AMA Wire® http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page Thu, 28 Apr 2016 23:00:00 GMT Better health, costs: One practice’s value-based care outcomes http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_better-health-costs-one-practices-value-based-care-outcomes Thu, 28 Apr 2016 23:00:00 GMT <p> As 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/15/88d0bd4e-7751-4fcf-bffd-25fa3467abec.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/15/88d0bd4e-7751-4fcf-bffd-25fa3467abec.Large.jpg?1" 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="https://www.stepsforward.org/modules/value-based-care" rel="nofollow" target="_blank">new module</a> for the AMA’s <a href="https://www.stepsforward.org/modules" 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 care model incorporated a team of three internists, an embedded behavioral health provider, pharmacy services, a health navigator and a nutritionist. A 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 more than $3,000 in per patient savings and more than $6 million in total savings for 461 patients. 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.</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="https://www.stepsforward.org/modules" 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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" 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="https://cc.readytalk.com/cc/s/registrations/new?cid=u7mt4mdrsoub" rel="nofollow" target="_blank">Register to participate</a>.</p> <p> <strong>Read more about new payment models underway:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_blank">Testing new payment models: One pilot program’s success</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_blank">How doctors are developing new payment models for their specialties</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_blank">Specialty development key to new payment models’ success</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_blank">Payment models that can help you better address patients’ needs</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-traits-of-successful-payment-models" target="_blank">3 traits of successful payment models</a></li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Troy_AMAWire" 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? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_answer-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="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" 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="http://www.youtube.com/v/U98ifF3geBI" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/U98ifF3geBI" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/U98ifF3geBI" /><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="http://www.youtube.com/v/U98ifF3geBI" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_draft-regulations-outline-next-phase-of-medicare Wed, 27 Apr 2016 23:11:00 GMT <p> A 962-page <a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf" 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="http://www.ama-assn.org/ama/ama-wire/post/physicians-tell-house-panel-keys-macra-implementation" 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="https://energycommerce.house.gov/hearings-and-votes/hearings/medicare-access-and-chip-reauthorization-act-2015-examining-physician" 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="http://www.annfammed.org/content/12/6/573.full" rel="nofollow" target="_blank">Quadruple Aim</a>.”</p> <p> An <a href="http://www.rand.org/pubs/research_reports/RR439.html" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/physician-payment-models.page#ps2-pg4-rand-report" 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="http://www.ama-assn.org/ama/ama-wire/post/historic-medicare-payment-policy-changes-opportunity-success" 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="http://www.ama-assn.org/ama/pub/news/news/2016/2016-04-27-ama-responds-medicare-proposals-macra.page" 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="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" target="_blank">Resources currently available</a> include an expert-authored <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">guide to physician-focused payment models</a>, <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_blank">key points of MIPS</a> and <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_blank">five things you can do now to prepare</a>.</p> <p> The AMA’s <a href="https://www.stepsforward.org/" 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="https://www.stepsforward.org/modules/value-based-care" 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="https://cc.readytalk.com/cc/s/registrations/new?cid=u7mt4mdrsoub" 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="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_blank">Testing new payment models: One pilot program’s success</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_blank">How doctors are developing new payment models for their specialties</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_blank">Specialty development key to new payment models’ success</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_blank">Payment models that can help you better address patients’ needs</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-traits-of-successful-payment-models" target="_blank">3 traits of successful payment models</a></li> </ul> <p align="right"> <em>By AMA Wire editor</em> <a href="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_historic-medicare-payment-policy-changes-opportunity-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/5/60431934-07fb-4ab6-95cb-0c019030f9ee.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/5/60431934-07fb-4ab6-95cb-0c019030f9ee.Large.jpg?1" style="margin:15px;float:left;" /></a><a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10032.pdf" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">guide to physician-focused payment models</a>, <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_blank">key points of MIPS</a> and <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_blank">five things you can do now to prepare,</a> among <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" target="_blank">other resources</a>. The AMA’s <a href="https://www.stepsforward.org/" 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="https://www.stepsforward.org/modules/value-based-care" 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="http://www.ama-assn.org/ama/ama-wire/blog/Medicare_Reform/1" 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="https://cc.readytalk.com/cc/s/registrations/new?cid=u7mt4mdrsoub" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-negotiate-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/2/9ce6e247-e254-4da0-b281-89c021a6ca22.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/2/9ce6e247-e254-4da0-b281-89c021a6ca22.Large.jpg?1" 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="mailto:rfs@ama-assn.org" 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="http://www.ama-assn.org/ama/ama-wire/post/8-benefits-negotiate-next-job-offer" target="_blank">8 benefits to negotiate</a> for your next job offer.</li> <li> Discover <a href="http://www.ama-assn.org/ama/ama-wire/post/starting-job-hunt-use-employment-resources" target="_blank">employment resources</a> you need for starting their job hunt.</li> <li> Find out the <a href="http://www.ama-assn.org/ama/ama-wire/post/7-things-must-before-signing-employment-contract" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-satisfaction-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/b8a2d59f-df8b-4666-9937-e586aca9a2c5.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/b8a2d59f-df8b-4666-9937-e586aca9a2c5.Large.jpg?1" 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="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00071-3/abstract" 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="http://www.ama-assn.org/ama/pub/about-ama/our-people/house-delegates/2016-annual-meeting.page?" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">top priority</a> for the AMA, which will host the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" 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="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">improving physician resiliency</a>, <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="https://www.stepsforward.org/modules/physician-wellness" 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="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">Seven steps to prevent burnout in your practice</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-institutions-can-prevent-resident-burnout" target="_blank">Five things institutions can do to prevent resident burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/8-things-can-put-risk-of-burnout" target="_blank">Eight things that can put you at risk of burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-busters-boost-satisfaction-personal-life-practice" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/13/753e64d0-075f-4793-9d87-bbf302e88b6b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/13/753e64d0-075f-4793-9d87-bbf302e88b6b.Large.jpg?1" /></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="http://www.youtube.com/v/OC3mePfgLRM" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/OC3mePfgLRM" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/OC3mePfgLRM" /><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="http://www.youtube.com/v/OC3mePfgLRM" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_supreme-court-case-could-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/2/5ea4b5e8-d476-4eda-a225-c440087acf4d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/2/5ea4b5e8-d476-4eda-a225-c440087acf4d.Full.jpg?1" 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="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> said in an <a href="https://download.ama-assn.org/resources/doc/legal-issues/x-pub/wv-v-epa.pdf" 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="http://www.ama-assn.org/ama/ama-wire/blog/Infectious_Diseases/1">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="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_blank">increase liability exposure and redefine injury</a>.</li> <li> Learn how one of the nation’s leading <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reform-risk-state-supreme-court-case" 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="http://www.ama-assn.org/ama/ama-wire/post/court-decide-censorship-exam-room" target="_blank">censorship in the exam room</a>.</li> <li> See the outcome of a court’s decision regarding <a href="http://www.ama-assn.org/ama/ama-wire/post/court-decides-patient-safety-information-protected" target="_blank">protected patient safety information</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_growing-divide-life-expectancy-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="http://jama.jamanetwork.com/article.aspx?articleid=2513561" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/15/d0b7ade1-61e1-4caf-af74-c9204b90ce16.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/15/d0b7ade1-61e1-4caf-af74-c9204b90ce16.Full.jpg?1" style="height:595px;width:360px;" /></a></td> </tr> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/6/544daf56-7684-41c2-a66c-35aad0675f6a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/6/544daf56-7684-41c2-a66c-35aad0675f6a.Full.jpg?1" 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="http://www.city-data.com/" 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="http://jama.jamanetwork.com/multimediaPlayer.aspx?mediaid=12647873" 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="http://sites.jamanetwork.com/health-disparities/" rel="nofollow" target="_blank">health disparities website</a>.</li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/3-environmental-issues-disproportionately-affecting-patients" target="_blank">three environmental issues</a> disproportionately affecting Hispanic patients.</li> <li> Find out how a Chicago health network is <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-chicago-health-network-improving-community-health" target="_blank">improving health for low-income residents</a>.</li> <li> Discover how an inner city care team is <a href="http://www.ama-assn.org/ama/ama-wire/post/inner-city-care-team-reducing-hypertension-disparities" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://www.ama-assn.org/resources/doc/prevent-diabetes-stat/x-pub/point-of-care-prediabetes-identification-algorithm.pdf" target="_blank">simple algorithm</a> (log in) to walk through the steps. The process starts with giving patients a <a href="http://www.ama-assn.org/resources/doc/prevent-diabetes-stat/x-pub/diabetes-risk-assessment.pdf" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/2/a09ef844-0135-4287-b24d-71490233e332.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/2/a09ef844-0135-4287-b24d-71490233e332.Full.jpg?1" 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="https://www.stepsforward.org/modules/pre-visit-planning" 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="http://www.ama-assn.org/resources/doc/prevent-diabetes-stat/x-pub/retrospective-prediabetes-identification-algorithm.pdf" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/3/b7bf302a-1788-474c-93a1-6f83b24e2f6c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/3/b7bf302a-1788-474c-93a1-6f83b24e2f6c.Full.jpg?1" 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="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" 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="https://nccd.cdc.gov/DDT_DPRP/Registry.aspx" rel="nofollow" target="_blank">diabetes prevention program</a></p> <p> The U.S. Department of Health and Human Services <a href="http://www.ama-assn.org/ama/ama-wire/post/groundbreaking-effort-prevent-diabetes-announced" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/3/84d26d28-6a31-4791-83a0-9506c3ba3bf1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/3/84d26d28-6a31-4791-83a0-9506c3ba3bf1.Full.jpg?1" style="margin:15px;" /></a></p> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_financial-data-going-public-review-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="https://portal.cms.gov/wps/portal/unauthportal/registration" 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="https://portal.cms.gov/wps/portal/unauthportal/faq#eidm" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/sunshine-act-and-physician-financial-transparency-reports.page" 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="mailto:openpayments@cms.hhs.gov" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://journals.lww.com/academicmedicine/Abstract/publishahead/Medical_Student_Perceptions_of_the_Learning.98552.aspx" target="_blank" rel="nofollow">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="http://www.ama-assn.org/sub/accelerating-change/pdf/learning-environment-sondheimer.pdf" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" 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="http://www.ama-assn.org/ama/ama-wire/post/students-forefront-of-transforming-med-ed" target="_blank">How students are at the forefront of transforming med ed</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/med-ed-organizational-change-common" target="_blank">What med ed and organizational change have in common</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/med-school-explores-new-way-assess-millennial-learners" target="_blank">Med school explores new way to assess millennial learners</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/20-schools-tapped-transform-physician-training" target="_blank">21 more schools tapped to transform physician training</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/residency-training-environments-primed-transformation" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_practicing-end-of-world-one-physicians-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="http://www.youtube.com/v/iKxp__k0Fu8" height="350" hspace="5" id="ltVideoYouTube" src="http://www.youtube.com/v/iKxp__k0Fu8" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="http://www.youtube.com/v/iKxp__k0Fu8" /><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="http://www.youtube.com/v/iKxp__k0Fu8" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/5/2f24b33d-52fd-45c9-a593-c065da44b244.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/5/2f24b33d-52fd-45c9-a593-c065da44b244.Large.jpg?1" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-building-blocks-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/0/4bf9a51d-ae8e-41cb-a023-6c9397d84eae.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/0/4bf9a51d-ae8e-41cb-a023-6c9397d84eae.Large.png?1" 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="http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2015&issue=01000&article=00022&type=abstract" 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="http://journals.lww.com/academicmedicine/pages/default.aspx" 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="http://www.ama-assn.org/ama/ama-wire/post/6-tips-balancing-two-physician-family" target="_blank">two-physician family</a>.</li> <li> Strengthen <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">your connection</a> to your partner as your relationship grows.</li> <li> Find out why a <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">fellow health care professional</a> may be your best match.</li> <li> Learn physician-recommend steps to a <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-tell-house-panel-keys-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="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" 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="https://energycommerce.house.gov/hearings-and-votes/hearings/medicare-access-and-chip-reauthorization-act-2015-examining-physician" 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="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-testimony-19april2016.pdf" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_testing-new-payment-models-one-pilot-programs-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="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" 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="http://www.ama-assn.org/ama/ama-wire/post/3-traits-of-successful-payment-models" target="_blank">three traits of successful payment models</a> and the <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-new-models-of-care" target="_blank">most common barriers</a> in the current payment system.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/whos-using-new-delivery-payment-models-1" target="_blank">who is using new delivery and payment models</a>. </li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_blank">seven payment models that address physician needs</a>.</li> <li> Read more about the importance of <a href="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_blank">working with your specialty society to develop APMs</a>.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/meaningful-use-macra-need-now" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-neurology-shadowing-dr-govindarajan Mon, 18 Apr 2016 22:02:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/5af26116-5fcd-438f-ba0d-06da0b43694c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/5af26116-5fcd-438f-ba0d-06da0b43694c.Large.jpg?1" 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="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" 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="https://www.aan.com/Fellowship" 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="http://www.neurocriticalcare.org/" rel="nofollow" target="_blank">neurocritical care</a> and <a href="http://www.nrmp.org/fellowships/vascular-neurology-match/" rel="nofollow" target="_blank">vascular neurology</a>, which are predominantly hospital- and inpatient-based. Further, the <a href="http://neurohospitalistsociety.org/" 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="http://www.medscape.com/viewarticle/827680" rel="nofollow" target="_blank">non-medical careers</a>.</p> <p> The American Academy of Neurology also offers <a href="https://www.aan.com/trainees/medical-student-resources/careers-in-neurology/" 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="https://www.aan.com/trainees/medical-student-resources/" 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="http://www.svin.org/i4a/pages/index.cfm?pageid=1" 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="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_blank">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-otolaryngology-shadowing-dr-gillespie" target="_blank">otolaryngology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-vascular-surgery-shadowing-dr-aziz" target="_blank">vascular surgery</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_blank">infectious disease</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-adolescent-internal-medicine-shadowing-dr-rohr-kirchgraber" target="_blank">adolescent medicine</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-physical-medicine-rehabilitation-shadowing-dr-wolfe" target="_blank">physical medicine and rehabilitation</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-nephrology-shadowing-dr-desai Mon, 18 Apr 2016 21:58:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/4/c3fd1920-e3a5-44a7-b443-f88f0361ff2c.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/4/c3fd1920-e3a5-44a7-b443-f88f0361ff2c.Large.png?1" 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="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" 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="http://ajkdblog.org/" rel="nofollow" target="_blank">AJKD Blog</a></li> <li> <a href="http://www.theisn.org/" rel="nofollow" target="_blank">The International Society of Nephrology</a></li> <li> <a href="https://www.kidney.org/" rel="nofollow" target="_blank">National Kidney Foundation</a></li> <li> <a href="https://itunes.apple.com/us/app/nephrology-on-demand-plus/id872194018?mt=8" rel="nofollow" target="_blank">Nephrology On-Demand</a></li> <li> <a href="http://ukidney.com/" 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="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_blank">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-otolaryngology-shadowing-dr-gillespie" target="_blank">otolaryngology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-vascular-surgery-shadowing-dr-aziz" target="_blank">vascular surgery</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_blank">infectious disease</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-adolescent-internal-medicine-shadowing-dr-rohr-kirchgraber" target="_blank">adolescent medicine</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-physical-medicine-rehabilitation-shadowing-dr-wolfe" target="_blank">physical medicine and rehabilitation</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_containing-zika-urgent-need-funds-pregnancy-guidance Mon, 18 Apr 2016 21:28:00 GMT <p> The Centers for Disease Control and Prevention’s (CDC) <a href="http://www.nejm.org/doi/full/10.1056/NEJMsr1604338?query=featured_home&" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/14/218818fd-aca5-465f-9e0e-2484b2e323ff.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/14/218818fd-aca5-465f-9e0e-2484b2e323ff.Large.jpg?1" style="margin:15px;float:right;" /></a>The CDC counts 39 countries and U.S. territories that are reporting <a href="http://www.cdc.gov/zika/geo/index.html" 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="http://www.cdc.gov/zika/vector/range.html" 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="http://www.cdc.gov/zap/pdfs/preparing-and-responding-to-zika.pdf" 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="http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm490246.htm" 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="http://www.cdc.gov/mmwr/volumes/65/wr/mm6512e2.htm" 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="http://www.cdc.gov/zika/symptoms/index.html" 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="http://www.ama-assn.org/ama/ama-wire/post/can-now-address-zika-outbreak" target="_blank">how you can respond</a> to the Zika outbreak.</li> <li> Find a wealth of information in the <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_blank">AMA Zika Resource Center</a>.</li> <li> See what <a href="http://www.cdc.gov/zika/pregnancy/index.html/" rel="nofollow" target="_blank">advice</a> the CDC has for pregnant women.</li> <li> Check out the CDC map of <a href="http://www.cdc.gov/zika/geo/active-countries.html" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_volume-value-one-health-system-making-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="https://www.stepsforward.org/modules/team-huddles" 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="http://www.ama-assn.org/ama/ama-wire/post/ways-chicago-health-network-improving-community-health" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_doctors-developing-new-payment-models-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="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-service.page?" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" 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="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_blank">specialty development is key to new payment models’ success</a>.</li> <li> Get the details on <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_blank">payment models that can help you better address patients’ needs</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/meaningful-use-macra-need-now" target="_blank">what you need to know about the transition from meaningful use to MACRA</a>.</li> <li> Understand <a href="http://www.ama-assn.org/ama/ama-wire/post/macra-matters-practice" target="_blank">why MACRA matters for your practice</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-members-appointed-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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_idea-could-shape-medicines-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="http://www.youtube.com/v/3f5q9PQQPns" height="350" hspace="5" id="ltVideoYouTube" src="http://www.youtube.com/v/3f5q9PQQPns" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="http://www.youtube.com/v/3f5q9PQQPns" /><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="http://www.youtube.com/v/3f5q9PQQPns" type="application/x-shockwave-flash" vspace="5" width="450" wmode="transparent"></embed></object></p> <p> The AMA <a href="http://www.innovatewithama.com/" 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="http://www.ama-assn.org/ama/pub/news/news/2016/2016-04-14-new-ideas-create-healthier-nation.page" 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 16 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_push-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="http://www.alltrials.net/" 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="https://clinicaltrials.gov/" target="_blank" rel="nofollow">ClinicalTrials.gov</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="http://www.senseaboutscienceusa.org/" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="https://vimeo.com/130359798" target="_blank" rel="nofollow"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/1/3af6b94a-da08-4068-910e-b778adea6d9e.Large.jpg?1" 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="https://vimeo.com/130359798" target="_blank" rel="nofollow">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="https://www.acgme.org/Portals/0/PDFs/AwardRecipientsAnnouncement.pdf#page=4" target="_blank" rel="nofollow">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="https://www.stepsforward.org/modules/physician-wellness" target="_blank" rel="nofollow">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="http://www.ama-assn.org/ama/ama-wire/post/6-key-aspects-residents-need-well-being" 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="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" 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="http://www.ama-assn.org/ama/ama-wire/post/residents-beating-burnout-theatre" target="_blank">Residents are beating burnout with help from the theatre</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">How one program achieved resident wellness, work-life balance</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">Ways residents have found to conquer burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_stanford-added-team-based-care-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/11/5867afe2-0a9c-4e79-ab8b-60c612d64c1b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/11/5867afe2-0a9c-4e79-ab8b-60c612d64c1b.Large.jpg?1" 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="https://www.stepsforward.org/modules/team-based-care" 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="https://www.stepsforward.org/modules" 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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_out-made-list-of-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="http://www.modernhealthcare.com/article/20160402/50_MOST_INFLUENTIAL/160329948/" rel="nofollow" target="_blank">Read about</a> this year’s top physician leaders and <a href="http://www.modernhealthcare.com/community/50-most-influential/2016/" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_2016-match-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="http://www.nrmp.org/wp-content/uploads/2016/03/Advance-Data-Tables-2016_Final.pdf" 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="https://www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_projections.pdf" 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="http://www.ama-assn.org/resources/doc/washington/x-pub/graduate-medical-education-letter-16jan2015.pdf" 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="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/california-allots-7-million-primary-care-residency-slots" 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="http://www.ama-assn.org/ama/ama-wire/post/report-points-toward-path-alternative-gme-funding" 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="http://savegme.org/" rel="nofollow" target="_blank">SaveGME</a> campaign to protect federal funding and the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_michigan-relaying-student-competency-residency-programs Mon, 11 Apr 2016 21:56:00 GMT <p> A <a href="http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=9000&issue=00000&article=98667&type=abstract" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/13/4df01b7e-578c-4a01-bd81-4f1da1e82dc8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/13/4df01b7e-578c-4a01-bd81-4f1da1e82dc8.Large.jpg?1" 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="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education Consortium</a> have been working on flexible, <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-education-explores-competency-based-assessment" 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="http://www.ama-assn.org/ama/ama-wire/post/medical-education-explores-competency-based-assessment" 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="http://www.ama-assn.org/ama/ama-wire/post/med-school-explores-new-way-assess-millennial-learners" 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="http://www.ama-assn.org/ama/ama-wire/post/new-three-year-curriculum-producing-primary-care-physicians" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="https://admissions.iit.edu/summer" rel="nofollow" target="_blank">Illinois Institute of Technology</a> program that sparked his interest in science and a program at <a href="http://www.feinberg.northwestern.edu/diversity/education/high-school.html" 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="http://bravoweb.lausd.net/" 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="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/doctors-back-school.page" 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="http://www.ama-assn.org/resources/doc/public-health/x-pub/doctors-back-to-school-kit.pdf" target="_blank">Doctors Back to School kit</a> (log in) for members that includes presentation ideas, handouts and checklists. <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/doctors-back-school.page" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_test-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="http://www.ama-assn.org/ama/ama-wire/post/sharing-health-data-hipaa-may-allow-freedom-think" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/3/dfe13803-893f-443d-a38e-629009047801.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/3/dfe13803-893f-443d-a38e-629009047801.Large.jpg?1" 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="https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/interoperability-electronic-health-and-medical-records/the-real-hipaa-supports-interoperability/" 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="https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/interoperability-electronic-health-and-medical-records/the-real-hipaa-supports-interoperability/" 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="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f4452dc9-0b16-423e-b00f-69d72c6e2b0e How a Minnesota practice is preventing diabetes--and you can too http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_minnesota-practice-preventing-diabetes-can 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, the AMA teamed up with the Y-USA and <a href="http://www.ama-assn.org/resources/doc/about-ama/x-pub/cmmi-sites.pdf" 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="http://care.diabetesjournals.org/content/25/12/2165.full" 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="http://www.ama-assn.org/ama/ama-wire/post/groundbreaking-effort-prevent-diabetes-announced" 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="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" 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="https://nccd.cdc.gov/DDT_DPRP/Registry.aspx" rel="nofollow" target="_blank">diabetes prevention program</a></p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a04ff218-bfb0-4aeb-974e-5547cda94eaa Focus on training: Treating patients with intellectual disabilities http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_focus-training-treating-patients-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="http://journalofethics.ama-assn.org/site/current.html" 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="http://journalofethics.ama-assn.org/2016/04/mnar1-1604.html" 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="http://journalofethics.ama-assn.org/2016/04/medu1-1604.html" 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="http://journalofethics.ama-assn.org/2016/04/ecas3-1604.html" 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="http://journalofethics.ama-assn.org/2016/04/ecas2-1604.html" 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="http://journalofethics.ama-assn.org/podcast/ethics-talk-apr-2016.mp3" 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="http://journalofethics.ama-assn.org/site/poll.html" 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="https://www.rapidreview.com/AMA/CALogon.jsp" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-tips-live-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="http://www.physicianfamilymedia.org/?p=198" rel="nofollow" target="_blank"><span class="s1">post</span></a> for <a href="http://www.amaalliance.org/" 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="http://www.ama-assn.org/ama/ama-wire/post/want-eat-healthy-budget-5-student-friendly-tips" target="_blank">5 student-friendly tips for eating healthy on a budget</a></span></li> <li class="p4"> <span class="s2"><a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-finish-residency-falling-further-debt" target="_blank">How to finish residency without falling further into debt</a></span></li> <li class="p4"> <span class="s2"><a href="http://www.ama-assn.org/ama/ama-wire/post/5-top-tips-financial-life-after-residency" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_single-gme-accreditation-could-mean-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="http://www.ama-assn.org/ama/ama-wire/post/expect-of-new-single-gme-accreditation-system" 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="mailto:singlegme@aacom.org" rel="nofollow"><span class="s1">AACOM</span></a>, <a href="mailto:info@acgme.org" rel="nofollow"><span class="s1">ACGME</span></a> or <a href="mailto:singlegme@osteopathic.org" 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="http://www.acgme.org/acgmeweb" rel="nofollow" target="_blank"><span class="s1">website</span></a><span class="s1">,</span> the <a href="http://www.aacom.org/singlegme" rel="nofollow" target="_blank"><span class="s1">AACOM Single GME Accreditation System</span></a> Web page or the <a href="https://www.osteopathic.org" rel="nofollow" target="_blank"><span class="s1">AOA</span></a> website.</p> <p class="p1"> The ACGME answers <a href="https://www.acgme.org/acgmeweb/Portals/0/PDFs/Nasca-Community/FAQs.pdf" 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="http://www.aacom.org/news-and-events/single-gme/frequently-asked-questions" 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="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_meaningful-use-macra-need-now Tue, 05 Apr 2016 22:00:00 GMT <p class="p1"> <span class="s1"><i>An </i><a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1%22%20%5Ct%20%22_blank" target="_blank"><span class="s2"><i>AMA Viewpoints</i></span></a><i> post by AMA Board Chair </i><span class="s2"><i><a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/board-trustees/our-members/stephen-permut.page" target="_blank">Stephen R. Permut, MD</a></i></span></span></p> <p class="p3"> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/7/689a33e2-4392-4b64-8722-081bfc91ed7d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/7/689a33e2-4392-4b64-8722-081bfc91ed7d.Large.jpg?1" 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="https://breaktheredtape.org/" 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="http://www.ama-assn.org/ama/ama-wire/post/ehrs-tied-up-physician-time-2015" 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="http://www.ama-assn.org/ama/ama-wire/post/cms-chief-vows-replace-meaningful-use-better-policy" 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="http://www.ama-assn.org/ama/ama-wire/post/3-changes-cms-making-put-patients-back-center-of-care" 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="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_can-now-address-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="http://www.cdc.gov/zap/index.html" 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="http://www.cdc.gov/zika/hc-providers/clinicalevaluation.html" 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="http://wwwnc.cdc.gov/travel/page/zika-travel-information" 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="http://www.cdc.gov/zika/hc-providers/diagnostic.html" 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="http://www.cdc.gov/zika/pdfs/zika-pregnancy-registry-hcp.pdf" 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="http://www.cdc.gov/zika/pregnancy/protect-yourself.html" 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="http://www.cdc.gov/vitalsigns/zika/index.html?s_cid=bb-vitalsigns-265" 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="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/8/c5fc4d6c-4172-4096-b84d-28074d5f9025.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/8/c5fc4d6c-4172-4096-b84d-28074d5f9025.Large.jpg?1" 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="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> said in an <a href="https://download.ama-assn.org/resources/doc/legal-issues/x-pub/moon-v-rhode.pdf" 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="http://www.ama-assn.org/ama/ama-wire/post/liability-technicality-could-expose-physicians-large-fines" target="_blank">could leave physicians exposed to large fines</a></li> <li> Read about how physicians are planning to tackle <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reforms-will-advanced-challenged-2016" target="_blank">liability reform challenges in 2016</a></li> <li> Find out how a case in Oregon could <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_blank">increase liability exposure and redefine injury</a></li> <li> Learn how one of the nation’s leading <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reform-risk-state-supreme-court-case" 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="http://www.ama-assn.org/ama/ama-wire/post/court-decide-censorship-exam-room" target="_blank">censorship in the exam room</a></li> <li> See the outcome of a court’s decision regarding <a href="http://www.ama-assn.org/ama/ama-wire/post/court-decides-patient-safety-information-protected" target="_blank">protected patient safety information</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_experts-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="https://download.ama-assn.org/resources/doc/washington/x-pub/competition-anthem-cigna-merger-full.pdf" 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="http://www.cmanet.org/files/assets/news/2016/03/merger-survey-results-032816.pdf" 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="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_blank">Physicians stand up against mergers of powerful insurers</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/states-health-insurers-squeezing-out-competition" target="_blank">States where health insurers are squeezing out competition</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="https://www.stepsforward.org/modules/team-based-care" 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> 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="https://www.stepsforward.org/events" 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="https://www.stepsforward.org/modules/team-huddles" 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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:541efe27-eee7-4d75-831a-591c262d0e50 How Obama’s opioid initiatives align with physician recommendations http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_obamas-opioid-initiatives-align-physician-recommendations Thu, 31 Mar 2016 17:00:00 GMT <p> <em>An</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Viewpoints/1" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/8/c31271d8-694a-494e-b81c-e657b35a7eb8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/8/c31271d8-694a-494e-b81c-e657b35a7eb8.Large.jpg?1" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" 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="http://www.ama-assn.org/resources/doc/washington/opioid-naloxone-ama.pdf" target="_blank">downloading an AMA guide on naloxone</a>.</p> <p> Other important solutions the task force has identified include <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-resource-guide.page?" target="_blank">enhanced physician education</a> on managing pain and promoting safe, responsible opioid prescribing and use of state <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" 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="https://www.whitehouse.gov/the-press-office/2016/03/29/fact-sheet-obama-administration-announces-additional-actions-address" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/3/c09bcc0a-8b00-4c8d-a366-b278f85d60b6.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/3/c09bcc0a-8b00-4c8d-a366-b278f85d60b6.Large.jpg?1" 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="https://www.irs.gov/uac/Taxpayer-Guide-to-Identity-Theft" 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="https://idverify.irs.gov/IE/e-authenticate/welcome.do" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_master-publishing-process Wed, 30 Mar 2016 21:50:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/6/f16bd117-a70f-4c10-86fe-1a5d21f26c97.