AMA Wire® http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page Thu, 30 Jun 2016 19:00:00 GMT Becoming a master in med school takes on new meaning http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_becoming-master-med-school-takes-new-meaning Thu, 30 Jun 2016 19:00:00 GMT <p> Tackling a master’s degree during medical school—usually in public health or business—has become increasingly popular among students as they prepare for the rigors of the profession. Many schools now are focused on developing a mastery of learning that is essential for physicians’ entire careers—but it doesn’t involve an additional degree.</p> <p> The AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page"><u>Accelerating Change in Medical Education Consortium</u></a>—working to modernize and reshape the way physicians are trained—brings schools together to share ideas and experiences with new programs designed to improve competency, leadership and patient care through innovations that prepare students to thrive in an evolving care delivery system. A priority area for many of the schools is training students to become lifelong learners, also known as “master adaptive learners.”</p> <p> <strong>Pathways at Harvard</strong></p> <p> Harvard Medical School, which joined the consortium this year, created the Pathways Curriculum and implemented it in August 2015. The program aims to create master adaptive leaners who are self-directed, reflective, curious, cognitively flexible, and capable of embracing uncertainty and dealing with complexity.</p> <p> To foster that, the school has moved to a 14-month pre-clerkship curriculum and then returns students to integrated classroom/clinical experiences after their core clerkships. Among other changes, three Professional Development Weeks provide students with feedback about their evolving skills, and students meet regularly with their advisers to work on individualized plans to guide their development.</p> <p> “There is a great emphasis on self-directed learning … we want people to be motived by learning and growing, not just studying for what they are being tested on,” said Edward Krupat, PhD, director of Harvard Medical School’s Center for Evaluation and an associate professor of psychology in the Department of Psychiatry at the Beth Israel Deaconess Medical Center.</p> <p> Harvard Medical School leaders also are trying to change the culture so students understand that there are shades of gray in medicine and will be willing to say that they don’t know something, Krupat said.</p> <p> <strong>Translational learning in North Carolina</strong></p> <p> The University of North Carolina School of Medicine, which also joined the consortium this year, is in its second year of Translational Education at Carolina (TEC), a change that has the school expanding the ways in which it develops students’ physician leadership skills. As part of the changes, UNC will now tap into the university’s public health and population science and business school talents.</p> <p> The TEC program is built on three threads: the translation of medical science to the care of people, patients and populations. It also now will include a professional development thread that will be woven throughout the four years of medical school. Students will become more familiar with the health care system and how it is financed and become familiar with business terms, such as value-based purchasing.</p> <p> Physicians will need to focus on populations instead of just the patients, said Julie Byerley, MD, vice dean for education at the University of North Carolina School of Medicine. It also demands that physicians work in teams and recognize their unique role on the team.</p> <p> “Medicine is always changing, but the pace of change in health care right now is incredibly rapid,” Dr. Byerley said. “We want our graduates to take care of the patients in front of them with the goal in mind of taking care of the entire population.”</p> <p> <strong>Technology in Texas</strong></p> <p> The University of Texas Rio Grande Valley School of Medicine (UTRGV SOM) in Edinburg, Texas, another school that joined the consortium in 2016, will use technology to support communication and empathetic interactions with patients in diverse groups and in multiple settings for numerous preventive health, health maintenance and health care delivery purposes.</p> <p> “The aspects of the UTRGV SOM curriculum that we are most excited about in terms of facilitating the students to becoming master adaptive learners are the structured and guided opportunities threaded throughout the curriculum for reflection and self-directed, independent learning so that the students become competent, self-aware lifelong learners with an interest in and skills to work with underserved populations,” said Arden D. Dingle, MD, psychiatry professor and UTRGV SOM’s chief of child and adolescent psychiatry, and Valerie Terry, PhD, instructional development designer and communication discipline coordinator at UTRGV SOM.</p> <p> The school, which matriculated its inaugural class of 55 students in June 2016, is in the Lower Rio Grande Valley. The region shares its southern border with Mexico, and much of the population lacks access to quality, affordable health care. The medical school’s curriculum features problem/case-based learning and hands-on experiences that incorporate information and approaches that are relevant to working with underserved populations.</p> <p> “Due to the different cultural background of this large population, we are engaging students with family ties and similar socioeconomic backgrounds as well as cultural traditions who  would want to stay long term in the Rio Grande Valley,” Francisco Fernandez, MD, the school of medicine’s dean wrote in a letter to the consortium.</p> <p> <strong>Curriculum 2.0 at Vanderbilt</strong></p> <p> Leaders at Vanderbilt University School of Medicine, one of the 11 founding members of the consortium in 2013, said they have benefited from participating in the consortium. Among the changes they have accomplished:</p> <ul> <li> Attention to all domains from the first day</li> <li> Standardized milestones across settings</li> <li> A portfolio coach for each student</li> <li> Systems-oriented activities in clerkships</li> <li> Population health and advocacy</li> </ul> <p> Improving student perceptions of competency-based assessment, practical applications of the master adaptive learner construct and connecting personalized learning goals to daily work are among the areas Vanderbilt medical school leaders are now working to change.</p> <p> <strong>Other consortium projects</strong></p> <p> The 32 consortium schools are also changing other ways medical students study, including <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">paving a new path to residency</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/michigan-relaying-student-competency-residency-programs" target="_self">relaying student competency to residency programs</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/one-school-training-students-rural-medicine" target="_self">training students for rural medicine</a>. You also can read about what <a href="http://www.ama-assn.org/ama/ama-wire/post/students-forefront-of-transforming-med-ed" target="_self">students at the forefront of transforming med ed</a> have to say about their experiences.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8e959e28-3984-4146-8593-439e2590b168 Nonclinical careers: Insights from Rep. Tom Price, MD http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nonclinical-careers-insights-rep-tom-price-md Wed, 29 Jun 2016 22:13:00 GMT <p> As you complete your medical training and advance in your career as a physician, do you ever wonder where your career might take you beyond the exam room? In this new mini-series, we’re getting a glimpse of the jobs some physicians take on to support health care in the United States through nonclinical means.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/0/b8d2efb6-c0ec-4d57-90c3-e40428ba22d0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/0/b8d2efb6-c0ec-4d57-90c3-e40428ba22d0.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Rep. Tom Price, MD, was first elected to represent Georgia’s 6th district in November 2004. Prior to going to Washington, Dr. Price served four terms in the Georgia State Senate, two of which as minority whip. Dr. Price worked in private practice as an orthopaedic surgeon for nearly 20 years. </p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>What led you to run for public office?</strong><br /> This was never my grand plan. However, at some point early in my career, I recognized that there were a whole lot of people in our state capitol and in Washington who were making decisions about what I could do for and with my patients who never practiced medicine or took care of a patient. That knowledge, and the concerns of my patients, led me into public service. These were non-medical people making medical decisions, and I thought that was not appropriate or needed. </p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>How did your clinical background equip you to take on your role as a member of Congress?</strong><br /> The expertise and training we undergo as physicians, I believe, is ideally suited to public service. In the political arena, folks are most interested in someone who listens and appreciates the big picture. If that doesn’t describe doctors, I don’t know what does. Our challenge is to bring the scientific method of problem solving to the public service arena. We’d all be better off.</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>What do you find the most rewarding about being a member of Congress? What have you found the most challenging or surprising?</strong><br /> Being able to participate in solving, and have an opportunity to help move, big problems is a remarkable privilege. There are so many challenges confronting us as a nation. Working with colleagues from different parts of the country with unique and diverse points of view is tremendously rewarding. One of the more challenging aspects of this job is the patience that’s required when it comes to getting real solutions enacted. The legislative process, by design, can be laboriously extended, even when folks are in general agreement on how to proceed. That took some getting used to after coming from a profession where quite often, by necessity, decisions are made quickly and a treatment plan is put into action shortly after the patient comes through the door.</p> <p style="margin-left:40px;"> <strong>4.   </strong><strong>What advice would you give medical residents and young physicians who are interested in running for public office in the future?</strong><br /> Find your passion in medicine and pursue it. There is no greater honor or joy that one could ever gain in life than in caring for one's fellow man. If public service calls you, plant yourself firmly in a community and pour yourself into the issues that confront folks locally every day. Then, and only then, will you be able to feel the personal concerns and frustrations of your fellow citizens—and then, and only then, will you be able to gain their trust to have them consider you as a person who might possibly be able to represent their interests at any level. I’d be more than pleased to discuss any one individual’s personal goals with them as we move forward.  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ac681391-0447-47c5-90ff-b133ad29f2b2 36 med students, young physicians recognized as future leaders http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_36-med-students-young-physicians-recognized-future-leaders Wed, 29 Jun 2016 22:10:00 GMT <p> Three dozen students, residents and early career physicians from around the country are being recognized for their commitment to reducing health care disparities and their non-clinical leadership in advocacy, community service and education. Find out who has been awarded this year’s honors.</p> <p> <strong>Minority med students receive equity honors</strong></p> <p> Growing up, Aaron Doctor had a front-row view of the barriers to health care.</p> <p> The Gullah Sea Islands off the coast of South Carolina are among the nation’s most remote and insular communities. Daily life offered Doctor a range of lessons on coping with a lack of care.</p> <p> “Often people who are from communities like mine are mistrusting of people that they deem as outsiders, and that’s where I come in,” said Doctor, a student at Morehouse School of Medicine. “A familiar face goes a long way to creating the comfort necessary to build a successful relationship.”</p> <p> “I’m motivated because I’m a product of a community where social inequality and health disparities are a very real concern,” he said.</p> <p> That motivation makes Doctor one of this year’s recipients of the <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/medical-education/minority-scholars-award.page" target="_self">Minority Scholars Award</a>, part of the AMA Foundation’s <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page" target="_self">Excellence in Medicine</a> program. The award provides $10,000 scholarships to first- and second-year students who show academic achievement and a commitment to reducing health care disparities.</p> <p> Scholarship recipients were honored June 10 in Chicago at the 2016 AMA Annual Meeting.</p> <p> The 21 recipients this year come from groups historically underrepresented in the medical profession, including African-American, American Indian, Native Hawaiian, Alaska Native and Latino. Less than 9 percent of U.S. physicians come from these groups.</p> <p> Since 2014, one student also has been honored by a scholarship to promote diversity specifically in cardiology. The Dr. Richard Allen Williams and Genita Evangelista Johnson /Association of Black Cardiologists Scholarship recognizes a first- or second-year African-American student with an expressed interest in cardiology.</p> <p> This year’s Minority Scholars Award list includes students from schools throughout the nation, with a range of cultural experiences:</p> <ul> <li> Jemma Alarcon, University of California, Irvine School of Medicine</li> <li> Anya Bazzell, Morehouse School of Medicine</li> <li> Shakira Burton, Drexel University College of Medicine</li> <li> Amanda Compadre, the University of Arkansas for Medical Sciences</li> <li> Elizabeth Dalchand, Stony Brook University School of Medicine</li> <li> Aaron Doctor, Morehouse School of Medicine</li> <li> Mariana Gomez, University of California, Irvine School of Medicine</li> <li> Gerard Holder, Alabama College of Osteopathic Medicine</li> <li> Maseray Kamara, Michigan State College of Human Medicine</li> <li> Bianca Lizarraga, David Geffen School of Medicine at UCLA</li> <li> Joana Loeza, University of California, San Francisco</li> <li> Mariela Martinez, Ponce Health Sciences University</li> <li> Ana Ortiz Ilizaliturri, University of California, San Diego School of Medicine</li> <li> Maricruz Rivera, Case Western Reserve University School of Medicine</li> <li> Nancy Rodriguez, University of California, Davis School of Medicine</li> <li> Zena Salim, Michigan State College of Human Medicine</li> <li> Javier Sotelo, Jr., Keck School of Medicine of University of Southern California</li> <li> Ashley White-Stern, Columbia College of Physicians and Surgeons</li> <li> Kelsey Williams, University of South Carolina School of Medicine, Greenville</li> <li> Shannon Zullo, University of Arizona, College of Medicine</li> <li> Paris Austell, Rush Medical College (recipient of the Dr. Richard Allen Williams and Genita Evangelista Johnson /Association of Black Cardiologists Scholarship)</li> </ul> <p> <strong>Future community and medical leaders selected</strong></p> <p> Also honored this year were 15 medical students, residents, fellows and early career physicians who received the AMA Foundation’s Leadership Award.</p> <p> Recipients are recognized for outstanding non-clinical leadership in advocacy, community service and education. The award provides recipients from around the country with training to develop their skills as future leaders in medicine and community affairs.</p> <p> The winners are:</p> <ul> <li> Annalise O. Abiodun, MD, Greater Baltimore Medical Center</li> <li> Rohit Abraham, Michigan State University College of Medicine</li> <li> Eric James Chow, MD, Brown University</li> <li> Anupriya Dayal, Medical College of Wisconsin-Milwaukee</li> <li> Olatokunbo Famakinwa, MD, Yale-New Haven Hospital</li> <li> Cherie Fathy, Vanderbilt University School of Medicine</li> <li> Oswaldo Hasbún Avalos, Columbia University College of Physicians and Surgeons</li> <li> Leedor Lieberman, Wayne State University School of Medicine</li> <li> David A. Nissan, MD, New York-Presbyterian Hospital/Weill Cornell Medical Center</li> <li> Ravi Bharat Parikh, MD, Brigham and Women’s Hospital</li> <li> Hunter Pattison, University of Florida College of Medicine</li> <li> Christa Pulvino, Tulane University School of Medicine</li> <li> Nikita Saxena, Boston University School of Medicine</li> <li> Aleesha Shaik, Drexel University College of Medicine</li> <li> Christiana Shoushtari, University of Illinois-Chicago, College of Medicine</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9c61f143-6434-4b1b-928f-aa0c75c418db Nonclinical careers: What it’s like working at the FDA http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_nonclinical-careers-its-like-working-fda Wed, 29 Jun 2016 22:04:00 GMT <p> As you complete your medical training and advance in your career as a physician, do you ever wonder about career options outside the exam room? In this new mini-series, we’re getting a glimpse of the jobs some physicians take on to support health care in the United States through nonclinical means.</p> <p> Here’s a look into the work of John Whyte, MD, director of professional affairs and stakeholder engagement at the U.S. Food and Drug Administration (FDA). Dr. Whyte completed his medical training in internal medicine and also holds a Master of Public Health.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/0/da46c298-1d87-4cc7-90fa-b805d244bd39.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/0/da46c298-1d87-4cc7-90fa-b805d244bd39.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>What are your main responsibilities in your current role?</strong></p> <p> My main responsibilities include improving our stakeholders’ drug regulatory insight and understanding to:</p> <ul> <li> Enrich the experience of patients, advocacy groups, health care professionals and agencies in engaging with the FDA</li> <li> Provide a focal point for advocacy and two-way engagement on drug development, review and safety</li> <li> Enhance safe use of medications and reduce preventable harm from medication misuse, abuse and errors</li> </ul> <p> <strong>How did you get into this position?</strong></p> <p> I actually was recruited to the position. It’s a new office at FDA, and they knew of my work communicating health messages at the Discovery Channel.</p> <p> At the Discovery Channel, I was responsible for health documentaries and medical education programs, both on television and online. This experience made me learn how to distill complicated information into a few salient points. I also appreciated how critical it is to engage and even entertain an audience—after all, there’s a reason why Shark Week is so popular!</p> <p> <strong>How did your clinical background equip you to take on this role?</strong></p> <p> Clinical medicine definitely taught me how to multitask. Just like on the wards and in the emergency room, you need to manage multiple issues contemporaneously.</p> <p> <strong>What do you find the most rewarding about your current job?</strong> <strong>What do you find the most challenging or surprising?</strong></p> <p> The ability to change a culture by creating more transparency at a regulatory agency is exciting. The government moves much more slowly, though, than the private sector. And sometimes there are rules and policies that don’t quite seem to make sense.</p> <p> <strong>What advice would you give medical residents who are interested in pursuing a career in your current field?</strong></p> <p> Spend time learning what physicians in government (or in media) really do day-to-day. Search for and ask about participating in four-week internships.</p> <p> <strong>Are there any resources, organizations or networking events you’d suggest for medical residents who are interested in your field?</strong></p> <p> I have found organized medicine (like the AMA) to be one of the most valuable resources. I have been interested in health policy issues since college. Medical school and residency don’t provide you the opportunity to learn about broader policy issues. But being involved with the AMA, state medical societies and specialty groups provides an unparalleled opportunity to learn a whole new discipline separate from clinical medicine.</p> <p> <strong>What advice would you offer to medical residents on how to find a mentor in your profession?</strong></p> <p> Be creative. If the job you want doesn’t exist, think of ways you can create it. Several of my jobs were ones for which I created the role. Reach out and talk to people. Most leaders are interested in talking to residents and students. But be prepared: Come with questions and do some homework on the person from whom you want advice.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:65368e19-5e34-4e42-9b0e-99163d910b9a Take the challenge: Answer this USMLE Step 1 question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_challenge-answer-this-usmle-step-1-question Tue, 28 Jun 2016 22:02:00 GMT <div> When it comes to taking exams, not all questions are created equal. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you need this exclusive scoop on one of the most commonly missed USMLE test prep questions. Find out what this month’s challenging question is, and view an expert video explanation of the answer from Kaplan Medical.</div> <div>  </div> <div> 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="_self">all posts in this series</a>.</div> <div>  </div> <div> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</div> <div>  </div> <div> Ready. Set. Go.</div> <p style="margin:0in 0in 0.0001pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;">  </p> <p style="margin:0in 0in 0.0001pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;"> <strong>This month’s question that stumped most students:</strong></p> <p> A 66-year-old man is brought to the emergency department after recent discharge following a Whipple’s procedure for pancreatic cancer performed seven days prior. He has a six-hour history of worsening shortness of breath and sudden onset chest pain. He is given oxygen supplementation, which moderately improves his saturation. A contrast-enhanced CT scan of the chest is shown. Which of the following is the most likely origin of the abnormality seen on CT?</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/1/3fe51c18-d4aa-4b1e-8125-d3ae4f5cb507.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/1/3fe51c18-d4aa-4b1e-8125-d3ae4f5cb507.Large.jpg?1" style="margin:15px;height:251px;width:350px;" /></a></p> <p> A. Basilic vein<br /> B. Brachial vein<br /> C. Cephalic vein<br /> D. Femoral vein<br /> E. Great saphenous vein<br /> F. Lesser saphenous vein</p> <p> <object data="http://www.youtube.com/v/ENwpm8GRrn0" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/ENwpm8GRrn0" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/ENwpm8GRrn0" /><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></p> <p> <strong>The correct answer is D.</strong></p> <p> <strong>Kaplan says, here’s why: </strong></p> <p> The patient most likely has a pulmonary embolism (PE). The large filling defect in the right pulmonary artery and in the superior branch of the left pulmonary artery (see circles in the left image below) in the CT scan support the diagnosis. For comparison, a normal image through the same region is shown on the right.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/9/dd3278ee-2cdf-476e-899e-d67e6bb85f19.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/9/dd3278ee-2cdf-476e-899e-d67e6bb85f19.Full.jpg?1" style="margin:15px;" /></a></p> <p> More than 90 percent of pulmonary emboli originate from the deep veins of the lower limbs. The only deep vein of the lower limb listed in the answer choices is the femoral vein. Venous thromboses can also form more distally in the popliteal vein. The risk of embolism increases as the clot extends proximally.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choices A and C:</strong> The basilic and cephalic veins are two superficial veins of the upper limbs and are the ones most frequently accessed with IV catheters. Virtually the only time you see major clots in the upper extremities is when they contain some sort of catheter.</p> <p> <strong>Choice B:</strong> The brachial vein is the major deep vein of the upper extremities. Venous thromboses can form in the deep veins of the upper extremities but venous thromboembolism much more commonly arises from DVTs in the lower extremities.</p> <p> <strong>Choices E and F:</strong> The great saphenous and lesser saphenous veins are the superficial veins of the lower limbs and do not commonly result in pulmonary embolism. The great saphenous vein is commonly harvested for bypass procedures.</p> <p> <strong>Key tips to remember:</strong></p> <ul> <li> More than 90 percent of pulmonary emboli begin in the deep veins of the lower limbs.</li> <li> Deep vein thromboses of the lower extremities generally form in the popliteal veins and extend proximally.</li> <li> The more proximal the clot, the more likely it is to embolize to the lungs. </li> </ul> <p style="margin:0in 0in 0.0001pt;background-image:initial;background-attachment:initial;background-size:initial;background-origin:initial;background-clip:initial;background-position:initial;background-repeat:initial;">  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1ae75718-87c0-488d-bf34-2c09efad9593 Pain expert: Judge the opioid treatment, not the patient http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_pain-expert-judge-opioid-treatment-not-patient Tue, 28 Jun 2016 21:05:00 GMT <p> With medications that carry significant risks, such as opioids, appropriate prescribing practices are critical to patient safety. One physician in Boston lives by a mantra that puts patients first: Judge the treatment, not the patient.</p> <p> We need to start re-conceptualizing chronic pain as a chronic disease, said Daniel P. Alford, MD, associate professor of medicine at the Boston University School of Medicine and director of the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program.</p> <p> “Acute pain is a symptom, and it’s life-sustaining—and you need to feel acute pain in order to survive,” Dr. Alford said. But “there is no advantage to chronic pain. Chronic pain really is a malfunctioning of the nervous system and requires, like other chronic diseases, a multimodal approach.”</p> <p> <strong>Assessing whether opioids are the appropriate course of treatment</strong></p> <p> Many potential physical, psycho-behavioral, procedural and pharmacologic options exist for managing chronic pain. Dr. Alford follows a process that helps him to make the appropriate clinical judgment regarding whether or not opioids are an appropriate course of treatment for each individual patient:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Determine whether the patient has a pain process that is likely to respond to opioid therapy. </strong>For a lot of chronic pain disorders, opioids are probably not the answer, Dr. Alford said. “For example, chronic migraine headaches, fibromyalgia and back pain … tend to be less opioid responsive, and so I’d be reluctant to start them.”<br /> <br /> For non-cancer chronic pain, opioids are indicated when pain is severe, has significant impact on function and quality of life and other treatments have been inadequate. “When you’ve tried other things and they haven’t been successful,” he said, “a trial with an opioid is appropriate.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Prior to prescribing opioids, do a risk assessment. </strong>Attempt to evaluate how risky it might be to prescribe opioids to the individual patient, Dr. Alford said. “There are opioid misuse risk stratification tools … including the opioid risk tool (ORT),” which are intended to classify patients as low, moderate and high risk for opioid misuse.  But you cannot rely on these tools alone because they have not been rigorously tested<br /> <br /> They can help start the  conversation about other known risk factors and predictors for problematic prescription opioids with the patient so that they’re informed about their risk, Dr. Alford said. “[This conversation] also helps you determine how to structure therapy and monitor them for safety—that is, if they’re at higher risk or misusing their opioids, then they need to be monitored more closely.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Use universal precautions.</strong> Because no one can predict problematic behavior with absolute certainty, you have to “assume that every single person who’s prescribed opioids carries some risk for misusing that opioid,” Dr. Alford said. “Every one of my patients on chronic opioid therapy gets that initial risk assessment but also needs to be monitored for adherence and misuse.”<br /> <br /> “The frequency of doing all those things,” he said, “is going to be based on your initial and ongoing assessment of their response to therapy, particular risks and behavior.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Structuring care and monitoring the patient for safety.</strong> Over time, monitor the patient for adherence using objective information including checking the prescription drug monitoring program (PDMP), urine testing, pill counts and making sure the interval between visits is appropriate. “If the patient is doing well based on pain relief, function and daily activities,” he said, “then I’m going to be less worried about their potential misuse of opioids.”<br /> <br /> At least a 30 percent improvement in pain and function is a reasonable goal.<br /> <br /> “Even if the person appears to be benefitting,” he said, “if you start to get a sense that they are misusing the opioid—that is, loss of control, compulsive use, continued use despite harm, they keep running out early, showing up in the emergency room, calling the on-call service, or they become so focused on the drug they can’t even imagine doing anything else for their pain, or they’re having some negative consequences from the opioid but still want more—I would probably end up tapering that opioid because I just feel that it’s too unsafe.”<br /> <br /> “These are all very difficult decisions to be made,” he said. </p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Prescribing opioids for chronic pain at the lowest dose possible. </strong>Dr. Alford said you should initiate therapy in a way that the patient understands that it is a test or a trial to see whether or not they will benefit from the treatment.<br /> <br /> “If they’re not benefitting, then they may be in the portion of patients who are never going to benefit from an opioid because their pain is just not responsive to opioids” and the risks are too high, he said. “If they are responding, that’s encouraging—but I’m going to be very reluctant to increase the dose.”<br /> <br /> As you increase the dose, the risk for overdose and other complications increases, Dr. Alford said. “If the patient is benefitting on the opioid, I want to try to maintain them on the lowest dose possible … keeping in mind that [with chronic pain] like other chronic diseases, I want to try to [use] other therapies concurrent to it, whether it be other medications, using rational polypharmacy or other non-pharmacological treatments like acupuncture, behavioral and physical treatments.”</p> <p> <strong>Judge the treatment not the patient</strong></p> <p> Conceptually, treating chronic pain with opioids has to be viewed through the same lens as treating any other chronic disease with any other medication, Dr. Alford said. “That is, when I put someone on an antihypertensive for their blood pressure, I’m judging whether or not the treatment is working by measuring the person’s blood pressure and checking for adverse effects.”</p> <p> “If it isn’t working, I’m not blaming the patient, saying this medication should work, but that patient is a bad person; they can’t take it right,” he said. “I’m judging the treatment both from a benefit and risk perspective.”</p> <p> “Apply the same thing to opioids for pain,” he recommends. “Are the opioids helping the patient more than they’re hurting the patient? If that’s not the case, if I can’t be satisfied that the person is benefitting more than being harmed, then the treatment has failed—not the patient. … And it’s time to consider something else.”</p> <p> “We need to put our clinician cap on and avoid becoming a police officer, or a DEA agent or a judge when it comes to opioids and chronic pain,” Dr. Alford said. “Chronic pain is a chronic disease, and opioids are one tool that benefits some patients but carries a whole lot of risk. And we should just treat it that way.”</p> <p> Naloxone also can be a way to <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">start the broader conversation about the risks</a> that opioid medications carry without contributing to the stigma that surrounds overdose and substance use disorders.</p> <p> <strong>For more on treating patients with chronic pain using opioid therapy treatment:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas" target="_self">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-things-physician-should-treating-pain" target="_self">3 things every physician should do when treating pain</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:d910d54c-3620-4468-a53b-d9bed051a003 This month’s toughest USMLE Step 2 question to master http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_this-months-toughest-usmle-step-2-question-master Tue, 28 Jun 2016 20:59:00 GMT <p> Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> A 70-year-old woman presents to her primary care physician with diarrhea. She describes watery stools associated with abdominal cramping for the last week. There has been no fever, nausea, or vomiting. She was hospitalized 1 month ago for community-acquired pneumonia, which was treated with ceftriaxone and azithromycin. She also has a history of watery diarrhea with abdominal cramps when she consumes milk products. Physical examination reveals lower abdominal tenderness. The initial laboratory evaluation of stool is significant for the presence of fecal leukocytes. Which of the following is the most useful step in diagnosing this patient?</p> <p style="margin-left:40px;"> <strong>A. </strong> Avoiding milk products</p> <p style="margin-left:40px;"> <strong>B.  </strong>Colonoscopy with biopsy</p> <p style="margin-left:40px;"> <strong>C.  </strong>Stool <em>C. difficile</em> cytotoxic assay</p> <p style="margin-left:40px;"> <strong>D. </strong> Trial of loperamide</p> <p style="margin-left:40px;"> <strong>E.  </strong>Trial of metronidazole</p> <p>  </p> <p> <object data="http://www.youtube.com/v/gH9qgijQclU?list=PL5PtfrifXVhS2U6BflV9KKmfolL1x_qEc" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/gH9qgijQclU?list=PL5PtfrifXVhS2U6BflV9KKmfolL1x_qEc" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/gH9qgijQclU?list=PL5PtfrifXVhS2U6BflV9KKmfolL1x_qEc" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is C.</strong></p> <p> <strong>Kaplan says, here’s why: </strong><br /> This patient has findings suggestive of <em>C. difficile</em>-associated diarrhea, which is characterized by loose, watery stools plus fecal leukocytosis and abdominal cramping several weeks after treatment with antibiotics. A cytotoxin tissue culture assay is used to show the presence of the toxin and is the most useful test in establishing the diagnosis of <em>C. difficile</em> colitis. Enzyme-linked immunoassays can also be done.</p> <p> Treatment includes stopping the offending antibiotic and initiating metronidazole. Vancomycin is indicated in severe disease or after more than two treatment courses with metronidazole (i.e., on the third recurrent episode of <em>C. difficile</em> colitis).</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> Avoiding milk products is useful in diagnosing lactose intolerance. This patient’s history suggests that she has suffered from lactose intolerance in the past (which presents in a similar fashion), but the recent use of antibiotics and the fecal leukocytosis suggest that the cause of this patient’s watery diarrhea is <em>C. difficile</em> infection rather than lactose intolerance, which is simply an osmotic diarrhea.</p> <p> <strong>Choice B:</strong> Colonoscopy with biopsy may show pseudomembranes, which, combined with the history of diarrhea after recent antibiotic use, is virtually pathognomonic for <em>C. difficile</em> infection. However, sigmoidoscopy and colonoscopy are not generally recommended in patients with classic clinical findings and a positive stool toxin assay. In some patients, when there is a doubt about diagnosis or when it is crucial that a diagnosis be established quickly (the results of toxin assays take a longer time), colonoscopy with biopsy proves extremely useful.</p> <p> <strong>Choice E:</strong> A trial of metronidazole is not the correct option. Metronidazole is the first-line therapy for <em>C. difficile </em>colitis after the diagnosis is established with positive stool assay for cytotoxins. Empiric therapy with metronidazole is indicated if the initial diagnostic assay is negative and clinical suspicion is high.</p> <p> <strong>Choice D:</strong> Antimotility agents such as loperamide are contraindicated because they may predispose the development of toxic megacolon in patients with pseudomembranous colitis.</p> <p> <strong>One tip to remember:</strong></p> <p> When <em>C. difficile </em>colitis (watery diarrhea, abdominal cramps, recent antibiotic use, fecal leukocytosis) is suspected, the first step in management is stool assay for cytotoxins. With a positive assay, metronidazole is the initial treatment of choice.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ec9b72a2-d04d-4831-973a-40ff098d5dd9 Key changes the new Medicare payment system needs http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_key-changes-new-medicare-payment-system-needs Mon, 27 Jun 2016 20:22:00 GMT <p> Physicians have submitted <a href="https://download.ama-assn.org/resources/doc/washington/ama-macra-comments-27june2016.pdf" target="_self">comments</a> to the Centers for Medicare & Medicaid Services (CMS), detailing the changes that need to be made to the <a href="http://www.ama-assn.org/ama/ama-wire/post/draft-regulations-outline-next-phase-of-medicare" target="_self">draft rule</a> for the new Medicare payment system so it works for physicians and their patients.</p> <p> The AMA is urging changes across the reformed program as well as revisions that are specific to the Merit-based Incentive Performance System (MIPS) and the alternative payment model (APM) option.</p> <p> Three of the overarching program recommendations call on CMS to:</p> <ul> <li> Create a transitional reporting period in the first year, beginning July 1, to allow sufficient time to prepare physicians and have a successful launch of the new payment system.</li> <li> Provide more flexibility for solo physicians and small group practices, such as modifying the low volume threshold, lowering reporting burdens, comparing practices to their peers, and providing education, training and technical assistance to these practices.</li> <li> Provide physicians with more timely and actionable feedback in a more usable and clear format.</li> </ul> <p> <strong>Changes needed to improve the MIPS</strong></p> <p> The comments outline several key recommendations regarding the MIPS, which currently is separated into four components. The comments ask CMS to:</p> <ul> <li> Align the different components so the MIPS operates as a single program, rather than four separate parts.</li> <li> Further simplify reporting burdens by creating more opportunities for partial credit and reducing the number of required measures.</li> <li> Maintain the thresholds for reporting on quality measures at 50 percent.</li> <li> Replace current cost-of-care measures that were developed for hospital-level measurement and refine new episode-of-care measures prior to widespread adoption.</li> <li> Remove the pass-fail component of the Advancing Care Information score and restructure the electronic health record performance measures rather than folding the current Meaningful Use Stage 3 requirements into the MIPS.</li> <li> Improve risk adjustment and attribution methods before moving forward with the resource use category, and reduce the number of required Clinical Practice Improvement Activities.</li> </ul> <p> <strong>Changes needed to improve the advanced APMs option</strong></p> <p> The MIPS is a revised fee-for-service model that most physicians will participate in initially. But the program allows for an alternative course through APMs that may work better for some practice types.</p> <p> Physicians detailed several ways the APM option could be improved, including:</p> <ul> <li> Simplify and lower financial risk standards for advanced APMs, and base the risk requirements on physicians’ Medicare revenues instead of total Medicare expenditures.</li> <li> Provide more opportunities for APM participation.</li> </ul> <p> <strong>Physician organizations submit collective recommendations</strong></p> <p> More than 110 state medical associations and national medical specialty societies joined the AMA in a <a href="https://download.ama-assn.org/resources/doc/washington/macra-state-speciality-sign-on-letter.pdf">sign-on letter</a> to CMS that called for simplification, an easier APM pathway, and accommodations for physicians in small and rural practices.</p> <p> “The overall goal in MIPS should be to create a more unified reporting program with greater choice and fewer requirements,” the letter said. “While we see several positive changes in the proposed rule, our main concern is that CMS continues to view the four components as separate programs, each with distinct measures, scoring methodologies and requirements.”</p> <p> Physicians identified in the letter several of the positive MIPS proposals that should be finalized, including reporting quality information through a variety of methods, such as electronic health records (EHR), clinical registry, qualified clinical data registry (QCDR) and group practice reporting.</p> <p> <strong>Resources to prepare for the new Medicare payment systems</strong></p> <p> The AMA offers an <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" target="_self">action kit and other resources</a> to help your practice get ready for the upcoming transition and learn more about the new Medicare payment system.</p> <p> The AMA’s STEPS Forward™ collection of practice improvement initiatives provides a step-by-step process to help you <a href="https://www.stepsforward.org/modules/value-based-care" target="_blank" rel="nofollow">prepare your practice for value-based care</a>. </p> <p> Also, <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-guiding-new-payment-system-cms-chief-says" target="_self">read what CMS Acting Administrator Andy Slavitt</a> had to say in his address at the 2016 AMA Annual Meeting, and <a href="https://reachmd.com/programs/focus-on-public-health-policy/future-medicare-payment-reform-perspectives-macra-cmss-andy-slavitt/8179/" target="_blank" rel="nofollow">listen to a ReachMD podcast interview</a> with Slavitt on how physician input is driving the new Medicare payment system.</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:6a0111a5-d8f6-4bed-9fd1-b322b438be31 How to talk to Congress about the issues http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_talk-congress-issues Fri, 24 Jun 2016 20:34:00 GMT <p> Members of Congress will be heading home in a few weeks for summer recess to meet with their constituents—now’s the time to make sure you get a seat at the table to make sure your legislators are well-informed on the issues that you care about. Learn from an expert how to conduct in-person visits with legislators and how to keep that relationship going.</p> <p> Jim Wilson, PhD, manager of the AMA’s political education programs including the popular <a href="http://www.ampaconline.org/" target="_blank" rel="nofollow">AMPAC</a> Candidate Workshop and AMPAC Campaign School, recently spoke about advocating for health care issues during a session at the 2016 AMA Annual Meeting.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/8dcdde29-11e9-4e24-a61c-5969af1014ef.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/6/8dcdde29-11e9-4e24-a61c-5969af1014ef.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>You are the best advocate for your patients—and yourself</strong></p> <p> “There are a whole lot of people who don’t have anywhere near the training you [do],” Wilson said. “Yet they help drive decisions that determine how you do” your work.</p> <p> “No one else is going to be able to do this for you,” he said. “You’re the best possible advocate that you can have.” So what do you do when you want a member of Congress or a state legislator to vote for or against a bill that you feel strongly about?</p> <p> Figure out a way to engage legislators on a year-round basis, Wilson said. “It’s important that when you want them to do something, you’re not only there when <em>you</em> need something. Because then they say, ‘Well, they only call me when they want me to do something, but I had a question about loan policy three months ago, and I emailed them and I never heard back.’”</p> <p> “It’s easy to get cynical about politics,” Wilson said. “Think about it in a different way.” Try to have a symbiotic relationship with them: They need information on health care policy, and you need help with legislation.</p> <p> “Keep in mind that your elected representatives expect this of different groups,” Wilson said. “If you’re not in the office, the drug company will be, the insurance company will be …. It’s a representative democracy; you have a right to petition the government for grievances, and if you’re not petitioning for grievances, somebody else will be.”</p> <p> In a survey conducted by the <a href="http://www.congressfoundation.org/" target="_blank" rel="nofollow">Congressional Management Foundation</a>, senators’ and representatives’ offices were asked how much influence certain activities have on their decision making. The No. 1 influence was in-person visits from constituents.</p> <p> “They expect you to be there,” Wilson said. “They expect to hear from you …. When you’re personally taking the time to visit your representative, you’re making a difference.”</p> <p> <strong>How to be better at advocacy “asks”</strong></p> <p> When you prepare for a meeting—whether it’s in Washington or your state capitol or even the county commissioner’s office—take time to better understand who your lawmaker is, Wilson said.</p> <p> To better understand your legislator, pay attention to these four things:</p> <ul> <li> <strong>Interests. </strong>They might be a business professional, a physician, a nurse, a software engineer or a farmer, Wilson said. “Is there any way you can find an intersection between what they know and care about as a legislator and what you know and care about in terms of health care policy?”<br /> <br /> “What are they doing in their regular life?” he said. “What are they interested in, or what are they working on? Can you make your ask relevant to them?</li> </ul> <ul> <li> <strong>Leadership.</strong> “Keep in mind if they’re in leadership, whatever party … if they’re the minority leader or the majority leader or a whip, their interests are a little different,” he said. “If there’s legislation out there, they have an interest in either getting it passed or holding it up. Can you get on the right side of that?”<br /> <br /> “If they’re in leadership, they know the issues,” he said. “You have to give them a reason why to vote yes and not hold up the bill or vote no.”</li> </ul> <ul> <li> <strong>Committees.</strong> “What committees are they on?” Wilson said. “Are they on an education committee? You might have to educate them a little bit more about health care policy. If they’re on a health committee, they’re probably going to be pretty conversant with the issues already, and you might take a different tactic with them.”</li> </ul> <ul> <li> <strong>Positions taken.</strong> “Sometimes people go into a meeting to lobby somebody, and they don’t realize that [they] have already taken a position on the bill,” Wilson said. Don’t waste your time if they’ve already made up their mind and stated it publicly. Do your research.</li> </ul> <p> <strong>The visit</strong></p> <p> Once you have done your research and are prepared, it’s time for the visit. But how do you conduct yourself from the moment you enter the office?</p> <ul> <li> <strong>Identify yourself.</strong> “When you go in, quickly introduce yourself,” Wilson said. “Say who you are and where you’re from. Establish that connection right away. Make sure they realize that you are in fact a constituent.”</li> </ul> <ul> <li> <strong>Get right to the point.</strong> “‘I want you to vote this way on this bill,’” Wilson said. “Make it clear, make it simple.” If they have an interest in that issue, explain why it is important to you.</li> </ul> <ul> <li> <strong>Focus on the patient impact.</strong> “When you make that ask,” he said, don’t talk about yourself. Rather, talk about the people who are going to be your patients. “[Legislators] understand what being a patient is because they’ve been a patient.”<br /> <br /> “Make them understand how a particular policy is going to affect the people that you are trying to take care of,” he said. As healers, physicians have an incredible amount of credibility.<br /> <br /> “Once you talk to them in terms of the people you want to take care of,” Wilson said, “They’re going to see your request in a whole different way.” Tell a story about a particular patient or situation that will help them understand the impact on the community.</li> </ul> <ul> <li> <strong>Ask for an answer.</strong> “Get a commitment if you can,” he said. “If they say no, that’s fine … stay in touch.” Leave behind one or two pages on the issue—something you can get from the AMA—that will summarize what your case is and what you want them to do.</li> </ul> <ul> <li> <strong>Express your thanks</strong>. “Don’t forget to say thank you afterwards,” Wilson said. “A written note in this day and age is great, an email is still fine, but make sure that they know that you appreciate that they took time out of their schedules.”</li> </ul> <p> In August, Congress will head home for the annual month-long summer recess during which time lawmakers will be back in their districts holding constituent meetings, listening sessions and town halls. Take the time to learn the issues that you care about and set up a meeting to make those concerns known. Check out AMA resources to learn about <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-physician-payment-reform.page" target="_self">Medicare payment reform</a> or visit <a href="https://savegme.org/" target="_blank" rel="nofollow">SaveGME.org</a> to learn about advocacy efforts regarding student loan debt.</p> <p align="right"> <em>By AMA </em><em>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:a9467c29-46de-4d14-b820-549c3edd7b78 Confidential patient safety information threatened in court case http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_confidential-patient-safety-information-threatened-court-case Fri, 24 Jun 2016 20:30:00 GMT <p> An intermediate level appellate court in Florida last year held that patient safety information can be shielded from disclosure in a medical liability case. Now, that same case is on appeal—this time, in the Supreme Court of Florida.</p> <p> <strong>What happened last year</strong></p> <p> In <em>Southern Baptist Hospital of Florida, Inc. v. Charles</em>, a trial court had ordered the release of medical documents used for patient safety and quality improvement efforts as part of litigation discovery. Then, in October of last year, a Florida district court of appeal overturned the trial court’s decision and found that health care information, which was being used for patient safety improvement efforts, was privileged from discovery.</p> <p> The district court of appeal held that the Patient Safety and Quality Improvement Act of 2005 (PSQIA) preempted a provision in the Florida constitution.</p> <p> The PSQIA enables physicians and hospitals to share medical information used for quality improvement through a patient safety organization (PSO). The data within these systems is deemed privileged under the PSQIA, with the exception of requests that state administrative agencies might make for the information. If this information is not protected from litigation discovery, it could stifle the sharing of information and impeded upon quality and patient safety improvements.</p> <p> PSOs were established to gather and analyze information critical to the improvement of patient safety and quality of care. The information is submitted to PSOs in accordance with the PSQIA and is protected from disclosure as a patient safety work product (PSWP).</p> <p> The district court of appeal’s decision allowed for continued confidential sharing of patient safety information without fear of disclosure in medical liability litigation.</p> <p> <strong>Protected patient safety information again under threat</strong></p> <p> Now on appeal in the Supreme Court of Florida, the case is focused on documents prepared as the result of a state legal requirement.</p> <p> Both sides are in agreement on one thing: Physicians and hospitals must under some circumstances submit patient safety information upon request from a state agency—even with the protections afforded to PSWPs.</p> <p> The  twist in this particular case is that the PSWP information, although prepared as the result of a state agency requirement, was never submitted to the state agency because the agency did not request it.</p> <p>  The question before the Florida Supreme Court is whether, under the PSQIA, if the state agency does not request the PSWP documents from a physician or hospital, those documents will be protected from disclosure in medical liability litigation.</p> <p> A reversal of the First District Court of Appeal holding would “effectively nullify the PSQIA in the state of Florida,” the <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page" target="_self">Litigation Center of the AMA and State Medical Societies</a> said in an amicus brief.</p> <p> “This court’s reversal of the First District’s ruling in this case,” the brief said, “would undo the progress made to date and undermine the valuable work that has been done by PSOs and their member health care providers. Patients, who are the ultimate beneficiaries of the PSQIA, would suffer.”</p> <p> <strong>Other medical liability cases in which the Litigation Center is involved include:</strong></p> <ul> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">case could increase liability exposure and redefine injury</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:27a98727-eab3-4516-ac6d-bb49957c3705 3 things every physician should do when treating pain http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-things-physician-should-treating-pain Wed, 22 Jun 2016 23:00:00 GMT <p> A panel of physician experts offered three actions every physician can take to appropriately treat patients with acute or chronic pain. Presenting at the 2016 AMA Annual Meeting, they also discussed tools that can help keep patients safe from overdose and improve their quality of life.</p> <p> The panel was comprised of physician representatives from 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> and one of the nation’s leading health policy experts.</p> <p> In light of the opioid epidemic, the task force has put forth recommendations for physicians. “These recommendations come from our colleagues,” Patrice A. Harris, MD, psychiatrist and chair of the AMA Board of Trustees, said. “We are better physicians when we learn from one another.”</p> <p> Dr. Harris said the task force is encouraging physicians to support comprehensive pain care and reduce the stigma associated with pain, reduce the stigma of substance use disorders, increase access to treatment and naloxone, and to use state PDMPs to make more informed prescribing decisions.</p> <p> <strong>Using PDMPs to improve care</strong></p> <p> “[Guidelines] are useful to inform clinical judgement,” said Cynthia Reilly, director of the prescription drug abuse project at Pew Charitable Trusts, “but they alone will not reduce the harm that we see from opioids. Really, one of the challenges here is unless you are aware of medications that your patients may be receiving from other prescribers—even if you follow those guidelines to a ‘T’—the patient may still be at risk from harm.”</p> <p> “PDMPs are one strategy to help with that,” Reilly said. “In an ideal world, a PDMP would be connected to … electronic health records (EHR) and other states. While efforts are underway to address that, we don’t have that yet.”</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/45371ac1-e124-47db-b279-6a82efb86f30.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/2/45371ac1-e124-47db-b279-6a82efb86f30.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Frank Dowling, MD</em></span></td> </tr> </tbody> </table> <p> Frank Dowling, MD, clinical associate professor of psychiatry at SUNY at Stony Brook and medical director at Long Island Behavioral Medicine, said his state recently mandated PDMP use. The reason doctors are using the tool in New York is because the PDMP—called I-STOP—has the funding and technological support to make it useful. There were more than 18 million queries of I-STOP in 2015, according to the New York Department of Health.</p> <p> This valuable tool is not just for when a physician plans to prescribe but can also aid in treatment. “Any time I’m assessing and making a treatment decision, I can look up that information that may be useful, even if I’m not going to prescribe,” Dr. Dowling said. “Some docs will look up all patients in their practice who may be on the schedule … others may look up only when they feel it’s clinically indicated because of a suspicion or a worry or they’re considering a prescription.”</p> <p> “When using the PDMP in clinical care,” Dr. Dowling said, keep a couple of things in mind:</p> <ul> <li> “Stigma is high for people with pain and with a substance use disorder,” he said. “It’s even worse when they’re co-occurring. The info [from the PDMP] is a clinical tool; it’s an assist. It’s not a mandate that you must prescribe or not prescribe.”<br /> <br /> “Even with [patients] without a substance use disorder, aberrant behaviors are common,” he said. Patients may get scripts from other physicians or take more than they’re supposed to. They may need education on the matter or have “the reigns pulled in a little,” he said.</li> </ul> <ul> <li> Remember that the PDMP is a tool to use, “and it starts a conversation,” Dr. Dowling said. “In every unique patient that we all have, 80 percent of the time it’s very simple, 20 percent of the time it’s complex …. The information from your PDMP can be very useful.”</li> </ul> <p> <strong>Managing chronic pain—focus on the patient’s goals</strong></p> <p> Treating patients with chronic, non-cancer pain comes down to the individual clinic visits and facing problems one-on-one with patients, said Erin Krebs, MD, medical director at the Women Veterans Comprehensive Health Center in Minneapolis. “What do we need to do that well?”</p> <table align="left" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/bc787873-8976-41cd-93d3-9d66e51283f6.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/bc787873-8976-41cd-93d3-9d66e51283f6.Large.jpg?1" /></a></td> <td>  </td> </tr> <tr> <td> <span style="font-size:10px;"><em>Erin Krebs, MD</em></span></td> <td>  </td> </tr> </tbody> </table> <p> Dr. Krebs highlighted one of her patients, a woman with chronic back pain and multiple co-morbidities, including insomnia, fatigue, obesity, nausea and depression.</p> <p> The patient’s prescription drug monitoring results showed that her use of the medications was appropriate. “There was no concern that this woman was misusing her medications,” she said. “But how is she doing?”</p> <p> “Her pain and depression scores are persistently high,” Dr. Krebs said. “You can look at scores all day long, but ask her ‘how is pain affecting your life, or how is your day-to-day life going?’”</p> <p> “She says, ‘I can’t leave the house very much; I can barely walk more than a block,’” Dr. Krebs said. “’My house is a mess; I’m not really cooking dinner anymore because I can’t stand at the stove long enough … I’m not even going to my kid’s activities anymore …. If I can do just one thing, I want to be a good mom.’”</p> <p> “So what are the tools you need to help this woman?” Dr. Krebs asked. “Technology helps, but it comes down to a lot of other things. From my perspective, I need time with this woman. I need visits that are more than twice a year …. I need a team that’s going to help me.”</p> <p> “This is really what it comes down to on a one-to-one basis,” she said. “We’re going to have to turn this around one patient at a time and help each patient manage their pain—get their life back and avoid avoidable risk.”</p> <p> Dr. Krebs offered some advice for dealing with patients whose pain seems to persist. “I think the key thing is to keep focusing and refocusing on what the patient’s goals are, not [just] the pain intensity,” she said. “What does she care about and how can I get her closer to achieving what she cares about, because that’s a positive conversation that you can have at every visit.”</p> <p> “This is my line,” she said, “‘I’m your cheerleader and your coach. I’m not going to promise a cure for this problem, but I’m going to be here every time you come in, and I’m going to talk to you about this and try to help you figure out how you can change your life to get closer to where you want to be.’”</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/6/ba530a53-3fc0-4b1d-b6df-6b339dfd57fb.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/6/ba530a53-3fc0-4b1d-b6df-6b339dfd57fb.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:10px;"><em>Robert Rich, MD</em></span></td> </tr> </tbody> </table> <p> <strong>Naloxone as a conversation starter</strong></p> <p> Robert Rich, MD, a family medicine specialist in North Carolina, offered advice on the use of naloxone and detailed the role he plays as a family physician.</p> <p> In 2008, <a href="http://projectlazarus.org/" rel="nofollow" target="_blank">Project Lazarus</a> was started in Wilkes County, N.C., which is a rural county that was dealing with one of the highest per capita overdose rates in the country. Project Lazarus developed a take-home naloxone overdose kit that contains two needle-free syringes of naloxone, two nasal adapters, a DVD instructional video and guides for patients on how to talk to their families about overdose.</p> <p> “I use the Project Lazarus discussion as a way to introduce my concern to the patient that they may have a lot of medical problems, which may increase their risk of overdose,” Dr. Rich said. “I’m trying to say, ‘Let’s do something to help manage your risk; here’s another tool to help you do that.’”</p> <p> “I’m saying, ‘I’m concerned about your overall health and well-being,’” he said, “‘not being judgmental at all …. I want to do something to help you.’”</p> <p> Naloxone also can be a way to <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone" target="_self">start the broader conversation about the risks</a> that opioid medications carry without contributing to the stigma that surrounds overdose and substance use disorders.</p> <p> <strong>For more on physician efforts to end the opioid overdose epidemic:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/obamas-opioid-initiatives-align-physician-recommendations" target="_self">How Obama’s opioid initiatives align with physician recommendations</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas" target="_self">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder" target="_self">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription" target="_self">Entire state gets one naloxone prescription</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:d3f71d36-7f56-4d3e-af13-ce60cc9514c9 New benefit: Get evidence-based information at the point of care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-benefit-evidence-based-information-point-of-care Wed, 22 Jun 2016 22:02:00 GMT <p> Make sure you’re equipped with all the information you need to deliver the best care for your patients, whatever their condition. <em>DynaMed Plus®</em>, a next-generation information resource, provides the most up-to-date, evidence-based information on any digital device. And now AMA members get free access.</p> <p> <strong>Content and features you don’t want to miss</strong></p> <p> A trusted resource by physicians around the world, <em>DynaMed Plus</em> was designed from the ground up last year. It offers an optimal blend of evidence and expertise as a real-time clinical reference, and is updated daily.</p> <p> Enhance your clinical decision-making. This resource offers:</p> <ul> <li> Concise, accurate overviews for the most common conditions and evidence-based recommendations for action—all developed by physicians</li> <li> More than 10,000 images from The JAMA Network and other valuable content providers</li> <li> Specialty content, covering thousands of topics in emergency medicine, cardiology, oncology, infectious diseases, pediatrics, obstetrics and gynecology, and many other specialties</li> <li> Links to 2,500 full-text journals (with <em>MEDLINE Complete</em>)</li> </ul> <p> In addition to traveling with you on any device, <em>DynaMed Plus </em>integrates with your electronic health record (EHR) system. A real-time web service API enables customized and contextually based searches of clinical content directly from your EHR.</p> <p> <strong>How to access this resource</strong></p> <p> AMA members get a free 18-month trial of <em>DynaMed Plus</em>. <a href="https://offers.jamanetwork.com/" target="_self" rel="nofollow">Sign up for your free trial today</a>.</p> <p> Once the free trial ends, AMA members get a special discounted rate to continue the subscription. The annual subscription fee is $199 for physician members (a $395 value), $75 for resident and fellow members (a $150 value), and $50 for student members (a $100 value).</p> <p> If you’re not yet an AMA member, <a href="https://commerce.ama-assn.org/membership/" target="_self">join or renew your membership</a> today.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:90b4a2b7-4e12-430e-8ef9-e891048a1e15 Ink on the page: Get your quality improvement project published http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ink-quality-improvement-project-published Wed, 22 Jun 2016 20:24:00 GMT <p> Medical journals welcome research papers from trainees on quality improvement (QI), but those papers are often faulted for inconsistent approaches and formats. Two editors at the <em>Journal of Graduate Medical Education</em> offer some <a href="http://www.jgme.org/doi/full/10.4300/JGME-D-16-00086.1" target="_blank" rel="nofollow">guidelines</a> on how to construct your paper and what to emphasize most in order to get your research published and enhance your CV.</p> <p> <strong>How to construct a compelling paper</strong></p> <p> The editors discuss what you should explicitly emphasize within each section of your manuscript as it pertains to your QI project. If you haven’t yet begun your QI project, these suggestions also should help you with planning and implementing your project with publication in mind.</p> <ul> <li> <strong>The introduction</strong> should consist of a clear, concise statement of the primary aim of your QI project and how the problem is relevant beyond your institution. It should describe the gap between current practice and the proposed practice.<br /> <br /> “The introduction section must be brief,” the editors said. “This is not the time to provide an in-depth review of the literature on your quality problem of interest—which could be an important but separate paper.”</li> </ul> <ul> <li> <strong>A methods section</strong> should help readers understand how they can translate the proposal into their own setting. It should contain a rationale for why the intervention was chosen and link it to the specific problem it will solve.<br /> <br /> “The truth is that if authors do not articulate a theory or rationale for why their proposed intervention should fix the quality problem of interest,” the editors said, “they run the risk of designing a suboptimal intervention or choosing the wrong approach altogether.”