>, physicians can find resources at <a href="" rel="nofollow" target="_blank"><span class="s1">The Polaris Project</span></a><span class="s1">,</span> which also operates the textline “BeFree.” The Department of Health and Human Services’ <a href="" rel="nofollow" target="_blank"><span class="s1">Office on Trafficking in Persons</span></a> provides tools for health care professionals, and <a href="" rel="nofollow" target="_blank"><span class="s1">HEAL Trafficking</span></a> connects interdisciplinary health professionals to fight human trafficking. </p> <p class="p1"> The National Human Trafficking Resource Center has a <a href="" rel="nofollow" target="_blank"><span class="s1">checklist</span></a> of what to look for in the health care setting when trying to identify a human trafficking victim. The center also has a one-page <a href="" rel="nofollow" target="_blank"><span class="s1">health care assessment tool</span></a> for physicians. </p> <p class="p1"> The National Academy of Medicine, formerly known as the Institute of Medicine, offers a <a href="" rel="nofollow" target="_blank"><span class="s1">guide</span></a> to help health care professionals confront sexual exploitation and trafficking of minors. And the American Academy of Pediatrics last year published a <a href="" rel="nofollow" target="_blank"><span class="s1">clinical report</span></a> on the health care needs of victims.</p> <p class="p1"> The AMA recently <a href="" target="_blank"><span class="s1">adopted policy</span></a> that calls for educating physicians about human trafficking and teaching them how to report cases of suspected human trafficking to appropriate authorities to provide a conduit to resources to address the victim’s medical, legal and social needs.</p> <p class="p5" style="text-align:right;"> <i>By contributing writer Tanya Albert Henry</i></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:631ee4aa-4626-4811-b827-f23ddd1e8a71 Experts explain high drug prices, offer solutions Tue, 15 Mar 2016 21:22:00 GMT <p> Prescription spending is on the rise, according to a recent <a href="" target="_blank">analysis</a>, but what can be done to address patient and physician concerns about rising drug costs and change the course for the future? Find out what three experts had to say about the problem and what solutions they offered.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" /></a></td> </tr> <tr> <td>  </td> <td> <em><span style="font-size:10px;">From left to right: Marilyn Werber Serafini, Alliance for Health Reform; Steve Miller, MD, Express Scripts; Lori Reilly, PhRMA; David Certner, AARP</span></em></td> </tr> </tbody> </table> <p> Three specialists in the field of pharmaceuticals last month came together at the 2016 National Advocacy Conference to discuss current drug spending and pricing, trends in the marketplace and how those trends are affecting patient access and adherence.</p> <p> <strong>Why drug spending and prices are up</strong></p> <p> “There are four real reasons why [we] see drug prices going up,” said Steve Miller, MD, senior vice president and chief medical officer of Express Scripts. Here are the four reasons Dr. Miller gave:</p> <ol> <li style="margin-left:40px;"> “The introductory price of new drugs is higher than it has ever been,” he said.<br />  </li> <li style="margin-left:40px;"> “The inflationary increase of prices of existing branded products is the biggest factor driving the new trend,” Dr. Miller said.  <br />  </li> <li style="margin-left:40px;"> “For the first time,” Dr. Miller said, “generic prices aren’t going down like they used to, and in some cases generic prices are going up.”<br />  </li> <li style="margin-left:40px;"> “[What] is really important is the end of the generic wave,” he said. “In the past, for every patient that you put on a new expensive drug, you had 10 patients that you could move to a generic. And so total drug spending was able to be held in check because generics created the head room that we needed to keep drug spend relatively flat.”<br /> <br /> “We’re coming to the end of that phenomenon,” he added. “So for all those reasons, you see drug prices going up.”</li> </ol> <p> The Centers for Medicare & Medicaid Services (CMS) recently reported that U.S. prescription drug spending rose about 12 percent in 2014—up from a 2.4 percent growth in 2013—but what does this drastic change in spending mean?</p> <p> “I think clearly in 2014 it was an unusual year,” said Lori Reilly, executive vice president of policy and research at PhRMA. “It was the first year where we actually had the Affordable Care Act implementation and Medicaid expansion.”</p> <p> 2014 was a high-water mark in terms of new drug approvals, she said. “We also had a new medicine hit the market that cures a disease that kills five times as many people as HIV/AIDS does in this country—Hepatitis C.”</p> <p> “We saw large numbers of people enter Medicaid [who] had coverage for the very first time,” Reilly said.</p> <p> “For the first time, we have about 50 percent of Americans that have a deductible for prescription medicine. Just three years ago, only 20 percent of patients actually had a deductible for prescription medicine.”</p> <p> “A typical Medicare beneficiary has an income of about $23,500 a year,” said David Certner, legislative counsel and director of legislative policy at AARP. “Well, if you take the average price for some of the new specialty drugs, it’s about $53,000. That’s two times the income of a Medicare beneficiary.”</p> <p> <strong>How we can move forward</strong></p> <p> In addition to citing the problems in the current system, all three panelists offered their solutions to these issues.</p> <p> <strong>Change regulations, and create policy that makes sense</strong><br /> Regulatory delays and the cost and time it takes to get a product to the marketplace are standing in the way, Reilly said. “[Regulations] are certainly not helpful to the broader pharmaceutical industry and they’re not helpful to the patients who rely on those medicines.” Market-based incentives to bring more manufacturers into the mix could be one solution, she said.<br /> <br /> “50 months is the average time it takes to get a generic through the FDA today,” she said. When there are smaller market-share products holding up the line, manufacturers that want to enter the market with larger market-share products could receive a voucher to jump to the front of that line, Reilly said. More manufacturers in the market means more of the right kind of competition and lower drug prices.<br /> <br /> “[W]e need policies to help keep the generic market competitive,” Dr. Miller said. “Historically, the generic market was self-correcting. When the generic prices went up, many generic companies would reactivate their license, they’d get them to the marketplace, and they would start producing again.”<br /> <br /> “Now, because of the ways of the FDA,” he said, “it’s hard to reactivate your license—it could take three to four years. And so the market is no longer self-correcting. We need policies that make sense.”<br /> <br /> All three panelists agreed that the regulations around biosimilars are going to be important for the marketplace of the future to prevent skyrocketing drug prices.</p> <p> <strong>Transparency</strong><br /> “There [are] more and more transparency tools,” Certner said. “I will be the first to admit that drug pricing is a very complicated thing, which is not good for patients.”</p> <p> “We want and should demand transparency for our patients … for those people who pay for health care, that is the employers and the insurance companies,” he said. “You want your patients to be able to go on [a] website … and see exactly what it’s going to cost them out of their pocket.”</p> <p> What [we] don’t want,” he said, “is transparency amongst competitors,” he said. “Transparency for competitors actually doesn’t lower the price.”<br /> <br /> “You as physicians have a really big role to play in this,” Dr. Miller added, encouraging physicians to take action on behalf of their patients.</p> <p> At the end of last year, <a href="" target="_blank">physicians called for fairness in drug prices and availability</a> and offered solutions at the 2015 AMA Interim Meeting. Prescription drug costs also made it on the list of the <a href="" target="_blank">top 9 issues that will affect physicians in 2016</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:34b8b0f1-cb16-4974-b809-0cbf8ddaa41a Residency training environments primed for transformation Tue, 15 Mar 2016 21:00:00 GMT <p> An initiative to address the evolving needs of patients, trainees and the health care system could soon bring dramatic changes to residents’ clinical learning environments. Accreditation Council for Graduate Medical Education (ACGME) leadership spoke with <em>AMA Wire</em>® about how this initiative will support improvements in training and what it may mean for residents and the future of graduate medical education (GME).</p> <p> <strong>The key areas for change</strong></p> <p> The ACGME last month announced its <a href="" rel="nofollow" target="_blank">Pursuing Excellence in Clinical Learning Environments initiative</a>, building on three years of the Clinical Learning Environment Review (CLER), an intensive examination of how successful the nation’s teaching hospitals and medical centers are at engaging residents in improving quality and safety in the systems of care in which they train.</p> <p> “We recognized four overarching themes,” said Kevin Weiss, MD, senior vice president for institutional accreditation at the ACGME. The four themes cover a broad range of issues:</p> <ol> <li> When it comes to training in patient safety and quality, residents need hands-on experience. “They have the knowledge but not the application,” Dr. Weiss said.<br />  </li> <li> Educational goals for GME activities need to be in alignment with strategic planning around patient care. “The world of GME needs to be brought in much closer with alignment of patient service activity to drive the kinds of high-quality patient care we want to see,” he said.<br />  </li> <li> Faculty need more advanced training in patient safety to train residents at the high level needed. Institutions need to invest in faculty development around patient safety, Dr. Weiss said.<br />  </li> <li> Medical training needs to be integrated with other clinical professions. “We saw that medical education … often was happening a bit insular to the other clinical professions,” he said. Resources and the learning environments of the various professions need to be brought together to better train residents for the 21st-century health care environment.</li> </ol> <p> <strong>A continuum of change</strong></p> <p> “We started to get a sense from the very beginning in our work on CLER that it may not be enough to simply inform the community about what we’re seeing,” Dr. Weiss said. “What we want to do is enhance the capacity of the community to define best practices and share them with each other.”</p> <p> The Pursuing Excellence initiative aims to bring together teaching hospitals and academic medical centers in “a shared collaborative learning program, in which early participants develop innovations that are passed along to an ever-expanding circle of participants at other clinical learning environments,” Dr. Weiss and other ACGME leaders recently wrote in an <a href="" rel="nofollow" target="_blank">article</a> in the <em>Journal of Graduate Medical Education</em>.</p> <p> If this collaboration concept sounds familiar, it should. It’s based in part on a model already proving effective in transforming undergraduate medical education. Since 2013, the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education Consortium</a> has brought together leading medical schools to develop major innovations that are developing the components of the medical school of the future. Many of these innovations are being adopted at other medical schools as the consortium has expanded to include nearly one-fifth of the nation’s medical schools.</p> <p> “We knew what we wanted to do; we just didn’t know the how and why,” Dr. Weiss said. “That’s when the AMA’s Accelerating Change in Medical Education initiative became a wonderful asset to help advance the thinking in our community.”</p> <p> ACGME leaders came together with AMA leaders and heard insights from participants about the collaborative nature of the AMA consortium. “From that meeting, it became apparent that there’s such a compelling reason to develop the community’s capacity and develop a shared learning network. That enabled us to accelerate our idea forward,” Dr. Weiss said.</p> <p> Susan Skochelak, MD, group vice president for medical education at the AMA, said she anticipates future collaborations among the schools in the AMA consortium and the eight sponsoring institutions that will be selected for the ACGME initiative.</p> <p> “Our students and residents all train within the same learning environment and health care systems,” Dr. Skochelak said. “Natural collaborations already occur, and the AMA’s Accelerating Change in Medical Education initiative and ACGME are already working on ways to bring our two groups together to share innovations and best practices.”</p> <p> “We know we can improve physician education,” she said of the two groups.“We aspire to so much more than settling for our current state of training. We want to develop the needed tools and best practices for our faculty, our residents and our students, to provide the best care to our patients and communities.”</p> <p> <strong>What the Pursuing Excellence Initiative will mean for residents</strong></p> <p> Although changes rarely happen overnight, residents could soon start seeing changes that make a real difference in their training.</p> <p> “Patient care will improve because the more we engage residents and give them tools, the more things will change,” he said. “Patient care will benefit. And leaders will evolve.”</p> <p> Dr. Weiss said residents bring a lot to the table and already are making important changes when enabled to do so. “When you make a change, it can affect patients in the multiples,” he said. “One resident’s recent quality improvement project improved care for thousands—if not tens of thousands—of patients. That’s so rewarding for both the resident and patient care. Those are the kinds of changes that we are looking to accelerate.”</p> <p> <strong>Next steps</strong></p> <p> The deadline for proposals from interested institutions is May 4, and the ACGME already has heard tremendous interest in the initiative. When the group issued a request for information in preparation for the initiative late last year, the majority of respondents indicated an interest in participating.</p> <p> “We’re expecting a pretty robust set of applications,” Dr. Weiss said. “What’s most exciting is that we’re seeing it from a wide swath of interest, from the very large academic centers to the community hospitals and ambulatory care training sites, which are also asking if they can be a part of this. We’re looking for a balanced portfolio in those who are selected, so we have a balance of different types of institutions.”</p> <p align="right"> <em>By AMA Wire editor </em><a href="" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:82a558fb-db56-4ed2-94f2-247f909df918 Inspire a new generation of physicians May 3 Tue, 15 Mar 2016 14:00:00 GMT <p> Medical students and physicians across the country will inspire the next generation of minority physicians as part of National Doctor’s Back to School™ Day May 3. Join the movement and schedule your school visit today.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> The goal of the AMA Minority Affairs Section (MAS) Doctors Back to School program is to increase the number of minority physicians and ultimately work toward eliminating racial and ethnic health disparities. The program sends minority physicians and medical students into communities as a way to introduce children to professional role models. Doctors Back to School shows kids of all ages, especially those from underrepresented racial and ethnic groups, that medicine is an attainable career option for everyone.</p> <p> <strong>How you can get involved</strong></p> <p> Contact a school in your community and schedule a visit on or near May 3 to talk to students about why you became a physician and how they can follow in your footsteps. Your efforts will contribute toward the goal of increasing the number of historically underrepresented minority medical students. </p> <p> <a href="" rel="nofollow" target="_blank">Register your school visit</a> to purchase “Future Doctor” stickers and backpacks to distribute during your visit. A limited number of complimentary “Future Doctor” backpacks will be shipped to participants who register their confirmed school visit before April 15. You will be notified via email if your order will be free.</p> <p> For more information, visit the <a href="" target="_blank">Doctors Back to School Web page</a> or <a href="" rel="nofollow">send an email</a> to the AMA-MAS. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:56e885f6-810b-4bd0-9692-d2e432afa1de Case could leave physicians exposed to large fines Mon, 14 Mar 2016 21:32:00 GMT <p> Physicians are in a constant state of education to keep their skills and knowledge at the forefront so that their patients get the best care possible. But sometimes unintentional missteps on the business side of medicine can have serious ramifications for both physicians and their patients. A case before a state supreme court could put physicians in danger of exposure to large fines based on a legal technicality.<a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a></p> <p> <strong>Inadvertent mistakes and sizeable consequences</strong></p> <p> At stake in <em>Allstate Insurance Co. v. Northfield Medical Center</em>, currently before the Supreme Court of New Jersey, is whether liability under the New Jersey Insurance Fraud Prevention Act (IFPA) can be based on what the medical group or practice should have known, as opposed to what they actually knew.</p> <p> The IFPA is designed to protect against fraud in a way similar to the federal Stark Law and False Claims Act, which may subject physicians to large penalties for referring patients to health care facilities with which they have certain financial relationships.</p> <p> “The detection and prevention of insurance fraud must be a two-way street,” the Litigation Center of the AMA and State Medical Societies said in an <a href="" target="_blank">amicus brief</a> (log in). “With the considerable latitude that has been afforded to insurance carriers in rooting out the reprehensible conduct of a select few, comes an equally great responsibility to demonstrate restraint as it relates to the vast majority of health professionals who strive on a daily basis to meet the need of their patients.”</p> <p> The cause for concern in this case is not to challenge the Stark Law or the IFPA, but rather to encourage a narrow interpretation of complex and changing regulations to prevent medical professionals from being exposed to large unnecessary fines when they have not deliberately violated those regulations.</p> <p> Northfield Medical Center, the health care group in question, thought it was in compliance with state regulations concerning the corporate practice of medicine. But because regulations are in a constant state of change—a position many physicians could find themselves dealing with—they suddenly found they were on the wrong side of the fence.</p> <p> “There is no argument to support deliberate fraud,” the Litigation Center brief said, supporting a narrow reading of the IFPA. “But there is a [difference] between deliberate fraud and mistake. An appropriate standard and definition of ‘knowing’ prevents that [difference] from becoming a slippery slope that punishes health care practitioners who reasonably believe that they are in conformance with their professional ethical obligations and with state law.”</p> <p> <strong>Other recent cases in which the Litigation Center is involved</strong></p> <ul> <li> Read about how physicians are planning to tackle <a href="" target="_blank">liability reform challenges in 2016</a></li> <li> Find out how a case in Oregon could <a href="" target="_blank">increase liability exposure and redefine injury</a></li> <li> Learn how one of the nation’s leading <a href="" target="_blank">medical liability reform laws could be undercut in a state supreme court</a></li> <li> Understand the implications of a case that is set to decide on <a href="" target="_blank">censorship in the exam room</a></li> <li> See the outcome of a court’s decision regarding <a href="" target="_blank">protected patient safety information</a></li> </ul> <p>  </p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em><u>Troy Parks</u></em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f171c1b7-5421-48d3-8878-ca22422439eb How one practice is using self-measured BP with few resources Mon, 14 Mar 2016 20:06:00 GMT <p> Self-measured blood pressure (SMBP) can help physicians confirm a hypertension diagnosis and engage patients in managing their hypertension. Find out how one rural practice began using SMBP with minimal resources to improve patient outcomes.</p> <p> The U.S. Preventive Services Task Force (USPSTF) in October released <a href="" target="_blank" rel="nofollow">recommendations</a> for physicians to screen adults aged 18 years or older for high blood pressure and obtain measurements outside of the clinical setting to confirm a diagnosis before starting treatment.</p> <p> <strong>How Sterling Health Solutions got started</strong></p> <p> After joining the <a href="" target="_blank" rel="nofollow">Million Hearts initiative</a> around the time the USPSTF recommendations were released, Sterling Health Solutions in the small town of Mount Sterling, Ky., began using SMBP in practice, despite having minimal resources at their disposal.</p> <p> Richard Hall, MD, an internal medicine and pediatrics physician at Sterling Health Solutions, and his colleagues have already seen the impact SMBP has had on their practice in just four months.</p> <p> One of the first of Dr. Hall’s patients with hypertension to use SMBP is already seeing some improvements. “He would come into the office and his blood pressure readings would be out of sight, so we had him start doing a pretty intensive [program] with daily checks, sometimes twice a day when we first started,” Dr. Hall said. “He’s been under much better control.”</p> <p> The patients were receptive from the beginning, Dr. Hall said. The main obstacle has been that not all patients have access to a blood pressure cuff. “We’re trying to see if we can get more blood pressure cuffs to hand out—that’s the next step,” he said.</p> <p> <strong>Using minimal resources for better patient outcomes</strong></p> <p> Dr. Hall and his team developed a wallet-sized card that patients can keep with them. It’s “an educational tool we designed on our own,” he said. “It has information about blood pressure—the signs and symptoms, recommendations on diet and exercise, the importance of taking your medication every day, and finally a log they can use to track their blood pressures and pulse.”</p> <p> “The logs are for new patients with hypertension, new diagnoses or patients where we’ve made changes in their therapy,” he said.</p> <p> “If they don’t have a way of [measuring] on their own,” Dr. Hall said, “I encourage them to keep their card with them, and if they happen to go to a specialist appointment or another doctor, they can log their readings. Many of our patients have a relative or a neighbor with a blood pressure cuff that they can use.”</p> <p> Dr. Hall also encourages his patients to stop by when they’re in town and let the nurses check their blood pressure. “I have some patients who come back for their appointment and have only four readings,” he said, “but I tell them, that’s still four more than we would have [had] otherwise.”</p> <p> Dr. Hall last summer attended the National Association of Community Health Centers conference, where he heard a physician expert from the AMA’s <a href="" target="_blank">Improving Health Outcomes</a> initiative speak about the importance of using SMBP to help patients gain better control of their blood pressure.</p> <p> “I always tell [patients], ‘you spend 99 percent of your life outside of my office, so I want to know what your blood pressure is where you spend your life, not what it is in my office,’” he said. “I ask them when they come in if they did their homework, and they pull out their log and hand it to me. It’s a little joke between me and my patients, but it keeps them thinking about their blood pressure when they’re not in the office.”</p> <p> <strong>More on using SMBP in your practice</strong></p> <ul> <li> Find out <a href="" target="_blank">why you should use SMBP monitoring</a>.</li> <li> Learn how to <a href="" target="_blank">start using SMBP in your practice</a>.