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/6/f16bd117-a70f-4c10-86fe-1a5d21f26c97.Large.png?1" 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="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" 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="http://www.ama-assn.org/ama/ama-wire/post/published-using-5-writing-research-tips" 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="http://www.ama-assn.org/ama/ama-wire/post/research-published" 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="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" 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="http://www.ama-assn.org/ama/ama-wire/post/5-medical-publishing-pitfalls-residents-overlook" 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="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_role-of-personal-accomplishment-physician-burnout Tue, 29 Mar 2016 20:54:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/8/0c839bb3-514b-4173-8828-63e9158ef6d1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/8/0c839bb3-514b-4173-8828-63e9158ef6d1.Large.jpg?1" 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="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract" 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="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00798-3/abstract" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">top priority</a> for the AMA, which will host the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" 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="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">improving physician resiliency</a>, <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">preventing physician burnout</a> and <a href="https://www.stepsforward.org/modules/physician-wellness" 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="http://www.ama-assn.org/ama/ama-wire/post/mayo-clinic-battling-burnout" target="_blank">How the Mayo Clinic is battling burnout</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" target="_blank">Ward off burnout: Your peer network may impact more than you think</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_blank">4 physician-recommended steps to work- and home-life balance</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/6-key-aspects-residents-need-well-being" target="_blank">6 key aspects residents need for well-being</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-burnout-compares-general-working-population" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_raw-data-not-enough-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/0/626b3bc8-7c29-40af-9033-01ae10c974b2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/0/626b3bc8-7c29-40af-9033-01ae10c974b2.Large.jpg?1" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-key-factors-build-residents-trust-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/5aed2810-9f0f-4adb-b57c-aeb596c50946.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/5/5aed2810-9f0f-4adb-b57c-aeb596c50946.Large.jpg?1" 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="http://journals.lww.com/academicmedicine/Abstract/publishahead/How_Residents_Develop_Trust_in_Interns___A.98551.aspx" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ways-chicago-health-network-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/10/dca437c8-1c6a-40f0-9af2-dd3b75fad0f7.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/10/dca437c8-1c6a-40f0-9af2-dd3b75fad0f7.Large.jpg?1" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_test-usmle-step-2-readiness-this-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="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" 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="http://www.youtube.com/v/6NPUopuPLVE" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/6NPUopuPLVE" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/6NPUopuPLVE" /><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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_health-system-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="http://www.ama-assn.org/ama/ama-wire/post/one-ed-uses-telemedicine-ambulance" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/6/ec7bc353-489e-417f-a646-0c58f1efe78d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/6/ec7bc353-489e-417f-a646-0c58f1efe78d.Large.jpg?1" 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="https://www.stepsforward.org/modules/adopting-telemedicine" target="_blank" rel="nofollow">new module</a> from the AMA’s <a href="https://www.stepsforward.org/" 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="http://www.telehealthresourcecenter.org/" 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="http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure/state-medical-boards.page" 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="http://www.ama-assn.org/ama/ama-wire/post/questions-telemedicine-answered" target="_blank">answers to your telemedicine questions</a></li> <li> See how the AMA is <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-telemedicine-bolster-care-delivery" target="_blank">addressing the top telemedicine issues</a></li> <li> Learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-physicians-prepping-telemedicines-success" target="_blank">three ways physicians are prepping for telemedicine’s success</a></li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/one-health-insurer-embracing-telemedicine" 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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_med-ed-organizational-change-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="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="http://www.youtube.com/v/3QAWO-QXkso" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/3QAWO-QXkso" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/3QAWO-QXkso" /><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="http://www.youtube.com/v/3QAWO-QXkso" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-trips-abroad-invaluable-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="http://www.jgme.org/doi/full/10.4300/JGME-D-15-00406.1" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_groundbreaking-effort-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="http://www.hhs.gov/about/news/2016/03/23/independent-experts-confirm-diabetes-prevention-model-supported-affordable-care-act-saves-money.html" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, the AMA teamed up with the Y-USA and <a href="http://www.ama-assn.org/resources/doc/about-ama/x-pub/cmmi-sites.pdf" 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="https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/ActuarialStudies/Downloads/Diabetes-Prevention-Certification-2016-03-14.pdf" 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="http://care.diabetesjournals.org/content/25/12/2165.full" 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="http://www.diabetes.org/assets/pdfs/advocacy/estimated-federal-impact-of.pdf" 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="http://www.ama-assn.org/ama/pub/news/news/2016/2016-03-23-medicare-coverage-type-2-diabetes.page" 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="https://ama-roi-calculator.appspot.com/" 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="http://www.ama-assn.org/ama/ama-wire/post/prevent-diabetes-sneaking-up-patients" 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="http://www.doihaveprediabetes.org/" rel="nofollow" target="_blank">DoIHavePrediabetes.org</a>.</p> <p> For physicians, the AMA and the CDC offer practical resources through the joint <a href="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" 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="https://nccd.cdc.gov/DDT_DPRP/Registry.aspx" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education.page?">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="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/11/92ab26b4-48a8-47c5-8b3e-3e95388b3cd1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/11/92ab26b4-48a8-47c5-8b3e-3e95388b3cd1.Large.jpg?1" /></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="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/9/27b82e0d-96f4-4a97-b985-664abbee623a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/9/27b82e0d-96f4-4a97-b985-664abbee623a.Large.jpg?1" /></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="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/senior-physicians-section.page">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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_coordinate-patient-visits-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/0/d162bb24-33d0-4b32-a099-fd29b929356d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/0/d162bb24-33d0-4b32-a099-fd29b929356d.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> A new <a href="https://www.stepsforward.org/modules/team-based-care" 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="https://www.stepsforward.org/modules/team-based-care#downloadable" 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="https://www.stepsforward.org/modules/team-based-care#downloadable" target="_blank" rel="nofollow">visit planner checklist</a>.</li> </ul> <ul> <li> <strong>Start the day with a </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/one-simple-solution-helped-practices-work-efficiently" 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="http://www.ama-assn.org/ama/ama-wire/post/up-15-hours-work-day" target="_blank">more time to interact with patients</a>. You can use the <a href="https://www.stepsforward.org/modules/team-based-care#downloadable" 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="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" 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="https://www.stepsforward.org/modules/team-based-care#downloadable" 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="https://www.stepsforward.org/modules/team-huddles" 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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-simple-steps-address-prediabetes-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/7/cf7d3acc-af5d-4804-a70e-decc1d1354cd.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/7/cf7d3acc-af5d-4804-a70e-decc1d1354cd.Large.jpg?1" 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="http://www.doihaveprediabetes.org/" rel="nofollow" target="_blank">DoIHavePrediabetes.org</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="http://www.ama-assn.org/sub/prevent-diabetes-stat/for-health-care-professionals.html" 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="https://nccd.cdc.gov/DDT_DPRP/Registry.aspx" 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="http://www.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html" 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="http://www.ama-assn.org/sub/prevent-diabetes-stat/toolkit.html" 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="https://www.stepsforward.org/modules/prevent-type-2-diabetes" 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="https://cme.ama-assn.org/Activity/2741078/Detail.aspx" 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="https://twitter.com/search?q=%23DiabetesAlertDay&src=tyah" rel="nofollow" target="_blank">#DiabetesAlertDay</a> on Twitter for more information.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" 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? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_can-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="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" 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="http://www.youtube.com/v/IX4QCRXNjm4" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/IX4QCRXNjm4" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/IX4QCRXNjm4" /><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="http://www.youtube.com/v/IX4QCRXNjm4" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_patient-satisfaction-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="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm" 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="http://www.cdc.gov/nchs/data/databriefs/db190.htm" 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="http://archpsyc.jamanetwork.com/article.aspx?articleid=1874575" 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="https://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse-in-america" 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="https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA131-HCR-16" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_sharing-health-data-hipaa-may-allow-freedom-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/8/04576077-1e57-4826-a8ab-25300e8c71c6.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/8/04576077-1e57-4826-a8ab-25300e8c71c6.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> ONC recently published a <a href="https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/interoperability-electronic-health-and-medical-records/the-real-hipaa-supports-interoperability/" 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="https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/interoperability-electronic-health-and-medical-records/the-real-hipaa-supports-interoperability/" 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="https://www.healthit.gov/sites/default/files/exchange_treatment.pdf" target="_blank" rel="nofollow">Permitted uses and disclosures: Exchange for treatment</a>”</li> <li> “<a href="https://www.healthit.gov/sites/default/files/exchange_health_care_ops.pdf" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_lighter-look-match-finding-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="http://www.youtube.com/v/diXBNZGNc2I" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/diXBNZGNc2I" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/diXBNZGNc2I" /><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="http://www.youtube.com/v/diXBNZGNc2I" 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="https://youtu.be/6PLh67klr5U" 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="https://www.youtube.com/watch?v=Cw7JEO46k88&feature=youtu.be" 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="https://www.youtube.com/watch?v=OBCtLaTjUtY&feature=youtu.be" rel="nofollow">Undeniable chemistry</a>."</li> </ul> <p> Be sure to follow <a href="https://twitter.com/hashtag/Match2016?src=hash" rel="nofollow" target="_blank">#Match2016</a> on Twitter to see where other students matched and check out <a href="https://twitter.com/hashtag/MatchThrowback?src=hash" 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="http://www.ama-assn.org/ama/ama-wire/post/graduating-students-tell-match" 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="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ca3dd844-11c6-44b3-a4a2-d52123a37e70 What physicians are saying about the new CDC opioid guidelines http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-saying-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="http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2016.1464" rel="nofollow" target="_blank"><span class="s1">published in <i>JAMA</i></span></a> and on the <a href="http://www.cdc.gov/drugoverdose/prescribing/guideline.html" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" 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="http://jama.jamanetwork.com/article.aspx?articleid=2503503" 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="http://archinte.jamanetwork.com/article.aspx?articleid=2502413" 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="http://archneur.jamanetwork.com/article.aspx?articleid=2503487" 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="http://archpedi.jamanetwork.com/article.aspx?articleid=2502219" 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="http://jama.jamanetwork.com/article.aspx?articleid=2503504" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://www.globalcenturion.org/wp-content/uploads/2014/08/The-Health-Consequences-of-Sex-Trafficking.pdf" 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="http://www.jpagonline.org/article/S1083-3188(14)00057-6/abstract" 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="http://www.doc-path.org/" 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="http://www.doc-path.org/" rel="nofollow" target="_blank"><span class="s1">PATH’s tools</span></a>, physicians can find resources at <a href="https://polarisproject.org" 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="http://www.acf.hhs.gov/programs/endtrafficking/resource/about-rescue-restore" rel="nofollow" target="_blank"><span class="s1">Office on Trafficking in Persons</span></a> provides tools for health care professionals, and <a href="https://healtrafficking.wordpress.com" 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="https://traffickingresourcecenter.org/reso" 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="https://traffickingresourcecenter.org/sites/default/files/Healthcare%20Assessment%20-%20FINAL%20-%202.16.16.pdf" 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="http://iom.nationalacademies.org/hmd/~/media/Files/Resources/SexTrafficking/guideforhealthcaresector.pdf" 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="http://pediatrics.aappublications.org/content/135/3/566" 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="http://www.ama-assn.org/ama/ama-wire/post/doctors-uniquely-suited-human-trafficking-victims" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://www.ama-assn.org/ama/ama-wire/post/health-care-dollars" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/14/25c3fab0-0f2f-41fb-9e9a-969d373a11dd.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/14/25c3fab0-0f2f-41fb-9e9a-969d373a11dd.Large.jpg?1" /></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="http://www.ama-assn.org/ama/ama-wire/post/physicians-call-fairness-drug-prices-availability" 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="http://www.ama-assn.org/ama/ama-wire/post/top-9-issues-will-affect-physicians-2016" target="_blank">top 9 issues that will affect physicians in 2016</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residency-training-environments-primed-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="http://www.acgme.org/What-We-Do/Initiatives/Pursuing-Excellence-Program/Overview" 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="http://jgme.org/doi/full/10.4300/JGME-D-15-00737.1" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_inspire-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/5/bdf1e0fa-7564-4302-951d-70108043bce3.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/5/bdf1e0fa-7564-4302-951d-70108043bce3.Large.jpg?1" 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="http://www.cvent.com/events/national-doctors-back-to-school-day/event-summary-063b055c5018426a841f45381e441f66.aspx?i=b2a2bdba-4a2a-4a6a-b654-e0ae00528008" 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="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/doctors-back-school.page" target="_blank">Doctors Back to School Web page</a> or <a href="mailto:mas@ama-assn.org" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_liability-technicality-could-expose-physicians-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/14/7f8e8100-fcb5-48b4-ae96-50922264c2ef.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/14/7f8e8100-fcb5-48b4-ae96-50922264c2ef.Large.jpg?1" 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="https://download.ama-assn.org/resources/doc/legal-issues/x-pub/allstate-v-northfield.pdf" 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="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reforms-will-advanced-challenged-2016" target="_blank">liability reform challenges in 2016</a></li> <li> Find out how a case in Oregon could <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_blank">increase liability exposure and redefine injury</a></li> <li> Learn how one of the nation’s leading <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reform-risk-state-supreme-court-case" 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="http://www.ama-assn.org/ama/ama-wire/post/court-decide-censorship-exam-room" target="_blank">censorship in the exam room</a></li> <li> See the outcome of a court’s decision regarding <a href="http://www.ama-assn.org/ama/ama-wire/post/court-decides-patient-safety-information-protected" target="_blank">protected patient safety information</a></li> </ul> <p>  </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-practice-using-self-measured-bp-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="http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening" 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="http://millionhearts.hhs.gov/" 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="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" 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="http://www.ama-assn.org/ama/ama-wire/post/should-use-self-measured-blood-pressure-monitoring" target="_blank">why you should use SMBP monitoring</a>.</li> <li> Learn how to <a href="http://www.ama-assn.org/ama/ama-wire/post/need-start-self-measured-bp-practice" target="_blank">start using SMBP in your practice</a>.</li> <li> Check out what blood pressure experts had to say about the <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-offer-insights-latest-bp-trials-guidelines" target="_blank">latest blood pressure trials and guidelines</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_academic-physicians-sure-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="https://apps.ama-assn.org/mtgregcvent/register/search?ECODE=%20f4424ff9-95db-472e-88b4-f17d1d13c433" rel="nofollow" target="_blank">Register now</a>, and view the <a href="https://custom.cvent.com/BC3A8A7D98694E7CA16D8C00223B13BA/files/fb8cabd6c85c46b090ab39e549f99b06.pdf" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education.page" 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="http://www.ama-assn.org/ama/pub/membership/membership-benefits/for-academic-physicians.page" 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="http://jama.jamanetwork.com/article.aspx?articleid=2474433" 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="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/section-medical-schools.page" target="_blank">AMA-APS Web page </a>to stay apprised of updates. Also, read a <a href="http://www.ama-assn.org/ama/ama-wire/post/ama-academic-physicians-section-2015-interim-meeting-highlights" target="_blank">summary</a> of the Nov. 2015 AMA-APS meeting held in Atlanta.</p> <p> The AMA welcomes your feedback: Please <a href="mailto:section@ama-assn.org" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_overview-clarifies-cme-reporting-under-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="http://www.ama-assn.org/resources/doc/washington/open-payments-continuing-medical-education.pdf" 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="https://portal.cms.gov/wps/portal/unauthportal/registration" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-new-approach-improve-mental-health Mon, 14 Mar 2016 04:07:00 GMT <div> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/9/a0ee1720-6b7e-4b59-a9bf-3b46a2733d73.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/9/a0ee1720-6b7e-4b59-a9bf-3b46a2733d73.Large.jpg?1" 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="https://www.stepsforward.org/modules/integrated-behavioral-health" 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="https://www.stepsforward.org/modules/intensive-primary-care" 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="https://www.stepsforward.org/modules/team-huddles" 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="https://www.stepsforward.org/modules/practice-transformation" 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="http://www.ama-assn.org/ama/ama-wire/post/collaboration-giving-practices-resources-need" 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="http://www.mgma.com/education/conferences/collaborate" 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="https://www.stepsforward.org/modules/team-huddles" 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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</div> <div>  </div> <div style="text-align:right;"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-wps-elects-governing-council-members Fri, 11 Mar 2016 16:00:00 GMT <p> The AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section.page">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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_med-ed-transformations-benefiting-students-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="http://www.ama-assn.org/ama/ama-wire/post/pivoting-new-way-of-training-future-physicians-mayo-clinic" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_support-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="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod1170021&navAction=push#description-tab" target="_blank">subscription</a>. Not an AMA member? <a href="https://commerce.ama-assn.org/membership/" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_increasing-diversity-of-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="https://urldefense.proofpoint.com/v2/url?u=http-3A__mailview.bulletinhealthcare.com_mailview.aspx-3Fm-3D2016040912amaweekend-5Ftest-26r-3D7779013-2D3fe3-26l-3D021-2D34f-26t-3Dc&d=CwMDaQ&c=iqeSLYkBTKTEV8nJYtdW_A&r=aKHHfFOgKt5vRLjvfq2YEM4Av5y9c5PZ-ZwM01DjPPk&m=mJvBUWRBJLGKv5pnfz3w4qRnWMP2-lwxnUJFGSLBh78&s=kbHBZG1kkrIu40Nl9mgcllYV7_6lkYR63XMuhek4sfs&e=" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_imgs-dont-always-match-strategies-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="http://www.nrmp.org/new-nrmp-published-in-jgme-behaviors-of-unmatched-imgs/" 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="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates/img-mock-interview.page" 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="http://www.ama-assn.org/ama/pub/education-careers/graduate-medical-education/freida-online.page" 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="http://www.nrmp.org/wp-content/uploads/2015/05/Main-Match-Results-and-Data-2015_final.pdf" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_training-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="http://www.ama-assn.org/ama/ama-wire/post/botticelli-need-hands-deck-opioid-crisis" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" 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="http://pcssmat.org/education-training/waiver-eligibility-training" 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="http://events.r20.constantcontact.com/register/event?oeidk=a07ebtha0o3b50715b6&llr=c9shxsbab" 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="http://events.r20.constantcontact.com/register/event?oeidk=a07ebthej0h6a2cf1bb&llr=c9shxsbab" 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="http://events.r20.constantcontact.com/register/event?oeidk=a07ec87ice8b85046b2&llr=c9shxsbab" 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="http://nationalrxdrugabusesummit.org/" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_blank">Task Force to Reduce Prescription Opioid Abuse</a>, will lead a <a href="http://nationalrxdrugabusesummit.org/vision-sessions-3/#VIS1" 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="http://nationalrxdrugabusesummit.org/event/" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-transforming-med-ed-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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="http://www.innovatewithama.com/" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page#developing-expand" 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="http://www.ama-assn.org/ama/ama-wire/post/real-time-tracker-puts-education-decisions-students-hands" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_flexible-duty-hours-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/12/e0bd225d-1c50-4494-8c19-959305908954.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/12/e0bd225d-1c50-4494-8c19-959305908954.Full.jpg?1" 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="http://www.thefirsttrial.org/" 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="http://www.ama-assn.org/ama/ama-wire/post/duty-hour-trials-examine-effects-of-dropping-current-standards" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_mayo-clinic-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="http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates" 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="http://www.mgma.com/education/conferences/collaborate" 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="http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates" target="_blank">which specialties have the highest burnout rates</a></li> <li> Learn how <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-burnout-compares-general-working-population" target="_blank">physician burnout compares to the general working population</a></li> <li> Explore <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" 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="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_blank">Improving physician resiliency</a></li> <li> <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_blank">Preventing physician burnout</a></li> <li> <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">Preventing resident and fellow burnout</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-transforming-med-ed-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="http://www.ama-assn.org/ama/ama-wire/post/students-wish-were-learning-med-school" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page#developing-expand" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medicine-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/12/52d4df78-bc6c-42cf-8c93-cf160363cdbd.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/12/52d4df78-bc6c-42cf-8c93-cf160363cdbd.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" 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="http://journalofethics.ama-assn.org/2016/03/ecas4-1603.html" 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="http://journalofethics.ama-assn.org/2016/03/pfor2-1603.html" 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="http://journalofethics.ama-assn.org/2016/03/pfor4-1603.html" 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="http://journalofethics.ama-assn.org/2016/03/pfor6-1603.html" 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="http://journalofethics.ama-assn.org/podcast/ethics-talk-mar-2016.mp3" 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="http://journalofethics.ama-assn.org/site/poll.html" 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="https://www.rapidreview.com/AMA/CALogon.jsp" rel="nofollow" target="_blank">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" 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? http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_can-postresidency-interview-communications-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/14/a0ce3876-ca57-4ddc-9e6e-1ac70bd7a533.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/14/a0ce3876-ca57-4ddc-9e6e-1ac70bd7a533.Full.png?1" 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="http://www.jgme.org/doi/full/10.4300/JGME-D-15-00062.1" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-transforming-med-ed-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="http://www.ama-assn.org/ama/ama-wire/post/two-schools-embracing-new-science-medical-education" target="_blank"><strong>new curriculum to teach health care delivery science</strong></a><strong> to making </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-personalized-medicine-moving-forward" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-transforming-med-ed-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="http://www.ama-assn.org/ama/ama-wire/post/students-effecting-med-ed-transformation" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page#developing-expand" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-selected-top-ideas-turn-med-ed-its-head Mon, 07 Mar 2016 15:14:00 GMT <p> <object align="right" data="http://www.youtube.com/v/whnkxr6ROis" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/whnkxr6ROis" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/whnkxr6ROis" /><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="http://www.youtube.com/v/whnkxr6ROis" 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="http://www.innovatewithama.com/mededchallenge/" rel="nofollow">Medical Education Innovation Challenge</a> were announced Monday at the first meeting of the newly expanded AMA <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page">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="http://www.youtube.com/v/cKoJRRVsYtk" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/cKoJRRVsYtk" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/cKoJRRVsYtk" /><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="http://www.youtube.com/v/XdP2J0yiITU" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/XdP2J0yiITU" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/XdP2J0yiITU" /><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="http://www.youtube.com/v/dtrCjDPv38k" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/dtrCjDPv38k" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/dtrCjDPv38k" /><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="http://www.youtube.com/v/dtrCjDPv38k" 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="http://www.ama-assn.org/resources/doc/accelerating-change/x-pub/ace-innovation-booklet.pdf" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_macra-matters-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/1/d9bca943-b19d-47d3-a196-7e0d558946b1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/1/d9bca943-b19d-47d3-a196-7e0d558946b1.Full.jpg?1" 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="http://www.ama-assn.org/ama/ama-wire/post/ehrs-need-physicians-offer-solutions-town-hall" 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="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" 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="http://www.ama-assn.org/ama/ama-wire/post/3-changes-cms-making-put-patients-back-center-of-care" 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="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-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="http://www.ama-assn.org/ama/ama-wire/post/changes-med-ed-will-students-integral-health-system-solutions" target="_blank"><strong>mentioned before</strong></a><strong> that the AMA’s </strong><a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" 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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="http://www.ama-assn.org/ama/ama-wire/post/med-school-explores-new-way-assess-millennial-learners" target="_blank">competency learning management system</a> at Vanderbilt, the student engagement process in <a href="http://www.ama-assn.org/ama/ama-wire/post/new-care-curriculum-paves-way-advanced-student-learning" target="_blank">curriculum redesign</a> at Michigan and the <a href="http://education.med.nyu.edu/ace" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-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="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" 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="http://www.ama-assn.org/ama/ama-wire/post/students-helping-transform-medical-education" 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="http://www.ama-assn.org/ama/ama-wire/blog/Student_Spotlight/1" 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="http://www.ama-assn.org/ama/ama-wire/post/students-transforming-med-ed-university-of-michigan" target="_blank">perspective from Jesse Burk-Rafel</a>, a third-year student at the University of Michigan Medical School</li> <li> A <a href="http://www.ama-assn.org/ama/ama-wire/post/students-transforming-med-ed-mayo-medical-school" target="_blank">perspective from Ricky Cui</a>, a second-year at Mayo Medical School</li> <li> A <a href="http://www.ama-assn.org/ama/ama-wire/post/students-transforming-med-ed-brody-school-of-medicine" 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="http://www.ama-assn.org/ama/ama-wire/post/students-transforming-med-ed-university-of-nebraska" target="_blank">perspective from R. Logan Jones</a>, a third-year student at University of Nebraska College of Medicine</li> <li> A <a href="http://www.ama-assn.org/ama/ama-wire/post/med-ed-transformations-benefiting-students-mayo" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_health-care-dollars 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="http://www.ama-assn.org/resources/doc/health-policy/x-ama/prp2016-01spending.pdf" target="_blank">analysis</a> (log in) from the AMA sheds light on health care spending.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/6/beb6ad57-9a30-4a5a-a69c-357c05440f13.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/6/beb6ad57-9a30-4a5a-a69c-357c05440f13.Full.jpg?1" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/spending-health-care.page" target="_blank">spending in health care</a> Web page for further insight.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_expert-coding-assistance-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="http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-network.page" 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="https://apps.ama-assn.org/cptkb/registration-view.do" target="_blank">Review the subscription options</a> or <a href="https://login.ama-assn.org/account/login" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_mentor-amas-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="mailto:lgbt@ama-assn.org" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_four-med-students-landed-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/8/ee0969e1-20d5-4725-982c-1b529ed6ff83.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/8/ee0969e1-20d5-4725-982c-1b529ed6ff83.Large.jpg?1" /></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="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/5/c0e605e6-135e-4ee7-a51e-aa19b95013cf.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/5/c0e605e6-135e-4ee7-a51e-aa19b95013cf.Large.jpg?1" /></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="http://www.ama-assn.org/ama/ama-wire/post/heres-must-checklist-med-school-success" target="_blank">first and second years</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/checklist-success-third-year-of-med-school" target="_blank">third year</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_abms-seeking-young-scholars-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="mailto:ABMSVisitingScholars@abms.org" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_collaboration-giving-practices-resources-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/9/cd1383e8-377d-4ebc-99c1-e58fd3348c8a.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/9/cd1383e8-377d-4ebc-99c1-e58fd3348c8a.Full.jpg?1" 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="https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/" 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="http://glptn.org/" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_documentation-woes-study-tracks-residents-time-spent-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="http://www.jgme.org/doi/abs/10.4300/JGME-D-15-00240.1" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/10/717b4b56-3f5d-4203-baab-912980cddba0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/10/717b4b56-3f5d-4203-baab-912980cddba0.Large.jpg?1" 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="http://www.ama-assn.org/ama/ama-wire/post/one-residency-program-improved-documentation-reduced-stress" 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="http://www.ama-assn.org/ama/ama-wire/post/ehrs-tied-up-physician-time-2015" target="_blank">made addressing problems within the EHR</a> a top priority. In the fall, the AMA and MedStar Health released an <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" 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="http://www.ama-assn.org/ama/ama-wire/post/physicians-helping-rethink-ehrs" 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="https://www.stepsforward.org/" target="_blank" rel="nofollow">STEPS Forward</a>™ modules are available from the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">Professional Satisfaction and Practice Sustainability</a> initiative to help physicians <a href="https://www.stepsforward.org/modules/ehr-software-vendor-selection" target="_blank" rel="nofollow">select and purchase EHR products</a> and <a href="https://www.stepsforward.org/modules/ehr-implementation" 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="http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf" 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="http://www.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-stage-3-comment-letter-15dec2015.pdf" 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="http://breaktheredtape.org/" target="_blank" rel="nofollow">BreakTheRedTape.org</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="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the foundation of the MIPS, and the AMA provided <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-letter-17nov2015.pdf" target="_blank">detailed comments</a> (log in) as part of its ongoing efforts on this issue and submitted a <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-share-plan-meaningful-use-should-really-work" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_register-may-24-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="http://www.ama-assn.org/go/a16registration" 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="mailto:alice.reed@ama-assn.org" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_barbara-hummel-md-inaugurated-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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-ira-questions-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/13/5caa3576-3a29-4a28-aded-e97b645f09fe.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/13/5caa3576-3a29-4a28-aded-e97b645f09fe.Large.jpg?1" 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="http://www.cvent.com/events/2016-physicians-financial-summit/event-summary-063e4fc84ba94bc8b48ce1e943dca680.aspx" 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="https://www.amainsure.com/2016-Physicians-Financial-Summit.html" 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="http://www.ama-assn.org/ama/ama-wire/blog/Financial_Issues/1" 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="http://www.ama-assn.org/ama/ama-wire/post/retirement-savings-strategies-physicians-start-late" target="_blank">Retirement savings strategies for physicians that start late</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-partner-physician-friendly-financial-advisor" target="_blank">5 ways to partner with a physician-friendly financial advisor</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/kick-financial-plan-high-gear" target="_blank">How to kick your financial plan into high gear</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/consider-planning-practice-exit-strategy" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_experts-offer-insights-latest-bp-trials-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="http://www.ama-assn.org/ama/ama-wire/post/120-mm-hg-new-bp-target-headlines-arent-telling" target="_blank">SPRINT trail made a big splash</a> in the world of blood pressure control last year, and with the recent <a href="http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening" 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="http://content.onlinejacc.org/article.aspx?articleID=2468917" 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="http://annals.org/article.aspx?articleid=2494542" 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="https://www.youtube.com/watch?v=LEy1lNeK42A" rel="nofollow" target="_blank">watch the full discussion</a> or visit the <a href="https://plus.google.com/events/cm46vln7vjtshla1l18u990i4bg" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-staff-bylaws-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="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod1240059&navAction=push#description-tab" 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="http://info.commerce.ama-assn.org/AMA-credentialing-services-home" 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="https://commerce.ama-assn.org/store/" 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="https://commerce.ama-assn.org/membership/" target="_blank">join today</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fd2571a5-108a-4d5b-ba53-27c21871dfef Congressmen share insights for physician advocates http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_congressmen-share-insights-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/0/996e0228-7876-4de4-8049-c55222924cc2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/0/996e0228-7876-4de4-8049-c55222924cc2.Large.jpg?1" /></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="http://www.ama-assn.org/ama/ama-wire/post/one-health-insurer-embracing-telemedicine" 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="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/8/e15858dc-8427-44fa-b83e-3908f0ece816.