<br /> <br /> You should outline how the intervention was tested, refined and implemented.</li> </ul> <ul> <li> <strong>A discussion section</strong> “should concisely summarize the main findings of the QI project, relate the key finding to what is already known in the published literature, reflect on the broader implications of the findings, discuss how important limitations could have affected the findings, and briefly introduce next steps to further understand the field,” the editors said.</li> </ul> <ul> <li> <strong>The conclusion</strong> should simply serve as a summary. “This short paragraph succinctly summarizes the most important findings from the study, without speculating beyond the results,” the authors said. “Conclusions should be appropriately conservative in relation to the study findings.”</li> </ul> <ul> <li> <strong>Figures and tables</strong> can be used, “which will avoid excess word length while still providing a concise summary of what was actually done,” the editors said. “Another option for providing more details is to include additional supplemental information for publication online.”</li> </ul> <p> <strong>Don’t fear the dark side</strong></p> <p> The editors urge authors to consider including negative outcomes in their papers, including failures of the proposed intervention. Measures of unintended consequences also should be reported to ensure that the intervention does not create new problems.</p> <p> Projects that fail to achieve the intended results are still important because they can help others who might consider similar projects and allow them to build on the author’s work.</p> <p> Residents have a unique chance to showcase their QI projects at the 2016 AMA Research Symposium. The symposium features hundreds of poster and oral presentations, and takes place this year on Nov. 11 at the 2016 AMA Interim Meeting in Orlando, Fla.</p> <p> The event is hosted annually by the AMA Medical Student Section, the AMA Resident and Fellow Section and the AMA International Medical Graduates Section. Each section holds a separate competition within the event. Abstracts will be accepted beginning in July and are due by Aug. 17.</p> <p> <strong>Learn more about getting your project onto the page:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-like-pro-5-expert-strategies-innovative-research" target="_self">5 steps to getting your research published</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/publish-top-journals-physicians-training" target="_self">Top journals for physicians in training</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/9-top-tips-getting-published-medical-journal" target="_self">9 tips for getting published from fellows, residents</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/research-paper-got-rejected-heres-handle" target="_self">How to handle it when the editor rejects your paper</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/future-physicians-honored-top-research-ama-symposium" target="_self">Winners of the 2015 AMA Research Symposium</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:74ac5505-d78e-47b2-9477-6e25bc3b9ddb A double-edged sword: What makes doctors great also drives burnout http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_double-edged-sword-doctors-great-also-drives-burnout Wed, 22 Jun 2016 03:00:00 GMT <p> A physician burnout expert from the Mayo Clinic explained earlier this month at the 2016 AMA Annual Meeting how physicians in the current health care system often have an intrinsic risk of burnout. Learn about the role that the “physician personality” can play in burnout and ways Mayo has found to help address burnout as a system-wide issue.</p> <p> <strong>What’s happening to physicians?</strong></p> <p> “If I told you we had a system issue that affected quality of care, limited access to care, and eroded patient satisfaction, that affected up to half of patient encounters,” said Tait Shanafelt, MD, a hematologist and physician burnout researcher at the Mayo Clinic, “you would immediately assign a team of systems engineers, physicians, administrators at your center to fix that problem rapidly.”</p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/14/ba0792a6-f25c-4828-8e1a-6c2cec982e88.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/14/ba0792a6-f25c-4828-8e1a-6c2cec982e88.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <em>Tait Shanafelt, MD, hematologist and physician burnout researcher at the Mayo Clinic</em></td> </tr> </tbody> </table> <p> That’s what burnout is, he said. It’s a system issue. “And we have not mobilized the way we would to address other factors affecting quality access and patient satisfaction,” Dr. Shanafelt said.</p> <p> “On a societal level folks would look at us and think we have a recipe for great personal and professional satisfaction,” he said. “We engage in work that society values and thinks is meaningful work. And yet our own literature has been telling a different story about the experience of being a physician.”</p> <p> A recent study published in <em>Mayo Clinic Proceedings</em> took a look at <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-burnout-compares-general-working-population" target="_self">how physician burnout compares to the general population</a> and found that physicians displayed almost double the rate of emotional exhaustion as the general working population and reported lower satisfaction with work-life balance (36.0 percent for physicians, versus 61.3 percent of the general working population).</p> <p> Dr. Shanafelt said that burnout is often the result of three components:</p> <ul> <li> Depersonalization: Treating people as though they’re objects rather than human beings</li> <li> Emotional exhaustion: Losing enthusiasm for your work</li> <li> Low personal accomplishment: Feeling you’re ineffective in your work, whether or not that is an accurate perception</li> </ul> <p> “All of us have those feelings to some frequency and some severity,” he said. “But when they come too often and to too severe an extent, they can begin to undermine your effectiveness in your work.”</p> <p> “This syndrome differs from the global impairment of depression,” he said. “It primarily relates to your professional spirit of life, and it primarily affects individuals whose work involves an intense interaction with people—so professions such as teachers, social workers, police officers, nurses and physicians.”</p> <p> <strong>The survival mentality and the physician personality</strong></p> <p> “I think we all remember that survival mentality of residency,” Dr. Shanafelt said. “‘I’ve just got to make it through; things will get better when I’m done with residency.’ But what we find is that physicians perpetuate that framework throughout their whole career.”</p> <p> Dr. Shanafelt said that in one study, 37 percent of physicians reported looking forward to retirement as an effective wellness strategy. “This is the same thing as the survival mentality … and what was notable was that it was equally common to report that strategy for those under the age of 40 as those who were older,” he said. “It’s not just those who were actually getting closer to retirement.”</p> <p> It’s a mentality of “work now, when I retire I’ll get to personal life,” he said.</p> <p> Dr. Shanafelt said that one suggestion many researchers have found to be a possible cause of physician burnout is “that we are also at inherently higher risk due to what they’ve coined the ‘physician personality,’” he said. “Now, this is where if I wasn’t a physician myself you would start throwing rotten fruit.”</p> <p> “They say … that the characteristics that define many doctors are doubt, guilt and an exaggerated sense of personal responsibility,” he said. “But these are the qualities that make you a good physician. They lead you to be thorough, committed, leaving no stone unturned, to always be thinking about Mrs. Jones and what else I could do, what am I missing? How could we do a better job taking care of her?”</p> <p> “The qualities that make people good physicians are a double-edged sword,” he said. “It’s those who are most dedicated to their work who are at greatest risk to be most consumed by it.”</p> <p> <strong>A strategy to examine work-life balance</strong></p> <p> If you’re experiencing burnout, identifying values—both personally and professionally—is an important factor in addressing what causes burnout, Dr. Shanafelt said. One way to do that is to engage in a series of questions to examine the two sides.</p> <p> The first set of questions:</p> <ul> <li> What are the things you care about in your personal life?</li> <li> What does it look like for you to live in a way that demonstrates those are the things you care about?</li> </ul> <p> The second set of questions:</p> <ul> <li> What are the things you care about in your professional life?</li> <li> How are you devoting and spending your time to align with those things?</li> </ul> <p> “Physicians usually are relying on things around being a healer, teacher, making discoveries or operating a successful practice,” Dr. Shanafelt said. “The thing I can guarantee you is that your two lists are incompatible and that you cannot achieve everything on those lists.”</p> <p> “If I think that I’m going to be a world expert in my field,” he said, “but never miss a soccer game to be away at study section, presenting at a meeting, to be writing a grant or manuscript, that’s an unrealistic expectation. I will miss soccer games to make a difference for the patients with this disease that I care about.”</p> <p> “The question is,” he said, “how many soccer games is it OK to miss to still have the relationship with my kids that I want and the impact professionally that I aspire to? It’s this integration of these two spheres that’s really where the rubber meets the road.”</p> <p> <strong>Addressing isolation</strong></p> <p> Due to some of the changes to the medical profession over the past few decades that have resulted in busier schedules, higher productivity expectations and more time spent documenting, physicians have less time to interact with each other.</p> <p> “That interaction has always been part of the fabric of the profession,” Dr. Shanafelt said. “We have amazing colleagues, and getting to work with those people is what makes this profession great. But we have less of that interaction now than we did in the past.”</p> <p> In a study at the Mayo Clinic, Dr. Shanafelt and colleagues randomized 75 physicians and “bought” an hour of their time. One-half of them used the hour every other week however they wanted for nine months—for instance, to catch up on administrative tasks or get home early. The other one-half used it to meet with a group of colleagues to engage a curriculum largely around sharing their experience of the challenges and virtues of being a physician.</p> <p> “We measured a variety of personal and professional characteristics,” he said. Both groups saw a reduction in physician-reported burnout symptoms, but the group who met with their colleagues also had an improvement in meaning of work, “and we came back a year after the intervention ended.”</p> <p> “The group who had that hour to catch up on admin went immediately back to baseline with respect to burnout as soon as they stopped getting an hour,” he said, “but those who had met with their colleagues every other week for nine months, the burnout and meaning in work remained improved a year after the intervention ended.”</p> <p> As a result, Mayo conducted a second study during which physicians met for happy hour, breakfast, lunch or dinner. Mayo would buy the meal and send five questions the physicians could choose from to talk about as a group. The study saw the same outcomes as the previous study in improvement in burnout and meaning in work just from that interaction.</p> <p> The Mayo Clinic’s board approved the program, which they now offer to all physicians. As a standard practice, Mayo pays for groups of colleagues every two weeks to go out to a restaurant in town with their colleagues. Dr. Shanafelt said about 1,000 physicians have signed up.</p> <p> One physician in the audience who teaches in a residency program noted, “One of the questions that I got once—that I still don’t know how to answer—is: ‘Aren’t you just teaching us how to trick ourselves into being happier when we really are in this horrible situation?’”</p> <p> “I look at it just like clinical skills,” Dr. Shanafelt answered. “You as an individual want to do your [continuing medical education] and keep yourself current and refine your art as best you can. And the system in which you plug into is also going to make you a better or less effective physician.”</p> <p> “The answer is: ‘Yeah, I get it, this isn’t all yours and the organization has to do its part,’” he said. “But you want to be as good as you can at navigating the choppy water and knowing it’s going to come. And we’re trying to give you that skill set.”</p> <p> <strong>More resources to help combat burnout</strong></p> <p> The AMA’s <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvement strategies helps physicians make transformative changes to their practices. It offers modules on <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">preventing physician burnout in practice</a>, <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_self">preventing resident and fellow burnout</a> and <a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_self">improving physician resiliency</a>.</p> <p> Physicians and experts from around the world will gather Sept. 18-20 in Boston for the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_self">International Conference on Physician Health™</a>. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will showcases research and perspectives into physicians’ health and offer practical, evidence-based skills and strategies to promote a healthier medical culture for physicians. <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page?" target="_self">Learn more and register</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:cdc782e6-0b79-469b-b8e7-bec87e0391b8 VA invites physicians to join as agency recovers from scandal http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_va-invites-physicians-join-agency-recovers-scandal Tue, 21 Jun 2016 22:31:00 GMT <p> The <a href="http://www.va.gov/health/" target="_blank" rel="nofollow">U.S. Department of Veterans Affairs</a> (VA) is in the midst of fundamental changes after a period of struggle and public criticism—and some of those changes could make it an appealing place for physicians to work.</p> <p> <strong>Appeal for help</strong></p> <p> David Shulkin, MD, undersecretary of health at the VA, delivered that message of hope for his once-beleaguered organization during a presentation at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a> in Chicago. He issued a passionate appeal for physicians to contribute to the VA’s colossal rebuilding effort.</p> <p> “We desperately need physicians and have to make it an attractive place to work,” Dr. Shulkin, a primary care physician, said. “I think we’re working on that.”</p> <p> The VA has openings for 1,800 physicians and 44,000 employees of all kinds as it accommodates a growing patient population, Dr. Shulkin said.</p> <p> <strong>An agency in crisis</strong></p> <p> The VA hit a low point in 2014 when it drew criticism over excessive patient wait times and allegations of deceptive record-keeping at its Phoenix medical center. President Obama called for an investigation after it was discovered that 40 veterans had died in Phoenix while awaiting treatment.</p> <p> The scandal soon spread as shoddy practices were discovered at centers around the nation. In May 2014 President Obama accepted VA Director Eric Shinseki’s resignation.</p> <p> The crisis has spurred the VA to respond with five key efforts, Dr. Shulkin said:</p> <ul> <li> Reducing wait times for patients</li> <li> Engaging employees once again in their sense of mission</li> <li> Adopting best practices consistently across all VA facilities</li> <li> Partnering with the private sector to expand access to care</li> <li> Restoring the confidence of veterans and the public in the VA</li> </ul> <p> Dr. Shulkin said the VA has already reduced wait times, and this year has set a goal of same-day access to care for veterans. As conditions improve, the VA is becoming a more satisfying place for physicians to work, he said.</p> <p> <strong>Fewer contributors to burnout</strong></p> <p> For example, VA physicians don’t have to deal with insurance companies and medical liability issues, he said.</p> <p> “You don’t have to deal with a lot of the things that create burnout in the private sector,” he told physicians.</p> <p> He said physicians who go to work for the VA will discover many reasons to be proud of its historic mission. For instance, in partnership with 1,800 other institutions, the VA is the largest trainer of physicians in the nation. It is a leader in reducing hepatitis C, addressing the opioids crisis and preventing suicide, he said.</p> <p> Dr. Shulkin also touted the long and distinguished history of VA research that has paved the way for solutions in prosthetics, cancer, liver transplant, CAT scans and dialysis.</p> <p> “The discoveries that have come out the VA are important to all of us in American medicine,” he said.</p> <p> <strong>New AMA policy</strong></p> <p> Also at the 2016 AMA Annual Meeting, physicians adopted new policy that directs the AMA to work with the VA to enhance its loan forgiveness efforts to help with physician recruitment and retention and to improve patient access in VA facilities. That includes a call for the Public Service Loan Forgiveness Program to allow physicians to receive immediate loan forgiveness when they practice in a VA facility.</p> <p> The AMA also will be working with the VA to minimize the administrative burdens that can prevent physicians who are not employed by the VA from volunteering their time to care for veterans.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ce0e8013-33e8-4e4d-ad8c-e3c2f1090b41 How students can thrive in the wards, from one who knows http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_students-can-thrive-wards-one-knows Mon, 20 Jun 2016 21:30:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/1/d4ce35a5-4cfb-4863-b14f-64aac692bba1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/1/d4ce35a5-4cfb-4863-b14f-64aac692bba1.Large.jpg?1" style="margin:15px;float:right;" /></a>Always be nice to the nurses. Mark Nolan Hill, MD, professor of surgery at Chicago Medical School at Rosalind Franklin University, had that and more advice for students as they prepare for their third year and the start of caring for patients.</p> <p> “The nurses will save your butt,” Dr. Hill assured students at the 2016 AMA Annual Meeting earlier this month. “They can teach you—always be nice to the nurses.”</p> <p> <strong>All about attitude</strong></p> <p> Nurses, along with residents, attending physicians and others, will loom large on the wards. But Dr. Hill spent much of his animated hourlong address focused on the crucial physician-patient relationship and how to shape it in the cause of good medicine.</p> <p> He had no secret formulas to offer.</p> <p> “The most important thing is attitude, attitude, attitude,” Dr. Hill said. “When you’re dealing with patients, listen to them. Sit down, touch them, be warm to patients.”</p> <p> That approach goes hand-in-hand with clear, respectful language, free of jargon. He favors using “Mr.” and “Mrs.” when addressing patients, and he advises that you avoid making value judgments.</p> <p> <strong>Roles and routines</strong></p> <p> Students have to not only treat patients but navigate the routines and roles of the wards, and Dr. Hill offered a few basics to keep in mind:</p> <ul> <li> Don’t arrive late, so you can avoid getting behind.</li> <li> Look neat and clean—it’s part of your image on the wards.</li> <li> Ask questions of your professors and attendings, and don’t let the fear of looking stupid hold you back. “The only stupid thing is not asking the question,” he reminded students.</li> <li> Seek out mentors and make ample use of them. “Always hang around people who will teach you and guide you.”</li> </ul> <p> <strong>The payoff</strong></p> <p> Perhaps most challenging of all Dr. Hill’s counsel is staying optimistic and not lamenting the sacrifices you have to make as a medical student with growing obligations. Take heart when your friends head out for a tropical vacation, and you have to stay at home and study. The payoff will come.</p> <p> “You are in the absolute greatest profession there is,” he said. “When you get out [there], it’s a lot of work, but I’m telling you, it’s all worth it.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:76c7cebc-dcb3-4490-b5af-f58c2e3e300d Why criminal justice should be part of fostering public health http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_criminal-justice-should-part-of-fostering-public-health Mon, 20 Jun 2016 21:27:00 GMT <p> Mass incarceration poses a threat to public health, fueling chronic disease and mental illness that physicians must address, according to a recent panel discussion.</p> <p> <strong>A physician’s duty</strong></p> <p> Physicians have a duty to work for health justice for inmates, especially minors, said Nzinga Harrison, MD, a founder of <a href="http://www.pfcjreform.org/" target="_blank" rel="nofollow">Physicians for Criminal Justice Reform</a>, an activist organization made up of academics, government officials, psychiatrists, neurologists and others.</p> <p> Dr. Harrison and other panelists explained their efforts on behalf of health justice at a discussion held by the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/minority-affairs-section.page" target="_self">Minority Affairs Section</a> during the 2016 AMA Annual Meeting in Chicago.</p> <p> <strong>Primary goals for justice reform</strong></p> <p> Dr. Harrison said Physicians for Criminal Justice Reform invites physicians, medical students and the lay public to join in working for its primary objectives:</p> <ul> <li> <strong>Decriminalizing mental health and addictive disorders</strong>. Across the nation, people with severe mental illness are three times more likely to be in jail or prison than a mental health facility. Twenty percent of prison inmates have serious mental illness, and up to 60 percent have serious addictive problems, Dr. Harrison said.<br />  </li> <li> <strong>Diverting at-risk youths from adult jails and prisons</strong>. Youths in adult jails are 36 times more likely to take their own lives than youths housed in juvenile facilities, Dr. Harrison said, and minors are far more likely to be victims of sexual assault in jails.<br />  </li> <li> <strong>Providing adequate physical and mental health care for inmates</strong>. Inmates are far more likely to enter prison without a history of primary care and to suffer from addictive disorders. Prison inmates suffer a higher incidence of chronic and infectious diseases such as AIDS and hepatitis C than the general population, Dr. Harrison said.</li> </ul> <p> The United States incarcerates far more of its residents than any other industrialized nation, Dr. Harrison said, so improving care for that population improves the health of the community as a whole. Diversion from the criminal justice system not only saves lives but saves money in the long run, she said.</p> <p> <strong>Three foundations of health</strong></p> <p> Spiritual, physical and mental health care are intimately linked, both in prisons and the community at large, the Rev. Carmin Frederick told attendees at the session.</p> <p> “We are all connected,” said Rev. Frederick, a panelist. She is associate pastor to teens and families at <a href="https://trinitychicago.org/social-justice/" target="_blank" rel="nofollow">Trinity United Church of Christ</a>. The Chicago church works for social justice, an end to mass incarceration, access to health care and a living wage.</p> <p> Poverty itself undermines well-being and plays a role as an early and powerful social determinant of health, according to panelist Carl Bell, MD, a psychiatry professor at the University of Illinois College of Medicine in Chicago.</p> <p> “Being poor is a problem,” Dr. Bell said. “Because if you’re poor, you’re going to be living in a community where the only business that is thriving is the liquor store.” His work at the Jackson Park Hospital’s Family Medical Clinic highlights the long-term impact of fetal alcohol syndrome on youths.</p> <p> “They’re slow in school. They’ve got bad tempers. They have poor social skills,” he said.</p> <p> <strong>Tools for achieving justice reform</strong></p> <p> Physicians for Criminal Justice Reform named strategies to advocate for changes in health care and the criminal justice system:</p> <ul> <li> The organization increases awareness of the ties between health and the justice system by educating the public with consulting services, webinars and keynote speakers.<br />  </li> <li> It maintains a social media presence, circulates petitions and fosters a relationship with the media to expand awareness of its issues.<br />  </li> <li> It partners with allied organizations to leverage distribution of its message.</li> </ul> <p> Dr. Harrison issued an appeal to action for physicians to recognize the relationship between the justice system and health.</p> <p> “We can make a change,” she said. “I hope I have compelled you to joins us and raise your voice so we can minimalize the impact of the criminal justice system on our patients.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1ef4d8e5-c2dd-42c2-ad9c-7a7a4518d7ac 40 years of shaping medical education http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_40-years-of-shaping-medical-education Mon, 20 Jun 2016 18:00:00 GMT <p> In 1976, the average cost of a new home was $43,400, Apple Computer Inc. was established, and an important group in medical education was just getting started.</p> <p> <strong>A notable history</strong></p> <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_self">AMA Academic Physicians Section</a> (APS) is celebrating its 40th anniversary this month, and physicians who were a part of the group in its early years can tell of its strong history in shaping medical education and the practice of medicine.</p> <p> From its beginning as the AMA Section on Medical Schools, this group of physician educators had high aspirations.</p> <p> Within a few years of its founding, the section had played an important role in contributing to the “Future directions of medical education” report adopted by the AMA in 1982 and began a series of medical education conferences with the AMA Council on Medical Education, the Association of American Medical Colleges (AAMC) and the American Hospital Association.</p> <p> Myron Genel, MD, professor emeritus of pediatrics and senior research scientist at Yale Child Health Research Center and Yale School of Medicine and a clinical professor of nursing at the Yale School of Nursing, recounts that the work of the section and the AMA Council on Scientific Affairs in the mid-1980s led to a joint effort with the AAMC that culminated in the Graylyn Clinical Research Summit.</p> <p> The summit in turn led directly to the formation of the Clinical Research Roundtable at the Institute of Medicine and enhancement of the National Institutes of Health’s clinical research program.</p> <p> In the early 1990s, the section began participating in a series of conferences with the Society of Directors of Research in Medical Education and produced a report on the potential impact health system reform would have on medical education.</p> <p> Moving into the 2000s, the section was instrumental in the AMA’s collaboration with the AAMC on the Initiative to Transform Medical Education, which included the 2010 New Horizons in Medical Education conference.</p> <p> More recently, the section has been involved in the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education initiative</a>, which awarded $11 million in grants to 11 leading medical schools for major medical education innovations in 2013. These schools have made tremendous progress in creating the medical school of the future and transforming physician training.</p> <p> This year, 21 additional medical schools joined these 11 founding members of the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Accelerating Change in Medical Education Consortium</a> to continue spreading innovative medical education ideas. An estimated 19,000 medical students—18 percent of all U.S. allopathic and osteopathic students—study at a consortium school.</p> <p> <strong>Representing the continuum of medical education</strong></p> <p> While the section is very active in undergraduate medical education, its work isn’t limited to what takes place in medical school. The section instituted a new membership category back in 1996 to ensure the section encompassed graduate medical education (GME) and continuing medical education as well.</p> <p> Just last year, the section officially changed its name to the AMA Academic Physicians Section to better reflect this commitment to shaping the full continuum of medical education.</p> <p> “The transition from the AMA Section on Medical Schools to the AMA Academic Physicians Section symbolizes and codifies our commitment to inclusiveness for all those who educate our students and house staff,” said Kenneth Simons, MD, senior associate dean for GME and accreditation at the Medical College of Wisconsin.</p> <p> Throughout its four decades, the section has introduced and influenced AMA policy.</p> <p> “This section is a strong advocate of medical education at undergraduate, graduate and postgraduate levels,” said Surendra Varma, MD, executive associate dean for GME and resident affairs and the Ted Hartman Endowed Chair in Medical Education, university distinguished professor and vice-chair of Pediatrics at Texas Tech University Health Sciences Center School of Medicine.</p> <p> Members of the AMA Academic Physicians Section also view their work as a service to the full medical education community. The section “influence[s] policy in order to help faculty in our academic institutions do their jobs with more efficiency and satisfaction,” said George Mejicano, MD, professor of medicine and senior associate dean for education at Oregon Health and Sciences University. The school is one of the founding members of the Accelerating Change in Medical Education Consortium, and Dr. Mejicano is the principal investigator of the school’s consortium project.  </p> <p> Cynda Ann Johnson, MD, president and founding dean of Virginia Tech Carilion School of Medicine, encourages all academic physicians to get involved in the section. “It matters,” Dr. Johnson said. “The AMA takes its role in shaping medical education seriously, and it has political clout.”</p> <p> Over the years, the section has introduced 173 resolutions on important matters, including expansion of medical schools, faculty development, physician workforce, duty hours, maintenance of certification, resident and student rotations and challenges of primary care.</p> <p> “There has been a tremendous wealth in important topics that we address in our individual institutions and in our daily work,” M. Dewayne Andrews, MD, executive dean of the University of Oklahoma College of Medicine, told physicians during a special lecture in honor of the section’s anniversary, named after its founder John Chapman, MD.</p> <p> “Physicians need a strong voice to advocate for our patients and our profession. The AMA Academic Physicians Section can and should be that voice,” said Maria C. Savoia, MD, dean for medical education and professor of medicine at the University of California–San Diego School of Medicine.</p> <p> The section also gives members key roles to play beyond the AMA.</p> <p> “Membership in the AMA Academic Physicians Section is an avenue toward nomination for important national committees in education and practice, such as the LCME, ACGME and RRCs,” said Betty Drees, MD, professor and dean emerita at the University of Missouri–Kansas City School of Medicine. “This is a way for faculty from all institutions to get involved at a national level to have input and also to provide avenues for career advancement. This type of service counts toward promotion guidelines in most institutions, but also gives participants the opportunity to build networks of colleagues.” </p> <p> If you’re not yet a member of the AMA Academic Physicians Section, now is an exciting time to <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section/members.page" target="_self">join your colleagues</a> in this important work. The next meeting of the section will take place Nov. 11 in Seattle.</p> <p style="text-align:right;"> <em>By AMA Wire editor Amy Farouk<a href="https://twitter.com/amy_amawire" rel="nofollow" target="_blank">https://twitter.com/amy_amawire</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b707a4f0-4cd9-420f-a57f-cb381c7b247e Senior physicians recognized for caring for the underserved http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_senior-physicians-recognized-caring-underserved Mon, 20 Jun 2016 01:16:00 GMT <p class="p1"> Four physicians are being recognized by the <span class="s1">AMA</span> Foundation for showing an extraordinary commitment to leadership, community service and care for those in need—each with decades of service that run the gamut from Ebola research to primary care.<b> </b>Find out who has been awarded this year’s honors.</p> <p class="p1"> <b>Serving underserved international populations</b></p> <p class="p1"> The AMA Foundation presented this year’s <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-foundation/our-programs/public-health/excellence-medicine-awards.page"><span class="s1">Excellence in Medicine Awards</span></a> to  physicians June 10 at the 2016 AMA Annual Meeting in Chicago.</p> <p class="p1"> <b>Jennifer A. Downs, MD, PhD,</b> assistant professor of medicine and assistant professor of microbiology and immunology at the Center for Global Health at Weill Cornell Medical College, is equally comfortable in Ithaca as in her small concrete home in Tanzania.</p> <p class="p1"> When she went to that country years ago as a rotating resident, she didn’t suspect she would develop a heartfelt commitment to caring for its people. </p> <p class="p1"> “But now I love this country,” said Dr. Downs, “and it is difficult to imagine not working here.”</p> <p class="p1"> She<b> </b>is the recipient of this year’s Dr. Debasish Mridha Spirit of Medicine Award, which recognizes a U.S. physician who has demonstrated altruism, compassion, integrity, leadership and personal sacrifice while providing care to marginalized populations. </p> <p class="p1"> Dr. Downs’ first days working with the underserved population of Africa led to an epiphany: “I took care of women younger than I was who were dying of AIDS,” she recalled. “It was haunting. And I knew then that I wanted to come back and work to address the problem.”</p> <p class="p1"> Dr. Downs, who has learned the local language and become enmeshed in the culture of Tanzania, teaches, mentors and carries out clinical care. She makes the care and education of women a priority.. A $2,500 grant will be given to the Center for Global Health in her name.</p> <p class="p1"> <b>Adam Levine, MD</b>,<b> </b>an associate professor of emergency medicine at the Warren Alpert Medical School of Brown University, is the recipient of the Dr. Nathan Davis International Award in Medicine. It comes with a grant of $2,500 to the International Medical Corps. </p> <p class="p1"> The award recognizes Dr. Levine for outstanding international service. He has responded to humanitarian emergencies in Haiti, Libya, South Sudan and Liberia, and has led research and training initiatives in Zambia, Bangladesh, Rwanda, Liberia and Sierra Leone. </p> <p class="p1"> He currently serves as the emergency medicine coordinator for the USAID-funded Human Resources for Health Program, helping to develop the first emergency medicine training program in Rwanda. He serves as the primary investigator for the Ebola research team of the International Medical Corps, a disaster and humanitarian relief organization, and as director for the Humanitarian Innovation Initiative at Brown University. </p> <p class="p1"> Dr. Levine also is editor-in-chief of Academic Emergency Medicine's annual Global Emergency Medicine Literature Review. His research focuses on improving the delivery of emergency care in resource-limited settings and during humanitarian emergencies.</p> <p class="p1"> <b>Providing care for U.S. patients without access</b></p> <p class="p1"> This year the AMA Foundation recognizes two recipients<b> </b>of the<b> </b>Jack B. McConnell, MD, Award for Excellence in Volunteerism, honoring senior physicians who provide treatment to U.S. patients who lack access to health care. </p> <p class="p1"> <b>Charles Clements, MD</b>, a family medicine specialist in Huntington, W.V., helped found the Marshall Medical Outreach, a medical screening and treatment program for the local homeless community. The program provides an average of 35 patients a day with family medicine, internal medicine, ophthalmology and dermatology treatment. Many patients are referred to Recovery Point, an addiction treatment facility. </p> <p class="p1"> Dr. Clements plans to spend his summer with a group of medical students on his seventh trip to treat underserved villages in Honduras. He and his students will examine and treat more than 1,500 people, providing perhaps the only medical attention they receive this year.</p> <p class="p1"> His award comes with a grant of $2,500 to Marshall Medical Outreach.</p> <p class="p1"> The second McConnell recipient, <b>Rafael A. Zaragoza, MD</b>, is a urologist who lives in Delaware. His award comes with a $2,500 grant to the Delaware Prostate Cancer Coalition.</p> <p class="p1"> Dr. Zaragoza formed the Volunteer Ambulatory Surgical Access Program to provide free low-risk outpatient surgery to the uninsured in Kent County, Del., who cannot afford private pay and are not eligible for Medicaid. </p> <p class="p1"> Participating surgeons and nurses volunteer their time, and use of operating rooms is free to patients. He also launched the Hope Clinic, which provides non-emergency medical care to the uninsured.</p> <p class="p3"> <i>By contributing writer Michael Winters</i></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8115d0e1-da9f-4c1f-b75c-f9e40cb60aff California joins growing opposition to insurer mergers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_california-joins-growing-opposition-insurer-mergers Fri, 17 Jun 2016 20:42:00 GMT <p> In a letter to the U.S. Department of Justice (DOJ), the California Department of Insurance (CDI) Thursday urged the DOJ to block the Anthem-Cigna merger in California on the grounds that the merger would substantially lessen competition.</p> <p> The call for a block is a major development given that California has the largest health insurance market in the nation and the CDI is nationally known for its expertise in health insurance regulation.</p> <p> <strong>Why California said no</strong></p> <p> The CDI based its conclusion on the information obtained in a March 29 public hearing that included testimony and written comments from the public, patient advocates, experts on health insurance mergers and both the AMA and California Medical Association (CMA).</p> <p> The AMA and CMA jointly filed a comprehensive, evidence-based <a href="https://download.ama-assn.org/resources/doc/washington/x-pub/competition-anthem-cigna-merger-full.pdf" target="_self">analysis</a> (log in) explaining why the merger should be blocked. Both organizations also testified in person at the hearing before Insurance Commissioner David Jones, and worked hand-in-hand in developing a survey to determine the effect the merger would have on physician practices and patients.</p> <p> “Based on the merger guidelines and data from California alone,” Jones said in the <a href="https://www.insurance.ca.gov/0400-news/0100-press-releases/2016/upload/LetterUSDOJAnthem-Cigna06-16-16.pdf" rel="nofollow" target="_blank">letter</a>, “the proposed merger of Anthem and Cigna will substantially lessen competition in the most populous state containing four of the 20 largest MSAs [metropolitan statistical areas] in the country.”</p> <p> <strong>Premiums would increase</strong></p> <p> Citing the AMA analysis, the CDI found that the Anthem-Cigna merger would likely enhance market power or raise significant competitive concerns in most of California’s MSAs. The CDI also agreed with the AMA that lost competition through a merger would likely be permanent and acquired health insurer market power would be durable because of barriers to entry into the California health insurance markets.</p> <p> As a consequence, the CDI reasoned, quality adjusted premiums would increase notwithstanding new medical loss rating requirements that to some extent regulate unreasonable premium increases.</p> <p> <strong>Quality and consumer choice would suffer</strong></p> <p> The CDI recognized that the merger will harm patients because of its anticompetitive impact on physicians. In the letter, Jones stated that “… the merger would increase the monopsony power of the combined entities in purchasing the services of healthcare providers, thus likely decreasing the quality of services and increasing the price of health insurance.”</p> <p> Based in part on the AMA-CMA survey of physicians, the CDI letter also says that the physician surveys in other states in which Anthem has a substantial market share would likely “replicate the CMA survey results concerning physician vulnerability to Anthem-Cigna monopsony power. Allowing Anthem to increase its already enormous bargaining power will further limit network size and excessively squeeze reimbursement rates, thereby discouraging provider contracting and unacceptably reducing consumer choice and quality of care.”</p> <p> "The AMA commends the Commissioner for acknowledging the <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-09-08-analysis-anthem-cigna-aetna-humana-mergers.page" target="_self">evidence</a> physicians and others presented,” said AMA President Andrew W. Gurman, MD, in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-16-california-commissioner-insurance-competition.page" target="_self">statement</a>, “demonstrating that the Anthem-Cigna merger would likely enhance market power or raise significant competitive concerns in most of California metropolitan areas.”</p> <p> The prospect of the other merger, Aetna’s acquisition of Humana, last month received a major blow when the Missouri Department of Insurance issued an <a href="http://insurance.mo.gov/documents/findings-fact-5-24-16.pdf" rel="nofollow" target="_blank">order</a> preventing the companies from doing any post-merger business in Missouri's Medicare Advantage markets and some commercial insurance markets—if the merger should be allowed.</p> <p> <strong>Price increases: An excerpt from the hearing</strong></p> <p> At the hearing in California on March 29, Jones directly questioned Jay Wagner, Anthem’s vice president and counsel, and Thomas Richards, Cigna’s global leader for strategy and business development, on the possibility of price increases and their claim that prices would actually decrease:</p> <p style="margin-left:40px;"> “ … cost will not go up? [On] any product?” Jones asked.</p> <p style="margin-left:40px;"> “No, I can’t commit to that,” Wagner said.</p> <p style="margin-left:40px;"> “We would need … a guaranteed commitment from our provider partners in order to do that,” Richards said. “I don’t know that we have those in terms of multi-year guarantees in the system to be able [to] do that this morning.”</p> <p style="margin-left:40px;"> “So none of you can provide any assurance that any of the health insurance products sold by any of the entities that will continue selling after the mergers will not increase in price, but at the same time, you’re both very confident that there’s going to be $2 billion in savings?” Jones asked.</p> <p style="margin-left:40px;"> “Correct,” Wagner replied.</p> <p> In the CDI letter to the DOJ, Jones said that he and his staff have been unable to find “reliable evidence in the public record that this merger will result in price decreases overall.”</p> <p> <strong>Learn more about the effects of proposed mergers:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-stand-against-insurance-mergers" target="_self">Experts take a stand against insurance mergers</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-stand-up-against-mergers-of-powerful-insurers" target="_self">Physicians stand up against mergers of powerful insurers</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/states-health-insurers-squeezing-out-competition" target="_self">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:5f4d8d7b-c804-4398-abb8-e376490ac033 Deeper dive into digital snake oil: Q&A with Dr. Madara http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_deeper-dive-digital-snake-oil-qa-dr-madara Fri, 17 Jun 2016 18:00:00 GMT <p> In <a href="https://www.youtube.com/watch?v=RbWgJIOWQmQ" rel="nofollow" target="_blank">his address to the AMA’s House of Delegates</a> at the 2016 Annual Meeting last weekend, AMA CEO and Executive Vice President James L. Madara, MD, used the term “digital snake oil” to begin a critical conversation about emerging technologies in medicine. Following his remarks, he sat down with<em> AMA Wire®</em> for a conversation on what it means to separate the snake oil products from the products that improve patient care.</p> <p> The premise of Dr. Madara’s remarks was that innovations in medicine must be validated, evidence-based, actionable and connected. For new technologies to reach their potential, they must exhibit these primary features in order to bring patients and physicians closer together for the common purpose of improving health outcomes.  </p> <p> Since the speech, reporters, physicians and people from across the field of health IT have had questions for Dr. Madara. Here’s what he had to say on the AMA’s role in the ever-changing landscape of health care in the digital age.</p> <p> <strong><em>AMA Wire:</em></strong><strong> What has been the response to your remarks and your use of the term “digital snake oil”?</strong></p> <p> <strong>Dr. Madara:</strong> The early response has fallen into two general camps, which is exciting because it has initiated a healthy and much-needed discussion about this issue. The first camp is those who are generally comfortable with the pace of development of new technologies, the tsunami of digital tools and apps that I spoke of, and who perhaps aren’t concerned or don’t know enough about the potential health risks of what sometimes amounts to un-validated toys.</p> <p> The second camp sees this issue differently, and their response to me has been: “That’s right, we are moving toward a mess where the useful tools are not clearly differentiated from the toys. We had better get this right if we really believe in a digital health future.”</p> <p> Physicians recognize the tremendous potential in digital health and are looking to the AMA to help make sense of the changing landscape and incorporate new technologies into their practice—technologies that have been shown to improve patient care and outcomes.  </p> <p> But there is too much fantasy right now, blending what could and should be possible with what actually exists today. There are books, for example, that are still promoting use of un-validated approaches that are now under federal investigation—unhelpful and misleading to say the least. This makes a hash of our current digital health state and slows progress.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Why did you choose this message for the House of Delegates?</strong></p> <p> <strong>Dr. Madara:</strong> The AMA has a long history of speaking out on issues important to physicians and patients. Our predecessors helped stamp out medical quackery in the 19<sup>th</sup> Century, as well as created the first code of clinical medical ethics, and crafted the nation’s first educational standards in medicine.</p> <p> Digital health, which spans the entire ecosystem of health IT, continues to play a greater role in the practice of medicine. The AMA is carefully examining the role health IT plays in providing high-quality care to patients and is helping physicians navigate and successfully use these technologies to improve health. We are identifying key challenges physicians face with health IT and focusing on improved usability and interoperability.</p> <p> At the core of the AMA’s mission—to promote the art and science of medicine and the betterment of public health—is the work to improve the health of the nation. With that in mind, we speak out when the all-important physician-patient relationship is threatened or a new health risk is identified.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Which current digital technologies in medicine do you consider to be “snake oil”?</strong></p> <p> <strong>Dr. Madara:</strong> Right now we are often dealing with first-generation technology that has a remarkable potential to change medicine, health care delivery and even the doctor-patient relationship. The term digital snake oil isn’t meant to be a criticism of any one product, rather a critique of a direct-to-consumer industry that exists today with little oversight and often questionable scientific evidence to support the claims made.</p> <p> Though these products may be well-intended, far too many provide incomplete or inaccurate snapshots of a patient’s health and, ultimately, fail to deliver on their promises. Our challenge is finding, fostering and refining the real medical advancements—separating the medically useful from the merely entertaining. </p> <p> One can find products, for example, that claim to measure your blood pressure but in the fine print indicate the product is for entertainment only—that the readings are not to be trusted! I believe a digital environment is critical to enhancing medical practice. However, mixing the medically useful digital advances with what amounts to poorly-validated digital toys slows the advance of this promising field.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Are you saying there is a deliberate attempt by these tech innovators to deceive the public?</strong></p> <p> <strong>Dr. Madara:</strong> The vast majority of these products are well intended, even if they fail to deliver true health benefits. Health is not just another field of entertainment. While some new technologies represent wonderful advances in medicine, hidden among them are countless other products that don’t have an appropriate evidence base and others that just don’t work well—elements that impede the care physicians provide and serve no purpose but to confuse patients and waste time.</p> <p> Another misguided direction in the digital health space stems from a failure to correctly understand the interconnected nature of health care. Health and health care are not monolithic, linear manufacturing processes. Rather, they are more akin to a systems engineering model with the added layer of considerable practice-to-practice, geographic and other variations. As such, interconnectedness and data liquidity are critical and, unfortunately, we have precious little of either today. Isolated tools, even when validated, do not fit this model.</p> <p> According to a Price Waterhouse study released just last month, 65 percent of adults who own and use a wearable device are “excited” by the opportunity to use a wearable to interact in a doctor’s office, which is also the site they identified at the highest level of trust level in interpreting the data collected by the device. At the same time, a recent Commonwealth Fund <a href="http://www.commonwealthfund.org/publications/issue-briefs/2016/feb/evaluating-mobile-health-apps" rel="nofollow" target="_blank">report</a> stated that while mobile applications are a “potentially promising tool for engaging patients in their health care …” only about 43 percent of iOS apps and 27 percent of Android apps appeared to be useful.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Do you consider electronic health records (EHR) to be a form of digital snake oil?</strong></p> <p> <strong>Dr. Madara:</strong> No. But, EHRs are symbolic of a system that is not fully functional or living up to its potential. There are significant usability challenges when it comes to EHR implementation and the delivery of quality care. To resolve these challenges, the AMA put forth eight <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/digital-health.page" target="_self">EHR usability priorities</a> to be urgently addressed and we are partnering with multiple stakeholders to improve EHR usability for physicians.</p> <p> A detailed AMA Rand study revealed that, while physicians do not want to go back to paper and see the promise of EHRs, they are highly frustrated by the current form of these records.  They tend not to be interoperable, at least not with ease, and many argue that the copy-and-paste culture they induce actually deteriorate the quality of the medical record.  One day we will look back on the current 1.0 state of the electronic record the way we currently look back on typewriters.</p> <p> The AMA is taking a multi-pronged approach to helping to influence the improvement and evolution of EHRs and working to ensure physicians have high-performing EHRs that support a learning health system. We continue to consult with experts in the EHR and digital health fields, speak to vendors, advocate for changes to the Meaningful Use and EHR certification programs, and promote interoperability through participation in industry-led efforts.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Is the AMA trying to slow the development of new products?</strong></p> <p> <strong>Dr. Madara:</strong> It’s the opposite actually. We want a more robust conversion to support a digital environment that consists of evidence-based tools that are validated, actionable, and interconnected. Taking such elements and intermixing them with toys that do not have these characteristics, slows progress.</p> <p> We need to get digital tools right. The AMA is taking a leadership role to support the development of new technologies by building a bridge to tech innovators and entrepreneurs so that physicians have a seat at the table when new technologies are being designed and created. This ensures that new innovations, once fully formed, have real-world applications in clinics and hospitals … that they work to reduce inefficiencies in health care delivery, improve patient access, lower costs and, ultimately, increase the quality of care.</p> <p> The AMA is committed to innovation and collaboration that will help advance our ongoing work on behalf of the nation’s physicians and patients to meet the needs of 21st Century health care. We call this the AMA’s health innovation ecosystem.</p> <p> For example, in Chicago we are partnering with the technology incubator <a href="http://matterchicago.com/" rel="nofollow" target="_blank">MATTER</a>, connecting entrepreneurs and physicians at the very point of the “idea conception” to develop new technologies, services and products to better serve physicians and patients. And earlier this year, we launched <a href="https://www.health2047.com/" rel="nofollow" target="_blank">Health2047</a> in San Francisco. Health2047 is an integrated innovation company, which takes on many of the problems sourced from AMA studies (as well as from others) and applies rapid prototyping and design to achieve tools based on physician need. Emerging prototypes will be iterated with physicians until the tool gets it right. Partnering with industry on the development of needed products is an additional possible pathway for Health 2047.</p> <p> <strong><em>AMA Wire:</em></strong><strong> Are consumers at risk by these so-called “defective” tech products? Do you have research that supports that claim?</strong></p> <p> <strong>Dr. Madara:</strong> Consumers can be at risk when new technologies make claims that cannot be supported by evidence and science—particularly if they are allowed to enter the marketplace unchecked.</p> <p> In calling attention to these emerging technologies, the AMA is trying to raise awareness about the risks and establish high industry standards so that consumers know what they’re getting and can trust the data as they track their general wellness and manage chronic diseases. The field of medicine deserves the same attention to validated interconnected digital quality as the field of aviation. Can you imagine digital instruments that are not validated, not evidence based, not actionable, and not connected being used in a cockpit?</p> <p> <strong><em>AMA Wire:</em></strong><strong> What’s next? How should the AMA carry this message forward?</strong></p> <p> <strong>Dr. Madara:</strong> By leading with action, such as our work at MATTER and our role as founding investor in the Health 2047 innovation studio, the AMA is not simply sitting on the sideline. The promise of a functional, supportive digital future is simply too important for that. We need to do all we can to ensure that digital medicine lives up to its promise, even if it means calling attention to so-called innovations that confuse, and therefore inhibit, the supportive digital future that physicians and patients want.</p> <p> We look forward to that day when a trustworthy, validated, interconnected digital environment both frees and support physicians to do what they value most—spend time with their patients.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8a4cc823-1fd7-4a9b-8827-5754756dc574 Physicians elect AMA trustees, council members http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-elect-ama-trustees-council-members Thu, 16 Jun 2016 22:54:00 GMT <p> In a daylong series of runoff and special elections, delegates at the 2016 AMA Annual Meeting Tuesday voted for officer positions—including president-elect, members for the AMA Board of Trustees, speaker and vice speaker of the AMA House of Delegates, and six seats on four councils.</p> <p> <strong>Results of officer elections</strong></p> <p> Following a compelling debate by both candidates, David O. Barbe, MD, was voted president-elect of the AMA. Dr. Barbe is a family physician from Mountain Grove, Mo., and previously served as the chair of the AMA Board of Trustees. Following a year-long term as president-elect, Dr. Barbe will assume the office of AMA president in June 2017.</p> <p> “It is a tremendous honor and privilege to be elected by my peers to be president-elect of an organization that is dedicated to improving the practice environment for physicians, the education of our medical students and the health of the patients we serve,” Dr. Barbe said. “I am eager to continue the strong work of the AMA in shaping America’s health care system to better meet the needs of patients and physicians both now and in the future.”</p> <p> Running unopposed for reelection to the offices of speaker and vice speaker of the AMA House of Delegates were Susan R. Bailey, MD, and Bruce A. Scott, MD, respectively. Both candidates were voted by acclamation to complete another term.</p> <p> Six qualified candidates ran for three seats on the AMA Board of Trustees. Delegates reelected William E. Kobler, MD, and elected two new members to the board: Willarda V. Edwards, MD, and William A. McDade, MD.</p> <p> Also appointed to the executive committee of the AMA Board of Trustees:</p> <ul> <li> Chair: Patrice A. Harris, MD</li> <li> Chair-elect: Gerald E. Harmon, MD</li> <li> Secretary: Jack Resneck, Jr., MD</li> </ul> <p> <strong>Council elections</strong></p> <p> In competitive elections for council seats, five delegates were selected by their peers to serve in open positions:</p> <ul> <li> AMA Council on Constitution and Bylaws: Pino Colone, MD</li> <li> AMA Council on Medical Service: Alan Harmon, MD, and Lynn Jeffers, MD</li> <li> AMA Council on Medical Service resident and fellow seat: Laura Faye Gephart, MD</li> <li> AMA Council on Science and Public Health: Alex Ding, MD, and David J. Welsh, MD</li> <li> AMA Council on Medical Education: Cynthia Jumper, MD</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ed9a4680-fa2f-42f1-9d94-8fc0f8593322 Preventing gun violence is all about saving lives http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_preventing-gun-violence-saving-lives Thu, 16 Jun 2016 21:41:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/4/b892f0b5-f0fe-4f84-a4b0-88862e8c8de0.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/4/b892f0b5-f0fe-4f84-a4b0-88862e8c8de0.Large.jpg?1" style="margin:10px;float:left;" /></a><em>An AMA Viewpoints post by AMA Immediate-Past President Steven J. Stack, MD</em></p> <p> When dozens of physicians lined up to testify at the 2016 <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">AMA Annual Meeting</a> this week, the remarks were impassioned and derived from lifetimes of treating victims of gun violence. While this topic has become highly politicized in our country, the passion in the room stemmed from the urgent need to take a stance on a vital public health issue—one that could help save thousands of lives and prevent needless tragedies that affect so many families in our nation.</p> <p> <strong>Agreement across regions, specialties and political leanings</strong></p> <p> One of the remarkable things about the AMA policymaking process is how truly democratic it is. The AMA House of Delegates includes representatives from every corner of the country, from 118 specialties and every kind of practice setting. Delegates range from young medical students to veterans of the profession. Every perspective is included, and everyone gets a voice.</p> <p> Hearing medical students and physicians from so many backgrounds and points of view share their perspectives spoke to the importance of intervening to stop gun-related violence and how it gets at the very heart of our calling as physicians.</p> <p> We heard from physicians who practice in places with high rates of violence—including a poverty-stricken neighborhood in Washington, D.C., inner city Wilmington, Del., and downtown Los Angeles. We heard from one physician who was among the medical responders for the Boston Marathon bombing and another from Orlando who was among the physicians who were paged regarding the mass casualties and injuries from the tragic shooting there last week.</p> <p> One physician testified that she had treated so many gunshot victims as a resident that she was told to stop tracking the head and neck surgeries she performed because she had more than enough to demonstrate her competency to complete her training.</p> <p> A young emergency physician shared that trying to revive gunshot victims and treat the wounded had become shockingly routine for him. What’s more, he noted that even as an academic physician treating such a high number of victims, he doesn’t have the ability to turn to data to examine how these injuries might be prevented.</p> <p> Many physicians from states that traditionally are highly supportive of gun ownership also expressed the need to get behind any evidence-based policy that would help prevent violence from befalling our patients.</p> <p> A senior delegate perhaps characterized the AMA policymaking discussion best when he testified that it wasn’t about questioning second amendment rights but about conducting research to better understand the issue because we currently suffer from a lack of data to look at gun violence from an epidemiological point of view.</p> <p> <strong>How the AMA is taking action</strong></p> <p> AMA policy guides our advocacy efforts for patients and physicians and at this meeting, we built on existing policy with several key developments:</p> <ul> <li> Officially calling gun violence in the United States a public health crisis that requires a comprehensive public health response and solution</li> <li> Directing the AMA to actively lobby Congress to overturn legislation that for 20 years has prevented the Centers for Disease Control and Prevention from researching gun violence</li> <li> Calling for background checks and a waiting period for all firearms purchasers, whereas previous policy only dealt with handguns</li> </ul> <p> These are very important steps to tackle a public health crisis. It truly is an issue that affects us all and demands our best efforts to address it.</p> <p> In addition to the expanded AMA policy, we’ve also been hard at work over the last few years in the nation’s courts to preserve freedom of speech in the exam room for physicians to talk to patients and family members about safety.</p> <p> A recent law in Florida would effectively put a gag on physicians, preventing them from discussing gun safety with their patients. This kind of counseling is especially important for families with young children because it can prevent accidental gun-related injuries and deaths. It seems like every time you see the news, another child is accidentally shot or accidentally shoots someone else because of unsafe gun storage practices.</p> <p> The AMA and several other medical associations have been <a href="http://www.ama-assn.org/ama/ama-wire/post/freedom-of-patient-physician-conversations-hinges-court-case" target="_self">fighting this law</a>, and the case is scheduled to be heard by a rare 11-judge panel beginning June 21 in Atlanta.</p> <p> It’s significant that so many physicians at the 2016 AMA Annual Meeting gave a standing ovation upon passage of our new policy: It represents our common, unwavering commitment to protect our patients and improve the health of the nation in the most meaningful ways possible.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4f8c340e-4587-437e-8395-38a94a7552cf From ethics to gun violence: Top stories from 2016 AMA Annual Meeting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethics-gun-violence-top-stories-2016-ama-annual-meeting Thu, 16 Jun 2016 19:00:00 GMT <p> The 2016 AMA Annual Meeting took place this week. Read these highlights from the meeting, and see <em>AMA Wire's</em><em>®</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Meeting/1" target="_blank">full coverage</a> of the event to learn more.</p> <p> <strong>1.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/code-of-medical-ethics-modernized-first-time-50-years"><strong><em>Code of Medical Ethics </em>modernized for first time in 50 years</strong></a><a href="https://www.youtube.com/watch?v=39W1xhvUEbM" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/6/4/b6f94b37-24a2-4207-a400-f1b7b7e94853.Large.jpg?1" style="margin:5px;float:right;width:247px;height:150px;" /></a><br /> Physicians have just affirmed a comprehensive update of the nearly 170-year-old <em>AMA Code of Medical Ethics</em>, the conclusion of a meticulous project started eight years ago to ensure that this ethical guidance keeps pace with the demands of the changing world of medical practice.</p> <div> <p> <strong>2.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/bright-future-horizon-path-there"><strong>Bright future on the horizon—and we know the path to get there</strong></a> <br /> Physicians live in a world of contradictions, outgoing AMA President Steven J. Stack, MD, said in his address. It’s a profession of rewards and privilege amid the toll of frustration and burnout, borne of administrative hassles and bureaucratic overreach. The challenge is to persevere and lead the way for others.</p> <p> <strong>3.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/ama-calls-background-checks-wait-periods-prevent-gun-violence"><strong>AMA calls for gun research, background checks to prevent violence</strong></a><br /> <a href="https://www.youtube.com/watch?v=-yQQiTzuGQs" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/4/d053a23b-6900-409d-b42a-b568d1415396.Large.jpg?1" style="color:rgb(0, 0, 238);margin:5px;float:right;width:247px;height:150px;" /></a>Calling gun violence a “public health crisis,” the AMA is urging background checks and a waiting period for all firearms purchasers and will lobby Congress to overturn legislation that for 20 years has prevented the Centers for Disease Control and Prevention from researching gun violence.</p> <p> <strong>4.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/ethical-considerations-prompt-new-telemedicine-ground-rules"><strong>Ethical considerations prompt new telemedicine ground rules</strong></a><br /> With the increasing use of telemedicine and telehealth technologies, delegates adopted new policy that outlines ethical ground rules for physicians using these technologies to treat patients.</p> </div> <div> <p> <strong>5.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-guiding-new-payment-system-cms-chief-says"><strong>Physicians are guiding new payment system, CMS chief says</strong></a><br /> In the effort to design the new Medicare payment system, Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), said that the driving factor behind many of the changes was physician input. But the physician’s role does not stop there.