</li> <li> Check out what blood pressure experts had to say about the <a href="" target="_blank">latest blood pressure trials and guidelines</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:aaa39c1f-5610-4b12-8773-e1f31024f0a3 Academic physicians: Be sure to attend AMA-APS meeting, June 10-11 Mon, 14 Mar 2016 15:00:00 GMT <p> Academic physicians should plan to attend the 2016 AMA Academic Physicians Section (APS) Annual Meeting, which will take place June 10-11 at the Hyatt Regency Hotel in Chicago. <a href="" rel="nofollow" target="_blank">Register now</a>, and view the <a href="" rel="nofollow" target="_blank">draft meeting agenda</a>.</p> <p> <strong>Updates and policy review</strong></p> <p> The meeting begins at 12:30 p.m. June 10 (with an optional orientation for new members at 10 a.m.). That day, meeting participants will learn about a variety of timely topics, including:</p> <ul> <li> Progress of the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education Consortium</a></li> <li> Updates from the Liaison Committee on Medical Education</li> <li> How the AMA-APS plays a role in the making of AMA policy</li> <li> The latest legislative news from the AMA’s Washington, D.C., office</li> <li> Updates on the <a href="" target="_blank">Academic Leadership Program</a>, which offers 20 percent or higher discounts on AMA dues for medical school deans and faculty</li> </ul> <p> Attendees also will hear a welcome presentation from Kenneth S. Polonsky, MD, dean and executive vice president for medical affairs at the University of Chicago Pritzker School of Medicine, which is the host medical school for this year’s meeting.</p> <p> After the AMA-APS meeting concludes June 10, attendees are invited to join the AMA Council on Medical Education at 3 p.m. for its forum “Beyond the USMLE score: Assessing competence for entering residency.”</p> <p> At 7:30 a.m. the next day, join the section for a review of medical education-related reports and resolutions to go before the AMA House of Delegates. Section members will vote on proposed AMA-APS actions on these items (i.e., adopt, adopt as amended, refer, not adopt). In addition, AMA-APS members will elect the members of the 2016-2017 AMA-APS Governing Council.</p> <p> <strong>Educational sessions and hands-on activities</strong></p> <p> Then at 9 a.m., the AMA-APS welcomes Tait Shanafelt, MD, director of the Mayo Clinic Program on Physician Well-being, for an educational session on addressing physician burnout throughout medical education and practice.</p> <p> In his talk, “Finding meaning, balance and personal satisfaction in the practice of medicine,” Dr. Shanafelt will review the literature on physician satisfaction and burnout, and he’ll discuss the personal and professional repercussions of physician distress. Dr. Shanafelt also will describe successful individual and organizational approaches to promoting physician well-being.</p> <p> At 10:30 a.m., a second educational segment will provide practical techniques to address burnout. In his talk “Masks, comics and the ‘art of darkness’: Improving physician wellness throughout medical education and practice,” Michael J. Green, MD, from the Department of Humanities at Penn State College of Medicine, will discuss his work (<a href="" rel="nofollow" target="_blank">recently profiled</a> in <em>JAMA</em>) and lessons learned from comics produced by medical students.</p> <p> Next, session participants can take part in a hands-on activity, led by Mark Stephens, MD, at-large member of the AMA-APS Governing Council, to make a mask and/or draw a comic that reflects their perception of professional roles and responsibilities. Using this activity in medical education settings can help learners explore professional identity formation recognize themes of identity dissonance and counter address the negative effects of the “hidden curriculum.”</p> <p> After the AMA-APS meeting concludes, attendees are invited to join the AMA Senior Physicians Section for a session at noon on wellness and satisfaction among retired physicians, “Burning up, burning out or burning brightly?” The featured presenter will be Richard Gunderman, MD, professor of radiology, pediatrics, medical education, philosophy, liberal arts, philanthropy, and medical humanities and health studies at Indiana University.</p> <p> Finally, academic physicians and others interested in further exploration of key medical education issues are invited to attend the Academic Medicine Caucus, which will be held at 9:30 a.m. June 13. The report of Reference Committee C (which addresses medical education issues) will be a key topic of discussion.</p> <p> Be sure to check the <a href="" target="_blank">AMA-APS Web page </a>to stay apprised of updates. Also, read a <a href="" target="_blank">summary</a> of the Nov. 2015 AMA-APS meeting held in Atlanta.</p> <p> The AMA welcomes your feedback: Please <a href="" rel="nofollow">email the section</a> or call (312) 464-4635.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ca05c2fa-8538-46cf-9dbf-9212f91e4e50 Overview clarifies CME reporting under the Sunshine Act Mon, 14 Mar 2016 15:00:00 GMT <p> The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. The Centers for Medicare & Medicaid Services (CMS) has been charged with implementing the Sunshine Act and has called it the “Open Payments Program.”</p> <p> A subset of drug, biological and device manufacturers have raised questions concerning the Open Payments Program’s reporting requirements and participation in commercially supported, accredited and certified continuing medical education (CME) programs in 2016. To respond to these concerns, the AMA has provided an <a href="" target="_blank">overview</a> of the relevant statutory, regulatory and sub-regulatory guidance issued by CMS through Feb. 1, which exempts compliant certified and accredited independent CME from reporting in the Open Payments Program.</p> <p> Under the AMA CME credit system standards, AMA <em>Code of Medical Ethics</em> and Accreditation Council for Continuing Medical Education (ACCME) accreditation standards, commercial supporters are prohibited from having any direct or indirect influence or control with respect to the content, faculty, speakers or attendees of an educational program or activity.</p> <p> Therefore, educational grants given to AMA-certified and ACCME-accredited programs (including online or enduring educational programs) that comply with those standards do not meet the definition of an “indirect payment” and as such are exempt from reporting by commercial supporters under the Open Payments Program, according to the overview document.</p> <p> Physicians are encouraged to register with the <a href="" target="_blank" rel="nofollow">CMS Enterprise Portal</a> so they can exercise their right to review their reports and challenge reports that are false, inaccurate or misleading. Physicians will have access to 2015 data in early April.  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6332c72f-db06-46e2-a785-ef9e853a698a Physicians take a new approach to improve mental health Mon, 14 Mar 2016 04:07:00 GMT <div> <a href="" target="_blank"><img src="" style="margin:15px;float:right;" /></a>Mental and behavioral health issues such as anxiety, depression, smoking and physical inactivity impact many aspects of health. Find out how one university health service incorporated behavioral health to help their patients live happier, healthier lives.</div> <div>  </div> <div> While primary care seeks to improve the overall health of patients which includes both mind and body, treating both medical needs is often met with barriers such as lack of resources, lack of time and the perceived stigma that many patients have toward mental health care. </div> <div>  </div> <div> A <a href="" target="_blank" rel="nofollow">new module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies offers ways in which you can embed behavioral health within a primary care or certain secondary care practices to expand services to meet both the mental and general health needs of your patients. </div> <div>  </div> <div> <strong>How Cornell University did it</strong></div> <div> Cornell University Health Services recently set out to show the value of an embedded behavioral health consultant as a cost-effective and culturally sensitive approach to merging mental health with standard practice.</div> <div>  </div> <div> Nearly 80 percent of Cornell students used campus medical services. Although surveys showed as many as 40 percent of students could have benefited from mental health care, only about 18 percent used such services. One barrier was that counseling and medical services were provided separately. </div> <div>  </div> <div> To offer their student population the best possible access to care and overcome barriers, Cornell developed a one-year pilot program in which they embedded a behavioral health consultant within a medical unit to work with four clinicians. </div> <div>  </div> <div> Suddenly students who said they would not have sought out traditional mental health services were finding the behavioral health consultant very helpful. The program reached under-represented minorities, international and graduate students, and others well beyond the general student population. The clinicians reported that this partnership increased the quality of care, and the entire staff developed a new appreciation for the volume and significance of mental health concerns in the primary care setting. </div> <div>  </div> <div> With the success of the pilot, Janet Corson-Rikert, MD, executive director and associate vice president of Cornell University Health Services, decided to expand the program. Now, each medical team includes at least one behavioral health consultant. </div> <div>  </div> <div> Dr. Corson-Rikert offered these three suggestions for those currently implementing or considering similar programs:</div> <div>  </div> <div style="margin-left:40px;"> 1.<span class="Apple-tab-span" style="white-space:pre;"> </span>Set up an interdisciplinary team to support the behavioral health consultant and enable nimble problem-solving around operational challenges. </div> <div style="margin-left:40px;"> 2.<span class="Apple-tab-span" style="white-space:pre;"> </span>Leverage the behavioral health consultant’s expertise for both behavioral and cultural concerns.</div> <div style="margin-left:40px;"> 3.<span class="Apple-tab-span" style="white-space:pre;"> </span>Use regular case reviews to facilitate education and team discussion based on the behavioral health consultant’s experience.</div> <div>  </div> <div> <strong>More ways to transform your practice</strong></div> <div> Improving the quality and reach of care is never an easy feat. Check out these other modules from the STEPS Forward collection to help guide your practice improvement strategies:</div> <div>  </div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span>Learn how to <a href="" target="_blank" rel="nofollow">build an intensive primary care practice</a></div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Find out what <a href="" target="_blank" rel="nofollow">implementing a daily team huddle</a> can do for your team’s morale</div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Learn the best ways to <a href="" target="_blank" rel="nofollow">prepare your practice for change</a></div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  See how collaboration within a <a href="" target="_blank">peer-based learning network</a> is giving practices the resources they need.</div> <div>  </div> <div> You also can take some of your team members to the AMA-MGMA Collaborate in Practice Meeting, March 20-22 in Colorado Springs, to gather leadership techniques to help propel you and your practice team toward future success. Former U.S. Sen. Bill Bradley, D-N.J., and Richard Deem, AMA senior vice president of advocacy, will speak on leadership and the changing health care landscape. <a href="" target="_blank" rel="nofollow">Register online</a>, and receive a discount when you register two or more of your team members.</div> <div>  </div> <div> More than 25 modules are available in the AMA’s <a href="" target="_blank" rel="nofollow">STEPS Forward</a> collection, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</div> <div>  </div> <div style="text-align:right;"> <em>By AMA staff writer <a href="" target="_blank" rel="nofollow">Troy Parks</a></em></div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d3265943-7a38-4b9b-98f3-a6c122d957c7 AMA-WPS elects governing council members Fri, 11 Mar 2016 16:00:00 GMT <p> The AMA <a href="">Women Physicians Section</a> (WPS) recently held its governing council elections. Read on to find out which women were elected by their peers to serve in the coming year.</p> <p> <strong>Newly elected members:</strong></p> <ul> <li> Josephine Nguyen, MD, delegate</li> <li> Ami Shah, MD,  alternate delegate</li> <li> Lynda Kabbash, MD, at-large member</li> <li> Kusum Punjabi, MD, AMA Young Physicians Section representative</li> <li> Christina Talerico, MD, AMA Resident and Fellows Section representative</li> <li> Poornima Oruganti, AMA Medical Student Section representative</li> </ul> <p> <strong>Continuing members:</strong></p> <ul> <li> Alice Coombs, MD, at-large member</li> <li> Neelum T. Aggarwal, MD, American Medical Women’s Association representative</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8ed77e1e-43b4-4ee3-a1bb-9b064ebc77aa How med ed transformations are benefiting students at Mayo Fri, 11 Mar 2016 16:00:00 GMT <p> <em>A Spotlight on Innovation post with</em> <em>Ben Mundell, first-year student at Mayo Medical School.</em></p> <p> <strong><em>AMA Wire®</em></strong><strong>: You’re part of the first medical class to participate in Mayo Medical School’s </strong><a href="" target="_blank"><strong>new educational opportunities</strong></a><strong> for providing value-driven care, which have stemmed from the school’s participation in the AMA’s </strong><a href="" target="_blank"><strong>Accelerating Change in Medical Education Consortium</strong></a><strong>. What do you think are the benefits of this new approach to your training?</strong></p> <p> <strong>Mundell:</strong> Being exposed to team-based care at Mayo, both in the classroom and the clinical setting, not only provides more time to prepare for practicing in this setting, but also helps frame the rest of the didactic experience of the first two years.</p> <p> Physicians can no longer afford to think only about diagnoses or proper therapeutics in isolation. Patients and society expect that we will deliver care that is not only medically appropriate but is also what the patient wants while using the proper resources and level of care necessary to deliver high-value care. Learning to bring the patient preferences and the skill sets other health care team members bring to medicine early on will make me a more effective physician.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are some ways that you have participated in the delivery of team-based care to patients and populations?</strong></p> <p> <strong>Mundell:</strong> Within the first month of medical school, I was out in a primary care clinic that was putting team-based care in to practice. I had done some research in the past on the value of team-based care, specifically in settings using the patient-centered medical home construct. Actually observing team-based care made me an even bigger believer in the promises of delivering health care in a collaborative manner. I am looking forward to working in team-based settings as my education continues, and I hope to contribute to the expanding body of knowledge on how to best deliver health care.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What was it like transitioning directly from the classroom to a complex health system as a first-year student? What were your initial reactions, and what have you enjoyed learning thus far?</strong></p> <p> <strong>Mundell:</strong> I chose Mayo for medical school because of its excellent reputation in training clinicians in a team-based setting. Moving from the theory of team-based care to the practice was less intimidating as it was inspirational. Every one of the team members I followed was incredibly knowledgeable and willing to answer the questions I had about their roles as they cared for the patient and supported the rest of the care team.</p> <p> The team functioned in a way that no one role was more important than any other, with everyone centered on providing the best care for the patient. It was exciting to see the enthusiasm of each team member. Oftentimes we hear only about the complexities and inefficiencies of modern medicine; being able to experience team-based care early on has shown me that we are succeeding at ways to improve health care.</p> <p> <strong><em>AMA Wire</em></strong><strong>: Based on your own experience, what advice would you offer to other first-year students exploring health systems early in training to make the most of their new learning environment?</strong></p> <p> <strong>Mundell: </strong>It is important to not only focus on the basic science aspects of medical training but also build the knowledge and learn the skills to become a responsible physician-citizen. Reading articles and studies on how the delivery of care can be improved is important to become familiar with concepts and terminology, but being exposed to team-based care in a clinical setting is an unmatched learning experience. Take the time to observe the interactions between the team members and ask about their roles. Be curious!</p> <p> <strong><em>AMA Wire</em></strong>: <strong>Are there any members within the health care system that you’re particularly excited to learn more about?</strong></p> <p> <strong>Mundell:</strong> Patients are at the center of health care, and while we learn a lot about how to diagnose and manage diseases, we have not always done a great job of asking the patients about their goals of care. Traditionally, there has been information asymmetry in the patient-physician relationship.</p> <p> As I move forward with my education and career, I am excited to learn about ways in which this asymmetry can be reduced. Part of this improvement in the relationship with the patient comes with engaging other members of the care team, especially the nursing staff and pharmacists. These individuals offer a unique expertise and knowledge base that I hope will continue to be used to better assist the patient in meeting his or her goals. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c1d5def2-b4dd-46c1-a748-33f68760aefc Get support from CPT® Assistant newsletter Fri, 11 Mar 2016 15:00:00 GMT <p> For in-depth information you need to code accurately and efficiently, subscribe to the AMA’s <em>CPT® Assistant</em> newsletter, which offers the most up-to-date information on codes and trends in the industry each month.</p> <p> The <em>CPT® Assistant</em> newsletter has been instrumental to many physicians in their appeal of insurance denials, validating coding to auditors, training staff and answering the day-to-day coding questions that arise.</p> <p> Each monthly issue of this newsletter offers vital and timely information for people who use the CPT codebook, including:</p> <ul> <li> Clinical scenarios that demystify confusing codes</li> <li> Answers to your most frequently asked questions</li> <li> Quick reference to anatomical illustrations, charts and graphs</li> </ul> <p> AMA members receive a $94 discount on their <a href="" target="_blank">subscription</a>. Not an AMA member? <a href="" target="_blank">Join today</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:08a0fe4f-48b2-4cf5-933c-9aab25c008c6 Increasing the diversity of the AMA House of Delegates Fri, 11 Mar 2016 15:00:00 GMT <p> A forum at the 2016 AMA Annual Meeting in Chicago will explore ways to promote diversity among state and specialty society delegations to the AMA House of Delegates. Ahead of that, the AMA Council on Long Range Planning and Development has launched an online forum for you to contribute your thoughts, ideas and concerns regarding the diversity of delegations.</p> <p> All members of the AMA Academic Physician Section are encouraged to contribute to this important effort. <a href="" target="_blank" rel="nofollow">Log in to share</a> your input, ideas and personal insights. The online forum will close May 13. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5cfb9371-6b0c-452f-a886-49f67d266cd4 Why IMGs don’t always match--and strategies for a better outcome Thu, 10 Mar 2016 18:11:00 GMT <p> International medical graduates (IMG) have comprised a growing contingent of Match applicants in recent years. They have achieved notable success but also have accounted for the majority of unmatched applicants. While the 2016 Match results still are forthcoming, recent history suggests that the outcomes and experiences for IMGs are tied to a few key interview and ranking strategies.</p> <p> <strong>Match trends for IMGs</strong></p> <p> The Match rate for IMGs has been trending upward, but in 2013, the majority of unmatched applicants were IMGs. Of all 8,388 unmatched applicants, 27.9 percent were U.S. citizens who attended an international medical school, and 46.4 percent were non-U.S. citizen international medical school graduates, according to an <a href="" rel="nofollow" target="_blank">analysis</a> done by researchers at the National Resident Matching Program (NRMP) and the University of California, San Diego.</p> <p> A firmer understanding of the matching process could increase the IMG match rate, as a significant proportion of unmatched IMGs approached the interview and ranking process differently from matched applicants, according to the analysis of 2013 data. The study authors considered responses to the NRMP Applicant Survey and other data sources.</p> <p> <strong>4 ways IMGs can boost their odds of matching</strong></p> <p> Among the takeaways, these are four strategies that more IMGs—and other applicants—could adopt to improve their odds of matching:</p> <p style="margin-left:.5in;"> <strong>1. Attend all interviews.</strong> Of unmatched U.S. citizen IMGs in 2013, 11 percent did not attend all interviews. That percentage rose to 17 percent for unmatched IMGs who were not U.S. citizens. By not attending all interviews, IMGs “failed to capitalize on every opportunity to market themselves,” the study authors noted. The authors acknowledged that further research is needed to determine why IMGs may not be attending interviews, as geographic, financial and cultural considerations could come into play.</p> <p style="margin-left:.5in;"> <strong>2. Rank all programs at which they interview.</strong> Among unmatched U.S. citizen IMGs, 7 percent did not rank all programs at which they interviewed. For unmatched non-U.S. citizen IMGs, 22 percent declined to rank all programs at which they interviewed. By looking at the rank order lists of unfilled programs, the researchers determined that 70 unmatched IMGs who had a preferred specialty would have matched if they had ranked an unfilled program that had ranked them. Along the same lines, ranking programs at which the applicant did <u>not</u> interview is another unsuccessful strategy that was more often employed by unmatched IMGs compared to matched IMGs.</p> <p style="margin-left:.5in;"> <strong>3. Rank all programs they are willing to attend. </strong>Among U.S. citizen IMG applicants who matched, 52.3 percent ranked all the programs they would be willing to attend, but only 40 percent of unmatched IMG applicants did so. For non-U.S. citizen IMG applicants, 40.1 percent of matched applicants ranked all programs they would be willing to attend, compared with only 31.1 percent of unmatched applicants.</p> <p style="margin-left:.5in;"> <strong>4. Do not rank programs based on a perceived likelihood of matching.</strong> Due to how the matching algorithm works, it is not advisable to rank programs based on a perceived likelihood of matching with them, the authors said. But 36.3 percent of unmatched U.S. citizen IMGs and 33.5 percent of unmatched non-U.S. citizen IMGs did so in 2013. Only 19.5 percent of matched U.S. citizen IMGs and 18.1 percent of matched non-U.S. citizen IMGs adopted this strategy.</p> <p> There are numerous other interview and ranking strategies that IMG applicants could benefit from utilizing more often, the findings suggested. These include ranking a mix of competitive and less competitive programs, and ranking one or more programs in an alternative specialty as a “fall-back plan.”</p> <p> Overall, some IMGs may benefit from a more complete understanding of how matching works. This may be one reason that IMGs sometimes turn to for-profit companies that claim to increase the chances of matching—but program directors by and large “disdain” these companies, the study authors stressed. IMGs instead should seek out education that will enable them to “champion their own capabilities,” they wrote.