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/8/e15858dc-8427-44fa-b83e-3908f0ece816.Large.jpg?1" /></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="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/2/8f6572b7-923a-4f2e-a251-46420cb9aaba.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/2/8f6572b7-923a-4f2e-a251-46420cb9aaba.Large.jpg?1" /></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="http://www.ama-assn.org/ama/ama-wire/post/one-ed-uses-telemedicine-ambulance" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_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="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" 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="https://questions.cms.gov/faq.php?faqId=14357&id=5005" 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="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html" target="_blank" rel="nofollow">download an application</a> from CMS and consult <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-avoiding-2017-penalty.pdf" 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="https://twitter.com/amy_amawire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-steps-lasting-change-lessons-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/7/c6f74ce6-4db2-4b6a-876a-bd988292106d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/7/c6f74ce6-4db2-4b6a-876a-bd988292106d.Large.jpg?1" 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="http://www.ama-assn.org/ama/ama-wire/post/medicare-payment-formula-bites-dust" 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="http://breaktheredtape.org/" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);">BreakTheRedTape.org</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="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" 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="https://www.stepsforward.org" 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="https://twitter.com/Troy_AMAWire" 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 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_botticelli-need-hands-deck-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="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/9/61f5d61a-5698-4196-89cc-78bd4d8efe67.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/9/61f5d61a-5698-4196-89cc-78bd4d8efe67.Large.jpg?1" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" 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="http://www.ama-assn.org/ama/ama-wire/post/physicians-identify-ways-improve-opioid-overdose-prevention" 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="http://www.c-span.org/video/?404617-4/nga-forum-prescription-drug-abuse" 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="http://www.ama-assn.org/ama/pub/news/news/2016/2016-02-22-ama-nga-national-opioid-epidemic.page" 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="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" 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="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page?" 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-family:Arial;"> <span style="font-size:12px;">“It’s great to have [the AMA’s] support for this and for ending the stigma surrounding this,” he said. Several organizations provide <a href="http://www.samhsa.gov/medication-assisted-treatment/training-resources/buprenorphine-physician-training" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);">physician training and</span></a><span style="text-decoration:underline;color:#0433ff;"> resources on MAT</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;">Naloxone has quickly become one of the greatest tools for overdose intervention, and it’s saving lives all across the country. “Communities in many states are already using it to reduce overdose deaths,” Botticelli said. “But for those that aren’t, we need to make sure that every first responder is equipped to deliver naloxone when they need it and that people can save their friends and loved ones who are at risk for overdose.”</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;">“Standing order programs and collaborative practice agreements are great ways to help people obtain these medicines,” he said. “We need … to recognize when patients might be at risk for an overdose and prescribe naloxone to patients for use by their loved ones or caregivers. And I appreciate the focus of the AMA on co-prescribing naloxone for patients at risk.”</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;">Botticelli thanked physician advocates and the AMA for their work to “reduce the opioid use and overdose epidemic, strengthen the medical system through education, and reduce the effects of substance use on society,” he said. “I look forward to continuing to work together to improve our nation’s health.”</span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <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="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></i></span></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2e9750dc-aecd-4749-8e7d-39bbc61eb8ba Studying for USMLE Step 2? Master this most missed question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_studying-usmle-step-2-master-this-missed-question Thu, 25 Feb 2016 22:32:00 GMT <p> Studying for the United States Medical Licensing Examination® (USMLE®) Step 2 may seem daunting, but not to fear. Starting this 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> Welcome to the first Step 2 post in <em>AMA Wire’s</em>® series, “Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank.” Each month, we’re revealing the top questions students miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" 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><br /> A 59-year-old ranch hand presents to the outpatient department with chest pain. Over the past eight months, he has noticed a dull, central chest pain that radiates to his left arm and jaw while walking. The pain subsides after about two minutes of rest but quickly returns upon walking again. This is severely affecting his work, and he is concerned that he will lose his job because of poor productivity. His vital signs are temperature 37.0ºC (98.6ºF), pulse 74/min and blood pressure 135/82 mm Hg. Stress test reveals ST-segment depression in leads I, aVL, V4, V5 and V6. Aspirin, nitrates and metoprolol are initiated. A 12-hour fasting serum LDL cholesterol concentration is 140 mg/dL. He is also started on atorvastatin and advised to implement a low-fat diet. Two months later the patient returns and is still experiencing chest pain during exercise. However, he states that his productivity at the farm has increased. His resting pulse is 58/min. Echocardiogram reveals an ejection fraction 55 percent.<br /> <br /> What is the next best step in management?</p> <p style="margin-left:.5in;"> A.  Eptifibatide and then perform a percutaneous transluminal coronary angioplasty<br /> B.  Tirofiban<br /> C.  Coronary angiography<br /> D.  Lisinopril<br /> E.  Coronary artery bypass graft (CABG)</p> <p>  </p> <p> <object data="http://www.youtube.com/v/Lcn8Umwo8J4" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/Lcn8Umwo8J4" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/Lcn8Umwo8J4" /><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> <strong>The correct answer is C.</strong></p> <p> <strong>Kaplan says, here’s why:</strong> This patient has stable angina with symptoms affecting his livelihood. He is placed on aspirin, nitrates, a beta-blocker and a statin; however, angina-like symptoms are reported two months later. Maximal medical therapy has been achieved—an important part of medical therapy is a goal heart rate 55–60/min. If this goal is not met, the next step is to increase the dose of metoprolol. Coronary angiography is only done with stable angina when a patient is still having symptoms of optimal medical management. Heart rate goal is an important part of medical management, thus he should undergo coronary angiography. The coronary angiogram maps out the diseased vessels and dictates future management, such as angioplasty or stenting. If the angiogram shows left main coronary artery disease, or two- or three-vessel disease, he would be a candidate for CABG.<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>Choices A and B: </strong>Eptifibatide, percutaneous transluminal coronary angioplasty and tirofiban are incorrect because there is no statistically significant data to suggest that giving tirofiban or eptifibatide lowers mortality in stable angina. These drugs are used for acute coronary syndrome. They act as glycoprotein IIb/IIIa inhibitors and have a pronounced antiplatelet effect. When given to patients post-PTCA, they reduce the risk of stent re-stenosis. Both drugs carry a risk of hemorrhage, though the risk is greater with eptifibatide than with tirofiban.<br /> <br /> <strong>Choice D:</strong> Lisinopril is incorrect but brings up a very good high-yield point for the USMLE: When to give an ACE inhibitor to a patient with stable angina. The indications for prescribing an ACE inhibitor in a patient with stable angina are:</p> <ul> <li> Diabetes</li> <li> Hypertension</li> <li> Low ejection fraction (<50 percent)</li> <li> The presence of proteinuria</li> </ul> <p> This patient does not fit into any of these categories (his ejection fraction on echo is 55 percent). ACE inhibitors have been shown to reduce mortality in patients with heart failure and diabetes.</p> <p> <strong>Choice E: </strong>CABG is not appropriate until the extent of coronary disease has been determined, as described above.<br /> <br /> <strong>One key tip to remember:</strong><br /> When maximal pharmacologic therapy for the treatment of stable angina has been reached (this is a combination and maximal doses of a beta-blocker, aspirin, statin and nitrates with persistence of symptoms), the next step is percutaneous coronary angiography. The extent of coronary disease will dictate whether angioplasty with stenting or coronary bypass grafting is indicated. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b0c1d297-628f-43dd-b6d6-cef12114ca98 Conversing with Congress: Physicians take top issues to the Hill http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_conversing-congress-physicians-top-issues-hill Thu, 25 Feb 2016 02:07:00 GMT <table align="right"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/7/43ea10be-9cec-4da8-877d-122b1d311865.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/7/43ea10be-9cec-4da8-877d-122b1d311865.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Colorado physicians meet with Sen. Bennet</em></span></td> </tr> </tbody> </table> <p> Hundreds of physician voices echoed through the halls of offices on Capitol Hill this week as they took their message to Congress on what needs to be done to address top health policy issues and burdensome regulations that steal time and resources from patients.</p> <p> The 2016 National Advocacy Conference, which lasted Monday through Wednesday, gave physicians the opportunity to meet face to face with members of Congress and gain important insights from industry experts, political insiders and members of Congress.</p> <p> Among the topics physicians discussed this year were the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-changes-cms-making-put-patients-back-center-of-care" target="_blank">upcoming regulations</a> for implementing the Medicare Access and CHIP Reauthorization Act, <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-identify-ways-improve-opioid-overdose-prevention" target="_blank">solutions for addressing the opioid epidemic</a> and legislation that would ensure that patients and their physicians are able to use new technologies that remove barriers to timely, high-quality care.</p> <p> <strong>Why physicians are talking to their lawmakers</strong></p> <p> “Simplify, standardize and make clinically relevant laws and regulations to make more time for patients, less red tape and less physician burnout,” said Katie Lozano, MD, a musculoskeletal radiologist and president-elect of the Colorado Medical Society. “That’s the mantra in our state, and the AMA has been really supportive.”</p> <p> Dr. Lozano and her group met with several representatives and senators from Colorado throughout the three days they spent in the nation’s capital. Most groups of physicians from different states who attended the conference had between five and eight appointments with their members of Congress.</p> <p> “Though we’re bringing our own issues to the Hill,” Dr. Lozano said, “we want to thank them for the work they’ve done so far—for repealing [Medicare’s sustainable growth rate formula]. But we also want to ask them what they need from us. We offer to serve as a resource because this is a partnership for the people in our state.”</p> <p> Scott E. Shapiro, MD, a cardiovascular disease and internal medicine specialist and president of the Pennsylvania Medical Society, attended the conference with a number of colleagues from the Keystone State. “We are going to several representatives to talk about … how small independent practices are going to be able to participate in alternative payment models under [the Merit-Based Incentive Payment System],” Dr. Shapiro said as the group prepared for their meetings on the Hill.</p> <p> “We need viable options to deal with population health management and help with payment reform,” he said. Dr. Shapiro and his colleagues also talked with their members of Congress about their state prescription drug monitoring program (PDMP), which has seen funding problems as a result of budgetary issues in their state.</p> <p> <strong>Discussing solutions to the opioid epidemic</strong></p> <p> Sheila Rege, MD, a radiation oncologist from the state of Washington, sat down with six members of Congress during the National Advocacy Conference to discuss the opioid epidemic. Addressing the epidemic in the right way is important, both to prevent overdoses and to ensure “that oncologists like me can still help our cancer patients,” she said. “Having the AMA involved and the effort being physician-led is key.”</p> <p> “[I]t’s critical that we do this right away,” Dr. Rege said. “One thing I like about these legislators is that they actually do try to come. I think physicians don’t realize that they do want to hear from us.”</p> <p> Bob Dannenhoffer, MD, a pediatrician in Oregon, flew into D.C. to raise similar concerns. “We’re going to talk a lot about opioids,” he said. “This is really important in Oregon; we’re seeing this become especially devastating for our rural county.”</p> <p> “I think it’s really important that the congressional delegation knows about this,” Dr. Dannenhoffer said. “This is affecting all ages and all races. We need better use of PDMPs and naloxone. I think this will be an issue where there will be a lot of bipartisan support.”</p> <p> <strong>Positive results</strong></p> <p> Dr. Lozano and her group had an excellent series of visits, which culminated in a meeting with Sen. Michael Bennet, D-Colo., who is a member of the Committee on Health, Education, Labor and Pensions (HELP).</p> <p> “We’ve been doing this all day,” Dr. Lozano said Tuesday. “We gave them our real-life experiences; that’s why we brought everyone to the meeting. It’s important for them to see how it affects us day to day.”</p> <p> “I think it went really well,” said Patrick Pevoto, MD, an OB-GYN who was part of the Colorado group. “We had four points we wanted to bring up. … I think everyone was receptive. I’m very encouraged by the response we had from both the House and the Senate.”</p> <p style="text-align:right;"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cce8ff1b-c779-4037-9015-335e0c1d5ada How one program helped trainees launch research, academic careers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-program-helped-trainees-launch-research-academic-careers Thu, 25 Feb 2016 00:00:00 GMT <p> Interested in a career in research or academic medicine? Learn how one novel program helped physicians in training develop successful research projects, earn grants and transition to “high leadership positions” in medical education. These program outcomes can help you better assess your plans for an academic research career.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/11/b58cc09d-f2de-4ea7-bb1e-e8e171000abf.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/11/b58cc09d-f2de-4ea7-bb1e-e8e171000abf.Large.jpg?1" style="float:right;margin:15px;" /></a><strong>A unique approach to graduate research </strong></p> <p> Faculty at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) launched the Specialty Training and Advanced Research (STAR) Program in 1993 to give trainees protected time to pursue graduate coursework beyond their medical degrees while completing specialty or subspecialty clinical training. The program aimed to produce successful physician-scientists by offering trainees guided mentorship from faculty, opportunities for lab research at UCLA’s partnering institutions and specialty training within clinical departments. Trainees were given the options to pursue a PhD in basic science or health services research, a Master of Science degree in clinical research or postdoctoral research.</p> <p> Now 20 years later, UCLA professors have conducted a retrospective study to determine the career outcomes of 123 graduates from the STAR program. They recently published <a href="http://www.jgme.org/doi/abs/10.4300/JGME-D-15-00135.1?journalCode=jgme" rel="nofollow" target="_blank">their findings</a> in the <em>Journal of Graduate Medical Education.</em></p> <p> <strong>The results: How graduates of the program advanced their research careers </strong></p> <p> Using curriculum vitae, direct contact and online confirmation, the authorrs compiled data on graduates' activities as of 2013 and found that graduates not only excelled after completing the STAR program but many of them went on to lead successful careers in academic medicine and research. In fact, among graduates in the study:</p> <ul> <li> More than 80 percent were conducting research in academic, institutional or industrial careers</li> <li> 71 percent held academic faculty appointments, while 20 percent were employed in private practice</li> <li> 50 percent received career development awards, including 44 from the National Institutes of Health (NIH) and six from the U.S. Department of Veterans Affairs</li> <li> 19 percent received investigator-initiated NIH Research Project Grants (R01) or equivalent grants</li> </ul> <p> Several graduates held “high leadership positions,” such as department chair, vice chair, assistant vice chancellor and chief scientific officer at a university-affiliated research institute. Collectively, they’ve also “published at least 1,981 publications, including 1,705 peer-reviewed manuscripts, 142 book chapters and 134 review articles,” according to the study.</p> <p> “Overall, the outcomes for this 20-year period suggest that incorporating graduate degree research at the level of specialty or subspecialty clinical training is a feasible and successful path to training and retaining physician-scientists,” the authors wrote.</p> <p> <strong>Insights for residents and fellows pursuing careers in academic research</strong></p> <p> Although the STAR program marks a departure from the common MD-PhD track many trainees pursue, the study authors noted that residents and fellows who typically “receive PhD training after medical school have more published papers, grant funding and protected research time, as well as fewer clinical responsibilities than those who obtained PhDs before or during medical school.” For instance, an <a href="http://journals.lww.com/academicmedicine/Fulltext/2007/03000/The_Research_Productivity_of_Canadian_Physicians_.18.aspx" rel="nofollow" target="_blank">earlier study</a> published in <em>Academic Medicine</em> found that physicians who had pursued their PhDs after graduating from medical school “spent more time in research and less time on clinical practice” than physicians who earned their PhDs before or during medical school.</p> <p> Plus, the authors pointed out, there are unique benefits to pursuing advanced degree research at the clinical fellowship level: “Although a degree is not essential for success, the formal graduate programs have the advantages of rigorous structure, expertise and established curricula,” they wrote. “Having chosen a subspecialty allows the trainee to focus research on a complementary area. Trainees also reach peak research skills, with command of the literature and knowledge of the state-of-the art techniques, at precisely the time they apply for grants and faculty positions.”</p> <p> <strong>Also explore these resources on research and publishing: </strong></p> <ul> <li style="margin-left:18.75pt;"> Get expert advice on <a href="http://www.ama-assn.org/ama/ama-wire/post/published-using-5-writing-research-tips" target="_blank">writing and publishing research</a>.</li> <li style="margin-left:18.75pt;"> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_blank">how to publish your research</a> like a pro and the <a href="http://www.ama-assn.org/ama/ama-wire/post/5-medical-publishing-pitfalls-residents-overlook" target="_blank">five medical publishing mistakes</a> to avoid.</li> <li style="margin-left:18.75pt;"> Bookmark <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_blank">this list</a> of the top journals that accept research from physicians in training.</li> <li style="margin-left:18.75pt;"> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/future-physicians-honored-top-research-ama-symposium" target="_blank">how the AMA Research Symposium</a> helps physicians in training build competitive research skills.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f3ab8ca4-c247-4bb9-8f9b-60802d17b61e How an inner city care team is reducing hypertension disparities http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_inner-city-care-team-reducing-hypertension-disparities Tue, 23 Feb 2016 23:30:00 GMT <p> Improving blood pressure control rates among medically underserved patients is no easy feat—but that’s precisely what one academic medical center in New Jersey has done. Learn how care teams launched an effective pilot project to lower blood pressure, reduce disparities and improve quality care among black and Hispanic patients. </p> <p> <strong>Disparities in the inner city</strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/8/3dbcf6fc-e77d-409b-8849-cd8d731a79f4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/8/3dbcf6fc-e77d-409b-8849-cd8d731a79f4.Large.jpg?1" style="margin:15px;float:right;" /></a>When the Urban Health Institute (UHI) at <a href="http://www.cooperhealth.org/about-us" rel="nofollow" target="_blank">Cooper University Health Care</a> first opened its doors in 2013, physicians and care teams had one common goal in mind: Improving the health of some of New Jersey’s most medically disadvantaged and underserved patients who live or receive medical care<span style="font-family:Arial, sans-serif;font-size:10pt;line-height:115%;"> </span>in Camden.</p> <p> In a city where the <a href="http://www.ci.camden.nj.us/wp-content/flyers/camdencityforumplan2013.pdf" rel="nofollow" target="_blank">murder rate is 12 times higher </a>than the national average and <a href="http://quickfacts.census.gov/qfd/states/34/3410000.html" rel="nofollow" target="_blank">nearly 40 percent of residents</a> live in poverty, patients encounter daily challenges—beyond issues they may disclose in the exam room—that can compromise their health.</p> <p> “Residents of Camden are living … with a median average family income of about $26,000,” said Rachel Adams, an advanced practice nurse at UHI. “So many of our patients are saddled with the challenges of … choosing between” crucial life necessities such as blood pressure medication or groceries to feed their children.  </p> <p> Roughly 50 percent of the city’s residents are black, and 47 percent are Hispanic, according to <a href="http://www.census.gov/quickfacts/table/PST045215/3410000,00" rel="nofollow" target="_blank">data</a> from the U.S. Census Bureau. Adams noted that most patients “have lower health literacy in terms of their knowledge about basic health necessities” and “only about 56 percent of Camden residents have a high school diploma.”</p> <p> <strong>Finding inspiration for hypertension solutions in India</strong></p> <p> To help address these disparities, Adams said Kathy Stillo, the executive director and co-founder of UHI, advised care teams to travel to India to learn about innovative solutions that would address the unique needs of Camden’s residents and ways to improve their health outcomes.</p> <p> Stillo had previously traveled to the country and was aware of community-based care models developed by the <a href="http://www.aravind.org/default/clinicscontent/aehmadurai" rel="nofollow" target="_blank">Aravind Eye Hospital</a> in Madurai, India, which serves a population of 26.7 million people across multiple districts, Adams said.</p> <p> While in India, the UHI care team learned how care teams at Aravind conducted “task-shifting,” which allowed volunteers in local communities to assist care teams with tasks such as basic eye screenings “that were typically repetitive and took a long time for physicians to do,” Adams said. The goal of shifting these tasks was to free up time for “physicians to focus on what they were trained to do, which was the actual eye intervention and surgery.”</p> <p> “Being able to see what [care teams at Aravind did] was really the impetus for our work,” Adams said. After returning from India, she and her colleagues developed a task-shifting protocol to help UHI physicians refer patients with hypertension to nurses for follow-up appointments and educational sessions that would help lower patients’ blood pressure.</p> <p> <strong>How care teams at UHI tackled hypertension and disparities </strong></p> <p> The protocol has now been implemented as part of a pilot project to lower blood pressure among 74 patients at UHI—and it’s effectiveness is being demonstrated. In one year, 51 percent of these patients have attained their goal blood pressure of <150/<90 mm Hg. Meeting this target means patients “improved both their systolic and diastolic blood pressures,” Adams said.</p> <p> What was the secret to their success? Adams recently shared insights on the project at a showcase of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities/commission-end-health-care-disparities.page?" target="_blank">Commission to End Health Care Disparities</a>. She said physicians and care teams improved blood pressure control among some of New Jersey’s most vulnerable patients by:</p> <ul> <li> <strong>Offering targeted patient visits and hypertension treatments.</strong> As part of the new protocol, nurses at UHI held three 30-minute visits with referred patients to accurately measure their blood pressure and discuss specific aspects of their hypertension treatments. These include blood pressure medications and lifestyle changes—such as proper diet and exercise—patients could make to improve their blood pressure. Since the project has been underway, UHI has conducted 231 such visits with patients.<br /> <br /> These personalized visits were essential to the project’s success, Adams said. Patients typically met with the same nurse for each of their three visits, which improved patient accountability and motivated them to better partner with UHI’s care teams.<br /> <br /> If patients attended three blood pressure visits and had two subsequent readings at their goal blood pressure, they graduated from the program, Adams said—but not without first speaking with their physician. After their third visit, nurses “referred every patient back to their physician,” she added. “If at that point it’s decided that the patient still needs to come for these visits, we continue them.”</li> </ul> <ul> <li> <strong>Educating patients on hypertension and sodium intake.</strong> “So few people know what hypertension really is or that a low-salt intake can improve their blood pressure readings,” Adams said.<br /> <br /> That’s why during initial blood pressure visits, nurses played an educational video for patients, which featured an overview of hypertension, its associated health risks and key facts patients need to know about blood pressure medications. Nurses also discussed patients’ questions, provided handouts on hypertension and issued patients wallet cards for documenting in-office blood pressure readings and that provide information for healthy lifestyles.<br /> <br /> After this introduction to the program, nurses met with patients for a second visit to teach them how to properly read nutritional labels for sodium content and which high-sodium foods to avoid.</li> </ul> <ul> <li> <strong>Establishing an algorithm to titrate blood pressure medications.</strong> “We followed the JNC-8 guidelines and wrote an algorithm” to assess whether patients were meeting their target blood pressure and if they needed to adjust their medication dosage, Adams said. <br />  </li> <li> <strong>Partnering with AmeriCorp representatives to address social determinants of health. </strong>Despite having more time to speak with patients, “sometimes [they] were embarrassed to tell their … nurse that they didn’t understand how to take their medication or didn’t have the money to cover the copay for their medication,” Adams said. “AmeriCorp [staff] were able to identify those challenges, and we could problem-solve ways to help the patient.”<br /> <br /> AmeriCorp representatives also helped patients find “transportation and medical accompaniment to appointments,” Adams said. “Being able to [integrate] a health coach [in the project] was really helpful.”</li> </ul> <p> <strong>Explore these additional resources to improve your practice’s hypertension management:</strong></p> <ul> <li style="margin-left:18.75pt;"> Get the <a href="http://www.ama-assn.org/ama/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_blank">one infographic you need</a> for accurate blood pressure reading.</li> <li style="margin-left:18.75pt;"> Read the <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/3-questions-ask-patients-measuring-blood-pressure" target="_blank">three questions you should ask patients</a> when measuring their blood pressure.</li> <li style="margin-left:18.75pt;"> Hear <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/physicians-saying-doing-control-hypertension" target="_blank">what other physicians are doing</a> to control hypertension in their practices.</li> <li style="margin-left:18.75pt;"> See how you can help patients <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/patients-manage-blood-pressure-outside-office-visits" target="_blank">manage blood pressure outside of office visits</a>.</li> <li style="margin-left:18.75pt;"> Explore resources in the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/improving-blood-pressure-control.page" target="_blank">“M.A.P.” (Measure accurately, Act rapidly, Partner with patients) collection</a>, offered through the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative. Resources include a list of common errors in blood pressure measurement, posters that show the proper positioning for the patient and the cuff, and resources about self-measured blood pressure.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:688263fc-0a2b-4d1e-bfe7-a1efee55a692 3 changes CMS is making to put patients back at the center of care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-changes-cms-making-put-patients-back-center-of-care Tue, 23 Feb 2016 21:44:00 GMT <p> Centers for Medicare & Medicaid Services (CMS) Acting Administrator Andy Slavitt Monday said that the agency’s 2016 agenda is a busy one, but CMS will focus on the physician community’s input and a collaborative future that provides better care for patients.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/15/ae28f2c0-a1d5-4dbd-bf47-a16efdcac2b4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/15/ae28f2c0-a1d5-4dbd-bf47-a16efdcac2b4.Large.jpg?1" style="margin:15px;float:left;" /></a></p> <p> “I think about our agenda not only in terms of how it impacts life for patients and their physicians and caregivers today but also in how CMS can set a tone to work constructively with [physicians] for years to come,” Slavitt said to hundreds of physician leaders at the AMA National Advocacy Conference in Washington, D.C.</p> <p> “Our charge at CMS is clear,” he said. “Meeting the evolving needs of the 140 million Americans [covered by the Medicare, Medicaid, CHIP and Marketplace programs]. Most [are] on low or fixed incomes, whether they are living with a disability, trying to afford a prescription or are in need of coverage as they look for a better job. These are the people we serve every day, and these are the people that I wake up every day thinking about.”</p> <p> Slavitt laid out the three focus areas that CMS will apply to its work with the physician community throughout the year ahead:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Listening to physicians</strong>
<br /> “Our first priority for 2016 is opening the lines of communication and listening to the physicians and other clinicians who provide our care,” Slavitt said, backing up his <a href="http://www.ama-assn.org/ama/ama-wire/post/cms-chief-vows-replace-meaningful-use-better-policy" target="_blank">claim in January</a> that the agency is changing its culture to focus more on listening to physician needs and giving them the freedom they need to keep patients at the center of the practice of medicine. 

<br /> <br /> CMS must “get a better and more direct feel for what is happening on the front lines of care delivery,” he said. “Good policy must be ultimately informed by the impact it has at the kitchen table of the American family and in the clinic or office where they seek care.”

<br /> <br /> “It is clear from listening to physicians there is fatigue,” he said, “with change, with measurement, with new requirements that come from the outside and aren’t simple to implement.”

<br /> <br /> “We are soliciting an unprecedented amount of direct physician input as we work to implement the Merit-Based Incentive Payment System (MIPS) payment models,” Slavitt said. “This will be a journey for all of us—one that requires a trusted partnership underpinned by honest, productive dialogue that helps each of us meet our common goal of better patient care.”

<br /> <br /> “I’m optimistic that this first objective—listening better to what happens in daily practice—is not just a passing idea,” he said, “but will make real lasting change on how things are done at CMS far beyond my tenure.”
</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Simplifying: Reducing the burden and give physicians more time with patients</strong>
<br /> “I visited with a physician in suburban Massachusetts a month or so ago,” Slavitt said. “The visit painted a vivid picture of the gulf that can exist between public policy—even well-intended and good public policy—and what it feels like on the front line of practice.” 

<br /> <br /> This physician was in a busy practice with just one other doctor. “I asked the physician to take me through a typical day and his interactions with technology and measurement and how it helped and hindered his interactions with patients.”<br /> <br /> “He was very pleased to have technology in his office,” Slavitt said. “But it didn’t do the thing[s] he needed most, like give him feedback on referrals he made, and it required a fair amount of effort from him that took time but didn’t add a lot to patient care. He also discussed his interactions with various commercial health plans and with CMS and with payment model changes and administrative burden.”<br /> <br /> “We must reduce [this] burden and give physicians back more time to spend with patients,” Slavitt said.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Supporting change in care delivery</strong><br /> “We believe we need to move back to a place where we are paying for doctors to talk to patients about their health, not just paying for new technology, devices, surgeries and prescriptions that have certainly been dominant drivers over the last number of years,” Slavitt said.<br /> <br /> “Last year, with active support from the AMA, we began <a href="http://www.ama-assn.org/ama/ama-wire/post/advance-care-planning-could-become-routine-part-of-care" target="_blank">paying for advanced care directive conversations</a>,” he said. “While this was seen as big news and a step forward in dealing with an area with lots of strong views, there is other news I hope you take away as well: And that’s the value we place on conversations between the patient and their doctor.”<br /> <br /> “We are committed to building a program that is as flexible as possible and adapts around the goal of a provider’s individual practice and patient population,” he said. “If you commit to continually providing the input, we will commit to continually improving [the program].”</p> <p> <strong>On the technology front</strong><br /> Slavitt announced that CMS will be sharing details and inviting comment as they roll out proposed regulations this spring implementing the Medicare Access and CHIP Reauthorization Act of 2015. The proposed regulations will include changes to the meaningful use program. He said these regulations will be guided by four principles:</p> <ul> <li> Allowing physicians the flexibility to customize goals to their individual practice needs.</li> <li> Rewarding physicians for the outcomes technology helps them achieve with their patients, not for using technology alone.</li> <li> Leveling the technology playing field to promote innovation. This way, new apps, analytic tools and plug-ins can be connected to address the “lock that early EHR decisions have created for some practices,” he said.</li> <li> Prioritizing interoperability by implementing standards and focusing on real-world uses of technology. “Business models that prevent and inhibit data from flowing to where the patient needs to go will not be tolerated,” he said.</li> </ul> <p> In November, the AMA and 100 state and specialty medical associations submitted <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the foundation of the MIPS. The AMA also provided <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-letter-17nov2015.pdf" target="_blank">detailed comments</a> (log in) as part of its ongoing efforts on this issue.<br /> <br /> Additionally, the AMA continues to drive home the message that the problems inherent in the meaningful use program must not be adopted into the MIPS. The AMA recently submitted a <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-share-plan-meaningful-use-should-really-work" target="_blank">detailed framework</a> for what needs to change in meaningful use and continues to advocate for improvements.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:32f8dffb-0369-4bca-b1ff-a6c65dac5964 Get the definitive resource for Medicare coding and billing http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_definitive-resource-medicare-coding-billing Tue, 23 Feb 2016 15:00:00 GMT <p style="margin:0in;margin-bottom:.0001pt;"> <span style="font-size:10pt;font-family:Arial, sans-serif;">Make sure your practice is running smoothly when it comes to Medicare claims. The</span><span style="font-size:10.0pt;font-family:"color:#333333;"><span class="apple-converted-space"> </span></span><span style="font-family:arial,helvetica,sans-serif;"><a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2680003&navAction=push#description-tab" target="_blank"><span style="font-size:10pt;">CPT®/RVU 2016 Data File</span></a></span><span class="apple-converted-space"><span style="font-size:10.0pt;font-family:"color:#333333;"> </span></span><span style="font-size:10pt;font-family:Arial, sans-serif;">contains the comprehensive set of CPT® and HCPCS procedure codes payable under Medicare and provides all 2016 relative value unit (RVU) elements necessary to calculate Medicare’s physician fee schedule.</span></p> <p style="margin:0in;margin-bottom:.0001pt;">  </p> <p> <span style="font-family:Arial, sans-serif;font-size:10pt;">If you’re seeking to import the 2016 RVUs as well as CPT and HCPCS codes and descriptors into your existing claims and billing systems, this is the product you need.</span></p> <p> <span style="font-family:Arial, sans-serif;font-size:10pt;">The data file lets you calculate Medicare’s physician fee schedule using every element of this year’s RVUs—physician work, practice expense (facility and nonfacility) and professional liability insurance.</span></p> <p> <span style="font-family:Arial, sans-serif;font-size:10pt;">Code set descriptors are provided as tab-delimited or pipe-delimited, and they come in three lengths—28-characters, 48-characters and unlimited length.</span></p> <p> <span class="apple-converted-space"><span style="font-size:10pt;font-family:Arial, sans-serif;">AMA members save up to 25 percent on products from the<span style="font-family:arial,helvetica,sans-serif;"> </span></span></span><span style="font-family:arial,helvetica,sans-serif;"><a href="https://commerce.ama-assn.org/store/" target="_blank"><span style="font-size:10pt;">AMA Store</span></a></span><span class="apple-converted-space"><span style="font-size:10pt;font-family:Arial, sans-serif;">. Not a member? </span></span><span style="font-family:arial,helvetica,sans-serif;"><a href="https://commerce.ama-assn.org/membership/" target="_blank"><span style="font-size:10pt;">Join today</span></a></span><span class="apple-converted-space"><span style="font-size:10.0pt;font-family:"color:#333333;">.</span></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:30080e38-152d-4693-934f-a2561e817376 Test your USMLE knowledge: Most missed Step 1 question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_test-usmle-knowledge-missed-step-1-question Mon, 22 Feb 2016 22:59:00 GMT <p style="margin:0in 0in 11.25pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;"> 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 ace it. 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="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" 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><br /> A 75-year-old man comes to the physician because of nocturia, urinary urgency and a feeling that he cannot completely empty his bladder. He voids six times per day and four times per night. He has a strong desire to void, and when he reaches the toilet can only void with a weakened stream with straining. Digital rectal examination shows a firm, enlarged prostate measuring approximately 30 grams. Post void residual by ultrasound is 300 mL. Bone scan shows multiple osteoblastic lesions in the vertebral bodies. Elevation of which of the following bone metabolites is most strongly associated with these lesions?</p> <p style="margin-left:.75in;"> A.  Prostate-specific antigen<br /> B.  Prostatic acid phosphatase<br /> C.  Serum alkaline phosphatase<br /> D.  Tartrate-resistant acid phosphatase<br /> E.  Urinary hydroxyproline</p> <p> <object data="http://www.youtube.com/v/VOcMIzVMWjk" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/VOcMIzVMWjk" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/VOcMIzVMWjk" /><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> <strong>The correct answer is C. </strong></p> <p> <strong>Kaplan says, here’s why: </strong>This patient has prostate cancer causing osteoblastic bone lesions. Osteoblastic cells respond to metastatic prostate carcinoma by forming bone (osteoid) and secreting alkaline phosphatase, which is thought to either initiate or facilitate mineralization. The use of serum alkaline phosphatase is not for prostate cancer screening purposes but for patient management and follow-up after treatment is initiated. Recurrence of elevated serum alkaline phosphatase would suggest recurrence of tumor metastasis. It is important to note that this patient will likely have an elevated PSA because of his prostate cancer. However, PSA is prostate-specific, and bony disease from prostate cancer also will show elevated alkaline phosphate levels.