</p> <p> <strong>6.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/new-ama-policies-patients-should"><strong>11 new AMA policies your patients should know</strong></a><br /> <a href="https://www.youtube.com/watch?v=yvsdz7O3m-c" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/aa3119b0-1782-4eb5-a9d2-74b679169ad9.Large.jpg?1" style="color:rgb(0, 0, 238);margin:5px;float:right;width:247px;height:150px;" /></a>At the heart of policymaking of the AMA is the mission to promote the betterment of public health. Physicians adopted policies that will help improve consumer safety and reduce harm—they range from preventing drug overdose to delaying school start times and supporting paid sick leave.</p> <p> <strong>7.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/sitting-sidelines-involved"><strong>If you’re sitting on the sidelines, get involved</strong></a><br /> Andrew W. Gurman, MD, in his inaugural speech as president of the AMA, issued a call to action for physicians to be leaders and advocates for their profession.</p> <p> <strong>8.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-making-ehrs-interoperable"><strong>How physicians are making EHRs interoperable</strong></a><br /> Electronic health records (EHR) have consistently caused problems for physicians due to a lack of interoperability. Physicians and health IT developers explained how physicians must lead—and are leading—the way forward.</p> <p> <strong>9.     </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/digital-dystopia-developing-tools-work-practice"><strong>Digital dystopia: Developing tools that work in practice</strong></a> <a href="https://www.youtube.com/watch?v=RbWgJIOWQmQ" rel="nofollow" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/13/ac884ee1-1399-4cae-8d92-c1d4d30e3b08.Large.jpg?1" style="margin:5px;float:right;width:247px;height:150px;" /></a><br /> Identifying the technology that makes care less efficient and building new tools that are based on physician perspectives from the start are critical to developing a digital practice environment that works for physicians and patients, AMA Executive Vice President and CEO James L. Madara, MD, said.</p> <p> <strong>10.  </strong><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-steps-address-opioid-overdose-epidemic"><strong>Physicians take steps to address opioid overdose epidemic</strong></a><br /> The physician role in reducing opioid medication misuse, overdose and death is an important one. New policies address factors that are critical to reversing the epidemic, including prescription drug monitoring programs, access to naloxone and addiction medicine as a sub-specialty.</p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8008fa08-eebc-4af9-bb56-462d389c7c46 EHRs to MOC: Physicians tackle practice issues in new policy http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ehrs-moc-physicians-tackle-practice-issues-new-policy Wed, 15 Jun 2016 21:00:00 GMT <p> During the third day of policymaking at the 2016 AMA Annual Meeting, physicians discussed a range of topics that affect their practice of medicine. Among them were maintenance of certification (MOC) concerns, the desire to improve patient safety amid the difficulties of electronic health records (EHR) and the need to ensure coverage of telemedicine services.</p> <p> <strong>Minimizing EHR-related patient safety risks</strong></p> <p> EHRs vendors have been required to make changes to EHR products at such a rapid pace in order to comply with required meaningful use certification that there hasn’t been enough time to align new functionalities with efficient practice work flows.</p> <p> Poor usability and a lack of interoperability between EHR systems carry patient safety risks and efforts at the local and state levels have been ineffective to reduce these risks.</p> <p> In order to improve patient safety, physicians Tuesday adopted policy to support efforts of the Office of the National Coordinator for Health IT to implement a Health IT Safety Center to minimize EHR-related patient safety risks through collection, aggregation and analysis of data reported from EHR-related adverse patient-safety events.</p> <p> <strong>Ensuring payment parity for telemedicine services</strong></p> <p> Telemedicine and telehealth services offer an opportunity for physicians to improve health outcomes among their existing patients, particularly for those with chronic conditions or who need routine follow-up care but have mobility issues. For instance, when physicians conduct <a href="http://www.ama-assn.org/ama/ama-wire/post/tablet-can-treat-diabetes-watch-this-film-out" target="_self">home monitoring of chronic conditions</a>, such as diabetes, they are better able to keep their patients healthy and reduce hospital admissions and emergency department visits.</p> <p> Delegates voted to adopt policy that calls for private health insurers to cover telemedicine-provided services that are comparable to that of in-person services and not limit coverage to services provided by select corporate telemedicine providers.</p> <p> “The AMA has supported state medical societies in developing telemedicine policies, which have provided tremendous benefit to rural communities. But these benefits will continue to be limited if patients must pay out of pocket for the services that should be covered by insurance,” AMA Board Member Russell W. H. Kridel, MD, said in a news release.</p> <p> The AMA in 2014 released model legislation to support states’ efforts to achieve parity in telemedicine coverage policies, ensure telemedicine is appropriately defined in each state’s medical practice statutes and that its regulation falls under the jurisdiction of the state medical board. The resolution adopted today reflects the great interest in the safe and effective practice of telemedicine, and the AMA will continue to work with state medical societies to accomplish this goal.</p> <p> <strong>Improving MOC and OCC</strong></p> <p> A new report from the AMA Council on Medical Education examines the current state of maintenance of certification (MOC) and osteopathic continuous certification (OCC), noting both the physician concerns around such elements as cost effectiveness and relevance to practice and the professional imperative to ensure patients are receiving high-quality care.</p> <p> The report notes that the council will continue to work with the relevant associations and member boards to identify and suggest improvements to the MOC and OCC programs. Additionally, the council “is committed to ensuring that MOC and OCC support physicians’ ongoing learning and practice improvement.”</p> <p> “The AMA will continue to advocate for a certification process that is evidence based and relevant to clinical practice as well as cost effective and inclusive to reduce duplication of work,” the report said.</p> <p> Delegates adopted policy to further these efforts, including:</p> <ul> <li> Examining the activities that medical specialty organizations have underway to review alternative pathways for board recertification</li> <li> Determining whether there is a need to establish criteria and construct a tool to evaluate whether alternative methods for board recertification are equivalent to established pathways</li> <li> Asking the American Board of Medical Specialties to encourage its member boards to review their MOC policies regarding the requirements for maintaining underlying primary or initial specialty board certification in addition to subspecialty board certification to allow physicians the option to focus on MOC activities most relevant to their practices</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:12270819-6742-4425-80ec-bc93524df726 Physicians take steps to address opioid overdose epidemic http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-steps-address-opioid-overdose-epidemic Wed, 15 Jun 2016 20:25:00 GMT <p> The physician role in reducing opioid medication misuse, overdose and death is an important one. Several new policies were put into place by physician delegates at the 2016 AMA Annual Meeting addressing factors that are critical  to reversing the epidemic, including prescription drug monitoring programs (PDMP), access to naloxone and addiction medicine as a sub-specialty.</p> <p> <strong>The importance and effectiveness of PDMPs</strong></p> <p> The prevention and treatment of opioid use disorder has been a focus of the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page">Task Force to Reduce Prescription Opioid Abuse</a> since its inception. PDMPs are important tools that physicians have to help them in this effort.</p> <p> Not all states allow physicians to access their own prescription records, which would provide better control against fraudulent prescribing. Physicians adopted policy to promote the efforts for state-run electronic PDMPs that allow individual physicians to access their opioid prescribing records for their entire panel of patients, including patient names and prescription information.</p> <p> New policy also asks that the AMA study current pathways that may allow physicians to report possible fraudulent use of their prescriptions.</p> <p> <strong>Increasing access to naloxone </strong></p> <p> There has been a large increase in naloxone dispensed over the past 18 months, a report from the AMA Board of Trustees stated. From the fourth quarter of 2014 to the second quarter of 2015, there was a 1,170 percent increase. This life-saving opioid overdose antidote is an important tool for physicians to minimize harm when treating at-risk patients with opioid medications.</p> <p> In response to the report, delegates at the 2016 AMA Annual Meeting adopted policy to:</p> <ul> <li> Support legislative and regulatory efforts that increase access to naloxone, including collaborative practice agreements with pharmacists and standing orders for pharmacies as well as community-based organizations, law enforcement agencies, correctional settings, schools, and other locations that do not restrict the route or administration for naloxone delivery.</li> <li> Support efforts that enable law enforcement agencies to carry and administer naloxone.</li> <li> Encourage physicians to co-prescribe naloxone to patients at risk of overdose and, where permitted by law, to the friends and family members of such patients.</li> <li> Encourage private and public payers to include all forms of naloxone on their preferred drug lists and formularies with minimal or no cost sharing.</li> <li> Support liability protections for physicians and other health care professionals and others who are authorized to prescribe, dispense or administer naloxone pursuant to state law.</li> <li> Support efforts to encourage individuals who are authorized to administer naloxone to receive appropriate education to enable them to do so effectively.</li> </ul> <p> <strong>Breaking down barriers to pain management</strong></p> <p> Although intended to promote pain assessment and effective treatment, notion of “pain as the fifth vital sign” and the evolution of patient satisfaction surveys that include a focus on the extent to which a patient’s pain is relieved has created a practice environment that likely contributed to an increase in opioid prescriptions, according to a report from the AMA Board of Trustees.</p> <p> Despite the substantial burden of persistent pain in the U.S., access to multidisciplinary care and insurance coverage for non-pharmacologic approaches is woefully inadequate, according to the report. These factors also have contributed to the routine use of opioid analgesics.</p> <p> Measuring adequate pain control in acute and subacute care settings is complicated by the subjective nature of pain intensity reports by patients. Delegates adopted policies intended to promote access to high quality, comprehensive pain care, including:</p> <ul> <li> Work with The Joint Commission to promote evidence-based, functional and effective pain assessment and treatment measures for accreditation standards.</li> <li> Support timely and appropriate access to non-opioid and non-pharmacologic treatments for pain, including removing barriers to such treatments when they inhibit a patient’s access to care.</li> <li> Advocate for the removal of the pain management component of patient satisfaction surveys as it pertains to payment and quality metrics.</li> </ul> <p> <strong>Specialties and guidelines—more action from physicians</strong></p> <p> Delegates also adopted policy supporting the American Board of Preventive Medicine’s (ABPM) establishment of addiction medicine as a subspecialty for physicians. The new policy also encourages ABPM to offer its first American Board of Medical Specialties-approved certification examination in addiction medicine expeditiously in order to improve access to care to treat addiction.</p> <p> “We applaud the American Board of Preventive Medicine for making addiction medicine a new subspecialty,” AMA Board Member Patrice A. Harris, MD, said news release. “We believe that having more physicians specifically trained to treat addiction will help improve access to care and help combat the nation’s opioid epidemic.”</p> <p> Delegates also instructed the AMA to work with the Centers for Disease Control and Prevention (CDC) and other regulatory agencies to have long-term care facilities viewed as exempt from the  recommendations contained in <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-saying-new-cdc-opioid-guidelines" target="_self">new guidelines</a> from the CDC for the use of  opioid medications for chronic pain, in much the same way as is being done for hospice and palliative care.</p> <p> The AMA Task Force to Reduce Prescription Opioid Abuse has established five recommendations for physicians to combat the opioid overdose epidemic. These recommendations include: Register for and use your state <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/prescription-drug-monitoring-programs.page?" target="_self">PDMP</a> to check your patient’s prescription history; <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-resource-guide.page?" target="_self">educate yourself</a> on managing pain and promoting safe, responsible opioid prescribing; support overdose prevention measures, such as <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page?" target="_self">increased access to naloxone</a>; reduce the stigma of <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_self">substance use disorder</a> and enhance access to treatment; and ensure patients in pain aren’t stigmatized and can receive comprehensive treatment.</p> <p> <strong>For more on physician efforts to end the opioid overdose epidemic:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/obamas-opioid-initiatives-align-physician-recommendations">How Obama’s opioid initiatives align with physician recommendations</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients">How to talk about substance use disorders with your patients</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas">Physicians team up to treat addiction in rural areas</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder">3 steps for talking with patients about substance use disorder</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription">Entire state gets one naloxone prescription</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/antidote-3-things-consider-co-prescribing-naloxone">The antidote: 3 things to consider when co-prescribing naloxone</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:5cf89e38-42f3-4b81-a760-ed66da47c45e Physicians take on timely public health issues http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-timely-public-health-issues Wed, 15 Jun 2016 18:00:00 GMT <p> In Days 2 and 3 of policymaking at the 2016 AMA Annual Meeting, delegates adopted a variety of policies on important issues affecting the health of patients across the country. Issues range from controlled LED lighting to safe provision of dry needling procedures to better training for hemorrhage control.</p> <p> <strong>Attorney ads on drug side-effects</strong></p> <p> Late-night television is rampant with attorney ads that seek plaintiffs regarding complications from new medications. Potential complications are spoken about in an alarming way, and often, it is the first time the public learns about those potential complications and side effects.</p> <p> These ads describe only the lethal side effects and not the benefits of the medications that many patients have experienced—but this is not explained to the viewers.</p> <p> To protect the health of the public, physicians Tuesday adopted policy to advocate for a requirement that attorney commercials which may cause patients to stop using necessary medications to have appropriate and conspicuous warnings that patients should not discontinue medications without seeking the advice of their physician.</p> <p> “The onslaught of attorney ads has the potential to frighten patients and place fear between them and their doctor,” AMA Board Member Russell W. H. Kridel, MD, said in a news release. “By emphasizing side effects while ignoring the benefits or the fact that the medication is FDA approved, these ads jeopardize patient care. For many patients, stopping a prescribed medication is far more dangerous, and we need to be looking out for them.”</p> <p> <strong>Standards of practice for dry needling</strong></p> <p> Ensuring patient safety is paramount for physicians. To that end, delegates adopted new policy that recognizes the procedure of dry needling as invasive.</p> <p> Physical therapists are increasingly incorporating dry needling into their practice. Dry needling is indistinguishable from acupuncture, yet physical therapists are using this invasive procedure with as little as 12 hours of training, while the industry standard minimum for physicians to practice acupuncture is 300 hours of training.</p> <p> Delegates agreed that the practice of dry needling by physical therapists and other non-physician groups should include—at a minimum—the benchmarking of training and standards to already existing standards of training, certification and continuing education that exist for the practice of acupuncture.</p> <p> The policy also maintains that dry needling as an invasive procedure should only be performed by practitioners with standard training and familiarity with routine use of needles in their practice, such as licensed medical physicians and licensed acupuncturists.</p> <p> “Lax regulation and nonexistent standards surround this invasive practice,” AMA Board Member Russel W.H. Kridel said in a news release. “For patients’ safety, practitioners should meet standards required for acupuncturists and physicians.”</p> <p> <strong>Physicians suggest controlled LED lighting</strong></p> <p> Strong arguments exist for overhauling the lighting systems on roadways with light emitting diode (LED), but conversions to improper LED technology can have adverse consequences.</p> <p> In response, physicians adopted guidance for communities on selecting LED lighting options to minimize potential harmful human and environmental effects. The guidance was based on a report from the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-science-public-health.page?" target="_self">AMA Council on Science and Public Health</a>.</p> <p> Converting conventional street light to energy-efficient LED lighting leads to cost and energy savings, and a lower reliance on fossil-based fuels. Approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with many efforts underway to accelerate this conversion.</p> <p> “Despite the energy efficiency benefits, some LED lights are harmful when used as street lighting,” AMA AMA Board Member Maya A. Babu, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-community-guidance-street-lighting.page" target="_self">news release</a>. “The new AMA guidance encourages proper attention to optimal design and engineering features that minimize detrimental health and environmental effects.”</p> <p> High-intensity LED lighting designs emit a large amount of blue light that appears white to the naked eye and create worse nighttime glare than conventional lighting. The intense, blue-rich LED lighting can decrease visual acuity, resulting in safety concerns and road hazards.</p> <p> The new policy encourages communities to:</p> <ul> <li> Minimize and control blue-rich environmental lighting by using the lowest emission of blue-light possible</li> <li> Properly shield all LED lighting to minimize glare and detrimental human health and environmental effects</li> <li> Consider using dimmers on LED lighting for off-peak times</li> </ul> <p> In addition to its impact on drivers, blue-rich LED streetlights operate at a wavelength that adversely suppresses melatonin during the night. It is estimated that white LED lamps have five times greater impact on the body’s natural sleep-wake cycle than conventional street lamps. Recent surveys found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.</p> <p> <strong>Action to address illegal methamphetamine production</strong></p> <p> Physicians adopted policy that supports the replacement of current pseudophoedrine-containing over-the-counter products with formulations that are resistant to methamphetamine production as well as initiatives that focus on prevention and treatment of methamphetamine abuse.</p> <p> Additionally, physicians encouraged the widespread and proper use of the national precursor log exchange (NPLEx), a real-time electronic logging system used to track over-the-counter medications that can be used to make methamphetamine.</p> <p> <strong>Increasing training for hemorrhage control</strong></p> <p> The AMA adopted policy calling for state medical and specialty societies to promote the training of first responders and the lay public in techniques of bleeding control. With increases in active shooter incidents, the need is greater than ever for training in hemorrhage control training, the AMA policy says.</p> <p> The AMA also called for providing hemorrhage control kits to law enforcement and other first responders. The U.S. military found that uncontrolled hemorrhage due to trauma was the most common cause of preventable death among more than 6,800 military casualties in Iraq and Afghanistan.</p> <p> “After implementing hemorrhage control training to help victims of trauma, the military saw a significant decrease in the number of deaths caused by uncontrolled bleeding in these patients,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “We believe that by equipping the public, police and others who are first on the scene of a traumatic event with training and supplies to control bleeding, we will also be able to help save more trauma patients.”</p> <p> <strong>Promoting long-term health and wellness in the juvenile justice system</strong></p> <p> The U.S. leads the industrialized world in the rate of confinement of young people. African-Americans and Latinos especially suffer from large-scale incarceration.</p> <p> The AMA adopted a policy calling for reforms of the nation’s juvenile justice system to help protect the long-term health and safety of adolescents during and after confinement. New policy also aims to help prevent youth incarceration when rehabilitation or community-based alternatives are most appropriate and no threat to public safety exists.</p> <p> The AMA called for other measures to reduce youth incarceration, including replacement of “zero-tolerance” school policies with other discipline policies, raising the upper age limit for juvenile court jurisdiction, research to identify programs that could reduce minority contact with the juvenile justice system and encouraging juvenile justice facilities to prohibit discrimination based on sexual orientation, gender identity and gender expression.</p> <p> “Most incarcerated youth today suffer from childhood trauma, mental health disorders or substance use disorders and require proper treatment,” Dr. Ehrenfeld said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “While we have extensive scientific evidence showing significant differences in cognitive function and decision-making between adolescents and adults and the impact trauma has on adolescent brain development, the law has been slow to apply these scientific findings to the juvenile justice system.” </p> <p> “The AMA is calling on the federal government, states and schools to implement policies and programs that focus on rehabilitating and treating incarcerated youth to promote their long-term health and wellness, and help prevent unnecessary confinement when better alternatives exist,” Dr. Ehrenfeld said. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:3ad1f2ff-6b97-4004-b2ac-2fed7aca514a 11 new AMA policies patients should know http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-ama-policies-patients-should Wed, 15 Jun 2016 18:00:00 GMT <p> At the heart of all policymaking of the AMA is the mission to promote the betterment of public health. Physicians at the 2016 AMA Annual Meeting adopted a variety of policies that will help improve consumer safety and reduce harm—they range from preventing drug overdose to delaying school start times and supporting paid sick leave.</p> <p> <strong>1. Medication disposal programs could help prevent overdose, improve health</strong></p> <p> An unprecedented drug overdose epidemic in the United State could be addressed in part by stronger medication return programs that treat unused medications as hazardous waste. The AMA called for support of medication return programs, funded by pharmaceutical manufacturers, and called for federal laws that encourage medication recycling and disposal.</p> <p> Estimates indicate that 30-80 percent of patients do not finish prescriptions for common medications, including pain medications, and many patients discard these drugs at home. The U.S. Geological Survey sampled rivers and streams and found that up to 80 percent showed traces of drugs, hormones, steroids and personal care products.</p> <p> “Many of these unused medications, most notably opioids, are diverted and used by someone other than the targeted patient,” AMA President-Elect David O. Barbe, MD, said in a news release. “Manufacturers should be stewards of their products throughout their lifecycle and provide this critical service to patients and our environment.”</p> <p> <strong>2. Protecting children’s eyes through air gun safety</strong></p> <p> In response to soaring rates of eye injuries among minors as a result of air guns, delegates adopted policy to better protect children and teenagers from injuries that can inflict lasting damages, despite treatment.</p> <p> The new policy directs the AMA to encourage the use and provision of protective eyewear when using air guns as well as education on the proper use of protective eyewear to avoid ocular injuries.</p> <p> “The increase in air gun use has not been met with increased safety awareness,” Dr. Barbe said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “Many of these injuries result in lasting changes in sight and can be avoided by wearing proper eye protection.”</p> <p> <strong>3. Ending sales tax on feminine hygiene products</strong></p> <p> The AMA adopted policy to support laws that strip taxes from the sale of feminine hygiene products. These essential products for women’s health are taxed, but delegates noted that many other far less necessary purchases—from cupcakes to circus performances—are exempt from sales taxes.</p> <p> Five states no longer charge a sales tax on these products and more are considering similar legislation. </p> <p> “Feminine hygiene products are essential for women’s health, and taxes on them are a regressive penalty,” Dr. Barbe said. “We applaud the states that have already eliminated sales taxes on these products, and we urge every state to follow suit.”</p> <p> <strong>4. The importance of radon testing in rentals</strong></p> <p> The AMA adopted policy that calls for renters to have similar protections as home buyers in terms testing for radon. Radon, a radioactive gas and known carcinogen, is the second leading cause of lung cancer and causes more than 20,000 deaths a year.</p> <p> Only two states mandate that new renters be informed of whether a radon test has been performed and the nature of its results. The new AMA policy calls for transparency and disclosure of prior radon tests and the most recent results of tests for renters entering into a lease.</p> <p> <strong>5. Dangers of detergent packets</strong></p> <p> Recognizing that concentrated detergent packets can compromise children’s health and safety, the AMA today adopted policy calling for the redesign of detergent product packages to make them less attractive to children to help prevent accidental exposure or ingestion.</p> <p> According to a <a href="http://pediatrics.aappublications.org/content/early/2014/11/05/peds.2014-0057" rel="nofollow" target="_blank">study</a> published in the <em>Journal of the American Academy of Pediatrics</em>, between 2012 and 2013 alone, more than 17,000 children under the age of six were exposed to highly-concentrated laundry detergent pods—resulting in hundreds of hospitalizations from ingestion and one confirmed death.</p> <p> “While liquid detergent pods were developed for the convenience for consumers, they have also have had unfortunate, unintended health consequences for children who ingested the colorful, candy-like packages,” AMA Board Member William E. Kobler, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>.</p> <p> “We urge state and federal authorities to enact laws, including the Detergent Poisoning and Child Safety Act, to ensure that these packages are child-resistant, less attractive in color and design, and include clear and obvious warning labels to help deter further child exposure and the harmful health effects that could result,” Dr. Kobler said.</p> <p> <strong>6. Preventing hearing loss in children caused by noisy toys</strong></p> <p> From talking dolls to musical instruments, many children’s toys emit intense sound that could cause lasting hearing damage. To help prevent long-term hearing loss in children, the AMA today adopted policy in support of specific noise exposure standards for children's toys.</p> <p> “Parents need to know that their children’s toys could be producing dangerously high levels of sound that could seriously impair their hearing,” AMA Board Member Jesse M. Ehrenfeld, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “We encourage manufacturers to ensure that the toys they produce adhere to pediatric noise exposure standards and include a warning label on any products that exceed safety standards so that parents can make an informed decision when buying sound-emitting toys.”</p> <p> <strong>7. Supporting a ban on powdered alcohol</strong></p> <p> With concerns mounting from physicians and public health advocates about the health dangers associated with powdered alcohol, the AMA adopted policy supporting federal and state laws banning this substance.</p> <p> Excessive alcohol use is the fourth leading preventable cause of death in the United States. Alcohol is responsible for the deaths of 4,300 youths each year, and current AMA policy supports efforts to reduce youth access and consumption. Powdered alcohol, which can be mixed with liquid, poses a particular hazard to youths.</p> <p> “Given the variety of flavors that could be enticing to youth and concerns that the final alcohol concentration could be much greater than intended by the manufacturer, we believe that powdered alcohol has the potential to cause serious harm to minors and should be banned,” Dr. Ehrenfeld said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-policy-ban-powdered-alcohol.page" target="_self">news release</a>. “We urge states and the federal government to prevent powdered alcohol from being manufactured, distributed, imported and sold in the U.S.”</p> <p> The AMA is a long-time advocate for reducing youth access to alcohol and is a strong supporter of banning the marketing of alcohol products that appeal to people under the age of 21.</p> <p> <strong>8. The case for delaying school start times</strong></p> <p> Given that AMA policy identifies insufficient sleep as a public health issue, and that sleep deprivation has particularly harmful health impacts in adolescents, the AMA adopted a resolution recommending that school districts start school no earlier than 8:30 a.m.</p> <p> According to recent studies, only 32 percent of American teenagers reported getting at least eight hours of sleep on an average school night. The American Academy of Pediatrics recommends that teenagers between 14 and 17 years of age should get 8.5-9.5 hours of sleep per night to achieve optimal health and learning.</p> <p> “Sleep deprivation is a growing public health issue affecting our nation’s adolescents, putting them at risk for mental, physical and emotional distress and disorders,” AMA Board Member William E. Kobler, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-supports-delayed-school-times.page" target="_self">news release</a>. “Evidence strongly suggests that allowing adolescents more time for sleep results in improvements in health, academic performance, behavior and general well-being.”</p> <p> “We believe delaying school start times will help ensure middle and high school students get enough sleep, and that it will improve the overall mental and physical health of our nation’s young people,” Dr. Kobler said.</p> <p> <strong>9. Paid sick leave can lead to better health</strong></p> <p> The AMA adopted new policy recognizing the public health benefits of paid sick leave and other discretionary time off. Citing a growing body of evidence that lack of access to paid sick leave results in the spread of infectious diseases, as well as delayed screenings, diagnoses and treatment, the new AMA policy supports paid sick leave as well as unpaid sick leave for employees to care for themselves or a family member.</p> <p> Workers without paid sick days are more likely to work sick and are more likely to delay needed medical care, which can lead to prolonged illness and worsen otherwise minor health issues, according to a report of the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-service.page?" target="_self">AMA Council on Medical Service</a> that the policy is based upon. The AMA noted that the U.S. is the only industrialized nation without a federal law that guarantees paid sick leave. However, the AMA also weighed the impact of sick leave on businesses finances. The AMA pledged to continue monitoring different approaches to sick leave.</p> <p> “With both dual-earner and single-parent households on the rise in the United States, it is increasingly challenging for workers to juggle family and work,” former AMA Board Chair Barbara L. McAneny, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-benefits-paid-sick-leave.page" target="_self">news release</a>.</p> <p> “Lack of paid leave also has a ripple effect across a worker’s family,” Dr. McAneny said. “Paid sick leave has been shown to aid children’s health, shorten hospital stays and reduce the risk of disease transmission by allowing parents to stay home with sick children. Paid sick leave keeps our homes, offices and communities healthier while ensuring the family’s economic security.”</p> <p> <strong>10. Increasing the use of HIV preventive treatment</strong></p> <p> The AMA adopted policy to educate physicians and the public on the use of pre-exposure prophylaxis for HIV.</p> <p> Tenofovir/emtricitabine (also known as PrEP) is a once-a-day prevention option for HIV-negative men and women that reduces the risk of HIV acquisition. Although the U.S. Food and Drug Administration approved PrEP in July of 2012, a 2015 survey by the Centers for Disease Control and Prevention (CDC) found that 34 percent of primary care physicians and nurses had never heard of PrEP.</p> <p> “With more than 1.2 million people in the United States living with substantial risk of HIV infection but fewer than 5 percent of them taking PrEP, there is significant ground to gain in stemming the incidence of HIV,” Dr. Ehrenfeld said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-physician-education-hiv-prep.page" target="_self">news release</a>. “Educating physicians and the public about the effective use of PrEP and supporting insurers to cover the costs associated with its administration will make the transmission of HIV rarer and our nation healthier.”</p> <p> The AMA will support the coverage of the treatment—which on average costs more than $1,500 for a month’s supply</p> <p> The new policy builds on years of AMA efforts to bolster education and training to combat HIV/AIDS and to increase multi-layer collaboration to increase public awareness.</p> <p> <strong>11. Physicians call for insurance parity for eating disorders</strong></p> <p> The AMA adopted policy in support of health insurance coverage for eating disorders. Although current federal law mandates parity in benefit levels for eating disorders, many payers do not offer parity of services, effectively excluding eating disorders from mental health parity.</p> <p> “Eating disorders have the highest mortality rate of any mental illness, but too often a patient’s care is determined by their insurance company instead of their health needs,” Dr. McAneny said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-health-care-eating-disorders.page" target="_self">news release</a>. “With only one in 10 patients with an eating disorder receiving treatment and with psychological intervention widely accepted as a critical component of care, ensuring mental health parity in benefits will save lives.”</p> <p> The policy builds on existing AMA policy related to eating disorders, mental health parity and body image. The AMA already encourages payment for physical and behavioral health care services on the same day and for Medicaid to pay for those services in school settings. Additionally, the AMA supports increased funding for research on diagnosis, prevention and treatment of eating disorders, including research on the effectiveness of school-based primary prevention programs for pre-adolescent children and their parents.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:372f8bde-650b-4c40-9c1a-05a7964f0081 AMA calls for background checks, wait periods to prevent gun violence http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-calls-background-checks-wait-periods-prevent-gun-violence Wed, 15 Jun 2016 16:30:00 GMT <p> The AMA adopted policy calling for background checks and a waiting period for all firearms purchasers, expanding on its previous policy of requiring the same for only handguns. </p> <p> "The shooting in Orlando is a horritic reminder of the public health crisis of gun violence rippling across the United States," AMA Immediate-Past President Steven J. Stack, MD, said in a<a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-15-background-checks-gun-purchasers.page"> news release</a>. "Mass killers have used AR-15s, rifles and handguns, and today we strengthened our policy on background checks and waiting periods to cover them all, with the goal of keeping lethal weapons out of the hands of dangerous people."</p> <p> Eighteen states have background check requirements, but the provisions vary widely. The AMA considers firearms a public health issue. The newest policy builds on numerous AMA policies that support increased firearm safety to reduce and prevent firearm violence. The new AMA policy parallels policies endorsed by other health organizations.</p> <p> <strong>Allowing research</strong></p> <p> Earlier at the 2016 AMA Annual Meeting, the AMA <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-gun-violence-lobby-congress.page" target="_self">adopted policy</a> calling gun violence in the United States “a public health crisis” requiring a comprehensive public health response and solution. Additionally, the AMA resolved to lobby Congress to overturn legislation that for 20 years has prevented the Centers for Disease Control and Prevention (CDC) from researching gun violence.</p> <p> “Even as America faces a crisis unrivaled in any other developed country, Congress prohibits the CDC from conducting the very research that would help us understand the problems associated with gun violence and determine how to reduce the high rate of firearm-related deaths and injuries,” Dr. Stack said. “An epidemiological analysis of gun violence is vital so physicians and other health providers, law enforcement, and society at large may be able to prevent injury, death and other harms to society resulting from firearms.”</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c8eafe1a-089a-4948-a3ad-b5d9475917fd If you’re sitting on the sidelines, get involved http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_sitting-sidelines-involved Wed, 15 Jun 2016 00:17:00 GMT <p> Andrew W. Gurman, MD, in his inaugural speech as president of the AMA, issued a call to action for physicians to be leaders and advocates for their profession.</p> <p> <strong>The goal of better outcomes</strong></p> <p> “Let this be the year we tell our colleagues about all that we are doing on their behalf and on behalf of our patients, so that more may join in our fight,” he told colleagues Tuesday at the AMA Annual Meeting in Chicago.</p> <p> <object align="right" data="http://www.youtube.com/v/yvsdz7O3m-c" height="350" hspace="5" id="ltVideoYouTube" src="http://www.youtube.com/v/yvsdz7O3m-c" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="http://www.youtube.com/v/yvsdz7O3m-c" /><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/yvsdz7O3m-c" type="application/x-shockwave-flash" vspace="5" width="450" wmode="transparent"></embed></object></p> <p> Dr. Gurman is an orthopedic hand surgeon in private practice in Altoona, Pa. During the last eight years, he has served as the speaker and vice speaker of the AMA House of Delegates and has been an active member of the AMA Board of Trustees.</p> <p> Amid accelerating change in medicine, Dr. Gurman said, physicians need to advocate to ensure the best outcomes for their patients and the profession. </p> <p> “It is fighting back against the powers in government, the private sector and elsewhere that are inserting themselves into health care, that are wedging themselves between us and our patients,” he said. “It is fighting against inappropriately narrow networks, unfunded mandates, senseless regulation, and the futility of conforming to protocols and requirements that have no basis in reality and no relationship to quality care.”</p> <p> Advocacy also is about leading the way for new opportunities. “In these challenges, there is opportunity,” Dr. Gurman said. “Think of it. You and I have access through our smartphones to a seemingly infinite amount of medical literature and data. We have access to technology that allows us to visualize and understand disease at a molecular level, and to customize and personalize medical care like never before.”</p> <p> “We must work together to ensure that, as physicians, we lead the way in delivering these advances to our patients. We must stand up for our patients in the face of excess commercialism, bureaucracy and regulation. We need to be their voice—their advocates in the true sense of the word.”</p> <p> <strong>What physicians can do now</strong></p> <p> Dr. Gurman outlined things every physician can do now:</p> <ul> <li> Take on leadership and speak up for the profession. “For the betterment of medicine, we need all those sitting on the sidelines to get involved,” he said. “We need more ideas at the table.”</li> <li> Reach out to the public to spread the word about preventive care, including screening for conditions such as prediabetes.</li> <li> Contact the business community, civic organizations and chambers of commerce to underline physician contributions to improving health care and strengthening communities.</li> <li> Build relationships inside and outside the medical profession, including mentoring. “Many of our colleagues do not yet know the power in these relationships, the power in working to create a shared legacy in medicine,” he said.</li> </ul> <p> <strong><object align="left" data="http://www.youtube.com/v/TU_4_KfM3oI" height="350" hspace="5" id="ltVideoYouTube" src="http://www.youtube.com/v/TU_4_KfM3oI" type="application/x-shockwave-flash" vspace="5" width="450"><param name="movie" value="http://www.youtube.com/v/TU_4_KfM3oI" /><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/TU_4_KfM3oI" type="application/x-shockwave-flash" vspace="5" width="450" wmode="transparent"></embed></object></strong></p> <p> And for those who already are active advocates, there’s one more thing they can do: “Let’s reach out to those around us,” he said. “Let’s build these relationships. Let’s encourage others to join us, to lend their voices, as we work together to create a future that supports thriving physicians, expands quality care and strengthens the health of our nation.”</p> <p> <strong>Warm farewell from outgoing AMA president</strong></p> <p> Passing on the baton of presidency to Dr. Gurman, AMA Immediate-Past President Steven Stack, MD, reflected on how quickly the year as president goes by.</p> <p> “I have had the amazing privilege to champion the causes important to us and to talk to the nation with the biggest megaphone in Medicine about the challenges we collectively face … the common frustrations driving physician burnout and threatening the sacred humanism of the patient-physician bond,” Dr. Stack said. </p> <p> He expressed his confidence in Dr. Gurman’s leadership for the year ahead: “You are representative of the passionate, independent doctor in America today and are ideally suited for this moment, and for this important role.”</p> <p> “You will carry on the vital work of the AMA,” Dr. Stack said, “so physicians and patients across the country know we are in their corner, fighting for them.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ad406680-41d7-4e7d-8b78-9ee8e535bad0 Physicians confront the rise of “smart drugs” http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-confront-rise-of-smart-drugs Tue, 14 Jun 2016 21:00:00 GMT <p> Responding to the safety concerns generated by a growing use of nootropics, physicians at the 2016 AMA Annual Meeting adopted new policy discouraging the nonmedical use of these prescription drugs for cognitive enhancement in healthy individuals.</p> <p> Nootropics—the so-called “smart drugs”—include a variety of prescription drugs, supplements and other substances that claim to improve cognitive functions of healthy individuals, particularly executive function, memory, learning or intelligence.</p> <p> Prescription drugs that are FDA-approved to treat attention-deficit hyperactivity disorder or narcolepsy are commonly associated with off-label use by students and others seeking to boost memory, learning or other aspects of cognition. Such use is associated with a variety of adverse mental health conditions and patterns of substance misuse.</p> <p> “As temptation grows to use prescription drugs for a competitive advantage at work and school, the nonmedical use of these drugs should be discouraged given potential for substance misuse and other adverse consequences,” said AMA Board Member Maya A. Babu, MD, in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-confronts-nootropics.page">news release</a>. “The AMA believes physicians can support this goal by not prescribing any drug for the purpose of cognitive enhancement in otherwise healthy individuals.”</p> <p> <strong>Risks versus benefits of smart drugs</strong></p> <p> While prescription stimulants carry real risks, they do not make people smarter. The available evidence suggests the cognitive effects of prescription stimulants appear to be highly variable among individuals, are dose-dependent, and limited or modest at best in healthy individuals, according to an AMA Council on Science and Public Health Report.</p> <p> Only a limited amount of information is available on the patterns of use for dietary supplements and herbal products that are marketed for cognitive enhancement. More than 100 substances from amino acids to botanical preparations are advertised on websites as having the ability to improve cognitive performance, and their safety and efficacy have not been systematically examined.</p> <p> The new AMA policy recognizes there is a gap in available information and calls for more research into the patterns of use, as well as risks and benefits, of dietary supplements and herbal remedies being promoted for cognitive enhancement.</p> <p> Delegates also agreed to urge the Federal Trade Commission to examine advertisements for dietary supplements and herbal remedies that claim cognitive enhancement to ensure that they are not misleading and are substantiated</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:c84810a7-1df6-473a-8268-c763dea4696d Payment model design needs to be physician-led: New report http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_payment-model-design-needs-physician-led-new-report Tue, 14 Jun 2016 20:50:00 GMT <p> As new payment models become a reality, physicians know that they are best poised to balance the goal of reducing costs while delivering high quality care. Physicians passed new policy Tuesday to ensure that those payment models are physician-led to allow for the resources and flexibility needed to implement their own solutions for improving care for patients, rather than letting regulators dictate the way care should be delivered.</p> <p> No single approach to payment reform will yield the best outcome for every physician or every specialty. If properly structured, physician-focused payment models will create an opportunity for physicians to improve patient care in ways that are feasible in their unique practice environments.</p> <p> Specialty-specific and condition-based models allow physicians to redesign care based on specific patient needs, and the goal of these models should be to break down the barriers that prevent physicians from taking advantage of opportunities to control cost and care.</p> <p> Learn how physicians <a href="http://www.ama-assn.org/ama/ama-wire/post/doctors-developing-new-payment-models-their-specialties" target="_self">are developing new payment models for their specialties</a>.</p> <p> <strong>Making sure physicians determine patient care</strong></p> <p> Current AMA policy calls for advocating with the Centers for Medicare & Medicaid Services (CMS) and Congress for alternative payment models (APM) developed in collaboration with specialty and state medical organizations so that the best possible care is available to patients.</p> <p> After reviewing a report from the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-service.page" target="_self">AMA Council on Medical Service</a>, delegates at the 2016 AMA Annual Meeting adopted policy that recommends pursuing the following goals as part of an APM:</p> <ul> <li> Provide resources to support the services physician practices need to deliver to patients, including mechanisms for regular updates to the amounts of payment to ensure they continue to be adequate to support the costs of high-quality care</li> <li> Reduce burdens of health IT usage in medical practice</li> <li> Promote physician-led team-based care coordination that is collaborative and patient-centered</li> <li> Designed by physicians and provide the flexibility so that physicians can deliver the care their patients need</li> <li> Limit physician accountability to aspects of spending and quality that they can reasonably influence</li> <li> Avoid placing physician practices at substantial financial risk and minimize administrative burdens</li> <li> Be feasible for physicians in every specialty and all practice sizes to participate in</li> </ul> <p> Also, new policy was adopted to support many types of technical assistance for practices that are working to implement successful APMs, including:</p> <ul> <li> Designing and employing a team approach</li> <li> Obtaining the data and analysis needed to monitor and improve performance</li> <li> Forming partnerships and alliances to share tools, resources and data</li> <li> Obtaining the financial resources needed to make the transition to new payment models</li> </ul> <p> The AMA is encouraging CMS and private payers to support technical assistance and will continue to work with appropriate organizations, including national medical specialty societies and state medical associations, to educate physicians on APMs and provide educational resources and support that encourage physician-led development and implementation of APMs.</p> <p> <strong>Learn more about the development of APMs and how you can use them in practice:</strong></p> <ul> <li> Check out the AMA’s Medicare payment reform <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_self">Web page</a> for resources</li> <li> Find out what CMS had to say about <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-guiding-new-payment-system-cms-chief-says" target="_self">how physicians are guiding the new payment system</a></li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_self">how one practice piloted a new payment model</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:9ea10d05-82f1-4a54-8335-d5426e272e54 Physicians call for funding, strategies to control Zika http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-call-funding-strategies-control-zika Tue, 14 Jun 2016 19:29:00 GMT <p> As mosquito season escalates in many states, physicians and others are sounding the alarm that the United States needs to act quickly to control the Zika virus, particularly when it comes to pregnant women for whom the virus could mean devastating consequences for their unborn babies.</p> <p> <strong>The need for immediate action</strong></p> <p> On the heels of a <a href="https://download.ama-assn.org/resources/doc/washington/zika-house-letter-26may2016.pdf" target="_self">letter</a> in late May that urged Congress to make sufficient funding available to combat the virus, delegates at the 2016 AMA Annual Meeting called on lawmakers to act immediately in the best interest of public health.</p> <p> “Without sufficient funding for research, prevention, control and treatment of illnesses associated with the Zika virus, the United States will be ill-equipped to deploy the kind of public health response needed to keep our citizens safe and healthy,” incoming AMA President Andrew W. Gurman, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-funding-combat-zika-virus.page" target="_self">news release</a>.</p> <p> Among the <a href="http://www.nejm.org/doi/full/10.1056/NEJMsr1604338?query=featured_home&" rel="nofollow" target="_blank">confirmed birth defects</a> associated with the virus are microcephaly and other congenital brain abnormalities.</p> <p> New policy also directs the AMA to work with experts in all relevant disciplines to help develop needed strategies to limit the spread and impact of the virus.</p> <p> <strong>Putting safeguards in place</strong></p> <p> Delegates also adopted policy that aims to get in front of public health threats before they become crises. The new policy encourages the reauthorization and appropriation of sufficient funds to a public health emergency fund within the U.S. Department of Health and Human Services to facilitate adequate responses to public health emergencies without redistributing funds from established public health accounts.</p> <p> “A dedicated, fully-funded public health emergency fund would allow the federal government to quickly direct funding for public health emergencies without having to await congressional action,” Dr. Gurman said. “Public health crises can happen at any time, and whether we address pressing needs should not depend on the congressional calendar.”</p> <p> Physicians also emphasized that public officials and others should follow guidance of health care experts when it comes to the treatment of individuals who have contracted the virus. The AMA’s new policy officially opposes quarantine measures for Zika-infected patients since scientific evidence shows that quarantine is not an appropriate public health response to address the virus. </p> <p> <strong>Learn more about Zika virus and what you can do:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/pub/physician-resources/public-health/zika-resource-center.page" target="_self">AMA Zika Resource Center</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/containing-zika-urgent-need-funds-pregnancy-guidance" target="_self">Pregnancy guidance for containing Zika</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/can-now-address-zika-outbreak" target="_self">What you can do now to help address a U.S. Zika outbreak</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/need-new-zika-guidelines" target="_self">What you need to know about the new Zika guidelines</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:e1a643e8-bca1-473c-a6f4-4ce8f27c0294 Flint lead crisis gives rise to policy promoting water purity http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_flint-lead-crisis-gives-rise-policy-promoting-water-purity Tue, 14 Jun 2016 19:25:00 GMT <p> The AMA took vigorous action in response to lead contamination in the water in Flint, Mich., with extensive policy intended to promote public health and safety not only in that city but across the nation.</p> <p> Making a clear connection between Flint’s crisis and the health of all Americans, the AMA adopted policy Tuesday at the 2016 AMA Annual Meeting, encouraging the timely removal of lead services lines, public availability of water test results, regular testing of water at schools, daycares and health care facilities, and more.</p> <p> “We must do everything in our power to ensure that another Flint-like water crisis never happens again,” incoming AMA President Andrew W. Gurman, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-prevent-future-lead-poisoning.page" target="_self">news release</a>. “To truly ensure that our nation’s water supply is safe and free of lead, we are calling for measures to actively monitor the drinking water within our communities, require timely notification to the public when lead levels are high, and completely move away from a lead-based plumbing infrastructure.”</p> <p> The new policy calls for:</p> <ul> <li> Removing in a timely manner lead service lines and other leaded plumbing materials that come into contact with drinking water</li> <li> Requiring public water systems to establish a mechanism for consumers to access information on lead service line locations</li> <li> Informing consumers about the health risks of partial lead service line replacement</li> <li> Requiring the inclusion of schools, licensed daycare and health care settings among the sites routinely tested by municipal water quality assurance systems</li> <li> Improving public access to testing data on water lead levels by requiring testing results from public water systems to be posted on a publicly available website in a reasonable timeframe to allow consumers to take precautions to protect their health</li> <li> Establishing more robust and frequent public education efforts and outreach to consumers that have lead service lines, including vulnerable populations</li> <li> Requiring public water systems to notify public health agencies and health care providers when local water samples test above the action level for lead</li> <li> Seeking to shorten and streamline the compliance deadline requirements in the Safe Drinking Water Act</li> </ul> <p> “We know that there is no safe level of lead consumption, yet 20 percent of the lead that is ingested comes from the drinking water that flows through lead plumbing in communities across the nation,” Dr. Gurman said.</p> <p> “Evidence clearly shows that lead plumbing is a major source of lead in our drinking water,” he said. “The AMA believes now is the time for America to take swift action to replace all lead plumbing throughout the country. We pledge to advocate for the removal of lead plumbing as well as federal standards to ensure that our drinking water is actually lead-free.”</p> <p> <strong>Monitoring water at schools and daycare sites</strong></p> <p> Children are among the most vulnerable to the toxic effects of lead, yet schools and daycare centers are not required to test the water they give children.</p> <p> As a result of today’s policy action, the AMA also will advocate for laws that require all schools and registered daycare sites to receive routine municipal water quality assurance testing. Current laws do not  require municipalities to test water at school and daycare sites in the U.S., and water testing by the facility is voluntary. According to the Environmental Protection Agency, 90,000 public schools and 500,000 child care facilities are not being regulated, and may or may not be conducting quality testing of their drinking water.</p> <p> “Even though children and infants absorb more lead than the average adult, there are no real safeguards in place to ensure that the drinking water is safe at the facilities where most of their time is spent,” said Dr. Kobler. “We must do everything we can to change the law to make sure our young people are kept safe and healthy.”</p> <p> Because those affected from lead exposure will continue to require dedicated attention, the AMA is advocating for biologic testing for children with elevated blood lead levels and health screenings and nutritional support for all people exposed to lead contaminated water.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bf8eda40-7005-418e-8ea1-71fc9b8161ce Protecting health care workers from workplace violence http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_protecting-health-care-workers-workplace-violence Tue, 14 Jun 2016 17:58:00 GMT <p> A new report by the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-science-public-health.page?" target="_self">AMA Council on Science and Public Health</a> responds to increasingly common violence directed at physicians and other health care professionals where they work, looking at the trends in violence, solutions that have been tested and barriers to addressing the problem. The AMA adopted policy to help prevent violent acts in the health care setting.</p> <p> <strong>An unacceptable hazard of the job</strong></p> <p> The U.S. Bureau of Labor Statistics <a href="https://www.osha.gov/Publications/osha3148.pdf" rel="nofollow" target="_blank">reports</a> that workplace assaults from 2011 to 2013 were 23,540-25,630 annually, with upwards of 70 percent occurring in health care and social service settings. Health care workers are three to four times more likely than other private sector employees to sustain injuries that involve days of work missed.</p> <p> “Emergency department, mental health and long-term care providers are among the most frequent victims of patient and visitor attacks,” the report said. “A nationwide survey of emergency medicine residents and attending physicians found that 78 percent of respondents had reported at least on workplace violence act in the previous year, and 21 percent had reported more than one type of violent act.”</p> <p> <strong>Addressing violence: Barriers and steps</strong></p> <p> One of the biggest obstacles to fully understanding the scope of the problem and taking corrective action is the fact that many incidents go unreported.</p> <p> “Reasons for not reporting can be as simple as health care workers not knowing what constitutes an act of workplace violence or a reporting process that is too cumbersome and time consuming,” the report said. “Other reasons for not reporting include a perception that workplace violence is ‘normal’ or a part of the job, fearing the response they may receive when reporting these events (blaming the victim), and lacking support from leadership to encourage reporting.”</p> <p> Some hospitals and health systems are taking steps to prevent violence, according to the report. They range from more traditional facility safety to more clinical approaches. Henry Ford Hospital in Detroit, for instance, has installed metal detectors at its entrances to prevent people from bringing weapons into the buildings. In the first six months of screening, the hospital confiscated 33 handguns, 1,324 knives and 97 chemical sprays.</p> <p> The Veterans Health Administration, meanwhile, flags patient records to help clinicians and others identify patients who may pose a threat to themselves or others. Patients are flagged in tiers, one for those who are high risk for violent or disruptive behavior based on a history of violence and credible threats, and another for patients with other high-risk factors, such as drug-seeking behavior, a history of wandering or spinal cord injuries.</p> <p> <strong>Physicians call for enforced standards</strong></p> <p> Delegates at the 2016 AMA Annual Meeting adopted policy that calls on all parties to take an active approach to increase the safety of health care workers:</p> <ul> <li> New policy calls on the<strong> Occupational Safety and Health Administration</strong> to develop and enforce a standard addressing workplace violence prevention in health care and social service industries.<br />  </li> <li> The AMA will encourage <strong>Congress</strong> to provide additional funding to the National Institute for Occupational Safety and Health to further evaluate programs and policies to prevent violence against health care workers, and asks the National Institute for Occupational Safety and Health to adapt the content of their online continuing education course on workplace violence for nurses into a continuing medical education course for physicians.<br />  </li> <li> The AMA is urging all <strong>health care facilities</strong> to adopt policies to reduce all forms of workplace violence and abuse; develop reporting tools that are easy for workers to find and complete; make prevention training courses available; and include physicians in safety and health committees.<br />  </li> <li> Updated policy also encourages <strong>physicians</strong> to take an active role in their safety by participating in training to prevent and respond to workplace violence threats, report all incidents of workplace violence and promote a culture of safety within their places of work.</li> </ul> <p> “As violent incidents continue to plague hospitals, emergency departments, residential care settings and treatment centers, we must do everything we can to protect the health and well-being of our health care workers,” AMA Board Member William E. Kobler, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-14-ama-public-health-policies.page" target="_self">news release</a>. “We urge the federal government to develop and enforce a federal standard for health care employers to help shield health care workers from workplace violence.”</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:3c5dfefb-b019-47b4-8812-f96f68776afe Code of Medical Ethics modernized for first time in 50 years http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_code-of-medical-ethics-modernized-first-time-50-years Tue, 14 Jun 2016 14:33:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/321813db-7ef3-41bb-82c8-980255256648.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/321813db-7ef3-41bb-82c8-980255256648.Large.jpg?1" style="margin:15px;float:right;" /></a>Physicians have just affirmed a comprehensive update of the nearly 170-year-old <em>AMA</em> <em>Code of Medical Ethics</em>, the conclusion of a meticulous project started eight years ago to ensure that this ethical guidance keeps pace with the demands of the changing world of medical practice.</p> <p> The modernized <em>Code</em>, approved Monday during the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a>, is the first comprehensive review of this foundational document in more than half a century. For this undertaking, the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-ethical-judicial-affairs.page" target="_self">Council on Ethical and Judicial Affairs</a> reviewed each individual ethical opinion for clarity, timeliness, ongoing relevance in today’s health care environment and consistency across the <em>Code</em>.</p> <p> “Contemporary medicine must remain moral medicine during the current rapid pace of change in health care delivery system, and just as it did during its founding, the AMA has responded to this challenge by again putting ethics on center stage,” AMA President Steven J. Stack, MD, said in a news release. “The comprehensive update to the <em>Code’s</em> ethics guidance keeps pace with emerging demands physicians face with new technologies, changing patient expectations and shifting health care priorities.”