</p> <p> <strong>Resources to help</strong></p> <p> The AMA <a href="" target="_blank">offers a variety of resources</a> to help IMGs be their own best advocate while navigating the interview and ranking process. These include access to <a href="" target="_blank">FREIDA Online</a>®, the AMA Residency & Fellowship Database™ (which has information on more than 10,000 accredited graduate medical education programs), a guide to the medical residency interview for IMGs, advice from current residents and a sample residency interview.</p> <p> The AMA is dedicated to supporting and advocating for its IMG members, who are 38,000 strong. And the number of IMGs seems destined to grow, the NRMP figures <a href="" rel="nofollow" target="_blank">show</a>: The number of U.S. citizen IMGs in the Match increased 33 percent between 2011 and 2015, and the number of non-U.S. citizen IMGs who matched last year (3,641) set a new record.</p> <p align="right"> <em>By contributing writer Tim Mullaney</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:22946b3a-c2af-4017-86cf-11b9930c6a48 Get free training to provide substance use disorder treatment Thu, 10 Mar 2016 16:04:00 GMT <p> As the country strives to overcome the opioid epidemic, many patients need treatment for opioid use disorders—and physicians are stepping up to the plate. Find out how you can get the proper training to provide medication-assisted treatment (MAT) for your patients. Three free opportunities are quickly approaching.</p> <p> MAT is treatment for substance use disorders that includes the use of medication paired with counseling and other support. In order to prescribe buprenorphine, a partial opioid agonist used to treat opioid addiction, physicians must have eight hours of certified training and obtain a waiver.</p> <p> “There are literally millions of people across the country who need our help, and they need it now,” Michael Botticelli, director of National Drug Control Policy recently said to physician leaders at the <a href="" target="_blank">2016 National Advocacy Conference in Washington, D.C.</a> “We know that [MAT], when combined with counseling, is a proven path to recovery.” The AMA’s Task Force to Reduce Prescription Opioid Abuse also supports <a href="" target="_blank">increasing access to MAT</a> for opioid use disorder.</p> <p> If you are seeking to obtain your waiver to prescribe this life-saving medication, the Providers’ Clinical Support System (PCSS) is now offering <a href="" target="_blank" rel="nofollow">certified MAT training for physicians</a>.</p> <p> The “half-and-half” training is completed in two parts:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>The first half</strong> of the course is 3.75 hours of online training on substance abuse treatment, opioids and the use of buprenorphine in the treatment of opioid use disorders. Physicians obtain their waivers after successfully completing an examination.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>The second half</strong> of the course is 4.25 hours of live training, which focuses on the specifics of treating patients with opioid use disorders in office-based settings and clinical vignettes to help trainees think through real-life experiences in opioid use disorder treatment.</p> <p> Upcoming webinars:</p> <ul> <li> <a href="" target="_blank" rel="nofollow">Register</a> for the March 19 training webinar from 8 a.m. to 12:30 p.m. Eastern time.</li> <li> <a href="" target="_blank" rel="nofollow">Register</a> for the March 23 training webinar from 8:30 p.m. to 12:30 a.m. Eastern time.</li> <li> <a href="" target="_blank" rel="nofollow">Register</a> for the April 9 training webinar from 9 a.m. to 12:30 p.m. Eastern time.</li> </ul> <p> The presenter for the March 19 and April 9 webinars is Steven A. Wyatt, DO, medical director of addiction medicine and behavioral health at the Carolinas HealthCare System.</p> <p> The presenter for the March 23 webinar is William Morrone, DO, assistant director of family medicine at the Central Michigan University College of Medicine and medical director at Hospice of Michigan.</p> <p> <strong>Register to attend the National Rx Drug Abuse and Heroin Summit</strong></p> <p> Another opportunity for physicians who are interested in learning more about how they can help combat the opioid epidemic is the <a href="" target="_blank" rel="nofollow">National Rx Drug Abuse and Heroin Summit</a>, to be held March 28-31 in Atlanta. Attendees will learn about the latest research from the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the National Institutes of Health, university medical centers and more.</p> <p> Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees and chair of the AMA <a href="" target="_blank">Task Force to Reduce Prescription Opioid Abuse</a>, will lead a <a href="" target="_blank" rel="nofollow">vision session</a> to discuss the work of the task force and how the nation’s medical societies have responded to America’s opioid epidemic.</p> <p> <a href="" target="_blank" rel="nofollow">Register to attend</a> this summit, which is now the largest national collaboration of stakeholders to impact the opioid crisis. AMA members can receive a $100 registration discount by calling Cheryl Keaton of Operation UNITE at (606) 657-3218.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0240c01d-d43e-4c2f-a504-35fb71c4e914 How students are transforming med ed at University of Nebraska Thu, 10 Mar 2016 16:00:00 GMT <p> <em>A Spotlight on Innovation post with</em> <em>R. Logan Jones, a third-year student at University of Nebraska College of Medicine (UNMC).</em></p> <p> <strong><em>AMA Wire®:</em></strong> <strong>What’s one project that UNMC is pursuing within their work in the AMA’s </strong><a href="" target="_blank"><strong>Accelerating Change in Medical Education Consortium</strong></a> <strong>that you’re particularly excited about?</strong></p> <p> <strong>Jones: </strong>One project with which I’ve been excited to work is UNMC’s Interprofessional Experiential Center for Enduring Learning, otherwise known as iEXCEL℠. This is the campus entity that represents the collaborative efforts among the various colleges to enhance interprofessional education across the continuum of medical education through the adaptive use of cutting-edge technologies.</p> <p> As part of iEXCEL, UNMC Is planning to start construction on the Global Center for Advanced Interprofessional Learning—a 125,000 square foot facility that will house immersive virtual reality environments, simulated clinical environments and tele-education capabilities to link the center’s resources with students and providers across Nebraska and around the world.  </p> <p> I imagine iEXCEL offering a future in which medical students have the opportunity to participate in “virtual-reality rounds” with nursing students, pharmacy, PT/OT and other professional students as they work collaboratively to care for a census of virtual patients. This would afford students a safe, simulated learning environment in which they are able to expand their professional knowledge through experiential learning, refine the various skills of their profession and develop the professional attitudes necessary to deliver highly effective team-based, patient-centered care.</p> <p> As a student in the throes of my third-year clerkships, if nothing else, I have learned that no one person has the ability to fully address a patient’s needs and that it takes a team of people to truly care for their whole person. Furthermore, as our medical system increases in complexity and the patient care demands become more specialized, the reliance on teams of people to provide total patient care can only increase from here. Thus, efforts like UNMC’s work in the AMA’s Accelerating Change in Medical Education Consortium to enhance interprofessional education and practice are poised to play a large part in training the next generation of health professionals.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are some of the barriers students face when trying to spark change at their medical school, and how is UNMC’s work within the AMA’s Accelerating Change in Medical Education Consortium helping to break down those barriers for students?</strong></p> <p> <strong>Jones: </strong>I think that there are two big barriers that stop students from feeling empowered to pursue a course of change at their medical schools. The first of these is a shortage of time. Medical students are an extremely busy bunch of people. Take your average medical student: Type A personality, extremely bright and very goal-driven. These attributes coupled with the constant pressure to succeed in class and obtain a good spot in the Match leaves what little free time is left at the end of the day rationed off to participate in CV building activities, such as research, interest group involvement or volunteer work.  While UNMC’s involvement with the consortium has done little to ameliorate the time crunch students are constantly struggling with, it has helped immensely with the other barrier—opportunity awareness.</p> <p> At the start of the academic year, I believe that most students had very little insight into the numerous ongoing curricular reform efforts taking place on campus. Those students who had been involved with such efforts were typically on class governing councils, student senate and other leadership positions which facilitated easy participation in efforts. Despite the usual means of information dissemination, the calls to garner student participation often fell on deaf ears.</p> <p> However, with the announcement of UNMC joining the AMA’s Accelerating Change in Medical Education Consortium came a spark of student interest and curiosity of what was going on behind the scenes. Furthermore, the recent AMA medical education <a href="" rel="nofollow" target="_blank">innovation challenge</a> took the call of action directly to students and culminated in at least three UNMC based proposals.</p> <p> More than ever in my experience are students talking about what UNMC is doing to change and how they can get involved. I am hopeful that as UNMC continues to collaborate with the other consortium members to refine our project and slowly unveil it to the campus, the barrier of opportunity awareness for students on how to get involved will become a thing of the past. </p> <p> <strong><em>AMA Wire</em></strong><strong>: Is there </strong><a href="" target="_blank"><strong>a particular project</strong></a><strong> from a consortium school that especially inspires you?</strong></p> <p> <strong>Jones: </strong>My first exposure to the AMA and subsequently its Accelerating Change in Medical Education Consortium took place at the 2014 AMA Annual Meeting in Chicago. I sat in on a presentation about Oregon Health and Science University School of Medicine’s <a href="" target="_blank">project</a> using a flexible, learner-centered, competency-based curriculum model. Their project has been especially inspirational for me as it has been one of the more ambitious in terms of revolutionizing the medical education timeline in addition to really challenging the Flexnerian status quo.</p> <p> There are three main aspects that most intrigue me about their project. First is the opportunity it provides students to take direct ownership of the education timeline. I believe that this should incentivize students to better develop skills of self-directed learning, and I am hopeful that this hypothesis will hold up over time.</p> <p> Second, the flexible training times may offer some students the opportunity to reduce their overall cost of medical education by finishing sooner than traditional programs would have them.</p> <p> Finally, medical students bring a vast array of past life experiences when they step into the classroom, but all too often, students find themselves conforming to their education instead of the other way around. I am excited to see where this project will be in five to 10 years, what lessons were learned and if their model can be a sustainable new paradigm for medical education in our country.</p> <p> <strong><em>AMA</em></strong><strong> <em>Wire</em>: What should be the result of true innovation in medical education?</strong></p> <p> <strong>Jones:</strong> Many of the thought leaders in medicine have been indicating that the physician’s role in health care is changing. No longer will the epitome of health care be the direct care of a patient by a single physician; team-based care is where the compass rose is pointed. As such, if the medical profession and the federation of organized medicine truly support the notion that our society is best served with physicians leading our health care, then our medical education must seek to train agents of change equipped with the knowledge, skills and attitudes to approach any problem.</p> <p> Innovative medical education should aim to train medical graduates who can effectively make decisions in collaboration with the other professionals charged with caring for their patients—decisions that leverage all the strengths of the medical team to attain the best health outcomes while doing so in a cost conscious manner. Medical education should strive to produce graduates who look at health care systems not as barriers but as tools and methods to improve and streamline their ability to deliver care.</p> <p> Innovation in medical education should strive to incorporate cutting-edge technologies into teaching, not just for the sake of technology, but to use it in meaningful ways to enhance and accelerate the learning process. It should also instruct students on how to use technology to augment their clinical practice without sacrificing the ability to practice medicine in the absence of technology. </p> <p> If we can pursue personalized medicine, why can’t we pursue personalized medical education? Innovation in medical education should allow for the educational process to complement each student’s individual strengths and weaknesses. It should afford students the ability to shorten or lengthen their training while confidently assuring that each graduate is a physician who society can be assured is fully competent and capable of assuming care of our populations. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ee61a5da-6720-4827-b48a-b6da9281fcb1 Flexible duty hours allow a more positive learning experience Wed, 09 Mar 2016 22:50:00 GMT <p> The results of a landmark duty-hours trial are in, and the findings indicate that allowing general surgery residents to work flexible, less restrictive hours improves continuity of care. While residents generally had more positive perceptions of their training, there were some personal trade-offs.</p> <p> <a href="" target="_blank"><img src="" style="float:right;margin:15px;height:1059px;width:275px;" /></a></p> <p> <strong>The FIRST Trial</strong></p> <p> Results of the highly anticipated Flexibility in Duty Hour Requirements for Surgical Trainees Trial, commonly known as the <a href="" rel="nofollow" target="_blank">FIRST Trial</a>, were recently published in the <em>New England Journal of Medicine</em>. This national, cluster-randomized trial involved 117 general surgery residency programs and 151 affiliated hospitals during the 2014-2015 academic year. Fifty-nine residency programs and their 71 affiliated hospitals followed standard Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies, while 58 programs and their 80 affiliated hospitals followed a flexible duty-hour policy.</p> <p> The study is the first large-scale, national study to examine the impact of ACGME duty-hour reforms established to prevent residents from fatigue-related errors. Residents and their mentors have been eager for data on the topic after some have raised concerns that the limits could undermine the goals of surgical training if residents are unable to follow patients through critical aspects of their care.</p> <p> Under the flexible-hours policy, which included the ability to work longer shifts and take less time off between shifts than allowed under current duty-hour requirements, residents were better able to see patients through to the end of their episodes of care.</p> <p> An “important finding in our study was that residents in the flexible-policy group were about half as likely to leave or miss an operation or hand-off in an active patient care issue than were those in the standard-policy group,” study authors wrote. “This suggests that the flexible, less-restrictive duty hours had their intended effect of improving continuity of care.”</p> <p> <strong>Some learning environment pros; some personal life cons </strong></p> <p> Being able to stay with patients through an operation or hand-off may have contributed to residents in the flexible-policy group reporting a less negative perception of the impact that duty-hour policies had on the learning environment than residents in the standard duty-hours group.</p> <p> For example, when it came to learning clinical skills, 36.4 percent of residents in the standard-policy group believed duty-hour rules had a negative impact on learning, while just 13.1 percent in the flexible-group felt that way. About 49 percent of residents working under the standard duty-hour rules said they had a negative impact on learning operative skills. In comparison, 18.9 percent of residents working under the flexible duty hour-rules perceived a negative impact.</p> <p> The trade-off seems to be on residents’ time away from the hospital. Residents in the flexible-policy group were more likely to report that duty hours had a negative impact on their personal lives. About 25 percent of those who worked more flexible hours reported that duty hours had a negative impact on time with family and friends, extracurricular activities, rest and health. Among those who worked the standard hours, just under 10 percent said duty hours had a negative impact on those areas.</p> <p> Despite differences on specific questions, residents in both groups reported similar satisfaction rates with their overall quality of education and their overall well-being. In the standard-policy group, 10.7 percent reported being dissatisfied with the overall quality of their resident education; 11 percent in the flexible-policy group reported being dissatisfied. When it came to overall well-being, 12 percent of standard-policy residents were dissatisfied, and 14.9 percent of flexible-policy residents were dissatisfied.</p> <p> <strong>Patient safety differences were negligible</strong></p> <p> Data from more than 138,000 patients showed that the less restrictive policies did not significantly increase the rate of death or serious complications for patients. The rate was 9.1 percent for the flexible-policy group and 9 percent for the standard-policy group. The similarity in rates held steady whether the surgery was emergency or elective and whether it was an outpatient or inpatient setting, study authors reported.</p> <p> The FIRST trial is one of two large, multi-national <a href="" target="_blank">resident trials</a> that are expected to answer questions about duty-hour rules.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:78f5106e-d749-4f4f-945d-cadfbff955fa How the Mayo Clinic is battling burnout Wed, 09 Mar 2016 22:07:00 GMT <p> With physician burnout at 54.4 percent nationwide, according to a recent <a href="" target="_blank">study</a>, the medical world needs solutions now—and the Mayo Clinic is pioneering a model designed to raise camaraderie and increase collaboration to reduce burnout among its physicians. Find out why this health system started treating physicians as architects in practice rather than construction workers.</p> <p> <strong>A physician-led solution</strong></p> <p> Stephen Swenson, MD, medical director of the Office of Leadership and Organization Development at the Mayo Clinic and professor of radiology at the Mayo Medical School, worked with his colleagues to develop the Listen-Act-Develop model that focuses on physician engagement as a strategy to reduce burnout and involve physicians in the mission of their organization.</p> <p> “If you have seen the causes of burnout in one unit, you have seen the causes of burnout in one unit,” Dr. Swenson said. “They are unique and variable.”</p> <p> The first staple of the model is establishing a formal listening forum to hear from physicians. Dr. Swenson’s group made sure physicians were in a psychologically safe setting while they discussed top pain points physicians identified, such as clerical work, process inefficiencies, and ways for clinicians to have some control of their daily and weekly schedules.</p> <p> What was “important was the simple act of caring and listening and then working together,” Dr. Swenson said. This is what he calls participative management. “Response [from physicians] was positive and hopeful,” he said. “It is critical, once expectations are raised with a survey or focus group, to really and authentically follow through. Otherwise,” he added, “[it] could actually make the situation worse.”</p> <p> The Listen-Act-Develop model considers three factors that physicians need to flourish:</p> <ul> <li> <strong>Choice:</strong> Physicians want to have some control over their lives. This comes with granting certain levels of flexibility and placing genuine value on physician input in the process.<br /> <br /> Organizations can increase flexibility and control for physicians by treating them as “architects” in the design of their care delivery model and not “construction workers” who follow someone else’s plans, Dr. Swenson said.</li> </ul> <ul> <li> <strong>Camaraderie or social connectedness:</strong> Taking the time to socialize with team members and colleagues can lift spirits and improve collaboration.<br /> <br /> “We led two randomized controlled studies with docs,” Dr. Swenson said. “Both showed that simply getting together for a meeting or a meal raised camaraderie and lowered markers of burnout.”<br /> <br /> “The teamwork involved in addressing the local drivers of burnout is also a vehicle for growing camaraderie,” he added.</li> </ul> <ul> <li> <strong>Excellence:</strong> Everyone wants to be a part of something meaningful. Organization leaders should establish constructive relationships with physicians and have a “genuine conversation [with physicians] to understand life in their moccasins,” Dr. Swenson said. “And then [create] a partnership to address the opportunities at the frontline and organizational levels.”<br /> <br /> “If [physicians] are treated as employees or cost centers, that is how they will behave,” he said. “If they are treated as partners in delivering the needs of patients, [physicians] will ignore their job descriptions and skyrocket discretionary effort.”</li> </ul> <p> Dr. Swenson will be speaking in much more detail about these efforts at the AMA-MGMA Collaborate in Practice Meeting, taking place March 20-22 in Colorado Springs. The meeting is designed to help physicians and practice teams gather leadership techniques to propel them and their organizations toward future success. Other speakers include former U.S. Sen. Bill Bradly, D-N.J., and Richard Deem, AMA senior vice president of advocacy, who will speak on leadership and the changing health care landscape. Interested participants can <a href="" rel="nofollow" target="_blank">register online</a> now to receive a discount.</p> <p> <strong>More on physician burnout</strong></p> <ul> <li> Find out <a href="" target="_blank">which specialties have the highest burnout rates</a></li> <li> Learn how <a href="" target="_blank">physician burnout compares to the general working population</a></li> <li> Explore <a href="" target="_blank">four physician-recommended steps to work- and home-life balance</a></li> </ul> <p> Also, check out these modules from the AMA’s STEPS Forward™ collection:</p> <ul> <li> <a href="" rel="nofollow" target="_blank">Improving physician resiliency</a></li> <li> <a href="" rel="nofollow" target="_blank">Preventing physician burnout</a></li> <li> <a href="" rel="nofollow" target="_blank">Preventing resident and fellow burnout</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:6d38444b-ad2b-4075-9a05-0405be35a50e How students are transforming med ed at Brody School of Medicine Wed, 09 Mar 2016 16:00:00 GMT <p> <em>A Spotlight on Innovation post with</em> <em>Kevin Harris, a third-year student at the Brody School of Medicine at East Carolina University.</em></p> <p> <strong><em>AMA Wire®:</em></strong> <strong>Last year, you were among 10 medical students who shared their perspectives on </strong><a href="" target="_blank"><strong>what students wish they were learning in medical school</strong></a><strong>. How do you think Brody School of Medicine’s work within the AMA’s </strong><a href="" target="_blank"><strong>Accelerating Change in Medical Education Consortium</strong></a><strong> has addressed some of those crucial topics for medical students?