</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><br /> <br /> <strong>Choices A and B:</strong> Prostate-specific antigen and prostatic acid phosphatase are not correct because they do not answer the question being asked. The question asks for bone metabolites related to the patient’s skeletal metastasis. These two markers are synthesized by the tumor and would most likely be elevated in this case; however, they are elevated due to the prostatic cancer, independent from the bony metastasis.<br /> <br /> <strong>Choices D and E:</strong> Tartrate-resistant acid phosphatase and urinary hydroxyproline are metabolic markers of osteoclastic (not osteoblastic) cell activity. Lytic tumor metastasis (lung, kidney, gastrointestinal tract, melanoma) would be associated with increased levels of these markers. Tartrate-resistant acid phosphatase is secreted by the osteoclast during bone resorption. Hydroxyproline is associated with collagen breakdown and increased levels are excreted in the urine.<br /> <br /> <strong>Tips to remember:</strong></p> <ul> <li> Serum alkaline phosphatase levels are used to screen for osteoblastic bony metastases in prostate cancer.</li> <li> General screening tests for prostate cancer include prostatic acid phosphatase and prostate-specific antigen. However, the PSA is the more accepted test to have performed and is the current standard of care for prostate cancer screening.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:60a3d2a4-5d65-47ea-ae12-2c7cde019154 Specialty development key to new payment models’ success http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_specialty-development-key-new-payment-models-success Mon, 22 Feb 2016 21:00:00 GMT <p> Alternative payment models (APM) could soon be a reality for most physicians—and specialty societies already have begun developing payment models for the conditions and episodes of care that their members treat. Some physicians are even piloting initial models in practice. Find out how you can get involved in making sure these new payment models will enhance the care your patients receive.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/8/ce76999e-8335-41ec-9830-51c6e738dbc1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/8/ce76999e-8335-41ec-9830-51c6e738dbc1.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> It’s important for physicians in every medical specialty to begin working now toward APMs that solve the specific barriers they face in the current payment system. “A doorway has been opened that has not been opened before,” said Harold Miller of the Center for Healthcare Quality and Payment Reform, who is also a member of the new federal Physician-Focused Payment Model Technical Advisory Committee (PTAC). “Physician effort and input is needed in the development of these new payment models.”</p> <p> The Medicare Access and CHIP Reauthorization Act (MACRA)—the legislation which repealed Medicare’s sustainable growth rate formula last year—provides incentives and funding to develop APMs that could give physicians the resources and flexibility to deliver care in new and better ways. </p> <p> PTAC, a permanent committee created by Congress to advise CMS on APMs, held its first meeting earlier this month. The AMA and several medical specialty societies told the Committee that more specialty-specific APMs were needed.</p> <p> “Physicians and specialty societies are going to need help to develop these models and in ways that meet the requirements for MACRA and that are feasible for Medicare and payers to implement,” Miller said. One of the roles of PTAC will be to provide that help.</p> <p> “Designing a good alternative payment model is basically a three-step process,” Miller said. “First, what are the opportunities for improving care for patients that could result in savings? Second, what are the barriers in the current payment system that prevent those improvements? Then, what kind of payment model enables the physician to overcome those barriers and achieve those opportunities?”</p> <p> For example, the current payment system does not support taking calls from patients after hours, coordinating with emergency services and hospitals, hiring care managers, or even taking time to consult with other physicians. Many specialties are developing models that can solve these problems, improve patient care and lower spending. </p> <p> <strong>How physicians and specialty societies are working together</strong></p> <p> Physicians should start working now through their specialty societies to develop these models, Miller said. “There are a number of examples around the country of physicians in various specialties who have been able to improve care for their patients and lower costs through payers through a grant or a supportive health plan, and those would be good places to start in developing APMs that could enable all physicians in the specialty to deliver similar benefits for their patients.”</p> <p> For example, Barbara L. McAneny, MD, immediate past-chair of the AMA Board of Trustees and an oncologist in New Mexico, has been <a href="http://www.ama-assn.org/ama/ama-wire/post/practice-improving-patient-care-reducing-costs" target="_blank">leading a project</a> to reduce the frequency at which patients who are undergoing chemotherapy end up in the emergency department or hospital due to complications.</p> <p> “They have achieved dramatic results, but they won’t be able to sustain the changes unless there are changes in the way they are paid,” Miller said.</p> <p> Dr. McAneny worked with the American Society of Clinical Oncology (ASCO) to develop the Patient-Centered Oncology Payment proposal. “Dr. McAneny’s experience helped the ASCO to develop an APM that would work for a broad range of practices,” Miller said.</p> <p> Another society, the American Association of Clinical Endocrinologists (AACE), is discussing a condition-based APM for managing patients with diabetes. An APM is needed to support educating patients about their diabetes, checking blood sugars, phone calls to change therapy, arranging necessary consultations, communicating with the primary care physician and other consultants, and office visits.</p> <p> Physician input is critical to making sure these payment models work. Additionally, it is important for specialty societies to work together to develop payment models that support coordinated care of patient health problems that are treated by multiple specialties.</p> <p> <strong>Making sure new payment models work</strong></p> <p> It is important that the criteria for physician-focused APMs allow physicians to take accountability for costs and outcomes they can influence but not hold them responsible for costs they cannot control or to impose new administrative burdens, Miller said.</p> <p> In order to help accelerate efforts to develop physician-designed APMs in all specialties, the AMA compiled a process that physicians and their specialty societies can use to develop payment models that will meet the specialty-specific needs of physicians’ practices and patient populations:</p> <p style="margin-left:40px;"> 1.   Identify specific ways in which patient care could be improved that will result in lower health care spending.</p> <p style="margin-left:40px;"> 2.   Identify the specific barriers that current payment systems create that make it difficult or impossible for physicians to implement these improvements in patient care.</p> <p style="margin-left:40px;"> 3.   Identify the changes in payment needed to overcome these payment barriers. Not all changes in payment systems actually overcome the barriers to payment, and many payment changes can create new problems for physicians.</p> <p style="margin-left:40px;"> 4.   Analyze whether the benefits for patients and the savings for payers and patients are sufficient to justify any costs associated with appropriate payment changes.</p> <p style="margin-left:40px;"> 5.   Design a payment model that removes the barriers to improving care so that physicians can improve outcomes for patients and achieve savings for payers.</p> <p> <strong>How physicians are leading payment reform efforts</strong></p> <p> At the first PTAC meeting, the AMA testified that it is important to involve physicians at every part of the payment model development process and for PTAC to work with specialty societies to ensure that APMs adopted under MACRA are truly beneficial models.</p> <p> More than 100 state and specialty medical associations recently joined the AMA in sending a <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/macra-sign-on-letter-16nov2015.pdf" target="_blank">letter</a> (log in) recommending <a href="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> that the Centers for Medicare & Medicaid Services (CMS) should follow in implementing the MACRA, including principles as to how APMs should be developed and implemented.</p> <p> To help physicians and specialty societies in the effort to create these payment models, the AMA worked with Miller to develop the “<a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_blank">Guide to Physician-Focused Alternative Payment Models</a>.”</p> <p> For more on alternative payment models, check out the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-traits-of-successful-payment-models" target="_blank">three traits of successful payment models</a> and the <a href="http://www.ama-assn.org/ama/ama-wire/post/overcoming-barriers-new-models-of-care" target="_blank">most common barriers</a> in the current payment system. Also, find out <a href="http://www.ama-assn.org/ama/ama-wire/post/whos-using-new-delivery-payment-models-1" target="_blank">who is using new delivery and payment models</a> and learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/payment-models-can-better-address-patients-needs" target="_blank">seven payment models that address physician needs</a>.</p> <p align="right"> <em>BY AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:04a736e2-76b2-4c76-9e70-e7ac5ca7c0f6 How a new funding model could create debt-free medical education http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-funding-model-could-create-debt-medical-education Fri, 19 Feb 2016 23:20:00 GMT <p> Will debt-free medical education be an option for future physicians in training? One medical education expert shared a vision for a bold funding model that would eliminate student debt and improve how coveted medical education dollars are spent. Learn about the new funding model and why debt-free education may be a reality for future physicians in training.</p> <p> <strong>What a debt-free model could look like </strong></p> <p> “Out of the $2.81 trillion spent [on health care] in 2012, the total spend on all of medical education—[including] undergraduate and graduate—is approximately $20 billion in the United States, or 0.68 percent,” Jeffrey P. Gold, MD, chancellor of the University of Nebraska Medical Center, told a group of educators at the AMA’s ChangeMedEd  conference in October. “So we want to focus on how we can better spend that 0.68 percent,” Dr. Gold said.<object align="right" data="http://www.youtube.com/v/FnUaI6Q8D_E" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/FnUaI6Q8D_E" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/FnUaI6Q8D_E" /><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="http://www.youtube.com/v/FnUaI6Q8D_E" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> To improve how these limited medical education dollars are spent, Dr. Gold and two colleagues at the University of Nebraska Medical Center have proposed a new funding model that will:</p> <ul> <li> <strong>Build a trust fund for undergraduate medical tuition</strong>. This fund would “cover all undergraduate medical education tuition [and eliminate] all student debt in return for professional health care services after completing GME in a designated area in their chosen specialty,” Dr. Gold said. “So this is a work-for-return-of-service type of model.”<br />  </li> <li> <strong>Replace all indirect and direct GME dollars with a new “funds-flow” mechanism using fees paid for health care expenditures by all payers. </strong>“We propose the establishment of a novel all-payer system whereby government, commercial and private entities, as well as self-pay individuals, invest in the education of all physicians in exchange for the highest quality of health care,” Dr. Gold and colleagues wrote in <a href="http://journals.lww.com/academicmedicine/Fulltext/2015/09000/Envisioning_a_Future_Governance_and_Funding_System.20.aspx" rel="nofollow" target="_blank">an article</a> published in <em>Academic Medicine.</em><br /> <br /> The proposed model would alleviate GME’s heavy dependence on Medicare and Medicaid funding. Dr. Gold also said this all-payer system would help advance other areas of medical education, including increased scholarship funding for underrepresented students in medicine.</li> </ul> <ul> <li> <strong>Enhance accountability among educators and institutions receiving medical education funds. </strong>Medical schools and educators would have to “link their funding levels [to] their ability to achieve predetermined, specialty-specific institutional program-, faculty- and learner-outcome benchmarks,” Dr. Gold said. This will ensure that medical education dollars are being spent on programs that produce measured results and enhance the learning of physicians in training.</li> </ul> <p> <strong>Potential outcomes of this funding model</strong></p> <p> So what would happen if undergraduate medical school debt were eliminated and replaced using an all-payer system? Dr. Gold said medical students and schools could expect several favorable outcomes, including:</p> <ul> <li> <strong>The elimination of medical school debt and the insurmountable pressure it puts on physicians. </strong>73 percent of physicians under the age of 40 still are paying off their medical school loans, according to AMA Insurance’s <a href="http://www.amainsure.com/resourcecenter/introduction-to-work-life-profiles-of-todays-us-physician.html" rel="nofollow" target="_blank">2014 National Work/Life Profiles report</a>. Nearly one-half of these young physicians carry a debt of $150,000-$200,000.<br /> <br /> Considering the high long-term cost of medical training, “we could argue for a long time about how important this [new funding model] is,” Dr. Gold said. “Given the average graduation debt right now, [this is] a big deal.”</li> </ul> <ul> <li> <strong>An increase in the number of physicians who meet the needs of underserved patients and communities. </strong>Under this new funding model, institutions could infuse thousands of “fully trained, board-eligible physicians into the underserved community workforce for a period between one and four years, depending on how much debt they want to work down,” Dr. Gold said. This would improve access to quality care for patients in vulnerable communities while freeing students from the crushing burden of paying back loans during residency.<br />  </li> <li> <strong>Direct compensation of all teaching institutions and professional educators. </strong>Throughout his career in medical education, Dr. Gold said he’s observed how researchers and clinicians in medical education are often paid differently, yet they wish to be paid the same way for their meaningful work with students. Under this new payment model, clinical educators and researchers would receive compensation directly from the established medical education fund, so all educators would be paid the same way—no matter their title or position.<br /> <br /> Dr. Gold said this is especially helpful for clinical educators who can no longer rely on an “apprenticeship model” as the main method for teaching students in clinical settings. Educators now are creating innovative curricula, teach and measures students’ progress. “That all takes time and … with all the workload on our faculty, there has to be a way to compensate [them], and it should be built into our system,” he said.  </li> </ul> <ul> <li> <strong>More funds to allocate for residency positions. </strong>In fact, this new funding model “will generate more funds to do the equivalent of adding 3,000 GME positions to the United States,” Dr. Gold said.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0ad01369-7f00-4c33-8f1a-084bcce13f49 CMS extends meaningful use deadline: Attest by March 11 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_cms-extends-meaningful-use-deadline-attest-march-11 Fri, 19 Feb 2016 21:39:00 GMT <p> The Centers for Medicare & Medicaid Services (CMS) has extended the attestation deadline for the electronic health record (EHR) meaningful use program, providing additional time for physicians to report on the 2015 program year.</p> <p> Physicians now have until March 11 to attest, almost two weeks longer than the original deadline of Feb. 29. They may report on any continuous 90 day period from Jan. 1 through Dec. 31, 2015. Consult the <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/2015_EPAttestationWorksheet.pdf" rel="nofollow" target="_blank">attestation worksheet</a> and <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/UserGuide_EPAttestationUserGuide2015_2017.pdf" rel="nofollow" target="_blank">user guide</a> from CMS to learn more.</p> <p> The reporting period for hospitals and critical access hospitals is any continuous 90 day period from Oct. 1, 2014, through Dec. 31, 2015.</p> <p> To speed the attestation process, it is recommended that physicians attest during off-peak hours, such as evenings and weekends, and take time now to ensure that their information is up-to-date before beginning to enter 2015 data.</p> <p> For more information on how to attest for meaningful use, visit CMS’ <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html" rel="nofollow" target="_blank">registration and attestation</a> Web page.</p> <p> <strong>No downside to applying for hardship exemption</strong></p> <p> Previously, CMS also <a href="http://www.ama-assn.org/ama/ama-wire/post/avoid-meaningful-use-penalties-apply-exemption-march-15" target="_blank">posted the application for a hardship exemption</a> from the EHR meaningful use financial penalties for the 2015 program year. Even if physicians are attesting by March 11, submitting an application for a hardship exemption <a href="https://questions.cms.gov/faq.php?faqId=14357&id=5005" rel="nofollow" target="_blank">will not prevent</a> those who qualify from receiving an incentive payment.</p> <p> CMS has said that it will broadly grant hardship exemptions as a result of the delayed release of the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" target="_blank">Stage 2 meaningful use modifications rule</a>, which left physicians with little time to report under the modified program requirements issued in late 2015.</p> <p> This inclusive approach to hardship exemptions is a result of the Patient Access and Medicare Protection Act, passed just before Congress adjourned for the holidays. The legislation <a href="http://www.ama-assn.org/ama/ama-wire/post/bill-gives-blanket-approval-meaningful-use-exemptions" target="_blank">directed CMS to make AMA-supported changes</a> to the previously limited exemption process.</p> <p> Physicians have until midnight Eastern time March 15 to apply for a hardship exemption. To get started, <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html" rel="nofollow" target="_blank">download an application</a> from CMS and consult <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-avoiding-2017-penalty.pdf" target="_blank">step-by-step instructions</a> (log in) the AMA compiled to help simplify the submission process.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1db85108-e52b-493d-989f-067f59b773e9 Get in-depth ICD-10 training and earn CME http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_depth-icd-10-training-earn-cme Fri, 19 Feb 2016 15:00:00 GMT <p> Now that the ICD-10 transition is complete, go beyond the basics with the ICD-10 Specialty Coding Summit 2016 June 6 at The Cosmopolitan in Las Vegas. This two-day event will help your practice stay attuned to the errors, misinterpretations and revenue risk points all around you.</p> <p> This year’s summit will cover the gamut of ICD-10 issues that threaten the success and financial stability of your practice in 2016 and into the future, including:</p> <ul> <li> <strong>Safe harbor expiration. </strong>Go beyond ICD-9 equivalency and become truly ICD-10 capable.</li> <li> <strong>Auditors on the loose. </strong>Learn how to keep your claims out of the crosshairs for denials.</li> <li> <strong>2017 ICD-10 code changes and guideline updates. </strong>Stay ahead to avoid productivity and revenue setbacks.</li> <li> <strong>Medical necessity policy gaps. </strong>Learn about the hidden denial traps no safe harbor can protect you from.</li> </ul> <p> An ICD-10 Documentation Workshop on Day 1 of the summit will help you tackle gaps and change processes for success.</p> <p> Day 2 of the conference will focus on specialty tracks, offering a deep dive into real-world coding examples, live skills practice with intermediate and advanced scenarios, and hours of interaction and Q&As with specialty experts. Focus your attention on one of five specialty-specific tracks:</p> <ul> <li> Cardiology</li> <li> Primary care/internal medicine</li> <li> ICD-10 PCS</li> <li> Orthopedics</li> <li> Pain management</li> </ul> <p> Participants can earn continuing education applicable to coders, documentation specialists, physicians and nurses. <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2700003&navAction=push" target="_blank">Learn</a> more about the full summit at the AMA Store <a href="https://commerce.ama-assn.org/store/catalog/productDetail.jsp?product_id=prod2700003&navAction=push" target="_blank">and register</a> by March 25 to receive the early bird rate, a discount of $100.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:79b79d8d-1da3-4304-8f08-7d370c3a236b Physicians identify ways to improve opioid overdose prevention http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-identify-ways-improve-opioid-overdose-prevention Thu, 18 Feb 2016 22:49:00 GMT <p> A national physician survey released Thursday shows strong support for key policies and recommendations to end the nation’s opioid epidemic, including ways to improve prescription drug monitoring programs (PDMP), enhance physician education and remove barriers to care. Learn what physicians said and discover resources that can help advance their efforts.</p> <p> The survey, which was commissioned by the AMA and the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_blank">AMA Task Force to Reduce Prescription Opioid Abuse</a>, had five key findings:</p> <ul> <li> <strong>PDMPs can be valuable tools:</strong> 87 percent of physicians agree that PDMPs help them become more informed about a patient’s prescription history. Physicians who aren’t already registered to use their state’s PDMP can easily find how to do so through the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" target="_blank">task force resource pages</a>, which include links directly to the state databases and education materials on how physicians can use PDMPs to enhance clinical treatment.<br />  </li> <li> <strong>PDMPs need changes to be more beneficial:</strong> Physicians said that PDMPs would be much more helpful if they were improved to integrate with electronic health records, provide real-time data and other key features that would make them even more useful.<br /> <br /> The AMA task force is urging states to ensure these and other <a href="http://www.ama-assn.org/resources/doc/washington/15-0398-opioid-one-lawmaker.pdf" target="_blank">important features</a> are part of their PDMPs.<br />  </li> <li> <strong>Physicians are educated but want more specific continuing medical education (CME):</strong> 68 percent of survey respondents said they have taken CME on safe opioid prescribing, and 55 percent have taken CME on managing pain with opioid alternatives. But the survey found that physicians are seeking more practice-specific and specialty-specific education, with 1 in 4 physicians saying the CME they needed was not readily available.<br /> <br /> The task force offers a <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/state-society-resources.page?" target="_blank">full collection</a> of the most up-to-date <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/state-society-resources.page?" target="_blank">state and specialty-specific education resources</a> so physicians can easily find the materials they need.<br /> <br /> In addition, several medical organizations offer <a href="http://www.samhsa.gov/medication-assisted-treatment/training-resources/buprenorphine-physician-training" rel="nofollow" target="_blank">waiver-qualifying medication-assisted treatment (MAT) training</a> to help physicians recognize patients with substance use disorder and become certified to increase access to treatment.<br />  </li> <li> <strong>Significant barriers exist to non-pharmacologic and non-opioid treatments: </strong>Physicians said the main barriers to using alternatives to opioids include a lack of coverage by insurance companies, difficulty finding a specialist to which they can refer their patients for pain treatment and pressures to ensure they achieve a high patient satisfaction score.</li> </ul> <p style="margin-left:40px;"> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/11/99128218-344c-4d53-9b74-49dfe0362bee.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/11/99128218-344c-4d53-9b74-49dfe0362bee.Full.jpg?1" style="margin:15px;" /></a></p> <ul> <li> <strong>Physicians strongly support co-prescribing naloxone:</strong> More than 80 percent of physicians said that naloxone should be available to a patient at risk of an overdose via a standing order or collaborative practice agreement with a pharmacist. The AMA offers model legislation that includes support for standing orders and also has supported more than 20 state laws that increase access to naloxone in the community.<br /> <br /> Physicians can access <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page?" target="_blank">additional information about naloxone</a> from the task force and download <a href="https://download.ama-assn.org/resources/doc/washington/opioid-naloxone-ama.pdf" target="_blank">recommendations for co-prescribing</a>.</li> </ul> <p> “This survey provides an important window into physicians’ perceptions about caring for patients with pain and those with substance use disorders,” AMA President Steven J. Stack, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-02-18-barriers-non-opioid-therapy.page" target="_blank">press release</a>. “This survey confirms that physicians support many of the key policies being considered to end this crisis. The AMA and the nation’s physicians are committed to partnering with others to implement proven solutions.”</p> <p> The survey was conducted for the AMA by TNS Global Research between Nov. 13 and 23. The sample size was 2,130 practicing physicians who provide a minimum of 20 hours per week in direct patient care, have a current Drug Enforcement Administration license to prescribe Schedule II controlled substances and prescribe opioids at least on a weekly basis. The sample included all practice settings and regions in the United States.</p> <p align="right"> <em>By AMA Wire editor </em><a href="https://twitter.com/amy_amawire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f8c600f0-853b-4755-991c-1c38481205e1 4 tips for dating a medical student http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-tips-dating-medical-student Wed, 17 Feb 2016 22:29:00 GMT <p> As a medical student, you may face particular relationship challenges if your significant other doesn’t have firsthand experience with juggling the unique demands of medical school. If this sounds familiar, reference these key insights for a successful relationship from the partner of a recent med school graduate.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/3/aee4e6cd-b557-4c70-b3a0-70b6b167e3d3.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/3/aee4e6cd-b557-4c70-b3a0-70b6b167e3d3.Large.jpg?1" style="margin:15px;float:right;" /></a>Kevin Dwyer is happily engaged to a second-year resident he began dating when she was in medical school, but he admits that their progress as a couple did not come without its lessons and challenges. Based on their experiences, he recently shared advice on maintaining a healthy relationship with a physician in training in the <a href="http://www.amaalliance.org/" rel="nofollow" target="_blank">AMA Alliance</a> magazine <a href="http://www.physicianfamilymedia.org/" rel="nofollow" target="_blank"><em>Physician Family</em></a><em>.</em> Among his insights are four tips:</p> <p> <strong>1. </strong><strong>Set realistic expectations about your time and finances.</strong> Dwyer admits he had to shed his romantic ideals about being in a long-term relationship with a medical student.<br /> <br /> “I came to realize that being a … medical student meant that, aside from the three to four hours we had together each week, virtually all of her time was spent at the hospital or studying,” Dwyer wrote. “Not to mention, residents make around $13 per hour and carry” a lot of medical education debt.</p> <p> <strong>2. </strong><strong>Strategize your time together, especially during clinical years of training. </strong>“To say third year was tough is an understatement,” Dwyer wrote. “Obviously it was challenging for her with the studying and whatnot, but it also put a strain on our budding romance. This is when I first learned about ‘free-time envy.’”<br /> <br /> “The only time we would get to see each other was on the weekends,” he wrote. “I started taking her out on Friday and seeing how long I could stay into Saturday. Normally I would make her breakfast, help tidy up the place and generally keep her company.”</p> <p> <strong>3. </strong><strong>Keep an open mind and be adaptable. </strong>Be prepared to navigate important life changes with your medical student as they transition from medical school to residency.<br /> <br /> “I quickly learned that traditional gender roles cannot exist,” Dwyer wrote. “It took almost 18 months of residency to become comfortable in my new role as gourmet chef, designated shopper, occasional handyman, life coach, comforter, personal assistant and full-time listener. It took her almost as long to fully understand that my greatest satisfaction comes from her success, even if it means the hospital gets more time with her than I do.”</p> <p> <strong>4. </strong><strong>Communicate openly and effectively. </strong>After Dwyer’s girlfriend began residency, she’d often arrive home stressed or exhausted, which Dwyer said really strained their relationship because he repressed many frustrations about their lack of time together.<br /> <br /> “We had a couple of major blowups, in large part due to my inability to understand and express how everything was affecting me,” he wrote. “Fortunately, once we started communicating more, things got better again.”</p> <p> See more <a href="http://www.bluetoad.com/publication/?i=287407&pre=1#{"issue_id":287407,"page":0}" rel="nofollow" target="_blank">tips for dating a medical student</a> in <em>Physician Family</em>. Also, learn more advice about <a href="http://www.ama-assn.org/ama/ama-wire/post/4-tips-communicating-medical-student" target="_blank">how to effectively communicate</a> with a medical student in a relationship.</p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8869f062-4ee2-4006-85ff-21d1b96c6a5e Your patients may have unmet needs: 4 questions to ask http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_patients-may-unmet-needs-4-questions-ask Wed, 17 Feb 2016 21:00:00 GMT <p> A deeper look into the way your patients experience care delivery can provide a new perspective into how your team coordinates care from the waiting room to the exam room to the parking lot. Learn four simple, physician-authored questions you can ask your patients to find out if your practice is meeting their needs.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/9/368de60a-c664-428a-8915-dd0b94c1997d.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/9/368de60a-c664-428a-8915-dd0b94c1997d.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> A new <a href="https://www.stepsforward.org/modules/intensive-primary-care" target="_blank" rel="nofollow">module</a> from the AMA’s <a href="https://www.stepsforward.org/" target="_blank" rel="nofollow">STEPS Forward™</a> collection, written by physicians from the Stanford University School of Medicine, shows you how to analyze your patient population’s clinical needs to build an intensive primary care practice. Check out the “STEPS in practice” section of the module to see how it’s working at Stanford.</p> <p> Though the module is designed to build an intensive primary care practice, knowing the care delivery experience and needs of your patients can help any practice type.</p> <p> Engaging patients and asking them these four questions may give your practice a better understanding of opportunities to improve your care process:</p> <ul> <li> What is the worst thing about your health situation?</li> <li> What in your life helps to make the situation better?</li> <li> What does medical care do that helps make the situation better?</li> <li> What does medical care do that doesn’t help your situation or makes it worse?</li> </ul> <p> Once you’ve gathered your patients’ answers to these questions, you will have a clearer picture of what kind of changes your practice can make to better meet their needs.</p> <p> <strong>Taking a comprehensive approach to your patients’ needs</strong></p> <p> For physicians in primary care who are looking for ways to better keep their patients healthy, the intensive primary care practice may be an option to consider. An intensive primary care practice comprehensively addresses the goals and medical needs of patients with multiple chronic conditions whose needs would likely not be met in a short primary care visit.</p> <p> In this type of practice, it is important to provide patients with expanded in-person and remote access to the care team. The STEPS Forward module offers several options for bolstering your medical staff to address this type of practice setting.</p> <p> For instance, medical assistants can perform routine care and act as a coordinator to see patients through the care process. Also, bringing more registered nurses on board can shift some responsibilities in providing direct patient care. They can work more closely with the extended care team once the physician’s assessment is complete. Similarly, hiring advanced practice clinicians, such as nurse practitioners and physician assistants, who can exercise advanced clinical responsibilities can aid in continuity and coordination of care.</p> <p> Other team members, such as receptionists, dietitians or diabetes educators may round out your practice team if your patients’ needs require such additions. The reality is that most practices likely will not be able to hire a full-time care coordinator or health coach. Instead, you can identify existing members of your care team who have the proper interpersonal skills and send them for training so they can focus on those activities.</p> <p> You may want to add certain specialized professionals to your care team if coordinating with physicians outside your practice isn’t working for patients. These may include:</p> <ul> <li> A <strong>behavioral health specialist</strong> for patients who experience depression or other similar issues is often helpful. For example, you might look for a licensed clinical social worker with the combined skills of a social worker and a therapist.</li> <li> Adding a <strong>physical therapist</strong> to your care team could help streamline care coordination for patients with chronic pain who are having trouble making it to their appointments with physical therapists outside of your practice.</li> <li> A <strong>clinical pharmacist</strong> could add value to the team as well. This person can help patients understand their medications, promote adherence and adjust medications accordingly while continuing a dialogue with the care team.</li> </ul> <p> <strong>Additional resources</strong></p> <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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p> 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="http://www.mgma.com/education/conferences/collaborate" target="_blank" rel="nofollow">Register online</a>, and receive a discount when you register two or more of your team members.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c7c31d0f-e071-4ea7-9b90-a2bc8f280181 A call to action: Physicians must turn the tide of the opioid epidemic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_call-action-physicians-must-turn-tide-of-opioid-epidemic Wed, 17 Feb 2016 15:00:00 GMT <p> <em>An AMA Viewpoints post by AMA President Steven J. Stack, MD</em></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/10/10705d54-b891-4446-aa71-d09d932f6432.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/10/10705d54-b891-4446-aa71-d09d932f6432.Large.jpg?1" style="margin:15px;float:left;" /></a></p> <p> We have a defining moment before us—the kind of moment that we will look back on in years to come as one in which we as a profession rose to the challenge to save our patients, our families and our communities during a time of crisis.</p> <p> Our nation is needlessly losing thousands of people to a preventable epidemic, and we must take action for our patients.</p> <p> <strong>A time for action</strong></p> <p> Over the past 15 years, the nation’s opioid epidemic has claimed more than 250,000 lives, according to data from the Centers for Disease Control and Prevention (CDC). In the last year alone, we lost nearly 30,000 friends, neighbors, children and spouses.</p> <p> Those numbers are alarming—and they require swift intervention.</p> <p> In fact, there’s something of a parallel with what we’re seeing now and the early years of the HIV/AIDS epidemic. Nearly 320,000 people died in the first 15 years of that epidemic.</p> <p> Thankfully, the narrative doesn’t end there. The nation’s policymakers, public health leaders and physicians came together to implement solutions that changed the course of history for people with an HIV/AIDS diagnosis and their loved ones.</p> <p> It’s time to mount a similar response for the opioid epidemic. The loss of lives we are seeing around us and in the news every day is unacceptable—and we don’t have to accept it. Each and every one of us must band together to take specific actions that will turn the tide.</p> <p> <strong>What we need to do</strong></p> <p> One of the great hallmarks of our profession is to run toward an emergency, to stand with our patients in the midst of their most pressing needs and to show the nation a clear path forward.</p> <p> One way that our profession has done that for the opioid epidemic so far has been to <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_blank">convene a task force</a> with more than 20 state and specialty medical associations, the American Osteopathic Association and the American Dental Association to identify best practices and implement them across the country.</p> <p> For us as individuals, there are five specific steps we all must take:</p> <p style="margin-left:40px;"> <strong>1.     </strong><strong>We should </strong><a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" target="_blank"><strong>register for and use</strong></a><strong> our state’s prescription drug monitoring program </strong>(PDMP) if we treat patients for pain, mental illness or any other condition for which a controlled substance could be prescribed.<br /> <br /> Not every PDMP is perfect, but they provide important information that can help us when considering whether to prescribe a controlled substance for a particular patient.</p> <p style="margin-left:40px;"> <strong>2.     </strong><strong>We may need to enhance our education and training about safe prescribing. </strong>There are significant barriers to providing non-opioid and non-pharmacologic treatment alternatives, but we should ask ourselves two simple questions: When was the last time we looked at the research on opioid alternatives? And when was the last time we took education to ensure we are prescribing safely and appropriately? <br /> <br /> The AMA has gathered more than 100 <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/state-society-resources.page?" target="_blank">state and specialty-specific education resources</a> in a one-stop shop for the best and most up-to-date education that organized medicine has to offer. Be sure to take advantage of these materials.</p> <p style="margin-left:40px;"> <strong>3.     </strong><strong>We should co-prescribe naloxone to patients at risk of overdose. </strong>The overdose reversal drug naloxone has saved more than 26,000 lives in the community in recent years, according to the CDC. The AMA Task Force to Reduce Prescription Opioid Abuse offers <a href="https://download.ama-assn.org/resources/doc/washington/opioid-naloxone-ama.pdf" target="_blank">concrete recommendations</a> for when you should consider co-prescribing naloxone to your patients.</p> <p style="margin-left:40px;"> <strong>4.     </strong><strong>We should get training to provide medication-assisted treatment (MAT) for substance use disorders. </strong>More of us need to be trained to recognize patients with substance use disorder, and more physicians need to become certified to increase access to treatment. Several medical organizations offer <a href="http://www.samhsa.gov/medication-assisted-treatment/training-resources/buprenorphine-physician-training" rel="nofollow" target="_blank">waiver-qualifying MAT training</a> in multiple formats.</p> <p style="margin-left:40px;"> <strong>5.     </strong><strong>We need to </strong><a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_blank"><strong>speak out against stigma</strong></a><strong> and stand up for what we know is right. </strong>Patients in pain deserve care and compassion, not judgment. Treating pain is among the most difficult—and most common—reasons patients come to us. As physicians, we are often under pressure to “satisfy a patient’s pain.” Sometimes this requires prescribing an opioid. But caring also means sometimes saying no and recommending an alternative course of treatment—no matter how difficult that may be.</p> <p> Our nation’s opioid epidemic won’t end unless we become leaders by supporting the necessary policies and making the necessary practice changes. I urge you to join me in taking these steps today. Now is the time to act—this is our moment to turn the tide.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a5339855-dbf4-4d9c-bc62-9148e22e8356 6 tips for balancing a two-physician family http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-tips-balancing-two-physician-family Tue, 16 Feb 2016 22:44:00 GMT <p> Managing a family with two working physicians requires artful balance and strategy—two skills Tracy Roth, MD, has learned as a private practice owner, mother of six children and wife of a fellow physician. Learn how to tap into the strengths of your medical marriage with these six tips Dr. Roth recommends for two-physician families.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/13/b4f0dac4-7846-472d-8d74-7baf71846400.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/13/b4f0dac4-7846-472d-8d74-7baf71846400.Large.jpg?1" style="margin:15px;float:right;" /></a>In the beginning—at least during residency—raising two children and working long hours seemed easy for Dr. Roth and her husband. After all, they had a consistent source of income, fewer expenses and had managed to still find time for their social lives.</p> <p> As residents, “we both worked long hours and often had call on alternate nights,” Dr. Roth recently wrote in AMA Alliance publication <em>Physician Family. </em>“This really wasn’t so bad because it gave us time to ourselves and with friends while the other was at work. On our combined days/nights off, we had nothing to worry about but each other, so it was a romantic fun catchup.”