</p> <p> <strong>Making the <em>Code</em> more accessible</strong></p> <p> One of the goals of the modernization was to make the <em>Code</em> simpler to navigate and related opinions easier to find so that physicians could more readily apply it in their daily practice of medicine. Changes made include:</p> <ul> <li> Created a more intuitive chapter structure so that guidance is easy to find</li> <li> Implemented a uniform format for opinions so that guidance is easy to read and apply</li> <li> Consolidated guidance into a single, comprehensive statement on each topic</li> <li> Harmonized guidance on related issues</li> <li> Identified, updated and retired guidance that had become significantly outdated over time</li> </ul> <p> The updated <em>Code</em> also includes a new preface to clarify the different levels of ethical obligation in the various ethical opinions.</p> <p> <strong>A major effort across medicine</strong></p> <p> For the past five years, the council has opened the review process to physicians across the medical profession, soliciting their feedback and making modifications accordingly. A key part of this process has been the council’s online discussion forum, where AMA members have provided feedback on incremental updates.</p> <p> The council also held special open forums, reference committee hearings and other informal discussions to collect extensive feedback from physicians in various practice settings, locations and specialties.</p> <p> The <em>Code</em> was one of the two principal orders of business at the first AMA meeting in 1847. Even as much has changed in medicine over the last 169 years, this founding document still is the basis of an explicit social contract between physicians and their patients. The first uniform code of ethics of its kind, the <em>Code</em> is regularly cited as the medical profession’s authoritative voice in legal opinions and in scholarly journals.</p> <p> “The modernization project ensures that the <em>Code of Medical Ethics</em> will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality and integrity enshrined in the original Code,” Dr. Stack said.</p> <p> The updated <em>Code</em> will be available online shortly.</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:80bc2bf3-9b0f-45d9-9841-3636b2ec30bd Physicians are guiding new payment system, CMS chief says http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-guiding-new-payment-system-cms-chief-says Tue, 14 Jun 2016 00:08:00 GMT <p> In the effort to design the new Medicare payment system, Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), said that the driving factor behind many of the changes was physician input—and the proposed rule attempts to reflect that. But the physician’s role does not stop there.</p> <p> <strong>How physicians are having a voice in regulations</strong></p> <p> “You represent one of America’s most potent and proudest forces of talent and ability,” Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), told physicians Monday at the 2016 AMA Annual Meeting in Chicago. There is an historic opportunity before us, he said, “to change how Medicare pays for care.”</p> <p> “I’m also here to talk about something bigger: Reversing a pattern of regulations and frustration and ultimately unleashing a new wave of collaboration between the people who spend their lives taking care of us and those of us whose job it is to support that cause,” Slavitt said.</p> <p> <object align="right" data="http://www.youtube.com/v/-yQQiTzuGQs" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/-yQQiTzuGQs" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/-yQQiTzuGQs" /><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/-yQQiTzuGQs" type="application/x-shockwave-flash" width="450" wmode="transparent"></embed></object></p> <p> With little time left in his tenure, Slavitt called upon physicians to not only work with him until that time is up but also continue to work with CMS in the same manner after he departs from Washington.</p> <p> “We don’t profess to have all the answers,” he said. “We continue to look for comments … on how to simplify further, how to align the performance categories, how to make sure we’re not encouraging compliance but rather rewarding care.”</p> <p> CMS has collected comments, visited practices and held listening sessions with physicians and other health care professionals to learn from their expertise and experience as the new route in which health care system is headed is finalized, Slavitt said.</p> <p> The proposed rule is open for comment through June 27, giving physicians and medical associations and societies an opportunity to provide their input to collaborate in the design of the new payment and care system. Physicians can submit comments through <a href="https://breaktheredtape.org/" rel="nofollow" target="_blank">BreakTheRedTape.org</a>, the AMA’s grassroots campaign.</p> <p> The AMA will submit comments to CMS by that date to ensure physicians in all specialties and all practice sizes are properly represented so the system works in a way that allows them to determine the best ways to provide care for their patients.</p> <p> <strong>What CMS wants physicians to know now about MACRA</strong></p> <p> As the health care system transitions to a new care and payment delivery system under the Medicare Access and CHIP Reauthorization Act (MACRA), physicians have a number of questions about how this process is going to work.</p> <p> Slavitt provided some clarity on the details currently known about implementation, quality reporting, the Merit-Based Incentive Payment System (MIPS) and participation in alternative payment models (APM).</p> <p> “The new program wraps around changes intended to promote coordinated care at reasonable costs through a uniform merit-based system,” he said. “This system is defined in the statute to focus on quality, cost, technology and practice improvement.”</p> <p> The system also allows for physicians to design and participate in new models of payment, such as medical homes, specialty models, team-based models and other APMs. It also is intended to “reward physicians in those models with additional bonuses,” he said. But, “the first question, of course, for many physicians is: What do you really need to know about the program?”</p> <p> “The goal of the program,” Slavitt said, “is to return the focus to patient care, not spend time learning a new program.”</p> <p> Through CMS’ listening sessions with physicians, four cross-cutting themes have emerged:</p> <ul> <li> <strong>Keeping patients at the center of care—and everything else</strong><br /> “In all my years, I have never met—nor do I hope to meet—a physician who makes her decision on how to treat a patient based on how she gets paid,” Slavitt said. “She does what she thinks is right for the patient and hopes that the system will support her.”<br /> <br /> “Over the last couple of years, we’ve been rapidly advancing models that put patients at the center. This includes over nine million Medicare beneficiaries today in accountable care organizations,” he said. Newer specialty models are already being used across the country, and the new system will support those models and reward physicians for their participation.<br /> <br /> “MIPS is intended to move the focus to patients as well,” he said. “There are more than 90 clinical practice improvement activities for physicians to choose from which support patient-friendly steps.”<br /> <br /> “If participating in an APM, no other reporting is required,” he said. “Either way, we need these first steps to help us move away from a compliance program to something truly patient-centered.”</li> </ul> <ul> <li> <strong>Allow practices the flexibility to drive how they use the program to support the unique needs of their patients</strong><br /> Many physicians have told CMS that a one-size-fits-all program won’t work, Slavitt said. “We have to aim for the sweet spot in building a program that is as flexible as possible so physicians can focus on what’s right for their patients and makes sense in their local communities and choose from a number of ways to participate in the quality payment program.”<br /> <br /> “That means more options on choosing appropriate measures… on whether to participate in models like accountable care organizations and medical homes,” he said, “and the flexibility to move between them without having to report multiple times.”<br /> <br /> “It also means using quality measures selected directly from work with specialty societies,” he said. “For specialists, there are many different avenues to success within the quality payment program. Already nationally, 70 percent of practices participate in accountable care organizations … and we are working on the development of more specialty-focused models.”</li> </ul> <ul> <li> <strong>Focus on the policies that are based on the needs of small practices or practices in rural or underserved areas</strong><br /> “We must make sure that our policies fit with the realities of the local markets where you operate,” Slavitt said. “We all need to acknowledge and work against the reality that many changes in health care today make it more difficult for solo and small practices to stay independent.”<br /> <br /> “To level the playing field against these things—more complexity, the fast –pace of change, the call for collaboration— we need to focus hard on the areas which increase the costs of operating a practice and look for other things we can do to offset these challenges,” he said.<br /> <br /> The proposed rule calls direct attention to this with a schedule that demonstrates the negative impact on solo and small practices when they don’t report. “Under the quality payment program, we know that physicians in small practices who report performance can do equivalently well as mid-sized practices,” he said. “We’re committed to significantly reducing the financial cost and the burden of reporting.”</li> </ul> <ul> <li> <strong>Simplify wherever and whenever possible, and give physicians back the time to spend with patients</strong><br /> “One of the major opportunities is to use the rulemaking process to connect these programs together,” he said. “The good news is that the combined magnitude and reporting effort are far less than they are currently.”<br /> <br /> “One reason we think we’re hearing some concern from physicians is that it’s the first time the entirety of these programs can be seen end-to-end in one place,” Slavitt said. He called attention to three simplifications in the proposed rule.<br /> <br /> “We’ve reduced by one-third the number of quality metrics that need to be reported,” he said. “We simplified the process … [and] we made it so the programs talked to each other.”</li> </ul> <p> <strong>Podcast: ReachMD interviews Slavitt on MACRA</strong></p> <p> Immediately following his address to physician delegates, Slavitt sat down with Matt Burnholz, MD, of ReachMD for a podcast to discuss why it is important for CMS to take an “outside-in” approach of listening to physicians as they finalize and implement MACRA.</p> <p> “What the physician community has experienced is a reality on the ground that feels very different from all the big strategic policy talk,” he said. “I don’t say this to cheapen the policy process, but … it needs to be grounded in the realities of the world.”</p> <p> <a href="https://reachmd.com/programs/focus-on-public-health-policy/future-medicare-payment-reform-perspectives-macra-cmss-andy-slavitt/8179/" rel="nofollow" target="_blank">Listen to the full interview</a> from ReachMD. You also can listen through the ReachMD mobile app—<a href="https://reachmd.com/pages/about/#policies" rel="nofollow" target="_blank">learn more</a>.</p> <p> <strong>Resources to help you prepare for the new payment systems</strong></p> <p> The AMA offers a number of resources to help physicians prepare for the coming payment policies, including:</p> <ul> <li> <a href="http://www.ama-assn.org/resources/doc/washington/macra-summary-05052016.pdf" target="_self">A summary of the proposed regulations</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-steps-prepare-medicares-new-payment-systems" target="_self">4 steps to prepare for Medicare’s new payment systems</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_self">A guide to physician-focused payment models</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_self">Key points of the Merit-based Incentive Payment System</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_self">What you can do now to prepare</a>  </li> <li> The AMA’s <a href="https://www.stepsforward.org/%22%20%5Ct%20%22_blank" rel="nofollow" target="_self">STEPS Forward™ collection</a> of practice improvement strategies, which includes modules on advancing team-based care, implementing electronic health records, improving care and practicing value-based care</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d3cab594-6f8a-48ce-9125-99330452da44 Ethical considerations prompt new telemedicine ground rules http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethical-considerations-prompt-new-telemedicine-ground-rules Mon, 13 Jun 2016 23:18:00 GMT <p> With the increasing use of telemedicine and telehealth technologies, delegates at the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a> adopted new policy that outlines ethical ground rules for physicians using these technologies to treat patients.</p> <p> <strong>The guidelines</strong></p> <p> The policy, based on a report from the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-ethical-judicial-affairs.page" target="_self">AMA Council on Ethical and Judicial Affairs</a>, notes that while physicians’ fundamental ethical responsibilities don’t change when providing telemedicine, new technology has given rise to the need for further guidance.</p> <p> “Telehealth and telemedicine are another stage in the ongoing evolution of new models for the delivery of care and patient-physician interactions,” AMA Board Member Jack Resneck, MD, said in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-06-13-new-ethical-guidance-telemedicine.page" target="_self">news release</a>. “The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.”</p> <p> According to the new policy, any physician engaging in telemedicine must:</p> <ul> <li> Disclose any financial or other interests in particular telemedicine applications or services</li> <li> Protect patient privacy and confidentiality</li> </ul> <p> The policy outlines guidelines for physicians who either respond to individual health queries electronically or provide clinical services through telemedicine. Broadly, some of these guidelines include:</p> <ul> <li> Informing patients about the limitations of the relationship and services provided</li> <li> Encouraging telemedicine patients who have a primary care physician to inform them about their online health consultation and ensure the information from the encounter can be accessed for future episodes of care</li> <li> Recognizing the limitations of technology and taking appropriate steps to overcome them, such as by having another health care professional at the patient’s location conduct an exam or obtaining vital information through remote technologies</li> <li> Ensuring patients have a basic understanding of how telemedicine technologies are used in their care, the limitations of the technologies and ways the information will be used after the patient encounter</li> </ul> <p> “Physicians who provide clinical services through telemedicine must recognize the limitation of the relevant technologies and take appropriate steps to overcome those limitations,” Dr. Resneck said. “What matters is that physicians have access to the relevant information they need to make well-grounded recommendations for each patient.”</p> <p> The full report and guidelines will be published in a peer-reviewed journal in the coming months.</p> <p> <strong>Defining the patient-physician relationship in telemedicine</strong></p> <p> Physicians <a href="http://www.ama-assn.org/ama/pub/ama-wire/ama-wire/post/new-telemedicine-policy-lays-out-principles-coverage-payment" target="_self">voted two years ago</a> to adopt policy governing the appropriate use of telemedicine. Most importantly, a valid physician-patient relationship must exist before telemedicine services are provided. This relationship can be established in a few different ways:</p> <ul> <li> A face-to-face examination—an exam using two-way, real-time audio and visual capabilities, like a videoconference—if a face-to-face encounter would be required for the same service in person</li> <li> A consultation with another physician who has an ongoing relationship with the patient</li> <li> Meeting evidence-based telemedicine practice guidelines developed by major medical specialty societies for establishing a patient-physician relationship</li> </ul> <p> Once that relationship is established, physicians can use telemedicine technologies with their patients at their discretion.</p> <p> The AMA policy requires physicians who deliver telemedicine services to be licensed in the state where the patient receives services, and the delivery of care must be consistent with state’s scope-of-practice laws.</p> <p> Patients seeking care via telemedicine must be able to choose their physician and be aware of their cost-sharing responsibilities. The physician must have the patient’s medical history as part of providing this care, which should be coordinated with physicians who already are treating the patient.</p> <p> See answers to <a href="http://www.ama-assn.org/ama/ama-wire/post/questions-telemedicine-answered" target="_self">your questions on telemedicine</a> at <em>AMA Wire</em>®.</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:e1593e98-c9e6-4a8d-a1a3-e3f2bb960a61 Three teams tapped to create a healthier nation http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_three-teams-tapped-create-healthier-nation Mon, 13 Jun 2016 16:39:00 GMT <p> Three health care technology solutions are one step closer to wider spread availability as of Saturday night after the AMA Healthier Nation Innovation Challenge winners were announced. The top choice: A smartphone app that has already started saving lives and bridging communication gaps in health care.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/10/915bbeb4-87d6-4370-ba5e-2ed86ec6f29b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/10/915bbeb4-87d6-4370-ba5e-2ed86ec6f29b.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The AMA’s Healthier Nation Innovation Challenge kicked off in April and invited all U.S. physicians, residents and medical students to be a positive force for health care and present their best ideas for shaping 21st-century medicine. The three winning ideas were selected from a total of 116 solutions submitted to compete in the challenge.</p> <p> <strong>The Healthier Nation Challenge winning teams</strong></p> <p> The winners were selected during a live event at <a href="http://matterchicago.com/" rel="nofollow" target="_blank">MATTER</a>, Chicago’s health care technology incubator. They will share $50,000 in prizes to accelerate their solutions.</p> <ul> <li> <strong>First place—$25,000:</strong> <a href="https://www.innovatewithama.com/project/detail/165" rel="nofollow" target="_blank">Twiage</a> is a secure, pre-hospital platform that helps hospitals not only save time and money but also patient lives. “We’ve built a free smartphone application for EMS that’s faster, easier and more powerful than radios,” said YiDing Yu, MD, a practicing internist and founder of Twiage.<br /> <br /> “A paramedic can send photos and videos in real time to the hospital,” Dr. Yu said. “They can, in one click, select the chief complaint and use our proprietary algorithms that help provide decision support that helps standardize diagnosis pre-hospital.”<br /> <br /> For example, if a patient has a broken arm and is on their way to the hospital in an ambulance while another patient is having a heart attack and is also traveling to that same hospital in an ambulance, the emergency department is able to obtain the necessary information before they arrive to prioritize and make sure they are ready to immediately treat the patient having the heart attack.</li> </ul> <ul> <li> <strong>Second place—$15,000:</strong> <a href="https://www.innovatewithama.com/project/detail/377" rel="nofollow" target="_blank">Light line catheter</a>, presented by Mitchell Barneck, a rising fourth-year medical student at Oregon Health and Science University and co-founder of Veritas Medical, and John Langell, MD, who mentored the development team, is a catheter that employs a novel visible light phototherapy technology to actively disinfect the device while residing within a patient’s body.<br /> <br /> “405 nanometer blue light, a component of visible spectrum light, has proven to be a powerful weapon against … deadly bacteria,” Barneck said. “Our team has been able to isolate, intensify and harness this blue light source, and we can now use a proprietary technology to propagate it … through any commercial catheter, where we can actively destroy [the] bacteria that cause infections.”<br /> <br /> “We can kill 99.9999 percent of organisms,” he said. “At our current dose, we are completely nontoxic to mammalian cells, and we’ve shown that we have no impact on blood components.”</li> </ul> <ul> <li> <strong>Third place—$10,000:</strong> <a href="https://www.innovatewithama.com/project/detail/349" rel="nofollow" target="_blank">Ceeable</a> is a mobile digital health technology to detect and diagnose eye disease, including glaucoma and age-related macular degeneration. The concept was presented by presented by Cynthia Matossian, MD, an ophthalmologist and owner, CEO and medical director of Matossian Eye Associates, and Chris Adams, co-founder and CEO of Ceeable.<br /> <br /> “With this tool,” Dr. Matossian said, “we are going to be able to detect disease processes much earlier by recognizing patterns of these different entities, so we can pick up disease early and prevent blindness.”</li> </ul> <p> In addition to $50,000, winners will gain access to the AMA’s network of partners that specialize in strategy and design support for entrepreneurs and startups, including Business Models, Inc., Edge One Medical, Healthbox, MATTER, MU/DAI and Techstars.</p> <p> “A passion for transforming health care is a quality physicians and medical students share with many pioneering entrepreneurs,” said James L. Madara, MD, AMA CEO and executive vice president. “To harness this passion for health care innovation, the AMA is expanding efforts to inspire and support physician-led medical advances, and is proud to support the best new ideas to create a healthier nation.”</p> <p> During the submission period, physicians, residents, medical students, nurses, patients, hospital staff, health leaders and investors had the opportunity to review and provide feedback on the ideas. This crowd engagement generated nearly 16,000 online interactions between applicants and reviewers, including votes, follows, interest to pilot, interest to partner and feedback.</p> <p> <strong>The purpose of the challenge</strong></p> <p> The AMA’s Healthier Nation Innovation Challenge underscores the commitment of America’s physicians to supporting health care innovation and collaboration. The AMA is now deeply involved in driving transformative health care innovation as it ramps up efforts to bridge the gap between creative idea development and the realities of patient care.</p> <p> From revitalizing medical practices to ensuring that digital health helps provide high-quality patient care, the AMA’s ongoing work is striving to forge new paths that expand the bounds of science, enhance patient care and improve the health of the nation.</p> <p> <strong>Learn more about how physicians are driving health care technology innovation:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/idea-practice-solution-becoming-physician-entrepreneur" target="_self">From idea to practice solution: Becoming a physician entrepreneur</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/digital-dystopia-developing-tools-work-practice" target="_self">Digital dystopia: Developing tools that work in practice</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-making-ehrs-interoperable" target="_self">How physicians are making EHRs interoperable</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/brigham-womens-using-claims-data-improve-outcomes" target="_self">How Brigham and Women’s is using claims data to improve outcomes</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/health-system-cutting-edge-telemedicine-affordable" target="_self">Health system makes cutting-edge telemedicine affordable</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:057ad1a4-c585-4d60-86ea-a764af5bb48e Physician behind KevinMD reveals how to leverage social media http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physician-behind-kevinmd-reveals-leverage-social-media Sun, 12 Jun 2016 17:34:00 GMT <p> Kevin Pho, MD, founder and editor of the popular physician blog bearing his name, <span data-term="goog_368264170" tabindex="0">Saturday</span> shared practical insights about how to make a difference in health care through social media at the <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.ama-assn.org/sub/meeting/index.html&source=gmail&ust=1465839050812000&usg=AFQjCNFyChrxu3lPzIRwgdHYn_XGGoSTNg" href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2016 AMA Annual Meeting</a>. Learn Dr. Pho’s tips for using social media and taking control of your online reputation before it’s defined for you.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/14/cd2bd1e9-e3f8-4360-ae4b-9551653f99c8.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/14/cd2bd1e9-e3f8-4360-ae4b-9551653f99c8.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Social media’s potential to connect with patients</strong></p> <p> Dr. Pho began his social media journey as a researcher for Google Answers back when Google was just getting off the ground. He answered medical questions that patients posted online. “At first those questions were relatively general,” he said, “but then the questions started becoming more personal: ‘Doctor, what is causing my abdominal pain?’ ‘Can you give a second opinion for my husband’s cancer diagnosis?’”</p> <p> “People would upload copies of their lab tests for me to interpret,” Dr. Pho said. “They would get ahold of my email address and email me high resolution images of every body part imaginable.”</p> <p> Then, Dr. Pho had a realization.</p> <p> “Patients weren’t getting the information they needed in the exam room,” he said. “I realized how the Internet can play a role in filling that information void.”</p> <p> In 2004, he started a blog. In the fall of that year there was a major drug recall, and his patients on that medication would call his practice and ask if it had done any permanent damage and if there were any other medications they could take instead.</p> <p> So he wrote a blog post on the issue and gave suggestions to patients that they could ask their doctors. A few days later, a patient came in and said how much that blog post comforted her and let her know she had other options.</p> <p> “I sat there stunned, for two reasons,” Dr. Pho said. “The first was that anyone other than my mother was interested in what I had to say online. And the second was that social media had tremendous potential to connect with patients.”</p> <p> <strong>Connecting with and educating patients</strong></p> <p> Seven out of 10 Internet users look for health information, he said. “It’s the third most popular activity after email and using a search engine.” Specifically, patients are looking for information on diagnosis and treatment options.</p> <p> “The Internet empowers patients,” he said. But “sometimes the information they read on the Web isn’t the most reliable.”</p> <p> For example, “parents who went online to research sleep information for their infants found that fewer than half of websites had accurate information that was consistent with American Academy of Pediatrics guidelines,” he said. “The problem that we face today isn’t so much a lack of knowledge …. we suffer from a lack of wisdom on the Web.”</p> <p> “In today’s transparent era when patients have as much access to information as their doctors do, we in health care have to redefine ourselves,” he said. “We need to stop seeing ourselves as gatekeepers of medical and drug information. If we’re to stay relevant, we need to be curators of that information instead.”</p> <p> Social media gives physicians many opportunities to be the filters that sort out the correct information from the incorrect for their patients, he said. For example, a pediatrician in California, Robert Hamilton, MD, who gives advice to young parents on how to sooth their crying infants, created YouTube videos to allow that information to be accessible in the easiest way possible at the request of his patients.</p> <p> “More of us are going to be faced with patients who come to us with print-outs from the Internet, information on their mobile devices, and when that happens we’re going to have two choices,” he said. “We can roll our eyes and tell patients not to go online …. But we have a second choice, and that’s to embrace it … because it’s going to happen anyway.”</p> <p> <strong>Defining your online reputation</strong></p> <p> Social media also is a powerful way to define an online reputation. “When it comes to being online in a professional context,” he said, “a lot of doctors I talk to are a little bit apprehensive. They’re scared of making a mistake … as a result, they don’t go online at all.”</p> <p> “Patients today aren’t just going online to research their diagnosis and treatment options,” he said, “they’re going online to research their doctors as well.” Dr. Pho suggests googling yourself once a week to see what comes up. “If you don’t have an online presence, when patients Google you, it will show physician rating sites.”</p> <p> “If you look at every other industry, whether it’s books, movies, hotels, restaurants,” he said, “people want to know what others are thinking … online ratings are not going away.”</p> <p> In Texas, a disgruntled patient created a fake website for a physician and filled it with false patient reviews. The physician didn’t know about it until another patient came in and said something was wrong with his website. “It wasn’t [the physician’s] skill as a surgeon or bedside manner that defined him … it was in fact his online reputation,” Dr. Pho said. <br /> <br /> “When it comes to establishing an online presence, the best way to do so is to create content online,” he said. “About a third of readers will click on the first result [of a search engine query] …. We need to control those top listings on Google. We need tools that are powerful in the eyes of Google and allow us to create that content online. Those tools are of course available to us; they are social media platforms—blogs, Facebook, twitter, LinkedIn, Youtube.”<br /> <br /> “Can you translate your social media skills through the lens of a physician?” Dr. Pho asked. “Not only will patients Google you … but so will your residency director, your hospital credentialing committee and your future employer.”<br /> <br /> “The more social media platforms you engage in, the bigger your online presence will be,” he said. “Establish your online reputation.”</p> <p> <strong>How to do it</strong></p> <p> Dr. Pho shared a step by step approach to defining yourself online:</p> <p style="margin-left:40px;"> <strong>1. </strong><strong>Get your bio and headshot first.</strong> These two things are common across social media platforms, and they should include three traits—likeability, trustworthiness and competence. 
Your headshot should be a high-resolution image that is not cropped from another image, and don’t use a full body shot. Your bio should be a well-written introduction to people who will find you on the Web. 
</p> <p style="margin-left:40px;"> <strong>2. </strong><strong>Claim your profile from a physician rating site.</strong> Personalize that page and put in your bio and your headshot. The most visible site is <a data-saferedirecturl="https://www.google.com/url?hl=en&q=https://www.healthgrades.com/&source=gmail&ust=1465839050812000&usg=AFQjCNFl9qcZI8NnFciLEK1wHsYbWHPNCw" href="https://www.healthgrades.com/" rel="nofollow" target="_blank">Healthgrades</a>; other options are<a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.vitals.com/&source=gmail&ust=1465839050812000&usg=AFQjCNHrS2u3VzF0aJ9DlK9auIusY7HDKw" href="http://www.vitals.com/" rel="nofollow" target="_blank">Vitals</a>, <a data-saferedirecturl="https://www.google.com/url?hl=en&q=https://www.ratemds.com&source=gmail&ust=1465839050812000&usg=AFQjCNGrnhY3zdSe_zEuUL_zdBARHtcTXg" href="https://www.ratemds.com/" rel="nofollow" target="_blank">RateMDs</a> and <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.yelp.com/&source=gmail&ust=1465839050812000&usg=AFQjCNG80X5RpoTCJZNCmWowenmLzjB1DQ" href="http://www.yelp.com/" rel="nofollow" target="_blank">Yelp</a>. 
</p> <p style="margin-left:40px;"> <strong>3. </strong><strong>Create a profile on a professional social networking site.</strong> “I like <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.linkedin.com&source=gmail&ust=1465839050812000&usg=AFQjCNEp2YxZ87R4J_8Dj4Ve-Ae1G6MdeA" href="http://www.linkedin.com/" rel="nofollow" target="_blank">LinkedIn</a> and <a data-saferedirecturl="https://www.google.com/url?hl=en&q=https://www.doximity.com/&source=gmail&ust=1465839050812000&usg=AFQjCNEeVaigZHimUri-lYXBYcDgAJnlUg" href="https://www.doximity.com/" rel="nofollow" target="_blank">Doximity</a>,” Dr. Pho said. “A profile on these sites is no more than a digital translation of your CV.”</p> <p> “Doing all of these things should not take more than a few hours to do,” he said. “And after doing them, stop. Ask yourself, ‘What are my goals for social media?’ Is it educating patients, is it connecting with colleagues, is it advocating for a cause, or is it debating health care reform?”</p> <p> After gradually becoming more comfortable with your online presence, you can adapt your different social media platforms to these roles, Dr. Pho said. First, listen to what people on Twitter have to say about those subjects you are interested in. Then you will be prepared to share once you feel more comfortable.</p> <p> “There will be a few that will take the ultimate step and create your own content,” he said. “It could be articles and blogs or videos on YouTube …. The goal is to dominate the search engine rankings for your name so you’re in control of the information that comes out when patients Google you.”</p> <p> “The biggest risk of social media is not using it at all in health care,” Dr. Pho said. “We need to realize social media’s power to connect and be heard …. It’s a responsibility we must embrace; it’s an opportunity we cannot miss. So let’s use social media, change the world and make that difference in health care.”</p> <p> <em>AMA Wire</em>® sat down with Dr. Pho after his presentation for a few additional questions. Check out the interview on <a data-saferedirecturl="https://www.google.com/url?hl=en&q=https://www.periscope.tv/w/1kvKplMBzwQKE&source=gmail&ust=1465839050812000&usg=AFQjCNE0sn6TlowDekwCjEqot8meg7F_xQ" href="https://www.periscope.tv/w/1kvKplMBzwQKE" rel="nofollow" target="_blank">Periscope</a>.</p> <p align="right"> <em>By AMA staff writer </em><a data-saferedirecturl="https://www.google.com/url?hl=en&q=https://twitter.com/Troy_AMAWire&source=gmail&ust=1465839050812000&usg=AFQjCNEWnS3wxbwsgT16EbnF_MX9XWa5-g" href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:95333b0c-4bd3-49e5-a3e6-814b6aa101bb The key to making new models of care work http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_key-making-new-models-of-care-work Sun, 12 Jun 2016 17:18:00 GMT <p> When it comes to new models of care, there are many variables at play that can contribute to the success or failure of your organization. The primary factor for whether your practice will thrive in this new environment, experts say, lies with the individuals who work there.</p> <table align="right" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/15/b5ecef37-c3b5-4573-8f6e-a386ddee2351.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/15/b5ecef37-c3b5-4573-8f6e-a386ddee2351.Large.jpg?1" /></a></td> </tr> <tr> <td>   </td> <td> <p> <span style="font-size:11px;"><em>John Combes, MD, spoke about the foundation for integrated leadership.</em></span></p> </td> </tr> </tbody> </table> <p> Leaders from across medical professions came together for a special panel discussion Saturday at the 2016 AMA Annual Meeting. They agreed that one of the most important components clinicians and hospitals should be focusing on now is integrated leadership, which can ensure new models of care have an environment in which they can succeed.</p> <p> “Designing the care that will be delivered to patients must be defined by clinicians—not the government,” said Liz Summy, executive vice president of the American College of Healthcare Executives. “And the only way we can do that is by working together.”</p> <p> <strong>Rethinking the current leadership model</strong></p> <p> Building on the <a href="http://www.ama-assn.org/ama/ama-wire/post/6-characteristics-of-successful-physician-hospital-relationships" target="_self">Principles of Integrated Leadership for Hospitals and Health Systems</a>, which the AMA and the American Hospital Association (AHA) jointly released one year ago, the panel examined both what current leadership looks like in health care organizations and what is needed for the future.</p> <p> “There has to be a place where … administrators, physicians and other clinicians can sit down and make decisions about the management of the organization and how it can move forward,” said John Combes, MD, chief medical officer at the AHA. “Physicians must be in the leadership of all levels of the organization. There has to be a team approach of clinicians and managers and others working together.”</p> <p> But how do organizations get to that point?</p> <p> “First it starts with this shared vision, shared mission, with physicians and hospitals,” Dr. Combes said. “And I think at the core, we really do have this shared mission and vision.”</p> <p> Dr. Combes shared a story of one place he worked, where he would attend meetings of the administration in which the executives would complain that there was something wrong with the physicians because they didn’t share the same priorities they did. Then Dr. Combes would attend a meeting of the physicians, and they would voice the same complaint about the administration’s priorities. In reality, both groups had made taking care of patients their top priority.</p> <p> It turned out that “we both had the same core mission,” Dr. Combes said, “But we didn’t have a whole lot of trust.”</p> <p> He said one of the six core principles for integrated leadership that will propel new care models to success and achieve the aims of better care, better health, lower costs and improved satisfaction is changing this paradigm. “It has to be a collaborative, participatory partnership built on—and this is the key word—<em>trust</em>,” Dr. Combes said.</p> <p> Part of that trust means that physicians and other leaders will need to share all information across the organization—that includes clinical and business details. It also means that the appropriate leaders will be included in all important decisions.</p> <p> J. James Rohack, MD, a Texas cardiologist and former AMA president who is an advisor for the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_self">Professional Satisfaction and Practice Sustainability</a> initiative, gave the example of how physician leaders frequently are left out of decision-making about the adoption of health IT.</p> <p> “Unfortunately, in many systems, the person selecting IT isn’t a clinician and is selecting technology that makes good business sense but actually impedes care at the bedside,” Dr. Rohack said.</p> <p> <strong>Leadership changes will need to start with training</strong></p> <p> The current training for physicians and executives leaves gaps, Dr. Rohack said. “[As physicians,] we’re trained in a clinician-oriented, take-care-of-the-patient model.” Leadership training hasn’t been a part of medical school or residency for most physicians.</p> <p> Ensuring that both administrators and physicians understand the importance of the different kinds of leaders in the organization and that there is mutual trust will require continued training, he said.</p> <table align="right" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>   </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/b2b42df8-5fbf-462b-ad27-3d5c43928f74.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/13/b2b42df8-5fbf-462b-ad27-3d5c43928f74.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <p> <span style="font-size:11px;"><em>Pam Thompson spoke about the importance of interprofessional training.</em></span></p> </td> </tr> </tbody> </table> <p> Pam Thompson, CEO of the American Organization of Nurse Executives, said training will need to start with interprofessional education in schools so integration across the professions isn’t new when physicians and other team members start working together in practice. This kind of leadership development is in fact a key component of the work underway through the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>.</p> <p> For physicians and others already in practice, leadership training can go a long way to help fill the gaps for which they did not receive formal instruction as students and residents.</p> <p> “I strongly believe that all physicians are leaders—you don’t have to be in a title role,” said Peter Angood, MD, CEO and president of the American Association for Physician Leadership. “Society certainly expects it of us. And we can impact our industry in important ways.”</p> <p> Clinicians need to become “disciplined in our own leadership development,” Thompson said. “Leadership doesn’t just happen from happenstance.”</p> <p> That’s especially important because “change is constant now” in health care, she said. Clinicians need to become experts at decision-making amidst ambiguity. “This whole conversation around integrated leadership is so that we can be more strategic.”</p> <p> Dr. Combes summed it up: New models of care need a new model of leadership. “If you have a new model of care with the old leadership, it’s not going to work.”</p> <p> <strong>Want to become a better-trained leader?</strong></p> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/physician-leadership-training.page" target="_self">Learn more</a> about physician training opportunities.</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:4cba508c-4a82-4293-a310-fcd7bb6c35b7 AMA-IMG Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-img-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 16:00:00 GMT <p> The AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates.page" target="_blank">International Medical Graduates (IMG) Section</a>  celebrated its 19th year of annual meetings, beginning with the congress reception and business meeting, which featured Ami Shah, MD, founder of Face2Face Health in New York, who discussed innovation in medicine. Physicians learned about the importance of the inclusion of integrative health into their medical practice.</p> <p> The 2016-2017 AMA-IMG Section Governing Council officers were ratified at this meeting. The officers included Bhushan Pandya, MD, chair; Ved Gossain, MD, chair-elect; Subhash Chandra, MD, delegate; Kevin King, MD, alternate delegate; and at-large members Guillermo Godoy, MD, and Col. Ronit Katz, MD.</p> <p> The AMA-IMG Section business meeting was successful in reviewing the items considered for the 2016 AMA Annual Meeting and was a positive forum for discussing IMG and other policy initiatives and organizational reports.</p> <p> The AMA-IMG Section meetings culminated with its joint caucus with the AMA Minority Affairs Section, held Monday at 8:30 a.m. It was followed by the Busharat Ahmad, MD, Leadership Development Program at 10:30 a.m., which featured Sunil Wimalawansa, MD, PhD, a former university professor, who discussed “Why physician leaders fail: How to ensure success.”</p> <p>  </p> <p>  </p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ca66b99f-4d7f-43e8-b991-c9c7c87907c7 From idea to practice solution: Becoming a physician entrepreneur http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_idea-practice-solution-becoming-physician-entrepreneur Sun, 12 Jun 2016 15:04:00 GMT <p class="p1"> As health care continues to rapidly evolve, physician entrepreneurship is increasingly important to ensure the right changes are made for patient care. Physician entrepreneurs and investment experts spoke to residents and medical students at the 2016 AMA Annual Meeting about the decision to take ideas from concept to company. </p> <p class="p1"> <span class="s1">“The best advice I received,” said Jay Joshi, MD, primary care physician, CEO and founder of Output Medical, and co-founder of MD Angels, “is that this is not different than any other form of clinical practice. Being a physician entrepreneur does not necessarily mean that you’re sacrificing current clinical practices for a business.”</span></p> <table align="right" border="0" cellpadding="0" cellspacing="15" style="width:365px;"> <tbody> <tr> <td>  </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/5/f50b82e2-3bd9-4f92-8569-5d25beb25a47.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/5/f50b82e2-3bd9-4f92-8569-5d25beb25a47.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <em>Jay Joshi, MD, primary care physician, CEO and founder of Output Medical, and co-founder of MD Angels</em></td> </tr> </tbody> </table> <p class="p1"> <span class="s1">“In order to be successful in medical and health care innovation, you have to have a very strong understanding of the clinical fundamentals that you’re trying to address,” Dr. Joshi said. “Don’t think of this as trying to divert off the path of traditional clinical medicine, but rather think of this as a way to enhance current clinical guidelines in terms of practice.”</span></p> <p class="p1"> <span class="s1"><b>Entering the entrepreneur space requires risk and soul searching</b></span></p> <p class="p1"> <span class="s1">We live in a world of startups and innovative ideas. So when an idea comes to you and you go through the steps to design, develop and prototype your idea, the next logical step is to seek funding and partnership. But you need to know what you’re getting into.</span></p> <p class="p1"> <span class="s1">“How do you really know that this is for you?” Dr. Joshi said. “Look at it analytically …. The way I like to look at this is to understand the opportunity-cost and the risk associated with the opportunity-cost of any decision that you want to make.”</span></p> <p class="p1"> <span class="s1">For example, if you finish your education and residency and make the decision that you want to pursue an entrepreneurial venture, look 10 years into the future when you would have your practice and your business and ask yourself how much time and energy you would allocate to your practice relative to your business, he said.</span></p> <p class="p1"> <span class="s1">Make sure you’re comfortable with taking the risks that are involved regarding your time and the fact that you may not be paid for every hour that you put into your business. If the benefits and your passion outweigh the risks—and you are willing to take those risks—then it may be the right path for you.</span></p> <p class="p1"> <span class="s1">An entrepreneur is somebody who not only has an idea and is willing to start a business but who is also willing to take risks to get it off the launch pad.</span></p> <p class="p1"> <span class="s1"><b>Finding those “lightbulb” moments</b></span></p> <p class="p1"> <span class="s1">The panelists agreed that there are obvious clinical unmet needs everywhere you look. It’s a matter of trying to understand what is inefficient or problematic in patient care and how you can make it better.</span></p> <p class="p1"> <span class="s1">Here are two ways the panelists said that a resident or medical student can get started:</span></p> <ul> <li class="p1"> <span class="s1"><b>Right place, right time</b></span><br /> One shared opinion was that if you don’t have an idea, create the atmosphere for the ideas to come to you. The best and most efficient way for medical students or residents to access to those lightbulb moments is to pick the brains of your attendings.<br /> <br /> While students or residents can think of innovative, creative ways to do things better, the people who’ve already identified all of those inefficiencies and problems for you are those attendings who’ve been there for many years and have already thought through how surgery could be done in new ways or how to better channel patients through the clinic.<br />  </li> <li class="p1"> <b>Inject yourself into the tech world</b><br /> “Getting involved with a company early on is also going to help you,” said Arnab Sarker, director of operations at K Street Capital and founding member of 1776, an incubator and seed fund.<br /> <br /> “One of the most underrated opportunities for residents, fellows and med students is being a first follower at a company because then you really get to understand what are the mechanics behind an idea.”<br /> <br /> “There’s a lot that matters outside of the idea,” Sarker said. “There’s plenty of ideas out there, but to understand which ones are actually viable, it’s good to get involved with an actual company. I tell people to just work for free.”<br /> <br /> “Tell them you’re a clinician full time and you just want to get some experience,” he said. “You do have something to offer from your experience …. Be a consultant, be on their board and after a while—I guarantee—they’re going to need you.”</li> </ul> <p class="p1"> <span class="s1"><b>Learn more about physician entrepreneurship:</b></span></p> <ul> <li class="p2"> <span class="s5"><a href="http://www.ama-assn.org/ama/ama-wire/post/3-insights-physician-entrepreneurs" target="_self"><span class="s6">3 insights from physician entrepreneurs</span></a></span></li> <li class="p2"> <span class="s5"><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-finally-say-tech-development" target="_self"><span class="s6">Physicians (finally) get a say in tech development</span></a></span></li> <li class="p2"> <span class="s5"><a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-silicon-valley-common" target="_self"><span class="s6">What physicians and Silicon Valley have in common</span></a></span></li> <li class="p2"> <span class="s5"><a href="http://www.ama-assn.org/ama/ama-wire/post/6-things-physicians-wish-health-developers-knew" target="_self"><span class="s6">6 things physicians wish health IT developers knew</span></a></span></li> <li class="p2"> <span class="s5"><span class="s6"><a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-physicians-moving-health-forward" target="_self">4 ways physicians are moving health IT forward</a></span></span></li> </ul> <p class="p3" style="text-align:right;"> <span class="s1"><i>By AMA staff writer </i><a href="https://twitter.com/troy_amawire" target="_blank" rel="nofollow"><span class="s7"><i>Troy Parks</i></span></a></span></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0d3dbb93-d7a0-43c2-b5fa-e5fb0758fce4 AMA Senior Physicians Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-senior-physicians-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> The AMA Senior Physicians Section (SPS) sponsored a joint educational program titled “Burning Up, Burning Out or Burning Brightly.” This well-attended program featured Richard B. Gunderman, MD, PhD, Chancellor’s Professor at Indiana University.</p> <p> The program was facilitated by Barbara A. Hummel, MD, chair of the AMA-SPS and president of the Wisconsin Medical Society. The program focused on strategies to reduce burnout in senior physicians and their colleagues. Participants learned strategies to use when confronted by these challenges that would help them thrive and make a difference.</p> <p> The AMA-SPS Governing Council met Friday to review resolutions and reports related to senior physician issues, and completed board candidate interviews. During the assembly meeting, this year’s elected committee officers were announced. Claire V. Wolfe, MD, of Dublin, Ohio,, was reelected delegate. John A. Knote, MD, of West Lafayette, Ind., was reelected as alternate delegate. Two officer-at-large members were elected: Richard Allen, MD, of Happy Valley, Ore.,  and Paul H. Wick, MD, of Tyler, Texas,, reelected for a second term.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:4bdaf2a8-cd0e-45d3-8ce1-7a380365bd24 Resident and Fellow Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_resident-fellow-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> The AMA Resident and Fellow Section (RFS) welcome reception, held Thursday was a great success. More than 150 residents, fellows and medical students attended the event. Attendees took advantage of the opportunity to network with peers, and attendees also offered guidance to medical students on their upcoming transition to residency and becoming members of the AMA-RFS.</p> <p> <strong>Education sessions</strong></p> <p> On Friday David Shulkin, MD, undersecretary of health, U.S. Department of Veterans Affairs, discussed how the VA is influencing American medicine during the largest transformation in its history. He shared opportunities for how young physicians can become innovators at the VA.</p> <p> Also on Friday, the AMA-RFS Committee on Business Economics presented a dynamic education session, “From inspiration to invention: Understanding the process of becoming an entrepreneur,” which included a panel of experts.</p> <p> <strong>Elections</strong></p> <p> The AMA-RFS elected six new members to the governing council:</p> <ul> <li> Vanessa Stan, MD, vice chair</li> <li> McKinley Glover, IV, MD, speaker</li> <li> Jerry Abraham, MD,  vice speaker</li> <li> Mike Lubrano, MD, delegate</li> <li> Ben Karfunkle, MD, alternate delegate</li> <li> Scott Resnick, MD, member-at-large</li> </ul> <p> <strong>Resolutions</strong></p> <p> The AMA-RFS assembly passed 16 resolutions (five were amended on the floor) and three reports at its business meeting Saturday:</p> <ul> <li style="margin-left:0.5in;"> Report E: Sunset Mechanism (Review of 2005 Policy)</li> <li style="margin-left:0.5in;"> Report F: Privacy Personal Use and Funding of Mobile Devices</li> <li style="margin-left:0.5in;"> Report G: Clinical Implications and Policy Considerations of Cannabis Use</li> <li style="margin-left:0.5in;"> Late Resolution 2:  Specialty-specific Allocation of GME Funding</li> <li style="margin-left:0.5in;"> Resolution 1:  Expansion of Public Service Loan Forgiveness</li> <li style="margin-left:0.5in;"> Resolution 2: Inclusion of Sexual Orientation and Gender Identity Information in Electronic Health Records</li> <li style="margin-left:0.5in;"> Resolution 3: Universal Prescriber Access to Prescription Drug Monitoring Programs</li> <li style="margin-left:0.5in;"> Resolution 4: Eliminating Legacy Admissions</li> <li style="margin-left:0.5in;"> Resolution 6: Expanding GME Concurrently with UME</li> <li style="margin-left:0.5in;"> Resolution 7: Chronic Traumatic Encephalopathy (CTE) Awareness</li> <li style="margin-left:0.5in;"> Resolution 9: Firearm Background Checks</li> <li style="margin-left:0.5in;"> Resolution 10: Reducing Perioperative Opioid Consumptions</li> <li style="margin-left:0.5in;"> Resolution 11: Expanding the Treatment of Opiate Dependence Using Medication- Assisted Treatment by Physicians in Residency Training Programs</li> <li style="margin-left:0.5in;"> Resolution 12: Protecting Rights of Breastfeeding Residents and Fellows</li> <li style="margin-left:0.5in;"> Resolution 13: Primary Care and Mental Health Training in Residency</li> <li style="margin-left:0.5in;"> Resolution 14: Universal Color Scheme for Respiratory Inhalers</li> <li style="margin-left:0.5in;"> Resolution 15: Mitigating Abusive Pre-Certification/Pre-Authorization Practices</li> <li style="margin-left:0.5in;"> Resolution 16: Improving Access to Care Health Outcome</li> <li style="margin-left:0.5in;"> Resolution 17: Accident Prevention: Concussions</li> </ul> <p> The RFS immediately forwarded four resolutions to the AMA House of Delegates:</p> <ul> <li style="margin-left:0.75in;"> Late Resolution 2: Specialty-Specific Allocation of GME Funding</li> <li style="margin-left:0.75in;"> Resolution 1:  Expansion of Public Service Loan Forgiveness</li> <li style="margin-left:0.75in;"> Resolution 6: Expanding GME Concurrently with UME</li> <li style="margin-left:0.75in;"> Resolution 15: Mitigating Abusive Pre-Certification/Pre-Authorization Practices</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5d723144-61f5-4b3d-8668-f53827a8c60a AMA Organized Medical Staff Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-organized-medical-staff-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> The AMA Organized Medical Staff Section (OMSS) held its 34th Annual Meeting June 9-11 in Chicago, with more than 100 OMSS representatives and guests in attendance. As part of its continuing dedication to educating medical staff leaders and other physicians on emerging issues in health care, the section hosted eight innovative and interactive education programs offering a total of 6.75 hours of <em>AMA PRA Category 1 Credit</em>:</p> <ul> <li style="margin-left:0.25in;"> Linking EHR connectivity with data analytics: Providing value for physicians and patients in the transforming system.</li> <li style="margin-left:0.25in;"> Improving EHR usability and interoperability.</li> <li style="margin-left:0.25in;"> Tackling quality improvement through targeted solutions.</li> <li style="margin-left:0.25in;"> Preparing for the Medicare Access and CHIP Reauthorization Act.</li> <li style="margin-left:0.25in;"> Integrated leadership for hospitals and health systems: Principles for success (co-sponsored with the AMA Integrated Physician Practice Section; American Hospital Association; American Association for Physician Leadership; American Organization of Nurse Executives and American College of Healthcare Executives)</li> <li style="margin-left:0.25in;"> Developing medical staff leaders.</li> <li style="margin-left:0.25in;"> Peer review the right way: Correcting your medical staff bylaws.</li> <li style="margin-left:0.25in;"> Burning up, burning out, or burning brightly? (co-sponsored with the AMA Academic Physician Section and the AMA Senior Physician Section)</li> <li style="margin-left:0.25in;"> Physician employment: Key considerations</li> </ul> <p> Education program presentations and related materials are available for download on the OMSS meeting <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/organized-medical-staff-section/" target="_self">Web page</a>.</p> <p> The OMSS assembly considered 19 items of business, prompting robust discussion on a range of issues,</p> <p> including medical staff engagement, maintenance of certification and medical staff privileging, National Practitioner Data Bank reporting requirements and a recent proposal by the Department of Veterans Affairs to expand the scope of practice of advanced practice nurse practitioners within the VA system. The section transmitted six resolutions to the AMA House of Delegates for consideration at the 2016 AMA Annual Meeting.</p> <p> Finally, the assembly elected the 2016-2018 OMSS Governing Council: David J. Welsh, MD, (Ind.), chair; John Spurlock, MD, (Penn.), vice chair; Nancy Church (Ill.), secretary; Lee S. Perrin, MD (Mass.), reelected delegate; Matthew Gold, MD (Mass.), reelected alternate delegate; Hoyt Burdick, MD (W.Va.) member-at-large; and John Flores, MD (Ill.), member-at-large. The section would like to recognize and thank Arthur Snow Jr., MD, (Kan.) outgoing chair, and Melvyn Sterling, MD, (Calif.) outgoing member-at-large, for their service. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5a9fca48-51eb-4c40-9e5c-5f53d1b3f5d1 AMA Academic Physicians Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-academic-physicians-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> AMA policy review, educational sessions and networking opportunities with academic physician colleagues were part of the historic 40th anniversary meeting of the AMA Academic Physicians Section (APS), June 10-11 in Chicago.</p> <p> Meeting participants—comprising deans and faculty from a wide range of medical schools, graduate medical education programs, and academic health systems nationwide—voiced their opinions and reached decisions on recommendations for several reports and resolutions to be acted upon by delegates at the Annual Meeting of the AMA House of Delegates, June 10-15. Their work guides the section delegate and alternate delegate in the discussions and voting during the AMA meeting.</p> <p> Issues covered included graduate medical education funding, clinical skills testing of medical students, and maintenance of certification. In all, the AMA-APS reviewed more than 30 business items (reports and resolutions) to go before the AMA House of Delegates.</p> <p> <strong>Celebrating the 40th anniversary of the AMA-APS</strong></p> <p> This meeting also marked the 40th<sup>th</sup> anniversary of the AMA-APS (formerly the AMA Section on Medical Schools), which was approved by the AMA House of Delegates in 1976. A banner with key APS activities throughout its history was displayed at the meeting, and a commemorative logo was imprinted on cookies that were given to attendees.</p> <p> In addition, a special 40th anniversary lecture was delivered by M. Dewayne Andrews, MD, executive dean, University of Oklahoma College of Medicine, and a former chair of the APS Governing Council. Dr. Andrews’ address was the inaugural John Chapman, MD, Lecture, named after the late dean of the Vanderbilt University School of Medicine, who was considered the founder of the Section on Medical Schools. Dr. Andrews’ talk touched on the many changes in medical education and health care over the past 40 years, and the many ways in which the AMA-APS has worked to help the AMA respond to those changes.</p> <p> <strong>Updates on key nationwide medical education activities</strong></p> <p> After welcome and introductions from Alma Littles, MD, APS chair for 2015-2016 and senior associate dean for medical education and academic affairs at Florida State University College of Medicine, a number of speakers covered key issues affecting academic physicians (presentations are <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section/meetings.page?">available</a> on the AMA-APS website)</p> <p> One of the meeting’s highlights was the welcome address from Kenneth S. Polonsky, MD, dean and executive vice president for medical affairs, University of Chicago Pritzker School of Medicine, the host medical school for the AMA-APS meeting. Dr. Polonsky’s institution is also one of the 21 new members of the AMA’s Accelerating Change in Medical Education consortium. Dr. Polonsky spoke of the many innovations in medical education that spring from this storied Chicago institution, including VISTA: Curriculum & Culture Change to Cultivate Physicians for the Future, and the Center for Healthcare Delivery Science and Innovation.</p> <p> Susan Skochelak, MD, group vice president of medical education at the AMA, provided an update on the work of the AMA’s Accelerating Change in Medical Education Consortium to advance and disseminate innovations to all U.S. medical schools. After a recent expansion in late 2015, the consortium now encompasses 32 medical schools and reaches 19,000 medical students, who will one day provide 33 million patient care visits every year. Dr. Skochelak highlighted the initiative’s focus on what is being call “the third science”—health system science—and an AMA partnership with Elsevier to produce a medical education textbook on this topic later in 2016.</p> <p> Also presenting were representatives of the AMA’s two other strategic focus areas: Omar Hasan, MD, vice president of Improving Health Outcomes at the AMA, and Michael Tutty, PhD, group vice president of Professional Satisfaction and Practice Sustainability at the AMA. Both speakers called for academic physician involvement in these key AMA initiatives.</p> <p> Other highlights included a welcome/orientation for new attendees and a review of the AMA-APS role in developing and reviewing AMA policy, a legislative update from the AMA’s Washington office, an AMA academic physician membership update, a review of the work of the AMA Council on Medical Education and the activities of the AMA Foundation (presented by president William E. Kobler, MD, who also serves as a member of the AMA Board of Trustees).</p> <p> Related to membership, the AMA-APS now comprises nearly 500 academic physicians from the majority of U.S. medical schools (allopathic and osteopathic). With the recent development of a membership committee, the APS hopes to build on this number in the coming year.</p> <p> <strong>Election of 2016-2017 AMA-APS Governing Council</strong></p> <p> For the annual elections to the AMA-APS Governing Council, the section’s nine-member leadership body, members in attendance voted to elect the proposed slate put forward by the nomination committee, as follows:</p> <p> Chair-elect: George Mejicano, MD, senior associate dean for education, Oregon Health & Science University School of Medicine</p> <p> Delegate: Kenneth B. Simons, MD, senior associate dean for GME and accreditation, Medical College of Wisconsin</p> <p> Alternate delegate: Donald G. Eckhoff, MD, professor of orthopaedics, University of Colorado School of Medicine</p> <p> Members-at-large:</p> <ul> <li> Cynda Ann Johnson, MD, president and founding dean, Virginia Tech Carilion of School of Medicine and Research Institute</li> <li> Jose Manuel de la Rosa, MD, provost and vice president for academic affairs and  founding dean, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine</li> <li> Mark B. Stephens, MD, CAPT MC USN, professor and chair of the  Department of Family Medicine, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine</li> </ul> <p> <strong>Educational sessions on burnout/physician wellness</strong></p> <p> The education component of the meeting focused on burnout and physician wellness and resiliency throughout the medical education and practice continuum. Distress is common among physicians and can have substantial personal and professional implications. An extensive body of research has demonstrated a strong link between physicians’ personal well-being and the quality of care they provide patients. </p> <p> In his talk, Tait Shanafelt, MD, director of the Mayo Clinic Department of Medicine Program on Physician Well-being at the Mayo School of Medicine in Rochester, Minn., reviewed the literature on physician satisfaction and burnout and discussed the personal and professional repercussions of physician distress. He also reviewed the individual and organizational approaches to promoting physician well-being.</p> <p> Next, an interactive, hands-on session provided the opportunity for medical education leaders to learn how creative expression can mitigate the impacts of an unhealthy emotional environment, which can lead to burnout. Lead faculty Michael J. Green, MD, of the Department of Humanities at Penn State College of Medicine in Hershey, Pa., and Dr. Stephens showed session participants how creating and designing a mask and drawing a comic can help promote personal reflection about professional roles and responsibilities as well as offer a technique to help medical students and resident/fellow physicians explore their own professional identity formation throughout medical education and practice.</p> <p> After the AMA-APS meeting concluded, attendees were invited to a third session on burnout, “Burning up, burning out or burning brightly?” which was co-sponsored by the AMA-APS and the AMA Senior Physicians Section. The featured presenter was Richard Gunderman, MD, an AMA-APS member and professor at Indiana University.</p> <p> <strong>Next AMA-APS meeting</strong></p> <p> The next meeting of the AMA-APS is Nov. 11, 2016, in Seattle, in conjunction with the Annual Meeting of the Association of American Medical Colleges.</p> <p> <strong>About the AMA-APS</strong></p> <p> The AMA-APS, formerly the AMA Section on Medical Schools, is the AMA member section that represents all academic physicians. Members include MD and DO physicians who hold a faculty appointment at a United States medical school, as well as physicians who do not hold a medical school faculty appointment but have an active role in student (undergraduate), resident/fellow (graduate), and/or faculty (continuing) medical education, or serve in a clinical/research capacity with an academic medical center, community hospital, or other health care setting. <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/academic-physicians-section.page" target="_self">Learn more</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:620560a2-87ba-4e50-8712-71a3c417a4fd AMA Minority Affairs Section: 2016 AMA Annual Meeting http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-minority-affairs-section-2016-ama-annual-meeting Sun, 12 Jun 2016 14:00:00 GMT <p> The AMA Minority Affairs Section (MAS) held its business meeting on Friday evening, June 10. The keynote speaker, Ronald Wyatt, MD, MHA, the patient safety officer for The Joint Commission, discussed health disparities, health equity, and physicians’ unconscious bias. The meeting also featured an open forum on AMA House of Delegates reports and resolutions that impact minority physicians and patients.