</strong></p> <p> <strong>Harris:</strong> Attending the consortium meeting in Portland, Oregon, was a great opportunity for collaboration between students. I was able to meet with nine other student leaders helping their schools navigate curricular change. During this meeting, student leaders were able to discuss what we perceived as curriculum gaps in the current undergraduate medical education system. Recurring themes included the need to increase exposure to early experiential learning, leadership training, health policy and health economics. </p> <p> At the Brody School of Medicine, our LINC (Leaders in Innovative Care) Scholars program has helped address these curricular needs. Up to 10 students in each class may be selected as LINC Scholars. The LINC Scholars Program consists of an intensive, eight-week summer immersion course that takes place between the first and second years of medical school, with additional course and project work to be completed during the second through fourth years of medical school. </p> <p> During the eight-week summer immersion course, scholars are able to interface with leaders from ECU Physicians and Vidant Medical Center. They are exposed to the infrastructure of a large health care system and gain an appreciation for the complexity of the system. Scholars learn how supply chain operators, administrators, financial managers and other key stakeholders operate in health care systems and the roles that physician leaders fill within this larger complex framework.</p> <p> They also have an opportunity to navigate the health care system through the lens of a patient. Scholars are immersed with health care leaders, administrators and physicians across multiple clinical disciplines during their summer immersion. They shadow patients throughout their entire health care encounter and interview their patients about their experience navigating the system and receiving care. Scholars identify factors that facilitated the encounter and those things that made the system difficult to navigate.</p> <p> Using observations gathered during these shadowing experiences, LINC Scholars draft a report featuring recommendations to improve the patient experience. LINC Scholars learn to deliver health care through a lens of patient-centered solutions and quality improvement. By participating in the summer immersion course, LINC Scholars learn not only how the health care system works but also the external forces that shape the system’s complexity. In addition, the LINC Scholars are paired with a mentor and participate in a health care quality improvement project. </p> <p> In addition to the LINC Scholars program, Brody has designed a longitudinal health systems science curriculum, which incorporates the basic principles of patient safety, quality improvement, population health and team-based care for all medical students. The curriculum is integrated throughout the existing curriculum and incorporates active learning principles and a flip-classroom model that links experiential sessions with independent completion of IHI modules. Students participate in an interprofessional quality improvement Olympics, problem-based learning cases focused on cost-conscious care and error disclosure, root cause analysis, and handover training.</p> <p> Each of the core clerkships incorporate a component during the clerkship. During transitions to practice, medical and nursing students participate in Team STEPPS training and interprofessional simulation training focused on improving teamwork and communication skills.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are some of the barriers students may face when trying to create change in medical education, and how is Brody’s work as part of the AMA’s Accelerating Change in Medical Education Consortium helping to break down those barriers?</strong></p> <p> <strong>Harris:</strong> When trying to create change in medical education, students may face several barriers. One barrier is creating a sense of urgency that the change is timely and should occur now. Brody’s involvement in the consortium is a testament to our commitment to advance medical education.</p> <p> Brody recognizes the urgent need to change medical education to prepare physicians to practice in the increasingly complex health care system. Since our school recognizes the urgent need to accelerate change in medical education, our faculty and administration are open to student suggestions on ways to improve undergraduate medical education.</p> <p> Another barrier medical students may face is forming an effective guiding coalition to lead the change. Brody’s involvement with the AMA’s Accelerating Change in Medical Education initiative has created opportunities for collaboration between both faculty and students at consortium schools.</p> <p> For example, last November I was able to attend the Association of American Medical College’s Medical Education meeting in Baltimore, Maryland. At this meeting, I worked with four other students from consortium schools to discuss ways medical students can serve as “catalysts for curricular change.” We hope to form a guideline of best practices for student engagement in curricular change. Participation in the AMA’s Accelerating Change in Medical Education Consortium has facilitated student involvement across medical schools that would not have otherwise been possible. </p> <p> <strong><em>AMA Wire</em></strong><strong>: Is there </strong><a href="" target="_blank"><strong>a particular project</strong></a><strong> at your school or another school within the consortium that has inspired you, deepened your passion for learning or helped spur new ideas or solutions among you and your fellow students?</strong></p> <p> <strong>Harris:</strong> After developing the LINC Scholars program as part of the AMA’s Accelerating Change in Medical Education Consortium, the Brody School of Medicine created three additional “distinction tracks,” which Brody medical students may elect to pursue. In addition to LINC Scholars (distinction track in health care leadership and transformation), distinction tracks in service learning, research and medical education provide students with the opportunity to further explore career interests. </p> <p> Medical students have been involved in designing the curricula and admissions criteria for each track. Each distinction track has a required summer immersion experience between the first and second years of medical school, with additional course and project work to be completed throughout medical school and culminating in the presentation of a portfolio.</p> <p> The distinction tracks will allow medical students to tailor the medical school experience to their professional interests. I hope to pursue a career in academic medicine, so the medical education track is of particular interest to me. I believe all of the distinction tracks will be popular amongst Brody students, but more importantly, they have created opportunities for students to contribute to the medical education process.</p> <p> <strong><em>AMA Wire</em></strong><strong>: Have there been any particular instances when collaboration, especially peer-to-peer among students, helped foster a novel idea or project at Brody? </strong></p> <p> <strong>Harris:</strong> The Brody School of Medicine has always been open to student input in academic issues, but participation in the AMA’s Accelerating Change in Medical Education Consortium has increased student involvement at all levels of curriculum design. </p> <p> Students often collaborate with Brody School of Medicine faculty or in small peer-to-peer student groups to promote curricular change. Peer-to-peer student collaboration at Brody led to the development of the “Aim Higher” program. Members of the class of 2017 organized a structured review program for USMLE Step 1. A group of five second-year students developed the Aim Higher program. This program, though not part of the formal medical school curriculum, was approved by the M2 curriculum committee. </p> <p> The pilot program consisted of seven Aim Higher sessions. Students were given a pacing guide of material to review prior to attending each session. During Aim Higher sessions, both Aim Higher student facilitators and Aim Higher participants are exposed to USMLE Step 1 style multiple choice questions. Facilitators and participants are asked to discuss the proper rationale and salient features of each question. Following the success of the pilot program, Aim Higher was continued this academic year by the class of 2018. </p> <p> <strong><em>AMA Wire</em></strong><strong>: What’s one aspect of the student perspective you think educators better understand now that they’ve worked with students at Brody?</strong></p> <p> <strong>Harris:</strong> I think educators better understand our desire for experiential learning. Many of the summer immersion experiences for both the LINC Scholars program and for the distinction tracks occur outside of the classroom. Through experiential learning, students can better connect a theoretical framework with direct application. </p> <p> <strong><em>AMA Wire</em></strong><strong>: What advice would you give students who are interested in sparking change at their medical school?</strong></p> <p> <strong>Harris:</strong> I would give students interested in sparking change at their medical schools two pieces of advice: First, listen to your classmates. Your classmates are the consumers of your school’s curriculum. They live and breathe the curriculum each day and know its intricacies. Medical students should be able to quickly identify when a curriculum change needs to occur. Your role as a change agent is to effectively communicate this need for change to the faculty. </p> <p> Second, surround yourself with a group of dedicated and hardworking peers who are passionate about making improvements. In order to be successful, medical students must form an effective coalition to push for change. Utilize the unique skill sets of your peers. It is true that “teamwork makes the dream work.” </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c8430c82-5fb3-4983-a5d6-ecc4a7913c9d Medicine and the law: Important ethical questions Tue, 08 Mar 2016 22:40:00 GMT <p> From medical liability reform to undocumented patients, the medical world often intersects with the law. When these two worlds meet, how can physicians address the ethical and legal questions that shape the present and future of the practice of medicine?<a href="" target="_blank"><img src="" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> The <a href="" target="_blank">March issue</a> of the <em>AMA Journal of Ethics</em> explores key ethical concepts that determine the ways in which medicine and the law merge. Articles featured in this issue include:</p> <ul> <li style="margin-left:0.25in;"> <a href="" target="_blank">“How should clinicians treat patients who might be undocumented?”</a> Physicians should never discriminate against patients or violate patients’ legal rights. Find out how to use professional ethical principles to guide you through questions that arise when undocumented patients come to your office seeking treatment.</li> <li style="margin-left:0.25in;"> <a href="" target="_blank">“Shedding privacy along with our genetic material: What constitutes adequate legal protection against harms of surreptitious genetic testing?”</a> Unauthorized uses of patients’ DNA are not always adequately addressed by the law. How can physicians establish legal privacy protections that actually work? Learn how a focus on ethics can help.</li> <li style="margin-left:0.25in;"> <a href="" target="_blank">“Privacy protection in billing and health insurance communications.”</a> Medical bills and explanations of benefits can contain protected health information. What can physicians do to respond to patients’ concerns that this information could be unintentionally disclosed? Learn about the unique privacy issues that have been raised as a result of the streamlining of the health care business.</li> <li style="margin-left:0.25in;"> <a href="" target="_blank">“Medical malpractice reform—historical approaches, alternative models, and communication and resolution programs.”</a> To be effective, medical liability reform must balance everyone’s needs and offer protections for all parties involved. Explore alternatives to lawsuits that are being developed and implemented in practices across the country.</li> </ul> <p> In the journal’s <a href="" target="_blank">March podcast</a>, Megan Sandel, MD, medical director of the National Center for Medical-Legal Partnership, discusses how physicians can establish healthy partnerships with attorneys.</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="" target="_blank">Give your answer</a> to this month’s poll: Expedited partner therapy (EPT) permits treatment of sexually transmitted infections among people who might not yet know they’ve been exposed—which ethical factors should be considered when determining whether to use EPT?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="" rel="nofollow" target="_blank">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:49f3bbd7-e8a2-4159-a467-4d292ec8e12b Can postresidency interview communications be harmful? Tue, 08 Mar 2016 22:37:00 GMT <p> With Match Day just around the corner, a new study suggests that “sensible” regulations governing how communication is handled after interviews during the match process could lead to more authentic dialogue, ensure ethical behavior and promote a positive Match experience for medical students and residency programs alike in future years.<a href="" target="_blank"><img src="" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> National Resident Matching Program (NRMP) policy already restricts communication. For example, it allows applicants and programs to express interest in one another but not to solicit verbal or written statements implying a commitment. The NRMP also prohibits either side from saying their rank order depends on a promise from the other side—“you rank me No. 1, and I’ll rank you No. 1.”</p> <p> <strong>5 recommendations to make the post-interview process positive</strong></p> <p> But a <a href="" target="_blank" rel="nofollow">recent perspective</a> published in the <em>Journal of Graduate Medical Education</em> advocates that residency programs could take five steps to make the post-interview process a better experience for future residents and program leaders. Physician authors from Duke University Medical Center recommend that residency programs:</p> <ul> <li style="margin-left:0.25in;"> Set clear expectations for applicants on interview day about what are considered appropriate forms of post-interview communications.</li> <li style="margin-left:0.25in;"> Limit post-interview communications to objective information.</li> <li style="margin-left:0.25in;"> Provide a point person to handle all post-interview communications.</li> <li style="margin-left:0.25in;"> Consider logging all post-interview communications to safeguard ethical standards. If additional oversight is needed, communications could be forced to pass through a messaging service on the NRMP website.</li> <li style="margin-left:0.25in;"> Initiate dialogue on a national level within specialties to create specialty-specific consensus guidelines. The authors note that needs vary among specialties.</li> </ul> <p> The authors made these recommendations after surveying 268 diverse residency programs nationwide about the communication they had with applicants after interviews. The study concluded both sides felt misled by communications.</p> <p> Study authors noted that previous studies have shown that up to 94 percent of applicants send communications to program leaders after an interview, often believing their communications will improve their ranking. But just 5.2 percent of program directors who participated in the study published in February said that they always or usually move up applicants on their rank order lists after the applicant promises to rank their program No. 1.</p> <p> <strong>Preventing unproductive communications</strong></p> <p> With no mechanism in place to stop an applicant from telling multiple programs they have ranked a program No. 1, 52.6 percent of program directors surveyed reported that at least once a year they have one or more applicants say they are ranking the residency program No. 1 when the applicant has actually given the program a different ranking.</p> <p> And authors note that medical students may easily interpret any positive language from a residency program as a promise to be ranked to match. Previous studies have shown up to 33 percent of applicants have reported they were misled by a communication from a residency program leader, and 8.3 percent of applicants who responded to one survey said a residency program directly asked them how their program would be ranked.</p> <p> Yet the new survey showed that 64.6 percent of programs reported that they never share any information with applicants about their likelihood to match, “signifying a disconnect between the reporting on either side,” study authors said.</p> <p> The study noted that banning all communication would be the “simplest solution” to prevent communication concerns. In fact, nearly 46 percent of survey respondents favored that approach. But, authors noted, it also would be the most impractical way to change the system because residency programs and applicants spend up to seven years together. Authors said “it is important to make sure that all questions and doubts are addressed up front before a binding commitment is made.”</p> <p> Instead, the authors encouraged “residency program directors in all specialties to talk with their colleagues and propose sensible regulations for post-interview communications” to ensure a productive and ethical exchange for everyone involved.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e25c4822-7a19-40d3-bc7c-e5c60bd77243 How students are transforming med ed at Mayo Medical School Tue, 08 Mar 2016 16:00:00 GMT <p> <em>A Spotlight on Innovation post with</em> <em>Ricky Cui, a second-year at Mayo Medical School.</em></p> <p> <strong><em>AMA Wire®:</em></strong> <strong>From creating a </strong><a href="" target="_blank"><strong>new curriculum to teach health care delivery science</strong></a><strong> to making </strong><a href="" target="_blank"><strong>personalized care</strong></a><strong> a key part of student learning, Mayo Medical School has launched several projects as part of its work within the AMA’s </strong><a href="" target="_blank"><strong>Accelerating Change in Medical Education Consortium</strong></a><strong>. What’s one way these projects have improved how you learn and your overall experience as a student at Mayo?</strong></p> <p> <strong>Cui:</strong> One of the most rewarding experiences for me is being a part of the Science of Health Care Delivery Committee and contributing to the development of the new curriculum. As a medical student, I am grateful for my role in helping to identify areas of the curriculum that have potential for improvement and helping educators shape and refine innovative visions for medical education. I believe this is a unique opportunity, and it certainly adds to the multi-dimensionality of my training.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are some of the barriers students face when trying to create change at their medical school, and how is Mayo’s work as part of the AMA’s Accelerating Change in Medical Education Consortium helping to break down those barriers for students?</strong></p> <p> <strong>Cui:</strong> Creating change takes time and reaching the right people (i.e., educators, physicians, etc.). Through the AMA’s Accelerating Change in Medical Education initiative and Mayo’s formation of the Science of Health Care Delivery Committee, students now have a wonderful opportunity to contribute to the development of a new curriculum, and creating change became a lot simpler with educators looking to hear our voices.</p> <p> <strong><em>AMA Wire</em></strong><strong>: Have there been any particular instances when collaboration helped foster a novel idea or project at Mayo? </strong></p> <p> <strong>Cui:</strong> Collaboration with students and educators has been largely beneficial because we all tackle the same problem at different angles, and I believe our collaborative efforts to innovate and develop a new curriculum have improved the outcome of our vision.</p> <p> My experience with AMA’s Accelerating Change in Medical Education initiative has been tremendously rewarding. I am a member of the Science of Health Care Delivery committee at Mayo Medical School, and I’ve had the privilege of working with physicians and educators that are passionate about and devoted to improving medical education.</p> <p> The most humbling part of the collaborative process is seeing the way educators yearn to hear student voices, opinions and feedback to challenge and refine their work. It is remarkable to see how much educators care about training the next generation of physicians and to challenge the status quo to improve medical education.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What’s one aspect of the student perspective you think educators better understand now that they’ve worked with students at Mayo?</strong></p> <p> <strong>Cui:</strong> As much as educators try to challenge students, students also challenge educators to be adaptive in their teaching. One crucial lesson is for educators to meet the students’ expectations on topics they are presenting. If the presentation is out of the scope of our current understanding, students truly appreciate educators taking a pause to gauge the audience and adapting their lesson accordingly to be in tune with student objectives for learning. This symbiotic relationship not only provides crucial feedback for educators but makes for a much better learning experience for students.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What advice would you give students who are interested in sparking change at their medical school?</strong></p> <p> <strong>Cui:</strong> Change is sparked by those who dream big. So keep dreaming, and challenge yourself to understand the current system, identify areas of improvement, and come up with ideas to make the system more efficient, enjoyable and in tune with student expectations. Importantly, join a team that will support your goals but also challenge you to refine your vision to improve the change you seek to impart. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b61b17f6-92df-484f-8f34-8db6b8b0acff How students are transforming med ed at the University of Michigan Mon, 07 Mar 2016 16:00:00 GMT <p> <em>A Spotlight on Innovation post with Jesse Burk-Rafel, a third-year student at the University of Michigan Medical School.</em></p> <p> <strong><em>AMA Wire</em></strong><strong>®: Last February,</strong> <a href="" target="_blank"><strong>you spoke with <em>AMA Wire</em></strong></a><strong> about your work with the University of Michigan Medical School’s curriculum redesign as a member of the AMA’s </strong><a href="" target="_blank"><strong>Accelerating Change in Medical Education Consortium</strong></a><strong>. You mentioned that the previous curriculum didn’t “do enough to frame the issues facing health care, help with personal development of students’ existing leadership strengths or even break down barriers for students as future physicians.”</strong> <strong>How do you think Michigan’s new curriculum is helping students to better engage with these topics now?</strong></p> <p> <strong>Burk-Rafel:</strong> Many ways. Michigan’s new curriculum will equip students to be leaders in addressing health care challenges. One concrete way is inclusion of core curriculum in health policy, which students have—for many years—been craving.</p> <p> In addition, students will develop expertise in other topics, like quality improvement and patient safety, that extend beyond the patient-physician interaction and require systems thinking. This training will be complemented by practical, longitudinal mentored professional development. Today’s medical students bring a wealth of skills and passions when they enter medical school, and we should be doing everything possible to cultivate those passions and develop leadership skills so that they might turn their passions into real impact. Thus, students will work with multiple coaches and mentors from day one.</p> <p> The professional development focus of our new curriculum is tremendously exciting to me—I think it will provide students opportunities to better understand the landscape of U.S. health care and how they might make an impact while having a fulfilling career. In short, I expect future Michigan graduates to be in a better position to craft their dream career.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are some of the barriers students face when trying to create change in medical education, and how is Michigan’s work as part of the AMA’s Accelerating Change in Medical Education Consortium helping to break down those barriers?