</p> <p> But then private practice began and life took a turn. “Throw in a new community, a mortgage and a baby. Lots of changes had to occur,” Dr. Roth said.</p> <p> So how did they manage them? Here are six strategies that helped Dr. Roth and her husband weather daily pressures as busy physicians and parents:</p> <p> <strong>1. </strong><strong>Accept help—it’ll save you time and energy.</strong> When workloads increased for Dr. Roth and her husband, they hired a nanny. “We were … fortunate to find a nanny we affectionately called ‘Mary Poppins.’ She helped keep us all in line,” Dr. Roth wrote. With a nanny on board, she and her husband were able to better divide their time evenly between caring for their children and patients.</p> <p> <strong>2. </strong><strong>Create a schedule for yourselves and the kids.</strong> “A large dry erase board with everyone’s activities is a must,” Dr. Roth wrote. "We have structured routines in the morning, whether the sitter or I are at the house. This helps the kids stay on track. Our afternoons are less predictable because of extracurricular activities, but the children have learned to do homework on the run and keep their stuff together. We are working hard on preparing for the next day at night.”</p> <p> <strong>3. </strong><strong>Stay organized. </strong>“‘A place for everything, and everything in its place’ is the motto we are trying to live by,” Dr. Roth wrote. “I am working hard to instill this in my kids because so much time is wasted and anxiety expended when looking for lost items. Everyone is more relaxed when they can find what they need.”</p> <p> <strong>4. </strong><strong>Evaluate leadership roles in your household (note: this may require embracing changes in your careers). </strong>For instance, “My husband and I now realize that our family functions better when one person takes on the responsibility of being the ‘primary’ parent/house CEO,” Dr. Roth wrote. “Both of us cannot be on the fast track at work and expect the house and family to stay healthy. I am fortunate to have found a part-time position in academics that will give me professional fulfillment but still allow me to be the primary person in charge at home.”</p> <p> By being more honest about their family preference, Dr. Roth still enjoys a valuable career without being saddled with pressure to choose it over her family. “I decided that work is good for me. I feel smart, needed and valued (things that you don’t get at home on a daily basis as your kids say ‘you are so mean,’ and they whine, beg and create one mess after another), but I also want to be present for my children and husband,” Dr. Roth wrote.</p> <p> <strong>5. </strong><strong>Make time for each other, especially as your careers change</strong>. This was a lesson Dr. Roth learned as she and her husband’s practices were growing. “We were very 50-50 during that time,” she wrote. “We were intent on establishing our careers while being ever present for our two young children. We each took time off when someone was sick or had a school program. When our nanny had surgery, we each took vacation time to be the primary parent at home. We also made sure to never be on call the same nights. This was all great for the kids, but it led to a lot of exhaustion and little time for each other.”<br /> <br /> Now, she and her husband “have made it a priority to schedule at least one night a week to be alone, without kids or friends. This can be difficult because our schedules are so busy, but the health of our relationship and the health of our family is dependent on this,” Dr. Roth wrote.</p> <p> <strong>6. </strong><strong>Make time for yourself.</strong> No matter how busy your schedule, be sure to block off time for personal hobbies and self-care, Dr. Roth recommends. “Reading, running and tennis are things I enjoy,” she wrote. “I try to allot some time for these activities because I need an outlet. Sometimes my kids or husband are involved, and other times it is strictly me time.”</p> <p> Accepting that next invitation to a party or social event may also be a good idea: “I … make time for a weekend away with friends once a year. It is amazing how invigorating that time is,” Dr. Roth wrote.</p> <p> Check out the <a href="http://www.physicianfamilymedia.org/" rel="nofollow" target="_blank">full issue</a> of <em>Physician Family</em> for additional insights from Dr. Roth.</p> <p> <strong>Additional medical marriage advice from physicians and marriage experts:</strong></p> <ul> <li> Get <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">3 tips</a> for a successful medical marriage.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">advice from other physicians</a> who’ve navigated unique challenges in their medical marriage.</li> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-maintaining-happiness-marriage" target="_blank">these insights</a> from physician family experts to help you maintain happiness in your medical marriage.</li> <li> Follow these <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_blank">4 physician-recommended steps</a> to work- and home-life balance</li> </ul> <p align="right">  <em>By AMA staff writer</em> <em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f3a83be0-76a9-4ed0-b06a-164b65d062cc How a public health solution is reducing hypertension disparities http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_public-health-solution-reducing-hypertension-disparities Tue, 16 Feb 2016 21:40:00 GMT <p> Addressing health care disparities can help practices improve the health of patients in vulnerable at-risk populations. Learn how eight family medicine practices boosted hypertension control rates for diverse patients by more than 3 percentage points in just three months.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/2/8ae59a4c-9dc2-46ec-92af-c7cc35fb0dd9.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/2/8ae59a4c-9dc2-46ec-92af-c7cc35fb0dd9.Large.jpg?1" style="float:right;margin:15px;" /></a><strong>A targeted pilot</strong></p> <p> As part of the <a href="http://millionhearts.hhs.gov/" rel="nofollow" target="_blank">Million Hearts initiative</a>, the Summit County Public Health department (SCPH) and several partners in Ohio launched a pilot project with several family medicine practices to help reduce hypertension rates among black men.</p> <p> In Ohio, 38.5 percent of black patients have a diagnosis of hypertension, compared to 33.7 percent for white patients, according to the National Association of County and City Health Officials. Black men are also 49 percent more likely to die from stroke and 21 percent more likely to die from heart disease than white men.</p> <p> As a result of concerted efforts to combat these outcomes, in just three months, the eight practices reporting data in the pilot project were able to increase their blood pressure control rates for their patients with hypertension from 69.7 percent to 73.4 percent. The practices also saw the percentage of patients who scheduled follow-up appointments for their blood pressure increase from 66.0 percent to 68.8 percent. What was the secret to their success?</p> <p> <strong>Improving disparities and health outcomes</strong></p> <p> Kristi Kato, a community health supervisor at SCPH, recently shared key insights on the project at a showcase of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities/commission-end-health-care-disparities.page?" target="_blank">Commission to End Health Care Disparities</a>. She said the participating physicians and care teams improved blood pressure control among some of Ohio’s most vulnerable patients by:</p> <ul> <li> <strong>Effectively using health IT to enhance clinical quality measures. </strong><br /> Some of these improved clinical quality measures “included the development of hypertension registries pulled from the practices’ electronic health record (EHR) systems and clinical dashboards to closely monitor hypertension control rates within the practices,” Kato said.<br /> <br /> These measures allowed practices to better identify patients with hypertension, compile key data about their outcomes and create targeted measures to improve their blood pressure control rates.<br /> <br /> “Participating family practices identified close to 12,000 patients with uncontrolled hypertension, which they defined as having a diagnosis of hypertension and most recent blood pressure reading of />140/90 mmHg,” Kato said.</li> </ul> <ul> <li> <strong>Participating in official training sessions to improve team-based care and protocols for treating diverse patients with hypertension. </strong><br /> During the project, physicians and care teams—including family physicians, nurses, medical assistants, pharmacists and social workers—explored new ways to identify and care for black patients with hypertension.<br /> <br /> Care teams participated in an official team training day to improve processes and protocols for treating patients with hypertension. The training covered “the latest Joint National Committee guidelines for hypertension treatment, culturally competent hypertension care and team process mapping for identifying and treating patients with hypertension,” Kato said.</li> </ul> <ul> <li> <strong>Focusing on the social determinants of health.</strong> Physicians partnered with the SCPH care coordination units to “address nonmedical social needs that may be barriers to disease management” for patients with hypertension, Kato noted about the project. Care coordination staff helped address several community services for patients, such as transportation, housing, counseling, dental care, food assistance, utility assistance, and vision and hearing needs.<br /> <br /> Staff at the SCPH also developed a referral form for practice teams to use. These forms helped improve referrals for patients with hypertension to ensure they secured much-needed resources.<br /> <br /> “Physicians or their staff could fill out the patient’s information—including what social service needs may need to be addressed—then fax or email the completed form, with signed patient consent, to the SCPH care coordination unit,” Kato said.</li> </ul> <p> <strong>Explore these additional resources to improve your practice’s hypertension management:</strong></p> <ul> <li> Get the <a href="http://www.ama-assn.org/ama/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_blank">one infographic you need</a> for accurate blood pressure reading.</li> <li> Read the <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/3-questions-ask-patients-measuring-blood-pressure" target="_blank">three questions you should ask patients</a> when measuring their blood pressure.</li> <li> Hear <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/physicians-saying-doing-control-hypertension" target="_blank">what other physicians are doing</a> to control hypertension in their practices.</li> <li> See how you can help patients <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/patients-manage-blood-pressure-outside-office-visits" target="_blank">manage blood pressure outside of office visits</a>.</li> <li> Explore resources in the <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/improving-blood-pressure-control.page" target="_blank">“M.A.P.” (Measure accurately, Act rapidly, Partner with patients) collection</a>, offered through the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative. Resources include a list of common errors in blood pressure measurement, posters that show the proper positioning for the patient and the cuff, and resources about self-measured blood pressure.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4b6ab183-c3da-4ec7-a888-2d2cf006440e AMA-APS now member of Commission to End Health Care Disparities http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-aps-now-member-of-commission-end-health-care-disparities Tue, 16 Feb 2016 16:10:00 GMT <p> The AMA Academic Physicians Section (APS) is now a member of the <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/eliminating-health-disparities/commission-end-health-care-disparities.page?" target="_blank">Commission to End Health Care Disparities</a>. This will help ensure the section’s role in addressing disparities and increasing diversity in medicine.</p> <p> On a related note, AMA-APS chair Alma Littles, MD, was invited to participate, along with Patrice Harris, MD, chair-elect of the AMA Board of Trustees, in a Feb. 4 webinar, “<a href="https://www.aamc.org/initiatives/diversity/learningseries/454330/attractingblackmentomedicinephysicianscalltoaction.html" target="_blank" rel="nofollow">Attracting Black Men to Medicine: Physicians’ Call to Action</a>,” sponsored by the AMA, the Association of American Medical Colleges and the National Medical Association. </p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bca304e6-b494-4aa8-a168-f383c6d1c0e2 Involved in GME? Join the AMA Academic Physicians Section http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_involved-gme-join-ama-academic-physicians-section Tue, 16 Feb 2016 16:00:00 GMT <p> AMA members who are designated institutional officials, residency program directors and faculty involved in graduate medical education (GME) are invited to join the AMA Academic Physicians Section (APS).</p> <p> <strong>How the AMA-APS explores new solutions for GME</strong></p> <p> The AMA-APS holds two meetings per year, in June and November, and serves as the voice of academic physicians to the AMA House of Delegates. The next AMA-APS meeting is June 10-11 in Chicago.</p> <p> Educational sessions at previous section meetings have reflected a high interest level in topics related to GME, such as resident and fellow duty hours, GME funding, the Match process and the new single accreditation system for allopathic and osteopathic GME.</p> <p> <strong>Why the section adopted a new name </strong></p> <p> Formerly known as the AMA Section on Medical Schools, the section changed its name to the AMA Academic Physicians Section in light of a strategic refocus to better meet the needs of AMA members involved in all levels of medical education.</p> <p> The name change also serves to better reflect the breadth of the section, the scope of which includes faculty at nonmedical school-affiliated medical centers and residency programs. The prior name connoted an exclusive focus on undergraduate medical education, even though the section has welcomed academic physicians interested in graduate and continuing medical education, as well as those who serve in a clinical or research capacity within an academic medical center, community hospital or other health care setting that participates in medical education.</p> <p> “For all these reasons, the moniker ‘Section on Medical Schools’ was ready for retirement,” said Alma B. Littles, MD, chair of the AMA-APS Governing Council and senior associate dean for medical education and academic affairs at the Florida State University College of Medicine.</p> <p> “We believe this change will help the AMA-APS expand its engagement with academic physicians nationwide and help address the key challenge we all face—how best to educate our nation’s physicians,” Dr. Littles said.</p> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_blank">Learn more</a> about the AMA-APS, and <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section/members.page?" target="_blank">join now</a>. Also, check out <a href="http://www.ama-assn.org/ama/ama-wire/post/ama-academic-physicians-section-2015-interim-meeting-highlights" target="_blank">highlights</a> from the section’s meeting in November.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b2185bd5-6f25-4b83-8565-8b95df2a23b0 How residents in one state are fighting the opioid epidemic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residents-one-state-fighting-opioid-epidemic Mon, 15 Feb 2016 23:05:00 GMT <p> Amidst the national opioid epidemic, resident physicians in Massachusetts have taken matters into their own hands to improve public health and promote safe prescribing in their state. Learn how they gained access to a critical tool and put themselves in a better position to reduce prescription opioid misuse and provide more informed care to their patients.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/9/dc5502e6-3bdb-406a-b907-d97317d44c84.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/9/dc5502e6-3bdb-406a-b907-d97317d44c84.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Accessing the state’s prescribing database</strong></p> <p> In Massachusetts, the state’s prescription drug monitoring program (PDMP), an electronic database that physicians can consult to learn, among other things, patients’ controlled substance histories, has been in place since 1992. Although several major teaching hospitals exist in the Boston area alone, resident physicians have never had access to this database to check their patient’s prescription history before prescribing opioids.</p> <p> That is, until last December when two resident organizations came together and created a plan to gain access to their state PDMP through regulatory action.</p> <p> “Over the past couple months, it’s been a whirlwind of advocacy that ended in us getting access [to the PDMP],” said Grayson Armstrong, MD, an ophthalmology resident at Harvard Medical school and a leader within the Cambridge Health Alliance union, known as the Committee on Interns and Residents–Service Employees International Union. “Residents can [now] take an active role in managing and controlling the nation’s prescription opioid epidemic.”</p> <p> <strong>Why access is so important for resident physicians</strong></p> <p> “Prior to this change, residents were lacking one critical tool to inform our prescribing,” Dr. Armstrong said. “We were often in the dark in regards to a patient’s prior opioid prescription history. Now, we can be more confident in our decision to prescribe or withhold opioids.”</p> <p> Before gaining the authority to access the state PDMP, residents had to find an attending physician to check the PDMP for them when they had a patient who might require a prescription for a controlled substance.</p> <p> “The question used to come up all the time,” Dr. Armstrong said, “Should we check the PDMP? Is it worth the hassle of finding an attending who is willing to spend 15 minutes of their day trying to log in on our behalf? Or do we just trust this patient and give them opiates?”</p> <p> “Now, it’s going to completely revolutionize the way we approach this problem,” he said. “We can actually get a better grasp on whether this person has been prescribed opiates recently or in the past year, how many, when and by whom. I think it’s going to change a lot.”</p> <p> <strong>How they did it</strong></p> <p> Cambridge Health Alliance’s resident union “recently hired an incredible new member organizer, Melissa Markstrom, who listened when residents raised the opioid epidemic as a major topic of interest,” Dr. Armstrong said. “When I suggested we fight to get residents access to the PDMP, she took it and ran with it.”</p> <p> The union then created and circulated a petition requesting access for residents to the PDMP that garnered almost 300 signatures of medical students, residents and attending physicians from throughout the state.</p> <p> The Massachusetts Medical Society also was involved. “At their most recent state-wide meeting,” Dr. Armstrong said, “I presented members with the petition, and a large number of doctors signed on. Then the petition was sent to Gov. Charlie Baker.”</p> <p> “We had a chance to go to a forum where the governor was speaking on the opioid crisis in Massachusetts and spoke with him there,” he said. “I told him that residents didn’t have access to this, and he wasn’t aware of this issue prior to that day. As soon as he was aware, everyone else got on board with it …. It was a relatively quick change.”</p> <p> <strong>5 ways residents can help reduce prescription opioid overdose</strong></p> <p> The AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page" target="_blank">Task Force to Reduce Prescription Opioid Abuse</a>, made up of representatives from more than 25 health care associations, recommends five steps all physicians—including residents—should take to curb the epidemic.</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Register for and use your state PDMP</strong><br /> “I’m excited that now a huge portion of the prescribers in the state of Massachusetts will have access where they didn’t before,” Dr. Armstrong said. “Physicians and residents are the gatekeepers of the health care system’s resources, and it is important that we use these resources judiciously.”<br /> <br /> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" target="_blank">Learn more</a> about how to register for and use your state’s PDMP. Residents in a few states still don’t have access to PDMPs.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Enhance your education on effective, evidence-based prescribing</strong><br /> “It all boils down to education,” Dr. Armstrong said. “Residents can start by ensuring that they are educated and informed about the benefits and risks of opiate medications. Medical schools may or may not have taught current residents about pain management. If that training wasn’t provided, residents should take it upon themselves to learn all they can about appropriate prescribing of opiates.”<br /> <br /> Access a <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-resource-guide.page?" target="_blank">variety of expert educational resources</a> about opioid prescribing to get up to speed on this issue.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Expand access to naloxone in the community and through co-prescribing</strong><br /> Medical residents in Massachusetts aren’t finished with their work in moving their state toward reversing the nation’s opioid epidemic. We want now to “increase the number of naloxone and other prescribers at our hospital to try to give more residents access … by providing the treatments that [the local community] needs,” Dr. Armstrong said.<br /> <br /> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page?" target="_blank">Find out</a> whether your state has enacted measures to increase the use of naloxone and learn more about co-prescribing naloxone with this <a href="https://download.ama-assn.org/resources/doc/arc/x-pub/opioid-naloxone-ama.pdf" target="_blank">guide</a> (log in) compiled by the AMA Task Force.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Reduce the stigma of pain and promote comprehensive assessment and treatment</strong><br /> It’s important to reduce the stigma that surrounds pain patients in order for those with chronic pain to receive the care and the prescriptions they need to live happier, healthier lives.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Reduce the stigma of substance use disorder and expand access to comprehensive treatment</strong><br /> Residents should “be cognizant that addiction is a disease and needs treatment,” Dr. Armstrong said. “If you are seeing a patient that you think might be suffering from opiate addiction, you should do all you can to connect those individuals to appropriate care.”<br /> <br /> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_blank">Learn more</a> about substance use disorder and steps you can take to help patients with this condition.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a59e8cc7-8894-49db-beb6-9ff0b4715f92 What you need to start self-measured BP in your practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-start-self-measured-bp-practice Mon, 15 Feb 2016 22:50:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/ed5ee30d-57e2-4fc2-9612-31c9e72c0a42.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/ed5ee30d-57e2-4fc2-9612-31c9e72c0a42.Large.jpg?1" style="margin:15px;float:right;" /></a>Studies show that multiple blood pressures measured by patients in their homes over time can better predict cardiovascular morbidity and mortality rather than single, routine blood pressure measures that occur during an office visit. Whether your practice would like to implement <a href="http://www.ama-assn.org/ama/ama-wire/post/should-use-self-measured-blood-pressure-monitoring" target="_blank">self-measured blood pressure monitoring</a> (SMBP) or improve on how SMBP is being used with your patients, here are three resources that can help:</p> <p> <strong>1. </strong><a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/improving-blood-pressure-control.page" target="_blank"><strong>“M.A.P.” (Measure accurately, Act rapidly, Partner with patients) collection of tools</strong></a>, developed as part of the AMA’s commitment to <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a>, provide practical resources to help clinical teams collaborate successfully to improve patients’ blood pressure control. These tools include:</p> <ul> <li> Evidence-based checklists  </li> <li> Posters that illustrate proper positioning</li> <li> Tools to help you assess how well you’re clinical team is implementing the proper techniques required for accurate blood pressure measurement</li> <li> An infographic to remind patients and the care team of the common errors to avoid when measuring blood pressure</li> </ul> <p> <strong>2. The </strong><a href="https://download.ama-assn.org/resources/doc/about-ama/x-pub/iho-bp-engaging-patients-in-self-measurment.pdf" target="_blank"><strong>clinical guide</strong></a> <strong>(log in) to creating an effective </strong><strong>SMBP monitoring program</strong>, developed by the AMA and Johns Hopkins Medicine, provides everything you need to start using SMBP in your practice. This includes teaching patients how to self-measure blood pressure accurately and the appropriate set-up procedures to document and manage the process.</p> <p> The guide also offers suggestions for more successful implementation using SMBP, such as the following factors to help you select which patients will benefit the most from using SMBP:</p> <ul> <li> Patients with elevated readings that persist for two or more subsequent office visits</li> <li> Patients who already have a diagnosis of hypertension, are being ruled out for hypertension or have white coat hypertension</li> <li> Patients who have the ability to take accurate blood pressure measurements and are willing to do so consistently</li> <li> Patients who are willing and able to document the readings every time if the device doesn’t have memory storage capability</li> </ul> <p> <strong>3. </strong><a href="https://download.ama-assn.org/resources/doc/iho/x-pub/self-measured-blood-pressure.pdf" target="_blank"><strong>Fast facts on measuring accurately</strong></a> (log in), created by the AMA and Johns Hopkins Medicine, offer answers to common questions frequently asked by patients and physicians. These include:</p> <ul> <li> <span style="font-size:12px;"><strong>Where should I recommend my patients get a home blood pressure monitor?</strong><br /> Most monitors are purchased in pharmacies. Unfortunately, many public and private health insurance plans don’t cover the cost of self-monitoring devices. Prices for a typical high-quality device can range from $50 to $100. Another option for physicians is to purchase SMBP monitors for your practice and loan them out to patients.</span><br />  </li> <li> <span style="font-size:12px;"><strong style="font-size:12px;">Which monitor should I recommend?</strong><br /> Automated upper arm monitors are the most commonly recommended self-measured blood pressure monitors because they are more accurate and reliable than wrist or finger devices. With this type, the patient wraps a cuff around the upper arm and presses a button to get a digital blood pressure reading.<br /> <br /> When recommending an automated device, tell your patients to make sure the device is validated as being accurate and has memory to store readings whenever possible. If the monitor can calculate an average of two or three readings taken at short intervals, this is a very desirable feature that saves both you and the patient time, and provides more reliable readings.</span></li> </ul> <ul> <li> <span style="font-size:12px;"><strong>What is the best way for patients to use their blood pressure monitor at home?</strong><br /> Before starting to use SMBP with a patient, it is critical to perform a one-time training session when you or someone on your care team can watch the patient conduct a blood pressure measurement and make sure their blood pressure monitor is accurate when used on their arm.<br /> <br /> Share this <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" style="font-size:12px;" target="_blank">infographic</a> with your patients to reinforce the appropriate position recommended to get the most accurate readings. When measuring at home, patients should always rest for five minutes, then take two readings at one to two-minute intervals, both morning and evening for seven consecutive days. That’s a total of four measurements a day and 28 per week. After the first week, patients should report all of the numbers back to the office.<br /> <br /> When you receive the blood pressures from your patients, calculate the average value of all the systolic and diastolic blood pressures. Use this single average systolic and average diastolic blood pressure to determine whether your patient has hypertension or your patient’s blood pressure is controlled. Blood pressures at home ≥ 135/85 mm Hg are the cut point for hypertension in most patients using SMBP.<br /> <br /> Always make a plan with every patient so they know what to do if their blood pressure is out of the expected range or if they have symptoms associated with high or low blood pressure.</span></li> </ul> <p> <strong>Other ways to improve blood pressure monitoring</strong></p> <p> Make sure your care team is getting the most accurate readings and taking the most effective action to help your patients with hypertension get their blood pressure under control. Check out additional insights to help improve blood pressure management among your patients:</p> <ul> <li> Read the <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/3-questions-ask-patients-measuring-blood-pressure" target="_blank">three questions you should ask patients</a> when measuring their blood pressure.</li> <li> Discover <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/physicians-saying-doing-control-hypertension" target="_blank">what other physicians are doing</a> to control hypertension in their practices.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/120-mm-hg-new-bp-target-headlines-arent-telling" target="_blank">what the headlines aren’t telling you</a> about the SPRINT trial.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:405a08d1-b862-4149-8a41-f6bcba37d983 Serve your fellow academic physicians-seek election to AMA-APS http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_serve-fellow-academic-physicians-seek-election-ama-aps-2 Fri, 12 Feb 2016 15:04:00 GMT <p> Use your experience and talent in the service of the medical profession. AMA members can take advantage of the opportunity to serve on the 2016 AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/section-medical-schools.page" target="_blank">Academic Physicians Section (APS)</a> Governing Council. The deadline for nominations in March 7.</p> <p> AMA members are invited to apply for the following open positions on the governing council to begin in June 2016:</p> <ul> <li> Chair-elect</li> <li> At-large member (three slots)</li> <li> Delegate</li> <li> Alternate delegate</li> </ul> <p> Visit the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/section-medical-schools/leadership.page?" target="_blank">AMA-APS Web page</a> for position descriptions and term lengths. The section’s nominating subcommittee will review all applications and make recommendations to the AMA-APS Governing Council. If the proposed slate is approved by the governing council, it will be brought before the section for a vote at its annual meeting, June 10-11 in Chicago.</p> <p> To apply, email <a href="mailto:fred.lenhoff@ama-assn.org?subject=SMS%20nominations" rel="nofollow">Fred Lenhoff</a> of the AMA or call (312) 464-4635 to obtain the application form.</p> <p> AMA members also are invited to become more involved in medical education at the national level by seeking appointments to serve on boards and committees of key national medical education organizations. <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education/leadership.page?" target="_blank">Learn more now, and view current openings</a>. Email <a href="mailto:mary.oleary@ama-assn.org?subject=Nominations" rel="nofollow">Mary O'Leary</a> of the AMA or call (312) 464-4515 with questions.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2ea9cc4c-0cf2-4f76-96f2-2acdf0157723 Plan to attend education session on pre-exposure prophylaxis http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_plan-attend-education-session-pre-exposure-prophylaxis Fri, 12 Feb 2016 15:00:00 GMT <p> The Centers for Disease Control and Prevention <a href="http://www.cdc.gov/hiv/risk/prep/index.html" rel="nofollow" target="_blank">has emphasized</a> that pre-exposure prophylaxis (PrEP), a daily treatment that has been shown to be up to 92 percent effective in preventing HIV, will help reduce HIV infections by at least 70 percent, playing a key role in ending the HIV epidemic.</p> <p> The AMA Advisory Committee on Lesbian, Gay, Bisexual, and Transgender (LGBT) Issues will host an education session titled “Using PrEP in primary care settings” at the 2016 AMA Annual Meeting in Chicago this June to discuss the latest strategies in addressing the HIV epidemic with PrEP.</p> <p> This session will review current evidence, guidelines and best practices for integrating PrEP management in various clinical settings. Check the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page" target="_blank">advisory committee Web page</a> in mid-April for more details. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3e01d73b-5961-4cca-896e-1388a45eb8fb Altering the course to med school: The minority pipeline http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_altering-course-med-school-minority-pipeline Thu, 11 Feb 2016 21:23:00 GMT <p> The number of black men attending medical school <a href="http://www.ama-assn.org/ama/ama-wire/post/decline-of-black-men-medical-education" target="_blank">hasn’t increased since 1978</a>, underscoring a critical need for initiatives that will attract black men to medicine. How can medical schools and organizations tackle this timely issue? Learn from these key pipeline programs that already are helping underrepresented minorities overcome societal barriers to successfully transition to medical school.</p> <p> Last year, the Association of American Medical Colleges (AAMC) released its report, <a href="https://members.aamc.org/eweb/DynamicPage.aspx?Action=Add&ObjectKeyFrom=1A83491A-9853-4C87-86A4-F7D95601C2E2&WebCode=PubDetailAdd&DoNotSave=yes&ParentObject=CentralizedOrderEntry&ParentDataObject=Invoice%20Detail&ivd_formkey=69202792-63d7-4ba2-bf4e-a0da41270555&ivd_prc_prd_key=78B38423-34D5-433C-B4FB-76F0F5CAE008" rel="nofollow" target="_blank">“Altering the Course: Black Men in Medicine,”</a> which highlighted the decline among black men applying to and attending medical schools in the last 36 years. As a follow-up to the report, the AAMC, the AMA and the Student National Medical Association (SNMA) held<a href="https://urldefense.proofpoint.com/v2/url?u=https-3A__www.aamc.org_initiatives_diversity_learningseries_454330_attractingblackmentomedicinephysicianscalltoaction.html&d=CwMFAw&c=iqeSLYkBTKTEV8nJYtdW_A&r=Q_mJ8pN9ipgi28TKJ_MgzTSbWNrk_qY9w1AsmCui20c&m=XfgCXApS9cb3nVM6GFgMK_qIqV4gyLSmmvUxq2Y5q2A&s=SZUAn1PrE-N22_e5q18GYS8JzN6E38tZm5iSJ2YYwEw&e=" rel="nofollow" target="_blank"> a webinar </a>last week that discussed new solutions that will help increase the number of underrepresented minorities—particularly black men—attending medical school.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/12/07dec5ab-b3c7-43f1-aca3-c8c0ad0b224e.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/12/07dec5ab-b3c7-43f1-aca3-c8c0ad0b224e.Large.jpg?1" style="margin:15px;float:right;" /></a><strong>Barriers to black men entering medicine</strong></p> <p> Before institutions create new solutions, they should first understand societal barriers, said Cedric Bright, MD, a former president of the National Medical Association and assistant dean of Special Programs and Admissions to Medical School at University of North Carolina at Chapel Hill. Common barriers include a lack of proper primary education in science and math subjects and economic constraints that must be overcome to navigate a rigorous and expensive medical school application process.</p> <p> Dr. Bright also stressed the importance of planting physician mentors and role models in communities of color to help minority children even conceive of the idea to become a physician.</p> <p> Aside from entertainers and athletes, Dr. Bright said, “it’s very rare that we have substantial role models that are shown in media, and I think that sends a certain message to our children about who they can be.”</p> <p> Physicians, mentors and medical school counselors wield major influence, Dr. Bright said, especially among young black men in college who are exploring premedical education. While some students may desire to pursue a career in medicine, “oftentimes they’re not getting the kind of encouragement to keep moving.”</p> <p> “I saw that a lot in my undergraduate days, when we had roughly 45 black students who were premed at the beginning of my class. And by the end of our four years, there were only about 20 of us who actually took the MCAT and continued on the path [to medical school],” Dr. Bright said. “A lot of that had to do with the ‘weeding out’ classes that occurred and how they impacted students’ perception of how competitive [medical school] would be.”</p> <p> <strong>How physicians and educators can increase the number of minorities in medicine </strong></p> <p> To help students overcome educational, social and economic barriers, medical schools and organizations have developed strategic programs that provide underrepresented minorities the knowledge and resources they need to pursue careers in medicine. Some key programs presenters discussed in the webinar included</p> <ul> <li>  <strong>The SSTRIDE and Master’s Bridges programs at Florida State University (FSU).</strong><br /> “The pipeline needs to start early, even before middle school,” said Alma Littles, MD, a family physician and senior associate dean for Medical Education and Academic Affairs at FSU. She also serves as chair of the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_blank">Academic Physicians Section</a>, which recently broadened its mission to focus on diversity among faculty and in medical education.<br /> <br /> At FSU, “we have a successful model called the <a href="http://med.fsu.edu/index.cfm?page=sstride.home" rel="nofollow" target="_blank">SSTRIDE©—Science Students Together Reaching Instructional Diversity and Excellence—program</a> that we believe can be deployed in many settings,” Dr. Littles said. “It’s a program that actually starts at the middle school level and continues through high school, undergraduate and even into our <a href="http://med.fsu.edu/?page=AdvisingOutreach.masters" rel="nofollow" target="_blank">Master’s Bridge Program</a>.”<br /> <br /> The SSTRIDE program identifies students who are interested in pursuing a career in science, engineering, mathematics, health or medicine and gives them support services that help them develop a sense of responsibility, focus and motivation that is necessary to succeed in their chosen fields.<br /> <br /> Students in the Master’s Bridge Program take a year of medical and clinical science courses that can be applied toward a Master of Science in Biomedical Sciences. After successfully completing the program, students are admitted to FSU’s medical school, where educators provide them with additional resources, such as mentoring and advising throughout their medical school training.<br /> <br /> “If we’re going to get serious about attracting more black men to medicine,” Dr. Littles said, institutional leaders and educators must “provide students resources that will continue to enhance their success and not make them feel isolated, neglected or guilty [for being admitted].”</li> </ul> <ul> <li> <strong>The Pipeline Mentoring Institute of the SNMA.</strong><br /> While schools and educators work to promote diversity, medical students in the SNMA also have created a network of effective programs that can help increase the number of black men in medicine—a key part of the organization’s mission, said Anthony Kulukulualani, a third-year medical student at Tufts University School of Medicine and the SNMA national president.  <br /> <br /> “Through our pipeline programs, SNMA provides outreach and improvement to the medical field by targeting students as young as grammar school all the way through college,” Kulukulualani said. “We also provide academic resources and mentoring to help strengthen the retention of students once they enter medical schools.”<br /> <br /> SNMA’s Pipeline Mentoring Institute houses five different pipeline programs for underrepresented minority students at various stages of their education and personal development, Kulukulualani said.<br /> <br /> For instance, the SNMA’s Youth Science Enrichment Program “serves to stimulate elementary and junior high school students’ interest in science and health,” Kulukulualani said.  “And this continues with the Health Professions Recruitment Exposure Program, which exposes high school students to science-related activities, while introducing them to careers in the health field.”<br /> <br /> The SNMA also hosts the Brotherhood Alliance for Science Education, which “really tackles the issue of attracting black males to medicine” by partnering with grassroots and minority organizations working to increase “the encouragement, recruitment, admission and retention of young minority males into medicine,” Kulukulualani said.  <br /> <br /> The Pipeline Mentoring Institute also hosts programs that offer underrepresented minority students mentorship and resources throughout their premedical training. Learn more about the institute’s <a href="http://www.snma.org/index.php?pID=170" rel="nofollow" target="_blank">various pipeline programs</a>.</li> </ul> <ul> <li> <strong>The AMA’s Doctors Back to School Program (DBTS) and Minority Scholars Award.</strong><br /> “Organized medicine has a critical role to play” in ensuring that diversity in medicine is a real priority in health care, said Patrice A. Harris, MD, chair-elect of the AMA Board of Trustees.<br /> <br /> Dr. Harris said the AMA has developed critical policies and programs that support diversity in medicine. For instance, through the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/doctors-back-school.page?" target="_blank">Doctor’s Back to School Program</a>, physicians and physicians in training visit elementary schools to speak with students in underrepresented communities about future careers in medicine.<br /> <br /> “This is a critical program,” Dr. Harris said. “The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section.page?" target="_blank">AMA Minority Affairs Section</a> … conducts Doctor’s Back to School visits in conjunction with each AMA Interim and Annual Meeting.” The most recent program visits were hosted during the 2015 AMA Interim Meeting in Atlanta, where AMA members spoke to 900 children across two elementary schools.<br /> <br /> The <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/medical-education/minority-scholars-award.page?" target="_blank">AMA Foundation’s Minority Scholars Award</a> has provided $1.5 million in tuition assistance to nearly 150 medical students since the award was founded in 2004. The deadline for 2016 applicants is March 4. Dr. Harris noted that Kulukualani was among the award’s competitive scholarship recipients.<br /> <br /> Dr. Harris said the organization’s diversity efforts remind her of how valuable support for underrepresented minority students really is: “I grew up in West Virginia and wanted to be a physician since the eighth grade, but when I got to college, one of my college advisors recommended I attend nursing school,” Dr. Harris said. “Nursing is a noble profession but wasn’t what I wanted to do, so we need to make sure that there’s support out there for those who want to go to medical school and that support begins early.”