</p> <p> The business meeting also included an awards presentation honoring 21 medical students who received the 2016 Minority Scholars Awards. Award recipients won $10,000 scholarships from the AMA Foundation.  The scholarships were made possible with support from Pfizer Humanities Initiative and the American Society of Anesthesiologists.  One $5,000 scholarship was made possible by Richard Allen Williams, MD, Ms. Genita Johnson and the Association of Black Cardiologists (ABC). These scholarships recognize scholastic achievement, financial need and personal commitment to improving health care disparities among students in groups defined as historically underrepresented in the medical profession.</p> <p> On Monday morning, June 13, MAS hosted a continuing medical education (CME) session titled, “Medicine, Social Determinants of Health, and Criminal Justice Reform.”  MAS also co-sponsored a CME session with the LGBT Advisory Committee, “Adding HIV PrEP to Your Practice.”</p> <p> The MAS governing council elected Frank Clark, MD, as the section chair, and Tyeese Gaines, DO, as vice chair for one-year terms, which will begin at the conclusion of the 2016 AMA Annual Meeting.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b819e011-0240-4b85-bc21-ca54b1fa01cc AMA Medical Student Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-medical-student-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> More than 600 medical students from across the country formalized policy on health care issues affecting medical students and participated in various programming and networking events at the 2016 National Medical Student Meeting, held June 9-11 in Chicago.</p> <p> Medical students filled the ballroom to hear keynote speaker Kevin Pho, MD, discuss making a difference in health care with social media. Students also received advice from Mark Hill, MD, professor of surgery at the Chicago Medical School, on how to impress on the wards, and guidance from Christopher Cimino, MD, chief medical officer and vice president of Kaplan, on surviving the second year of medical school. Other programs included insights on pitching a tech idea and reducing the stigma of medical student mental health.</p> <p> The AMA Medical Student Section (MSS) assembly considered 32 items of business and adopted policy on a wide range of issues. Highlights include: advocating for the elimination of USMLE Step 2 CS and COMLEX level 2-PE exams, supporting the decriminalization of suicide in the military, opposing efforts to restrict public health crisis research, supporting the role spirituality plays in a patient’s health, supporting restrictions on weapons in hospitals, and supporting cultural competency training for medical school students when treating patients who are LGBT+.</p> <p> This meeting represented the fifth implementation of a completely virtual testimony process. The virtual reference committee generated more than 250 posts and continues to provide all medical student members, regardless of their ability to attend the meeting, the opportunity to provide testimony on each items of business.</p> <p> This meeting was the first that combined the Clinical Skills Workshop and Medical Specialty Showcase, which drew more than 200 students and provided networking and information-sharing opportunities between medical professionals and medical students.</p> <p> Finalists in the AMA Healthier Innovation Challenge—which asked medical students, residents and physicians from across the country to share their innovative solutions for improving the health of the nation—pitched their concepts at a live event Saturday. Selected from more than 100 submissions, a rising fourth-year medical student won second place for his Light Line catheter! The three winning teams received a share of $50,000 in prizes, as well as access to the AMA's network of accelerator and entrepreneurship partners. <a href="http://www.innovatewithama.com/" rel="nofollow">Learn more</a> about the winners and their innovations. </p> <p> The AMA-MSS assembly elected the following members to its 2016-2017 governing council:</p> <ul> <li> Chair: Christopher Libby, University of Massachusetts Medical School</li> <li> Vice chair: Lee Ouyang, Eastern Virginia Medical School</li> <li> Delegate: Sarah Smith, University of California, Irvine, School of Medicine</li> <li> Alternate delegate: William Estes, Texas A&M Health Science Center College of Medicine</li> <li> Speaker: Hunter Pattison, University of Florida College of Medicine</li> <li> Vice speaker: Theresa Phan, Texas Tech University Health Center School of Medicine</li> <li> At-large officer: Jayme Looper, University of South Carolina</li> </ul> <p> Omar Maniya, Georgetown University School of Medicine, begins his term as medical student representative on the AMA Board of Trustees at the close of the 2016 AMA Annual Meeting. The AMA-MSS Government Relations Advocacy Fellow, Chris Clifford, University of Nevada School of Medicine, begins his one-year term in July.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:713f7e31-7df0-4d68-b5da-4e3dd4cc81eb AMA Young Physicians Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-young-physicians-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> Young physicians from across the country discussed priority issues and worked on shaping AMA policy during this year’s AMA Young Physicians Section Annual Meeting.</p> <p> The AMA-YPS adopted one resolution that was considered at the 2016 AMA Annual Meeting. Resolution 717, “Unforeseen Consequences of Core Measures,” asked the AMA to discourage the implementation of protocols, core measures or directives relating to the care of patients in the outpatient or inpatient settings without structured trials designed to identify unforeseen costs and potential patient harms.  The AMA House of Delegates referred this resolution.</p> <p> After reviewing the AMA House of Delegates handbook, the AMA-YPS assembly identified items of particular relevance to the section and developed testimony for reference committee hearings and on the House floor. Details of all AMA-YPS positions can be found on the <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/young-physicians-section.page" target="_blank">AMA-YPS home page</a>.</p> <p> The assembly also held elections for the AMA-YPS Governing Council. Brandi Ring, MD, was elected chair-elect; Hilary Fairbrother, MD, was reelected delegate; and Nicole Riddle, MD, was elected member-at-large.</p> <p> The theme for the AMA-YPS C. Clayton Griffin, MD, Memorial Luncheon was “Physician burnout, professional satisfaction and wellness.” The luncheon featured a presentation by Allison M. Winkler, AMA senior practice development specialist. This interactive session provided attendees with an opportunity to learn more about professional satisfaction and personal burnout among physicians as well as personal and organizational approaches to promote physician well-being.</p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:39f2bd74-2beb-49d0-991e-94a2ecd6dfcb Women Physicians Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_women-physicians-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> The <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/women-physicians-section.page" target="_self">AMA Women Physicians Section</a> (WPS) hosted its business meeting and reception, which featured a talk by Michelle Materre and Dionne Hart, MD, titled, “Changing the face of medicine: Women physicians in the media.” The presentation addressed the negative imagery of African-American women often portrayed through the media with positive images of successful black women doctors.</p> <p> This presentation is a forerunner to the documentary, <em>Black Women in Medicine</em>, which aims to educate and inspire generations of future doctors of color and provide them with the role models they need to navigate the rigors of a medical education.</p> <p> The business meeting concluded with a review of the AMA House of Delegates Handbook and AMA-WPS items of business. The AMA-WPS Governing Council reviewed its positions on various items of business before the AMA House of Delegates. Its positions focus on issues of concern to women physicians, medical students and patients.</p> <p> The AMA-WPS sponsored two resolutions at this meeting.</p> <p> Resolution 506, “Heart disease and women,” asked the AMA to:</p> <ul> <li> Facilitate increased awareness of heart disease in women</li> <li> Support education on preventive measures for heart disease in women</li> <li> Encourage increased comprehensive care of heart disease in women</li> <li> Promote research to address the gaps in knowledge</li> <li> Encourage research to better understand the role of demographic, socioeconomic and psychological factors in the onset of heart disease in women</li> </ul> <p> The AMA House of Delegates amended this resolution to include the following two new policies:</p> <p> RESOLVED, That our American Medical Association supports increased awareness and education on preventive measures for heart disease in women and encourages comprehensive care of heart disease in women.</p> <p> RESOLVED, That our AMA urges research to address the four gaps in knowledge related to coronary pathophysiology and diagnostic, treatment, and interventional strategies for heart disease in women; and to better understand the role of demographic, socioeconomic, and psychological factors in the onset of heart disease in women.</p> <p> Resolution 507, “Interventions for opioid-dependent pregnant women,” asked the AMA to advocate for increased funding for education, prevention and treatment of opioid use disorder in pregnant women. This resolution also requested the AMA to advocate for comprehensive oversight of medication-assisted treatment for pregnant women with opioid use disorder. Finally, this resolution asked the AMA to lobby for increased funding for comprehensive programs to treat women with substance abuse problems and oppose fetal assault laws.</p> <p> The AMA House of Delegates adopted Alternate Resolution 507 in lieu of Resolution 507. <a href="https://download.ama-assn.org/resources/doc/hod/x-pub/a16-refcomm-e-annotated.pdf" target="_self">Login to see the report</a> of Reference Committee E to learn more.</p> <p> The governing council also held elections for its officers. Lynda Kabbash, MD, was elected chair, and Neelum Aggarwal, MD, was elected vice chair.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5f06b502-9e6c-4a1c-a869-5984e7fd3bae AMA Integrated Physician Practice Section: 2016 AMA Annual Meeting highlights http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-integrated-physician-practice-section-2016-ama-annual-meeting-highlights Sun, 12 Jun 2016 14:00:00 GMT <p> At its fourth Annual Meeting, members of the AMA Integrated Physician Practice Section (IPPS) heard a presentation on “The non-hospital of the future.” It opened with a patient testimonial followed by presentations on how new technologies and outside-the-box thinking can put patients more in control of their care and keep them out of the hospital.</p> <p> The afternoon program featured an overview of the Medicare Access and CHIP Reauthorization Act by Rich Deem, senior vice president of AMA advocacy. Doug Wood, MD, medical director of the Center for Innovation at the Mayo Clinic, used Mayo’s ground-breaking research to support the notion that, rather than measure multiple processes of health care, including specialty and sub-specialty processes, physicians should measure health in a meaningful way using patient-reported outcome measures and total cost of care over time.</p> <p> The AMA-IPPS elected a new member to the governing council: Randall Gibb, MD, chief medical officer at the Billings Clinic in Montana.</p> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/international-medical-graduates.page" target="_blank">Learn more</a> about the AMA-IPPS meeting.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a0632c37-6db6-432e-b755-07d25e96dfac Digital dystopia: Developing tools that work in practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_digital-dystopia-developing-tools-work-practice Sat, 11 Jun 2016 20:53:00 GMT <p> Physicians have access to many digital tools that can enhance care delivery. But identifying the technology that makes care more efficient and building new tools that are based on physician perspectives from the start are critical to developing a digital practice environment that works for physicians and patients, AMA Executive Vice President and CEO James L. Madara, MD, said in his address at the 2016 AMA Annual Meeting.</p> <p> <strong>The potential exists—changing the digital dystopia</strong></p> <p> <object align="right" data="http://www.youtube.com/v/RbWgJIOWQmQ" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/RbWgJIOWQmQ" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/RbWgJIOWQmQ" /><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/RbWgJIOWQmQ" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object>“Today … we have really remarkable tools,” Dr. Madara said, “robotic surgery, new forms of radiation therapy, emerging biologics. And we live in a time of rapid development in the digital world.”</p> <p> “But you know something, appearing in disguise among these positive products are other digital so-called advancements that don’t have an appropriate evidence base … or that just don’t work well or that actually impede care, confuse patients and waste our time,” he said, “from ineffective electronic health records (EHR) to an explosion of direct-to-consumer digital health products to apps, some of which are of poor quality.”</p> <p> Even digital products that might otherwise be helpful often lack a way of enriching the patient-physician relationship, Dr. Madara said. This environment is “something I might  call our digital dystopia.”</p> <p> Digital tools can be useful and hold the potential for magnificence, he said, but physicians today are tasked with separating the useful from the harmful by “inserting ourselves into the processes from which digital tools emanate.”</p> <p> “[A] more promising digital future can be envisioned that enhances the physician-patient relationship, produces better and more efficient care,  and allows more time for physician-patient interactions,” Dr. Madara said. “We need to be directly involved to make it happen.”</p> <p> <strong>How physicians are informing the development process</strong></p> <p> Dr. Madara gave three examples of how physicians are actively pursuing the development of new products that are informed by “the granular understanding of the physician-patient environment” that only physicians can bring to the table:</p> <ul> <li> <strong>Incubating ideas at MATTER.</strong> “We’re forming interactions with the emerging companies that produce health-related goods and services,” Dr. Madara said.<br /> <br /> For example, at <a href="http://matterchicago.com/" rel="nofollow" target="_blank">MATTER</a>, the Chicago-based incubator for emerging health care companies, the AMA has created a space where physicians can inform entrepreneurs of their needs at the creation of innovative ideas.<br /> <br /> “We do much better if new products and services are deeply informed by our actual problems and needs,” he said. This way, ideas are developed with those needs in mind and are much closer to implementation from the start, rather than requiring redesign to fit physician needs after the fact.<br />  </li> <li> <strong>Prototyping tools at Health 2047.</strong> “In January, we launched an innovation studio in Silicon Valley called <a href="https://www.health2047.com/" rel="nofollow" target="_blank">Health 2047</a>,” Dr. Madara said. Health 2047 takes many of the problems identified by AMA studies and applies rapid prototyping and design to achieve tools based on practice and patient needs.<br /> <br /> “Emerging prototypes will be iterated with physicians until the tool gets it right,” he said. “This effort is attracting high-level talent in Silicon Valley.”<br /> <br /> “Digital tools that would simplify and better organize our lives and adapt to the natural variations in our practices … would free more time for patient interactions,” he said. “That’s what we want.”<br />  </li> <li> <strong>Transforming practices.</strong> “While shaping the future, we also need to address the current state,” Dr. Madara said. This includes identifying work flow and practice adjustments that can produce higher professional satisfaction.<br /> <br /> “Digital modules, which we call <a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward™</a>,” he said, “are available to all physicians.” Since its announcement last year, more than 70,000 users have accessed these practice improvement strategies.<br /> <br /> New modules are being produced and tested, and the Centers for Medicare & Medicaid Services has recognized them as a form by which physicians can be acknowledged for practice improvement under the Medicare Access and CHIP Reauthorization Act.<br /> <br /> “The future is not about eliminating physicians,” Dr. Madara said, “it’s about leveraging physicians by providing digital and other tools that work like they do in virtually all other industries—making our environments more supportive, providing the data we actually need in an organized and efficient way, and saving time so we can spend more of it with our patients.”</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:0b4e0707-c4cb-44c4-b201-e799c5f0d895 Bright future on horizon--and we know the path to get there http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_bright-future-horizon-path-there Sat, 11 Jun 2016 20:50:00 GMT <p> Physicians live in a world of contradictions, AMA President Steven J. Stack, MD, told physicians during his address at the 2016 AMA Annual Meeting. It’s a profession of rewards and privilege amid the toll of frustration and burnout, borne of administrative hassles and bureaucratic overreach. The challenge is to persevere and lead the way for others, he said.</p> <p> <strong>A common calling</strong></p> <p> <object align="right" data="http://www.youtube.com/v/39W1xhvUEbM" height="350" hspace="15" id="ltVideoYouTube" src="http://www.youtube.com/v/39W1xhvUEbM" type="application/x-shockwave-flash" vspace="15" width="450"><param name="movie" value="http://www.youtube.com/v/39W1xhvUEbM" /><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/39W1xhvUEbM" type="application/x-shockwave-flash" vspace="15" width="450" wmode="transparent"></embed></object>“In my travels this year I have shared my belief that it is our opportunity, our obligation and our great privilege as leaders to recognize the challenges but to not allow ourselves to be consumed by them,” Dr. Stack said.</p> <p> Despite the challenges, he said, countless physicians cherish their calling and would never choose another.</p> <p> “Engaging with these dedicated professionals—people who revel in what they do for patients and remind me why the work of the AMA is so important—has been the best part of my year,” he said.</p> <p> <strong>Persevering together—and getting results</strong></p> <p> Looking back over the year, Dr. Stack outlined the valuable work of the association, including:</p> <ul> <li> Advocating an end to Meaningful Use as we know it, and working to untangle the convoluted payment systems that add to dissatisfaction among physicians</li> <li> Changing federal policies governing electronic health records (EHR) to better reflect the realities of medical practice</li> <li> Continuing to work in Washington to secure improvements in the Medicare Access and CHIP Reauthorization Act to ensure physicians can succeed in the new payment options and make informed decisions for their practices</li> <li> Helping shape the national conversation around the epidemic of opioid addiction and overdose through the AMA Task Force to Reduce Opioid Abuse</li> <li> Maintaining physician leadership training programs to encourage leadership in hospitals, clinics and communities</li> <li> Tackling the risk of costly chronic diseases, such as prediabetes and high blood pressure, which has included a national public service campaign online, on TV and in print</li> <li> Fighting mergers of health insurance giants that threaten to reduce competition, manipulate physician practice and drive up costs for patients</li> <li> Reimagining medical education by bringing together 32 medical schools to create the medical school of the future</li> </ul> <p> <strong>Unwavering committement</strong></p> <p> Dr. Stack reminded his colleagues that sacrifice, perseverance and public service are alive and well, and pointed to a recent public health crisis in Michigan.</p> <p> Mona Hanna-Attisha, MD, faced dismissive experts, skeptical colleagues, even personal attacks when she sounded the alarm in late 2014 over lead contamination in the water in Flint, Dr. Stack said. Yet her perseverance exposed a public health scandal.</p> <p> “Think about what it took Dr. Mona—as she is more widely known—to persevere under those circumstances,” he said.</p> <p> He told his colleagues that their challenge will be to persevere despite bureaucrats, administrators and “armchair quarterbacks,” and make sure “the sacred bond between patient and physician endures.”</p> <p> “With our unwavering commitment to this noble cause, we can—we will—create a future where physicians and patients thrive and where the doctors of tomorrow have the support and training they need to meet any challenge,” he said.</p> <p>  </p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d341c1ea-7552-4ac9-8f67-2c4f057f0da6 How physicians are making EHRs interoperable http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-making-ehrs-interoperable Fri, 10 Jun 2016 23:07:00 GMT <p> Electronic health records (EHR) have consistently caused problems for physicians due to a lack of interoperability. At the 2016 AMA Annual Meeting, physicians and health IT developers explained how physicians must lead—and <em>are</em> leading—the way forward.</p> <p> As the transformation of the health care system under the Medicare Access and CHIP Reauthorization Act (MACRA) moves closer to implementation, physicians are taking initiative in making sure that EHRs work in a way that allows them to improve patient care.</p> <p> <strong>Kansas is connecting physicians statewide</strong></p> <p> The vision that was established years ago for health care was a paperless, interoperable system in which physicians could share information to improve patient care. But, in Kansas, the state medical society and KaMMCO Health Solutions realized that physicians were not involved in the development of the solutions being offered to reach that vision.</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/9/8/9934f88f-16c1-42c7-a8da-593c07abe3a2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/9/8/9934f88f-16c1-42c7-a8da-593c07abe3a2.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:11px;"><em>Laura McCrary, senior vice president of KaMMCO</em></span></td> </tr> </tbody> </table> <p> “The medical society is building a private health information exchange (HIE) in Kansas,” said Laura McCrary, senior vice president of KaMMCO Health Solutions and executive director of the <a href="http://www.khinonline.org/" rel="nofollow" target="_blank">Kansas Health Information Network</a> (KHIN).</p> <p> And it is working.</p> <p> “This is an exchange that is owned by the doctors and the hospitals,” McCrary said. “It is governed and run by the people who contribute the data into the exchange, and that’s a very important concept—doctors create this data, and doctors have the responsibility to govern what happens with the data.”</p> <p> “Interoperability is something that you’ve all heard about for a long time,” she said. Similar to how cellphones operate and communicate on a network, you have to have a network that “allows the data to flow between those [EHR] systems.”</p> <p> Through their partnership with the Kansas Medical Society, KaMMCO has built this network and is very close to having all hospitals and practices in the state connected through their EHRs. 94 hospitals in Kansas today are live and sharing data.</p> <p> “The vision of health information exchange and an interoperable network that is secure, that clinicians can use to drive improvements in patient care, is beginning to take shape in our state,” said Jerry Slaughter, executive director of the Kansas Medical Society.</p> <p> “If we have a secret sauce,” Slaughter said, “it is that we insisted from the beginning that the efforts be truly physician led.”</p> <p> <strong>Rethinking health IT platforms</strong></p> <p> Improving EHRs is a long-term process, but there are actions we can take today, both systemically and in our own practices and hospitals to drive change, said Jesse Ehrenfeld, MD, AMA board member and anesthesiologist at Vanderbilt University. </p> <p> “At a systemic level, we’ve been deeply involved in many projects,” Dr. Ehrenfeld said. “One that I think has a lot of promise is the <a href="http://smarthealthit.org/" rel="nofollow" target="_blank">SMART</a> [Health IT] platform.”</p> <p> SMART Health IT is an open, standards-based technology platform that enables innovators to create apps that seamlessly and securely run across the health care system.</p> <p> “The idea is to have an app platform for your EHR and that there is functionality that might be specialty specific [or] specific to a population of patients that could allow us through the use of an app that sits on top of your EHR to have … better visualization tools that could be substituted by end users or hospital systems to make things better, faster and to allow innovation,” Dr. Ehrenfeld said.</p> <p> Moving toward this app structure creates a low barrier of entry for developers to enter the space and create apps that work for physicians and patients.  </p> <p> <strong>Vanderbilt improved the surgical “timeout”</strong></p> <p> At Vanderbilt, Dr. Ehrenfeld and his colleagues came up with a technological solution to ensure that wrong-sided surgeries would no longer occur as a result of an inefficient surgical timeout.</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/10/9/6a4dd839-2366-48d4-b9ac-87755e40aae7.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/6a4dd839-2366-48d4-b9ac-87755e40aae7.Large.jpg?1" /></a></td> <td>   </td> </tr> <tr> <td> <span style="font-size:11px;"><em>Jesse Ehrenfeld, MD, AMA board member</em></span></td> <td>  </td> </tr> </tbody> </table> <p> “We know that not doing the right surgery on the right patient continues to be a problem,” he said. “While checklists are important, helpful and are a requirement … you have to use a checklist reliably if you’re doing a timeout to have optimal performance.”<br />  </p> <p> “We created a technological solution tied to our EHR to try to back step this problem of not doing a timeout appropriately or well,” he said. Vanderbilt went from a paper process of laminated sheets to an electronically mediated timeout.</p> <p> “The questions are sequentially displayed to the entire care team in the [operating room] on a large screen monitor,” he said. “You only see the question that is required at the moment” for a focused, step-by-step process. When the process is completed, it is flagged as so on the screen for the team.</p> <p> The current national performance is one wrong-sided surgery per every 23,600 cases. Since implementation, Vanderbilt has had zero wrong-sided surgeries in more than 250,000 cases.</p> <p> <strong>AMA initiatives around EHR interoperability</strong></p> <p> EHRs that can’t communicate with one another have plagued the medical profession for years, but physicians have taken the lead and in several ways urged the developers and regulators to make this a thing of the past.  </p> <p> The AMA and 36 specialty medical associations recently sent a <a href="https://download.ama-assn.org/resources/doc/washington/interoperability-onc-cms-sign-on-letter-03june2016.pdf" target="_self">sign-on letter</a> to urge the Centers for Medicare & Medicaid Services and the Office of the National Coordinator for Health IT to rethink the way they measure the interoperability of EHRs</p> <p> Measures that only serve to count each “click” a physician makes detract from patient care. Health IT vendors are closely following federal reporting requirements when designing EHRs—often at the expense of software functionality or meaningful information exchange.</p> <p> Late last year, the AMA and MedStar developed a new framework to evaluate the top EHR products, said Michael L. Hodgkins, MD, AMA vice president and chief medical information officer. “And only three vendors got perfect scores.”</p> <p> The <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up">EHR User-Centered Design Evaluation Framework</a> employs a 15-point scale intended to go beyond the ONC’s criteria and evaluate EHR vendors’ compliance with best practices for a user-centered design process to encourage the ONC to raise the bar on federal usability certification.</p> <p> It is important that physicians stay in the conversation and take the lead to make sure that patient care is made easier through EHR use and not more difficult.</p> <p> Also, the AMA’s grassroots campaign <a href="https://breaktheredtape.org/" rel="nofollow" target="_self">BreakTheRedTape.org</a> in January held a town hall, in which physicians came together to offer solutions to <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-need-physicians-offer-solutions-town-hall" target="_self">what EHRs need</a> and how they could work better for physicians and their patients.</p> <p> In 2014, a panel of experts led by AMA President Steven J. Stack, MD, developed and published <a href="http://www.ama-assn.org/ama/ama-wire/post/8-top-challenges-solutions-making-ehrs-usable" target="_self">eight top challenges and solutions</a> for improving EHR usability for physicians and their patients. These principles focus on leveraging the potential of EHRs to enhance patient care, improve productivity and reduce administrative costs</p> <p> The AMA’s STEPS Forward™ collection of practice improvement strategies also offers several modules to help physicians relieve the burden of current EHR inefficiency, including <a href="https://www.stepsforward.org/modules/ehr-implementation" rel="nofollow" target="_self">EHR software selection and purchase</a> and <a href="https://www.stepsforward.org/modules/ehr-software-vendor-selection" rel="nofollow" target="_self">EHR implementation</a>.</p> <p> <strong>More on EHRs and interoperability:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/medicine-needs-cloud" target="_self">Why medicine needs a cloud</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-barriers-keeping-data-improving-health-outcomes" target="_self">3 barriers keeping data from improving health outcomes</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/fix-ehrs-patient-physician-relationship-senator-says" target="_self">Fix EHRs for the patient-physician relationship, senator says</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/3-changes-cms-making-put-patients-back-center-of-care" target="_self">3 changes CMS is making to put patients back at the center of care</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/search" target="_self">How EHRs tied up physician time in 2015</a></li> </ul> <p style="text-align:right;"> <em>By AMA staff writer <a href="https://twitter.com/troy_amawire" rel="nofollow" target="_blank">Troy Parks</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c0b51006-b63c-4666-a230-0a5544061eca The non-hospital: Putting patients at the center of care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_non-hospital-putting-patients-center-of-care Fri, 10 Jun 2016 23:06:00 GMT <p> For Melissa Hicks, it’s not the constant pain, the fatigue and the host of other symptoms that come with her autoimmune disease that make her sick. “What makes me feel really sick is all the work I have to do because I’m a patient,” she said. “Being sick became another full-time job. … When you’re sick, you can’t do two full-time jobs.”</p> <p> <strong>Burdens of the current health care environment</strong></p> <table align="right" border="0" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>    </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/11/5fe5b0a6-8408-4548-8b88-c608aa506ded.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/11/5fe5b0a6-8408-4548-8b88-c608aa506ded.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <p> <span style="font-size:11px;"><em>Melissa Hicks shares her perspective as a patient with a chronic disease.</em></span></p> </td> </tr> </tbody> </table> <p> Hicks, who suffers from Sjogren’s Syndrome, was talking to a room full of physician leaders from health systems around the country during the <a href="http://www.ama-assn.org/sub/meeting/" target="_self">2016 AMA Annual Meeting</a>.</p> <p> She described all the appointments she has to schedule over the phone, the calls to argue with her insurance company, the never-ending bills, the calls for test results, the unfilled prescriptions and canceled appointments that her insurance company refused to cover, the need to carry medical records from specialist to specialist, and the hours and days of lost work as she tries to coordinate her care.</p> <p> “I know there’s something called physician burnout, but I think there’s something called patient burnout too,” Hicks said. “Think what effect all this might be having on my health.”</p> <p> “What effect do you think that has on patient compliance?” she said. “My intentions are good, but I don’t always follow through. I <em>can’t</em> always follow through. There’s only so much I can do when I’m unwell.”</p> <p> Nick Dawson, the executive director of innovation at Johns Hopkins Sibley Memorial Hospital, said the “miserable” environment created by the complexities of U.S. health care is taking its toll on both patients and physicians.</p> <p> He also pointed to issues of sustainability for the current environment, noting that the cost of IT has outpaced the cost of human resources in health care. Calling out electronic health records (EHRs) as an example, he said there’s an “astronomical cost that doesn’t reflect the value we see in them.”</p> <p> <strong>An optimistic future</strong></p> <p> But Dawson doesn’t give a bleak outlook for health care. Quite the opposite. He said he has an “optimistic view of the future,” but it requires both confronting today’s problems and looking past them to the possibilities around us.</p> <p> Quoting science fiction writer William Gibson—“the future is here; it’s just not evenly distributed”—Dawson highlighted several examples of data and technologies that already are improving some patients’ health.</p> <p> “We can look at these things and say, what does it tell?” Dawson said. For example, his smartwatch vibrates when he gets social media alerts. A device like that could be used to help patients with chronic diseases monitor and better manage their conditions both where they are and remotely with their physicians, he said.</p> <p> “If we’re keeping patients with chronic diseases like diabetes out of the office, what does that mean for patients and the practice?” he said. Relying on her own technical skills, a woman named Dana who has diabetes recently spent $70 on technology that she has used to keep her blood glucose level flat.</p> <p> Another patient who has Parkinson’s disease keeps all her medical records in the EverNote app on her phone. It makes her records completely portable, which she finds liberating.</p> <p> Dawson also noted that many U.S. cities make specific data related to health publicly available. That data could be mined to predict health outcomes and prevent people from getting sick. For instance, research has shown a correlation between things like not being able to pay an electric bill or not having access to healthy foods and poor health. Hospitalizations and costly chronic conditions could possibly be prevented by looking ahead and offering inexpensive interventions, he said.</p> <p> <strong>A progression toward meeting people’s needs outside the hospital</strong></p> <table align="right" cellpadding="1" cellspacing="1"> <tbody> <tr> <td>   </td> <td> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/1/9e679368-7b9c-4f0c-a118-8b2cab5b6c16.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/1/9e679368-7b9c-4f0c-a118-8b2cab5b6c16.Large.jpg?1" /></a></td> </tr> <tr> <td>  </td> <td> <span style="font-size:11px;"><em>Dr. Weiss talks about how her health system is reaching patients<br /> in their community.</em></span></td> </tr> </tbody> </table> <p> In southwest Virginia, the Carilion Clinic health system is making strides in improving the health and care of that underserved population. Patrice Weiss, MD, the system’s executive vice president and chief medical officer, shared some of their success in finding ways to improve their community.</p> <p> “Every day that we do go to work, it’s about that patient,” she said.</p> <p> But work isn’t always in the exam or hospital room.</p> <p> Roanoke, where the Carilion Clinic is headquartered, was built as a railroad town, and much of the industry has centered on coal mining and tobacco. The people who live there tend to have low incomes and high rates of things like obesity and teen pregnancy.</p> <p> So the clinic has gone out into the community to meet patients’ needs where they live, work and go to school. They’ve provided food and nutrition education, as well as a fresh food prescription program. That includes weekly health education classes, weekly prescriptions for mobile market visits and monthly check-ins with clinicians.</p> <p> As a result, they’ve seen 5.2 percent lower A1C levels, a 2 percent reduction in BMI and an average of 2.2 pounds of weight loss.</p> <p> “We had to go beyond the hospital walls,” Dr. Weiss said. “This was about basic roll up your sleeves and improve the health of the community.”</p> <p> When members of the community do come for clinical care, Carilion Clinic has seen success in improving access to urgent care clinics and medical homes. In just two years, they’ve seen a 57 percent reduction in inpatient utilization and admissions.</p> <p> For patients involved in the medical homes, emergency department utilization has decreased 50 percent. Meanwhile, diabetes screening, pneumonia vaccinations and use of asthma controller medications have well exceeded national averages.</p> <p> When it comes to meeting patients’ needs where they are, Carilion takes an almost literal approach. They’re planning to establish an urgent care clinic at a busy interstate truck stop, where they may become the primary care provider for truck drivers who travel up and down the East Coast, many of whom have very limited care.</p> <p> <strong>It all comes back to the patient</strong></p> <p> Lawrence Chu, MD, is executive director of Stanford Medicine X, an initiative that explores how emerging technologies will advance the practice of medicine, improve health and empower patients to be active participants in their own care.</p> <p> Dr. Chu emphasized the importance of patient engagement to promote the best health care environments and outcomes. According to Dr. Chu, engagement is not just a patient’s willingness to make good health choices but an active partnership between the patient and the physician, which includes shared decision-making. Dr. Chu said that’s “untapped potential.”</p> <p> That potential is for improving patients’ individual health and also for efforts to better the entire system. “We can start by bringing the end users into the process,” he said, making sure patients are seen as critical members of the design team and are involved in all steps of the process through implementation.</p> <p align="right"> <em>By AMA Wire editor </em><em><a href="https://twitter.com/amy_amawire" rel="nofollow" target="_blank">Amy Farouk</a></em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:00cc47ab-0ffd-4ef9-9898-bc1b87d2abc5 Teaching students how to be part of a system should enhance care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_teaching-students-part-of-system-should-enhance-care Thu, 09 Jun 2016 21:00:00 GMT <p> As health care increasingly requires physicians to function as part of a system, medical schools are incorporating more hands-on, team-based experiences for students to learn the skills they need. Find out how students, clinics and patients alike may benefit from this emerging educational component.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/14/6a9c6957-8624-4fa0-bed4-82c4164535bc.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/14/6a9c6957-8624-4fa0-bed4-82c4164535bc.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>How is med ed changing?</strong></p> <p> Medical students soon are likely to spend time in clinics doing more than simply observing physicians taking care of patients. They increasingly may take part in more aspects of the health system, for example, helping patients navigate the health care system, helping physicians who run clinics identify areas for quality improvement or coordinating different aspects of a patient’s care.</p> <p> As accountable care organizations and patient-centered medical homes become a larger part of the health care system, health systems science (HSS) is becoming the third pillar of undergraduate medical education. That means professional teamwork and collaboration, population health, quality improvement, clinical informatics and high-value care all are skills that new physicians need to function in the 21st-century health care system, leaders in the HSS field say.</p> <p> Medical schools are incorporating HSS into classroom curriculums, but a new <a href="http://ajm.sagepub.com/content/early/2016/04/21/1062860616645401.abstract" target="_blank" rel="nofollow">study</a> points out that more needs to be done to provide students with hands-on experience. The study grew out of HSS work that Penn State University College of Medicine is doing after becoming 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/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a> in 2013.</p> <p> Study authors talked with leaders at 30 clinical sites and programs—a wide range of settings from primary care clinics to an inpatient discharge program—to find out what experiences would be useful to students and the professionals helping train the next generation of physicians.</p> <p> “This study’s results highlight the potential for integrating students into interprofessional care teams in a wide range of clinical sites to simultaneously add value to the health care system and enhance education,” study authors concluded.</p> <p> <strong>How can students help patients, clinics?</strong></p> <p> Clinicians who participated in the study said students could work directly with patients to improve their health. Examples of these kinds of activities include:</p> <ul> <li> Monitoring care plans via face-to-face meetings</li> </ul> <ul> <li> Facilitating patient access to services and resources, for example medical assistance or exercise programs</li> </ul> <ul> <li> Assessing patients to identify social or systems barriers that may impact the care plan</li> </ul> <ul> <li> Assisting patients to overcome challenges and motivating them to attain their goals by serving as a patient “coach”</li> </ul> <p> Participants in the study said that patients benefit from having another set of eyes on them and another contact for them.</p> <p> Students also would be able to help the clinic by serving as a link between patients and the clinic. For example, students could arrange appointments, communicate updates to specialist care teams or assist patients through the hospital discharge transition period.</p> <p> As part of hands-on HSS, students also could explore areas at a clinic where quality improvement initiatives would help advance patient care, or students could expand the educational library available for patients, the study said.</p> <p> <strong>What do students gain?</strong></p> <p> Professionals in the clinical setting told researchers that students would graduate from medical school with a better understanding of the health care delivery system and a better appreciation for the patient experience.</p> <p> “In identifying and addressing barriers to care, students would have the opportunity to appreciate firsthand the fragmentation of the health care system and participate in efforts to overcome those gaps to improve outcomes,” study authors wrote. Among the skills that leaders at the clinics and programs told researchers that medical students would gain:</p> <ul> <li style="margin-left:0.25in;"> “It will improve their ability to provide care to patients as they move on in their training. Sometimes people finish their medical training and don’t understand how you arrange visiting nurses or what community services are available for patients who may have a limited social network.”</li> </ul> <ul> <li style="margin-left:0.25in;"> “It’s really crucial to help students have a better understanding of all the barriers a person might face to get where they are when they show up in their exam room."</li> </ul> <ul> <li style="margin-left:0.25in;"> “Students need to be aware of the patient’s situation in life and how that is impacting their ability to either follow your recommendations or not, get the medications that they need or not, go to the referral that they need or not.”</li> </ul> <p> <strong>Learn more about ways medical education is changing, including:</strong></p> <ul> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/new-science-prepares-students-care-delivery-beyond-exam-room" target="_self">New science prepares students for care delivery beyond exam room</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">4 ways schools are paving a new path to residency</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/student-wellness-blueprints-curriculum-of-future" target="_self">Student wellness: Blueprints for an evolving curriculum</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/virtual-patients-create-med-ed-environment-of-future" target="_self">Virtual patients help create the med ed environment of the future</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/michigan-relaying-student-competency-residency-programs" target="_self">How Michigan is relaying student competency to residency programs</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d8c4862e-7044-42db-b0fe-00bc50c534f7 2016 AMA Annual Meeting gets underway--follow daily updates http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_2016-ama-annual-meeting-gets-underway-follow-daily-updates Thu, 09 Jun 2016 19:17:00 GMT <p> The nation’s physicians, residents and students are gathering June 11-15 in Chicago to weigh new AMA policy that will help advance the practice of medicine and improve the health of the nation. Members of the medical community who aren’t able to attend still can benefit from highlights of special educational sessions and follow the policymaking in daily updates.</p> <p> <strong>Policy discussion</strong></p> <p> Among the dozens of <a href="http://www.ama-assn.org/sub/meeting/reportsresolutions.html" target="_self">issues up for discussion</a> are such timely topics as:</p> <ul> <li style="margin-left:15pt;"> Improving the safety of drinking water</li> <li style="margin-left:15pt;"> Addressing the availability of addiction treatment centers</li> <li style="margin-left:15pt;"> Measuring and improving access to care for patients</li> <li style="margin-left:15pt;"> Increasing the number of residency positions available to train doctors for practice</li> <li style="margin-left:15pt;"> Reducing barriers to preventive and routine physical and mental health care for physicians in training</li> <li style="margin-left:15pt;"> Ensuring adequate resources and strategies to address the Zika virus</li> </ul> <p> Physicians representing every state and specialty will share perspectives and evaluate proposed solutions to national health care concerns.</p> <p> <strong>Special sessions</strong></p> <p> In addition to the policymaking portion of the meeting, physicians will hear from leading experts about pressing medical and professional issues, and other events will give physicians in training a chance to develop their skills.</p> <ul> <li> Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt will discuss the sweeping changes in delivery and payment being implemented under the landmark Medicare Access and CHIP Reauthorization Act (MACRA).</li> <li> Education sessions will cover timely topics ranging from addressing physician burnout to ending the nation's opioid epidemic, and from improving electronic health records to preparing for alternative payment models.</li> <li> Kevin Pho, MD, founder and editor of the popular physician blog KevinMD.com, will share practical insights about how to make a difference in health care through social media.</li> </ul> <p> <strong>How to follow the meeting</strong></p> <p> You can find meeting news—covering both policymaking and educational sessions—in several places. Beginning Friday night, look for <a href="http://www.ama-assn.org/ama/ama-wire/blog/AMA_Meeting/1" target="_self">daily updates</a> at <em>AMA Wire</em>®, visit the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">meeting website</a>, and check the AMA’s <a href="https://www.facebook.com/AmericanMedicalAssociation/" rel="nofollow" target="_blank">Facebook</a> and <a href="https://twitter.com/AmerMedicalAssn" rel="nofollow" target="_blank">Twitter</a> (#AMAmtg) news feeds. If you’re attending the meeting, make sure to <a href="http://www.ama-assn.org/sub/meeting/mobile.html" target="_self">download the AMA Meeting mobile app</a> as well.</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:41af8ac6-70c7-4b35-8131-9c72822735e9 Physicians take to “reset room” to battle burnout http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-reset-room-battle-burnout Wed, 08 Jun 2016 21:00:00 GMT <p> After surveying physicians and medical providers to assess the presence of burnout, one hospital in Minneapolis implemented several changes to their facility and processes to make sure the identified burnout triggers were addressed as soon as possible. In addition to scheduling and environmental transformations, a unique solution stands out—the creation of a room where physicians and medical providers can go to “reset” following a challenging or traumatic situation.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/5/a35d6862-abd8-4cf7-b5b4-5c1c88701ed1.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/5/a35d6862-abd8-4cf7-b5b4-5c1c88701ed1.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <div> <p> <strong>An office for work-life balance and burnout prevention</strong></p> <p> Leaders at Hennepin County Medical Center developed the Office for Professional Worklife to address the needs of its physicians and other medical providers.</p> <p> In order to make sure physicians and other providers are directly involved in burnout solutions, a wellness committee was created in 2013. It is made up of volunteers from each department who work with organizational leaders to periodically measure burnout through a survey called the <a href="https://www.stepsforward.org/Static/images/modules/15/downloadable/Mini%20Z%20burnout%20survey.docx" rel="nofollow" target="_self">“mini Z,”</a> which they administer annually. The committee meets for about an hour each month for brainstorming sessions to review current projects, plan new initiatives, discuss survey data and respond to new opportunities or stresses.</p> <p> “We sit down with the chair of each department and review their data from this year compared to last year and try and gain some insights about where the stress or burnout might be coming from,” said Mark Linzer, MD, internal medicine specialist and director of the division of general medicine at Hennepin County Medical Center.</p> <p> “Then we try and determine some next steps, which might require me to go to the executive leadership group to ask for flexibility or resources so they can put some plans into place,” Dr. Linzer said.</p> <p> Here are three ways Hennepin County Medical Center has already addressed burnout:</p> <ul> <li> <strong>Reset room.</strong> The reset room is a place physicians and other providers can go if they need a moment to reset during their day. If there is a traumatic event they wish to recover from, or they just want to get away for a moment, make a phone call or take a short nap, they can duck into the reset room.<br /> <br /> With LED lights, flameless candles, a sound machine, and comfortable chairs, several plants, and an “in-use” sign on the door, physicians and other providers can enter this quiet space for reflection or to disconnect for a moment.<br /> <br /> Few resources were required to create this welcoming space. The reset room was built inside what used to be an oddly shaped and poorly located office, which is perfect for this purpose because it is situated away from the regular action of the medical center.<br /> <br /> “I try not to monitor [the reset room] because I don’t want people to think I’m monitoring them,” said Sara Poplau, senior research project manager and assistant director of the Office for Professional Worklife. “That’s not what it’s about. But I know how I leave things, and I know how I find things, so I can tell that someone’s been in there—and that it’s benefitting our providers.”<br /> <br /> “Even if you don’t get to use it that often,” Poplau said, “at least you know that the institution values you in that sense.”</li> </ul> <ul> <li> <strong>Schedule changes for work-life balance.</strong> One of the first changes made at Hennepin County Medical Center addressed work-life balance. Physician parents were often unable to leave on time because their last complex patient was scheduled at 4:30 p.m. In many instances, this patient would not be ready for the physician to see until 4:45, making it challenging for a physician to pick up a child from daycare by 5:30 p.m.<br /> <br /> As a solution, the end-of-day schedule was re-engineered so the last complex patient was scheduled at 4 p.m. The 4:40 p.m. slot was changed to routine care instead of complex care, and this simple change helped parents leave work on time.<br /> <br /> Recognizing the demands of the day also was an important component.<br /> <br /> “We have one division where the burnout rate was high for nurse practitioners and PAs,” Dr. Linzer said. “We introduced some slots during their days to slow the pace of work and give them a chance to catch up with the [electronic health record], and that was very successful.”</li> </ul> <ul> <li> <strong>Environmental changes.</strong> One clinical department invested in new carpeting and asked staff to contribute ideas for locally sourced art.<br /> <br /> “A lot of the art ended up being from the staff,” Poplau said. “It was a fun team-building exercise in the sense that people might not have known that their co-worker was such a good photographer or painter.”<br /> <br /> The more welcoming environment and greater sense of community may have helped boost satisfaction among members of the department. Satisfaction in the department increased from 65 percent in the 2013 survey to 83 percent in 2014, while burnout decreased from 39 percent to 17 percent over the same time period.</li> </ul> <p> <strong>Changes in the pipeline</strong></p> <p> Many other changes to help physicians and other hospital staff in their daily routines are underway at Hennepin County Medical Center.</p> <p> “People come to us a lot,” Dr. Linzer said, “often with individual issues, and we really try to address those quickly so that they know that there’s an office that will take care of individual challenges to work life and wellness.”</p> <p> “We’ve been fundraising for the transformation of our old dining room into a provider dining and wellness center with a workout space, a shower and changing area, some meditation areas, yoga mats and an area to sit on the floor and debrief challenging events,” Dr. Linzer said. The wellness center is set to open by July.</p> <p> Also, one of the departments that reported a high stress as a result of electronic health records brought it to the attention of the wellness committee and together came up with a 10-point plan to reduce those stresses.</p> <p> “That’s a great example where the data spoke clearly that that was a major source of stress,” Dr. Linzer said, “and the organization is going to be able to respond.”</p> <p> Dr. Linzer, Poplau and Laura Guzman-Corrales, senior project coordinator at the Minneapolis Medical Research Foundation, authored a <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">module</a> on preventing physician burnout for the AMA’s <a href="https://www.stepsforward.org/modules/physician-burnout" rel="nofollow" target="_self">STEPS Forward™</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Other available modules on burnout cover <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_self">preventing resident and fellow burnout</a> and <a href="https://www.stepsforward.org/modules/improving-physician-resilience" rel="nofollow" target="_self">improving physician resiliency</a>.</p> <p> Thirty-five modules now are available in the 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" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p> Physicians and experts from around the world will gather Sept. 18-20 in Boston for the <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page" target="_self">International Conference on Physician Health™</a>. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will showcases research and perspectives into physicians’ health and offer practical, evidence-based skills and strategies to promote a healthier medical culture for physicians. <a href="http://www.ama-assn.org/ama/pub/physician-resources/physician-health/international-conference-physician-health.page?" target="_self">Learn more and register</a>.</p> <p> For more on how practices and organizations are preventing physician burnout:</p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/mayo-clinic-battling-burnout" target="_self">How the Mayo Clinic is battling burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/specialties-highest-burnout-rates" target="_self">Specialties with the highest burnout rates</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_self">4 physician-recommended steps to work- and home-life balance</a></li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></p> </div> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:721cfc48-01c3-43b5-98cc-f8379def1ca9 What FDA’s new sodium guidelines could look like in practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_fdas-new-sodium-guidelines-could-look-like-practice Wed, 08 Jun 2016 21:00:00 GMT <p> With nine out of 10 U.S. adults and children consuming too much sodium, the U.S. Food and Drug Administration (FDA) has released draft proposed voluntary guidelines to encourage companies to significantly reduce sodium in processed and restaurant foods by 2020. Some of the recommended changes may be eye-opening for patients who don’t closely monitor their sodium intake.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/12/92f99568-cc30-4ae8-9cff-3b81ebe8b489.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/12/92f99568-cc30-4ae8-9cff-3b81ebe8b489.Full.jpg?1" style="width:200px;height:1060px;margin:15px;float:right;" /></a></p> <p> <strong>The need to decrease sodium consumption</strong></p> <p> High sodium intake has a direct correlation to high blood pressure, which leads to heart disease and stroke—the most common causes of death in the U.S., contributing to more than 1,000 deaths per day.</p> <p> “There is strong evidence, including a recent analysis of more than 100 randomized clinical trials, that sodium reduction reduces blood pressure in adults,” Thomas R. Frieden, MD, director of the Centers for Disease Control and Prevention (CDC) said in a <a href="http://jama.jamanetwork.com/article.aspx?articleid=2527053" rel="nofollow" target="_self"><em>JAMA </em>Viewpoint</a>. “Excess dietary sodium intake may adversely affect the heart, kidneys, brain and blood vessels.”</p> <p> The <a href="http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/ucm494732.htm" rel="nofollow" target="_blank">proposed guidelines</a> set short- and long-term goals for a gradual reduction in sodium for both manufactured and restaurant products and should lead to a sustained reduction in the amount of sodium added to the food supply before foods reach consumers’ hands, he said.</p> <p> Dr. Frieden cited several problems with excess sodium in America:</p> <ul> <li> More than 70 percent of sodium consumed is in food products before they reach the table.</li> <li> Reducing sodium intake by 1,200 mg per day may reduce the number of people with hypertension by nearly 11 million.</li> <li> Reducing sodium intake by 400 mg per day could prevent 32,000 myocardial infarctions and 20,000 strokes annually.</li> </ul> <p> <strong>The guidelines in practice</strong></p> <p> In addition to the written proposed guidelines, the CDC also issued a <a href="http://www.fda.gov/downloads/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/UCM503801.xlsx" rel="nofollow" target="_blank">table</a> detailing 150 food categories in which sodium should be reduced. These decreases in sodium range from as low as 14 percent to as high as almost 67 percent.</p> <p> For example, under the category “bacon bits and pieces,” the 2010 baseline weighted mean was 2,534 mg of sodium per 100 g. By 2020, the CDC is asking that restaurants and manufacturers reduce this level to 1,000 mg of sodium per 100 g, for a decrease of 60.5 percent</p> <p> Though not significantly high in sodium, the category “canned vegetables,” for which the 2010 baseline weighted mean was 307 mg of sodium per 100 g, should be reduced to 250 mg of sodium per 100 g by 2020, according to the guidelines—that’s a decrease of 18.5 percent. This is not a giant leap, but even small decreases in sodium levels hold the opportunity to improve the health of the nation.</p> <p> “We applaud the FDA for proposing new sodium reduction targets and industry guidelines that will help Americans limit the amount of sodium they consume and, in turn, make our country healthier,” said AMA President Steven J. Stack, MD. “These voluntary guidelines are a blueprint for further action, but the onus is on the food industry to now take the necessary steps to reduce sodium in its products, and help us improve health outcomes for all Americans.”</p> <p> The FDA’s action also supports the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_self">Improving Health Outcomes</a> initiative to significantly reduce the number of American adults living with uncontrolled high blood pressure. Recently, in partnership with the American Heart Association, the AMA launched a national initiative called <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-11-09-prioritize-blood-pressure-control.page" target="_self"><em>Target: BP™</em></a>, to provide physician practices, care teams and health systems with the resources and support they need to improve blood pressure control rates within the communities they serve.</p> <p> The AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/prevent-heart-disease.page" target="_self">M.A.P. to Improve Blood Pressure Control</a>, developed in partnership with Johns Hopkins, calls for physicians and care teams to <strong>M</strong>easure blood pressure accurately, <strong>A</strong>ct rapidly to treat patients uncontrolled blood pressure and <strong>P</strong>artner with patients, families and communities to promote self-management.</p> <p> <strong>For more on how to better control blood pressure, check out these M.A.P. resources:</strong></p> <ul> <li> The <a href="https://download.ama-assn.org/resources/doc/about-ama/x-pub/ihobp-map-for-optimal-hypertension-control.pdf" target="_self">M.A.P. checklists</a> (log in) for your team to use</li> <li> A <a href="https://download.ama-assn.org/resources/doc/about-ama/x-pub/iho-bp-chart.pdf" target="_self">chart of common errors</a> (log in) while measuring BP</li> <li> The <a href="https://download.ama-assn.org/resources/doc/about-ama/x-pub/iho-bp-proper-positioning-technique-english.pdf" target="_self">proper positioning poster</a> (log in) shows proper techniques for taking a measurement</li> </ul> <p> Also, find out <a href="http://www.ama-assn.org/ama/ama-wire/post/need-start-self-measured-bp-practice" target="_self">what you need to start a self-measured blood pressure monitoring program</a> in your practice.</p> <p>  </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:c2a04c70-7c6a-4054-a5cb-f0009607063e Damaged patient-physician relationships: Ethics essay contest http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_damaged-patient-physician-relationships-ethics-essay-contest Tue, 07 Jun 2016 22:26:00 GMT <p> The <a href="http://journalofethics.ama-assn.org/" target="_blank"><em>AMA Journal of Ethics</em></a><em><sup>®</sup></em> is once again accepting essays analyzing a case in medical ethics. In this year’s case, clinicians respond to a so-called “difficult” patient with a history of chronic pain and opioid use who has just had an amputation. The John Conley Ethics Essay Contest is for currently enrolled U.S. medical students, offers cash prizes and qualifies winners to publish in the journal.</p> <p> Essayists are asked to respond to this question:</p> <p> <em>Is repairing a damaged patient-physician relationship an equally shared responsibility for a physician and patient, or does one person bear more responsibility?</em></p> <p> Essays of no more than 1,800 words are due by Sept. 19. Essays are judged on clarity of presentation, writing style and applicability of the argument to decision-making. After editing, winning essays will be published in the <em>AMA Journal of Ethics</em>.</p> <p> The John Conley Ethics Essay Contest offers prizes up to $5,000 to currently enrolled U.S. medical students and qualifies winners for publication in the journal. Authors of up to three runner-up essays can receive $1,000 prizes.</p> <p> The annual contest is supported by the John Conley Foundation for Ethics and Philosophy in Medicine. John J. Conley, MD, (1912-1999) was an otolaryngologist and head and neck surgeon with a passion for medicine and its ethical practice.</p> <p> Read some <a href="http://journalofethics.ama-assn.org/site/conleywinners.html" target="_blank">winning essays</a> from past contests.</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0eb4882f-f876-42cd-b6a1-934b1af32505 The one thing most young physicians put off--but shouldn’t http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_one-thing-young-physicians-put-off-but-shouldnt Tue, 07 Jun 2016 22:25:00 GMT <p> A recent report found that young physicians are unprepared in key ways for accidents and illnesses that could leave them disabled or worse.</p> <p> <strong>Planning for the unexpected</strong></p> <p> Preparing for unanticipated accidents or illnesses is an essential activity, but few young physicians take the time to make the necessary plans. Less than 25 percent of young physicians have an updated will, power of attorney documents and end-of-life or medical directives, according to a special report by AMA Insurance.</p> <p> Residency can be one of the most stressful periods in physicians’ professional lives, leaving little time for tasks that don’t require immediate attention. But setting aside these crucial documents for later can put you and your family at risk.</p> <p> In the “<a href="https://www.amainsure.com/reports/2015-young-physician-report/index.html?page=2" target="_blank" rel="nofollow">2015 report on physicians’ financial preparedness: Young physicians segment</a>,” AMA Insurance found critical gaps in financial and legal planning among young physicians. The lack of wills, medical directives and power of attorney stood out among survey respondents as one of the most glaring gaps:</p> <ul> <li> Just 24 percent of respondents have prepared a will.</li> <li> 23 percent have power of attorney documents.</li> <li> 21 percent have medical directives.</li> <li> 20 percent have end-of-life directives.</li> </ul> <p> <strong>Preparations that can’t wait</strong></p> <p> The report analyzed three national surveys of 1,937 physicians under 40 years of age. With those physicians in mind, AMA Insurance asked Jerry Moran, a senior wealth strategist with Millennium Brokerage Group, to offer five strategies for building a strong financial foundation.</p> <p> In a strategy that Moran titled “Prepare for the unexpected; protect the people you love,” he said wills, power of attorney and directives simply should not wait.