</strong></p> <p> <strong>Burk-Rafel:</strong> Students face many barriers in leading medical education transformation. Some of these barriers are common to their faculty counterparts: Namely, inertia—the “that’s what we went through, so you should too” mentality. Especially at a leading medical school like University of Michigan, it can be tempting to stick with the status quo—after all, it has worked well thus far.</p> <p> I find that the status quo has incredible inertia hindering innovation. It takes remarkable perseverance to achieve hard-fought small changes. Moreover, changes are unlikely to benefit the students who work to make them a reality—it’s a pay-it-forward proposition.</p> <p> Students also face unique barriers to engagement. They may be perceived to lack credibility, and they likely lack formal training in medical education. They may be asked to participate in a token fashion rather than as equal participants. They may lack mentors who will champion their vision, or they may not know where to start in leading change. Perhaps most critically, they may not speak the same “language” as faculty leaders.</p> <p> At the University of Michigan, the Accelerating Change in Medical Education effort has jumpstarted a transformation effort that has broken down barriers to student engagement. From the first days of this effort, faculty leaders collaborated with student leaders to formulate a student representation structure. This was a critical step and led to broad, rich engagement of students. Most importantly, our institution created an atmosphere where students were embraced as equal participants, with an important and unique perspective to contribute. As students have done important work in the curricular change effort, they’ve established credibility and built professional relationships with faculty leaders, all while developing their own leadership competencies.</p> <p> <strong><em>AMA Wire</em></strong><strong>: Is there</strong> <a href="" target="_blank"><strong>a particular project</strong></a><strong> at your school or another school within the AMA’s Accelerating Change in Medical Education Consortium that has inspired you, deepened your passion for learning or helped spur new ideas or solutions among you and your fellow students?</strong></p> <p> <strong>Burk-Rafel:</strong> The change process—as a whole—has been an opportunity for me to re-envision my education. It’s been incredibly empowering. For example, one innovative aspect of our new curriculum are the “Branches”—two yearlong professional development pathways in the third and fourth years. As a rising M4, I’ve had the opportunity to pilot new Branch programs and rethink what my ideal M4 year would look like. It’s been a blast to be the designer and subject to my own folly!</p> <p> <strong><em>AMA Wire</em></strong><strong>: Have there been any instances when collaboration, especially peer-to-peer among students, helped foster a novel idea or project in your program?</strong></p> <p> <strong>Burk-Rafel:</strong> Students bring energy, a sense of urgency, raw insight and fresh ideas. Student involvement generates buy-in from peers.</p> <p> Student-led innovations abound. For example, Michigan students led an effort to survey their peers—gathering over 450 responses—to better design a key component of our new curriculum in an evidence-based, learner-centric fashion. This work was instrumental in providing our curricular work groups empiric evidence with which to build an ambitious new program around. Other innovations include a new approach for incorporating science into our clinical training, which pilot students are helping to expand and improve.</p> <p> The Accelerating Change in Medical Education effort has also led to student collaborations across institutions. Working with students from four institutions in the consortium, we’ve run seminars at national meetings and are disseminating in medical education literature the many ways in which students can help lead curricular change.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What’s one aspect of the student perspective you think educators better understand now that they’ve worked with students at Michigan?</strong></p> <p> <strong>Burk-Rafel:</strong> At Michigan, educational leadership has always engaged students. What’s new is the breadth of engagement of both faculty and students in this curricular transformation. I’ve witnessed how front-line faculty—not merely educational leaders—have witnessed the exceptionally diverse, unique perspectives and experiences that students can bring to curricular change. I’ve seen how students’ infectious passion can inspire even the most reticent front-line faculty to embrace the transformation effort.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What advice would you give students who are interested in sparking change at their medical schools?</strong></p> <p> <strong>Burk-Rafel:</strong></p> <ol> <li> Organize student engagement into a cohesive effort.</li> <li> Gather evidence, through surveys and focus groups, that helps establish urgency and shape a vision for change that is learner-centric.</li> <li> Collaborate with faculty, forming partnerships around shared goals.</li> </ol> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:17c07336-a2e8-466e-98cd-f3a0d37c922e Students rewarded for top ideas to turn med ed on its head Mon, 07 Mar 2016 15:14:00 GMT <p> <object align="right" data="" height="350" hspace="15" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> Focusing on an array of topics from physician burnout to data sharing, medical students from all over the country submitted ideas to the AMA’s Medical Education Innovation Challenge—and the winners are in.</p> <p> The winners of the <a href="" rel="nofollow">Medical Education Innovation Challenge</a> were announced Monday at the first meeting of the newly expanded AMA <a href="">Accelerating Change in Medical Education Consortium</a>, which now includes 32 of the nation’s medical schools. The challenge received nearly 150 submissions from student teams who answered the question: What does the medical school of the future look like to you?</p> <p> Here are the four winning innovations from student teams:</p> <div> <ul> <li style="margin-left:0.25in;"> <strong>First place: “In search of a ‘Muse’: An open national exchange for the advancement of medical education.”</strong> Designed by Amol Utrankar and Jared Shenson of Vanderbilt University School of Medicine, “Muse” is meant to be an online national exchange where medical schools can publish curricular materials as open-access content for use by educators and learners to make medical education more collaborative, evenly distributed and adaptive. The two jointly presented their idea at the consortium meeting.<br /> <br /> “Muse was born from the observation that progress in medical education moves at an incremental pace and often remains siloed within institutions,” Utrankar said. “Right now, students at Sidney Kimmel Medical College are learning to apply design thinking to health systems and patient care. Likewise, Oregon Health and Sciences University is training future doctors in clinical informatics and data science. I look at these curricular advances, and think, ‘That’s something I need to know today to be a doctor tomorrow.’”<br /> <object align="right" data="" height="350" hspace="15" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object><br /> “But curriculum development in medical education takes time,” Utrankar said. “Building curricular modules, learning objectives, and learner materials is time- and effort-intensive. And right now, we do it in parallel within each institution. What if we shared our resources and opened flows of dialogue and resource-sharing across schools? Wouldn’t that make it easier for our administrators to import innovations that are generating change at other institutions?”<br /> <br /> Shenson explained how this might work. “On Muse, every curricular resource shared is evaluated by clinicians and educators in post-publication peer review as well as by learners and community members through quantitative and qualitative feedback,” he said. “By working together, the educational community surfaces organically the highest quality resources and the wealth of feedback provides evidence to guide continual improvement of all resources.”<br /> <br /> “Continual improvement and adaptation of resources is also a unique focus of the Muse platform,” Shenson said. “All content shared on Muse will be published under Creative Commons licensure, which encourages reuse and adaptation while preserving a chain of attribution and academic credit. Muse will feature tools that further enhance and simplify this process, highlighting contributors, changes and evaluative feedback.”</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong><object align="right" data="" height="350" hspace="15" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object>Second place: “Design-thinking, making and innovating: Fresh tools for the physician’s toolbox.” </strong>This idea was conceived to re-design medical education to empower students to understand their own problems and develop their own solutions through design and making skills.<br /> <br /> Mark Mallozzi, Ludwig Koeneke, Tim Bober and Lorenzo Albala, students at Sidney Kimmel Medical College at Thomas Jefferson University, seek a new pre-clinical curriculum that incorporates skills centered around computer science, textiles and medical materials, and rapid prototyping technologies. They feel that if students foster these skills early, they will be better equipped to innovate for and impact the future of health care.</li> </ul> <ul> <li style="margin-left:0.25in;"> <strong>Third place (tie): “Happy healers, healthy humans: A wellness curricular model as a means of effecting cultural change, reducing burnout and improving patient outcomes.”</strong> The goal of this model is to teach students the important skills of self-awareness, communication and empathy to avoid physician burnout and as a result improve patient satisfaction and outcomes.<strong><object align="right" data="" height="350" hspace="15" id="ltVideoYouTube" src="" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /><embed allowscriptaccess="always" bgcolor="#ffffff" height="350" hspace="15" quality="best" src="" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></strong><br /> <br /> Anish Deshmukh, Matt Neal, Melinda Ruberg and Katherine Yared, medical students from the University of Louisville School of Medicine, hope to “create a cultural shift amongst medical students, faculty and staff with the goal of improving health care systems and most importantly our relationships with our patients.”<br />  </li> <li style="margin-left:0.25in;"> <strong>Third place (tie): “Community and classroom approaches to cultural competency and health equity.” </strong>Nicole Paprocki and Carol Platt, students from Midwestern University/Chicago College of Osteopathic Medicine, propose that medical schools develop a four-year, service-learning curriculum to address health care disparities.<br /> <br /> It is important that we “train a new generation of culturally responsive physicians,” Platt said.<br /> <br /> The curriculum will expose medical students to local underserved communities to build a deeper understanding of the social determinants of health and equip them with the tools to apply this perspective to their medical practice.</li> </ul> </div> <div> <p> Learn about <a href="" target="_blank">more innovative ideas</a> (log in) student teams submitted as part of the Innovation Challenge.</p> <p align="right"> <em>By AMA staff writer</em> <a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c1bbf0b0-5283-4d03-ad17-6f697ebd05de Why MACRA matters for your practice Mon, 07 Mar 2016 08:01:00 GMT <p> The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the notorious sustainable growth rate (SGR) formula last year, but what will the new MACRA payment policies mean for your practice? Three experts offered answers to this question and detailed what physicians can do now to shape these changes themselves.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" style="width:365px;height:243px;" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Harold D. Miller speaks at the 2016 AMA National Advocacy Conference.</em></span></td> </tr> </tbody> </table> <p> <strong>Payment changes coming under MACRA</strong></p> <p> “While we are thrilled that Congress finally did away with SGR, it is very important that we take a closer look at what was adopted in its place,” said Barbara L. McAneny, MD, immediate past-chair of the AMA Board of Trustees and an oncologist in New Mexico.</p> <p> MACRA creates a new framework that was designed to offer physicians a choice between a modified approach to fee-for-service and transitioning to alternative payment models (APM), and physicians can offer their insights on these choices as they are being developed. Those who choose to stay with the fee-for-service model will see their payments increased or decreased under the new Merit-Based Incentive Payment System (MIPS).</p> <p> “MIPS is going to adjust the fee-for-service payments based on a number of factors including, clinical practice improvement, quality, judicious use of resources and use of <a href="" target="_blank">electronic [health] records (EHR)</a>,”Dr. McAneny said.</p> <p> “Performance measures are not new,” said Richard Hellman, MD, a clinical endocrinologist in Kansas City, Mo., and a past-president of the American Association of Clinical Endocrinologists. “But what you use these performance measures for is to improve your practices … and work together as a team.”</p> <p> “One of the things that the outside world doesn’t know,” Dr. Hellman said, “is the fact that ours is a very dynamic profession. There’s science coming in, there are new concepts coming in—things change.” Performance measures need to reflect that, he said.</p> <p> Physicians are able to elect to participate in alternative payment models (APM) as an alternative to the MIPS, Dr. McAneny said. “<a href="" target="_blank">Well-designed APMs</a> can allow physicians to provide better care to their patients, lower health care costs in general and improve the financial bottom line for the practices.”</p> <p> “I have seen the potential for APMs first hand,” Dr. McAneny said. “I led the design and implementation of an oncology medical home model, which received a health care innovation award from CMS. The grant allowed me to show that physicians have the ability to prove that we can provide better care at a lower cost if we are given the tools to do so.”</p> <p> <strong>What physicians can do to make the system work for them</strong></p> <p> The Centers for Medicare & Medicaid Services (CMS) <a href="" target="_blank">announced three changes</a> it is making to ensure these new systems are better for both physicians and their patients. It is important that physicians get involved right now in the development of performance measures and APMs that work as they need them to rather than leaving it to the government to design these tools.</p> <p> Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform and one of the 11 members of the federal Physician-focused Payment Model Technical Advisory Committee (PTAC) created by Congress to advise the Department of Health and Human Services on the creation of APMs under MACRA, spoke to physicians on how to create a physician-led health care future.</p> <p> “SGR is dead, and we need to keep the sword sharpened,” Miller said. “If [we] continue to [let] happen what is happening today … we’re going to continue to get what we’re getting today,” Miller said, “which is small physician practices and hospitals being forced out of business, high prices from those who are left, shifts in care to higher cost settings, overuse of expensive procedures, loss of innovation, large increases in insurance premiums and patients who can’t afford their care.”</p> <p> “If we have a physician-led future, that could change,” he said.</p> <p> “I think the most efficient health care delivery entities in the entire world are small physician practices,” Miller said to applause. “If we let them go, we will regret it.”</p> <p> “Alternative payment models, if they’re designed well, can be win-win-wins,” Miller said. “They can be wins for the payer because of lower spending; they can be wins for the patient because they’re getting better care without unnecessary services; and they can be wins for the physicians because they’re getting paid adequately to deliver high-value services.”</p> <p> Now it is up to physicians to work closely with their medical specialty societies to design APMs that will work for their practice, improve their patients’ care and meet the MACRA standards that are soon to be set by CMS. Find out how you can <a href="" target="_blank">work with your specialties to design APMs</a> that are broadly applicable.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4bdf2710-6efd-4b59-8078-d2ed432a22c1 How students are helping transform medical education Sun, 06 Mar 2016 16:03:00 GMT <p> <em>A Spotlight on Innovation post with David Savage, a sixth-year MD/PhD student at the University of Texas Medical School at Houston and the medical student member of the AMA’s Accelerating Change in Medical Education Initiative’s national advisory board.</em></p> <p> <strong><em>AMA Wire</em></strong><strong>®: You’ve </strong><a href="" target="_blank"><strong>mentioned before</strong></a><strong> that the AMA’s </strong><a href="" target="_blank"><strong>Accelerating Change in Medical Education</strong></a><strong> initiative “has prompted the participant schools to take some educational risks and try new models.” What are some of those risks you think the schools have taken, and how are they now better meeting the needs of today’s medical student?</strong></p> <p> <strong>Savage:</strong> A few of the schools in the AMA’s <a href="" target="_blank">Accelerating Change in Medical Education Consortium</a> took the risk to entirely redesign their curricula, which took a lot of on-campus politicking and advocacy to get buy-in from faculty. Vanderbilt University School of Medicine, for example, moved to a one-year basic science curriculum, and they now have an online system for tracking student competency progress over four years.</p> <p> The University of Michigan Medical School also totally revamped its curriculum, using a “trunk” and “branches” approach, whereby students get a common core of knowledge in the first two years, and then they choose a branch of clinical coursework for the last two years based on their career interests.</p> <p> Two medical schools—New York University School of Medicine and the University of California, Davis, School of Medicine—are now offering three-year accelerated undergraduate medical education programs for students who are pre-matched into a residency program before they even start medical school.</p> <p> These types of innovative programs are unconventional, but already they are demonstrating success, and I believe they will be models for the future. These schools are meeting student needs by helping them get the skills they need to be successful in their residency program of choice, rather than providing a “one-size-fits-all” education experience.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What have you enjoyed about your experience as a student member of the initiative’s national advisory board?</strong></p> <p> <strong>Savage:</strong> I believe that the AMA has been on the leading edge of a nationwide trend toward transformative innovation in medical education. As I was completing my first three years of medical school, I saw the ways that cloud computing, tablets and video streaming had transformed medical education. The AMA’s Accelerating Change in Medical Education national advisory board allowed me to be intricately involved in the screening, selection and evaluation of the initial 11 consortium schools, and later the 21 schools that were added in the second cohort in 2015.</p> <p> The panel has consistently called upon me to provide the “student perspective” on what might work and what won’t. In the process, I have seen many wonderful ideas take shape, such as the <a href="" target="_blank">competency learning management system</a> at Vanderbilt, the student engagement process in <a href="" target="_blank">curriculum redesign</a> at Michigan and the <a href="" rel="nofollow" target="_blank">Health Care by the Numbers program</a> at NYU. I have also grown to appreciate the way in which the AMA’s leadership and financial investment in medical education has truly accelerated a process that would have taken much longer without this help.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What are the key issues that you think the consortium schools are positively addressing?</strong></p> <p> <strong>Savage: </strong><strong>1.</strong> <strong>The disconnect between medical curricula and the skills needed by residency programs.</strong> Traditional medical schools emphasize basic science the first two years, with much of the learning geared toward the USMLE Step 1 exam. The last two years are the traditional hospital rotations, which require the same core rotations, regardless of the specialty that a student may be selecting. Students in rotations are graded by how they present patients on hospital rounds and how they score on end-of-course multiple-choice exams. None of this process assures that students will have certain technical, interpersonal and health system knowledge skills by the time they graduate.</p> <p> Many consortium schools, like Mayo Medical School, Vanderbilt and the University of Michigan, are redesigning their curricula to focus on achieving core competencies, rather than just grades and written evaluations. In this way, medical schools can assure that their graduates have certain skill sets that meet the needs of residency programs and the patients they serve.<br /> <br /> <strong>2. Health care delivery science.</strong> During the April 2015 consortium meeting at Oregon Health and Science University School of Medicine, the consortium featured a third area of medical education that has gone largely ignored by most medical schools: health care delivery science. This domain focuses on teaching students how the health care system works and how it is financed.</p> <p> Many students organize and lead electives that teach this important topic during lunch hours and at the end of the school day, but it is not a core element of the traditional curriculum of many schools. Yet residency programs and our patients expect doctors in training to have this information. The recognition of this deficiency in current curricula has led many consortium schools to find ways to integrate health care delivery science and give it the same priority as basic science and clinical care.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What’s one aspect of the student perspective you think educators better understand now that they’ve worked with students as part of the AMA’s Accelerating Change in Medical Education Initiative?</strong></p> <p> <strong>Savage:</strong> I think many educators now appreciate how savvy their students are in finding tools to promote learning. Medical students have limited time and a lot of information to master. During my basic science years of training, students optimized their time by opting out of many live lectures and instead listening to lectures online. This way, students could speed up the replay, slow it down, stop periodically or skip the lecture entirely, depending on how much value the lecture brought to the topic.</p> <p> Now students are supplementing or replacing school lectures with online tools like Pathoma or Sketchy Micro, and in some cases, they create their own study schedules entirely to maximize performance on USMLE Step 1. Faculty members have begun to embrace these asynchronous and multi-modal methods of learning rather than pushing back against them. This in turn reinforces the faculty role as guides to information, and it allows them to invest their time in activities like small groups for problem-solving and critical-thinking exercises with students.</p> <p> <strong><em>AMA Wire</em></strong><strong>: What advice would you give students looking to also create change at their medical schools?</strong></p> <p> <strong>Savage:</strong> Students wanting to catalyze a curriculum change should reach out to the administrators who run the curriculum and offer to help. My experience working with my school’s Office of Educational Programs has been that they are incredibly receptive to the student perspective. Ever since joining the AMA’s Accelerating Change in Medical Education national advisory panel, I have also been serving as a student representative on the curriculum redesign subcommittee at my school. My teachers have consistently looked toward me for new ideas, and they have asked my opinion on their ideas.