<br /> <br /> Dr. Harris underscored that there needs to be a “continuum of support … to [engage] African-American men and make sure they are well represented in medical schools as our future physician leaders.”</li> </ul> <p> <strong>Learn more ways to promote med school diversity:</strong></p> <ul> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/one-med-schools-innovative-approach-diversity" target="_blank">how one school successfully created</a> and implemented a strategic diversity action plan. Plus, five key steps educators can take to create a diversity action plan at their own school.</li> <li> Learn about the 21 medical students the AMA Foundation selected as future minority physician leaders in 2015. Read their unique perspectives on being students of color in medical school and <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">how they plan to succeed while promoting diversity in medicine</a>.</li> <li> Follow these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-boost-diversity-medical-community" target="_blank">5 med ed solutions</a> to help boost diversity, and <a href="http://www.ama-assn.org/ama/ama-wire/post/changing-face-of-med-ed-5-keys-student-diversity" target="_blank">flag these additional tips</a> for more ways to change the face of medical education.</li> <li> Learn how one school’s holistic solution <a href="http://www.ama-assn.org/ama/ama-wire/post/schools-holistic-solution-boosting-hispanic-students-medicine" target="_blank">is boosting the number of Hispanic physicians</a>.</li> <li> Visit the AMA Minority Affairs Section <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us.page?" target="_blank">Web page</a>, which features the latest on AMA policies, news and events to promote diversity in medicine and public health. You also can <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us/minority-affairs-consortium-membership/mac-membership-registration.page" target="_blank">join the section</a> to get more involved.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2e0ff53c-c4fb-4385-9599-82257e71f254 Experts discuss why improving EHRs should be a top priority http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_experts-discuss-improving-ehrs-should-top-priority Wed, 10 Feb 2016 20:18:00 GMT <p> A focus on the design and end-user experience of electronic health records (EHR) is key to improving the practice of medicine for both physicians and their patients. Find out what five experts had to say about why improving EHRs must be a top priority.</p> <p> <strong>What’s the problem with EHRs?</strong></p> <p> With the Medicare Merit-Based Incentive Payment System (MIPS) on the horizon, EHRs must be designed to work more effectively so the new system does not repeat the issues of the past.</p> <p> “Constraints are interfering with the evolution of the technology,” said AMA President Steven J. Stack, MD. “The vendors have designed products to satisfy the government and its certification program but … do not fulfill the needs of the clinicians.”</p> <p> “We have to help the technology blend into the background as a supporting role,” Dr. Stack said. “One of its central failures right now is that EHRs are the central actor in a play of people, and we need to get the people—the patients, the physicians and the other caregivers—back in the center of this performance.”</p> <p> “Physicians spend too much time away from their patients and also continuing their work at home,” said Christine Sinsky, MD, AMA vice president of professional satisfaction. A study at the University of Wisconsin found that doctors spend 38 hours a month of their own personal time on documentation, with a peak on Saturday nights, Dr. Sinsky said. “I don’t know if that’s good for patients …. I want my doctor to love her job.”</p> <p> Physicians often feel that their jobs have transformed from doctor to typist, Dr. Sinsky said. “In a courtroom, we don’t expect the judge or the attorneys to do their professional work … and [simultaneously] create the legal record of the proceedings, but we have asked that of our physicians. [In addition], we’re asking for a near verbal recounting of every detail that happened—and that’s not humanly possible.”</p> <p> <strong>What does the future of EHRs look like?</strong></p> <p> Designing the future first requires a dream, which then becomes a reality through hard work and diligence.</p> <p> “My dream for the EHR is to be able to provide the infrastructure, the technology to make it really, really easy for physicians to get back to the art of caring for the patient,” said Nancy Gagliano, MD, chief medical officer of CVS Minute Clinic. “Put in the pieces that let the system do the system kind of work, and let the physician be the doctor.”</p> <p> Population health also has been an important part of the conversation about the future state of EHRs. Michael Wasser, CEO of BloomAPI, spoke of promise in this realm. “We’re going to see populations of people getting healthier en masse [and] living longer, more healthy lives,” Wasser said.</p> <p> When reading current EHRs, “it’s almost like you have a scroll, and you have to read through the whole scroll to see what’s actually happened to this individual,” Wasser said. “There’s no index; you can’t look the thing up.” The ability to see this kind of information broken down into usable data for improved health outcomes will make a difference in the future, he said.</p> <p> <strong>Interested in hearing more of this discussion?</strong> A group of health IT and medical practice experts, including these leaders, are speaking at an IEEE PULSE On Stage event, “Electronic health records: What went wrong? Can it be fixed?” Sponsored in part by JAMA, this event is taking place Feb. 28 at the Venetian Hotel in Las Vegas and will offer continuing medical education credit. <a href="http://onstage.embs.org/ehr/" target="_blank" rel="nofollow">Learn more</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8b746439-f94d-435b-965b-4d75a6e0b1bc Where residents practice: 3 key postresidency trends http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_residents-practice-3-key-postresidency-trends Wed, 10 Feb 2016 18:32:00 GMT <p> Wonder where your peers practice after training? A national report highlights top practice trends among recent residents, including the percentage who practice in medically underserved areas and those who have earned faculty appointments at MD-granting schools.</p> <p> The Association of American Medical Colleges (AAMC) recently released its annual <a href="https://www.aamc.org/data/448474/residentsreport.html" rel="nofollow" target="_blank">Report on Residents</a>, which provides “information on certain characteristics of residency applicants and residents, as well as information on post-residency professional activities,” according to the AAMC.</p> <p> Using data from various sources, researchers at the AAMC noted these practice trends among residents who completed training from 2005 to 2014:</p> <p> <strong>1. Almost one-quarter of recent residents practiced in medically underserved areas</strong>.<br /> Overall, 23.9 percent of recent residents practiced in underserved areas after training, and “the rates of practicing in medically underserved areas were greater than 20 percent for many of the largest specialties,” according to <a href="https://www.aamc.org/data/448488/c2table.html" rel="nofollow" target="_blank">data</a> from the report. These specialties included:</p> <ul> <li> Family medicine (24.5 percent)</li> <li> Internal medicine (24.7 percent)</li> <li> Obstetrics-gynecology (22.4 percent)</li> <li> Neurology (25.3 percent)</li> <li> Pediatrics (24.5 percent)</li> <li> Psychiatry (25.2 percent)</li> <li> General surgery (24.4 percent)</li> </ul> <p> <strong>2. More than one-half—52.9 percent—of recent residents now practice in the state where they did their residency training</strong>.<br /> This trend was even more prevalent among recent residents practicing certain specialties, including emergency medicine, integrated thoracic surgery and the combined specialty of pediatrics-dermatology. The report provides a <a href="https://www.aamc.org/data/448492/c4table.html" rel="nofollow" target="_blank">full breakdown</a> of the percentage of residents who practiced in the same locations where they trained.</p> <p> <strong>3. A notable percentage of residents landed faculty appointments after training.</strong><br /> “Among those individuals who completed residency … 15.9 percent currently hold a full-time faculty appointment at a U.S. MD-granting medical school,” the report <a href="https://www.aamc.org/data/448498/c7table.html" rel="nofollow" target="_blank">notes</a>.<br /> <br /> The percentage of residents with full-time appointments varied greatly by specialty and subspecialty, ranging from 3.9 percent of residents in family medicine to 100 percent of residents in neuromuscular medicine. Additional subspecialties with a high percentage of residents who earned faculty appointments included:</p> <ul> <li> Neurodevelopmental disability (61.5 percent)</li> <li> Pediatric surgery (56.9 percent)</li> <li> Pediatrics-medical genetics (55.6 percent)</li> <li> Pediatric urology (52.5 percent)</li> <li> Otology-neurotology (51.9 percent)</li> </ul> <p> <strong>Get more insights on practice options after residency:</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-really-want-future-practice" target="_blank">what resident really want in a future practice</a>.</li> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/things-consider-before-choose-practice-setting" target="_blank">these key descriptions</a> of practice settings to ensure you understand your practice options after residency.  </li> <li> Use <a href="http://www.ama-assn.org/ama/ama-wire/post/starting-job-hunt-use-employment-resources" target="_blank">these employment resources</a> to conduct an effective job search. </li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ab0781b6-44f2-4511-86e0-75181f915022 6 top financial planning mistakes physicians make http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-top-financial-planning-mistakes-physicians Tue, 09 Feb 2016 22:30:00 GMT <p> Planning for your financial future is a personal priority for most physicians, but ensuring the security of the lifestyle you wish to maintain is a complex process fraught with risk. <em>AMA Wire</em>® spoke to an expert in physician finances, who shared the top mistakes physicians make—and ways to ensure they don’t derail you from your financial goals.</p> <p> <strong>Know what not to do</strong></p> <p> It’s important to understand the major pitfalls facing physicians so you can plan accordingly. We spoke to Bill Zelenik, CEO of Millennium Brokerage Group, about the issues he has seen during his decades of experience in financial planning. Zelenik said several common mistakes rise to the top of the list of things to avoid:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>You skip a “wellness approach” when it comes to personal finances.</strong><br /> “It’s very important to take a wellness approach to finances,” Zelenik said. The essence of this approach is that “you treat your retirement and your finances like you would your health. You should do a full review at least once a year, and it’s better to do a review of your finances in their entirety at least quarterly.”<br /> <br /> Zelenik said the problem is that many physicians don’t regularly meet with a financial professional to “go over their financial world in its entirety.” That means that physicians may make errors that could be prevented, such as allocating their savings without the appropriate diversity that would keep them from being exposed to too much risk.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>You make decisions based on market news.</strong><br /> Just keeping track of the ups and downs of finances via the news is too general in nature, Zelenik said. “The average person gets into and out of markets later than the experts, which can cause you to lose money.” You need a professional who stays on the pulse of these trends day in and day out.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>You manage and invest your finances on your own.</strong><br /> “A lot of doctors make the mistake of handling their own money,” Zelenik said. “That’s kind of like performing surgery on yourself.”<br /> <br /> “Many physicians have several people that they work with, but it’s on individual accounts, such as their retirement plan or insurance,” Zelenik said. But none of these professionals are connected or trusted with everything. “This is too much to keep up with,” Zelenik said.<br /> <br /> Instead, physicians need a good financial advisor who can look at their “whole financial world,” Zelenik said. That way, the advisor can help you make wise overall decisions. For instance, an advisor would be able to tell you if your mortgage is out of sync with your other investments or if you need to put greater emphasis on paying down your debt.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>You choose your financial advisor simply based on a friend’s recommendation.</strong><br /> Getting a friend or colleague’s recommendation of a financial advisor they trust and have enjoyed working with is a good start, but Zelenik said it’s even more important to find an advisor that you feel completely comfortable with.<br /> <br /> “A lot of people don’t spend enough time interviewing financial professionals,” he said. “But you need to find an advisor who fits with you. Long-term relationships with a financial advisor can be really beneficial—they come to know your kids, what you’ve set aside and your goals.”<br /> <br /> Zelenik said another important step is to do a search on a potential advisor’s Central Registration Depository (CRD) number. You can plug this number into an <a href="http://brokercheck.finra.org/" rel="nofollow" target="_blank">online lookup tool</a> offered by the Financial Industries Regulatory Authority (FINRA), which will list any issues associated with that advisor.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>You don’t involve your spouse in the planning and decision-making.</strong><br /> Physicians often don’t include their spouse enough in the overall financial management, Zelenik said. “It’s important so you both understand your shared goals and what you’re trying to accomplish,” he explained. “You need to understand your budget and what it includes.”<br /> <br /> And there’s another benefit beyond being on the same page: “Many times, involving a spouse … helps to keep things more conservative.”</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>You don’t know how to access your funds during retirement.</strong><br /> Having sufficient funds for retirement is a big achievement—but it’s only part of the equation for a secure financial future. Another major component is understanding how to take that money out during retirement.<br /> <br /> “You need to understand what the most efficient ways are,” Zelenik said. “The answer is not always to take it out of your retirement plan.” A good financial advisor should be able to help you make these decisions as well.</p> <p> <strong>Create a blueprint for the retirement you want</strong></p> <p> Fewer than 5 percent of physicians consider themselves “very knowledgeable” about personal finances and retirement planning, according to recent research by AMA Insurance. If you think you need to learn more about strategies to secure your financial future, you’re not alone.</p> <p> The <a href="http://www.cvent.com/events/2016-physicians-financial-summit/event-summary-063e4fc84ba94bc8b48ce1e943dca680.aspx" rel="nofollow" target="_blank">Physicians Financial Summit</a>, scheduled to take place May 1-4 in Orlando, 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> Constructing a retirement plan that will stand the test of time</li> <li> Avoiding costly IRA mistakes</li> <li> Minimizing taxes in retirement</li> <li> Determining strategies beyond a 401k to supplement retirement funds</li> <li> Funding personal long-term care expenses</li> </ul> <p> <a href="https://www.amainsure.com/2016-Physicians-Financial-Summit.html?utm_source=Wire-Announcement&utm_medium=AMA-Wire&utm_campaign=Physicians-Financial-Summit" rel="nofollow" target="_blank">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="http://www.ama-assn.org/ama/ama-wire/blog/Financial_Issues/1" target="_blank">additional insights</a> from professionals who specialize in physician finances in other <em>AMA Wire</em> posts, including:</p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-partner-physician-friendly-financial-advisor" target="_blank">5 ways to partner with a physician-friendly financial advisor</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/kick-financial-plan-high-gear" target="_blank">How to kick your financial plan into high gear</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/top-tips-developing-med-school-loan-repayment-strategy" target="_blank">Top tips for developing a med school loan repayment strategy</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/consider-planning-practice-exit-strategy" 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="https://twitter.com/amy_amawire" rel="nofollow" target="_blank"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:30f440f8-6905-4101-8033-6fc2e7446693 Court to decide on censorship in the exam room http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-decide-censorship-exam-room Tue, 09 Feb 2016 22:03:00 GMT <p> A rare rehearing has been granted for a case that could have significant ramifications for the patient-physician relationship. The outcome physicians are hoping for: That the court will overturn a state law that limits which health and safety topics physicians can talk about with their patients in the exam room.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/2/e6ce9c6b-6e17-4b08-8240-3f02c4f658d3.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/2/e6ce9c6b-6e17-4b08-8240-3f02c4f658d3.Full.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The 11th Circuit Court has granted a rare rehearing to decide whether a state can bar physicians from communicating freely with their patients and their families about firearm safety. Providing this kind of safety counseling can help prevent gun-related injuries and deaths, particularly among children.</p> <p> Physician groups in 2014 filed a brief in support of a formal petition for the rehearing of a precedent-setting case in which a federal appellate court had issued a split-decision that upheld a controversial Florida law that bars physicians from freely discussing firearm safety with their patients.</p> <p> While one of the judges on the three-person panel sided strongly with physicians in opposing the law, the two other judges ruled in favor of the state. The rehearing will be held <em>en banc</em>, meaning all 11 active judges will sit on the panel for decision.</p> <p> The AMA and several other medical associations last month filed an amicus brief in support of the rehearing. “The discussions physicians have with their patients do not threaten those patients’ right of gun ownership,” the <a href="https://download.ama-assn.org/resources/doc/legal-issues/x-pub/wollschlaeger-v-florida-2016-petition-rehearing.pdf" target="_blank">brief</a> (log in) said. “The Second Amendment protects citizens against governmental confiscation of their firearms. Physicians neither confiscate nor facilitate anyone else’s confiscation of firearms—nor is it likely that they could or would do so.”</p> <p> “This case,” the brief said, “affects the right of patients to be given the best possible medical care from their physicians—and not just on the topic of firearm safety.”</p> <p> The nine medical associations that asked for the rehearing have highlighted the “exceptional importance of this case.” The ruling not only has direct negative consequences on the practice of medicine in Florida but also sets a precedent that could encourage other state lawmakers to proceed with legislation that similarly would restrict physicians’ conversations with their patients about health and safety.</p> <p> <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center/case-summaries-topic.page?" target="_blank">Learn more</a> about other cases in which the AMA defended physicians and patients in the nation’s courts.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a20d28bd-79d2-4343-8b13-749ff0e48e99 What it’s like to be in otolaryngology: Shadowing Dr. Gillespie http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-otolaryngology-shadowing-dr-gillespie Mon, 08 Feb 2016 22:43:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/f8186b05-db46-4d2e-b946-a9885d02e771.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/f8186b05-db46-4d2e-b946-a9885d02e771.Large.jpg?1" style="margin:15px;float:right;" /></a>As a medical student, do you ever wonder what it’s like to be an ear, nose and throat (ENT) physician? Here’s your chance to find out.</p> <p> Meet Christina Gillespie, MD, an ENT specialist and featured physician in <em>AMA Wire’s</em>® “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties.</p> <p> Read her insights to help determine whether a career in otolaryngology might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. </strong><strong>Gillespie</strong></p> <p> <strong>Specialty: </strong>Otolaryngology</p> <p> <strong>Practice setting: </strong>Group practice (but I served in the U.S. Army as an ENT physician for 14 years).</p> <p> <strong>Employment type: </strong>Private practice</p> <p> <strong>Years in practice:</strong> 11 years</p> <p> <strong>A typical week in my practice: </strong><br /> I typically spend two-and-a-half to three days per week seeing patients in the office. I usually spend one day per week in the OR. I spend additional time seeing patients in the hospital. I typically work 8-12 hours per day during the workweek. I also work some weekends. </p> <p> <strong>The most challenging and rewarding aspects of caring for patients in otolaryngology:</strong><br /> I find the administrative burden of note writing and dealing with insurance companies the most challenging. The most rewarding is helping patients feel better. </p> <p> <strong>Three adjectives that describe the typical ENT physician:  </strong><br /> Smart. Action oriented. Sociable.</p> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school: </strong><br /> ENT doctors have reasonable hours. We spend most of our time seeing patients in the outpatient setting. I think I am able to maintain a good work-life balance. I also have a very helpful and supportive husband. We have a three–year-old child. Some evenings and weekends, he is the primary caregiver because I have to work. When we moved to New Jersey so I could start a new job, my husband took a year off from work to take care of our daughter and get us moved in and unpacked into our new house. He now works part time as a college professor, commuting twice per week to New York City and working from home three days a week. Our daughter started daycare at 14 months old. Before that, we kept her home. She is now in day care full time. The day care is down the street from where I work. I usually take her in the morning. My husband and I both pick her up depending upon our schedules. </p> <p> <strong>One skill every physician in training should have for otolaryngology but won’t be tested for on the board exam:  </strong><br /> You need to be flexible. ENT physicians deal with a wide variety of problems and patients. We care for everyone from newborns to the elderly. You also need to be able to function well in stressful situations. While most of what we do is low stress, we are called to deal with emergencies, such as airway obstruction and epistaxis. </p> <p> <strong>Advice for women medical trainees</strong><strong>:</strong><br /> I think gender impacts our specialty at the level of medical school. I think women are encouraged to become primary care providers like pediatricians and discouraged from pursuing surgical subspecialties. I always tell female medical students, become a pediatrician because you want to become a pediatrician. However, you have to love what you do. Women should lean into their careers. Do what you want. Do not make decisions because you may or may not get married or may or may not have children. A woman happy with her job makes a better wife and a better mother. Within the field, I think gender does not have a significant impact. Women otolaryngologist are becoming increasingly common. </p> <p> <strong>One question physicians in training should ask before pursuing otolaryngology: </strong><br /> Do they want a specialty that is a mix of both medical and surgical treatments for a wide variety of medical problems?</p> <p> <strong>Three books every medical student interested in otolaryngology should read:</strong></p> <ul> <li> <em>Otolaryngology–Head and Neck Surgery: Clinical Reference Guide</em> by Raza Pasha, MD, and Justin Golub, MD</li> <li> <em>Textbook of Head and Neck Anatomy </em>by James Hiatt, PhD, and Leslie Gartner, PhD</li> </ul> <p> <strong>Online resources students interested in my specialty should follow: </strong><br /> The website for <a href="http://www.entnet.org/" rel="nofollow" target="_blank">the American Academy of Otolaryngology</a>. Also, they should start working on their online professional social media profile.</p> <p> <strong>One quick insight I'd give students who are considering otolaryngology: </strong><br /> I think otolaryngology is a great specialty with a strong future, even with all the changes occurring in medicine.</p> <p> <strong>If I had a mantra or song to describe my life in this specialty, it’d be:</strong><br /> “Happy” by Pharrel Williams or “Welcome to the Jungle” by Guns and Roses. It kind of depends on the day!</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="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_blank">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_blank">infectious disease</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-adolescent-internal-medicine-shadowing-dr-rohr-kirchgraber" target="_blank">adolescent medicine</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-physical-medicine-rehabilitation-shadowing-dr-wolfe" target="_blank">physical medicine and rehabilitation</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-interventional-radiology-shadowing-dr-ding" target="_blank">radiology</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-orthopedic-surgeon-shadowing-dr-dangles" target="_blank">orthopedic surgery</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty </em><a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d2fafcc0-65c1-4e1b-8e2b-5a879a681315 What it’s like to be in vascular surgery: Shadowing Dr. Aziz http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-vascular-surgery-shadowing-dr-aziz Mon, 08 Feb 2016 22:38:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/282cfa2d-8877-43d4-b9bd-928e0074b389.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/282cfa2d-8877-43d4-b9bd-928e0074b389.Large.jpg?1" style="margin:15px;float:right;" /></a>As a medical student, do you ever wonder what it’s like to be a vascular surgeon? Here’s your chance to find out.</p> <p> Meet Faisal Aziz, MD, a vascular surgeon, educator and featured physician in <em>AMA Wire’s</em>® “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties.</p> <p> Read his insights to help determine whether a career in vascular surgery might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. Aziz</strong></p> <p> <strong>Specialty: </strong>Vascular surgery</p> <p> <strong>Practice setting: </strong>Academic university hospital  </p> <p> <strong>Employment type: </strong>Employed</p> <p> <strong>Years in practice: </strong>4</p> <p> <strong>A typical week in my practice: </strong><br /> A typical day involves making rounds, seeing patients in the outpatient setting or doing surgical operations. Workweek hours are variable, depending on the duration of operations. </p> <p> <strong>The most challenging and rewarding aspects of caring for patients in vascular surgery:</strong><br /> Patients who require vascular surgery operations are generally sicker patients with multiple medical comorbidities. The most challenging aspect is complex anatomy and extremely complicated post-operative course. The most rewarding feeling is saving somebody’s life or limb or preventing stroke by doing operations and bringing them back to their baseline.</p> <p> <strong>Three adjectives that describe the typical physician in vascular surgery:</strong><br /> Meticulous. Attention to detail. Dedication.</p> <p> <strong>One skill every physician in training should have for vascular surgery but won’t be tested for on the board exam:  </strong><br /> Technical skills to do surgical operations.</p> <p> <strong>One question physicians in training should ask before pursuing vascular surgery:</strong><br /> Am I dedicated to taking complete care of these very complex patients?</p> <p> <strong>Three books every medical student interested in vascular surgery should read:</strong></p> <ul> <li>  <em>Essentials of General Surgery</em> by Peter Lawrence, MD</li> <li>  <em>Current Surgical Diagnosis and Treatment</em> by Lawrence Way, MD</li> <li> <em>The Student’s Textbook of Surgery</em> by William Rambo, MD</li> </ul> <p> <strong>Online resources students interested in my specialty should follow:</strong></p> <ul> <li>  <a href="http://www.vascularweb.org/" rel="nofollow" target="_blank">Vascular Web</a>, the website of the Society for Vascular Surgery</li> </ul> <p> <strong>One quick tip I'd give students who are considering vascular surgery: </strong></p> <ul> <li> Apply for the Society for Vascular Surgery student scholarship, and attend the annual meeting to get all your questions answered about this specialty.</li> </ul> <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="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_blank">Shadow Me Specialty Series</a> to learn additional insights from physicians in such specialties as <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_blank">infectious disease</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-adolescent-internal-medicine-shadowing-dr-rohr-kirchgraber" target="_blank">adolescent medicine</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-physical-medicine-rehabilitation-shadowing-dr-wolfe" target="_blank">physical medicine and rehabilitation</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-interventional-radiology-shadowing-dr-ding" target="_blank">radiology</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-orthopedic-surgeon-shadowing-dr-dangles" target="_blank">orthopedic surgery</a>, among others.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty </em><a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_blank">resource guide</a> (member log in required).</li> <li> Be sure to avoid these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_blank">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:48541114-d9e6-44fb-a2d6-f21d4307c0a6 Why you should use self-measured blood pressure monitoring http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_should-use-self-measured-blood-pressure-monitoring Mon, 08 Feb 2016 21:37:00 GMT <p> In the last decade, the number of hypertension-related deaths in the United States <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/hypertension-related-deaths-climb-upward-heres-can" target="_blank">increased by 66 percent</a> according to the Centers for Disease Control and Prevention (CDC). Self-measured blood pressure monitoring (SMBP) is a great way to engage patients in managing their hypertension. With American Heart Month underway, we’re sharing three key advantages to using SMBP in your practice.</p> <p> Sometimes called home blood pressure monitoring, SMBP is any self-measured blood pressure that occurs outside the clinical setting. Research has shown that SMBP not only improves blood pressure control, but also increases patient engagement in making healthy lifestyle changes and improving medication adherence.</p> <p> Here are three clinical benefits of using SMBP in your practice:</p> <ul> <li> <strong>SMBP is a better predictor of health. </strong>Randomized controlled trials have shown that blood pressure measurements conducted at home predict cardiovascular morbidity and mortality better than blood pressure measurements taken at the doctor’s office.<br />  </li> <li> <strong>You will obtain more blood pressure readings over a longer period of time. </strong>Having blood pressure readings that are more representative of a patient’s true blood pressure are crucial to accurately diagnosing and assessing blood pressure control options for patients with hypertension.<br /> <br /> <span style="font-size:12px;">SMBP also helps guide your decision making when trying to diagnose a patient with high blood pressure. Using blood pressures measured outside of the office is now recommended by the U.S. Preventive Services Task Force to confirm the diagnosis of hypertension when office blood pressures are high.</span></li> </ul> <ul> <li> <strong>SMBP helps patients take control of their own health. </strong>Patients often adhere to treatment more often when they feel like they are a part of the process of improving their health.<br /> <br /> <a href="http://www.ama-assn.org/ama/ama-wire/post/self-monitoring-blood-pressure-changed-this-patients-life" style="font-size:12px;" target="_blank">Read how one patient</a><span style="font-size:12px;"> partnered with his physician to improve his health using self-measured blood pressure.</span></li> </ul> <p> <strong>Other ways to improve blood pressure monitoring</strong></p> <p> Make sure your health care team is getting the most accurate readings and taking the most effective action to help your patients with hypertension get their blood pressure under control. The AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative offers several resources for your team and your patients.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/improving-blood-pressure-control.page" target="_blank">“M.A.P.” (Measure accurately, Act rapidly, Partner with patients) collection of tools</a> includes:</p> <ul> <li> Common errors in blood pressure measurement</li> <li> Posters that shows the proper positioning for the patient and the cuff</li> <li> Additional resources about self-measured blood pressure</li> </ul> <p> Check out additional insights to help improve blood pressure management among your patients:</p> <ul> <li> This <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_blank">infographic</a> from the AMA is a quick reference for you, your team and your patients to avoid common measurement errors that can result in a misleading reading.</li> <li> Read the <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/3-questions-ask-patients-measuring-blood-pressure" target="_blank">three questions you should ask patients</a> when measuring their blood pressure.</li> <li> Hear <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/physicians-saying-doing-control-hypertension" target="_blank">what other physicians are doing</a> to control hypertension in their practices.</li> <li> See how you can help patients <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/patients-manage-blood-pressure-outside-office-visits" target="_blank">manage blood pressure outside of office visits</a>.</li> <li> Review the <a href="http://www.ama-assn.org/ama/ama-wire/blog/2" target="_blank">5 ways you can promote better heart health</a> throughout American Heart Month.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5e69d084-39e0-42cc-b132-c8c41da83203 Critical questions for the ethics of organ transplants http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_critical-questions-ethics-of-organ-transplants Mon, 08 Feb 2016 20:00:00 GMT <p> Transplant specialists’ success has created demand for their expertise, despite organ shortages. But how do you solve the ethical questions of organ donation when each transplant requires a voluntary sacrifice from another human being? Learn how physicians are grappling with these questions and the ways the medical community is looking to increase organ donation.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/3/743c404f-b970-43d8-a3f9-1a5763a1056c.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/3/743c404f-b970-43d8-a3f9-1a5763a1056c.Full.jpg?1" style="margin:15px;width:365px;height:250px;float:right;" /></a></p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">February issue</a> of the <em>AMA Journal of Ethics</em> explores the key ethical concepts for professionals and patients in transplant medicine, including consent, extended criteria organs, regulatory oversight and donor incentives.</p> <p> Articles featured in this issue include:</p> <ul> <li> <a href="http://journalofethics.ama-assn.org/2016/02/ecas2-1602.html" target="_blank">“How to communicate clearly about brain death and first-person consent to donate.”</a> Even when a patient gives clear donor consent, how can physicians also communicate openly and avoid confusion among family members who may be struggling to accept the inevitable death of their loved one?</li> <li> <a href="http://journalofethics.ama-assn.org/2016/02/sect1-1602.html" target="_blank">“Ethical considerations of transplantation and living donation for patients with alcoholic liver diseases.”</a> Given organ shortages and social and cultural stigmas that surround alcohol abuse, equal access can be a difficult goal to maintain when patients present with taboo illnesses. What should physicians prioritize when making transplantation decisions for patients with alcoholic liver disease?</li> <li> <a href="http://journalofethics.ama-assn.org/2016/02/ecas1-1602.html" target="_blank">“Should physicians attempt to persuade a patient to accept a compromised organ for transplant?”</a> The donor population is not necessarily always healthy, but when an organ with compromised quality is available, the physician must offer the best advice to the patient regarding risk while also respecting that patient’s autonomy.</li> <li> <a href="http://journalofethics.ama-assn.org/2016/02/pfor2-1602.html" target="_blank">“Technology- and policy-based strategies for increasing supply of deceased donor livers.”</a> Many strategies for increasing organ supplies—both policy-based and technological—have been proven successful. What are the next steps for global education efforts to raise organ donation awareness?</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-feb-2016.mp3" target="_blank">February podcast</a>, Dorry Segev, MD, associate professor of surgery at Johns Hopkins University School of Medicine, discusses whether current organ allocation policy contributes to disparities in access, possible ways to maximize equity, and what physicians should advise their patients to do between policy changes.</p> <p> <strong>Ethics Poll</strong></p> <p> Give your answer to <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">this month’s poll</a>: Which value is the most important when prioritizing patients listed for organ transplant?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insight for medical students and physicians. <a href="https://www.rapidreview.com/AMA/CALogon.jsp" rel="nofollow" target="_blank">Submit your work</a> for publication.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c8ef97da-2a83-48be-8cd1-5644b9add1b9 Graduating students: Tell us where you match http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_graduating-students-tell-match Mon, 08 Feb 2016 18:13:00 GMT <p> Tell us where you match for a chance to win one of the following prizes in the AMA’s Match Day 2016-Survive Your First Week of Residency Sweepstakes:</p> <ul> <li> A two-week meal subscription plan gift card from Blue Apron, Inc. (estimated value $120)</li> <li> An AMA branded water bottle (estimated value $10)</li> <li> An AMA branded gym bag (estimated value $20)</li> </ul> <p> A total of sixty (60) winners will be chosen in a random drawing. Winners will be notified directly by email on or about April 19, 2016.</p> <p> Here’s how to enter the sweepstakes:</p> <ol> <li> Write your match location on the back of the card you received from the AMA.</li> <li> Post a photo of yourself with the card on Match Day and tweet it to <a href="https://twitter.com/AmerMedicalAssn" rel="nofollow" target="_blank">@AmerMedicalAssn</a> using #Match2016.</li> <li> Enjoy your day—you’ve earned it!</li> </ol> <p> If you need any assistance, or have questions about your membership or member benefits, <u><a href="mailto:member.service@ama-assn.org" rel="nofollow">email</a></u> or call AMA Member Relations at (800) 262-3211.</p> <p>  </p> <p> <span style="font-size:8px;">NO PURCHASE NECESSARY. VOID WHERE PROHIBITED. Entrants must include both @AmerMedicalAssn and #Match2016 in order to participate in Sweepstakes. The Match Day 2016 - Survive Your First Week of Residency Sweepstakes entry period begins at 12:00 a.m. on February 8, 2016 and ends at 11:59 p.m. CST on April 18, 2016. Sweepstakes is only open to fourth (4) year medical students who are members of the American Medical Association, have been matched at medical residency program, received an invitation to participate the Match Day 2016 - Survive Your First Week of Residency Sweepstakes, a legal resident of the United States and 18 years or older. Limit one entry and one prize per person. For complete Sweepstakes Rules please see the "Official Rules" accessible by going to Official Rules site link at: <a href="http://www.ama-assn.org/go/surviveresidencysweeps">ama‑assn.org/go/surviveresidencysweeps</a> (includes alternate method of entry). This promotion is in no way sponsored, endorsed or administered by, or associated with Blue Apron, Inc.</span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:094e0a30-5e6d-4050-8c2f-7bc9e2bbd6bf What you need to know about the new Zika guidelines http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-new-zika-guidelines Fri, 05 Feb 2016 22:00:00 GMT <p> Following confirmation of sexual transmission of Zika virus to a non-traveler in the continental United States, the Centers for Disease Control and Prevention (CDC) has issued new interim guidance on preventing transmission and caring for women who are pregnant or of reproductive age. We’ve outlined several key facts you need to know.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/9/f5c246b4-a0a8-4147-a92a-97ad8b59dfe7.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/9/f5c246b4-a0a8-4147-a92a-97ad8b59dfe7.Full.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The CDC Friday issued two interim guidelines—one for the <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e1er.htm?s_cid=mm6505e1er_e" rel="nofollow">prevention of sexual transmission</a> and one for health care professionals who are <a href="http://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_ehttp://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_ehttp://www.cdc.gov/mmwr/volumes/65/wr/mm6505e2er.htm?s_cid=mm6505e2er_e" rel="nofollow">caring for pregnant women or women of reproductive age</a> with possible exposure to the Zika virus.</p> <ul> <li> <strong>Zika virus remains a mild illness, but it has been tied to serious birth defects.</strong><br /> <span style="font-size:12px;">Only one in five people infected with Zika virus exhibits symptoms, which are generally mild and self-limited. In other cases, the virus generally is asymptomatic. The primary concern is the possible association between maternal Zika virus infection and an increased risk for congenital microcephaly and other abnormalities of the brain and eye, according to the CDC.</span></li> </ul> <ul> <li> <strong>The period for possible sexual transmission of Zika virus is unknown.</strong><br /> <span style="font-size:12px;">For that reason, the guidelines advise that men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex for the duration of the pregnancy.</span><br /> <br /> <span style="font-size:12px;">The guidelines encourage pregnant women to discuss their male partner’s potential exposures and history of Zika-like illness with their physician.</span><br /> <br /> <span style="font-size:12px;">The guidelines also advise that couples in which the man has traveled to an area of active Zika virus transmission may consider using condoms consistently and correctly during sex or abstaining from sexual activity to avoid transmission of the virus.