</p> <p> You might find it a low priority to prepare documents that seem more appropriate for physicians near the end of their careers. But the AMA Insurance research underlines some key reasons to look ahead and plan for the unexpected, for both yourself and your family:</p> <ul> <li> Most young physicians are married.</li> <li> Two-thirds are homeowners.</li> <li> 60 percent are working parents.</li> </ul> <p> In some ways, putting off wills and kindred documents comes naturally. Tasks that don’t seem relevant at the time are easy to put off, procrastination researchers find. After all, most of us imagine we will die, preferably in bed, well into our twilight years.</p> <p> Other reasons to delay include perfectionism and the feeling that we lack the resources to accomplish the task, according to the <a href="https://www.brown.edu/campus-life/support/counseling-and-psychological-services/index.php?q=overcoming-procrastination" target="_blank" rel="nofollow">counseling center at Brown University</a>.</p> <p> Overcoming procrastination involves breaking down the task into small steps, and weighing the consequences of not acting. And according to financial experts, those consequences can be severe for residents and young physicians.</p> <p> <strong>Learn more about financial security for physicians:</strong></p> <ul> <li> The leading <a href="http://www.ama-assn.org/ama/ama-wire/post/6-top-financial-planning-mistakes-physicians" target="_self">financial planning mistakes</a> physicians make.</li> <li> The basics of <a href="http://www.ama-assn.org/ama/ama-wire/post/should-student-loan-refinancing" target="_self">student loan refinancing</a>.</li> <li> Kicking your <a href="http://www.ama-assn.org/ama/ama-wire/post/kick-financial-plan-high-gear" target="_self">financial plan into high gear</a>.</li> <li> Finding <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-partner-physician-friendly-financial-advisor" target="_self">a financial adviser</a> that’s right for you.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d521da9a-6611-49ba-8607-97ac0feb1b11 By the numbers: Specialty preferences before and after med school http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_numbers-specialty-preferences-before-after-med-school Tue, 07 Jun 2016 02:00:00 GMT <p> Do you know how many of your peers end up in the field they picked when they began medical school? Which specialties are students most likely to stick with, and which ones attract students along the way? We break down the statistics.</p> <p> <strong>The odds</strong></p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/1/02e997cb-84a1-48b1-81ba-d2d6fedb8130.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/1/02e997cb-84a1-48b1-81ba-d2d6fedb8130.Large.png?1" style="margin:15px;float:right;" /></a>Chances are you will end up in a different medical specialty than the one you had picked out when you first set foot on campus.</p> <p> Just 1 in 4 medical school graduates ended up in the same specialty they picked the summer before they started medical school, according to a recent <a href="https://www.aamc.org/data/448476/a1table.html" rel="nofollow" target="_blank">report</a> from the Association of American Medical Colleges. That statistic is based on information from 10,353 students who indicated a specialty preference on the 2015 Graduation Questionnaire (GQ) and participated in the Matriculating Student Questionnaire (MSQ) they were invited to complete the summer before the first year of medical school.</p> <p> Slightly more than one-half of the students who indicated a preference on the MSQ ended up in a different specialty than the one reported before gross anatomy and clinical rotations, the data showed. Another 15 percent were undecided when they took the MSQ, while 7 percent of the students had no MSQ response.</p> <p> <strong>Specialties with staying power</strong></p> <p> Orthopaedic surgery and its subspecialties had the highest percentage of students who initially indicated they planned to pursue that field, the data showed. Among the 2015 graduates going into a residency for orthopaedic surgery or a subspecialty, 53.6 percent had said that was what they wanted to pursue when they began medical school.</p> <p> Rounding out the top five specialties with the highest percentage of graduates pursuing their initial preference were:</p> <ul> <li> Pediatrics or a subspecialty: 37.7 percent</li> <li> Neurological surgery: 33.1 percent</li> <li> Emergency medicine or a subspecialty: 31.8 percent</li> <li> Family medicine or a subspecialty: 31.6 percent</li> </ul> <p> Among the 2,033 going into internal medicine or a subspecialty, 26.3 percent initially said they wanted to pursue that specialty.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/2/bdbbe657-67dc-40a1-a2a6-4b7cb7da8098.Full.png?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/2/bdbbe657-67dc-40a1-a2a6-4b7cb7da8098.Large.png?1" style="margin:15px;float:right;" /></a><strong>New specialty picks</strong></p> <p> Internal medicine/pediatrics had the largest percent of students who indicated a different specialty before they started medical school, with 78.9 percent thinking they would pursue a different field. The other top specialties with students who originally thought they would go into a different type of medicine were:</p> <ul> <li> Physical medicine and rehabilitation or subspecialty: 69.9 percent</li> <li> Urology: 71.0 percent</li> <li> Otolaryngology or subspecialty: 68.1 percent</li> <li> Preventive medicine or subspecialty: 66.7 percent</li> </ul> <p> Slightly less than one-half of the more than 2,000 graduates going into internal medicine and its subspecialties reported a different specialty interest before starting medical school.  </p> <p> <strong>Guidance in choosing a specialty</strong></p> <p> Students at the 2016 National Medical Student Meeting can talk to physicians about their practices during the AMA Medical Specialty Showcase and Clinical Skills Workshop scheduled for June 11 from 11:30 a.m. to 1:30 p.m. Practicing physicians will share information that can help students learn more about their preferred specialties, and students also can practice such clinical skills as ultrasound, airway management and suturing.</p> <p> <em>AMA Wire</em>’s <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_self">“Shadow Me” specialty series</a> helps students evaluate specialties in which they are interested by providing insights directly from physicians in a variety of specialties.</p> <p> 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="_self">resource guide</a> (AMA member log in required) highlights the major specialties and subspecialties, and offers Match data and career information statistics.</p> <p> Students also can read more <em>AMA Wire</em> posts on <a href="http://www.ama-assn.org/ama/ama-wire/post/medical-specialty-choice-under-microscope-2015" target="_self">specialty selection</a>, including <a href="http://www.ama-assn.org/ama/ama-wire/post/5-things-students-overlook-choosing-specialty" target="_self">what students often overlook</a> when choosing a specialty, <a href="http://www.ama-assn.org/ama/ama-wire/post/top-specialties-fellowship-applicants-2015-match-glance" target="_self">which specialties</a> drew the most students and which were the most competitive.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:9cdff57e-cfd3-4b6d-aa83-2b5002b2662a 4 steps to improve quality in your practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-steps-improve-quality-practice Mon, 06 Jun 2016 22:15:00 GMT <p> For doctors who want to improve patient care and office efficiency, there is a straight-forward, cost-effective way to achieve that goal. Learn the four steps you need to take.</p> <p> <strong>Plan-Do-Study-Act</strong></p> <p> A <a href="https://www.stepsforward.org/modules/pdsa-quality-improvement" rel="nofollow" target="_self">new module</a> in the AMA’s STEPS Forward™ collection of practice improvement strategies can guide you through the steps it will take to make quality-of-care improvements you have identified—anything from improving adult immunization rates to bettering diabetes or hypertension screening and care. It also can help your staff work flow concerns, such as lowering no-show rates and wait times and increasing your chances of finishing the day on time.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/15/e29f7e67-6531-40e9-bf1b-eb55c6f52982.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/15/e29f7e67-6531-40e9-bf1b-eb55c6f52982.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> And once you’ve made changes, the steps can help you find opportunities to make “improved” processes even better.</p> <p> The module—written by Laura Lee Hall, PhD, director of the Center for Quality and Office of Grants at the American College of Physicians—lays out a four-step Plan-Do-Study-Act (PDSA) strategy that physicians can follow.</p> <ul> <li style="margin-left:27pt;"> Plan: Develop the initiative</li> </ul> <ul> <li style="margin-left:27pt;"> Do: Implement your plan</li> </ul> <ul> <li style="margin-left:27pt;"> Study: Check the results</li> </ul> <ul> <li style="margin-left:27pt;"> Act: Make further improvements</li> </ul> <p> <strong>Developing a plan</strong></p> <p> When deciding upon the quality improvement initiative, physicians should ask people on the front lines—for example clinical team members and clerical staff—their opinions on what needs to change. Patient surveys also can be a useful tool. Ask:</p> <ul> <li style="margin-left:27pt;"> <em>Where does the practice need to improve patient care?</em> Performance measure data from a Physician Quality Reporting System or point-of-care registry may be able to point out gaps in care processes or patient outcomes.</li> </ul> <ul> <li style="margin-left:27pt;"> <em>Where is your practice less efficient than it should be?</em> Staff can help identify bottlenecks in the work flow and key areas for improvement. Prioritize areas in which you have some control and that the team thinks will have the most impact.</li> </ul> <ul> <li style="margin-left:27pt;"> <em>What about the day is most frustrating for your team and/or patients?</em> Ask them and prioritize which items should be improved.</li> </ul> <p> The module can walk you through the steps needed to develop the plan, including what your practice wants to accomplish, when the changes will take place, and what team training and preparation is required.</p> <p> <strong>Implementing a plan</strong></p> <p> The module also helps the change team with the follow-through once the plan is devised, offering suggestions and resources on how to implement the plan and determine how the changes are working.</p> <p> For example, physicians trying to improve diabetes care can look at the percentage of patients with diabetes who have a current A1c level documented to assess actions taken by the clinical team; to measure patient outcomes, look at the percentage of patients who have an A1c level less than 7.0.</p> <p> “I thought I had a good handle on managing my diabetic patients, but I learned about facilitating good decision-making by my patients, coaching behavioral changes and gaining insight into patient compliance,” said Baltimore internist Robert Dobbin Chow, MD, who used the PDSA model. “I also learned about how to engage my office staff into optimizing our care of our diabetic patients.”</p> <p> A multi-specialty group in Brooklyn, N.Y., improved patient communication and outcomes for diabetes patients without hiring any additional staff using the PDSA model. It began with a simple questionnaire that uncovered that diabetic patients knew far less about their disease and their care plan than physicians realized. Read more about that practice’s experience on the <a href="https://www.stepsforward.org/modules/pdsa-quality-improvement" rel="nofollow" target="_self">STEPS in practice</a> portion of the new module.</p> <p> <strong>More practice resources</strong></p> <p> The module on quality improvement using Plan-Do-Study-Act is one of eight new modules recently added to the AMA’s <a href="https://www.stepsforward.org/modules" rel="nofollow" target="_self">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p> <em>AMA Wire</em> explores many of the other <a href="http://www.ama-assn.org/ama/ama-wire/blog/STEPS_Forward/1" target="_self">modules</a>, including why your practice needs a health coach and four questions to ask to find out if your patients have unmet needs. </p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ff9b89c1-d981-46b4-889d-741c6043e117 The antidote: 3 things to consider when co-prescribing naloxone http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_antidote-3-things-consider-co-prescribing-naloxone Fri, 03 Jun 2016 21:00:00 GMT <p> Community distribution, use by first responders and co-prescribing of the opioid antagonist naloxone has been shown to reverse prescription opioid and heroin overdose and save lives across the country. But how do you explain the safety benefits of a naloxone prescription to your patients without the stigma that overdose carries? Learn how one physician approaches this issue in a way that helps patients understand that co-prescribing naloxone is for their own safety and well-being.</p> <p> Naloxone has saved tens of thousands of lives and will save many more as its availability continues to increase throughout the country. Some patients with chronic pain benefit from opioid treatment, but these medications carry certain risks, including respiratory depression, so co-prescribing naloxone for patient safety is an important tool for physicians.</p> <p> Recently, a study surveyed more than 100 prescribers in clinics that were dispensing naloxone in San Francisco, and about 80 percent had co-prescribed naloxone, said the study’s lead author Phillip O. Coffin, MD, director of substance use research at the San Francisco Department of Public Health and an internal medicine and infectious disease specialist. “99 percent felt that they were likely to prescribe naloxone in the future.”</p> <p> <strong>How to talk about naloxone with your patients</strong></p> <p> Dr. Coffin said routinely co-prescribing naloxone is important not just for patients physicians think may overdose, but also for safeguarding others who may have access to these medications.</p> <p> “No. 1 is, yes, that person may be at risk of overdose,” he said. “But No. 2 is the person may have enough opioids at their house that somebody else in their life or community could access those and be at risk of overdose.”</p> <p> When framing the conversation with patients, emphasize that opioid medications carry certain risks, not that the patients themselves are risky, Dr. Coffin said. “That’s important to help reduce the stigma and help make patients feel like they’re not being targeted or somehow accused of being out of control with their medications.”</p> <p> Here are three important things Dr. Coffin considers when co-prescribing naloxone:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Talking about overdose</strong><br /> “It is critical not to start out with the word ‘overdose,’” Dr. Coffin said. “The word ‘overdose’ to a patient, and to many providers, means either injecting heroin or taking a whole bottle of pills. That’s not what we mean as a medical system when we talk about the risk of overdose with opioids. What we mean is when there are more opioids in your body at a given time than your body can handle at that time.”<br /> <br /> “That might mean you have sleep apnea, and you stop using your C-PAP machine and so the opioids that you take could suppress your respiration too much for you to breathe enough that night, and you might effectively overdose,” he said. “It might mean you get a bout of pneumonia, and you’re not breathing as well …. It might mean that your five-year-old grandkid gets into your medicine cabinet.”<br /> <br /> “It can mean a lot of things, but it doesn’t mean that you’re a bad person or that you’re doing something wrong,” he said. “It means that these are risky medications, and we want to make sure that the antidote is nearby in case something happens to you or someone in your social network.”</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>The risks involved</strong><br /> Bringing naloxone into the conversation can help patients recognize that the medications they’re using can be dangerous, Dr. Coffin said. “Once you’re prescribed opioids, it’s hard to understand that this is risky. ‘Why would my doctor prescribe this to me if it’s risky?’ You can talk about the risks of opioids, but we know patients don’t really hear that.”<br /> <br /> “When you pair that with an actual prescription, with an actual intervention, it helps to impress upon the patient that … my goal in working with you with opioids is to maximize your safety and well-being.”<br /> <br /> “There’s that need to have some sort of tangible intervention that can really solidify the counseling that’s provided in the clinical interaction,” Dr. Coffin said. “Naloxone can serve that purpose in addition to the more direct potential benefits of reducing mortality.”</p> <p style="margin-left:40px;"> <strong>3.   </strong><strong>Who should get naloxone</strong><br /> There are two contexts in the distribution of naloxone, Dr. Coffin said. “One is the context of distributing it to drug users, and that’s usually through needle exchange programs,” he said. “That’s where it’s most likely to be used to reverse an overdose. Around 20 percent of the naloxone handed out at these programs ends up being used to reverse an overdose.”<br /> <br /> The next context for distribution is co-prescribing naloxone to patients—and that is much different. “You’re working with patients who are prescribed opioids, and they perceive their risk of overdose to be low or nonexistent,” Dr. Coffin said. This situation cannot be approached in the same way as handing out naloxone at a needle exchange program.<br /> <br /> “When you’re in a clinic, … patients don’t perceive that they’re at risk and they’re not hanging out with a bunch of people injecting opioids,” he said. “They’re not overdosing all the time, or perhaps they don’t see themselves as overdosing.”<br /> <br /> “In fact, we did interview some patients who … [were given] naloxone by the paramedics after taking opioid medications, but they didn’t perceive it as an overdose,” he said. “Many of our patients who had overdosed perceived the event as an adverse reaction to their medication. That’s a critical distinction that patients make … they see this as a bad reaction like having anaphylaxis to a medication or a severe rash.”<br /> <br /> In the clinic, “you have the added benefit of the clinician interaction,” he said. “You can use that naloxone prescription as a way to get in there and talk about broader opioid safety issues.”</p> <p> <strong>Learn more about physicians’ efforts to end the opioid epidemic:</strong></p> <ul> <li> Read Dr. Coffin’s advice for <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">talking about substance use disorders with your patients</a></li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder?utm_source=BulletinHealthCare&utm_medium=email&utm_term=052816&utm_content=residents&utm_campaign=article_alert-morning_rounds_weekend" target="_self">3 steps for your first conversation with a patient with a substance use disorder</a></li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/entire-state-gets-one-naloxone-prescription" target="_self">how one state made naloxone available for its entire population</a></li> <li> Learn what the AMA Task Force to Reduce Opioid Abuse <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_self">recommends for physicians to reduce stigma and increase use of </a>medication-assisted treatment.</li> <li> Read a <a href="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a>, and watch a <a href="https://www.youtube.com/watch?v=U2VUot6c8lw" rel="nofollow" target="_blank">video message</a> from AMA President Steven J. Stack, MD.</li> </ul> <p> Are you treating patients with substance use disorder? Send us an <a href="mailto:amawire@ama-assn.org" rel="nofollow">email</a> or comment below to tell us how you do it and how your practice is helping patients.</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:8d3b16bf-abe3-4afd-a114-eb0ed8dbc615 How Brigham and Women’s is using claims data to improve outcomes http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_brigham-womens-using-claims-data-improve-outcomes Fri, 03 Jun 2016 21:00:00 GMT <p> As more tools for data collection become available, physicians are adopting them in creative but simple ways to improve outcomes for patients. One physician explains how his hospital is leveraging these tools and other sources of data analysis for patient care.</p> <p> <strong>Reducing readmissions with the LACE index</strong></p> <p> Access to large amounts of data could allow physicians to get to specific actionable needs and gaps, said David Bates, MD, officer and chief of internal medicine and primary care at Brigham and Women’s Hospital in Boston. “We ought to be able to use sources of data to figure out … what’s relevant for individual patients.”</p> <p> At Brigham and Women’s Hospital, Dr. Bates and his colleagues use a tool based on the LACE index to identify patients that are at risk for readmission or death within 30 days of discharge:</p> <p style="margin-left:.5in;"> <strong>L:</strong> Length of stay</p> <p style="margin-left:.5in;"> <strong>A:</strong> Acuity of admission</p> <p style="margin-left:.5in;"> <strong>C:</strong> Co-morbidities</p> <p style="margin-left:.5in;"> <strong>E:</strong> Emergency department visits in last six months</p> <p> “We take claims data from the last 12 months—there are clinical conditions from a list of about 30 that are categorized high, moderate or low-acuity—then take combinations of conditions from each category to figure out how clinically complex the patient is.”</p> <p> By using this approach and having a care manager work with these patients, Brigham and Women’s Hospital has been able to decrease their inpatient discharge rate over time, “which is exactly what you’d want to see,” he said.</p> <p> <strong>Tools and data sources to take care one step further</strong></p> <p> In one trial, Brigham and Women’s Hospital used a device that measures pulse, respiratory rate and how much the patient was moving and decreased the number of subsequent intensive care unit days by 47 percent. “This is the kind of thing that can improve value,” Dr. Bates said.</p> <p> “Tools are now available to monitor patients, and that’s especially important outside of intensive care units, where we monitor patients fairly aggressively for a long period of time,” he said. “In intensive care units, it will be especially valuable to take all the data that we have and put it together and look for trends.”</p> <p> Clinical data are now ubiquitous in the U.S. “We have them in over 80 percent of hospitals and also in the outpatient setting,” Dr. Bates said. “Yet most organizations haven’t yet figured out how to best leverage this data, and they don’t have robust plans for doing that.”</p> <p> Making sure hospitals and practices have the appropriate resources and payment models available will be key. “Every organization will need to invest,” he said. “If there are incentives that pay people for value, they’ll have resources to do that.”</p> <p> “If you want to look from the bigger picture,” he said, “what is going to help the most at the margin in terms of doing better with these predictions—I think it will be novel sources like social data and mobile data, which will enable us to identify many things that we can’t today.”</p> <p> For more on data use in practice, find out why one surgeon says <a href="http://www.ama-assn.org/ama/ama-wire/post/medicine-needs-cloud" target="_self">medicine needs a cloud</a>, or read <a href="http://www.ama-assn.org/ama/ama-wire/post/minnesota-practice-preventing-diabetes-can" target="_self">how a practice in Minnesota is using patient data</a> to enroll patients in diabetes prevention programs.</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:c7faf687-7c35-4ba6-bb92-c064cdcd2f10 The physician’s ethical role in mental illness http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-ethical-role-mental-illness Thu, 02 Jun 2016 22:00:00 GMT <p> The diagnosis and treatment of mental illness can raise a lot of ethical questions and concerns that challenge the patient-physician relationship. Focusing on minimizing stigma and communicating in ways that emphasize a patient’s strengths can help reinforce the patient-physician bond. But as physicians know, not all courses of treatment have the desired result.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/9/03f37388-d5ba-45cc-8972-065926571a9c.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/3/9/03f37388-d5ba-45cc-8972-065926571a9c.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_self">June issue</a> of the <em>AMA Journal of Ethics®</em> explores some of the critical social, cultural and ethical dimensions of mental illness. Articles featured in this issue include:</p> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/06/stas1-1606.html" target="_self">Ethical and clinical dilemmas in using psychotropic medications during pregnancy</a>.” Pregnant women with mental illness tend to overestimate the risks of medication and underestimate the risks of untreated mental illness.  Learn how to address this perceived ethical dilemma and provide optimum care for pregnant patients.</li> <li> “<a href="http://journalofethics.ama-assn.org/2016/06/ecas2-1606.html" target="_self">Psychiatric diagnostic uncertainty: Challenges to patient-centered care</a>.” In a case study, a patient requests to be treated for depression without including the diagnostic label of bipolar II disorder in her health record. Find out how to ethically diagnose appropriately while also remaining sensitive to your patient’s request.</li> <li> “<a href="http://journalofethics.ama-assn.org/2016/06/msoc1-1606.html" target="_self">Psychosis risk: What is it, and how should we talk about it?</a>” Researchers and clinicians face ethical and policy-based challenges in disclosing, preventing and treating psychosis. Learn which diagnostic labels should be considered to motivate more effective public and professional dialogue about psychosis risk.</li> <li> “<a href="http://journalofethics.ama-assn.org/2016/06/ecas4-1606.html" target="_self">When is depression a terminal illness? Deliberative suicide in chronic mental illness.</a>” When a patient whose autonomy is intact vocalizes suicidal intent and is doubtful that any course of treatment will alter that intent, how should a physician respond? Explore the concept of hope and its therapeutic limitations.</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-jun-2016.mp3" target="_self">June podcast</a>, Srijan Sen, MD, an associate professor of psychiatry at University of Michigan Medical School, discusses how mental health care and medical culture can be changed to benefit medical trainees.</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_self">Give your answer</a> to this month’s poll: How is alcohol addiction most effectively treated?</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://amajournalofethics.msubmit.net/" 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:7f3af2fd-931c-43c9-b2a6-9a3939ef254c New science prepares students for care delivery beyond exam room http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-science-prepares-students-care-delivery-beyond-exam-room Thu, 02 Jun 2016 22:00:00 GMT <p> A new practice-based science can help prepare medical students to be the best physicians possible, but several barriers stand in the way of successfully incorporating it into students’ educations.</p> <p> <strong>Preparing students for today’s health system</strong></p> <p> Medical students recognize that learning about health systems science (HSS)—including population health, health systems improvement and high-value care—will help them be better physicians. But students say that preparing to pass their medical licensing board examinations and place in the best residency programs overshadows HSS, a new <a href="http://onlinelibrary.wiley.com/doi/10.1111/medu.12957/full" target="_blank" rel="nofollow">study</a> shows.</p> <p> 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/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>, Penn State University College of Medicine has been implementing a new curriculum that involves HSS.</p> <p> The goal has been to align medical education with the needs of health systems through a new course that focuses on topics such as insurance, cost, value, care coordination, population health, public health, health care performance, teamwork and leadership.</p> <p> To underscore the relevance of this classroom-based course, the program includes a component in which students are embedded in health systems in south-central Pennsylvania as patient navigators. In that role, students help patients work through complex health care systems to get the care they need and are involved in efforts to reduce health care disparities.</p> <p> This curriculum comes after medical literature and interviews with residents and educators over the past five to eight years suggested that medical school graduates are not prepared to hit the ground running when they begin residency, the study’s principal investigator Jed D. Gonzalo, MD, an internist and assistant professor of medicine and public health sciences at the Penn State University College of Medicine said in a <a href="http://medicaleducation.podbean.com/e/exploring-challenges-in-implementing-a-health-systems-science-curriculum-jed-gonzalo-interview/" target="_blank" rel="nofollow">podcast</a>.</p> <p> Residents “are very good, clinically astute physicians in doing the traditional diagnostics and therapeutics,” Dr. Gonzalo said. “But from a patient-centered lens or from understanding the health context and the health system in which our patients live and our health care is delivered, the knowledge and skills there may be insufficient.”</p> <p> <strong>Barriers to success for the new curriculum</strong></p> <p> In 2014, Dr. Gonzalo and his colleagues talked to 12 focus groups with 50 medical students across all years of medical school about the planned HSS curriculum at Penn State University College of Medicine. Students told researchers they believed an HSS curriculum would allow them to gain new knowledge and skills, enhance their understanding of patients’ perspectives, and improve their learning through hands-on roles.</p> <p> But the students also said they are feeling pressure to perform well on examinations and position themselves to match into their preferred residencies, making studying HSS a lower priority because HSS concepts are not on the exams.</p> <p> “As a result HSS is viewed as peripheral and non-essential, greatly limiting student engagement,” study authors concluded.</p> <p> Researchers identified four categories of barriers to HSS studies:</p> <ul> <li style="margin-left:27pt;"> Medical board licensing examinations foster a view of basic science as “core”</li> <li style="margin-left:27pt;"> Systems concepts are important but not essential</li> <li style="margin-left:27pt;"> Students lack sufficient knowledge and skills to perform systems roles</li> <li style="margin-left:27pt;"> Current medical education and clinical systems culture does not support systems education</li> </ul> <p> Study authors said “successfully addressing and working with this tension will require candid exploration of educational goals, competing commitments and rationales, along with careful testing of underlying assumptions.”</p> <p> <strong>An emerging field</strong></p> <p> Dr. Gonzalo said he and his colleagues have used the feedback to tweak the way they are implementing HSS. For example, educators tell students that they recognize that they are studying for other things. But they remind students about the oaths they took when they came to medical school, identifying the reasons they were going into medicine and expressing the type of physicians they wanted to become. For most students, understanding HSS is essential to them in becoming that physician, Dr. Gonzalo said. </p> <p> “We haven’t mastered this yet. We are two years into the program,” Dr. Gonzalo said. “It is a continuous improvement cycle.”</p> <p> <strong>Learn more about changes underway in med ed:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/new-third-science-bedrock-transforming-med-ed" target="_self">New “third science” a bedrock for transforming med ed</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/difficult-science-might-not-but-should" target="_self">The difficult science you might not know—but should</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-schools-paving-new-path-residency" target="_self">4 ways schools are paving a new path to residency</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/student-wellness-blueprints-curriculum-of-future" target="_self">Student wellness: Blueprints for the curriculum of the future</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:594452dc-135e-4f7c-aff6-030381a63cde Making residency more family friendly http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_making-residency-family-friendly Wed, 01 Jun 2016 22:00:00 GMT <p> With pregnancy and parenthood common during training, two recent studies examined the challenges residents encounter when becoming parents. Find out what the study discovered about childcare, breastfeeding and parental leave policies.  </p> <p> <strong>Parenthood is common</strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/4/0768aeec-78dc-4d66-8486-68780250e419.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/4/0768aeec-78dc-4d66-8486-68780250e419.Full.jpg?1" style="margin:15px;float:right;width:365px;height:250px;" /></a></p> <p> Residency programs need more consistent parental leave, breastfeeding mothers need more spaces to express and store breast milk while at work, and parents need better access to onsite childcare, two recent studies looking at parenthood during training concluded.</p> <p> These are areas of concern because residency coincides with the prime reproductive years and women comprise one-half of medical school graduates. Parenthood is and will continue to be a frequent occurrence during training.</p> <p> Slightly more than one-half of the 190 radiation oncology trainees who responded to a survey had children, according to a <a href="http://www.redjournal.org/article/S0360-3016(15)00202-3/abstract" rel="nofollow" target="_blank">study</a> in the <em>International Journal of Radiation Oncology</em>. Nearly 45 percent said they or their partner had a pregnancy during residency.</p> <p> Similarly, general surgery residents commonly take parental leave. In a <a href="http://www.journalacs.org/article/S1072-7515(15)01774-3/fulltext" rel="nofollow" target="_blank">study</a> published in the <em>Journal of the American College of Surgeons</em>, 41 percent of the 66 general surgery residency program directors who responded to a survey said at least once a year they have a resident who takes maternity or paternity leave.</p> <p> <strong>Breastfeeding and childcare concerns</strong></p> <p> New mothers told researchers they worried about being able to breastfeed when they went back to work. Among radiation oncology residents, just 40.7 percent said they had enough time and privacy to pump breast milk.</p> <p> General surgery residents told researchers they had a hard time finding time to express breast milk. Among the general surgery program directors, only 8 percent said their program had a formal breastfeeding policy. But 77 percent said a typical attending at their program would let a resident scrub out of a case to pump.</p> <p> Nearly 60 percent of program directors said there were lactation facilities at the hospitals; however, programs in the Northeast are less likely than other parts of the country to have a spot for mothers, with just 29 percent of program directors reporting available rooms, versus 71 percent in other parts of the country.</p> <p> Childcare facilities also were a concern. Nearly 40 percent of general surgery program directors said there was on-site childcare at the hospital. But even when available, residents can face waiting lists to enroll, and pick-up and drop-off times often do not work with their schedules.</p> <p> “We encourage program directors to be attentive to the well-being of trainees who are parents and where possible work to improve availability of childcare and lactation facilities,” authors of the general surgery study said.</p> <p> <strong>Standardizing parental leave?</strong></p> <p> Paternal leave is a concern for both men and women, and policies—when in place—vary nationwide.</p> <p> “Pregnancy- and parenthood-friendly policies are not a gender-specific issue, as men are increasingly interested in taking time off after the birth of a child; however, the time and energy and attention required for pregnancy and childbearing inherently disproportionately affects women, so attention to such policies can help to narrow the gender gap observed in academic and scientific achievement,” radiation oncology study authors said.</p> <p> Overall, about one-half of “respondents believed a standardized maternity and paternity leave policy should be put into place,” the study said. “The remaining respondents felt that different sizes and institutional cultures across programs would make a national standardized policy challenging and unrealistic.”</p> <p> Among program directors for general surgery, two-thirds reported having a formal maternity leave; 48 percent reported a paternity leave policy. Study authors encouraged programs without policies to create them.</p> <p> “Doing so may reduce the apprehension that residents feel in addressing these needs and allow for predictability in planning for parental leave,” general surgery study authors said. “Moreover, the existence of such guidelines is relevant to the recruitment of future trainees. … Talented students may opt out of pursuing surgery because they wish to be parents and view surgical training as incompatible with pregnancy and childrearing.”</p> <p> <strong>Read more about work-life balance issues:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_self">Physicians rank residency work-life balance by specialty</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_self">Four physician-recommended steps for a work- and home-life balance</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-share-4-tips-assessing-specialty-lifestyle" target="_self">Residents share 4 tips for assessing specialty lifestyle</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/will-gender-influence-specialty-physicians-offer-insights" target="_self">Will gender influence your specialty? Physicians offer insights</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:991f3215-3ec8-4992-a4f5-14b830e409b3 Why medicine needs a cloud http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_medicine-needs-cloud Wed, 01 Jun 2016 21:13:00 GMT <p> In the new era of value-based payment, how physicians use performance measures and data offers the potential to make strides in improving health outcomes. The new payment systems need to be designed around patient care, experts agree. One surgeon recently shared his point of view and explained how his association is using data to improve patient care and creating technology tools that could benefit physicians across the country.</p> <p> <strong>A payment system designed around patient care, not the reverse</strong></p> <p> When we look at performance measures from a physician standpoint, “they’re traveling down one of two pathways, whether it’s [the <a href="http://www.ama-assn.org/ama/ama-wire/post/4-steps-prepare-medicares-new-payment-systems" target="_self">Merit-based Incentive Payment System (MIPS) or alternative payment models (APM)</a>],” Frank Opelka, MD, said at a recent <em>Health Affairs’</em> forum, “<a href="http://www.healthaffairs.org/events/2016_05_12_value_based_payment/" target="_blank" rel="nofollow">Envisioning the future of value-based payment</a>.”<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/1/e1869eb0-26d6-42bd-a1a5-0739b68ffd71.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/1/1/e1869eb0-26d6-42bd-a1a5-0739b68ffd71.Full.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Dr. Opelka is a professor of surgery at Louisiana State University (LSU) School of Medicine, chair of the Physician Consortium for Performance Improvement, and medical director of quality and health policy at the American College of Surgeons (ACS). He also is leading a statewide effort in Louisiana to use data for quality improvement, real-time clinical decision support and outputs for national data registries.</p> <p> It doesn’t matter whether clinicians are in the MIPS or an APM, Dr. Opelka said. “This is all about patient care, not a payment system … we’ll tack on a payment system … that’s how [clinicians] are thinking about this.”</p> <p> According to Dr. Opelka, performance measures should do two things:</p> <ul> <li style="margin-left:0.25in;"> Regardless of the path a clinician takes—MIPS or an APM—performance measurement should reflect the patient care provided, not the payment system.</li> <li style="margin-left:0.25in;"> Clinicians need consistent measurement infrastructure using advanced analytics, multiple data sources, and registries—all of these represent a much larger clinical data ecosystem than electronic health records (EHR) can ever offer alone.</li> </ul> <p> EHRs will be one component of what must be a larger cloud architecture that grants access to much-needed data to improve patient care, Dr. Opelka said.</p> <p> This means looking toward a future state, where EHRs are the access point. Like a Web browser, they can be doorways into a much larger world of data, but must be usable, flexible and adhere to industry interoperability standards.</p> <p> But, data are difficult to gather into one place at the moment. Physicians and other health care professionals know that data can “give them an active dashboard that allows them to drive optimal care,” Dr. Opelka said. “In all the rest of their industries—banking, groceries, Amazon, you name it—they can get information that’s useful to them. We haven’t built that yet out of the architecture that’s in the [medical] data world.”</p> <p> <strong>How surgeons are using data to improve care</strong></p> <p> Dr. Opelka and his colleagues at ACS, through the National Surgical Quality Improvement Program (NSQIP), have developed a cloud architecture that holds the clinical data from registries that they need at the point of care. Through this cloud, they are able to identify indicators that allow them to predict what may affect specific groups of their patient population and get a head start on treatment. They are building dashboards for every surgeon at every point in the country that will gather cost data and patient data when they need it.</p> <p> For example, a surgeon seeing a cancer patient can go through their EHR and click through to see the date of diagnosis, the stage, previous operations, and chemo or radiation treatments—all separately. “Or I can build it into a dashboard so that when that patient comes in, it’s presented to me,” Dr. Opelka said. “Instead of looking at [the EHR] and clicking through, I can actually stop for a minute and take a look at a patient.”</p> <p> Anyone who’s used an EHR knows they hold a lot of potential. “It’s done marvelous things to bring the data architecture forward, but it’s not the end point,” he said. “Stop looking at EHRs and look at the cloud [and] what attaches to the cloud.”</p> <p> Public servers, payer servers, clinical EHR data, lab data and connections to other care points are just a few of the components that Dr. Opelka suggests should be attached to the cloud. “We’re starting to frame data in an architecture that I clinically can say, ‘I know what I’ve got to do,’” he said.</p> <p> Here are two ways Dr. Opelka said his health system at LSU uses the cloud architecture to help patients:</p> <p style="margin-left:40px;"> <strong>1.   </strong><strong>Pollen season.</strong> When the pollen count begins to rise, the practice checks the EHR to find all of their patients with asthma who have any kind of inhaler and check the pharmacy data set to see whether or not the inhaler prescriptions are renewed, current and active.<br /> <br /> “Those that aren’t get a smartphone message to get it in line because the pollen are coming,” he said. “That’s how you leverage data for better health care, and that’s how we ought to be looking at this.”</p> <p style="margin-left:40px;"> <strong>2.   </strong><strong>Mardi Gras.</strong> “We have issues with Mardi Gras,” Dr. Opelka said. Using the cloud the Thursday before Mardi Gras begins, the practice texts a message to all patients with diabetes, asking them to send their blood glucose readings for the next five days, through Fat Tuesday.<br /> <br /> “Then we put in alerts back to the [primary care physicians] when somebody is off the charts,” he said. “We try and get in front of where that patient is heading. This is how big data can be leveraged. When you put it together, you form collaboratives that lead to people working together to drive improvement.”</p> <p> “When we look at it from the American College of Surgeons’ standpoint, we’re registry based,” he said. “Five registries with terabytes of information—the national cancer database, the trauma database, the national surgery quality improvement database—[we] have over 800 data elements with about five to six metadata elements per data element moving into this framework today.”</p> <p> “We’ve automated a third of that,” he said. “Within the next two years, we will have all of it automated. These are data flows that are moving then to the point of delivering health care. We have to have reliability and validity that physicians can trust, that the patient can trust.”</p> <p> One of their many registry outputs shows the performance of each hospital involved in the NSQIP, from outstanding to underperforming. “These are benchmark activities that should be coming back at least quarterly to the clinical teams,” he said. “I want to look at all aspects across the continuum of care, of all the providers, not just me the surgeon—how are we as a team delivering?”</p> <p> Through the use of this registry output, 82 percent of hospitals decreased patient complications, 66 percent of hospitals decreased mortality rates and each hospital prevented 250-500 complications annually.</p> <p> “When you give people data like this, they love it and they hate it,” Dr. Opelka said. “They only want more. Once you create that addiction, now they’re going to react to it. It’s genetically bound to us from the moment we’re born. We start walking, and we want to keep up with our mother. And the next thing you know, we’re running, and we want mother to keep up with us—we compete.”</p> <p> For more on data use in practice, read <a href="http://www.ama-assn.org/ama/ama-wire/post/minnesota-practice-preventing-diabetes-can" target="_self">how a practice in Minnesota is using patient data</a> to enroll patients in diabetes prevention programs.</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:c37454a4-461a-4e5b-bbf9-c1a5114ae14a AMA-IMG Section elects new officers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ama-img-section-elects-new-officers Wed, 01 Jun 2016 21:00:00 GMT <p> Congratulations to the new officers for the 2016-2017 AMA International Medical Graduate (IMG) Section Governing Council, who were ratified at the 2016 AMA-IMG Section Annual Meeting earlier this month:</p> <ul> <li> Bhushan Pandya, MD, chair</li> <li> June-Anne Gold, MD, immediate-past chair</li> <li> Ved Gossain, MD, chair-elect</li> <li> Subhash Chandra, MD, delegate</li> <li> Kevin King, MD, alternate delegate</li> <li> Guillermo Godoy, MD, member at large</li> <li> Col. Ronit Katz, MD, member at large</li> <li> Sameer Avasarala, MD, resident/fellow representative</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b8bc8104-bcde-4040-ad63-39be91bafe99 14th annual AMA Research Symposium: Submit an abstract, be a judge http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_14th-annual-ama-research-symposium-submit-abstract-judge Wed, 01 Jun 2016 20:00:00 GMT <p> Mark your calendar to participate in this year’s AMA Research Symposium, taking place Nov. 11 in Orlando in conjunction with the 2016 AMA Interim Meeting.</p> <p> If you are ECFMG-certified and are awaiting residency, consider submitting an abstract for the symposium. Abstracts will be accepted through Aug. 17 in the following categories for international medical graduate (IMG) participants:</p> <ul> <li> Clinical vignette</li> <li> Clinical medicine</li> <li> Improving health outcomes (cardiovascular disease, diabetes)</li> </ul> <p> <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/medical-student-section/news-events/research-symposium.page" target="_self">Learn more</a> about the symposium guidelines and registration.</p> <p> If you are interested in being a judge for the symposium or have other questions about this event, <a href="mailto:img@ama-assn.org" rel="nofollow">email the AMA-IMG Section</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ae0c9daa-e57b-49c9-921f-7d871d61eb65 ACS Committee on Diversity Issues seeking new members http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_acs-committee-diversity-issues-seeking-new-members Wed, 01 Jun 2016 14:00:00 GMT <p style="margin-left:5.25pt;"> Nominations for candidates to fill two vacancies on the American College of Surgeons (ACS) Committee on Diversity Issues are due <strong> June 30</strong> for assignments that will begin in Oct. 2016.</p> <p style="margin-left:5.25pt;"> The committee’s mission is to study the educational and professional needs of underrepresented surgeons and surgical trainees. In addition, committee members will study the impact that the committee’s work may have on the elimination of health care disparities among diverse population groups.</p> <p style="margin-left:5.25pt;"> Committee work will include developing proposals and sessions on diversity for the ACS Clinical Congress and advancing tools and resources to enhance surgeons’ cultural competency.</p> <p style="margin-left:5.25pt;"> Nominees must be ACS fellows or associate fellows who are able to fulfill the following criteria:</p> <ul> <li> Serve an initial three-year term (2016−2019)</li> <li> Attend one in-person meeting at the ACS Clinical Congress and participate in regular committee conference calls</li> <li> Actively contribute to committee initiatives</li> </ul> <p style="margin-left:5.25pt;"> Nominees should submit:</p> <ul> <li> A letter of interest highlighting their skills and expertise, along with a list of contributions they would make to the committee</li> <li> A summary of their curriculum vitae (fewer than five pages)</li> </ul> <p style="margin-left:5.25pt;"> For more information and to submit nominations, email <a href="mailto:cbura@facs.org" rel="nofollow">Connie Bura</a>, associate director of the ACS Division of Member Services.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:97a24e9b-b9fa-4ad3-87f6-a786adcd319f “Bear proof” your retirement: How to protect your finances http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_bear-proof-retirement-protect-finances Wed, 01 Jun 2016 03:00:00 GMT <p> Saving for retirement? At some point—or points—stocks and bonds will have down turns as you withdraw funds during your golden years. Learn how you can “bear proof” your investments so those dips don’t zap your savings.   </p> <p> <strong>Evaluating your portfolio</strong></p> <p> Physicians tell their patients that they need to take preventive measures to stave off diabetes, heart attacks and other avoidable medical conditions. Similarly, physicians should be taking preventive measures to financially plan for the best possible retirement.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/11/7a92e1ba-d461-45a9-ab60-9d1901cf19c9.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/11/7a92e1ba-d461-45a9-ab60-9d1901cf19c9.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Most likely you are investing in 401(k)s and other market-driven investments, but what are you doing to prepare for years when the stock market goes down rather than up?</p> <p> According to a recent <em>Wall Street Journal</em> article, when savers “are forced to make withdrawals early in retirement from a declining portfolio, there will be fewer shares left over to benefit when the market eventually goes back up.” And this could cause irreparable harm to your retirement accounts. </p> <p> If you have maxed out what you can invest in your 401(k) and other retirement plans, it may be worth taking 20 percent of your additional planned investments to create an alternative source of income through a non-correlated asset, which would be an asset not directly tied to the market, says James L. Laughlin, II, senior vice president of marketing for Millennium Brokerage Group, LLC, a strategic marketing partner of AMA Insurance (AMAI).</p> <p> <strong>How it works</strong></p> <p> Diversifying a percentage of your investments into a non-correlated asset, such as life insurance, can help create more options for your income throughout retirement, especially if you live longer than expected. It also could make a difference in how much you are able to leave to your heirs. Take this scenario:</p> <p> A physician retired at age 65 with $2 million socked away in market-driven accounts. She took $150,000 annually during retirement and had a little more than $900,000 left at the end of 15 years.</p> <p> Now, if that same physician had invested part of her retirement money in a life insurance policy, not tied to the market, she would have had $3.3 million at the end of those same 15 years, while still taking the $150,000 annually.   </p> <p> Here’s how this math works:</p> <p> Over 15 years, let’s assume the market gained an average 11 percent a year (based on historical results from 1973 to 1987). But that’s an average. During the first, second, fifth and ninth years of the physician’s retirement, in this example, the market was down 14.8 percent, 26.5 percent, 7.3 percent and 4.9 percent, respectively.</p> <p> That means when the physician withdrew her $150,000 during those down years, she needed to sell off more shares of stock to reach that dollar amount than she did in other years, Laughlin explained. That left her with fewer shares of stock when the market went back up.</p> <p> If over the course of 20 years, the physician had taken $12,000 each year—about 25 percent of what she was investing—and purchased a $500,000 whole life insurance policy, she could have withdrawn money from the policy’s cash value in those down years and left more shares of stock intact within her market-driven account, such as her 401(k). By diversifying her retirement investments, she would have had multiple sources to take money from, depending on market conditions.</p> <p> <strong>Is this approach right for you?</strong></p> <p> Anyone investing for retirement who wants to protect themselves in a market downturn—something that is certain to happen over an extended horizon of retirement—should explore this option, Laughlin said.</p> <p> “While there isn’t a retirement crystal ball to know exactly what the markets will do in retirement, there are several strategies that a physician can implement to help smooth any potential bumps and extend their retirement runway,” Laughlin said.</p> <p> For physicians who may not qualify for a life insurance policy, Laughlin said, there may be other strategies and products available to help “bear proof” their retirement savings.</p> <p> Another strategy for physicians to consider is the order in which they liquidate their assets during retirement. “The sequence can make a world of difference,” Laughlin said. For one couple, the order in which they took their retirement income stream meant the difference between having $7 million and $12 million over the life expectancy of their retirement.</p> <p> A timely review of your investment and retirement income strategy will help answer questions and raise your chances for a “successful” retirement, Laughlin said.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f06abab3-76cb-430e-8991-c8f07d4e3f9e Court decides on medical liability protections http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-decides-medical-liability-protections Tue, 31 May 2016 20:46:00 GMT <p> The Supreme Court of California recently considered a case that could reduce important medical liability protections for physicians under the seminal Medical Injury Compensation Reform Act (MICRA).</p> <p> <strong>What was at stake</strong></p> <p> Under deliberation in <em>Winn v. Pioneer Medical Group</em> was whether a claim based on medical negligence committed against an elderly patient could give rise to action under the California Elder Abuse Act.  Such an approach would avoid protections allowed in medical negligence cases under MICRA, California’s historic tort reform law, which keeps liability insurance premiums low and places a $250,000 cap on noneconomic damages in medical liability lawsuits to ensure patients in the state have access to affordable health care.</p> <p> An elderly patient with peripheral vascular disease was treated over a period of time by Pioneer Medical Group, and the condition steadily worsened until she died in 2010. The plaintiffs alleged that Pioneer Medical Group violated the Elder Abuse Act by failing to provide the patient with proper care by not referring her to a specialist.</p> <p> Following lower court decisions that called into question whether the case was of professional negligence or reckless neglect, the case moved to the state supreme court. Professional negligence does not fall under the Elder Abuse Act, which specifically states that professional negligence should be governed by laws that apply to professional negligence—in this case, MICRA. A lower court held that if the conduct of a physician amounted to reckless neglect, then the Elder Abuse Act would apply.</p> <p> As defined by MICRA, professional negligence includes any negligent act, or failure to act, by a physician in the rendering of professional services. The Elder Abuse Act’s definition of reckless neglect focuses on the failure to provide medical care at all and specifically excludes professional negligence.</p> <p> The <a href="http://www.ama-assn.org/ama/pub/physician-resources/legal-topics/litigation-center.page?" target="_self">Litigation Center of the AMA and State Medical Societies</a> joined the California Medical Association and several others in an <a href="https://download.ama-assn.org/resources/doc/legal-issues/x-pub/winn-v-pioneer-medical-group.pdf" target="_blank">amicus brief</a> (log in) supporting Pioneer Medical Group in 2013. “The [lower court] decision fails to recognize the critical and necessary difference between reckless neglect and professional negligence,” the brief said. “As a result, it interprets the Elder Abuse Act in a way that fundamentally conflicts with MICRA.”</p> <p> “Clarification by this court is needed to make clear that reckless neglect elder abuse and professional negligence are indeed mutually exclusive,” the brief said, calling for appeal.</p> <p> <strong>The court’s decision</strong></p> <p> In order for the Elder Abuse Act to apply, the physician must to have had a relationship with the patient that involved specific caretaking responsibilities. The act defines “caretaker” as a “person who has the care, custody or control of … an elder or dependent adult.” Because the patient was treated in an outpatient facility and not in a nursing home or resident health care facility, the act does not apply.</p> <p> The state supreme court decision stated that the Elder Abuse Act “does not apply unless the defendant health care provider had a substantial caretaking or custodial relationship, involving ongoing responsibility for one or more basic needs, with the elder patient.”</p> <p> Rather, the decision said, it is the nature of the relationship between physician and patient—not the physician’s professional standing—that makes the physician potentially liable for neglect.</p> <p> “Plaintiffs cannot bring a claim of neglect under the Elder Abuse Act unless the defendant health care provider has a caretaking or custodial relationship with the elder,” the court said.</p> <p> This decision reverses the Court of Appeal decision and upholds the critical protections offered physicians within MICRA.</p> <p> <strong>Current medical liability cases in which the Litigation Center is involved:</strong></p> <ul> <li> Learn how a case <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-lead-unlimited-awards-of-punitive-damages" target="_self">could lead to unlimited awards of punitive damages</a>.</li> <li> Get the details on a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">case that could extend medical liability</a>.</li> <li> Find out how one <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">case could increase liability exposure and redefine injury</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:d85eb6a9-5a39-40a8-a538-c78f0971bc92 Entire state gets one naloxone prescription http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_entire-state-gets-one-naloxone-prescription Fri, 27 May 2016 20:51:00 GMT <p> There are many steps that need to be taken to end an epidemic—including policy, medication, coverage and treatment expansion—and require physicians to take the lead in fighting for their patients. Leaders in Pennsylvania are on a mission to provide that help to both the people who are suffering in the opioid epidemics and the physicians who treat them.</p> <p> <strong>A standing order for naloxone</strong></p> <p> Through a multiagency effort, Pennsylvania’s physician general Rachel Levine, MD, in October signed a statewide prescription for naloxone, making this lifesaving overdose reversal drug available to the entire population.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/a8a4137b-d42f-49a7-9938-0e3ee1c08bf2.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/8/9/a8a4137b-d42f-49a7-9938-0e3ee1c08bf2.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> “As we were studying the problem and working on the distribution of naloxone,” Dr. Levine said, “we decided that I would write two standing orders.”</p> <p> The first was a standing order for first responders—state police, municipal police and fire departments—to obtain naloxone. After this was accomplished, Dr. Levine and Department of Drug and Alcohol Programs Secretary Gary Tennis called all the insurance companies in the state and raised money to obtain two forms of naloxone, the nasal spray and auto-injector, for the public.</p> <p> “We wanted to facilitate as much as possible the public obtaining naloxone if they have a friend or family member or a loved one who is at risk of overdosing from prescription opioids or heroin,” Dr. Levine said. “Under Gov. Wolf’s leadership, I signed the standing order prescription for anyone in the public to go to a pharmacy and obtain naloxone.”</p> <p> Dr. Levine, as part of her statewide prescription, recommends that pharmacists take <a href="https://www.pamedsoc.org/PAMED_Downloads/PA%20Guidelines,%20on%20the%20Dispensing%20of%20Opioids.pdf" rel="nofollow" target="_blank">voluntary training</a> developed by the Pennsylvania Medical Society (PAMED) in consultation with the Pennsylvania Pharmacy Association. “We encourage pharmacists to do whatever teaching is necessary in the dispensing of naloxone,” she said.</p> <p> Now that the standing order for naloxone is in effect, there are three things Dr. Levine said need to happen:</p> <ul> <li> Making sure all the pharmacies are aware of the standing order and carry naloxone</li> <li> Working with insurance companies to ensure it is covered</li> <li> Getting the word out to the public that it is available</li> </ul> <p> The standing order “certainly has been successful in highlighting the importance of this issue, the risk of prescription opioids and heroin and the risk of overdoses,” she said. “It has served a number of purposes.”</p> <p> In March, Gov. Wolf honored hundreds of municipal and state police officers who together have reversed over 600 opioid overdoses in the short time that naloxone has been available.</p> <p> “Particularly with the increase in fast acting fentanyl in the heroin supply," said Alice Bell, the overdose prevention project coordinator of <a href="http://www.pppgh.org/" rel="nofollow" target="_blank">Prevention Point Pittsburgh</a>, "it is critical that those who are most likely to be already on the scene when someone overdoses—people who are using drugs together, friends, family members and other lay people—have naloxone available on the scene.   While it’s also critical for police and other first responders to carry naloxone, they may arrive too late.”</p> <p> Many states have worked closely with the AMA and state medical societies to <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/increase-naloxone-access.page?" target="_self">ensure widespread access to naloxone</a> and develop good Samaritan laws to help save lives.</p> <p> <strong>Next steps for Pennsylvania in fighting the opioid overdose epidemic</strong></p> <p> The standing order was not the last step in Pennsylvania’s efforts to end the epidemic, but rather the first. Working with PAMED and several other organizations, Dr. Levine is continuing the multi-agency effort to provide resources and guidance to the physicians and patients in her state.</p> <p> “This is a very collaborative effort under the leadership of Gov. Wolf and with many, if not most, state agencies,” she said. “It’s all hands on deck. The message when we go out and speak … is that addiction is a disease—it is a medical condition—it is not a moral failing. So we want to eliminate this stigma.”</p> <p> Here are five ways Pennsylvania is continuing their efforts:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Educating future physicians.</strong> “We are working on prevention,” Dr. Levine said. “We are working with all the medical school deans [in our state] to define the clinical competency that a medical student should have when they leave school about all these issues—opioid pharmacology, pain treatment, and about addiction referral and treatment.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Educating physicians.</strong> In collaboration with PAMED, the agencies are working on four to five modules that have continuing medical education credit for physicians and other medical professionals who prescribe opioids.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Prescribing guidelines.</strong> “We are working on specialty-specific prescribing guidelines in regards to opioid pain medication,” Dr. Levine said.<br /> <br /> Already published are guidelines for the treatment of and safe prescribing for <a href="https://www.pamedsoc.org/PAMED_Downloads/PAGuidelinesonOpioids.pdf" rel="nofollow" target="_blank">chronic non-cancer pain</a>, pain in the <a href="https://www.pamedsoc.org/PAMED_Downloads/PA%20ED%20Guidelines%20Opioids.pdf" rel="nofollow" target="_blank">emergency department</a>, pain among <a href="https://www.pamedsoc.org/PAMED_Downloads/OpioidGuidelinesOBGYN.pdf" rel="nofollow" target="_blank">OB-GYN patients</a>, pain among <a href="https://www.pamedsoc.org/PAMED_Downloads/OpioidGuidelinesGeriatrics.pdf" rel="nofollow" target="_blank">geriatric patients</a> and pain in <a href="https://www.pamedsoc.org/PAMED_Downloads/opioid_dental_prescribing_guidelines3_13_15.pdf" rel="nofollow" target="_blank">dental practice</a>. The state also has published dispensing guidelines for <a href="https://www.pamedsoc.org/PAMED_Downloads/PA%20Guidelines,%20on%20the%20Dispensing%20of%20Opioids.pdf" rel="nofollow" target="_blank">pharmacists</a>.<br /> <br /> In the works are guidelines for treatment of pregnant women who are addicted to opioids, use in orthopedics and sports medicine and use for pediatric and adolescent patients. Pennsylvania also is working on guidelines for the emergency department “warm handoff.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>PDMP use.</strong> “We are implementing the prescription drug monitoring program (PDMP) for Pennsylvania,” Dr. Levine said. “We have hired a director … a vendor … and the goal is that the PDMP will be up and running by August.”<br /> <br /> Use of the PDMP will be “required for all first prescriptions,” she said. “[And] strongly recommended for other prescriptions.”</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Expanding treatment.</strong> “We are working to expand treatment options both for abstinence-based treatments,” she said, “as well as a pivot toward emphasizing medication-assisted treatment (MAT) for patients addicted to opioids.”</p> <p> “We need to work on preventing [substance use disorders], diagnosing it and treating it as we do with diabetes or heart disease,” Dr. Levine said. “As physicians we know the pharmacology of this, we know how addiction works neurologically and we need to not treat this any differently than any other medical condition.”