</p> <p> Another suggestion is to always approach your faculty in a collegial and respectful manner. Many faculty members invest immense time in planning their classes, writing their curriculum notes and presenting their lectures. Even if you think a course is not well done, it may not be due to a lack of effort. If you only focus upon the negatives of a class, you may unintentionally hurt feelings and burn bridges toward collaboration. It is much more productive to offer incremental ideas along with a realistic plan for implementing them. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0bcfaf26-5371-4ec9-8142-c9015ebd1caf How students are at the forefront of transforming med ed Sun, 06 Mar 2016 16:00:00 GMT <p> You may have heard about the transformation of medical education underway at 32 of the nation’s medical schools—and with nearly 1 in 5 U.S. medical students working on their degrees at one of these schools, chances are that you or someone you know is attending one of these schools. Are you familiar with the bold changes at these schools? Six medical students are sharing their firsthand perspectives on how they’re leading and benefiting from this concerted effort to create the medical school of the future.</p> <p> <strong>Looking behind the scenes</strong></p> <p> As representatives of the 32 schools that make up the newly-expanded AMA <a href="" target="_blank">Accelerating Change in Medical Education Consortium</a> meet for the first time at Pennsylvania State University College of Medicine this week, students are giving a glimpse at the remarkable work taking place at their schools.</p> <p> Each day this week, a different student is being featured in a special Spotlight on Innovation series, each with a unique story to tell about their involvement in this national initiative.</p> <p> Start with a <a href="" target="_blank">post from David Savage</a>, the medical student member of the AMA’s Accelerating Change in Medical Education Initiative’s national advisory board. Then <a href="" target="_blank">follow the series</a> with insights from students at University of Michigan Medical School, Brody School of Medicine at East Carolina University, University of Nebraska College of Medicine and Mayo Medical School. The latest posts include:</p> <ul> <li> A <a href="" target="_blank">perspective from Jesse Burk-Rafel</a>, a third-year student at the University of Michigan Medical School</li> <li> A <a href="" target="_blank">perspective from Ricky Cui</a>, a second-year at Mayo Medical School</li> <li> A <a href="" target="_blank">perspective from Kevin Harris</a>, a third-year student at the Brody School of Medicine at East Carolina University</li> <li> A <a href="" target="_blank">perspective from R. Logan Jones</a>, a third-year student at University of Nebraska College of Medicine</li> <li> A <a href="" target="_blank">perspective from Ben Mundell</a>, a first-year student at Mayo Medical School </li> </ul> <p align="right"> <em>By AMA Wire editor</em> <a href="" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:af944f19-8fe1-498e-94c3-4a83ad81cd61 Where the health care dollars go Fri, 04 Mar 2016 19:25:00 GMT <p> With all the talk about rising health care costs, you may be wondering how those vital dollars are being spent. A new analysis answers this question.</p> <p> A close look at national health expenditures can offer physicians a clearer vision of the total costs and funding that are required each year to keep the health care system functioning. A new <a href="" target="_blank">analysis</a> (log in) from the AMA sheds light on health care spending.</p> <p> <a href="" target="_blank"><img src="" style="width:450px;height:557px;margin:15px;float:right;" /></a></p> <p> <strong>How our health care dollars are spent</strong></p> <p> In 2014, the last year for which data are available, U.S. health expenditures were more than $3.0 trillion—which breaks down to $9,523 per person. This reflects a growth rate of 5.3 percent over 2013. “In comparison,” the analysis said, “spending grew by 2.9 percent in 2013 and by an average of 4.0 percent per year” from 2007 to 2012.</p> <p> “Despite the uptick,” the analysis said, “the 5.3 percent growth rate is still low by historical standards.”</p> <p> “Important factors behind the acceleration in growth include the coverage expansions of the Affordable Care Act (ACA) as well as the introduction of new drug treatments for hepatitis C, cancer and multiple sclerosis,” the analysis said.</p> <p> Out of that $3.0 trillion, only 15.9 percent went to physician services. Furthermore, physician spending grew by an average of only 4.1 percent per year between 2004 and 2014, which is 1.5 percentage points lower than the average annual growth rate for hospital spending and a full 2 percentage points lower than that for clinical spending, showing physician spending is not the main driver behind rising health care costs.</p> <p> On the other hand, prescription drug spending rose 12.2 percent in 2014, marking an abrupt departure from growth rates of recent years. “There hadn’t been double digit growth in this category since 2003,” the analysis said, “and post-2006 growth rates had remained well below 6 percent.” More than one-third of the new drug spending was from new treatments for hepatitis C.</p> <p> <strong>Investigating a longer window of spending</strong></p> <p> The analysis also investigates the changes in health care spending over both 25 year and 50 year windows to present the patterns that allow analysts to look at short-term changes in a broader context.</p> <p> The ACA Medicaid expansion’s effect on spending is evident in 2014. Medicaid spending increased by 11 percent—the largest single year increase since 2001—and its share of spending increased from 15.5 percent to 16.4 percent.</p> <p> The most dramatic change over the past 10 years was in the share of spending paid for by Medicare, which increased from 16.4 percent of spending to 20.4 percent of spending between 2004 and 2014. Changes in the share of spending paid for by Medicare and Medicaid are tied to changes in program expansion and payment policy as well as economic cyclical factors for Medicaid.</p> <p> Private health insurance has historically been the largest source of funds for health care spending since the 1970s. It continued this trend in 2014 with a 32.7 percent share of the pie, followed by Medicare and Medicaid—these three sources account for the majority of payments in the health care system. The smallest source of funds was out of pocket spending, whose share has continued to trickle downward over the past 50 years from a high of over 40 percent to only 10.9 percent in 2014.</p> <p> Visit the AMA’s <a href="" target="_blank">spending in health care</a> Web page for further insight.</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b6b2fd69-0d82-48d2-8b5c-f6d9f4a168ec Get expert coding assistance from the CPT® Network Fri, 04 Mar 2016 15:00:00 GMT <p> If you’re looking for help with all of your CPT® coding needs, subscribe to the AMA’s <a href="" target="_blank">CPT® Network</a>. This system provides numerous resources for members to find the answers to their most pressing CPT questions and challenges.</p> <p> The CPT Network is a resource for answers “straight from the source.” The system offers subscribers the tools to quickly research a knowledge base of frequently asked questions and clinical examples. And if you can’t find an answer you’re looking for, authorized users can submit an electronic inquiry directly to CPT coding experts.</p> <p> A variety of subscription packages are available. AMA members receive a complimentary full-year subscription to the CPT Network, including access to the knowledge base and six free electronic inquiries.</p> <p> <a href="" target="_blank">Review the subscription options</a> or <a href="" target="_blank">login</a> to your AMA member account to start using the network today.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ba213d05-5963-4bd7-b04d-8d7f9bc0d1af Be a mentor in the AMA’s LGBT mentorship pilot program Fri, 04 Mar 2016 15:00:00 GMT <p> Are you interested in mentoring medical students and residents? The AMA Lesbian Gay Bisexual and Transgender (LGBT) Advisory Committee is piloting a mentorship program during an upcoming AMA meeting and is seeking physicians at all career levels to participate, including residents and fellows. If you are interested in participating, send an <a href="" rel="nofollow">email to the committee</a> with the following information:</p> <ul> <li> Your career stage (senior physician, mid-career physician, young physician, fellow, resident or other)</li> <li> The type(s) of mentorship you’re interested in providing (Examples include application advice for employment positions, including the Match; navigating a career in medicine as an LGBT physician; and how to make LGBT health a career focus.)</li> <li> Your medical specialty/subspecialty</li> </ul> <p> The committee appreciates feedback and looks forward to sharing more details as this program comes together.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:15b36190-bed9-4597-9add-c0076676ce94 How four med students landed a major publishing deal Thu, 03 Mar 2016 22:18:00 GMT <p> Breaking into publishing is a goal for many physicians in training, but how often do students publish research—let alone whole books—before even completing medical school? Medical student authors share how they landed a major book publishing deal and give their top tips for students looking to turn their own ideas into reality. </p> <p> <strong>Developing a novel book idea </strong></p> <p> As undergraduate science students at Dartmouth College, Andrew Zureick, Yoo Jung Kim, Justin Bauer and Daniel Lee viewed college as more than a series of lectures and high-stake exams. For the biology and chemistry majors, college was about discovery. It was a chance to ask questions, challenge established traditions and explore their convictions as future scientists.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Yoo Jung Kim, medical student at Stanford University</em></span></td> </tr> </tbody> </table> <p> It’s this frame of thinking that led Zureick, Kim, Bauer and Lee, now medical students at the University of Michigan, Stanford University, University of California–San Diego and Harvard University, respectively, to write <em>What Every Science Student Should Know, </em>an informative guide that extols the love of science and offers insights to students looking to successfully study science in college and launch science-based careers. The University of Chicago Press will publish the book in May 2016, and it has already garnered early positive reviews. Zureick and Kim recently spoke with <em>AMA Wire</em>® about their experience with the publishing industry.</p> <p> Zureick and Kim credit their success to collaborating with a trustworthy group of peers and pursuing the idea because of its personal connection to their lives—not its publishing potential. Plus, the group of four Dartmouth students had worked together as writers and editors for the <em>Dartmouth Undergraduate Journal of Science</em>, Zureick said. Collaborating on a project they each valued seemed like a logical next step.</p> <p> In 2012, they began to flesh out ideas for chapters and a writing process. “But once we started graduating, we were in multiple time zones fairly quickly,” Zureick said. Still, distance didn’t stop them. The group took advantage of technology: “We scheduled video calls regularly [with our team], and completed the entire writing process using Google Drive and Google Docs,” Zureick said. </p> <p> <strong>Navigating the publishing process</strong></p> <p> Once a few sample chapters were written, the team of student-writers navigated the publishing process by reaching out to a Dartmouth alumnus and author who offered advice on how to effectively pitch their book to literary agencies and publishers. With his guidance, the team began to contact literary agents to send a full book proposal, sample chapters and an outline.</p> <p> “Between September 2012 and September 2013, we went from starting to write a book proposal to having a literary agent and publishing company on our team,” Zureick said. While he noted that they garnered interest from publishers faster than the average first-time authors, their success didn’t arrive without hard work.</p> <p> Kim added that the subject of their book struck a chord with the publishing community at the time. “I think the reason our agent and publisher were interested in this is because of the timeliness of the subject matter. When we had first come up with the idea, there was a recent article in the <em>New York Times</em> that discussed how students were dropping out of the STEM majors” because they were perceived to be too challenging.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="" target="_blank"><img src="" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Andrew Zureick, medical student at the University of Michigan</em></span></td> </tr> </tbody> </table> <p> After learning about the article, Kim said she and her colleagues wanted to address students’ waning interest in the sciences and remind them why it’s actually a fulfilling field of study, brimming with exciting opportunities—not just defined by tests and lab reports.</p> <p> “Since we were all STEM majors, we understood what our counterparts at Dartmouth and other institutions were going through,” Kim said. “So we really wanted to write a book that would help students not only continue with their science majors but also feed the passion that helped them get interested in the sciences in the first place.”</p> <p> <strong>Tips for student success </strong></p> <p> Zureick and Kim said their book arrived as a culmination of creative collaboration and dedication to a subject they both genuinely enjoy. Here are some of the key insights they referenced along their path to publishing success. Follow these tips to see your own innovations come to fruition and ensure you have fun in the process:</p> <ul> <li> <strong>Establish a study strategy to effectively balance your coursework and original projects. </strong>Medical school can be overwhelming, especially in the early years of training when students have to cram in so much information. “It takes good study habits and discipline, which some students take longer to develop than others,” Zureick said. “Once people solidify their study habits, medical school and the sciences become a much more manageable process.”<br /> <br /> Students can start planning an effective study schedule using these must-have checklists to help prioritize tasks throughout med school: <em>AMA Wire</em> offers checklists for the <a href="" target="_blank">first and second years</a>, <a href="" target="_blank">third year</a> and <a href="" target="_blank">fourth year</a> of training.</li> </ul> <ul> <li> <strong>Learn from your mistakes.</strong> “From my experiences in scientific research, I know that there will always be setbacks,” Kim said. “There will be setbacks in my projects. There will be setbacks in my education and personal life, but I’ve always tried to learn something from every disappointment and every setback to apply new lessons … to better accomplish my goals with more efficiency.”<br /> <br /> “Just having this kind of outlook and learning from my mistakes has made being in the sciences a really positive experience,” Kim said. “That kind of resiliency is so important in the sciences … and everyday life.”</li> </ul> <ul> <li> <strong>Launch projects that connect with issues that are meaningful to you. “</strong>Certainly writing a book was a great experience in itself,” Zureick said, “but knowing that we could positively impact high school and college students and help them enjoy science was what truly kept us motivated throughout the writing process.”<br />  </li> <li> <strong>Embrace discovery in medicine—focus on more than tests and classes. </strong>“When people think about the sciences, all they [usually] think about are the classes they have to take and the problem sets, but [those] really are just the basics of what science actually is,” Kim said. “Science is about finding novel things that exist in the world, and the classes [and] didactics only really cover the basics of it.”<br /> <br /> While succeeding in the sciences requires a strong knowledge base, Kim said students also should focus on developing “soft skills,” such as resilience and effectively collaborating with peers.</li> </ul> <ul> <li> <strong>Nurture your passions outside of science—don’t feel pressured to only love one subject. </strong>As early as high school, Zureick and Kim knew they enjoyed writing just as much as science, so being editors for the <em>Dartmouth Undergraduate Journal of Science </em>allowed each of them to tap into their interests and creativity. They advise other students to explore similar avenues that will nurture all of their passions, rather than forcing themselves to choose one.<br />  </li> <li> <strong>Break large goals down into small, actionable ones.</strong> Once you develop a large project idea, think about the necessary steps required to accomplish the goal and begin to scale it down to the first step you can accomplish.<br /> <br /> “What we did in the very beginning, in terms of our book, was create a plan that would help us accomplish the project,” Kim said. “We had this basic outline of what we wanted to do and how to do it. Break anything into accomplishable bite-sized pieces that will help you to move toward your goal.”</li> </ul> <ul> <li> <strong>Build strong writing skills.</strong> “Whether you’re interested in creative writing or applying for research funding … writing skills are essential,” Zureick said. He noted that a strong writer can better craft grant proposals, communicate the significance of a project, and secure valuable partnerships and funding. </li> </ul> <p align="right"> <em>By AMA staff writer</em> <em>Lyndra Vassar</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c2086453-ddff-47ca-812e-2fb10c912c3a ABMS seeking young scholars for leadership, professional development Thu, 03 Mar 2016 15:00:00 GMT <p> Applications are being accepted through May 31 for the 2016-2017 class of the American Board of Medical Specialties (ABMS) Visiting Scholars Program.</p> <p> Junior faculty, PhDs, residents and fellows, medical students, public health students, and graduate students in health services research and other relevant disciplines are invited to apply to participate in this one-year, part-time program facilitating research projects designed to improve patient care.  </p> <p> For more information and to apply, <a href="" rel="nofollow">email the ABMS</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:347e2b14-2fe0-458f-a82e-abe256da1927 How collaboration is giving practices the resources they need Wed, 02 Mar 2016 22:29:00 GMT <p> Certain practice changes can help physicians deliver higher quality care at lower costs, but many physicians don’t have the time, staff or resources to make the necessary transformations or ensure that they take hold. Find out how one health care system is using a peer-based learning network to establish effective long-term changes.<a href="" target="_blank"><img src="" style="width:356px;height:450px;margin:15px;float:right;" /></a></p> <p> “When I came to the University of Illinois-Chicago (UIC),” said John Hickner, MD, department chair and professor of family medicine at UIC, “I saw that we had a long way to go in terms of a modern practice model. I’ve been working here steadily for the last three years, figuring out ways for us to improve.” Once you know that changes are necessary to keep your practice moving forward, it’s often difficult to find the time, staff and resources to make sure those changes can actually occur.</p> <p> The <a href="" target="_blank" rel="nofollow">Transforming Clinical Practice Initiative</a> is a four-year program of the Centers for Medicare & Medicaid Services (CMS) to help physicians meet new quality mandates, make practices more efficient and produce better outcomes for patients. The program includes a federal grant that provides the resources for practice transformation networks (PTN)—peer-based learning networks designed to coach, mentor, and assist physician practices and health care systems.</p> <p> “When I heard about the federal grant that was available, I immediately raised my hand to try to participate and help,” Dr. Hickner said. “I contacted Northwestern and got involved as a steering committee member for the group here in Illinois.”</p> <p> UIC is a part of the <a href="" target="_blank" rel="nofollow">Great Lakes Practice Transformation Network</a>, a regional group that encompasses Illinois, Indiana and Michigan. But what specific kind of assistance can a PTN offer?</p> <p> <strong>An extra set of hands</strong></p> <p> Once a practice or health care system joins a PTN, they add to their team a highly-skilled and trained quality improvement advisor (QIA) to work directly with physicians and other team members to assist with the transformation and improvement process.</p> <p> Dr. Hickner and his colleagues are currently in the process of hiring their QIA. “These people will be facilitators and connectors to the resources,” Dr. Hickner said. “I call it an ‘extra set of hands.’”</p> <p> UIC is now in the beginning stages of the PTN process, planning for what is to come. “The first short-term goal is to create awareness of the resources that will be available through this PTN,” Dr. Hickner said. “If the doctors and practice members don’t know that there’s somebody there to help, then they won’t know to call on them.”</p> <p> “The second short-term goal,” he said, “is to hire a really good [QIA] who will assist our practices with whatever projects are their priority, keeping in mind that the grant’s intention is to prepare us for the new quality measures that are coming down the pike from CMS.”</p> <p> “Long term,” he said, “is the same as what everybody’s goal is here in the United States right now in primary care—and that is to create highly efficient models that are productive and will generate better health outcomes for patients and more joy of practice for physicians while saving the health care system money.”</p> <p> “I think having some outside perspective will be very useful,” said Ariel Leifer, MD, assistant professor of clinical family medicine at UIC. “It takes an enormous amount of energy to make change and then sustain the change, and I hope this person will help with that. I feel that sometimes we put a lot of thought into making a change, and if there is not 100 percent agreement with the faculty, then the effort stalls or is abandoned.”</p> <p> The Great Lakes Practice Transformation Network offers five examples of how an on-demand network QIA can assist physician practices, no matter which regional network they join. These networks can help physicians:</p> <ul> <li style="margin-left:0.25in;"> Enhance participation in the Physician Quality Reporting System</li> <li style="margin-left:0.25in;"> Establish a chronic care management program and leverage new Medicare billing code changes</li> <li style="margin-left:0.25in;"> Understand upcoming payment changes under the new Medicare Merit-Based Incentive Payment System</li> <li style="margin-left:0.25in;"> Gain exclusive access to many free continuing medical education credits and other opportunities through support and alignment networks</li> <li style="margin-left:0.25in;"> Receive a  readiness assessment to create a customized road map to help better direct the PTN resources to reaching their practice goals</li> </ul> <p> If you’re thinking about joining a PTN and utilizing the extra set of hands, Dr. Hickner has some advice: “You’ve got nothing to lose, and you may actually get some benefits, so give it a try.”</p> <p align="right"> <em>By AMA staff writer </em><a href="" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cf99533c-3f42-45ee-86b0-31be73673b69 Documentation woes: Study tracks residents’ time spent on EHRs Wed, 02 Mar 2016 22:25:00 GMT <p> How much time do your peers really spend dealing with electronic health records (EHR)? One internal medicine program explored that question and tracked the average “mouse miles”–or active time—residents spent using EHRs, and the results were very telling. Find out how many hours residents spent on EHRs in just four months, and see how you compare.</p> <p> <strong>Exploring EHR usage among first-year residents</strong></p> <p> A team of researchers tracked the active EHR usage of 41 first-year residents at a university-affiliated community teaching hospital for the months of May, July and October 2014, and January 2015. During this time, “active EHR usage time was tallied for each patient chart viewed each day and was termed an electronic patient record encounter,” researchers recently wrote in <a href="" target="_blank" rel="nofollow">a study</a> published in the <em>Journal of Graduate Medical Education</em>. “The EHR usage activities within the electronic patient record encounter included chart reviews, orders, chart documentation and other activities.”