</span></li> </ul> <ul> <li> <strong>Clinical protocols should be followed for women with possible Zika virus exposure.</strong><br /> <span style="font-size:12px;">The new guidelines outline appropriate protocols for testing pregnant women. These include testing pregnant women who have symptoms consistent with Zika virus, when to test asymptomatic women and how to incorporate testing and monitoring with prenatal care.</span><br /> <br /> <span style="font-size:12px;">The guidelines include recommendations for counseling women of reproductive age who reside in areas with ongoing transmission.</span></li> </ul> <p> Visit the AMA’s <a href="https://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page">Zika Resource Center</a> to learn more about the virus and access the latest information and resources from infectious disease and public health experts.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8b68614d-b05b-4007-8844-c567ce11c80c How one ED uses telemedicine in the ambulance http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-ed-uses-telemedicine-ambulance Fri, 05 Feb 2016 21:09:00 GMT <p> When you think of telemedicine, what comes to mind? Often the answer is a split screen—physician and patient in separate locations on their computers or tablets. But one health system has shown the true breadth of telemedicine’s reach by using the technology to treat patients during the critical early moments of a stroke. Find out how.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/a9095d18-1b36-4d9e-82ae-4bc638652650.Full.jpg?1" style="font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/2/a9095d18-1b36-4d9e-82ae-4bc638652650.Full.jpg?1" style="width:365px;height:250px;margin:15px;float:right;" /></a></p> <p> The risk of damage and disability in patients who are experiencing a stroke increases with any delay in care delivery. Two emergency physicians at the University of Virginia (UVA) Health System understood the need for speed when it comes to caring for patients in the midst of acute stroke and designed a streamlined telemedicine system to begin treatment on way to the hospital.</p> <p> Nina Solenski, MD, and Andy Southerland, MD, designed the “telestroke” model using low-cost, “off-the-shelf” technology: A mobile device, 4G commercial broadband and HIPAA-compliant encrypted software for patient privacy.</p> <p> <strong>How the “telestroke” model works</strong></p> <p> The portable system is deployed in the ambulance to facilitate a livestream neurological exam with the remote on-call neurologist during the ambulance ride to the hospital. Valuable time is saved by enabling treatment prior to the patient’s arrival at the ED.</p> <p> These systems are “really designed to help support patients from rural communities to get the care they need quickly,” said David Cattell-Gordon, director of the UVA Telemedicine Office. “With a stroke, every minute matters. With this telestroke model, we’re applying the blazing speed of the Internet to life-saving decisions about therapy while patients are en route to the hospital.”</p> <p> As the patient arrives at the ED, pulling a Stat-Pak® envelope rapidly activates an acute stroke alert. The envelope contains a pilot list of instructions for each member of the care team. A single toll-free phone call alerts the remote telestroke neurologist so that live videoconferencing with the patient and family can start within minutes. Telemedicine technicians in the background continuously monitor the audio-video quality and facilitate the transmission of vital brain CT scan images.</p> <p> “We are in a golden age of mobile telecommunications,” Dr. Southerland said. “We can take advantage of these rapidly evolving media to effect change in medicine. We were able to reach out more rapidly to acute stroke patients in low-access areas … before they ever reach the hospital.”</p> <p> <strong>Learn how to adopt telemedicine in your practice</strong></p> <p> A <a href="https://www.stepsforward.org/modules/adopting-telemedicine" target="_blank" rel="nofollow">new module</a> from the AMA’s <a href="https://www.stepsforward.org/modules/adopting-telemedicine" target="_blank" rel="nofollow">STEPS Forward</a>™ collection can help you use telemedicine in your practice. In the module, you will find the four steps you need to adopt telemedicine and navigate the benefits and challenges of remotely monitoring patients.</p> <p> Visit <em>AMA Wire®</em> for <a href="http://www.ama-assn.org/ama/ama-wire/post/questions-telemedicine-answered" target="_blank">answers to your telemedicine questions</a> and to see how the AMA is <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-telemedicine-bolster-care-delivery" target="_blank">addressing the top telemedicine issues</a>. Also, learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-ways-physicians-prepping-telemedicines-success" target="_blank">three ways physicians are prepping for telemedicine’s success</a>, and find out <a href="http://www.ama-assn.org/ama/ama-wire/post/one-health-insurer-embracing-telemedicine" target="_blank">why one health insurer is embracing telemedicine</a>.</p> <p> 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="http://www.mgma.com/education/conferences/collaborate" target="_blank" rel="nofollow">Register online</a>, and receive a discount when you register two or more of your team members.</p> <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="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" target="_blank" rel="nofollow">Transforming Clinical Practices Initiative</a>.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9ef0aa22-370e-4258-a777-05752022612e BNGAP hosts LGBT Health Workforce Conference April 28-30 in New York http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_bngap-hosts-lgbt-health-workforce-conference-april-28-30-new-york Fri, 05 Feb 2016 15:03:00 GMT <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee.page" target="_blank">AMA Advisory Committee on LGBT Issues</a> is proud to announce that their panel presentation abstract entitled “Strategies to Integrate LGBT Health Into Medical Education” was accepted by the Building the Next Generation of Academic Physicians (BNGAP). The advisory committee encourages everyone to attend this <a href="http://bngap.org/lgbthwfconf/" target="_blank" rel="nofollow">LGBT Health Workforce Conference</a>, which will be held April 28-30 in New York City.</p> <p> The BNGAP’s mission is to help diverse medical students and residents become aware of academic medicine as a career option and to provide them with the resources to further explore and potentially embark on an academic medicine career.</p> <p> The <strong>LGBT Health Workforce Conference</strong> provides an overview of up-to-date practices (climate and educational) in preparing the health care workforce to address the health concerns of lesbian, gay, bisexual and transgender (LGBT) communities. This conference is designed for health professionals, educators and students, but all interested are invited to attend. Continuing medical education credit will be available.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5d1821c0-04cf-4b23-a2ec-53dff80f7640 Become a leader in the profession through AMA councils, committees http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_become-leader-profession-through-ama-councils-committees Fri, 05 Feb 2016 15:01:00 GMT <p> The AMA is looking to fill open positions on various councils and committees for this year. Nominations are due March 15. Visit the AMA's <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/nominations-councils-committees.page" target="_blank">Council and Committee Nominations Web page</a> to view available positions as well as instructions on the nomination process.</p> <p> The AMA is committed to promoting diversity in every facet of organized medicine and encourages the nomination of qualified women physicians, minority physicians and international medical graduates for AMA positions on councils.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5619abad-5429-4c6c-9733-e91f5da8f3c3 Resolutions due April 8 for 2016 AMA-SPS Annual Meeting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_resolutions-due-april-8-2016-ama-sps-annual-meeting Fri, 05 Feb 2016 15:00:00 GMT <p> AMA Senior Physicians Section (SPS) resolutions must be submitted by April 8 for the 2016 AMA-SPS Annual Meeting. Resolutions propose policy statements that you believe the section should support and that pertain to the mission of the section. <br /> <br /> Any AMA member who is 65 or above is automatically a member of the section and may submit a resolution for governing council review and approval. By authoring a resolution, you can become involved in the AMA-SPS and raise awareness of senior issues. Resolutions must be submitted <a href="mailto:sps@ama-assn.org" rel="nofollow">emailed to the section</a>. Be sure to review the section’s <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/senior-physicians-section/meetings/meeting-timeline.page" target="_blank">resolution guidelines</a>. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c9db873b-945a-4f2d-a751-e653b8eeb093 Changing the face of med ed: 5 keys to student diversity http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_changing-face-of-med-ed-5-keys-student-diversity Thu, 04 Feb 2016 18:47:00 GMT <p> <object align="right" data="http://www.youtube.com/v/vF9dxycOTOs" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/vF9dxycOTOs" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/vF9dxycOTOs" /><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="http://www.youtube.com/v/vF9dxycOTOs" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object>Looking to spearhead diversity solutions at your school? One physician educator shares five steps educators can take to develop effective programs that increase the number of underrepresented students in medicine.</p> <p> <strong>Why medical schools need new diversity solutions</strong></p> <p> Despite <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-this-years-medical-class-looks-like" target="_blank">medical classes becoming more diverse</a>, the rate in which underrepresented minorities enter medical school still significantly lags behind those who are traditionally well-represented. Among students in certain racial and ethnic groups, enrollment has even declined. This is particularly true for <a href="http://www.ama-assn.org/ama/ama-wire/post/decline-of-black-men-medical-education" target="_blank">African-American men in medicine</a>, William McDade, MD, PhD, former chair of the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education.page?" target="_blank">AMA Council on Medical Education</a> and deputy provost for research and minority issues at the University of Chicago, told a group of educators at the AMA’s CHANGEMEDED conference in October.</p> <p> “There were only 500 black men nationally who matriculated into medical school this past year … and it’s not just a one-off [incident] because you can see that 2013 and 2014 data” from the Association of American Medical Colleges shows roughly the same enrollment numbers, Dr. McDade said.</p> <p> He also noted that there are currently twice as many African-American women in medical school than black males and that the number of Latino physicians in medicine has actually worsened over the past 30 years, according to <a href="http://journals.lww.com/academicmedicine/Abstract/2015/07000/Latino_Physicians_in_the_United_States,_1980_2010_.20.aspx" rel="nofollow" target="_blank">recent research</a> published in <em>Academic Medicine</em>.</p> <p> But beyond drastic declines in underrepresented minorities, these numbers underscore a greater issue at hand: “You might even ask yourself, ‘What difference does it make if we don’t change the face of medicine?’” Dr. McDade said. “There’s strong evidence that suggests that racial, ethnic and linguistic diversity in health care providers is correlated with better access to and quality care of minority populations.”</p> <p> <strong>How medical schools can diversify student enrollment, address health care disparities </strong></p> <p> “A central goal of the physician workforce of tomorrow should be to eliminate health care disparities,” and medical schools are well-positioned to help accomplish this, Dr. McDade said. Schools looking to create new diversity solutions and train culturally-competent physicians can:</p> <p style="margin-left:.75in;"> <strong>1.  </strong><strong>Develop curricular innovations that focus on health care disparities and the social determinants of health. </strong><br /> Schools must “[recognize] that all physicians in any future scenario will have to learn about cultural and social determinants of health and be trained accordingly,” Dr. McDade said, noting that the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_blank">Accelerating Change in Medical Education</a> initiative has already begun spearheading such curricular developments.</p> <p style="margin-left:.75in;"> For instance, schools that focus on population health and big data are creating new ways for students to measure health care disparities, Dr. McDade said. Last year, New York University School of Medicine, one of the founding members of the AMA’s Accelerating Change in Medical Education Consortium, launched a novel toolset, <a href="http://education.med.nyu.edu/ace/curriculum/" rel="nofollow" target="_blank">Health Care by the Numbers</a>, which allows students to analyze real clinical data for more than 2.5 million patients from 29 hospitals in New York and answer population health questions.</p> <p style="margin-left:.75in;"> Dr. McDade said curricula <a href="http://www.ama-assn.org/ama/ama-wire/post/new-med-students-diving-health-care-delivery-science" target="_blank">that immerse students in health care delivery science</a> and teach quality improvement and cultural competency also will prepare future physicians to care for diverse patients in the country’s rapidly evolving health care system.</p> <p style="margin-left:.75in;"> <strong>2.  </strong><strong>Use the new Liaison Committee on Medical Education (LCME) Standards to garner institutional support for diversity pipeline programs. </strong> <br /> The <a href="http://www.lcme.org/publications.htm" rel="nofollow" target="_blank">2015-2016 LCME Standards</a> urge educators to diversify medical training by creating effective pipeline programs to prepare applicants in their defined diversity categories. Educators can reference these standards during key conversations with medical school leaders about the importance of creating actionable diversity solutions, Dr. McDade said.</p> <p style="margin-left:.75in;"> For example, “LCME Standard 3.3 asks medical schools to make sure they are focused on increasing diversity outcomes with respect to students, staff, senior admin staff and other relevant matter [for the] academic community,” Dr. Mc Dade said.</p> <p style="margin-left:.75in;"> He also recommends referencing LCME Standard 7.6, which asks schools to ensure that medical schools graduates know how to address issues related to racial and gender bias within system-based practice.  </p> <p style="margin-left:.75in;"> <strong>3. </strong><strong>Create premedical post-baccalaureate programs that offer a pathway for underrepresented students to enter medical training after college. </strong><br /> Why? While enriching diversity among medical students, <a href="https://muse.jhu.edu/login?auth=0&type=summary&url=/journals/journal_of_health_care_for_the_poor_and_underserved/v026/26.3.mcdougle.pdf" rel="nofollow" target="_blank">research shows</a> that graduates of premedical post-baccalaureate programs also are more likely to enter medical residencies in underserved communities.</p> <p style="margin-left:.75in;"> Dr. McDade noted that a large percentage of students training in these underserved areas also pursued residencies within primary care specialties, such as family medicine and internal medicine.</p> <p style="margin-left:.75in;"> <strong>4.  </strong><strong>Enhance admissions processes to promote diversity. </strong><br /> Schools can adapt a <a href="https://www.aamc.org/initiatives/holisticreview/about/" rel="nofollow" target="_blank">holistic review process</a>, which offers a way to relieve “some of the cognitive pressure” that emerges when schools only admit medical students based on a narrow range of application criteria, such as GPAs and test scores, Dr. McDade said.</p> <p style="margin-left:.75in;"> Some medical schools have already adapted holistic review processes that are proving effective. For instance, <a href="http://urbanuniversitiesforhealth.org/media/documents/Holistic_Admissions_in_the_Health_Professions.pdf" rel="nofollow" target="_blank">a national study</a> of admissions in university health programs in 2014 found that students admitted to medical school through a holistic review process performed just as well as those who were not. Schools that used a holistic review process “experienced increased diversity, no change to student success metrics and an improved teaching and learning environment,” according to the study.</p> <p style="margin-left:.75in;"> <strong>5.  </strong><strong>Develop a research agenda that measures and promotes the results of diversity-based programs. </strong><br /> If your institution offers diversity- based programs, be sure to ask: Has an increase in racial diversity within medical school led to improved educational outcomes? “If you can show this, that’s fabulous, and we need you to come up with studies that indicate the value of diversity in a quantitative way,” Dr. McDade said.   </p> <p style="margin-left:.75in;"> He encouraged educators to explore research projects that quantify the impact of diversity programs in medical schools. When creating a research proposal, Dr. McDade recommended starting with <a href="http://med-ed-online.net/index.php/meo/article/view/20531" rel="nofollow">this list</a> of 10 expert questions to ensure your research project effectively assesses diversity changes at your institution.</p> <p> <strong>Learn more ways to promote med school diversity and minority health with these resources:</strong></p> <ul> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/one-med-schools-innovative-approach-diversity" target="_blank">how one school successfully created</a> and implemented a strategic diversity action plan. Plus, five key steps educators can take to create a diversity action plan at their own school.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/decline-of-black-men-medical-education" target="_blank">why the number of black men in medicine</a> hasn’t increased since 1978, and follow these <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-boost-diversity-medical-community" target="_blank">5 med ed solutions</a> to help boost diversity.</li> <li> Learn how one school’s holistic solution <a href="http://www.ama-assn.org/ama/ama-wire/post/schools-holistic-solution-boosting-hispanic-students-medicine" target="_blank">is boosting the number of Hispanic physicians</a>.</li> <li> See <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/med-schools-tackling-challenges-health-disparities" target="_blank">how these medical schools are tackling challenges</a> in health disparities and cultural competencies.</li> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">the 21 medical students</a> the AMA Foundation recently selected as future minority physician leaders. Read their unique perspectives on being students of color in medical school and <a href="http://www.ama-assn.org/ama/ama-wire/post/21-med-students-selected-future-minority-physician-leaders" target="_blank">how they plan to succeed while promoting diversity in medicine</a>.</li> <li> Educate yourself and your peers on the <a href="http://www.ama-assn.org/ama/ama-wire/post/debunking-5-myths-diversity-medical-education" target="_blank">5 myths of diversity in med ed</a>.</li> <li> Watch <a href="https://www.youtube.com/watch?v=KG6GCc3Pu2s&list=PL7ZHBCvG4qsf4HalVXnQ-cdg48xlLgz3S" rel="nofollow" target="_blank">this Google Hangout</a> to learn more ways schools and students are promoting diversity in medical education.</li> <li> Visit the AMA Minority Affairs Section <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us.page?" target="_blank">Web page</a>, which features the latest on AMA policies, news and events to promote diversity in medicine and public health. You also can <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section/about-us/minority-affairs-consortium-membership/mac-membership-registration.page" target="_blank">join the section</a> to get more involved.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:eb2ec994-0fd8-4362-ad45-066a541de06f From hospitalist to rapper: The story of ZDoggMD http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_hospitalist-rapper-story-of-zdoggmd Wed, 03 Feb 2016 22:48:00 GMT <p> You may have heard of ZDoggMD—the rapping doctor whose parody music videos on medical topics like electronic health records (EHR), re-admission and sepsis have acquired millions of views. But who is the physician behind the persona?</p> <p> Primary care physician Michael Rakotz, MD, director of chronic disease prevention with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, sat down with Zubin Damania, MD, to talk about burnout, discuss EHRs and find out how he came to be the <a href="https://www.youtube.com/user/ZDoggMD" rel="nofollow" target="_blank">YouTube rapping sensation ZDoggMD</a>.</p> <p> <strong>The burnout story that started it all</strong></p> <p> <strong>Dr. Rakotz:</strong> “When did you first realize that you were facing burnout?”</p> <p> <strong>Dr. Damania:</strong> “For me it was really a slow creep. I started my career in hospital medicine …. I had a wonderful hospital job with mentorship with interns, medical students, residents.”</p> <p> <object align="right" data="http://www.youtube.com/v/xB_tSFJsjsw" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/xB_tSFJsjsw" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/xB_tSFJsjsw" /><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="http://www.youtube.com/v/xB_tSFJsjsw" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> “We had an electronic record, but [it was used] only [for] reading … the labs, and everything else was on paper. It was this beautiful collusion of being able to help people, like I intended when I went to medical school …. They tolerated me making jokes and using humor as a way to bring people together; it worked really well. But what started happening is … what we see in most of health care, which is increasing pressure on a financial level to produce to perform.”</p> <p> <strong>Dr. Rakotz: </strong>“So you experienced the hospital’s EHR transition first hand?”</p> <p> <strong>Dr. Damania:</strong> “I was on call the night our first EHR went live …. Say what you will about EHRs, they’re wonderful at storing data and potentially improving outcomes, but the fact is—from a ground-level experience—suddenly my day got so long and so complicated just clicking boxes. And with those boxes came an increased requirement to click more boxes.”</p> <p> “It became increasingly difficult. The productivity requirements went up, so we had less house staff coverage. Suddenly I was overwhelmed with the number of patients. And what really snapped for me is … I realized I wasn’t able to spend the time with the patient that actually obtained an outcome that was something other than some knee-jerk nonsense that would have them bounce back in 30 days.”</p> <p> <strong>Dr. Rakotz:</strong> “What was the last straw that took you in the direction that led you to where you are today?”</p> <p> <strong>Dr. Damania:</strong> “There was a patient in his 30s who had cancer. He was one of 30 patients I had in the hospital at the time. It was signed out to me like [he] was a difficult patient, doesn’t take their medications, multiple rounds of chemotherapy but still wants more, totally irrational. And I’m looking at this going this is an engineer, I don’t think irrational is necessarily part of the deal here, so what’s going on?”</p> <p> “I get in the room, and I feel this wave.  [As a physician] you build a wall around yourself to function, but for the first time this wall was wobbling. I did something I had no business doing: I sat down in the room instead of doing my five minute U-turn … and an hour went by.”</p> <p> “No one was coordinating their care. He wanted … to be home with his kids, but he couldn’t because his pain wasn’t controlled. What the wife really wanted was some balance, but he said, ‘If I get admitted for another round of chemotherapy since the visiting hours are so crappy, my family, my kids won’t see me … and I’ll die in the hospital.” … Luckily, we were able to have a great outcome with him by getting him home because I was able to get the team together. But that was an exception.”</p> <p> “Finally, I felt so disempowered. There were so many pressures on our time struggling between the record and the regulations and the patient volume, and it just broke me.”</p> <p> “When I really started getting burned out, I started to reconnect with who I was.  YouTube was a thing all of a sudden, [and] I said I’m going to make these silly videos … in a way to reach patients, educate them and also satirize the system that is so dysfunctional.”</p> <p> “I kept doing it.  Suddenly awakened in me was this idea that this is who I am.”</p> <p> “We did a Michael Jackson parody about testicular self-exam, and I was getting these messages from student health clinics playing it in their waiting room, and kids were catching early testicular tumors.  I asked, ‘How is it that I’m more empowered to prevent disease in this way than I was in the hospital?’ … That opened the door.”</p> <p> <strong>Enter … ZDoggMD</strong></p> <p> <strong>Dr. Rakotz:</strong> “So I would like to talk to ZDoggMD now if we can.”</p> <p> Without hesitation Dr. Damania flipped on his shades and effectively transformed into <a href="https://twitter.com/AmerMedicalAssn/status/695329371914108928" rel="nofollow">ZDoggMD—and Dr. Rakotz</a> joined him.</p> <p> <strong>Dr. Rakotz:</strong> “What comes first—do you pick a song to parody, or do you have an idea in mind and go looking for a song to remix?”</p> <p> <object align="left" data="http://www.youtube.com/v/aS3xaXsh6vo" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/aS3xaXsh6vo" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/aS3xaXsh6vo" /><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="http://www.youtube.com/v/aS3xaXsh6vo" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object></p> <p> <strong>ZDoggMD:</strong> “It’s a mix of things. For example, we did a song called ‘Re-admission,’ which was a parody of the [R. Kelly] song ‘Ignition.’ I forgot how dope that song is … I listened through it and I thought, I just want to go to the hospital and lip-sync this song in various medical spots, and then I started working on the lyrics. I realized they fit so perfectly.”</p> <p> <strong>Dr. Rakotz:</strong> “Who are you trying to reach … physicians, residents, students?”</p> <p> <strong>ZDoggMD:</strong> “We struggled in the beginning [to identify the audience], and then I realized we just have to make the videos and then figure out who the audience is. The truth is, I found I couldn’t censor myself as a doc. I had to speak in this language that is the tribal language of physicians. And then what ended up happening was nurses, docs, PAs, dentists, vets started becoming the fans.”</p> <p> “At first I wanted to be broader than that. I wanted to reach laypeople. But then I said … there is so much suffering in our own tribe, let’s focus on them and give them something that they can say, ‘this is my anthem.’”</p> <p> <strong>Dr. Rakotz:</strong> "What’s next for ZDoggMD?”</p> <p> <strong>ZDoggMD:</strong> “I want to try to help give a voice to people in health care that don’t really have much of a voice.  When I think about that, I think about the lab. Those guys, they’re down in the basement … doing their thing … people always kind of dump on them … so we did a parody of 50 Cent’s ‘In Da Club,’ called ‘In Da Lab.’”</p> <p> “It goes: ‘Go go go, go redraw, there’s no birthdate, you didn’t label it, there’s no birthdate, it’s in the wrong tube, and yo there’s no birthdate, and you know we don’t draw no blood without no birthdate … You can find me in the lab, bottle full of cr@p, but, homie, I got the plates if you’re in to growin’ that ….”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0beb8fd0-9cd1-4d8b-a2cd-55c665aa0b12 Ward off burnout: Your peer network may impact more than you think http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ward-off-burnout-peer-network-may-impact-think Wed, 03 Feb 2016 21:40:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/8/94cdd024-614d-4593-882d-9c1ea25fac71.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/8/94cdd024-614d-4593-882d-9c1ea25fac71.Large.jpg?1" style="float:right;margin:15px;" /></a>Can skipping social events with peers increase your chances for burnout? A <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00038.1" rel="nofollow" target="_blank">recent study</a> provides key findings on how loneliness and connectivity impact residents’ emotional well-being. </p> <p> Burnout often is thought of as an “individual affliction,” but authors note that connections between individual residents create social networks, and these ties also allow individuals to influence each other. The study findings regarding social networks, burnout and loneliness were recently published in <em>Academic Medicine. </em>“Residency programs represent unique social networks, and we sought to investigate the relationship between burnout and loneliness.”</p> <p> Authors of the study “hypothesized that residents with greater loneliness would have greater burnout, and that residents who are more central within their social network have less burnout.”</p> <p> They tested their hypothesis on internal medicine residents using a survey containing the Maslach Burnout Inventory (MBI), a three-question loneliness scale and a social connectivity component.</p> <p> <strong>The results: High burnout rates linked to greater loneliness among residents  </strong></p> <p> Many residents in the study reported “significant burnout” based on their MBI scores related to emotional exhaustion and depersonalization. Among respondents, 45 percent met the significant burnout criteria related to emotional exhaustion, 49 percent met the criteria for depersonalization and 33 percent met the criteria for both.</p> <p> Study authors found that their hypothesis proved true: Residents reporting significant burnout also had higher loneliness scores based on responses to three questions on a three-point Likert scale, with responses “hardly ever” (representing one point), “some of the time” (two points) and “often” (three points). Questions on the loneliness scale measured residents’ “lack of perceived connection to others.” The questions were:</p> <ul> <li> How often do you feel that you lack companionship?</li> <li> How often do you feel left out?</li> <li> How often do you feel isolated from others?</li> </ul> <p> Broken down by symptom, residents reporting significant burnout had higher loneliness scores than those who did not report significant burnout, which included:</p> <ul> <li> Residents reporting high emotional exhaustion also reported a 5.6 loneliness score, versus 4.5 for those who did not report significant burnout</li> <li> Residents reporting high depersonalization also reported a 5.4 loneliness score, versus 4.6</li> <li> Residents reporting both high emotional exhaustion and high depersonalization reported a 5.8 versus loneliness score, versus 4.6</li> </ul> <p> <strong>Why personal accomplishment may lead to a more active peer network </strong></p> <p> To explore how residency programs may function as “social networks,” authors of the study also “had residents rate their connectivity to all other residents and used [the] data to generate two categories of social network outcomes: Degree (number of connections) and centrality (location and/or role within the network),” according to the study.</p> <p> The study found that residents who had higher scores for personal accomplishment on the MBI survey also had greater “centrality within the residency” program and were more connected to their social network.</p> <p> “Our study is the first to demonstrate a relationship between loneliness and burnout,” study authors wrote. “Those with greater burnout—meeting burnout criteria by both emotional and depersonalization—had higher loneliness scores. There was no significant relationship between social network measures of degree or centrality and emotional exhaustion and/or depersonalization scores. However, high personal accomplishment scores were associated with several social network measures.”</p> <p> Although the study was limited to a single residency program, the authors noted that these findings provide a “starting point for future research to assess the effect of group and social networks on trainee burnout.”</p> <p> Read the <a href="http://www.jgme.org/doi/pdf/10.4300/JGME-D-15-00038.1" rel="nofollow" target="_blank">full study</a> for additional observations.</p> <p> <strong>Additional resources to help boost your personal well-being</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/want-eat-healthy-budget-5-student-friendly-tips" target="_blank">five tips for eating healthy on a budget</a>, offered by a medical trainee and registered dietician.</li> <li> Access a variety of <a href="http://www.ama-assn.org/ama/ama-wire/blog/Financial_Issues/1" target="_blank">expert financial advice</a> for physicians, from managing medical school debt to planning for retirement.</li> <li> Read about the <a href="http://www.ama-assn.org/ama/ama-wire/post/ways-residents-found-conquer-burnout" target="_blank">ways residents have found to conquer burnout</a>.</li> <li> Discover <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">three key tips for physicians in medical marriages</a> to strengthen your connection with your partner as your career and relationship progress.</li> </ul> <p align="right"> <em>By AMA staff writer Lyndra Vassar</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:43630734-5ff5-41dd-8341-c2780a172e68 4 physician-recommended steps to work- and home-life balance http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-physician-recommended-steps-work-home-life-balance Tue, 02 Feb 2016 23:35:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/7/27a668ce-3580-4c40-87fd-df713cbbe874.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/7/27a668ce-3580-4c40-87fd-df713cbbe874.Large.jpg?1" style="float:right;margin:15px;" /></a>Physicians often strive for “work-life balance,” but how do you define it? Getting the time you need may require a different approach. One physician and wellness expert recommends these four self-driven solutions to help you redefine balance and maintain a successful home and work life.</p> <p> Family physician Sara Taylor, MD, has learned valuable lessons of her own as a mother of two teenaged children, practicing physician, part-time practice owner, blogger and wife of a fellow physician. When she’s not balancing this full roster, she writes about physician wellness, personal development and social media.</p> <p> She recently shared some of her insights in <a href="http://www.physicianfamilymedia.org/" rel="nofollow" target="_blank">this month’s issue</a> of AMA Alliance Publication <em>Physician Family Magazine.</em> Here are some of the ways she’s learned to sort work-life and home-life into two balanced, productive spheres:</p> <p> <strong>1.  </strong><strong>Prioritize what you value, and plan for it.</strong> Early on, Dr. Taylor took a valuable lesson from Stephen Covey’s book <em>First Things First</em>: “My take-away message from this invaluable book is that if we spend more time dealing with things that are important such as planning, preparing and personal development, we spend less time in the ‘crisis/deadline’ mode that lends itself to feeling frenzied and imbalanced,” she wrote.</p> <p> Dr. Taylor also noted that “Covey cleverly describes urgency addiction as ‘a self-destructive behavior that temporarily fills the void created by unmet needs.’”</p> <p> Focusing on weekly goals is one way to effectively prioritize. “This does not mean to keep an exhaustive to-do list (like I used to), but rather to write down three ‘must-dos’ each day,” she wrote. “You can either do this for work-life and home-life separately, or as I do, approach it more globally.”</p> <p> <strong>2.  </strong><strong>Still give yourself time to “just be” and feel rooted in the moment.</strong> “In the book, <em>An Eight-Week Plan for Finding Peace in a Frantic World</em>, Dr. Mark Williams and Danny Penman describe our common state of ‘doing mode’ versus ‘being mode,’” Dr. Taylor wrote.<br /> <br /> Being in a constant state of “‘doing’ ends up depleting us, leading to exhaustion and burnout,” she wrote. “By consciously attending to ‘being,’ or mindfulness, we are more able to give both our body and mind what they need to be nourished.”<br /> <br /> One tip she recommended: Try meditating to help practice mindfulness and channel a sense of calm.<br /> <br /> <strong>3.  </strong><strong>Learn to say “no” to certain tasks.</strong> “It not only helps us set boundaries but also prevents us from falling prey to other people’s agendas,” Dr. Taylor wrote. She said saying “no” is an essential step to finding balance and ensuring you have time to prioritize your well-being.</p> <p> <strong>4.  </strong><strong>Practice self-care, focusing on small actionable steps. </strong>Start by exercising, getting proper sleep and setting digital limits from work or peers, so you can properly rejuvenate, Dr. Taylor said. If you don’t have time for yoga classes or the gym, online exercise classes or instruction can be other options.</p> <p> Get more solutions and insights from Dr. Taylor in <a href="http://www.physicianfamilymedia.org/" rel="nofollow" target="_blank">this month’s issue</a>.</p> <p> <strong>Also, don’t miss these resources for physician families:</strong></p> <ul> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-maintaining-happiness-marriage" target="_blank">these 3 tips</a> for maintaining happiness in a medical marriage.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">these expert insights</a> to ensure you’re successfully partnering with your spouse.</li> <li> Learn more about <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">the benefits of a medical marriage</a> and why physicians often marry fellow physicians.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <em><a href="http://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:98ec831e-d65a-4380-a788-3f78082df4f4 Avoid meaningful use penalties: Apply for exemption by March 15 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_avoid-meaningful-use-penalties-apply-exemption-march-15 Tue, 02 Feb 2016 23:13:00 GMT <p> Physicians have until March 15 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. The good news is that exemptions will be granted broadly this year.  </p> <p> <strong>Everyone should apply</strong></p> <p> The Centers for Medicare & Medicaid Services (CMS) has stated that it will broadly grant hardship exemptions as a result of the delayed publication of the <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-need-new-ehr-regulations" 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> This inclusive approach to hardship exemptions is a result of the Patient Access and Medicare Protection Act, passed just before Congress adjourned for the holidays, <a href="http://www.ama-assn.org/ama/ama-wire/post/bill-gives-blanket-approval-meaningful-use-exemptions" target="_blank">which directed CMS to make AMA-supported changes</a> to the previously limited exemption process.</p> <p> All physicians should apply for the exemption since 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. 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 March 15. To get started, <a href="https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/PaymentAdj_Hardship.html" rel="nofollow" target="_blank">download an application</a> from CMS and consult <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-avoiding-2017-penalty.pdf" target="_blank">step-by-step instructions</a> (log in) the AMA compiled to help simplify the submission process.</p> <p> New this year, individuals can apply on behalf of a group of physicians.</p> <p> While CMS has given a deadline for applications, it has not yet indicated when physicians will receive confirmation of their exemption status.</p> <p align="right"> <em>By AMA Wire editor <a href="https://twitter.com/amy_amawire" rel="nofollow" target="_blank">Amy Farouk</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0e4eac9a-40a2-421b-9e31-bd634657d9ae What you need to know about away electives and the Match http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-away-electives-match Mon, 01 Feb 2016 22:59:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/15/6697cc25-9b02-41e8-bf46-2f97bfbdd1e1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/15/6697cc25-9b02-41e8-bf46-2f97bfbdd1e1.Full.jpg?1" style="float:right;margin:15px;" /></a>Do away electives really give students an edge in the Match? Before committing to an away elective or audition, review these five key facts about away electives to help you make an informed decision. Plus, check out an infographic to help you break down the average cost of away electives.</p> <p> Authors of a recent <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Going__Fourth__From_Medical_School___Fourth_Year.98756.aspx" rel="nofollow" target="_blank">study</a> published in <em>Academic Medicine </em>surveyed 1,367 students about away electives and auditions. The study found that: </p> <p style="margin-left:40px;"> <strong>1. The primary reasons students pursued away electives were to evaluate specific residency programs and increase their chances of matching to their program of choice.</strong><br /> In fact, 90 percent of students agreed that the primary reason to pursue an away elective is to evaluate the residency program and 81.8 percent agreed that increasing the likelihood of matching at that residency program should also motivate students to pursue away electives.</p> <p style="margin-left:40px;"> <strong>2. Most students took away electives, and the number of students taking them varied by specialties. </strong><br /> “More than half of the students completed at least one monthlong away or audition elective in their career specialty of choice,” the study authors wrote.</p> <p style="margin-left:40px;"> “The number of students taking away electives varied by career specialty, ranging from approximately 42 percent for internal medicine to approximately 89 percent for emergency medicine,” the study said. “Overall, surgery and emergency medicine applicants were significantly more likely to complete an away elective than students applying to all other specialties.”</p> <p style="margin-left:40px;"> Study authors also noted that away electives were more expensive for students taking electives in nonprimary care residencies.</p> <p style="margin-left:40px;"> <strong>3. Electives aren’t cheap—some students had to limit their options. </strong><br /> “The majority of students who completed away or audition electives spent between $1,000 and $4,000 to complete these electives,” according to the study.<br /> <br /> Approximately 35 percent of students reported limiting the number of away electives they took because of financial constraints.</p> <p style="margin-left:40px;"> <strong>4. Away electives significantly impacted how students ranked their programs.  </strong><br /> Nearly 89 percent of students who completed an away elective felt that the elective affected their ranking of a program. This didn’t vary significantly across specialties, according to the study.</p> <p style="margin-left:40px;"> <strong>5. While away electives influenced how students ranked their programs, their impact on the Match is still unclear.</strong> <br /> Among students who completed an away elective, 34.1 percent matched to the programs at which they had done an away elective.<br /> <br /> “As only approximately one-third of students matched at a program where they had done an away or audition elective, it is unclear whether these electives enhance the likelihood of matching,” study authors wrote. “It may be that so many students in certain specialties complete away electives that any potential benefit to a single student is diluted.”