</p> <p> <strong>Learn more about physicians’ efforts to end the opioid epidemic:</strong></p> <ul> <li> Read a <a href="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a>, and watch a <a href="https://www.youtube.com/watch?v=U2VUot6c8lw" rel="nofollow" target="_blank">video message</a> from AMA President Steven J. Stack, MD.</li> <li> Find out how a substance use researcher in San Francisco <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">talks with his patients about substance use disorder</a>.</li> <li> Learn how <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-team-up-treat-addiction-rural-areas">physicians are teaming up to treat addiction in rural areas</a>.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/ama-wire/post/3-steps-talking-patients-substance-use-disorder">3 steps for talking with patients about substance use disorder</a> recommended by an internal medicine physician who is an addiction consultant.</li> <li> Learn what the AMA Task Force to Reduce Opioid Abuse <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_self">recommends for physicians to reduce stigma and increase use of MAT</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7c3e704b-3d5b-475e-8a96-0d6a8b20956d What it’s like to be in endocrine surgery: Shadowing Dr. Krishnamurthy http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-endocrine-surgery-shadowing-dr-krishnamurthy Fri, 27 May 2016 20:34:00 GMT <p> As a medical student, do you ever wonder what it’s like to be an endocrine surgeon? Here’s your chance to find out.</p> <p> Meet Vikram D. Krishnamurthy, MD, an endocrine surgeon and featured physician in <em>AMA Wire’s</em>® <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/cac4d7d8-6717-4f81-b9d7-de4b92f0392d.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/9/cac4d7d8-6717-4f81-b9d7-de4b92f0392d.Full.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Read his insights to help determine whether a career in endocrine surgery might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. Krishnamurthy</strong></p> <p> <strong>Specialty:</strong> Endocrine surgery</p> <p> <strong>Practice setting: </strong>Academic group practice in a health system of 10 hospitals and 18 ambulatory centers</p> <p> <strong>Years in practice:</strong> 1 year</p> <p> <strong>A typical day in my practice</strong>:</p> <p> Life during training is a lot different from life after fellowship. During general surgery residency, workweeks are usually 80 hours per week on rotations involving abdominal, oncologic, cardiovascular, thoracic, pediatric and trauma surgery. Endocrine surgery is focused on surgical conditions of the thyroid, parathyroid glands, adrenals, and neuroendocrine tumors of the pancreas and gastrointestinal tract. Workweeks during fellowship are typically around 50-60 hours per week with very limited night and weekend demands. </p> <p> After training, a typical week for most academic surgeons involves a couple days of surgeries, a couple days of clinic and one day (or half day) of administrative activities (protected time for academic, educational and research interests).</p> <p> For example, my workweek includes two days of OR, two days of clinic and one administrative day. A day in the OR (which can last from 7 a.m. to 4 p.m.) can involve three cases, ranging from thyroidectomies to lateral neck dissections to laparoscopic adrenalectomies. A day in the clinic (which is usually 8:30 a.m. to 3:30 p.m.) involves seeing 12-20 patients and performing ultrasounds, biopsies and laryngoscopies. Administrative days include lecturing students, meeting with residents and conducting research.</p> <p> It should be stated that when you work in academic surgery, you are expected to attend weekly conferences at your home institution and national meetings throughout the year to contribute to the academic community. This can add to the overall time you spend “working.” Fortunately, most endocrine surgeons enjoy these activities, so it feels like a calling rather than an obligation.</p> <p> As endocrine surgery gains recognition as a distinct specialty, an increasing number of fellowship graduates are entering non-academic community practices. This is indubitably beneficial to patients but also provides a new dimension to the field and new opportunities for those interested in becoming endocrine surgeons. These graduates are more likely to continue to perform general surgery procedures, in addition to endocrine operations, in their practices.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in </strong><strong>endocrine surgery</strong>:</p> <p> Endocrine surgeons are specialists who manage both routine and complex pathology. Thus, in addition to common patient presentations, we also treat advanced cases referred by non-fellowship trained surgeons or smaller hospitals. We also see and operate on patients who had aborted or failed operations by other surgeons, which makes patient education and re-operation more difficult. </p> <p> Fortunately, our training prepares us for this challenge, and continued mentorship throughout our career gives us the confidence and support to help these patients. The most rewarding part of our specialty is probably two things: (1) providing excellent oncologic outcomes that preserve functional capacity (e.g., voice) and optimize cosmesis and (2) reversing the debilitating effects of various tumors that produce excessive hormones.</p> <p> <strong>Three phrases that describe the typical physician in </strong><strong>endocrine surgery</strong><strong>:</strong></p> <ul> <li> Detail-oriented, overachievers</li> <li> Inquisitive investigators and educators</li> <li> Friendly and communicative</li> </ul> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> After training, endocrine surgery has allowed me to experience a healthy work-life balance. Most operations take one to four hours, and the majority of patients stay one night in the hospital and are discharged home the next day. This makes for a relatively light inpatient census and little need for clinical work on weekends. </p> <p> True endocrine surgery emergencies are rare; thus, nights and weekends are relatively free to work on academic pursuits and personal interests. My career has allowed me to have a vibrant professional and personal life filled with achievements, travel and time with loved ones. Furthermore, research shows that more than 95 percent of endocrine surgery fellowship graduates are satisfied with their jobs (approximately 50 percent are women and 50 percent men), speaking to ability to successfully balance professional and personal obligations.</p> <p> <strong>One skill every physician in training should have for </strong><strong>endocrine surgery but won’t be tested for on the board exam:</strong></p> <p> Perseverance, stamina, motivation (especially self-motivation), empathy and superb communication skills. Also a lifelong desire to learn and the ability to execute delicate, fine and purposeful movements in the operating room.</p> <p> <strong>One question physicians in training should ask before pursuing endocrine surgery: </strong></p> <p> Am I interested in routine and complex endocrine physiology, oncology and surgery?</p> <p> <strong>Six books every medical student interested in </strong><strong>endocrine surgery should read:  </strong></p> <ul> <li> <em>Essentials of Surgery</em> by Peter Lawrence, MD</li> <li> <em>Lange’s Current Diagnosis and Treatment: Surgery</em> by Gerard Doherty, MD</li> <li> <em>Rush University Medical Center Review of Surgery</em> by Jose Velasco, MD, et al</li> <li> <em>Common Surgical Diseases</em> by Theodore J. Saclarides, MD; Jonathan A. Myers, MD; and Keith W. Millikan, MD</li> <li> <em>Endocrine Surgery: Principles and Practice</em> by Johnathan Hubbard, MD; William B. Inabnet, III, MD;and Chung-Yau Lo, FRCS</li> <li> <em>Textbook of Endocrine Surgery</em> by Orlo Clark, MD; Quan-Yang Duh, MD; Electron Kebebew, MD; Jessica Gosnell, MD; and Wen Shen, MD</li> </ul> <p> <strong>Online resources students interested in my specialty should follow:</strong></p> <ul> <li> The <a href="https://www.endocrinesurgery.org/" rel="nofollow" target="_blank">website of the American Association of Endocrine Surgeons</a></li> <li> The <a href="http://endocrinediseases.org/index.shtml" rel="nofollow" target="_blank">American Association of Endocrine Surgeons patient education website</a></li> <li> An <a href="https://consultqd.clevelandclinic.org/2016/01/endocrine-surgerys-status-specialty/" rel="nofollow" target="_blank">explanation of the maturation of the specialty of endocrine surgery</a> from the Cleveland Clinic</li> <li> <a href="http://www.ncbi.nlm.nih.gov/pubmed/23618449" rel="nofollow" target="_blank">The endocrine surgery job market: A survey of fellows, department chairs and surgery recruiters</a></li> <li> <a href="http://www.ncbi.nlm.nih.gov/pubmed/26456130" rel="nofollow" target="_blank">Mapping endocrine surgery: Workforce analysis from the last six decades</a></li> </ul> <p> Also follow the American Association of Endocrine Surgeons on Twitter @AAES1. My Twitter handle is @healthyroidsurg.</p> <p> <strong>A quick insight I’d give students who are considering </strong><strong>endocrine surgery</strong><strong>:</strong></p> <p> Stay open-minded during your general surgery training and also consider surgical oncology, colorectal, hepatobiliary and breast surgery. Seek mentorship and research opportunities early on.</p> <p> <strong>If I had a song or two to describe my life in this specialty, they’d be:</strong></p> <p> “Hall of Fame” by The Script and “Such Great Heights” by the Postal Service</p> <p> <strong>Want to learn more about your specialty options?</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_self">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-neurology-shadowing-dr-govindarajan" target="_self">neurology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-nephrology-shadowing-dr-desai" target="_self">nephrology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-otolaryngology-shadowing-dr-gillespie" target="_self">otolaryngology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-vascular-surgery-shadowing-dr-aziz" target="_self">vascular surgery</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_self">infectious disease</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="_self">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="_self">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:abe88e95-c6e8-4a51-9c3a-6206a08a3eef What it’s like to be in obesity medicine: Shadowing Dr. Lazarus http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_its-like-obesity-medicine-shadowing-dr-lazarus Fri, 27 May 2016 20:30:00 GMT <p> As a medical student, do you ever wonder what it’s like to be an obesity specialist? Here’s your chance to find out.</p> <p> Meet Ethan Lazarus, MD, an obesity specialist and featured physician in <em>AMA Wire’s</em>® <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_self">“Shadow Me” Specialty Series</a>, which offers advice directly from physicians about life in their specialties. Dr. Lazarus is the secretary treasurer of the Obesity Medicine Association (OMA) and the OMA delegate for the AMA.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/7/ffe8608b-92ab-443d-9785-d65c0838c913.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/7/ffe8608b-92ab-443d-9785-d65c0838c913.Full.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Read his insights to help determine whether a career in obesity medicine might be a good fit for you.</p> <p> <strong>“Shadowing” Dr. Lazarus</strong></p> <p> <strong>Specialty:</strong> Obesity medicine</p> <p> <strong>Practice setting:</strong> Solo</p> <p> <strong>Years in practice:</strong> 18</p> <p> <strong>A typical day in my practice:</strong></p> <p> I see patients Tuesday, Wednesday and Thursday from 9 a.m. to 4 p.m. I spend 30 minutes with follow-up patients and 60 minutes with new patients. I teach free classes on obesity and related topics one or two times per week. When not at the office, I speak either at CME conferences or for pharmaceutical companies about once a week. I also serve as an adviser to Novo Nordisk regarding obesity treatment.</p> <p> <strong>The most challenging and rewarding aspects of caring for patients in obesity medicine:</strong></p> <p> Patients lose weight, then stop treatment, then they regain the weight and blame themselves. It is hard to get people to accept that obesity is a chronic disease. There is also a lot of bias against treating obesity as a disease, particularly with regards to the use of anti-obesity medications. Further, there is public perception that obesity is primarily a result of eating too much and exercising too little, so most individuals affected by obesity combat it by trying to eat less and move more. Unfortunately, since eating too much and exercising too little are not thought to be the <em>cause</em> of obesity, but perhaps instead the <em>result</em> of obesity, all too often the person ends up even heavier.</p> <p> <strong>Three adjectives that describe the typical obesity specialist:</strong></p> <p> Empathetic. Non-judgmental. Open-minded.</p> <p> <strong>How my lifestyle matches or differs from what I envisioned in med school:</strong></p> <p> It is completely different—I thought I’d be a surgeon. Instead, I spend the majority of my time either counseling patients or educating physicians. I never envisioned the speaking part of my career.</p> <p> <strong>One skill every physician in training should have for obesity medicine but won’t be tested for on the board exam:</strong></p> <p> Motivational interviewing.</p> <p> <strong>One question every physician in training should ask themselves before pursuing this specialty:</strong></p> <p> Do I really think that obesity is a disease? If so, am I willing to treat it with the same seriousness, compassion and respect as other diseases?</p> <p> <strong>Books every medical student interested in obesity medicine should read:</strong></p> <ul> <li> <em>Mindless eating: Why We Eat More Than We Think</em> by Brian Wansink, PhD</li> <li> <em>Best Weight: A Practical Guide to Office-based Obesity Management</em> by Yoni Freedhoff, MD, and Arya Sharma, MD, PhD</li> </ul> <p> <strong>Online resources students interested in my specialty should follow:  </strong></p> <ul> <li> <a href="http://obesitymedicine.org/about/board-of-trustees/" target="_blank" rel="nofollow">Obesity Medicine Association</a></li> </ul> <p> <strong>If I had a mantra to describe my life in this specialty, it’d be: </strong>Obesity is primarily a <em>physiological</em> phenomenon. This means that obesity is more complex than “eat less, exercise more.”</p> <p> <strong>Want to learn more about your specialty options?</strong></p> <ul> <li> Read more profiles in <em>AMA Wire’s</em> <a href="http://www.ama-assn.org/ama/ama-wire/blog/ShadowMe_Specialty/1" target="_self">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-neurology-shadowing-dr-govindarajan" target="_self">neurology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-nephrology-shadowing-dr-desai" target="_self">nephrology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-otolaryngology-shadowing-dr-gillespie" target="_self">otolaryngology</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-vascular-surgery-shadowing-dr-aziz" target="_self">vascular surgery</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/its-like-infectious-disease-shadowing-dr-schmitt" target="_self">infectious disease</a>, among others.</li> <li> Review a <em>JAMA®</em> article outlining the <a href="http://jama.jamanetwork.com/article.aspx?articleid=1871695" target="_self" rel="nofollow">biological drivers of weight gain</a>.</li> <li> Check out the AMA’s <em>Choosing a Medical Specialty</em> <a href="http://www.ama-assn.org/resources/doc/membership/x-ama/choosing-a-medical-specialty-resource-guide.pdf" target="_self">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="_self">5 common mistakes students make</a> when choosing a specialty.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5f9de148-d0c2-42fc-89ab-7d753f5cac0b What you need to do now to secure a firm financial future http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-now-secure-firm-financial-future Thu, 26 May 2016 21:11:00 GMT <p> When it comes to financial planning, one-half of young physicians go it alone. But such independence may cost you dearly in the long run.</p> <p> <strong>Establishing a strong financial foundation</strong></p> <p> A recent study by <a href="mhtml:file://F:\05_16_2016%20DRAFT%20MRD%20financial%20advisers.mht!https://www.amainsure.com/index.html" rel="nofollow" target="_blank">AMA Insurance</a> found that 71 percent of young physicians feel somewhat or not very knowledgeable about financial planning. At a time when your income climbs from modest to six figures, your biggest mistake could be counting only on yourself to get your arms around your financial future.</p> <p> That future likely includes higher income, increasing taxes and a set of pressing financial priorities, including retirement, your children’s education, and the long-term health of you and your spouse.</p> <p> “Finances are a primary concern among new residents,” said Adam Cantor, who starts his residency in June at Indiana University School of Medicine. “Many of us have not had an income since starting medical school and will have difficulties establishing a budget.”</p> <p> “My key concern is to be able to save enough money to support a family eventually,” said Cantor, who is part of the Young Physicians Financial Advisory Committee, a think tank that helps AMA Insurance address the financial needs of students, residents, fellows and young physicians.</p> <p> AMA Insurance, in collaboration with Jerry Moran, a senior wealth strategist with Millennium Brokerage Group, examined the finances of young physicians in its report, “<a href="https://www.amainsure.com/reports/2015-young-physician-report/index.html?page=2" rel="nofollow" target="_blank">2015 report on young physicians’ financial preparedness: Young physicians segment</a>.” The research found that those with financial advisers felt more confident about their finances, were more on track for retirement, had more money saved and had more diversified portfolios.</p> <p> Experts say going without an adviser is a fundamental mistake that can set the stage for others, like basing investment moves on market news and mishandling retirement funds.</p> <p> But the one-half of all young physicians who do not hire an adviser cite a lack of time, the cost and the inability to find someone they they’re comfortable with and trust. And some feel they have the skills to manage their own finances.</p> <p> “With our busy schedules, I think a financial adviser can help save a lot of time and avoid pitfalls,” Cantor said.</p> <p> <strong>How to choose the right financial adviser</strong></p> <p> In his report, Moran offered a few guidelines for finding an adviser who is right for you:</p> <ul> <li> Ask colleagues for at least three referrals.</li> <li> Take time to vet the advisers you’re considering.</li> <li> Do a quick <a href="http://www.brokercheck.finra.org/" rel="nofollow" target="_blank">FINRA check</a> of a prospective adviser’s certifications, employment history, license and complaints.</li> <li> Conduct your own interviews. Ask about your prospective adviser’s credentials, experience working with physician clients and fee structure.</li> <li> If you’d prefer a referral to a financial planner, AMA Insurance offers the <a href="https://www.amainsure.com/physicians-financial-partners.html?utm_source=PFP-Link-Pg71&utm_medium=YP_Full_Report&utm_campaign=Young_Physicians" rel="nofollow" target="_blank">Physicians Financial Partners</a> program.</li> <li> Trust your gut. This is going to be a face-to-face relationship, so choose someone you can see yourself partnering with.</li> </ul> <p> Advisers and established physicians agree that investing some time now can pave the way to financial health and happiness for the long haul.</p> <p> “Get mentorship on investing and financial and business practice now,” one established physician advised. “Don’t wait until you have a good income.”</p> <p> <strong>Gain additional insights on physician finances:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-financial-planning-tips-young-physician-should" target="_self">5 financial planning tips every young physician should know</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-partner-physician-friendly-financial-advisor" target="_self">How to partner with a physician-friendly financial adviser</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/kick-financial-plan-high-gear" target="_self">How to kick your financial plan into high gear</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:74fd3f97-2638-46be-97d6-f3a4362f0be5 Ready for travel? Make sure you’re prepared for the unexpected http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ready-travel-sure-prepared-unexpected Thu, 26 May 2016 14:00:00 GMT <p> With summer getting underway, make sure you include planning for the unpredictable. A new travel insurance plan designed especially for physicians and their families now is available through a new partnership between AMA Insurance and Travel Guard<sup>®</sup>. The Travel Guard<sup>®</sup> Deluxe Plus Plan, sponsored by the AMA, offers exclusive benefits to physicians and their families, including:</p> <ul> <li> Exclusive TSA PreÖ<sup>®</sup> Offer—purchasers are eligible to receive a waiver of the TSA PreÖ application fee. If approved by the TSA, travelers enjoy an expedited security screening experience that helps take the stress out of travel with no need to remove shoes, laptops, liquids, belts or light jackets.</li> <li> Pre-trip assistance, including health advisories, cultural inquiries and customs information.</li> <li> One-of-a-kind security features, including meet and greet, secure transportation, and customized security reports.</li> <li> Access to the AIG Travel Assistance mobile app, which offers travel alerts, country reports and medical and security data.</li> <li> Passport expediting.</li> <li> Luggage delivery service.</li> <li> Travel re-booking assistance.</li> <li> Concierge services, such as pet assistance and home assistance.</li> </ul> <p> Physicians who are insured in the AMA-Sponsored Travel Guard Deluxe Plus Plan also can gain a full year of access to concierge assistance services.</p> <p> Travel Guard plans cover travelers for emergency medical needs, trip cancellation and interruption, and baggage loss. Insurance plans also offer 24/7 instant access to assistance services around the globe. Travel Guard’s global reach and assistance centers are staffed by coordinators who speak more than 40 languages to help travelers solve problems and manage risks worldwide.</p> <p> Learn more about Travel Guard products and services <a href="http://www.travelguard.com/AMA" rel="nofollow">online</a> or by calling Travel Guard’s World Service Center at (866) 401-8273.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:0fdadf19-fd21-48ca-9d89-85ca04838003 The well-trained MA: One practice’s winning strategy http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_well-trained-ma-one-practices-winning-strategy Wed, 25 May 2016 21:44:00 GMT <p> Well-trained medical assistants (MA) can hold fast the front line of patient care, freeing up physicians from some of their routine administrative and clinical tasks. MAs can play an integral role in achieving practice goals, but sometimes inconsistencies in training and expectations can slow down the progression toward physician-led team-based care. Find out how one practice implemented a professional training program to ensure all of their MAs were able to provide high-quality care support.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/0/8bb10992-8e35-4ce1-8040-11a24c344d54.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/11/0/8bb10992-8e35-4ce1-8040-11a24c344d54.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Giving the MAs in your practice consistent and accurate professional development tools can help increase their knowledge and ability to contribute to the practice team in a meaningful way. A new <a href="https://www.stepsforward.org/modules/medical-assistant-professional-development" rel="nofollow" target="_self">module</a> in the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice further the training of MAs in a way that suits both the needs of the practice and the MAs—resulting in better care for your patients and a more efficient work day for you.</p> <p> <strong>Finding the source of the problem</strong></p> <p> Vanguard Medical Group in New Jersey, which contributed this STEPS Forward module after <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-teach-their-secrets-success" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge, was in the process of implementing a physician-led team-based care model in 2012 when the practice collected revealing feedback from physicians, patients, clinical and administrative staff and care coordinators. Their feedback indicated that, among MA staff, there were varied levels of performance, making the implementation of the new work flows more difficult and time consuming.</p> <p> Vanguard found that the variation in MA performance was in large part a result of three things:</p> <p style="margin-left:40px;"> 1.  Differences in prior education and experience</p> <p style="margin-left:40px;"> 2.  Lack of opportunity for MAs to access professional development beyond the initial new-hire orientation process</p> <p style="margin-left:40px;"> 3.  Non-formalized communication with MAs about performance expectations beyond the annual review</p> <p> As a result of these obstacles, physicians had to complete administrative tasks left unaddressed or repeat clinical tasks done incorrectly. The MAs felt undervalued and thought that the practice was not invested in supporting their professional growth. Meanwhile, some patients commented that MAs were inconsistent in terms of professionalism, phone skills, accurately relaying information and the rooming process.</p> <p> Vanguard determined that because MA performance was uneven, this essential component of the practice staff was left untapped and underdeveloped. The need for MA training was clear and prompted the implementation of a professional development program.</p> <p> <strong>The solution</strong></p> <p> Using topics selected through a staff survey, the nurse care coordinators lead the initiative at each site. These leaders deliver a monthly MA training session in a modular format. Modules are delivered each month in a “lunch and learn” format and are approximately 45 minutes long. They may include warm-up exercises, short electronic surveys, interactive presentations, handout materials, guest speakers and peer instruction.</p> <p> The professional development cycle begins with the distribution of pocket-sized flashcards (available for <a href="https://www.stepsforward.org/modules/medical-assistant-professional-development" rel="nofollow">download</a> as tools in the STEPS Forward module) as a pre-session learning exercise. Each flashcard set is divided into general topics, including professionalism in the MA role, diabetes management, hypertension and proper blood pressure measurement technique, hospice and palliative care, chronic kidney disease, cultural diversity in the workplace and stress reduction.</p> <p> After four weeks, cards are collected, and a pre-assessment is given to gauge how much the MAs are learning, which helps determine the content of the curriculum. MAs sign in at each session, and attendance is tracked by their supervisors as a component of their annual performance review.</p> <p> Vanguard does not collect quantitative data on the program, and the practice purposely eliminated the testing that was done in the past. Those who oversaw the training observed that “learning for the test” behavior created anxiety among MAs, rather than encouraging deeper learning and collaboration with peers. Instead, the practice tracks the success of the program by collecting qualitative data, including MA reports of increased confidence, greater pride in their roles and a stronger perception of being valued by the practice.</p> <p> Initial feedback from MAs, clinical supervisors, physicians and care coordinators has been positive. Vanguard learned from previous iterations that an information-dense lecture approach is less useful than the current interactive format, and the practice continues to tweak the program in ways that motivate MAs to learn and use the information from each session.</p> <p> The <a href="https://www.stepsforward.org/modules/medical-assistant-professional-development" rel="nofollow" target="_self">MA professional development</a> module is one of eight new modules recently added to the AMA’s <a href="https://www.stepsforward.org/modules" rel="nofollow" target="_self">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices. Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx" rel="nofollow" target="_blank">Transforming Clinical Practices Initiative</a>.</p> <p> <strong>Learn more about physician-led team-based care:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/stanford-added-team-based-care-step-further" target="_self">What Stanford added to make MAs key components to team-based care</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/rethinking-team-based-care" target="_self">Rethinking team-based care</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/coordinate-patient-visits-team-based-care-model" target="_self">How to coordinate patient visits in a team-based care model</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:1de33718-d9e0-4a0d-bf6f-410aea9eede8 Answer revealed to this top-missed USMLE Step 2 question http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_answer-revealed-this-top-missed-usmle-step-2-question Wed, 25 May 2016 21:29:00 GMT <p> Getting ready for the United States Medical Licensing Examination® (USMLE®) Step 2 is no easy feat, but we’re sharing expert insights to help give you a leg up. Take a look at the exclusive scoop on this month’s most-missed USMLE Step 2 test prep question. Think you have what it takes to rise above your peers? Test your USMLE knowledge, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Once you’ve got this question under your belt, be sure to test your knowledge with <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">other posts in this series</a>.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong><br /> A 42-year-old woman comes to the physician because of a four-month history of intermittent abdominal cramps and diarrhea. She has had episodes of skin flushing lasting from two to 15 minutes, most pronounced in the head and neck area. She denies nausea, vomiting, constipation or blood in her stools. Her medical history is unremarkable, and she takes no medications. A grade 3/6 murmur is heard along the mid left sternal border. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. Laboratory studies show urinary excretion of 5-hydroxyindoleacetic acid of 75 mg/day (normal: 0.5-9.0 mg/day). CT scan of the liver demonstrates a 2-cm lesion. Which of the following is the most likely diagnosis?</p> <p style="margin-left:40px;"> <strong>A. </strong>Carcinoid tumor, metastatic</p> <p style="margin-left:40px;"> <strong>B. </strong>Cholangiocarcinoma, primary</p> <p style="margin-left:40px;"> <strong>C. </strong>Hepatocellular carcinoma, primary</p> <p style="margin-left:40px;"> <strong>D. </strong>Mucinous adenocarcinoma of the colon, metastatic</p> <p style="margin-left:40px;"> <strong>E. </strong>Squamous cell carcinoma of the esophagus, metastatic</p> <p>  </p> <p> <object data="http://www.youtube.com/v/Ba-kK8XEqxc" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/Ba-kK8XEqxc" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/Ba-kK8XEqxc" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is A.</strong></p> <p>  </p> <p> <strong>Kaplan says, here’s why:</strong></p> <p> Carcinoid syndrome is the term used for the cluster of cutaneous flushing, abdominal cramps, bronchospasm and diarrhea that is seen in patients who have excess amounts of circulating vasoactive substances, including serotonin. The usual cause is an intestinal carcinoid tumor that has metastasized to the liver.</p> <p> Gastrointestinal carcinoids that have not yet metastasized are much less likely to produce carcinoid syndrome, because the liver metabolizes and clears the portal blood of the vasoactive substances. Much less commonly, carcinoids at nongastrointestinal sites, such as lung or ovary (whose venous blood does not pass through the liver before entering the systemic circulation), can cause carcinoid syndrome without metastatic disease.</p> <p> Right-sided endocardial fibrosis, with pulmonary stenosis and tricuspid regurgitation, is common in carcinoid patients and is the result of toxic damage to the heart. 5-hydroxyindoleacetic acid is a urinary metabolite of serotonin that can be used to confirm the clinical impression of carcinoid syndrome. Carcinoid tumors are often indolent, and 10- to 15-year survivals after liver metastasis can occur.</p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice B:</strong> Cholangiocarcinoma arises from the epithelial cells of the bile duct. Symptoms of cholangiocarcinoma include painless jaundice caused by obstruction of the biliary system, pruritus, abdominal pain, weight loss and fever. This tumor does not secrete hormonally active substances.</p> <p> <strong>Choice C:</strong> Hepatocellular carcinoma usually arises in the setting of cirrhosis or other risk factors, such as hepatitis B, hepatitis C, aflatoxin exposure or hemochromatosis. This tumor does not secrete hormonally active substances.</p> <p> <strong>Choice D:</strong> Mucinous adenocarcinoma of the colon typically causes iron-deficiency anemia caused by blood loss, bowel obstruction or change in bowel habits. This tumor does not secrete hormonally active substances.</p> <p> <strong>Choice E:</strong> Squamous cell carcinoma of the esophagus usually causes symptoms with swallowing; it is unlikely to cause diarrhea. This tumor does not secrete hormonally active substances.</p> <p> <strong>Key tips to remember:</strong></p> <ul> <li> Carcinoid syndrome is described as cutaneous flushing, abdominal cramps and diarrhea caused by excessive circulating serotonin.</li> <li> Metastasis of primary intestinal carcinoid to the liver, or primary lung or ovarian carcinoid tumor, results in symptoms of carcinoid syndrome.</li> <li> The small bowel is the most common site of carcinoid tumor; however, small bowel carcinoid tumors do not cause carcinoid syndrome because the liver metabolizes and clears the portal circulation of the excessive circulating serotonin.</li> </ul> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d8f5b3c1-0b41-41c5-af14-79e6630dfd91 6 tips to nurture your family during training http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-tips-nurture-family-during-training Tue, 24 May 2016 23:00:00 GMT <p> Medical school and residency are times of intensive training, so adding a family to the mix can necessitate even greater planning and attention. At the same time, medical trainees with families say the rewards of going through this period with such a support network are well worth the effort. One medical family shares their tips for success.</p> <p> <strong>It’s quite a ride</strong></p> <p> “I’m not exactly sure how to explain what it was like going to medical school as a family of five, but I guess the best way to describe [it] is a rollercoaster,” Angela Kalcec wrote in an article in the <a href="http://bluetoad.com/publication/?i=297297#{"issue_id":297297,"page":22}" target="_blank" rel="nofollow">spring 2016 issue</a> of <em>Physician Family</em>, a publication of the AMA Alliance.</p> <p> Kalcec and her husband Everett, a third-year medical student at Michigan State College of Osteopathic Medicine, have three elementary-school-aged children and came to medical school after successful teaching careers. They share their joint insights in the article.</p> <p> “There are highs and lows, and sometimes we just barely hang on, but it is a fun ride,” she said.</p> <p> Here are six tips the Kalcecs recommend for other physicians in training and their families:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Communication is essential to succeeding as a busy family. </strong>“If you and your spouse are not communicating and working as a team, things will be really hard,” Everett Kalcec said.<br /> <br /> “We talk every morning and every night and go through the plans for the day and the next,” Angela Kalcec said.<br /> <br /> And when plans change along the way, the Kalcecs said it’s important to stay in constant contact. “We talk and text often,” she said. “We communicate, and we make it work.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Don’t follow assigned responsibilities. </strong>With the sometimes chaotic schedules that come with the responsibilities of medical training, a partner’s job and the children’s needs and activities, each day may look a little different. That makes it all the more important for everyone to pitch in.<br /> <br /> “If something needs to get done, you just do it,” said Angela Kalcec. “From picking a child up from school to emptying the dishwasher or folding laundry, nothing is beneath either of us.”<br /> <br /> When there are multiple things that need to be done at the same time, that’s when communication and prioritization are most important. The Kalcecs advise that you talk to your spouse if you need more time for essential responsibilities—such as studying for an exam or meeting a work deadline—and rearrange the other priorities accordingly.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Plan carefully, but be ready to improvise. </strong>“We plan just about every minute of the day,” Angela Kalcec said. That includes using organizational tools, such as a shared Google Calendar that includes reminders about upcoming activities.<br /> <br /> But with children, the best of plans can get derailed. “You have to be able to improvise,” she said. “This includes backup and double back-up childcare, friends that can take notes and co-workers who can cover in a pinch.”</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Make family time a priority. </strong>“When my husband decided to go to medical school, we agreed to do our best to always make time for our family,” Angela Kalcec said. For their family, that means having dinner together and spending time together in the early evening before studies. Whatever family time fits with your schedule, the important part is to make it quality time together.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Follow a budget. </strong>Not only does this mean understanding how to manage your finances but also prioritizing what you will spend on and what you will save on.<br /> <br /> “One sacrifice I couldn’t make was opportunities for our kids,” Angela Kalcec said. Instead, the Kalcecs spend less on clothing, drive older cars, and use coupons and bargain shop.</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>Make the most of your support network. </strong>The Kalcecs recommend connecting as much as possible with built-in support networks. Angela Kalcec said she’s been very active in the local and national physician family groups, where she has met great mentors and friends.<br /> <br /> Everett Kalcec said taking advantage of the school’s resources for students has been invaluable. “Nothing important was ever done alone,” he said. “All medical schools have counselors and advisers to help students.” He said he also has made sure to talk with professors whenever possible.<br /> <br /> “Remember to reach out to each other, other medical student families and get involved,” he said. “We are all in this together!”</p> <p> <strong>Additional insights for physician families:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-building-blocks-successful-medical-marriage" target="_self">Building blocks for a successful medical marriage</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-balancing-two-physician-family" target="_self">How to balance a two-physician family</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-live-budget-during-training" target="_self">6 tips for living on a budget during training</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_self">Physician-recommended steps to work- and home-life balance</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/5-financial-planning-tips-young-physician-should" target="_self">5 financial planning tips every young physician should know</a></li> </ul> <p align="right"> <em>By AMA Wire editor</em> <a href="https://twitter.com/amy_amawire" target="_blank" rel="nofollow"><em>Amy Farouk</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:ed50c450-ec0f-4040-a68f-5f5f79ab9dc3 4 new ways HHS hopes to simplify, support patient care http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-new-ways-hhs-hopes-simplify-support-patient-care Tue, 24 May 2016 20:48:00 GMT <p> Physicians and patients could soon have access to tools that will help simplify complicated components of health care, including Medicare payment policies and medical bills. Learn about two new health IT challenges and funding opportunities that should bring greater clarity and simplicity to important administrative functions, from medication management to care coordination.</p> <p> <strong>Making sense of regulations and medical bills</strong></p> <p> “It’s not just a vision for our future,” said U.S. Department of Health and Human Services (HHS) Secretary Sylvia Burwell as she announced two new challenges at Health Datapalooza in Washington, D.C. “These changes are happening right now. We are getting closer to that better, smarter health care system every day.”</p> <p> The two challenges from HHS focus on clarity for both physicians and patients:</p> <ul> <li> <strong>MIPS Mobile Challenge. </strong>The Medicare Access and CHIP Reauthorization Act (MACRA) proposed rule is complicated, and many physicians are wondering how to make sense of it all. In an effort to help physicians understand the rule when it is finalized this fall, HHS has announced a new challenge to help physicians navigate the Merit-based Incentive Payment System (MIPS).<br /> <br /> The MIPS Mobile Challenge will focus on solving the problem that many physicians and their staff will face—the ability to easily access information that is relevant to improve patient care and enable successful reporting under the new payment system. The winning idea will create a mobile platform that features innovative ways of transmitting educational materials or facilitating collaboration among users.<br /> <br /> Submissions for mobile platforms that accomplish this goal are open through July 15. <a href="https://www.challenge.gov/challenge/medicare-program-merit-based-incentive-payment-system-mips-mobile-challenge/" rel="nofollow" target="_blank">Learn more</a> about the MIPS Mobile Challenge.</li> </ul> <ul> <li> <strong>A Bill You Can Understand Challenge. </strong>Medical bills can be difficult to understand, often feeling like a foreign language to patients. HHS recently announced a new challenge that seeks design solutions that result in clearer, less complex and more understandable medical bills that improve the patient financial experience.<br /> <br /> Idea submissions for a medical bill that makes sense are due Aug. 10. The winners will be announced at the Health 2.0 conference in September. <a href="http://www.abillyoucanunderstand.com/challenge/" rel="nofollow" target="_blank">Learn more</a> about the challenge.</li> </ul> <p> <strong>Technology that advances patient care</strong></p> <p> National Coordinator for Health IT Karen DeSalvo, MD, announced two new funding opportunities intended to boost implementation of standards and technology that can improve care delivery, health information exchange and the patient experience.</p> <p> The Office of the National Coordinator for Health IT is asking applicants to select focus areas from a list of categories, including comprehensive medication management, laboratory data exchange and care coordination.</p> <p> Each program differs in award amount and category selection:</p> <ul> <li> <strong>High Impact Pilots (HIP) program.</strong> Applicants select one priority category and a minimum of three impact dimensions that their project will address. Total funding available is $1.25 million. Submissions are welcome until July 8. <a href="https://www.healthit.gov/techlab/pilots/high-impact-pilots" rel="nofollow" target="_blank">Learn more</a> about the HIP program.</li> </ul> <ul> <li> <strong>Standards Exploration Award (SEA) program.</strong> Applicants select one priority category and one specific impact dimension that their project will address. Total funding available is $250,000. Submissions are welcome until July 8. <a href="https://www.healthit.gov/techlab/pilots/standards-exploration-awards" rel="nofollow" target="_blank">Learn more</a> about the SEA program.</li> </ul> <p> “We all need to move toward common standards,” Dr. DeSalvo said. “We have to move toward culture change—one in which access to health information is the norm, including addressing information blocking, and we have to build an appropriate business case for interoperability.”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d4101952-b171-4c88-a060-f54c2328aa8b This USMLE Step 1 question stumped test-takers http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_this-usmle-step-1-question-stumped-test-takers Mon, 23 May 2016 21:25:00 GMT <p> When it comes to taking exams, not all questions are created equal. If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you need this exclusive scoop on one of the most commonly missed USMLE test prep questions. Find out what this month’s challenging question is, and view an expert video explanation of the answer from Kaplan Medical.</p> <p> Welcome to this month’s installment of the <em>AMA Wire</em>® series, Tutor talk: Tips from Kaplan Medical on the most missed USMLE test prep questions from Kaplan’s Qbank: Step 1. Each month, we’re revealing the top questions physicians in training miss on the USMLE, a helpful analysis of answers and videos featuring tips on how to advance your test-taking strategies. See <a href="http://www.ama-assn.org/ama/ama-wire/blog/USMLE_Prep/1" target="_self">all posts in this series</a>.</p> <p> Think you have what it takes to rise above your peers? Test your USMLE knowledge below.</p> <p> Ready. Set. Go.</p> <p> <strong>This month’s question that stumped most students:</strong></p> <p> An investigator is evaluating the effects of new synthetic drugs on arteriolar resistance. Drug X maximally increases vascular resistance by 50 percent at a dose of 20 mg/mL. Drug Y maximally increases vascular resistance by 75 percent at a dose of 40 mg/mL. Which of the following conclusions can be drawn from this study?</p> <p> A. Drug X has a smaller volume of distribution than drug Y Angiotensin II</p> <p> B. Drug X has a shorter half-life than drug Y</p> <p> C. Drug X is less efficacious than drug Y</p> <p> D. Drug X is less potent than drug Y</p> <p> E. Drug X has a lower LD<sub>50</sub> than drug Y</p> <p>  </p> <p>  </p> <p> <object data="http://www.youtube.com/v/OHD901IdiYU" height="350" id="ltVideoYouTube" src="http://www.youtube.com/v/OHD901IdiYU" type="application/x-shockwave-flash" width="450"><param name="movie" value="http://www.youtube.com/v/OHD901IdiYU" /><param name="quality" value="best" /><param name="bgcolor" value="#ffffff" /><param name="wmode" value="transparent" /><param name="allowFullScreen" value="true" /><param name="allowScriptAccess" value="always" /><param name="flashvars" value="playerMode=embedded" /></object></p> <p>  </p> <p>  </p> <p> <strong>The correct answer is C.</strong></p> <p>  </p> <p> <strong>Kaplan says, here’s why: </strong><br /> The only conclusion that can be drawn from these data is that drug X is less efficacious than drug Y. Efficacy is defined as the maximum effect that can be produced by a drug, regardless of dose. Drug X can produce only a 50 percent change in resistance, whereas drug Y can produce a 75 percent change in resistance. Therefore, drug X is less efficacious than drug Y.</p> <p> In the figure below, Drug X has a greater efficacy than Drug Y because it produces a larger effect. Drug A is more potent than Drug B because less drug is required to produce a given response.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/12/6a749c0f-91a5-47c5-8cf1-e1e39947eb64.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/12/6a749c0f-91a5-47c5-8cf1-e1e39947eb64.Large.jpg?1" style="margin:15px;" /></a></p> <p> <strong>Why you shouldn’t choose the other answers:</strong><br /> <em>Read these explanations to understand the important rationale for each answer.</em></p> <p> <strong>Choice A:</strong> A volume of distribution is a hypothetical volume of body fluid that would be required to dissolve the total amount of drug at the same concentration that is found in the blood.</p> <p> <strong>Choice B:</strong> The half-life is the time it takes for the concentration of a drug to decrease 50 percent from its previous measurement. There is no information given to determine half-life.</p> <p> <strong>Choice D:</strong> The potency is the dose or concentration required to produce 50 percent of the drug’s maximal effect. We cannot determine the potency of drug Y from this question.</p> <p> <strong>Choice E:</strong> The LD<sub>50</sub> is the dose that causes death in 50 percent of a population of subjects. The experiment described does not involve a population study, and it does not give any indication about the toxicity of the drug. </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d2e34901-7427-4926-b3f3-47e069a357bb 3 steps for talking with patients about substance use disorder http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-steps-talking-patients-substance-use-disorder Mon, 23 May 2016 21:00:00 GMT <p> When a patient with a substance use disorder comes in for a visit, talking to them about treating their addiction in a way that avoids the stigma that surrounds these disorders can be difficult. Learn how one physician approaches this conversation during her addiction consultations with patients.</p> <p> Out in New Mexico, physicians and other medical professionals are putting in a lot of work toward ending the opioid overdose epidemic. <a href="http://echo.unm.edu/" rel="nofollow" target="_blank">Project ECHO</a> (Extension for Community Healthcare Outcomes), a free-of-charge distance education model, connects primary care physicians with specialists to help them develop and share knowledge in the care of a variety of complex health conditions The program also has facilitated medication-assisted treatment (MAT) trainings for more than 375 physicians who are now buprenorphine-waivered.</p> <p> But what about the simple yet critical act of beginning the conversation about treatment with a patient who has a substance use disorder?</p> <p> As associate director of Project ECHO, Miriam Komaromy, MD, an internal medicine specialist and addiction consultant in New Mexico, spends the bulk of her clinical time conducting addiction consultations.</p> <p> <strong>Beginning the conversation that could save a life</strong></p> <p> Primary care physicians refer patients to Dr. Komaromy so that she can talk with them, get to the heart of the disorder and figure out the best way to structure their treatment plans.</p> <p> When a patient comes in for that first visit, Dr. Komaromy focuses on three things to minimize stigma and promote an effective dialogue:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Let the patient tell their story.</strong> Start out broadly, asking open-ended questions to get the patient talking about their story—not their substance use disorder story, but rather their personal story.<br /> <br /> “I usually start by saying, ‘Tell me a little bit about yourself,” Dr. Komaromy said. “If they don’t immediately jump in talking about their substance use disorder, I say, ‘OK, now would you be comfortable telling me a little bit about your history of issues with substance use?’ The story really unfolds from there.”<br /> <br /> “People really want to tell their story, but they often feel constrained in a medical environment,” she said. “But if you allow them to [tell their story,] it can be the most efficient thing of all …. People want to be heard. You can get a lot of relevant information right up front.”<br /> <br /> “Certainly, by the time [a patient] is open to treatment, they’re not having a good time,” Dr. Komaromy said. “They’ve really exported to a phase of substance use disorder that’s miserable in trying to avoid withdrawal and struggling with something that feels like it’s got a stranglehold on them.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Get to the heart of the matter.</strong> Understanding the reason for a patient’s substance use is key to finding the treatment option most suitable for that patient.<br /> <br /> “They’re usually really hurting, and almost always they have some story of trauma that underlies it,” Dr. Komaromy said. “Part of what I try to do is not just help figure out how to address the substance use disorder right here and now, but also how do we start to address the underlying trauma or the possibility of post-traumatic stress disorder.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Convey respect.</strong> Stigma is a big issue in these conversations, and respect is a key ingredient to avoiding it.<br /> “People with substance use disorders, because of the stigma, are used to being treated badly,” Dr. Komaromy said. “It’s so important to convey respect. The message—on a really gut level—is that I’m just another human being like you, and I want to figure out how I can help.”<br /> <br /> She recommends paying attention the following:</p> <ul> <li style="margin-left:40px;"> Never conduct the interview while standing. Try to sit at the same level as the patient.</li> <li style="margin-left:40px;"> Make eye contact.</li> <li style="margin-left:40px;"> Say things that are encouraging, empathetic and simple during their story, “such as, ‘That sounds really difficult,’” she said. “It’s simple, but I think that plays a huge role in developing the start of a therapeutic relationship.”</li> </ul> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_self">five things physicians can do to prevent opioid abuse</a>, recommended by the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_self">AMA Task Force to Reduce Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> Learn more about physicians’ efforts to end the opioid epidemic:</p> <ul> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">how a substance use researcher in San Francisco talks with his patients about substance use disorder</a>.</li> <li> Learn <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_self">how President Obama’s opioid initiatives align with the task force’s recommendations</a>.</li> <li> Read a <a href="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a><u>,</u> and watch a <a href="https://www.youtube.com/watch?v=U2VUot6c8lw" rel="nofollow" target="_blank">video message</a><u> </u>from AMA President Steven J. Stack, MD.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-saying-new-cdc-opioid-guidelines" target="_self">what physicians are saying <u> about the new Centers for Disease Control and Prevention’s opioid guidelines</u></a>.</li> <li> Learn what the AMA Task Force <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/stigma-of-substance-use-disorder.page?" target="_self">recommends for physicians to reduce stigma and increase use of MAT</a></li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a66bbcec-f472-4287-9d12-a4590787866f 3 barriers keeping data from improving health outcomes http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-barriers-keeping-data-improving-health-outcomes Fri, 20 May 2016 21:00:00 GMT <p> Access to actionable, real-time data can create opportunities for physicians to improve the health of their patients, but the current environment often prevents physicians from being able to access and use that data. Find out what three experts think the future holds for data usage and what they say needs to change first.</p> <p> <strong>How health data can—and does—save lives</strong></p> <p> Experts recently spoke to the health IT community about current and future uses of data at Health Datapalooza in Washington, D.C. Though there are issues in the current health system that cause problems for data usage in practice, the panelists were first and foremost optimistic about the future.</p> <p> “We are using data to save people’s lives,” said David T. Feinberg, MD, president and CEO of Geisinger Health Systems. For example, his practice saw a 16-year-old girl, who came to the emergency department for dehydration but volunteered for Geisinger’s population health-based genetics program.</p> <p> “We take a look … and it turns out that she has two of the genes associate with fatal cardiac arrhythmias in young athletes,” he said. “She wasn’t dehydrated; it was the beginning of her cardiac symptoms.”</p> <p> “Our data shows that 30 people in her extended family are treated by us,” he said. Geisinger then brought in her family members and set up monitoring for those at risk.</p> <p> “To me, it’s the first time we looked at this kind of information and [could] anticipate what’s going to happen in people’s lives,” he said, “and completely change the trajectory.”</p> <p> <strong>Barriers standing in the way of progress</strong></p> <p> There are many practices already using data to coordinate care, create better outcomes and focus on population health, but three barriers are still slowing progress and impeding practices’ abilities to use data in a helpful way.</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Time and technology</strong><br /> “We ask people who are driven to spend time with their patients to complete complex cognitive tasks,” said James L. Madara, MD, AMA executive vice president and CEO. “[A lot of] of physicians’ time during the day is on the keyboard [not] face to face with patients, which is why they went into that field. Added onto that … hours in the evening finishing up their keyboard work.”<br /> <br /> “One of the issues is the failure to recognize the variation that occurs regionally and in terms of practice type,” Dr. Madara said. “We often get tools that have this monolithic kind of feel to them. A good place to start is a really well-defined problem, and then the ideas stem from that.”<br /> <br /> “For example, <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-tied-up-physician-time-2015" target="_self">electronic health records (EHRs)</a>,” he said. “The idea is that we have lots of data—we have to organize it in some digital way. If you would have said that was the problem initially, and the problem is actionable, organized data at the point of care, easy entry, protecting the interface between patient and physician and recognizing that … continuity and interoperability are really important, we would have had a digital approach with a very different set of products than we have today.”<br /> <br /> Chet Burrell, president and CEO of CareFirst BlueCross BlueShield, gave an example of how physicians have worked together to make improvements based on access to meaningful data outside of a handed-down mandate.  <br /> <br /> “We have tended to organize primary care physicians into small teams,” he said. “One of the things we have learned [is that] when they see each other’s data, they see things, do things, act on things in a way no government or regulator or payer ever could cause them to do.”</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>The wrong incentives</strong><br /> The rapid growth of high-deductible plans has made many patients reluctant to seek the care that they need, Burrell said. “We see people who need care coordination and need certain services but say, ‘I know I need it, but I can’t afford all the out-of-pocket expense.’ I’m worried about the long-term implications of those designs.”<br /> <br /> On the physician side, Burrell said, putting financial risks on physicians doesn’t foster improvements. It’s the current movement toward incentives that has been more effective, he said.<br /> <br /> But perhaps the real incentives U.S. health care needs aren’t financially based.<br /> <br /> “I think we have the incentive systems all wrong,” Dr. Madara said. A nationwide <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page#rand">study</a> the AMA conducted with the RAND Corporation found that “the primary driver of physicians was time face to face with patients,” he said, “and everything that got in the way of that was a disincentive.”<br /> <br /> “There have been studies that show that if you ask a physician what [they] need to improve [their] practice, they say actionable data in real-time,” he said. “[If] you give it to them, they produce higher quality care than one does with small economic incentives.”<br /> <br /> The incentive isn’t the payment—it’s the patient’s health and the physician’s relationship with him or her.<br /> <br /> “The more we shift toward paying for value, the better,” Dr. Feinberg said. “It will play out differently in different communities and at different levels, but the concept of paying for outcomes, paying for quality, for functionality … however it plays will be better.”<br /> <br /> “The biggest barrier is that we’re completely worried about our own turf,” Dr. Feinberg said. “This is a crisis in America—the type of health care we deliver, who gets it, the quality, who doesn’t get it and the cost.”<br /> <br /> Industry stakeholders are all worried about what’s happening to them, Dr. Feinberg said. “It’s never really been the year of the patient.”<br /> <br /> “Then something happens in your family, and you interact with this system, even as an insider,” he said. “It’s totally a pain. I think if we’re going to fix this, it’s going to take a huge dose of selflessness, and I don’t see the industry talking about that.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Gaps in education</strong><br /> “We’re focused on connecting the data to missing gaps in the health system,” Dr. Madara said. One example is the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Accelerating Change in Medical Education Consortium</a>, which consists of 32 medical schools. “We are now populating the consortium with a learning EHR … which [will] allow students to get the rhythm of what an EHR can do and get them ready for the next generation of EHRs.”<br /> <br /> “In terms of the flow of work in physician offices,” Dr. Madara said, “we have created a set of interactive modules—<a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward</a>™—that allow one to use data in a more effective way in practice.”<br /> <br /> It is important that the next generation of physicians is prepared and has the knowledge to make sure the system continues to shift in the right direction, he said. “And that requires changing the structure of medical school.”</p> <p> Explore ways data is changing care and education:</p> <ul> <li> Read what a U.S. senator is saying about <a href="http://www.ama-assn.org/ama/ama-wire/post/fix-ehrs-patient-physician-relationship-senator-says" target="_self">why the health system needs to fix EHRs</a>.</li> <li> Discover how Vice President Biden is <a href="http://www.ama-assn.org/ama/ama-wire/post/biden-seeks-physician-input-global-cancer-fight" target="_self">calling for physician input and breaking down the walls that prevent data sharing</a>.</li> <li> Find out how <a href="http://www.ama-assn.org/ama/ama-wire/post/virtual-patients-create-med-ed-environment-of-future" target="_self">virtual patients help create the med ed environment of the future</a>.</li> <li> Learn how to <a href="http://www.ama-assn.org/ama/ama-wire/post/diagnose-prediabetes" target="_self">diagnose prediabetes among your patients using a registry</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:e2384373-292e-4173-9528-2c96e84f5e92 How new Medicare payment system intends to help small practices http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_new-medicare-payment-system-intends-small-practices Fri, 20 May 2016 21:00:00 GMT <p> Draft regulations released last month outline sweeping changes to the Medicare payment system, and one of those eagerly anticipated changes is the Centers for Medicare & Medicaid Services’ (CMS) stated intent to ease physicians’ administrative burdens—including for those in small or rural practices. A new fact sheet outlines flexibilities the agency is proposing for physicians in the new payment system.</p> <p> <strong>Responding to physician feedback</strong></p> <p> The <a href="https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm" target="_blank" rel="nofollow">proposed rule</a> for implementing key provisions of the Medicare Access and CHIP Reauthorization Act (MACRA) has drawn concerns regarding its regulatory impact analysis, which projected that the quality and resource use components of the new Merit-based Incentive Payment System (MIPS) would have a negative impact on most solo physicians and small practices.</p> <p> CMS has clarified in its new <a href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Small-Practices-Fact-Sheet.pdf" target="_blank" rel="nofollow">small practices fact sheet</a> that the projections made in the analysis were “based on 2014 data when many small and solo practice physicians did not report their performance. It also does not reflect the accommodations in the proposed rule that are intended to provide additional flexibility to small practices.”</p> <p> In particular, the impact analysis table in the proposed rule only offers a partial picture of physicians’ potential success in MIPS because it fails to include participation in the categories of “clinical practice improvement” and “advancing care information”—formerly the electronic health record meaningful use program.</p> <p> Another flaw in the analysis was that it did not provide the magnitude of how physicians would be affected. For example, physicians who opted not to participate in quality reporting and meaningful use would be subject to an 11 percent payment cut in 2019 under previous law. Under MACRA, the maximum payment cut would be 4 percent. Unlike MACRA, previous law did not provide any partial credit for efforts that were not 100 percent successful.</p> <p> The analysis looked at successful participation of “eligible clinicians” in the Physician Quality Reporting System (PQRS) and under the value-based modifier. CMS’ definition of “eligible clinicians” includes nonphysician health professionals such as chiropractors. Many of these eligible clinicians could not participate in PQRS or the value-based modifier. Consequently, the subset of the physicians actually reflected in the analysis is relatively small.</p> <p> Andy Slavitt, acting administrator of CMS, <a href="http://www.ama-assn.org/ama/ama-wire/post/3-principles-driving-new-medicare-payment-systems" target="_self">recently testified</a> before a congressional committee, emphasizing that the agency is focused on providing the flexibility required for physicians in smaller practices to be as successful under MIPS as those in larger groups.</p> <p> Here are some of the flexibilities that CMS says were included in the proposed rule to accommodate the unique needs and challenges faced by physicians in small practices: </p> <ul> <li> <strong>Physicians with a low Medicare volume won’t be subject to the MIPS payment adjustment.</strong> To avoid unnecessary reporting burdens, clinicians or groups who have less than or equal to $10,000 in Medicare charges and less than or equal to 100 Medicare patients are excluded from the MIPS payment adjustment.</li> </ul> <ul> <li> <strong>Physicians should not be held accountable to inapplicable categories.</strong> If a MIPS performance category does not have enough measures or activities that are applicable for the practice, then the category would not be included in the practice’s MIPS score.</li> </ul> <ul> <li> <strong>Physicians will have fewer measures on which to report.</strong> The agency is proposing to remove unneeded measures and reduce administrative requirements. For example, CMS proposes to reduce the number of required measures in the quality and advancing care information categories.</li> </ul> <ul> <li> <strong>Physicians can use a single reporting mechanism.</strong> Three of the four categories will require reporting—all of which can be done through the same mechanism, instead of the distinct reporting options required under the current payment system. Physicians also have greater choice regarding which reporting mechanism to use.