<a href="" target="_blank"><img src="" style="float:right;margin:15px;" /></a></p> <p> They also tracked the time first-year residents spent using resources within the EHR system, such as “as communicating with providers via text-paging and crosschecking regulatory, medical or peer-reviewed resources,” according to the study.</p> <p> <strong>The results: Time residents spent on EHR and key behaviors </strong></p> <p> Using a built-in time tracking program within the hospital’s EHR, authors of the study found that:</p> <ul> <li> <strong>Each resident spent an average of 112 hours per month on 206 electronic patient record encounters.</strong>  “The internal medicine interns spent 18,322 hours to review 33,733” electronic patient record encounters in just four months, the authors wrote.<br />  </li> <li> <strong>The time residents spent on EHR usage is an objective finding consistent with previous literature that has been more subjective.</strong> “Our study objectively measured interns’ EHR use and found that interns spent at least five hours a day on the EHR caring for a maximum of 10 patients, confirming prior subjective reports,” according to the study.<br /> <br /> Authors of the study noted that the majority of studies on EHR usage are often self-reported, whereas their findings are based on a tracking system within the EHR system, which provided automated tracking logs of interns’ EHR times and minimized the “error of human reporting” in the study’s data.</li> </ul> <ul> <li> <strong>As residents became more familiar with EHRs, their time spent using them significantly improved</strong>. From July to January, total hours of active EHR use per resident decreased by 18 percent—shaving off roughly 23 hours of EHR time, despite residents having more patient encounters in January. Residents spent five hours a day on EHRs in January, as opposed to the seven hours a day they spent on EHRS in July.<br /> <br /> “This improvement was most likely gained from increased familiarity with using the EHR, comfort with managing different clinical scenarios and learning from colleagues,” authors of the study noted.</li> </ul> <ul> <li> <strong>Times spent on EHR activities—particularly chart reviews—also improved as residents learned how to navigate the EHR system</strong>. A significant reduction in time was noted across EHR activities from July to January, during which time residents reduced the time they spent on chart reviews and patient orders by two minutes. Documentation time decreased by three minutes, and time spent on other EHR activities went down by two minutes. <br />  </li> <li> <strong>Residents may learn how to successfully navigate their EHR system in seven months or less.</strong> “In January, interns spent shorter or comparable time to interns from a different cohort during the previous May,” the study authors wrote. In fact, in January, residents in the study only spent 30 minutes using EHRs—just one minute more than the time interns from the previous year had spent on their EHRs in May.<br /> <br /> “This suggests that interns reached the maximal proficiency level on clinical documentation prior to or around January,” the study authors wrote. “This is a novel observation to the best of our knowledge, which begs the question: Did the intern class reach their optimal time spent per electronic patient record encounter in seven months or less?”</li> </ul> <p> <strong>Why residents need more time with patients, less time in EHRs</strong></p> <p> While the time residents needed to become completely proficient in EHR use remains debatable, authors of the study noted one conclusion that few would dispute: Programs need to find novel solutions that will <a href="" target="_blank">reduce the time residents spend on documentation</a> in EHRs.</p> <p> Authors of the study noted that the findings correlate with national studies showing that residents are dissatisfied with the time they spend on EHRs. In a nationwide survey “residents’ perceptions of the time devoted to documentation were generally negative; residents felt that clinical documentation took time away from education, patient care and more importantly, motivation to provide high-quality care,” the study authors wrote. “This has been linked to reduced resident satisfaction and increased burnout.”</p> <p> <strong>How the AMA is addressing physicians’ concerns with EHRs </strong></p> <p> These types of issues are why the AMA has <a href="" target="_blank">made addressing problems within the EHR</a> a top priority. In the fall, the AMA and MedStar Health released an <a href="" target="_blank">EHR User-Centered Design Evaluation Framework</a> that compared the design and testing processes for 20 of the most common EHR products. Out of the 20 products examined, only three met the basic capabilities. The framework shines light on the low bar of the certification process and calls for improvements.</p> <p> Physicians also continue to guide the <a href="" target="_blank">Substitutable Medical Applications and Reusable Technology</a> (SMART) Platforms project, an initiative to guide the development of EHRs and promote physician involvement. This project seeks to reimagine health IT as a smartphone-like platform that can run plug-and-play apps.</p> <p> This method could accelerate innovation to accommodate differences in work flow, drive down health tech costs and create a more competitive marketplace, which is the ultimate goal of every effort—to remove burdens and give physicians the tools to provide the highest-quality patient care.</p> <p> Additionally, two <a href="" target="_blank" rel="nofollow">STEPS Forward</a>™ modules are available from the AMA’s <a href="" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative to help physicians <a href="" target="_blank" rel="nofollow">select and purchase EHR products</a> and <a href="" target="_blank" rel="nofollow">implement those EHR products</a> in their practice. </p> <p> Problems with EHRs are so prevalent that a 2013 <a href="" target="_blank" rel="nofollow">study</a> by the AMA and the RAND Corporation found that EHRs are one of the top sources of physician dissatisfaction.</p> <p> The meaningful use program continues to be a drag on physicians and also directly affects the design of EHRs. Federal program requirements tap down innovation in health IT and limit the ability of EHR vendors to create products that meet the needs of the end user. With Stage 3, the issues plaguing physicians and EHR vendors will only get worse. In the AMA’s <a href="" target="_blank">December 2015 letter</a> (log in) to the Centers of Medicare & Medicaid Services and the Office of the National Coordinator, the AMA outlined a forward-looking approach to fix the meaningful use program and Stage 3.</p> <p> To elevate and extend the voice of physicians around the country, the AMA launched <a href="" target="_blank" rel="nofollow"></a>, a grassroots campaign that spearheads efforts to change the burdensome federal program. Both physicians and patients have shared their stories online and in person at our town halls. These real-world experiences have helped deliver a clear message to the federal government that meaningful use must change to reflect the needs of physicians, nurses, patients and others involved in their care.</p> <p> Early last year, the Medicare Access and CHIP Reauthorization Act of 2015 repealed the sustainable growth rate formula and called for the new Merit-Based Incentive Payment System (MIPS), which is intended to sunset the three existing reporting programs and streamline them into a single program.</p> <p> The AMA and 100 state and specialty medical associations recently submitted <a href="" target="_blank">10 principles</a> to guide the foundation of the MIPS, and the AMA provided <a href="" target="_blank">detailed comments</a> (log in) as part of its ongoing efforts on this issue and submitted a <a href="" target="_blank">detailed framework</a> for what needs to change.</p> <p align="right"> <em>By AMA staff writer</em> <em>Lyndra Vassar</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9a94a032-3d1a-4865-b3c5-fef41fb5a7f2 Register by May 24 for AMA-SPS educational program Wed, 02 Mar 2016 17:00:00 GMT <p> The AMA Senior Physicians Section (SPS) will host a joint educational program at the 2016 AMA Annual Meeting titled “Burning up, burning out or burning brightly.” The program will take place from noon to 1:30 p.m. June 11 in Chicago.  </p> <p> Many senior physicians are encountering high levels of dissatisfaction with their profession as a result of more intense work environments. More time is being spent on less meaningful activities, such as the introduction of new quality standards and electronic health records, among other stressors. What should senior physicians—and physicians at all stages of development—focus on in order to reconnect with their calling, find professional fulfillment and offer their patients high-quality care? </p> <p> The speaker for the session will be Richard Gunderman, MD, PhD, Chancellor’s Professor of radiology, pediatrics, medical education, philosophy, liberal arts, philanthropy, and medical humanities and health studies, at Indiana University. The moderator for the program will be Barbara A. Hummel, MD, chair of the AMA-SPS.</p> <p> The section invites you to join them for this session and to enjoy the fellowship of your senior physician colleagues. This program is approved for 1.5 <em>AMA PRA Category 1 Credits<sup>TM</sup>. </em></p> <p> Advance <u><a href="" target="_blank">registration</a></u> is appreciated. If you have questions about the meeting or registering, please contact Alice Reed of the AMA via <a href="" rel="nofollow">email</a> or at (312) 464-5523.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d3aa9d04-7f79-43fb-a6dc-8ca06cc69660 Barbara Hummel, MD, inaugurated as president of Wisconsin Medical Society Wed, 02 Mar 2016 15:00:00 GMT <p> Barbara A. Hummel, MD, chair of the Senior Physicians Section, was inaugurated as president of the Wisconsin Medical Society April 2.  </p> <p> Dr. Hummel is a board-certified family physician in private practice and is affiliated with Aurora St. Luke’s Medical Center and Aurora West Allis Medical Center, and she has served as chair and vice chair of the Department of Family Practice at West Allis Memorial Hospital. She has been a member of the society’s board of directors since 2007 and served as vice chair the past two years.</p> <p> Dr. Hummel is currently an alternate delegate to the AMA from Wisconsin. She recently was appointed co-chair to a task force working in conjunction with the AMA Council on Medical Education to develop guidelines for determining competency in physicians.  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a1b9455f-224f-459e-a745-b30f7cc94841 4 IRA questions for which you need answers Tue, 01 Mar 2016 21:59:00 GMT <p> As a physician, you’re probably accustomed to hearing that IRAs are an essential component of your retirement planning. What you might not know is how to manage those funds to get the most out of your savings to achieve your personal financial goals. An experienced physician financial advisor shared insights into some of the main questions you need to understand to reap the full benefits of your IRA.<a href="" target="_blank"><img src="" style="float:right;margin:15px;" /></a></p> <p> <strong>Make sure you’re prepared to handle your savings</strong></p> <p> <em>AMA Wire</em>® talked to Trey Fairman, senior wealth and insurance planning strategist at Millennium Brokerage Group, about the most common problems physicians run up against with their IRAs. It comes down to making sure that you have the right financial plan for your particular goals—and a big part of that is understanding what you should do with your IRA funds once you’ve saved them.</p> <p> “What physicians—and most people—don’t hear is how you handle your IRA once you get close to retiring,” Fairman said. “You have a lot of market commentary on why IRAs are great, but not a lot of discussion about what to do now that you have it. How do you use your IRA to do a lot of really good things?”</p> <p> He suggests that you understand the answers to four common questions so you don’t make any major mistakes that limit the effectiveness of your IRA:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>How much should I withdraw—and when?</strong><br /> “The IRS says you need to start taking money out of your plan once you hit 70.5 years old,” Fairman said. “When you take the money out, how do you do it?”<br /> <br /> The IRS calculates a minimum amount that IRA holders are required to withdraw. “But we see people withdrawing more funds than they need to,” he said. “When it comes time to access money, take out the minimum amount for sure. If you need more, talk to someone who really understands tax planning. Because of market issues, it may make sense to sell some other investments for tax law harvesting. That’s more of a timing issue. It’s not always best to grab funds from your IRA just because it’s your most liquid account.”<br /> <br /> Fairman said it’s generally better to liquidate other assets for the remaining funds that you need. “A lot of people underestimate the power of tax deferral over time.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>How do I avoid taxes on my IRA funds? </strong><br /> Fairman said this is a common question people ask. While you can’t avoid income taxes on your IRA funds, you can minimize them.<br /> <br /> “The advantage of IRAs first and foremost is that you’re allowed to put money aside as you’re working, which is tax deferred,” Fairman said. But you’ll always need to pay taxes once you start withdrawing those funds. You’ll need to strategize how you want to use those funds.<br /> <br /> “Sit down with your financial planner or accountant and understand the tax implications for withdrawing from your IRA versus mutual savings or other funds,” he said. “If you’re accessing money from a non-IRA, you might have to pay capital gains taxes, but it is much more tax efficient to access non-IRA funds.”<br /> <br /> Additionally, if you have more savings than you need for your retirement, you could choose to spend the money in other ways. Making charitable deductions is one option. “Take the required minimum distribution and transfer it to a charity,” Fairman said. “You get some income tax advantages from that too.”<br /> <br /> “Or maybe it makes sense to give money to your children or fund your grandchildren’s college education,” he said.<br /> <br /> The key is to work your plans out with your financial advisor so however you decide to use your hard-earned funds meets your goals with minimal loss.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Should I plan to pay for long-term care from my IRA?</strong><br /> “Physicians by the nature of their work see long-term care, which is becoming a bigger and bigger issue,” Fairman said. “You do see some marketing pieces talking about how to use your IRA money to pay for long-term care. That’s technically true, but you still have to pay income taxes on it first.”<br /> <br /> Using money from your IRA for long-term care might not be the best funding option for all physicians. “It’s for physicians who have an IRA where the money is getting forced out. You can use some of the money in your IRA to fund long-term care.”<br /> <br /> For other physicians, there may be more tax-friendly ways to fund long-term care. Careful planning can maximize your savings.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>How should I leave funds for my children’s inheritance?</strong><br /> If part of your plans for your savings is to leave an inheritance for your children or grandchildren, you’ll want to think through additional options for your IRA.<br /> <br /> “90 percent of retirement plans are liquidated by children within six months of inheriting them,” Fairman said. But doing so can severely limit the potential net benefits of that inheritance.<br /> <br /> “Beneficiary designations are very important,” he said. “The standard way that IRA custodians allow you to pick is a one-page, check-the-box kind of form. In reality, there are better ways to do it.”<br /> <br /> For instance, you could designate your funds to an IRA beneficiary trust, Fairman said. “Choosing this option protects the money from your children’s creditors and manages the money for them, so they don’t get bad advice and take all the money out at once.”</p> <p> Fairman also noted that physicians with a high net worth may have unique tax considerations because their IRA savings could be taxed as high as 60 percent. “We council these people to take out money from your IRA before you’re 70,” he said. “Access money in your IRA early to use that in more sophisticated estate-planning techniques. We’d rather you pay income taxes today of 40 percent as opposed to not doing the planning, and then your estate pays upwards of 60 percent. If you aren’t considered high net worth, then you don’t have that problem.” Fairman said this just underscores the fact that you need to have the right estate plan for your unique circumstances.</p> <p> <strong>Create a blueprint for the retirement you want</strong></p> <p> Fairman will be among the expert speakers at the upcoming <a href="" target="_blank" rel="nofollow">Physicians Financial Summit</a>, scheduled to take place May 1-4 in Orlando. The event will offer an educational program developed by Millennium Brokerage Group based on extensive physician research conducted by AMA Insurance. The summit will cover such topics as:</p> <ul> <li style="margin-left:0.25in;"> Avoiding costly IRA mistakes</li> <li style="margin-left:0.25in;"> Constructing a retirement plan that will stand the test of time</li> <li style="margin-left:0.25in;"> Minimizing taxes in retirement</li> <li style="margin-left:0.25in;"> Determining strategies beyond a 401k to supplement retirement funds</li> <li style="margin-left:0.25in;"> Funding personal long-term care expenses</li> </ul> <p> <a href="" rel="nofollow">Learn more, and register today</a> to reserve a spot. The early bird registration deadline is March 15. AMA members receive an additional discount on registration.</p> <p> <strong>Get more financial insights for physicians</strong></p> <p> Find <a href="" target="_blank">additional insights</a> from professionals who specialize in physician finances in other <em>AMA Wire</em> posts, including:</p> <ul> <li style="margin-left:0.25in;"> <a href="" target="_blank">Retirement savings strategies for physicians that start late</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">5 ways to partner with a physician-friendly financial advisor</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">How to kick your financial plan into high gear</a></li> <li style="margin-left:0.25in;"> <a href="" target="_blank">What to consider when planning a practice exit strategy</a></li> </ul> <p align="right"> <em>By AMA Wire editor</em> <a href="" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4b5e78f3-d0f8-40cf-9017-b88cad628b17 Experts offer insights into latest BP trials and guidelines Tue, 01 Mar 2016 21:43:00 GMT <p> Three experts in hypertension control and treatment last week joined the AMA in a discussion that covered the results of the SPRINT trial, self-measured blood pressure monitoring (SMBP) and much more. Find out what they had to say and check out the resources they had to offer.</p> <p> The <a href="" target="_blank">SPRINT trail made a big splash</a> in the world of blood pressure control last year, and with the recent <a href="" rel="nofollow" target="_blank">USPSTF recommendation</a> to use out of office blood pressure monitoring to diagnose hypertension following closely behind, many physicians are wondering how all of this information can fit into daily practice in ways that benefit their patients.</p> <p> The moderator of the discussion was Michael Rakotz, the AMA’s director of chronic disease prevention. The three experts who joined Dr. Rakotz in discussion on the most pressing issues in blood pressure from 2015 were:</p> <ul> <li style="margin-left:0.25in;"> Harlan Krumholz, MD, a cardiologist, professor at Yale University, director of the Center for Outcomes Research and Evaluation at Yale-New Haven Hospital, and frequent contributor to the New York Times Well blog.</li> <li style="margin-left:0.25in;"> Janet S. Wright, MD, a cardiologist and executive director of the Million Hearts initiative.</li> <li style="margin-left:0.25in;"> Ray Townsend, MD, a nephrologist and director of the hypertension program at the Hospital of the University of Pennsylvania.</li> </ul> <p> Here are three key takeaways from the discussion:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>The SPRINT trial results apply only to the specific group of patients who meet the study’s inclusion criteria</strong></p> <ul> <li style="margin-left:0.75in;"> “There is a feature that I thought was very interesting,” Dr. Krumholz said. “You could get into this trial with a blood pressure as high as 180, yet when you looked at the blood pressure at baseline among the groups it was slightly below 140.”<br /> <br /> “You want to see to what extent [do the] inclusion criteria fit the people that I see in practice?” he added.</li> </ul> <ul> <li style="margin-left:0.75in;"> An article in the Journal of the American College of Cardiology, “<a href="" rel="nofollow" target="_blank">Generalizability of SPRINT results to the U.S. adult population</a>,” further investigates how many patients across the country might have been candidates for SPRINT. “The answer is 1 in 6,” Dr. Townsend said. “SPRINT was an important trial … but there [are] still a lot of patients out there, particularly younger ones, that don’t quite fit the inclusion criteria.”</li> </ul> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Is a lower blood pressure target better?</strong></p> <ul> <li style="margin-left:0.75in;"> “In some cases,” Dr. Townsend said, “if you can safely and effectively—and with very little side effects—get someone down to around 120 on two or three drugs I’m all for it.”</li> <li style="margin-left:0.75in;"> Dr. Krumholz took a slightly different approach. “We’re in a position of needing to understand what the person’s point of view is,” he said. “We need to understand who you are—are you a person that hates taking meds or likes taking meds? There’s evidence that pushing you down … might be helpful, but it’s at some risk.”</li> <li style="margin-left:0.75in;"> Citing an article recently published in the Annals of Internal Medicine, “<a href="" rel="nofollow" target="_blank">Let’s not SPRINT to judgement about new blood pressure goals,</a>” Dr. Krumholz told the group, “It’s up to [physicians] to be honest and frame it in different ways for people to say there is a way to lower your risk, but most [patients] won’t be benefitted or harmed.”</li> <li style="margin-left:0.75in;"> “There’s a handful that will avoid certain complications,” he added, “but what we need are tools to be able to have these conversations and help us communicate this.”</li> </ul> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Three reasons you should use out of office blood pressure measurement</strong><br /> In light of the USPSTF recommendation for out of office blood pressure measuring to diagnose hypertension, the experts offered three benefits to having patients measure their own blood pressure through SMBP—measured over a longer period between office visits:</p> <ul> <li style="margin-left:0.75in;"> It confirms the diagnosis of hypertension, eliminating the white coat response that is often present in the office.</li> <li style="margin-left:0.75in;"> It is a better predictor of future cardiovascular events than in-office measuring alone.</li> <li style="margin-left:0.75in;"> A patient who is self-monitoring is more likely to own their blood pressure control. “Patient engagement is critical to good [blood pressure] control,” Dr. Wright said.</li> </ul> <p> Drs. Krumholz, Townsend and Wright took their blood pressure discussion to the furthest depths, answering many of Dr. Rakotz’s questions. You can <a href="" rel="nofollow" target="_blank">watch the full discussion</a> or visit the <a href="" rel="nofollow" target="_blank">Google Hangout page</a> for more information on blood pressure and blood pressure control.</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f068cb04-c251-4087-aa84-f230181cfd9c Get help with your medical staff bylaws with AMA guide Tue, 01 Mar 2016 15:00:00 GMT <p> When making medical staff bylaws, it is important to meet relevant accreditation standards and regulatory requirements. Use the AMA <a href="" target="_blank">Physician’s Guide to Medical Staff Organization Bylaws</a> to help you create or make changes to your medical staff bylaws.