<br /> <br /> In the National Resident Matching Program’s <a href="http://www.nrmp.org/2014-program-director-survey-report-now-available/" rel="nofollow" target="_blank">2014 Program Director’s Survey</a>, 63 percent of program directors valued students taking away electives or auditions in their departments and cited electives as a factor when selecting applicants for residency interviews. However, only 55 percent of program directors cited applicants having completed an away rotation or audition within their specific programs as a factor when ranking applicants.</p> <p> <strong>Want tips on choosing away electives or auditions?</strong> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-answer-top-student-questions-away-rotations" target="_blank">these answers to the top questions</a> students asked residents about away electives and auditions.</p> <p> <strong>Want more tips for applying to residency? Check out these resources</strong></p> <ul> <li> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/top-questions-ask-during-residency-program-interview" target="_blank">this must-have list</a> of questions the Association of American Medical Colleges recommends students ask program directors and residents during their residency program interviews.</li> <li> Get <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-ace-video-interviews-residency" target="_blank">six key tips</a> to help you excel on video interviews for residency.</li> <li> Learn how to write a competitive CV using <a href="http://www.ama-assn.org/ama/ama-wire/post/6-steps-building-competitive-cv" target="_blank">these six strategic steps</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/heres-many-residency-programs-students-really-apply" target="_blank">how many residency programs students really apply to</a> each year (broken down by specialty)</li> <li> Check out <a href="http://www.ama-assn.org/ama/ama-wire/post/applying-residency-fourth-year-students-essential-checklist" target="_blank">this essential checklist</a> for fourth-year students featuring key tasks and deadlines to prioritize as you apply for residency.</li> </ul> <p style="margin-left:18.75pt;">  </p> <p align="right"> <em>By AMA staff writer </em><em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5c85cd7f-fde5-4552-a979-d9a8c9e7e4ab 5 ways to promote better heart health among your patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-ways-promote-better-heart-health-among-patients Mon, 01 Feb 2016 20:47:00 GMT <div> American Heart Month starts today. Find out how can you participate as a physician and help your patients focus on their heart health throughout the next four weeks.</div> <div>  </div> <div> <strong>How you and your patients can raise awareness for heart health this month</strong></div> <div> Uncontrolled hypertension is one of the leading causes of death in the country. This February, help turn the tide and improve heart health across the nation.</div> <div>  </div> <div> Here are the five ways to promote better heart health during American Heart Month:</div> <div>  </div> <div> <strong>1. Learn insights from experts on hypertension</strong></div> <div> Take part in a Google Hangout focused on the latest compelling information, research and technology on diagnosing and managing hypertension. All you need to participate in this AMA-hosted event is a Gmail account and a desire to discuss improving heart health to build <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/healthier-nation/build-a-healthier-nation.page" target="_blank">#AHealthierNation</a>. On Feb. 25 at 2 p.m. Eastern time, primary care physician Michael Rakotz, MD, director of chronic disease prevention with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative, will moderate the conversation among heart health experts: </div> <div>  </div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span>Harlan M. Krumholz, MD, 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</div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span>Ray Townsend, MD, professor of medicine and director of the hypertension program at the Hospital of the University of Pennsylvania</div> <div>  </div> <div> <strong>2. Make a statement in red</strong></div> <div> Another important day this month, sponsored by the American Heart Association, is the <a href="http://www.heart.org/HEARTORG/Affiliate/13th-Annual-National-Wear-Red-Day_UCM_456034_Event.jsp#.VqkzOPkrKUk" rel="nofollow" target="_blank">13th Annual National Wear Red Day</a>, taking place Feb. 5. Make a life-saving fashion statement by donning your favorite red outfit to raise awareness to help prevent heart disease and stroke—the leading causes of death in the nation. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/15/9d2133bd-2179-460d-bf5b-27e813482d66.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/15/9d2133bd-2179-460d-bf5b-27e813482d66.Large.jpg?1" style="margin:15px;float:right;" /></a></div> <div>  </div> <div> <strong>3. Participate in Million Hearts® weekly health activities</strong></div> <div> <a href="http://millionhearts.hhs.gov/" rel="nofollow" target="_blank">Million Hearts®</a>, a national initiative to prevent 1 million heart attacks and strokes in the United States by 2017, will focus on one aspect contributing to heart health each of the four weeks of American Heart Month. You and your patients can use the next four weeks as a launch pad to establishing lifelong—not just monthlong—healthy heart habits, including:</div> <div>  </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Eating healthy</div> <div style="margin-left:40px;"> •   Being physically active</div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Setting goals to improve your health</div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  Maintaining healthy blood pressure</div> <div>  </div> <div> <strong>4. Get timely information from physician commenters</strong></div> <div> Throughout the month, several heart health-focused organizations and individuals will be active on Twitter under the hashtag <a href="https://twitter.com/search?q=%23HeartMonth&src=typd" rel="nofollow" target="_blank">#HeartMonth</a>. Follow the AMA (<a href="https://twitter.com/AmerMedicalAssn" rel="nofollow" target="_blank">@AmerMedicalAssn</a>) and the American Heart Association (<a href="https://twitter.com/American_Heart" rel="nofollow" target="_blank">@American_Heart</a>) for resources and information on what’s happening during American Heart Month and resources that can help you advocate for heart health. </div> <div>  </div> <div> Also, follow these physician experts and health journalists:</div> <div>  </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  <a href="https://twitter.com/sandnsurf" rel="nofollow" target="_blank">Mike Cadogan, MD</a>, an emergency medicine physician in Perth, Australia </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  <a href="https://twitter.com/Doctor_V" rel="nofollow" target="_blank">Bryan Vartabedian, MD</a>, a pediatric gastroenterologist at Baylor College of Medicine in Houston</div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span><a href="https://twitter.com/BarbaraFicarra" rel="nofollow" target="_blank">Barbara Ficarra</a>, a leading nurse voice in health journalism and writer for the <em>Huffington Post</em></div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span><a href="https://twitter.com/ShelleyWood2" rel="nofollow" target="_blank">Shelley Wood</a>, a quality health systems administrator at 3M Healthcare </div> <div style="margin-left:40px;"> •<span class="Apple-tab-span" style="white-space:pre;"> </span>  <a href="https://twitter.com/cardiobrief" rel="nofollow" target="_blank">Larry Husten</a>, a health news writer and editor of cardiobrief.org </div> <div style="margin-left:40px;"> •  <span class="Apple-tab-span" style="white-space:pre;"> </span><a href="https://twitter.com/taraparkerpope" rel="nofollow" target="_blank">Tara Parker Pope</a>, editor of the <em>New York Times’ Well </em>blog </div> <div>  </div> <div> <strong>5. Access resources for getting the best blood pressure readings</strong></div> <div> Watch <em>AMA Wire</em>® for heart health information throughout the month, and learn what you need to know to <a href="http://www.ama-assn.org/ama/ama-wire/blog/Self_Measured_BP/1">implement successful self-measured blood pressure</a> with your patients. Also, check out the <a href="http://www.ama-assn.org/ama/ama-wire/post/one-video-need-accurate-blood-pressure-readings" target="_blank">one video you need for accurate blood pressure readings</a>.</div> <div>  </div> <div style="text-align:right;"> <em>By AMA staff writer <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></em></div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a452d92e-f0d8-44b0-bb99-58401656fd1e How medical liability reforms will be advanced, challenged in 2016 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medical-liability-reforms-will-advanced-challenged-2016 Sat, 30 Jan 2016 01:00:00 GMT <p> The existing medical liability system continues to drain health care resources that could be devoted instead to improved quality of care and access for patients—all while putting many physicians at unnecessary emotional, reputational and financial risk. Thankfully, positive medical liability reform efforts will continue this year to address both existing and developing issues.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/14/f253ed22-a659-448e-be93-39d519a84eb4.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/14/f253ed22-a659-448e-be93-39d519a84eb4.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The AMA is pursuing legislative solutions at both the federal and state levels to address these issues and is continuing collaboration with state medical associations and national medical specialty societies to advocate for its new medical liability reform legislation and defend existing reforms.</p> <p> <strong>Implementing new ideas and protecting existing strengths</strong></p> <p> Three states recently passed new bills to create early disclosure systems that expedite the resolution of meritorious claims, provide more consistent damage awards and reduce the practice of defensive medicine.</p> <p> In 2015, Iowa put their “Candor” law into action. The act facilitates communication between a physician or health facility and a patient following an adverse health care incident, with the understanding that disclosing adverse medical outcomes to patients can prevent the unnecessary expenditure of resources and be an effective form of risk management. Massachusetts and Oregon passed similar legislation in 2012 and 2013, respectively.</p> <p> Several other states will look to Iowa, Massachusetts and Oregon as they design their own systems to engage in early discussion with patients following adverse health care incidents to prevent the unnecessary escalation of such claims.</p> <p> States will also work to establish and protect existing traditional medical liability reforms in 2016. As of January, about one-half of states have enacted some variation of a cap on noneconomic damages, while six states place a cap on total damages. However, the caps in these states vary greatly by amount, exceptions and causes of action covered.</p> <p> Last year, Missouri’s governor signed a bill that created two caps on noneconomic damages, a primary limit of $400,000 and a higher cap of $700,000 for catastrophic personal injury or death. Both are subject to an annual 1.7 percent index for inflation. The state’s previous $350,000 cap was struck down in 2012.</p> <p> Despite many legal challenges, one of the nation’s leading medical liability reform laws was <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-damages-cap-upheld" target="_blank">upheld again</a> in November 2014. California’s historic tort reform law, the Medical Injury Compensation Reform Act, will remain in place with a $250,000 cap on noneconomic damages in medical liability lawsuits.</p> <p> <strong>A new threat to medical liability reform</strong></p> <p> Movements are underway in several states to adopt a patient compensation system for medical liability—a “no-fault” system similar in concept to the worker’s compensation system, in which patients would be compensated automatically for an adverse medical event, even if it was not the fault of the physician. Advocates of this model have made numerous claims about its advantages, according to the Physician Insurers Association of America (PIAA). “While the current system has flaws and is in need of reform, no-fault is not the answer,” the PIAA said in a statement.</p> <p> “Patient compensation systems would result in more doctors being reported more often to the National Practitioner Data Bank,” said Michael C. Stinson, vice president of government relations and public policy at the PIAA. Approximately 70 percent of all medical liability claims filed are found to be meritless and result in no payment, he added.</p> <p> “With the [patient compensation] system being based on adverse medical outcomes, and not on the fault of a health care professional, the number of claims being paid would skyrocket,” Stinson said. “And every one of those would get reported, wildly misrepresenting the health care professional’s record of practice.”</p> <p> Tennessee, Florida, Georgia and Maine are both expecting patient compensation systems legislation this year. The AMA is currently studying these proposals and will issue a report to the House of Delagates at the 2016 Interim Meeting.</p> <p> <strong>Federal efforts to achieve national medical liability reform</strong></p> <p> Significant medical liability reform was achieved with enactment of the Medicare Access and CHIP Reauthorization Act of 2015 in April. The law includes the Standard of Care Protection Act, which prohibits federal quality program standards and performance metrics from establishing a “standard of care” in medical liability actions.</p> <p> The AMA will advocate this year for the Sports Medicine Licensure Clarity Act. This legislation would protect sport medicine professionals, including physicians, when they travel with their teams or athletes and provide care in another state by ensuring they are covered by their liability insurance across state lines.</p> <p> Another bill coming down the line is the Good Samaritan Health Professionals Act. Under this bill’s protections, health care professionals who volunteer during a federally declared disaster would be protected from liability exposure. Another bill, the Family Health Care Accessibility Act legislation, would provide Federal Tort Claims Act medical liability coverage to all qualified health care professionals who volunteer at community health centers, or through offsite programs or events carried out by such centers. Under the bill, these volunteers would be deemed covered employees of the Public Health Service for liability purposes.</p> <p> The Help Efficient, Accessible, Low-Cost, Timely Healthcare (HEALTH) Act, is a comprehensive liability reform package that includes a federal cap on non-economic damage awards if a state does not have its own cap. Assisting members of the U.S. Senate and House of Representatives who are considering revisions to the HEALTH Act will continue to be a focus for the AMA this year.</p> <p> <strong>Standing up for reform in that nation’s courts</strong></p> <p> Physicians also are firmly supporting medical liability reforms in the midst of various legal challenges.</p> <p> For instance, a <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-liability-reform-risk-state-supreme-court-case" target="_blank">case before the Supreme Court of the State of New Mexico</a> calls into question whether Texas’ medical liability reforms should apply when New Mexicans seek care from physicians practicing in their neighbor state. A New Mexico Court of Appeals previously ruled in favor of holding Texas physicians to New Mexico law, which offers fewer protections for both physicians and patients. Many New Mexicans could lose the vital access to medical care provided by Texas physicians on which they rely.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_blank">Litigation Center of the AMA and State Medical Societies</a> filed an amicus brief in support of reversing the appeals court’s decision. The case puts “Texas doctors, nurses and hospitals seeing New Mexico patients at an even greater litigation risk,” the brief said. Increased litigation risk brings with it an increase in the frequency of lawsuit filings and an increase in the size of awards and settlements.</p> <p> Other ongoing medical liability legal challenges in which the AMA Litigation Center has been involved include:</p> <ul> <li> <em>Volk v. DeMeerleer</em>, a medical liability case before the Washington Supreme Court that also <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-threatens-physician-patient-confidentiality" target="_blank">threatens physician-patient confidentiality</a></li> <li> <em>Bayer v. Dobbins</em>, a case before a Wisconsin court of appeals that calls into question the admissibility of expert evidence</li> <li> <em>Seifert v. Balink</em>, a case on appeal to the Wisconsin Supreme Court weighs the standards of admissibility for expert testimony</li> </ul> <p> The 2016 edition of <a href="https://download.ama-assn.org/resources/doc/arc/x-pub/mlr-now.pdf">“Medical Liability Reform–Now!”</a> (log in) provides liability reform advocates with the information they need to advance and defend medical liability reform legislation. It includes background information, proven solutions and innovative reforms that could complement traditional medical liability provisions.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7c85290b-4552-4f53-9125-542bf5feb824 What EHRs need: Physicians offer solutions at town hall http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ehrs-need-physicians-offer-solutions-town-hall Fri, 29 Jan 2016 20:38:00 GMT <p> How can electronic health records (EHR) and regulations be designed to positively affect you in your practice? With the meaningful use program reportedly on the cusp of change, physicians gathered in Seattle for a town hall meeting to discuss both the difficulties and benefits of EHRs while also citing ways that they can be improved. Find out what your colleagues on the West Coast had to say.</p> <p> The meaningful use program has been successful in “forcing the adoption of EHRs … but they weren’t ready for prime time,” said AMA President Steven J. Stack, MD, Tuesday night during the town hall meeting on EHRs at the Swedish Medical Center in Seattle. This is the third AMA town hall on EHRs and was co-hosted by the Washington State Medical Association (WSMA).</p> <p> The focus of this special session: What is wrong with current EHRs and how they could be designed to benefit physicians in practice.</p> <p> Earlier this month Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt said the <a href="http://www.ama-assn.org/ama/ama-wire/post/cms-chief-vows-replace-meaningful-use-better-policy" target="_blank">agency is changing its culture</a> to focus more on listening to physician needs and will implement better policy in place of the meaningful use program when the new streamlined Medicare reporting program is created. With this statement, there’s never been a better time to speak up and offer constructive solutions to regulatory missteps that have stolen time from physicians that they would rather have spent with patients.</p> <p> <strong>Taking control: Regulations should not hinder care</strong></p> <p> As it did in <a href="http://www.ama-assn.org/ama/ama-wire/post/regulations-sidelining-patients-physicians-talk-ehrs" target="_blank">Boston</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_blank">Atlanta</a> last year, the physician voice resounded through Seattle during Tuesday night’s town hall, emphasizing that EHR design should be focused on usability and interoperability and the physician voice must be heard.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/7/52d0ddd6-fae0-4c51-97d9-f3e3ebadd7d3.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/7/52d0ddd6-fae0-4c51-97d9-f3e3ebadd7d3.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> “Administrative burdens are strangling medical practice and creating unnecessary and costly inefficiencies in health care delivery while adding stress to physicians and their teams,” said WSMA president Ray Hsiao, MD, kicking off the discussion. “It can make a cynic out of the happiest people and can lead to discouragement, professional dissatisfaction and burnout, and even drive physicians to leave the profession. We cannot let that happen.”</p> <p> Regulations force physicians to do “a lot of busy work that has nothing to do with the quality of care we provide,” said Jane Fellner, MD, a primary care physician at the University of Washington School of Medicine. “It needs to stop.”</p> <p> <strong>How we can make EHRs more functional in practice</strong></p> <p> Speaking to what they really need from these tools to help them in their practices, many physicians offered solutions and suggestions for how EHRs should work for the end-users who depend on them daily.</p> <p> Interoperability proved top of mind as the current EHRs struggle to communicate. “My EHR does not necessarily have the tools to interoperate well with other EHRs,” Dr. Fellner said. “But within the universe of the other medical centers who use the same software—it is magic. I can import an entire record from Florida in 20 seconds.” If all EHRs could talk to each other in this way, it would have a very positive effect on the way physicians treat patients nationally, she said. “It has revolutionized the care I provide.”</p> <p> Another focus for improvement during the discussion was the need for more data usage focused on population health to show physicians how their patients’ health compares to national trends.</p> <p> “What we don’t see is our information going in to create this big picture that we can then [see] in real time,” said Reena Koshy, MD, a family physician in Seattle. This capability is currently available but not to everyone using EHRs. Dr. Koshy said it would be very helpful if national patient data coordination were available to all practices.</p> <p> Thomas Payne, MD, medical director of information technology services at the University of Washington School of Medicine and board chair of the American Medical Informatics Association, said he uses his EHR in every patient visit. “We need to address documentation because that is the source of a lot of unnecessary new time that [we] spend,” he said. “Natural language processing is a great example …. As we speak as we are this evening … we can use that same capability to communicate in the medical record and … be able to record what kinds of care people have received.”</p> <p> “When you’re searching for billing codes, you have to type it exactly correct or it boots it out,” said Carrie Horwitch, MD, a primary care physician in Seattle. She suggested physicians could work much more efficiently if EHRs had the same kind of spell-check and search option drop-down menus as Internet search engines.</p> <p> <strong>The effort to change meaningful use and fix EHRs</strong></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="http://www.ama-assn.org/ama/ama-wire/post/10-principles-improve-care-medicare-patients" target="_blank">10 principles</a> to guide the foundation of the MIPS, and the AMA provided <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/macra-letter-17nov2015.pdf" target="_blank">detailed comments</a> (log in) as part of its ongoing efforts on this issue and submitted a <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-share-plan-meaningful-use-should-really-work" target="_blank">detailed framework</a> for what needs to change.</p> <p> The AMA and MedStar Health’s National Center for Human Factors in Healthcare last year developed an <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_blank">EHR User-Centered Design Evaluation Framework</a> to compare the design and testing processes for optimizing EHR usability. </p> <p> Visit <a href="http://breaktheredtape.org/" rel="nofollow" target="_blank">BreakTheRedTape.org</a>, the AMA’s grassroots campaign to advocate for ways to solve medicine’s regulatory and legislative challenges.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:21f83409-de1c-4822-978e-b15532e4bea4 What you need to know about Zika virus http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-zika-virus Fri, 29 Jan 2016 19:00:00 GMT <div> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/8/911228d6-eec6-4f00-98dd-4873482c2c10.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/8/911228d6-eec6-4f00-98dd-4873482c2c10.Large.jpg?1" style="margin:15px;float:right;" /></a>With global infection rates increasing rapidly, physicians should be prepared to handle possible cases of Zika virus and answer patients’ questions. No locally transmitted cases of the virus have been reported in the continental United States, but more than 30 cases have been confirmed in returning travelers.</div> <div>  </div> <div> Prepare your practice and your patients with resources developed by infectious disease experts and assembled by the AMA in one convenient location. </div> <div>  </div> <div> Visit the AMA’s online <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_blank">Zika Virus Resource Center</a> for information from the CDC and other public health groups. Resources cover:</div> <div>  </div> <ul> <li> <span style="font-size:14px;">Understanding the virus</span></li> <li> <span style="font-size:14px;">Managing and reporting Zika virus infections</span></li> <li> <span style="font-size:14px;">Caring for pregnant women during a Zika virus outbreak</span></li> <li> <span style="font-size:14px;">Evaluating and testing infants</span></li> </ul> <div> The resource center will be updated regularly to give you, your practice staff and your patients the most up-to-date information you need. </div> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:cf3ea061-50db-4c75-826b-04db5a2551d7 What’s new from the AMA Academic Physicians Section http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_whats-new-ama-academic-physicians-section Fri, 29 Jan 2016 15:08:00 GMT <p> During the 2015 AMA Interim Meeting, the AMA House of Delegates adopted changes to the bylaws of the AMA Academic Physicians Section (APS), to codify the section’s name change from “Section on Medical Schools” to “Academic Physicians Section” and clarify the pathways to membership in the AMA-APS.</p> <p> These changes were presented in a <a href="http://www.ama-assn.org/resources/doc/hod/x-pub/i15-ccb-1.pdf" target="_blank">report</a> (log in) from the AMA Council on Constitution and Bylaws, which was subsequently recommended for adoption by the Reference Committee on Amendments to Constitution and Bylaws.</p> <p> In its report, the reference committee wrote, “Testimony for this report was strongly in favor of adoption. The recommendations of the report were universally lauded for their inclusiveness in welcoming more members of the medical community into this section, especially for community physicians who are part-time faculty and may have been excluded previously.”</p> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_blank">Learn more</a> about the AMA-APS, and <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section/members.page?" target="_blank">join now</a>. Also, check out a <a href="http://www.ama-assn.org/ama/ama-wire/post/ama-academic-physicians-section-2015-interim-meeting-highlights" target="_blank">summary</a> of the section’s meeting in November.</p> <p> In related news, the Academic Medicine Caucus convened during the 2015 AMA Interim Meeting. A number of issues were discussed, including leadership for the caucus and speeches by candidates for AMA positions. <a href="https://connection.ama-assn.org/sites/MedEd/APS/Documents/Fred's%20folder/i-15-caucus-minutes.docx?Web=1" target="_blank">Read more</a> (log in).</p> <p> Also, save the date for the next caucus meeting: June 13 in Chicago during the 2016 AMA Annual Meeting. Elections for caucus leadership positions will be held during the meeting. Those interested in running for a position on the caucus should email the current caucus chair, <a href="mailto:Donald.Eckhoff@ucdenver.edu" rel="nofollow">Donald Eckhoff, MD</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b451455a-a93e-474f-9931-a43c887c1c3c Nominate a peer for the Excellence in Medicine Awards http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nominate-peer-excellence-medicine-awards Fri, 29 Jan 2016 15:04:00 GMT <p> The AMA Foundation’s Excellence in Medicine Awards program, with support from Pfizer Inc., recognizes physicians who exemplify the highest values of volunteerism, leadership and dedication to underserved populations, and present inspirational physician stories to the medical community and public. Consider nominating a physician you know that exemplifies these attributes. The awards include:</p> <ul> <li style="margin-left:0.25in;"> <strong>The Jack B. McConnell, MD Award for Excellence in Volunteerism</strong> recognizes the work of a senior physician who provides volunteer treatment to patients in the U.S. who lack access to health care.</li> <li style="margin-left:0.25in;"> <strong>The Pride in the Profession Award</strong> honors physicians who practice medicine in areas of crisis or devote their time to volunteerism and public service.</li> <li style="margin-left:0.25in;"> <strong>The Dr. Debasish Mridha Spirit of Medicine Award</strong> recognizes the work of a U.S. physician who has demonstrated altruism and compassion while providing quality health care to marginalized populations.</li> <li style="margin-left:0.25in;"> <strong>The Dr. Nathan Davis International Award in Medicine</strong> honors physicians whose influence reaches international patients for a positive impact on health care in the global arena.</li> </ul> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page" target="_blank">Applications</a> to nominate career and senior physicians are now available. The deadline for applications is Feb. 26 at 6 p.m. Eastern time. Award recipients will be honored in conjunction with the 2016 AMA Annual Meeting in Chicago. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b1f4d714-c280-4acb-aec3-4f26621c546e Call for LGBT Advisory Committee nominees http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_call-lgbt-advisory-committee-nominees Fri, 29 Jan 2016 15:02:00 GMT <p> The AMA Board of Trustees is seeking diverse candidates for two at-large positions on the AMA Advisory Committee on Lesbian, Gay, Bisexual and Transgender (LGBT) Issues.</p> <p> The AMA Advisory Committee on LGBT Issues meets twice a year and hosts monthly teleconferences between face-to-face meetings. The committee’s role is to advise the AMA Board of Trustees on LGBT issues and host the LGBT and Allies Caucus and Reception, along with other LGBT educational sessions.</p> <p> Nominees should have expertise and interest in LGBT issues and should have held previous leadership or committee positions. Newly appointed committee members are expected to attend the next committee meeting in Chicago, taking place June 9-11.</p> <p> At-large position nominees must complete and sign an <a href="http://www.ama-assn.org/resources/doc/glbt/x-pub/2016-lgbt-nominations-form.docx" target="_blank">AMA nominations form</a> (log in) along with their executive curricula vitae, not to exceed three pages. Nomination materials should be <a href="mailto:lgbt@ama-assn.org" rel="nofollow">submitted via email</a> by Feb. 29. If you have any questions, please contact <a href="mailto:JMori.Johnson@ama-assn.org" rel="nofollow">J. Mori Johnson of the AMA</a>, or call her at (312) 464-5678.</p> <p> <strong>Providing nonjudgmental care for LGBT populations</strong></p> <p> Lesbian, Gay, Bisexual and Transgender (LGBT) populations are at increased risk for specific health issues across the age spectrum, from depression, suicidality and eating disorders in childhood to substance abuse, sexually transmitted infections and domestic violence issues in adulthood.</p> <p> Yet within the clinical arena, unconscious biases can make patients uncertain or afraid to give sensitive information disclosing their sexual orientation, leading to missed guidance and care opportunities for higher-risk problems. <a href="https://www.reachmd.com/programs/everyday-family-medicine/providing-nonjudgmental-care-lgbt-populations-how-recognize-unconscious-bias/7812/?utm_campaign=RMD_Daily_Newsletter_01142016&utm_medium=Email&utm_source=ExactTarget" target="_blank" rel="nofollow">View</a> a video discussing the topic of unconscious bias in the clinical setting. Available from ReachMD, this education session was recorded on site at the American Osteopathic Association’s annual medical education conference.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:88b0772c-2f38-45b2-acf3-6ae0863c1f4f How video games could soon change med ed http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_video-games-could-soon-change-med-ed Thu, 28 Jan 2016 21:03:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/15/bf5b6487-859a-443b-9fd2-e50a212a279b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/15/bf5b6487-859a-443b-9fd2-e50a212a279b.Large.jpg?1" style="float:right;margin:15px;" /></a>Video games are creating new ways to teach physicians in training. One physician educator recently explained how gaming can transform competency-based education and shared three video games that are already helping students master clinical skills.</p> <p> <strong>Transforming student learning</strong></p> <p> “If any of you have teenagers or know millennials, they’re playing these games where they are in the isolation of their environment, but they’re communicating with others playing the same game all over the world,” Suraiya Rahman, MD (pictured right), assistant professor at Keck School of Medicine at University of Southern California, told a group of educators during a presentation at the AMA’s CHANGEMEDED conference in October. “They are coordinating, getting together and building plans. They’re able to adapt different characters, build environments and move in [them].”</p> <p> Dr. Rahman said students can reap the same benefits of massive multiplayer online role playing games by collaborating with their peers and educators in clinical learning environments.</p> <p> “You can create a game to mimic any kind of environment—the academic medical center, the community medical center, the VA center,” she said. Freed from the confines of an actual classroom, educators can use game theory to build environments for students to accomplish individualized goals, test their clinical knowledge and build competencies across care settings.</p> <p> Plus, gaming can appeal to some of the common traits of medical students and physicians. “Video games offer competitive environments, and medical students and physicians are type A. We love to win,” Dr. Rahman said. “We love being really good at something, learning something and getting better at it.” Games offer prime opportunities for self-directed learning.</p> <p> As gamers, she said medical students can test their skills and simultaneously have the freedom to fail and learn from their mistakes, which reinforces the concepts they need to master. Video games also offer unique opportunities for students to conduct risk-benefit analysis and follow tailored learning plans.</p> <p> <strong>3 med ed games students already use</strong></p> <p> Dr. Rahman noted three games that are already helping students master various skills in virtual medical settings:</p> <ul> <li> <strong>“</strong><a href="https://play.google.com/store/apps/details?id=com.medicaljoyworks.prognosis&hl=en" rel="nofollow" target="_blank"><strong>Prognosis</strong></a><strong><u>”</u></strong><strong>:</strong> “This [game] is similar to how we all teach and learn clinical diagnostic reasoning,” Dr. Rahman said. “Prognosis” provides clinical cases with pictorial representations of physical exams. Students can ask for labs and images for a simulated patient, and the game will generate them. This allows students to test their decision-making skills and assess their clinical knowledge in a risk-free virtual environment.<br /> <br /> “The game follows [the physician’s] trail of thinking. It creates that network of thinking that we’re used to,” Dr. Rahman said. “What better way to learn about patterns than to see [them] on screen and take that information in?”</li> </ul> <ul> <li> <strong><a href="http://www.kongregate.com/games/sage880/medical-school" rel="nofollow" target="_blank">“Medical School”:</a></strong> With this video game, premedical students can roam the virtual walls of a medical school, treat patients in clinical settings and order exams. “The game creates an environment where students can imagine they’re walking in and can ask the environment to do something for them .... It tries to simulate some of the work we do and the order [in which] we do it,” Dr. Rahman said.<br />  </li> <li> <strong>“</strong><a href="http://www.microbeinvader.com/" rel="nofollow" target="_blank"><strong>Microbe Invader</strong></a><strong><u>”</u></strong><strong>:</strong> This game lets students operate as busy clinicians in an understaffed virtual hospital. They can “diagnose patients by ordering lab tests and matching the symptoms and history to bacteria that fit the presentation,” according to the game’s official site.<br /> <br /> With a buzzing pager in tow, online characters can explore the hospital and choose from a variety of emoji-style <a href="http://www.microbeinvader.com/microbes/" rel="nofollow" target="_blank">microbes, antibiotics and characters</a> to help treat infectious diseases.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Lyndra_AMAWire" rel="nofollow" target="_blank"><em>Lyndra Vassar</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8b2c6209-ab6a-419c-9a94-ae556a745c87 How physician burnout compares to general working population http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-burnout-compares-general-working-population Wed, 27 Jan 2016 22:23:00 GMT <p> Over just three years, physicians reported a nearly 9 percent increase in burnout rates. But how does physician burnout compare to that of the general working population? A recent national study provides insights, including key findings on work-life balance. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/ba2f630c-72e9-425b-8ab1-c7455058539f.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/10/ba2f630c-72e9-425b-8ab1-c7455058539f.Full.jpg?1" style="width:356px;height:580px;margin:15px;float:right;" /></a></p> <p> <strong>Physicians compared to the general working population</strong><br /> Physician burnout experts at the AMA and the Mayo Clinic conducted a survey of 6,880 physicians to “evaluate the prevalence of burnout and physicians’ satisfaction with work-life balance compared to the general U.S. population relative to 2011 and 2014,” according to a <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/abstract" rel="nofollow" target="_blank">study</a> recently published in <em>Mayo Clinic Proceedings.</em></p> <p> Compared with the general U.S. population, physicians in 2014:</p> <ul> <li> Were more likely to be married (82.9 percent for physicians versus 67.5 for the general U.S. working population). </li> <li> Worked a median of 10 hours more per week (50 hours versus 40 hours).</li> <li> Displayed higher rates of emotional exhaustion (43.2 percent versus 24.8 percent), depersonalization (23.0 percent versus 14.0 percent) and overall burnout (48.8 percent versus 28.4 percent).</li> <li> Reported lower satisfaction with work-life balance (36.0 percent of physicians reported being satisfied with their work-life balance, compared to 61.3 percent of the general U.S. working population).</li> </ul> <p> “It is notable that the increase in burnout and decrease in satisfaction with work-life balance in physicians over the last three years runs counter to trends in the general U.S. working population over the same interval,” study authors noted.</p> <p> <strong>Gap in work-life balance widens for physicians</strong><br /> Beyond increasing dissatisfaction among physicians, poor work-life balance weighs on physician spouses and families. This is especially true in <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">medical marriages</a> as more physicians continue to have children and juggle high-stakes priorities after training.</p> <p> In fact, satisfaction with work-life balance declined in physicians between 2011 and 2014 (from 48.5 percent to 40.9 percent).</p> <p> “Only 40.9 percent of the physicians felt that their work schedule left enough time for personal and family life, with 14.6 percent neutral and 44.5 percent disagreeing with this assertion,” the study said. Yet satisfaction with work-life balance for the general U.S. working population was slightly more favorable in 2014 than in 2011—up from 55.1 to 61.3 percent, according to the study.</p> <p> “These disparate trends have resulted in a further widening in the rates of burnout and satisfaction with work-life balance among physicians relative to the U.S. working population, even after adjustment for differences in hours worked, age, sex and relationship status,” the study authors noted.</p> <p> Burnout rates also are increasing across all specialties, underscoring the need for community-driven solutions that foster wellness among physicians and physicians in training.</p> <p> “Students start medical school with stronger mental health profiles than their peers,” said Christine Sinsky, MD, AMA vice president of professional satisfaction and an author of the study. “It is especially concerning, then, that through the course of medical school, residency and practice physicians come to experience much higher rates of emotional exhaustion and burnout.”</p> <p> Review <a href="http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates" target="_blank">part one</a> of this post for additional observations on specialties with the highest burnout rates and a graphic that breaks down burnout rates across all specialties.</p> <p> <strong>Also, don’t miss these resources on burnout and physician families:</strong></p> <ul> <li>  Learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/beat-burnout-7-signs-physicians-should" target="_blank">7 signs of burnout</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/7-steps-prevent-burnout-practice" target="_blank">how to prevent them</a> in your practice.</li> <li> Review these <a href="http://www.ama-assn.org/ama/ama-wire/post/burnout-busters-boost-satisfaction-personal-life-practice" target="_blank">burnout busters</a> to increase physician satisfaction.</li> <li> Check out AMA Alliance <a href="http://www.amaalliance.org/site/news/physician-family-magazine/" rel="nofollow" target="_blank">publication</a> <em>Physician Family,</em> which offers advice for physicians balancing various aspects of their personal lives, careers and families.</li> <li> Read <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-maintaining-happiness-marriage" target="_blank">these 3 tips</a> for maintaining happiness in a medical marriage.</li> <li> Follow <a href="http://www.ama-assn.org/ama/ama-wire/post/3-tips-successful-medical-marriage" target="_blank">these expert insights</a> to ensure you’re successfully partnering with your spouse.</li> <li> Learn more about <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-marry-doctors-exploring-medical-marriages" target="_blank">the benefits of a medical marriage</a> and why physicians often marry fellow physicians.</li> </ul> <p align="right"> <em>By AMA staff writer </em><em><a href="http://twitter.com/Lyndra_AMAWire" rel="nofollow">Lyndra Vassar</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f34454bd-3f02-4869-a5a9-8c3336d2a35c Learning from patient death: One residency program’s solution http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_learning-patient-death-one-residency-programs-solution Wed, 27 Jan 2016 19:00:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/9beb2fa3-4615-4e81-99cf-154447076671.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/9/9beb2fa3-4615-4e81-99cf-154447076671.Large.jpg?1" style="margin:15px;float:right;" /></a>Patient deaths can trigger challenging emotions and care decisions, yet there are few programs that teach residents how to manage end-of-life care. That’s why one residency program decided to pilot