</p> <p> Physicians can learn how to draft and amend medical staff bylaws with this reference manual. The guide provides all the important elements that should be contained in any medical staff bylaws and includes many examples. The new edition has been updated to address codes of conduct, drug testing, physician-hospital compacts and much more.</p> <p> Additionally, the new edition features practical guidance and sample bylaw language on many issues, including:</p> <ul> <li style="margin-left:0.25in;"> Credentialing and privileging (<a href="" target="_blank">learn more</a> about the AMA’s role in credentialing)</li> <li style="margin-left:0.25in;"> Corrective action</li> <li style="margin-left:0.25in;"> Due process</li> <li style="margin-left:0.25in;"> Quality assessment and improvement</li> </ul> <p> Visit the <a href="" target="_blank">AMA Store</a> to learn more about the guide, which is free for AMA members. If you’re not a member, <a href="" target="_blank">join today</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fd2571a5-108a-4d5b-ba53-27c21871dfef Congressmen share insights for physician advocates Mon, 29 Feb 2016 21:12:00 GMT <p> Three members of Congress spoke to physician leaders last week at the 2016 National Advocacy Conference about the top federal issues in health care and the importance of physician advocacy. Find out what they had to say about new payment systems, telemedicine and the role of the physician.</p> <p> <strong>Physicians need to be at the center of meaningful change</strong></p> <table align="left" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <a href="" target="_blank"><img src="" /></a></td> <td>   </td> </tr> <tr> <td> <p> <em><span style="font-size:10px;">Rep. Pat Tiberi, R-Ohio, speaks to physicians at the 2016 AMA National Advocacy Conference in Washington, D.C.</span></em><br />  </p> </td> <td>  </td> </tr> </tbody> </table> <p> “What we need to actually do is [support] something that makes sense,” said Rep. Pat Tiberi, R-Ohio. “How do we have a model health care system that’s patient-centered, and at the very top of that patient-centered health care system is the importance of the doctor-patient relationship?”</p> <p> Tiberi told physicians that, other than treating their patients, there is no more important way they can spend their time than advocating for medicine. “There really isn’t anybody more important in the health care space than you,” he said, “a doctor.”</p> <p> “If your child is sick, who is the most important person—the pediatrician. I’ve been there,” he said. “[There is] nobody more important in the world. If you have an aging parent who maybe now is beginning to be forgetful or you see some signs of disease, there is no more important person than the right doctor.”</p> <p> Rep. Xavier Becerra, D-Calif., reminded physicians of a major victory from just one year ago. “We just buried [Medicare’s sustainable growth rate formula],” he said to great applause. “Now, we’ve got this new baby and this was a complicated birth—this new physician payment system. We’re still trying to incubate it.”</p> <p> “Make sure you’re working with us so we can make sure the implementation of this new payment scheme works for everyone,” Becerra suggested. “It will have bugs, but come to us, and we [will] all go together to Andy [Slavitt] and the folks at CMS.”</p> <p> <strong>Telemedicine is advancing</strong></p> <p> Physicians also heard a congressional perspective on telemedicine. The <a href="" target="_blank">possibilities for telemedicine</a> abound, but current legislation and regulation prevent its expansion. Sen. Brian Schatz, D-Hawaii, is leading a coalition to propose the Creating Opportunities Now for Necessary and Effective Care Technologies or CONNECT for Health Act, which it introduced earlier this month.</p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>   </td> <td> <a href="" target="_blank"><img src="" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Rep. Xavier Becerra, R-Calif.</em></span></td> </tr> </tbody> </table> <p> “The CONNECT for Health Act … will lift Medicare restrictions on the practice of telemedicine,” Schatz said. “It will do so in a cost-effective, quality-oriented way that will keep safeguards for doctors and patients.”</p> <p> Schatz pointed to the Social Security Act as the basic problem in telemedicine that must be fixed. “This is an old law that was written before the advent of smartphones and other technologies,” he said. The senator cited these five statutory restrictions that are holding telemedicine back:</p> <ul> <li> Patients receiving a telemedicine visit only may be in certain locations that include a physician office, rural health clinic or hospital.</li> <li> Patients must be located only in certain rural areas.</li> <li> Only certain practitioners can provide telemedicine services, according to existing definitions.</li> <li> Store and forward technology is permitted only in federal telemedicine demonstration programs conducted in Alaska or Hawaii.</li> <li> Telehealth coverage is restricted to specific codes under the U.S. Department of Health and Human Services rules developed in an annual process.</li> </ul> <p> “We structured [the CONNECT for Health ACT] in a way that it will still lift restrictions,” Schatz said, “but do so in a way that would save Medicare money.”</p> <table align="left" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <a href="" target="_blank"><img src="" /></a></td> <td>   </td> </tr> <tr> <td> <em><span style="font-size:10px;">Sen. Brian Schatz, D-Hawaii</span></em></td> <td>  </td> </tr> </tbody> </table> <p> Some of the key elements of the bill include:</p> <ul> <li> A bridge program to help physicians transition to the new Medicare Access and Chip Reauthorization Act payment system through the use of telehealth.</li> <li> The lifting of geographic restrictions is subject to state licensing requirements. It allows alternative payment models in Medicare to use telehealth without the existing restrictions.</li> <li> Allowing telehealth to be a basic benefit under Medicare Advantage plans.</li> <li> Expanding originating sites for <a href="" target="_blank">telestroke</a> and Native American programs.</li> </ul> <p> “The AMA commands respect in the nation’s capital on both sides of the aisle, and your support for our bill is a big boost,” Schatz said. “Being here today is special for me because I’m the son of a physician. … [My father] was my role model for public service, and as a result my admiration for the medical profession is deep and is personal.</p> <p> “I also know from my father that the personal and professional satisfaction from being in medicine being a doctor in America in 2016 comes with its share of frustrations, from billing and bureaucracy to EMR to managed care and everything in between,” he said. “But [now] there is something to be hopeful about. The CONNECT for Health Act … will lift Medicare restrictions on the practice of telemedicine.”</p> <p> “But in order to do that we need this bill to get a hearing in both chambers,” Schatz said. “And we need it to eventually pass through the legislative process. That won’t happen without all of your advocacy.”</p> <p align="right"> <em>By AMA staff writer </em><a href="" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f258f6f6-c28b-4e0f-ab9b-9e65bff5fe12 Avoid meaningful use penalties: Exemption deadline now July 1 Mon, 29 Feb 2016 20:21:00 GMT <p> Physicians now have until July 1—an additional three months—to apply for a hardship exemption from the electronic health record (EHR) meaningful use financial penalties for the 2015 program year. Those who don’t apply could face up to a 3 percent cut in their Medicare payments in 2017 since the meaningful use program operates on a two-year look-back period.</p> <p> <strong>Be sure to apply, whatever your circumstances</strong></p> <p> In a brief statement issued Friday, the Centers for Medicare & Medicaid Services (CMS) said it “is extending the deadline so providers have sufficient time to submit their applications to avoid adjustments to their Medicare payments in 2017.” </p> <p> CMS also has stated that it will broadly grant hardship exemptions as a result of the delayed publication of the <a href="" target="_blank">Stage 2 meaningful use modifications rule</a>, which left physicians with insufficient time to report under the modified program requirements issued in late 2015.</p> <p> All physicians should apply for the exemption—there isn’t a downside to doing so. Even physicians who believe they met the requirements of the meaningful use program in 2015 can apply. <a href="" target="_blank" rel="nofollow">CMS has said</a> that submitting an application for a hardship exemption will not prevent those who qualify from receiving an incentive payment.</p> <p> <strong>How to apply</strong></p> <p> Physicians should be sure to submit their applications before midnight Eastern time July 1. To get started, <a href="" target="_blank" rel="nofollow">download an application</a> from CMS and consult <a href="" target="_blank">step-by-step instructions</a> (log in) the AMA compiled to help simplify the submission process. Physicians do not need to include documentation of their circumstances with their application, but should hold onto it for their own records.</p> <p> New this year, individuals can apply on behalf of a group of physicians.</p> <p> CMS has indicated that physicians may soon begin to hear if their exemption application has been approved.</p> <p align="right"> <em>By AMA Wire editor </em><a href="" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:45cab403-6a8d-467a-bddf-ec0c54720563 5 steps to lasting change: Lessons from the Cold War Sun, 28 Feb 2016 19:00:00 GMT <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Committing to change is one thing, but seeing that commitment through to actuality is a difficult task. Whether taking your issues to Capitol Hill or making changes in your practice, how can you stay the course and do what needs to be done? Ken Adelman, former ambassador and arms control director for former President Ronald Reagan, spoke last week to physician leaders in Washington, D.C., about how the Cold War was won and what it takes to enact meaningful change.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>Making change happen</b></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Adelman addressed physicians at the 2016 National Advocacy Conference who were preparing to meet with their lawmakers about key issues in health care, from combatting the opioid epidemic to advancing telemedicine to improving electronic health records. He offered insights for physicians who are advocating for important changes, whether on the Hill, in their communities or in their practices.</span><br />  </p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <span style="font-size:12px;">  </span></td> <td> <span style="font-size:12px;"><a href="" target="_blank"><img src="" style="margin:5px 0px;" /></a></span></td> </tr> <tr> <td>  </td> <td style="text-align:left;vertical-align:top;height:35px;"> <span style="font-size:11px;"><span style="font-family:arial,helvetica,sans-serif;"><em>Ken Adelman, former ambassador and arms control director for former President Ronald Reagan, speaks at the 2016 National Advocacy Conference</em></span></span></td> </tr> </tbody> </table> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“You are real leaders in your field,” Adelman said. “What you’re leading on now—improving wellness for patients in heart disease and diabetes and innovation in medical schools and joy in the practice of medicine—are important.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>How to achieve your goal</b></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Adelman offered a five-step strategy for making sure that the changes that you want are made known and that those changes actually happen. At a small house in Reykjavik, Iceland, Reagan met with then-Soviet leader Mikhail Gorbachev to determine the fate of the nuclear arms race and the Cold War. Here’s how he did it:</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px 0px 0px 40px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>1.<span class="Apple-tab-span" style="white-space:pre;"> </span>Make no small plans.</b><br /> “Think big,” Adelman said. When a political advisor asked Reagan why he wanted to be president of the United States, he said firmly, “To end the cold war.” When asked how he would do it, Reagan said, “We win, they lose.”<br /> <br /> If you’re seeking change, “be very firm in what you want,” Adelman said. “Be very nice, personally … be willing to sit down [with those who can make the changes], but also be willing to stand up for what you need.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px 0px 0px 40px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>2.<span class="Apple-tab-span" style="white-space:pre;"> </span>Work out how to get from here to there.</b><br /> “It took us about nine months to plan that first summit [to try to end the Cold War],” Adelman said. Reagan had the plan in place and knew the components to make it happen.</span><br />  </p> <p style="margin:0px 0px 0px 40px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>3.<span class="Apple-tab-span" style="white-space:pre;"> </span>Trust the team.</b><br /> “Have a group that you can deal with that is reliable and carefully chosen—and then trust them,” Adelman said. Once Reagan and Gorbachev had discussed their initial talking points, they then trusted their teams, letting them into the room to negotiate.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px 0px 0px 40px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>4.<span class="Apple-tab-span" style="white-space:pre;"> </span>Don’t accept defeat.</b><br /> The summit in Reykjavik went into overtime, the only one in history to do so. After the initial conversations with the Russians were unsuccessful in the ultimate goal, “Reagan came to us and said, ‘I’m going to go down and talk to Gorbachev one more time, and that’s it,’” Adelman said. “[Reagan] said he told Nancy he’d be home for dinner.”<br /> <br /> Though that final meeting still did not result in the end of the Cold War, Reagan didn’t accept that as the final outcome. The initial word about the summit was that it had been a disaster and that the Russians would never back down. But to Reagan, the goal still was clear—the Cold War had to end.<br /> <br /> When things don’t go according to plan, it doesn’t mean that the game is over, Adelman said. It is important to treat defeat not as the end of the attempt but just another road block on the road to the goal.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px 0px 0px 40px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>5.<span class="Apple-tab-span" style="white-space:pre;"> </span>Stay the course.</b><br /> Seven months after the summit, Reagan was scheduled to give a speech in Berlin. He had one thing he wanted to say. It was removed from the speech by everyone, and he kept putting it back in. Finally the day came, and he stood in front of the Berlin Wall and delivered the most remembered speech of his presidency ending with, “Mr. Gorbachev, open this gate …. Mr. Gorbachev, tear down this wall.” In November 1989, the wall came down.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>Leading the way</b></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">That weekend in Reykjavik was “an example of great leadership,” Adelman said. “The type that physicians and the AMA are showing … the type of leadership we need in America today. Pitch hard when you’re taking your issues to the Hill.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">AMA President Steven J. Stack, MD, noted that physician leadership and persistence has made real changes for the nation’s patients and the medical profession alike. “This time last year,” he reminded attendees, “we were trying to get the sustainable growth rate [formula] repealed—and <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">now it’s gone</span></a>.” </span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Even if you aren’t meeting with your members of Congress, you can help lead the way on important changes for your patients and your practice. Among the actions you can take now:</span><br />  </p> <ul> <li style="margin:0px 0px 0px 18px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Visit <a href="" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);"></span></a>, the AMA’s grassroots campaign website, to advocate for ways to solve medicine’s regulatory and legislative challenges. The Medicare Access and CHIP Reauthorization Act will see its first draft rule this spring. Make sure your voice is part of the plan.</span></li> </ul> <ul> <li style="margin:0px 0px 0px 18px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Learn <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">five steps to help address the nation’s opioid epidemic</span></a> in your community, and access resources that can help you make a big difference.</span></li> </ul> <ul> <li style="margin:0px 0px 0px 18px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Learn how to transform your practice to increase your practice’s sustainability and improve patient care using the AMA’s <a href="" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);">STEPS Forward</span></a><span style="text-decoration:underline;color:#0433ff;">™</span> modules.</span></li> </ul> <p style="margin:0px;text-align:right;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><i>By AMA staff writer </i><span style="color:rgb(4, 51, 255);"><i><a href="" rel="nofollow" target="_blank">Troy Parks</a></i></span></span></p> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e95fb17c-69b6-4298-ab65-b317cb984c07 Botticelli: We need all hands on deck for opioid crisis Fri, 26 Feb 2016 23:00:00 GMT <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Michael Botticelli, director of National Drug Control Policy at the White House, Wednesday underscored the essential role of physicians as clinicians and advocates in the effort to combat the opioid epidemic. “We at the federal level can’t do it alone,” Botticelli said. “It’s a crisis that requires an all-hands-on-deck approach, and we need partners like the AMA to help steer our ship safely.”</span></p> <table align="right" border="0" cellpadding="1" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <span style="font-size:12px;"><a href="" target="_blank"><img src="" style="margin:5px 0px;" /></a></span></td> </tr> <tr> <td>  </td> <td> <span style="font-size:12px;"><em>Director of National Drug Control Policy Michael Botticelli speaks at the 2016 National Advocacy Conference in Washington, D.C.</em></span></td> </tr> </tbody> </table> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“We all know that it’s critical that health care leaders and stakeholders are part of our efforts,” Botticelli said at the conclusion of the 2016 National Advocacy Conference in Washington, D.C. “The <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">[AMA] task force</span></a> goals of increasing the use of prescription drug monitoring programs (PDMP), enhancing physician education, reducing stigma, and expanding access to lifesaving treatment and [the] opioid reversal drug naloxone are right on the money and clearly aligned with the administration’s priorities.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Tragically, every day in America, 78 people die from overdose due to prescription opioids or heroin. This national epidemic presents many challenges, which is why the government and the physician community need to work collaboratively to ensure that policies are designed that help the situation and don’t unintentionally hurt the effort.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“We need to work together to support policies and changes in practice that will have a meaningful impact,” Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees and chair of the AMA Task Force to Reduce Opioid Abuse, said when she introduced Botticelli at the conference. “Physicians must not only take responsibility—we welcome that responsibility, and we welcome your continued partnership in this effort.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><b>What physicians and the federal government can do together</b></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">According to a <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">recent AMA survey</span></a>, 90 percent of physicians said that PDMPs help them become more informed about their patient's medication history, including whether that patient is receiving multiple prescriptions from multiple health care professionals. </span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“Our prescribing decisions must be judicious, deliberative and rooted in the art and science of medicine,” Dr. Harris said, echoing <a href="" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);">words she shared</span></a> a few days before at the National Governors Association (NGA) Winter Meeting, where she was joined by Botticelli, Massachusetts Gov. Charlie Baker, New Hampshire Gov. Margaret Hassan and other prominent voices on the opioid epidemic. The AMA also issued a <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">joint statement</span></a> with the NGA, calling on physicians, governors, state legislatures and the private sector to come together to solve the crisis.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“Patients with pain and patients with substance use disorders deserve care and compassion, not judgement,” Dr. Harris said. ”They are our patients. They are not fakers or junkies or addicts; they are people who need our help. Stigma dehumanizes and demeans and does nothing to treat and cure.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“Your advocacy and action is needed today,” Botticelli said to physicians. “As Dr. Harris talked about, we are in the midst of one of the most urgent public health crises, and it’s our defining moment to do everything we can to make positive differences in people’s lives.” </span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">These remarks came a week after AMA President Steven J. Stack, MD, shared a <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">call to action</span></a> with physicians, urging them to “turn the tide” of the opioid epidemic through <a href="" target="_blank"><span style="color:rgb(4, 51, 255);">five specific actions</span></a> recommended by the AMA task force.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Some physicians have concerns that the patient satisfaction questions related to pain and pain medication in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey are leading to pressure to prescribe. </span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“This came to our attention awhile ago in terms of the extent to which HCAHPS surveys might be contributing to overprescribing because of misaligned financial incentives,” Botticelli said. “The President announced in October that [the Department of Health and Human Services] was undertaking a review of that survey … to make modifications to those questions.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">Last month, President Obama also moved the ball forward in expanding treatment for opioid use disorders when he announced his fiscal year 2017 budget, calling for $1.1 billion in new funding to expand access to treatment for opioid misuse to “help people seek treatment, complete treatment and sustain long-term recovery,” Botticelli said. “But this budget is more than just funding. It represents our country’s largest investment in treating and preventing substance use disorders in history.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“There’s a real need to make sure prescribers get the training they need, know their patients’ overdose history and use the tools at their disposal,” he said.</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“The real lynchpin of our efforts to stop the opioid epidemic [is] physician education,” Botticelli said. Equally as important is “ending stigma around getting people the treatment they need and the care they need to recover from substance use disorders,” he said. Reducing stigma is among the key goals of the opioid abuse task force. “And it’s exactly what we need to get people on the road to recovery,” Botticelli said. </span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;">“There are literally millions of people across the country who need our help, and they need it now,” Botticelli said, emphasizing the importance of expanding access to earlier intervention and treatment. “We know that medication assisted treatment (MAT) when combined with counseling, is a proven path to recovery.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font