</li> </ul> <p> <strong>Easing the burden within performance categories</strong></p> <p> CMS has proposed additional flexibilities within MIPS performance categories to account for the unique circumstances of individual clinicians, small groups, and practices in rural or professional shortage areas:</p> <ul> <li> <strong>Quality.</strong> The total possible points would be 80 for a group of nine or fewer, while a group of 10 or more would be 90 points. Also in an effort to reduce physicians’ reporting burden, the quality category would require practices of all sizes to report only on six measures, rather than the nine current measures. In addition, physicians would receive partial credit for measures.</li> </ul> <ul> <li> <strong>Clinical practice improvement activities.</strong> Under this category, physicians and other clinicians would be rewarded for clinical practice improvement activities, such as those focused on care coordination, beneficiary engagement and patient safety. A list of more than 90 options will be available for physicians to select activities that match their practice’s individual goals.<br /> <br /> For physicians in small practices located in rural or professional shortage areas, this category allows them to submit one activity of any weight to receive partial credit or two activities of any weight to receive full credit. Larger practices would be required to submit three to six activities.</li> </ul> <ul> <li> <strong>Cost.</strong> A cost score would not be calculated for physicians who don’t have a high enough patient volume for the cost measures (generally defined as a minimum of 20 cases pertaining to a particular measure). CMS would reweight the cost category to zero and adjust other MIPS performance category scores to make up the difference.</li> </ul> <p> While these proposals are important changes for physicians, the agency will need to make additional improvements during the rulemaking process to best address things that have been getting in the way of physicians focusing on providing high-quality care to their patients. The proposed rule is open for comment through June 27, and CMS has said it welcomes feedback from patients, physicians, caregivers, health care professionals and members of Congress, among others.</p> <p> The AMA is developing recommendations to further ease the burdens on physicians in small or solo practices to enable their success under this new payment system.</p> <p> <strong>Resources to help you prepare for the new payment systems</strong></p> <p> The AMA offers a number of resources to help physicians prepare for the coming payment policies, including:</p> <ul> <li> <a href="http://www.ama-assn.org/resources/doc/washington/macra-summary-05052016.pdf" target="_self">A summary of the proposed regulations</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-steps-prepare-medicares-new-payment-systems" target="_self">4 steps to prepare for Medicare’s new payment systems</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_self">A guide to physician-focused payment models</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_self">Key points of the Merit-based Incentive Payment System</a></li> <li> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_self">What you can do now to prepare</a>  </li> <li> The AMA’s <a href="https://www.stepsforward.org/%22%20%5Ct%20%22_blank" target="_self" rel="nofollow">STEPS Forward™ collection</a> of practice improvement strategies, which include advancing team-based care, implementing electronic health records, improving care and practicing value-based care</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" target="_blank" rel="nofollow"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:fddb8359-730d-431b-b580-e76905780de8 Weigh in on pressing health care issues by June 5 http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_weigh-pressing-health-care-issues-june-5 Thu, 19 May 2016 17:21:00 GMT <p> How do you think the practice of medicine should be improved in the United States? Share your thoughts on important health care topics—and have a chance to shape AMA policy—via the AMA <a href="http://www.ama-assn.org/ama/pub/community/forums/annual-2016/reference-committee.page" target="_self">Online Member Forums</a> (log in). They’re now open in advance of the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_self">2016 AMA Annual Meeting</a>, taking place June 11-15 in Chicago.</p> <p> Online forums allow AMA members to weigh in on key policy issues facing medicine at the convenience of their own schedules. By participating in the forums, you can add your voice to the AMA policy discussion from your home, at your office or on the go.</p> <p> Resolutions and reports up for discussion at the 2016 AMA Annual Meeting address such topics as:</p> <ul> <li style="margin-left:0.25in;"> Measuring and improving access to care for patients</li> <li style="margin-left:0.25in;"> Addressing the availability of addiction treatment centers</li> <li style="margin-left:0.25in;"> Reducing gun violence</li> <li style="margin-left:0.25in;"> Improving the safety of drinking water</li> <li style="margin-left:0.25in;"> Increasing the number of residency positions available to train doctors for practice</li> <li style="margin-left:0.25in;"> Reducing barriers to preventive and routine physical and mental health care for physicians in training</li> </ul> <p> All items of business from initial reports and resolutions for this policymaking meeting are posted in the forums, which are sorted by reference committee. Any AMA member can comment on any item of business. While the forums will be open until the start of the meeting, comments posted after June 5 may not be captured in the comment summaries that will be shared with reference committee members and posted on the <a href="http://www.ama-assn.org/sub/meeting/reportsresolutions.html" target="_self">2016 AMA Annual Meeting website</a>.</p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5ea6cf51-5743-492b-848d-3b463f1580b4 4 ways schools are paving a new path to residency http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-ways-schools-paving-new-path-residency Thu, 19 May 2016 16:57:00 GMT <p> Several medical schools are overhauling the way their students make the traditionally stressful leap into graduate medical education (GME).</p> <p> Schools are implementing these programs as part of their work with the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/innovations.page" target="_self">Accelerating Change in Medical Education Consortium</a>, which is working to modernize and reshape the way physicians are trained. The programs are designed to improve competency, leadership and patient care through innovations that bridge the curriculum gap between medical school and internship.</p> <p> <strong>A transition curriculum</strong></p> <p> “Interns in July are expected to hit the ground running and take care of patients,” said Julie Byerley, MD, vice dean for education at the University of North Carolina School of Medicine, a consortium member school. But greater emphasis needs to be placed on preparing students to make that transition.</p> <p> The school has launched its new <a href="http://www.med.unc.edu/md/curriculum/curriculum-structure/tec-curriculum-information/tec-overview" rel="nofollow" target="_blank">Translational Education at Carolina</a> curriculum, which weaves professional development throughout the four years of medical school. It also includes a “transition to internship” component designed to enhance leadership qualities, ethics and humanism with an eye specifically toward making a smoother transition from undergraduate medical education (UME) to GME.</p> <p> The school is on track to see their first class of students take part in the transition to internship aspect of the curriculum beginning in March 2018. This will include:</p> <ul> <li> Monthlong rotations specifically focused on the transition to internship</li> <li> Assessment of core entrustable professional activities (EPA) for entering residents</li> <li> More leadership education, enabling students to take on leadership roles sooner as residents</li> </ul> <p> Dr. Byerley said the updated transition plan promises fewer medical errors, better care and a priceless opportunity to shape the future of medical education.</p> <p> <strong>Focusing on patient safety</strong></p> <p> Michigan State University College of Osteopathic Medicine, also a member of the consortium, is considering the transition to residency through the lens of patient safety.</p> <p> An emphasis on safety education begins in the first year of medical school under its new program and continues into clerkship and residency. The goal is to enable students to use their undergraduate understanding of safety as a springboard to residency research projects on the same topic.</p> <p> “We hope to demonstrate that students can and should be valued elements of the overall goal of patient safety,” said Saroj Misra, DO, associate professor of family and community medicine at Michigan State<em>.</em></p> <p> So far, there is little training on patient safety at the undergraduate level and little effort to use a safety curriculum that bridges the transition from medical school to residency, Michigan State faculty who are leading the school’s curricular innovations say. While there is little evidence to date that longitudinal approaches to safety will have a positive impact, Dr. Misra said, they intend to discover if it does.</p> <p> With the use of a formalized curriculum involving validated modules combined with mock cases, Michigan State is training students to detect and react to medical errors. Students learn to identify errors, identify the stages of treatment most prone to errors, examine causes and communicate with the families of patients. The training involves such elements as how to apologize and how to conduct a root cause analysis.</p> <p> <strong>Embedding students in the care setting</strong></p> <p> At Ohio University Heritage College of Osteopathic Medicine, another consortium member, physician educators are laying the foundation for a seamless transition to internship by embedding students in patient-centered medical homes in Cleveland.</p> <p> “The impetus is, we need to be looking for more efficiency in education, just like we need to look for more efficiency in care,” said Isaac Kirstein, DO, dean of the college.</p> <p> In this model, students continually build skills needed to lead in health systems science, population health, communications, safety and health IT—practical skills that prepare them for their transition to the linked residency.</p> <p> For students who have been embedded in patient care throughout medical school, their first day of residency doesn’t seem very different from their last day of medical school, Dr. Kirstein said.</p> <p> He called leadership a key skill in playing a more meaningful part in a health care team from the first day of residency. “If we don’t produce physicians who can lead within health care teams, other professionals will take that role,” Dr. Kirstein said.</p> <p> <strong>A bridge between UME and GME</strong></p> <p> To usher students through the transition from medical school to residency, the University of California, Davis, School of Medicine and the Kaiser Permanente health care system have collaborated since 2014 as part of the school’s work as a founding member of the AMA’s Accelerating Change in Medical Education Consortium.</p> <p> “Internship is a huge mystery to medical students,” said Tonya Fancher, MD, associate professor of medicine. “If we can tell them, ‘here is what you need to be able to do on Day 1,’ then we’ve made it easier for them.”</p> <p> UC Davis puts students to work in Kaiser clinics throughout medical school, providing them with early experience in teamwork.</p> <p> At graduation, students are offered conditional acceptance to residency at either Kaiser or UC Davis. The project enhances the transition to internship and gets physicians into the workforce sooner, Dr. Fancher said. It also serves another vital purpose, she said—solving the acute shortage of primary care doctors in California.</p> <p> “It seems really important to bridge the gap between UME and GME,” she said. “These two worlds have really lived separately for probably too long.”</p> <p> <strong>More innovations in medical education:</strong></p> <ul> <li> Learn why <a href="http://www.ama-assn.org/ama/ama-wire/post/michigan-relaying-student-competency-residency-programs" target="_self">one school is relaying student competency to residency programs</a>.</li> <li> See <a href="http://www.ama-assn.org/ama/ama-wire/post/one-school-training-students-rural-medicine" target="_self">how a school is training students for rural medicine</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/students-forefront-of-transforming-med-ed" target="_self">how students are at the forefront of transforming med ed</a>.</li> <li> Discover <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-changing-med-ed-going-back-school" target="_self">why physician educators are going back to school</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e76ac848-377b-4f77-9aa9-02b7d40848fc The impact of parenthood on residency http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_impact-of-parenthood-residency Wed, 18 May 2016 21:21:00 GMT <p> With women comprising one-half of medical school graduates, two recent studies examined the experience that residents have when they decide to become parents during training. Find out how common parenthood is and how it impacts men versus women.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/10/d4b9ab9c-71f5-4c4a-8a18-500d250748e1.Full.jpg?1"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/4/10/d4b9ab9c-71f5-4c4a-8a18-500d250748e1.Full.jpg?1" style="width:350px;height:1259px;margin:15px;float:right;" /></a></p> <p> <strong>Deciding when to have children</strong></p> <p> Two recent investigations into parenthood during training found that residents are concerned about how having a child will impact their training and how their skills and work ethic will be perceived. But the studies showed women who become pregnant are more often impacted than men who become fathers during residency.</p> <p> With residents spending the prime of their reproductive years in training and more women going into medicine, a <a href="http://www.redjournal.org/article/S0360-3016(15)00202-3/abstract" rel="nofollow" target="_blank">study</a> in the <em>International Journal of Radiation Oncology</em> looked at how parenthood impacted radiation oncology residents and a <a href="http://www.journalacs.org/article/S1072-7515(15)01774-3/fulltext" rel="nofollow" target="_blank">second study</a> published in the <em>Journal of the American College of Surgeons</em> explored general surgery residents’ experiences.</p> <p> Among the 190 radiation oncology trainees who responded to a survey, slightly more than one-half had children. Nearly 45 percent said they or their partner had a pregnancy during residency, while 50.5 percent of respondents said they delayed or were delaying having children because of residency demands.</p> <p> And parental leave is a common occurrence among general surgery residents. In the study published in the <em>Journal of the American College of Surgeons</em>, 41 percent of the 66 general surgery residency program directors who responded to a survey said at least once a year they have a resident who takes maternity or paternity leave.</p> <p> <strong>Workload and training concerns</strong></p> <p> Radiation oncology residents expressed concerns about how a pregnancy would impact their training. One-third of those who were pregnant during residency believed colleagues would have extra work because of their pregnancy. Nearly one-half believed they had less research experience compared to colleagues, and more than one-fifth believed they gained less clinical experience than colleagues who didn’t become pregnant during training.</p> <p> General surgery residents who had become pregnant expressed concerns about “being a burden on colleagues,” “being perceived as ‘lazy’ or not carrying my weight,” and “being treated differently than my peers,” the study found.</p> <p> Similarly, men who became fathers said they felt guilty about leaving their teams shorthanded while on paternity leave and said “the good residents take as little time as possible.”</p> <p> The radiation oncology study showed no significant differences in academic productivity or academic career aspirations between men and women overall. It also found that over the total duration of training, radiation oncology residents who were mothers kept pace academically with male colleagues without children.</p> <p> “That could be due to more efficient use of time and resources,” study authors said. “Alternatively, perhaps hours spent on childcare do not come at the expense of academic pursuits but instead come at the expense of self-care and leisure activities.”</p> <p> General surgery program directors perceptions back that up. They saw children as decreasing female trainees’ well-being more often than male trainees—32 percent versus 9 percent.</p> <p> <strong>More challenging for women than men</strong></p> <p> Women were more often responsible for childcare duties than men. Among radiation oncology residents, 38.1 percent of fathers had non-employed partners to take care of a child. No mothers had a non-employed partner. Also:</p> <ul> <li style="margin-left:0.25in;"> Fathers reported performing a median 25 percent of cumulative familial childcare duties; they said their partner performed a median of 70 percent.</li> <li style="margin-left:0.25in;"> Mothers reported a median of 40 percent of childcare duties, compared to a median partner rate of 35 percent.</li> <li style="margin-left:0.25in;"> Nearly 75 percent of men said their partner “usually” was the caretaker when unexpected childcare needs arose; just 31 percent of women responded that way.</li> </ul> <p> <strong>Read more about work-life balance issues:</strong></p> <ul> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-rank-residency-work-life-balance-specialty" target="_self">Physicians rank residency work-life balance by specialty</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="_self">Four physician-recommended steps for a work- and home-life balance</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-share-4-tips-assessing-specialty-lifestyle" target="_self">Residents share 4 tips for assessing specialty lifestyle</a></li> <li style="margin-left:0.25in;"> <a href="http://www.ama-assn.org/ama/ama-wire/post/will-gender-influence-specialty-physicians-offer-insights" target="_self">Will gender influence your specialty? Physicians offer insights</a></li> </ul> <p align="right">  </p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a9708a3c-4249-4de2-945f-7800333ce266 Why your practice needs a health coach (and how to get one) http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_practice-needs-health-coach-one Wed, 18 May 2016 20:45:00 GMT <p> Engaging patients in behavior changes can improve their overall health and reduce the amount of medical care they need, but it’s often difficult for physicians to find the extra time to collaborate and plan these types of strategies. Trained health coaches can take on a lot of these responsibilities to advance lifestyle changes, prevention and patient health.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/0/cf9e0b54-4271-4a91-80c0-14625b969581.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/0/cf9e0b54-4271-4a91-80c0-14625b969581.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> Having a health coach involved in a patient’s care can not only increase patient satisfaction and engagement but also reduce physician stress and burnout by freeing up time.</p> <p> In a new <a href="https://www.stepsforward.org/modules/health-coaching" rel="nofollow" target="_self">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies, primary care physician Thomas Bodenheimer, MD, provides insights into implementing health coaching in your practice. Dr. Bodenheimer is a professor of family community medicine at the University of California San Francisco School of Medicine and contributed this module after <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-teach-their-secrets-success" target="_self">winning</a> the AMA-MGMA Practice Innovation Challenge.</p> <p> <strong>You don’t need to look far to find a health coach</strong></p> <p> A health coach can bring an extra boost to your practice’s methods for both prevention and treatment. Health coaches may be registered nurses, licensed practical nurses, medical assistants (MA), health educators or community health workers.</p> <p> You may consider transitioning a current staff member into the health coach role. Or you may consider recruiting pre-medical or pre-nursing student interns to serve as volunteer health coaches if there are not enough resources to support an additional team member. You could also train a current and loyal employee to take on the health coaching role part time.</p> <p> The education of health coaches depends on the role you expect them to play. If your health coaches are going to provide clinical education, a nurse or social worker may be a good option. If they will be reinforcing the physician’s plan of care and using phone calls to keep patients on track, someone without a clinical license could acquire that skill set.</p> <p> In a randomized clinical trial, MAs successfully filled the health coach role and were able to help patients improve HbA1c and LDL levels. Once your health coaching program has been established, you may opt to select patients who have met their health goals to become peer coaches. These types of coaches should have the same illness and similar backgrounds to the patients they coach.</p> <p> <strong>How it’s working in Oakland</strong></p> <p> Asian Health Services is a community health center that serves Asian-American and Asian immigrant patients in Oakland, Calif. After a successful health coaching pilot program, they chose to expand so that each physician is paired with a health coach.</p> <p> With this type of focused teamwork, each patient gets the care they need, understands the management of their treatment and is actively engaged in their own health care. The organization provides care to a high-needs population—approximately two-thirds of their patients are on Medicaid. Many of the remaining patients are uninsured or underinsured and were determined to be especially suited to health coaching.</p> <p> The health coaches at Asian Health Services are MAs who have received additional training in motivational interviewing, such as the “ask-tell-ask” technique (a sample dialogue is available for <a href="https://www.stepsforward.org/modules/health-coaching" rel="nofollow" target="_self">download</a> as a tool in the STEPS Forward module), <a href="https://www.stepsforward.org/modules/pre-visit-planning" rel="nofollow" target="_self">pre-visit planning</a>, chronic illness monitoring and electronic health record management. Training is ongoing, and members of the multi-disciplinary team in each clinic lead the educational sessions.</p> <p> The health coaches prep charts the day before a patient visit to see if the patient received care elsewhere between visits, review interval laboratory tests and refresh their memory using notes from the previous visit. The day of the appointment, the health coaches conduct a pre-visit <a href="http://www.ama-assn.org/ama/ama-wire/post/one-simple-solution-helped-practices-work-efficiently" target="_self">huddle</a> with the patient’s physician to discuss the upcoming visit.</p> <p> During the patient visit, the coach obtains the blood pressure and performs medication reconciliation, sets the agenda and conducts action planning with the patient. After the visit, the coach meets again with the patient in the exam room to ensure he or she understands the physician’s recommendations.</p> <p> The program is now active in all clinic locations, and Asian Health Services continues to evaluate and evolve their health coaching training and application. They plan to expand the health coaching program to include licensed vocational nurses who will serve patients with diabetes.</p> <p> The <a href="https://www.stepsforward.org/modules/health-coaching" rel="nofollow" target="_self">implementing health coaching module</a> module is one of eight new modules recently added to the AMA’s <a href="https://www.stepsforward.org/modules" rel="nofollow" target="_self">STEPS Forward</a> collection of practice improvement strategies to help physicians make transformative changes to their practices.</p> <p> Thirty-five modules now are available, and several more will be added later this year, thanks to a grant from and collaboration with the <a href="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:4c63e5f8-1e0f-4e92-ab12-db3a3d9d7d47 Student wellness: Blueprints for the curriculum of the future http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_student-wellness-blueprints-curriculum-of-future Tue, 17 May 2016 22:13:00 GMT <p> The focus on wellness in medical education is growing, and it’s motivating students and faculty to search for the path to the wellness-centered learning environment of the future.</p> <p> Several submissions to the <a href="http://www.ama-assn.org/ama/ama-wire/post/students-selected-top-ideas-turn-med-ed-its-head" target="_self">AMA Medical Education Innovation Challenge</a>, which encouraged students around the nation to upend the traditional medical school curriculum with outside-the-box ideas, and projects within the <a href="http://www.changemeded.org/" rel="nofollow" target="_self">AMA Accelerating Change in Medical Education Consortium</a> emphasize student wellness.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/14/574a10d4-f9f0-49a8-be64-be78b39f3168.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/7/14/574a10d4-f9f0-49a8-be64-be78b39f3168.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The goal is to create physicians who are better equipped to take care of themselves and therefore able to serve patients throughout the course of their medical careers.</p> <p> <strong>Building health for the healer</strong></p> <p> A team of students from the University of Louisville School of Medicine, which placed third in the Innovation Challenge, set out an ambitious goal to forge “an ideal version of medical education.”</p> <p> In their proposal, “Happy healers, healthy humans: A wellness curricular model as a means of effecting cultural change, reducing burnout and improving patient outcomes,” the four team members said the current environment is stressful and self-awareness, empathy and communication skills suffer.</p> <p> Their vision is of a medical school curriculum with an emphasis on student wellness comprised of physical, mental and spiritual health. Under their curriculum, students build coping and self-care skills with goal-setting groups, reflection and cognitive behavioral therapy.</p> <p> This vision even includes redesigning the medical school buildings. If the library is next to a gym, if the school provides stationary bikes, treadmill desks and meditation zones, the school promotes student wellness.</p> <p> “The healthiest choices also become the easiest choices,” said student Matthew Neal, an author of the proposal. “You make it so the path of least resistance leads to wellness, and folks will take care of the rest.”</p> <p> <strong>Fostering idealism</strong></p> <p> A team of Eastern Virginia Medical School (EVMS) students submitted a proposal to the challenge titled, “The medical education manifesto: Training the physician change agent of tomorrow,” and said the current system fails to preserve student idealism and the vision of “changing the world for the better.” Students tend to become more cynical and less idealistic as they move through their education, said Heath Patel, an author of the proposal.</p> <p> “Our work promotes wellness by preventing this phenomenon,” he said.</p> <p> Patel and three other students propose fostering wellness with a curriculum that preserves idealism and humanism, and makes time for what they call gratitude, mindfulness and reflection. The result is a student driven by his or her core values and beliefs and more resistant to burnout.</p> <p> “Intrinsic motivation is armor that protects from the difficulties of life,” Patel said.</p> <p> The medical school administration already has taken steps toward those values. In the fall of 2016 EVMS will debut the school’s CareForward Curriculum, which integrates student wellness as a guiding principal. EVMS is a member of the AMA’s <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Accelerating Change in Medical Education Consortium</a>.</p> <p> The four-year longitudinal curriculum promotes student well-being, academic success and resilience, said Allison Knight, PhD, who leads the wellness element of CareForward. Senthil Kumar Rajasekaran, MD, assistant dean for academic affairs, is leading the curriculum reform at EVMS.</p> <p> CareForward builds first-year students’ emotional skills to help deal with the transition to medical school and encourages students to monitor their sleep, nutrition and exercise routines. Throughout the curriculum, there is an emphasis on asking for help when needed and cultivating supportive relationships.</p> <p> The curriculum also features periodic, confidential mental health screenings and weekly protected time for health maintenance and well-being activities.</p> <p> <strong>Supporting medicine’s social mission</strong></p> <p> The Innovation Challenge proposal, “Reaffirming medicine’s social mission,” from a team based at Yale School of Medicine, called for greater emphasis on social responsibility as a way to wellness.</p> <p> “Reinforcing social responsibility as a crucial part of medicine through curricular reform and cultural changes is necessary to promote wellness,” said Tehreem Rehman, an author.</p> <p> Many who go into medicine with the goal of helping underserved populations face obstacles that challenge their own well-being. Those on the front lines of coping with health inequities suffer the most the proposal said.</p> <p> The proposal called for a curriculum that values contemplative practices that can lower burnout, improve joy and foster social responsibility. Rehman said contemplation allows those in the medical community to “process all of the chaos and trauma that medical training and practice inevitably entails.”</p> <p> <strong>Preparing students for the business side of practice</strong></p> <p> A team of students from Ohio University Heritage College of Osteopathic Medicine, Philadelphia College of Osteopathic Medicine and Rowan University School of Osteopathic Medicine in their Innovation Challenge proposal tied burnout and stress to a common lack understanding of the business side of medicine among physicians.</p> <p> According to their proposal, “Training students to be prepared for the modern challenges of health care: Lessons learned in business school,” that lack of understanding has grown in importance as business issues play an ever-larger role in decisions that affect physicians.</p> <p> “Being able to have a say [in] your practice can give you a sense of ownership and lead to less burnout,” said Dan Krajcik, a dual DO and MBA student at Ohio University and lead author of the proposal.</p> <p> A greater understanding of mental health issues among students inspired him to take part in the Medical Education Innovation Challenge, Krajcik said—he helped carry out a survey of 10,000 osteopathic students and found more depression, anxiety and suicide than in the general population.</p> <p> <strong>Addressing the hazards of education</strong></p> <p> These and other proposals are part of ongoing work to foster medical student wellness. Some efforts are as simple as retreats to the mountains or low rates for gym membership, while others are more comprehensive.</p> <p> Mayo Medical School researchers have studied wellness among students for more than 14 years. Lotte Dyrbye, MD, professor of medicine at Mayo, has studied burnout since 2004, and the school is a founding member of the AMA’s Accelerating Change in Medical Education Consortium. Close to one-half of medical students in the United States experience burnout, she has said.</p> <p> “Trying to become a doctor shouldn’t be a hazard,” Dr. Dyrbye said in a recent tweet chat convened by the AMA.</p> <p> She has identified six important ways to prevent future physicians from experiencing what she calls “student distress”—these actions recognize the need for broad changes and involvement by both students and the broader medical community in making them happen.</p> <p> <strong>For more on physician burnout:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-satisfaction-leadership-qualities-matter" target="_self">Physician satisfaction: Why leadership qualities matter</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_self">Preventing resident burnout: Mayo Clinic takes unique approach</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/role-of-personal-accomplishment-physician-burnout" target="_self">The role of personal accomplishment in physician burnout</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" target="_self">Ward off burnout: Your peer network may impact you more than you thin</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:74fda54a-21dc-4017-ae4d-e2c72b3a4b96 Freedom of patient-physician conversations hinges on court case http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_freedom-of-patient-physician-conversations-hinges-court-case Tue, 17 May 2016 22:08:00 GMT <p> A federal court will be hearing a case about the constitutionality of a state law that represses free discussion between physicians and patients regarding health and safety issues.</p> <p> In a friend-of-the-court brief filed April 26, the AMA and eight other medical societies urged the <a href="http://www.ca11.uscourts.gov/" target="_blank" rel="nofollow">Court of Appeals for the 11th Circuit</a> to overturn a Florida law that restricts physicians from discussing firearm safety with patients and their families.</p> <p> The brief argues that the <a href="http://www.myfloridahouse.gov/sections/Bills/billsdetail.aspx?BillId=44993" target="_blank" rel="nofollow">Firearm Owners’ Privacy Act</a> is unconstitutional and intrudes on the practice of medicine. The law will inevitably affect other aspects of patient care, the brief says.</p> <p> In 2012 the district court had found the 2011 law unconstitutional. In 2014 a court of appeals panel of three judges issued a split decision. While one judge sided strongly with physicians opposing the law, the other two ruled in favor of the state. Physician groups and others sought a rehearing.</p> <p> In a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-decide-censorship-exam-room" target="_self">rare decision</a>, the full court of appeals agreed to rehear the case. The rehearing will be held before the court <em>en banc—</em>all 11 active judges are to hear the case. Oral arguments are scheduled for June 21 in Atlanta.</p> <p> In its April 26 briefing, the AMA and other organizations call the law an example of politics overriding medicine. It has already led Florida physicians to self-censor when talking with patients, the brief says.</p> <p> “It is censorship, imposed for purely political motives,” it says.</p> <p> The law directly clashes with a consensus on care that dates to at least 1989. That year, the AMA enacted a <a href="https://searchpf.ama-assn.org/SearchML/searchDetails.action?uri=%2FAMADoc%2FHOD.xml-0-547.xml" target="_self">policy</a> that encourages members to inquire into the presence of firearms in households and to promote the use of safety locks on guns in an effort to reduce injuries to children.</p> <p> “Effective medical care requires unfettered communications between physicians and their patients,” the brief tells the court.</p> <p> <strong>Other recent cases in which the AMA has been involved:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_self">Court case could extend medical liability</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/liability-technicality-could-expose-physicians-large-fines" target="_self">Case could leave physicians exposed to large fines</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/supreme-court-case-could-major-health-implications" target="_self">Supreme Court case could have major health implications</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-increase-liability-exposure-redefine-injury" target="_self">Court case could increase liability exposure, redefine injury</a></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:c9e3064e-6495-45f4-93ad-3009a0ba8379 Harnessing senior physicians’ expertise http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_harnessing-senior-physicians-expertise Mon, 16 May 2016 21:34:00 GMT <p> Older physicians—especially those who are still interested in actively contributing to health care after retirement—have invaluable knowledge to pass on. Find out what one physician has to say about the profession finding new ways for these doctors to impart what they’ve learned.</p> <p> <strong>Creating new opportunities</strong></p> <p> Late-career physicians need pathways that let them pursue professional mentoring, teaching and meaningful community involvement, such as volunteering or working with service agencies or communities that are important to their organizations, a <em>Mayo Clinic Proceedings</em> <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(15)00469-3/fulltext" target="_blank" rel="nofollow">commentary</a> urges.</p> <p> Older physicians are less likely to be motivated by financial considerations and more likely to be looking for other rewards. Consequently, alternatives beyond cutting back their hours could help them “rediscover meaning and purpose in medicine and potentially prolong careers,” writes commentary author William M. Spinelli, MD, a researcher at Allina Health’s Division of Applied Research in Minnesota.</p> <p> “In return for this engagement, organizations would reap the benefit of the accumulated institutional wisdom and increased community engagement from senior clinicians as they continue medical practice and bridge the interval before the arrival of new primary care practitioners,” he said.</p> <p> <strong>A different way of thinking: From early exits to new roles</strong></p> <p> Long work hours, productivity demands and professional fatigue are driving a number of physicians out of practice earlier than they expected. Adding to the stress for some physicians is a growing number hospitals and practices requiring older physicians complete evaluations to see if they are still competent to practice.</p> <p> A 2014 Physicians Foundation <a href="http://www.physiciansfoundation.org/healthcare-research/2014-survey-of-americas-physicians-practice-patterns-and-perspectives" target="_blank" rel="nofollow">study</a> found that 44 percent of physicians surveyed planned to make changes that would ultimately reduce patient access to their services, including cutting back on the number of patients seen, retiring or working part time.</p> <p> Those statistics come at a time when primary care is facing a projected physician shortage. For years, fewer medical graduates have been choosing to go into primary care specialties such as family and internal medicine. At the same time, the U.S. population is living longer, resulting in more people needing care.</p> <p> “A great deal of the health care system is focused on innovative practices and such things as work flow processes and payment reform,” Dr. Spinelli said in a <a href="http://www.mayoclinicproceedings.org/cms/attachment/2035556028/2051157311/mmc1.mp4" target="_blank" rel="nofollow">video</a> accompanying his commentary. “I would suggest that another form of innovation is investing in the people who are responsible in helping with both patient care and implementation of these other new health care system design strategies.”</p> <p> Dr. Spinelli suggests that medicine can learn something from heartwood trees. As the trees age, the older cells at the core of the tree harden when they lose some of their ability to conduct water. As they harden, they perform the essential function of structurally supporting the tree.</p> <p> “Specifically, the question at hand is, ‘How can we leverage the knowledge, wisdom and experience of senior physicians at a time in their career when they are struggling with the pace, demands and changes in health care?’” Dr Spinelli said.</p> <p> He suggests that physicians can explore their commitment and passion for medicine and their communities by asking:</p> <ul> <li style="margin-left:0.25in;"> How did I get to this stage of my career?</li> <li style="margin-left:0.25in;"> What do I want the next stage of my career to look like?</li> <li style="margin-left:0.25in;"> What are the skills needed and the possibilities available for this next stage?</li> <li style="margin-left:0.25in;"> How can I learn from and share these journeys with colleagues?</li> </ul> <p> <strong>Tackling senior physicians’ concerns</strong></p> <p> The AMA earlier this year convened a national group of stakeholders to explore the growing trend of assessing the competency of aging physicians. The group, which included nearly three dozen representatives from organizations such as the Joint Commission and the Council of Medical Specialty Societies, was a recommendation of a recent report from the AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/ama-councils/council-medical-education.page?" target="_self">Council on Medical Education</a>.</p> <p> The AMA <a href="http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/senior-physicians-section.page" target="_self">Senior Physicians Section</a>, which stands more than 55,000 members strong, was the driving force behind the AMA policy that led to the council report and the convening of the stakeholder group.</p> <p> The AMA does not have a policy on whether physicians should be assessed, and the <a href="http://www.ama-assn.org/ama/ama-wire/post/key-stakeholders-explore-assessment-of-aging-physicians" target="_self">group began deliberation</a> around key issues and challenges for determining whether national guidelines for assessment should be developed. Considerations include the legal implications of screening physicians based on age and the uncertainty of how to interpret cognitive or motor function tests given to physicians.</p> <p> For those attending the 2016 AMA Annual Meeting in June, the AMA Senior Physicians Section will be hosting an <a href="http://www.ama-assn.org/ama/ama-wire/post/register-may-24-ama-sps-educational-program" target="_self">education session</a> on physician burnout and reconnecting with one’s professional calling at any career stage.</p> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:2200672b-ff7f-455b-8093-10d29c162704 Fix EHRs for the patient-physician relationship, senator says http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_fix-ehrs-patient-physician-relationship-senator-says Mon, 16 May 2016 21:20:00 GMT <p> Electronic health records (EHR) have caused many problems for the patient-physician relationship, and Sen. Bill Cassidy, MD, R-La., definitely has his fair share of troublesome EHR stories. The current state of EHRs is tearing the patient-physician relationship apart, Sen. Cassidy said. And that’s why he is taking steps in the U.S. Senate to relieve this burden and put physicians in the driver's seat.</p> <p> Sen. Cassidy recently spoke to the health IT community at Health Datapalooza in Washington, D.C.</p> <p> Sen. Cassidy and Sen. Sheldon Whitehouse, D-R.I., who also spoke at the event, introduced the Transparent Ratings on Usability and Security to Transform Information Technology Act of 2015, also called the TRUST IT Act, which would create a star rating system to assess the interoperability, usability and security of certified health IT. The AMA issued a <a href="http://www.ama-assn.org/resources/doc/washington/x-pub/meaningful-use-trust-it-act-09dec2015.pdf" target="_self">letter of support </a>(log in) for this bill.</p> <p> <strong>4 stories: How EHRs are affecting relationships with patients </strong></p> <p> <em>X-ray on a disc:</em> Sen. Cassidy said his mother recently had an injury, and he accompanied her to her physician’s office. All the required steps in the EHR almost led to the wrong test being ordered and a collapsed vertebra being missed.</p> <p> In seeking advice from a fellow physician and friend the next day, Sen. Cassidy asked if he could take a look at the x-ray and offer his opinion. The physician said that the two facilities don’t share data and so the senator would have to put the information on a disc and bring it in himself.</p> <p> “I’m thinking, this is great,” Sen. Cassidy said. “I used to bring films, and now I bring a disc.”</p> <p> <em>The EHR box:</em> Just two weeks ago, Sen. Cassidy received a call from a resident in his home state of Louisiana, who expressed her growing frustrations with her EHR. “She feels as if she is in a box,” he said. “She can’t do what she went to medical school for because she’s always in the EHR.”</p> <p> “She feels frustrated because she grew up with [technology],” the he said. “As a physician, but also as the son of a patient … I think what we should most focus on is the <a href="http://www.ama-assn.org/ama/ama-wire/post/patient-physician-relationship-central-medicine" target="_self">patient-physician relationship.</a>”</p> <p> But EHRs are tearing it apart, he said. “Whatever the promise and whatever the potential …unless we pay attention to that patient-physician relationship, it will all be for naught.”</p> <p> A recent study <a href="http://www.ama-assn.org/ama/ama-wire/post/documentation-woes-study-tracks-residents-time-spent-ehrs" target="_self">tracking resident EHR usage</a> found that residents in a teaching hospital each spent 112 hours per month on 206 patient encounters.</p> <p> “I think what we want,” Sen. Cassidy said, “is for the physician to have the capability to still focus what he or she needs to do based on that particular patient’s needs—not [be] driven by drop-down boxes.”</p> <p> <em>Interacting with the EHR, not the patient: </em>When recently visiting a physician friend who said he’s required to have 30-minute visits with each patient at the VA clinic, Sen. Cassidy asked if he really needed that full 30 minutes. “He said, ‘<a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-tied-up-physician-time-2015" target="_self">I don’t have time</a> to speak to the patient,’” Sen. Cassidy recalled. “‘I have 30 minutes, but I only have five minutes to actually turn, face the patient and see what his problem is.’”</p> <p> “When you spend so much time on an EHR,” Sen. Cassidy said, “the issue [is] not that you’re not paid for it …. Rather, it is [that] your time is consumed by your EHR.”</p> <p> <em>Pulled away from patients:</em> Sen. Cassidy’s wife is a retired breast cancer surgeon. “She said that when a woman came, and she had breast cancer,” he said, “she would speak to the woman—it was usually the husband who was crying—and she would want to look into their eyes to know that the diagnosis of breast cancer was not a sentence to death, but rather it was the next phase of their life and that there was hope and that they would come through this.”</p> <p> “It was looking into their eyes and reading body language and understanding when to pull back and when to press forward as she gave information that made my wife such an effective clinician,” Sen. Cassidy said. “I can promise you, [you can’t do that] if you’re staring at a drop-down box.”</p> <p> <strong>How the TRUST IT Act can help</strong></p> <p> “In the TRUST IT Act,” Sen. Cassidy said, “we attempt to establish a new paradigm—measure outcomes not processes.” It doesn’t matter how the patient gets to the best possible outcome, as long as they reach that outcome and their health is improved, he said.</p> <p> The act would create a grading system of EHR interoperability used by those who participate in the delivery of care. “Ideally,” he said, “the outcome would not be defined by somebody sitting in Washington but by the creativity of [physicians and developers].”</p> <p> “The focus should be the patient-physician relationship,” Sen. Cassidy said. “We have to start thinking less about what software works for those big institutions, which have every interest in the world in data-blocking, and more as to what works for me, the patient, me, the physician, [and] me, the son of the patient.”</p> <p> “Although many physicians are discouraged by EHRs,” he said, “Most don’t want to go back …. Physicians are dedicated people.”</p> <p> The AMA has taken action on EHRs in several ways:</p> <ul> <li> BreakTheRedTape, the AMA’s grassroots effort, held town halls in <a href="http://www.ama-assn.org/ama/ama-wire/post/ehrs-need-physicians-offer-solutions-town-hall" target="_self">Seattle</a>, <a href="http://www.ama-assn.org/ama/ama-wire/post/regulations-sidelining-patients-physicians-talk-ehrs" target="_self">Boston</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-hear-ehr-meaningful-use-isnt-meaningful" target="_self">Atlanta</a>.</li> <li> JAMA sponsored an event gathering experts to <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-discuss-improving-ehrs-should-top-priority" target="_self">discuss why EHRs should be a top priority</a></li> <li> The AMA’s STEPS Forward ™ collection of practice transformation initiatives can help you <a href="http://www.ama-assn.org/ama/ama-wire/post/3-things-consider-selecting-ehr" target="_self">select and purchase EHR products</a> and <a href="http://www.ama-assn.org/ama/ama-wire/post/8-steps-address-ehr-woes-team-documentation" target="_self">how to address documentation woes</a></li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/8-things-physicians-saying-their-ehrs" target="_self">eight things physicians said about EHRs</a> in an AMA-RAND study</li> <li> The AMA and MedStar evaluated the <a href="http://www.ama-assn.org/ama/ama-wire/post/framework-evaluates-top-20-ehrs-dont-quite-measure-up" target="_self">usability of the top 20 EHR products</a> with a new framework</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks </em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d75e20e7-cef1-4a41-a57d-8b197884f267 Biden seeks physician input in global cancer fight http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_biden-seeks-physician-input-global-cancer-fight Fri, 13 May 2016 20:00:00 GMT <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">U.S. Vice President Joe Biden passionately called for data experts, researchers and physicians to join him in the <a href="https://www.whitehouse.gov/the-press-office/2016/02/01/fact-sheet-investing-national-cancer-moonshot" rel="nofollow" target="_blank"><span style="color:rgb(4, 51, 255);">National Cancer Moonshot Initiative</span></a> announced earlier this year by lending their talents and expertise to the global fight against cancer. Breaking down the walls that prevent data sharing will be an essential component to the initiative, as is physician input. <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/2261f16b-3496-434d-92a7-3fb8fbec9e2f.Full.jpg?1" style="font-family:Arial, Verdana, sans-serif;font-size:12px;" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/2/2261f16b-3496-434d-92a7-3fb8fbec9e2f.Large.jpg?1" style="margin:15px;float:right;" /></a></span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Mr. Biden last week addressed the health IT community at Health Datapalooza in Washington, D.C. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Data and technology—when combined—can have an incredible impact on saving people’s lives and improving the health of people here and around the world,” the vice president said. “Six years ago our administration decided we should open up more of the data that’s held by the federal government to drive progress in medical research and health care delivery.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Since that time the U.S. Department of Health and Human Services has published more than 2,100 data sets. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Imagine what you could do to help in the fight against cancer if you had access to the millions of cancer pathologies and genomic sequences, family histories, and treatment outcomes,” he said. “You know what this significant access to data has enabled you to find out thus far, and I think we’re only scratching the surface.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><b>4 key ways data will play a role</b></span></span><br />  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Cancer-related deaths are down 23 percent over the last 21 years,” Mr. Biden said. “But we haven’t done nearly enough. We have to ask ourselves, ‘Why are we not progressing more rapidly?’” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">It’s expected, he said, that the world will see almost 20 million new cancer cases and 11.4 million more deaths from cancer by the year 2025 without dramatic intervention. “How can we prevent that from happening?” he asked. Mr. Biden cited four things that need to happen next:</span></span><br />  </p> <ul> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Generate large quantities of health data</span></span></li> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Make that data available to share by breaking down silos </span></span></li> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Build a network centered around patients that allows access to privacy-protected data</span></span></li> <li style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Support quality data analysis to turn raw data into knowledge</span></span></li> </ul> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Researchers need to share data in order to move discoveries more rapidly,” he said. “Published research is hidden behind paywalls that lead to unnecessary duplication and failed efforts and wasted time and money.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><b>A personal experience with cancer</b></span></span><br />  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Mr. Biden’s son passed away three years ago from glioblastoma. “When you have someone near and dear to you—and every one of you has experienced this in some form or another,” he said solemnly, “when they’re in trouble you try to learn as much as you can as rapidly as you can, with as much depth as you can to see if you can help.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“It wasn’t until then—now three years ago,” Mr. Biden said, “that I came to realize that if this had been five years earlier, or five years later, the circumstances would have been either more difficult … or maybe I’d be standing here with my boy.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“My son had an exotic and last-ditch treatment for the glioblastoma,” he said. “They injected a virus into the tumor in his brain, but it required MRIs on a regular basis.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">But the location where his son’s MRIs were taken could not share the data with the location where he was receiving his treatment. Mr. Biden had to go to great lengths to put the data on a disc and make sure it was available to the other location on a regular basis. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Most major cancer centers don’t have an easy way … to share data, including patients’ records, test results, family histories and treatment responses,” he said. “We’ve got to change this. We need to break down silos that keep research away from the world and from one another.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“This matters,” Mr. Biden said. “It’s a matter of life and death.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><b>Leading a global effort</b></span></span><br />  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“You all stepped up,” Mr. Biden said. “You developed apps to track your blood pressure and how you sleep. We need this same use of your talents and expertise in the fight against cancer.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“More and more people are working together,” he said. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">During a recent trip to the Middle East to discuss ISIS, the leader of the United Arab Emirates first wanted to discuss how they could take part in the moonshot. And at the recent nuclear security summit, where more than 50 of the world’s leaders assembled, President Obama first had to address the leaders’ interest in talking with the vice president about cancer research. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“A few years ago it took more than a decade and $2.7 billion to sequence a fresh human genome. Now it takes less than a day, and it costs roughly $1,000,” he said. “Big data and computing power together provide the possibility of significant insight into how genomics, family medical history, lifestyles, genetic changes can trigger cancer—and how the cancer should be treated.” </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“We are on the cusp of significant breakthroughs that will save lives, sooner, to the benefit of all humanity.”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;min-height:11px;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">Physicians, researchers and developers can go to the <a href="https://www.whitehouse.gov/cancermoonshot" rel="nofollow" target="_blank">National Cancer Moonshot Initiative </a>website and tell Mr. Biden about their plans to find collaborative solutions to accelerate progress and overcome barriers. </span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;">“Help in the fight against cancer,” he said. “Please use your talents and tell us how—tell me how—we can do more. Tell me where you disagree. What are the things we should be focusing on?”</span></span></p> <p style="margin:0px;font-size:10px;line-height:normal;font-family:Arial;">  </p> <p style="margin:0px;text-align:right;font-size:10px;line-height:normal;font-family:Arial;"> <span style="font-size:12px;"><span style="font-family:arial,helvetica,sans-serif;"><i>By AMA staff writer </i><span style="color:rgb(4, 51, 255);"><i><a href="http://www.twitter.com/Troy_AMAWire" rel="nofollow" target="_blank">Troy Parks</a></i></span></span></span></p> <div>  </div> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:d47bcd67-3edc-4733-957e-6554ae14f6ed 4 steps to prepare for Medicare’s new payment systems http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-steps-prepare-medicares-new-payment-systems Fri, 13 May 2016 18:19:00 GMT <p> While the details of the Medicare Access and CHIP Reauthorization Act (MACRA) regulations still are being hammered out, physicians should start preparing for the new payment systems now. Make sure you’re on track by taking four important steps.</p> <p> The lengthy <a href="https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm" rel="nofollow" target="_blank">proposed rule</a> released by the Centers for Medicare & Medicaid Services (CMS) outlines the draft regulations the agency is considering for implementation. This is just the beginning of the official rulemaking process, but what is known for sure is that physicians will have a choice in whether to participate in the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_self">Merit-based Incentive Payment System</a> (MIPS) or meet requirements for an <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_self">alternative payment model</a> (APM).</p> <p> Here are the steps you can take to prepare your practice for one of the two new Medicare paths:</p> <p style="margin-left:40px;"> <strong>1.  Review your quality measurement and reporting.</strong> Understanding current quality reporting requirements and how you are scoring across both the Medicare Physician Quality Reporting System (PQRS) and private payers will help your practice be better suited for the upcoming changes.<br /> <br /> You also should try to access and review your Medicare quality and resource use reports (QRUR) to see where you can make improvements related to cost ahead of time. Two particularly important components to identify as you prepare for meeting the care coordination requirements are: (1) your most costly patient population conditions and diagnoses, and (2) targeted care delivery plans for these conditions.<br /> <br /> <strong>Tip:</strong> You can access your 2014 annual PQRS feedback reports and QRURs on the CMS <a href="https://portal.cms.gov/wps/portal/unauthportal/home/" rel="nofollow" target="_blank">Enterprise Portal</a> using your Enterprise Identify Data Management account. <a href="https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Obtain-2013-QRUR.html" rel="nofollow" target="_blank">Learn more</a> about how to access these reports. If you are part of a large practice or health system, you may need to talk to your administrator about accessing your QRUR.</p> <p style="margin-left:40px;"> <strong>2.  Understand your patient data and benchmarks.</strong> Data registries can streamline reporting and improve performance scores. If you are not already participating in a patient clinical data registry, contact your medical specialty society to discuss how to participate in theirs. There also might be regional registries relevant to your practice.<br /> <br /> <strong>Tip:</strong> You can view a list of 2016 CMS-approved qualified clinical data registries and contact information on the <a href="https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2016QCDRPosting.pdf" rel="nofollow" target="_blank">CMS website</a>.</p> <p style="margin-left:40px;"> <strong>3.  Check on your electronic health record (EHR).</strong> If your practice uses an EHR, contact your vendor to discuss how its product supports adoption of new payment models.<br /> <br /> Make sure your EHR is certified to the Office of the National Coordinator for Health IT’s (ONC) 2014 or 2015 certification requirements. Using a 2014 or 2015 edition EHR is essential for participation in either MIPS or APMs.<br /> <br /> Ask your vendor when they will update your software to the 2015 certified edition and whether reporting quality measures through the EHR is a viable option based on the proposed MIPS quality requirements.<br /> <br /> <strong>Tip:</strong> You can check your product’s certification in a <a href="http://oncchpl.force.com/ehrcert" rel="nofollow" target="_blank">listing by the ONC</a>.</p> <p style="margin-left:40px;"> <strong>4.  Stay informed.</strong> There are several ways to keep your practice up-to-date on the new regulations:</p> <ul style="margin-left:80px;"> <li> Stay connected with the AMA for tools to assist you in implementation. Watch <em>AMA Wire</em>® to learn about a free online individual practice readiness assessment tool that will launch this summer.</li> <li> Contact your medical specialty society or state medical association to find out if there are APM opportunities for your practice and <a href="http://www.ama-assn.org/ama/ama-wire/post/testing-new-payment-models-one-pilot-programs-success" target="_self">how you can get involved in their development</a>.</li> <li> Seek out local support for your quality improvement activities. <a href="http://www.ama-assn.org/ama/ama-wire/post/collaboration-giving-practices-resources-need" target="_self">Practice transformation networks</a> and regional health improvement collaboratives provide resources and technical support.</li> </ul> <p> For more information on how to prepare for the new Medicare payment systems, review the AMA’s <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_self">MACRA checklist</a>, or check out the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_self">STEPS Forward</a><u>™</u> collection of practice improvement strategies that can help your practice <a href="https://www.stepsforward.org/modules/value-based-care" rel="nofollow" target="_self">prepare for value-based care</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:27eb626c-6b83-4b2c-bebe-204bd64ff3d7 3 principles driving new Medicare payment systems http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_3-principles-driving-new-medicare-payment-systems Thu, 12 May 2016 21:15:00 GMT <p class="p1"> When Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), testified before an influential congressional committee Wednesday about implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the focus was clear: The patient and physician must be at center of the new Medicare payment systems. </p> <p class="p1"> <b>A look at the draft regulations</b></p> <p class="p1"> Rep. Pat Tiberi, chairman of the U.S. House Ways and Means Committee, said the committee called the <a href="https://youtu.be/q82p3EPE9oI" rel="nofollow" target="_blank"><span class="s1">hearing</span></a> to discuss how the <a href="http://www.ama-assn.org/ama/ama-wire/post/draft-regulations-outline-next-phase-of-medicare" target="_self"><span class="s1">draft regulations</span></a> released last month match the congressional intent of the law. In particular, the committee was interested in how physicians and other stakeholders have responded to the draft regulations. They also focused many of their questions and remarks on the importance of final regulations that take special care to ensure the success of physicians in small practices, as well as those in larger groups.</p> <p class="p1"> “MACRA streamlined the patchwork of programs that currently measure value and quality into a single framework … where every physician and clinician has the opportunity to be paid more for providing better care for their patients,” Slavitt said. </p> <p class="p1"> He said CMS’ goal is to make the payment pathways under MACRA “flexible, transparent and simple so physicians can focus on patient care, not reporting or scorekeeping. Physicians know best how to provide high-quality care to our beneficiaries.”</p> <p class="p1"> Slavitt said three principles are guiding the agency’s implementation of the new Medicare payment systems:</p> <p class="li1" style="margin-left:40px;"> <b>1.<span class="Apple-tab-span"> </span> Keeping the focus on patient care.</b> “Patients are—and must remain—the key focus,” Slavitt said. “Financial incentives should work in the background to support physician and clinician efforts to provide the highest quality care and create incentives for more coordinated care.”</p> <p class="li1" style="margin-left:40px;"> <b>2.<span class="Apple-tab-span"> </span> Allowing flexibility.</b> The agency is working to ensure that physicians can adopt approaches that work for their practices, rather than forcing a “one-size-fits-all from Washington,” Slavitt said. “It will be important to allow physicians to define the measures of care most fitting with their patients.”</p> <p class="li1" style="margin-left:40px;"> <b>3.<span class="Apple-tab-span"> </span> Aiming for simplicity.</b> “Physician practices are already busy, and we are seeking every opportunity possible to minimize distractions from patient care by reducing, automating and streamlining existing programs,” Slavitt said. “One of the reasons why we don’t have the hearts and minds of physicians is because there’s just too much paperwork in health care.”</p> <p class="p1"> <b>The importance of physician feedback</b></p> <p class="p1"> Slavitt said the agency’s guiding principles were developed based on extensive feedback they received from thousands of physicians. He emphasized that physician feedback as the new Medicare payment systems are rolled out will be essential to their success.</p> <p class="p1"> “It is critical that we receive direct feedback from physicians and others stakeholders and are undertaking significant outreach efforts,” he said. “In the month of May alone, we have 35 scheduled events and listening sessions to hear from a wide range of stakeholders. It will take work and broad participation to get it right.”</p> <p class="p1"> Slavitt said the agency is looking for feedback from physicians—especially those in smaller practices—on how “what we do here in Washington” will impact their practices. He said they want to know what will work and what could have unintended negative consequences.</p> <p class="p1"> “We really do want to get to the best answer,” he said. “And we don’t have a monopoly on that.”</p> <p class="p1"> CMS is hosting a number of listening sessions, webinars and other opportunities for individual physicians to provide their insights. </p> <p class="p1"> A built-in physician feedback mechanism is the <a href="http://www.ama-assn.org/ama/ama-wire/post/specialty-development-key-new-payment-models-success" target="_self"><span class="s1">Physician-Focused Payment Model Technical Advisory Committee</span></a>, which is collecting physician ideas for alternative payment models that can be tested for the new Medicare payment system.</p> <p class="p1"> The AMA and other medical associations also are providing feedback to CMS and will be submitting formal comment letters by the June 27 deadline.</p> <p class="p1"> <b>Resources to help you prepare for the new payment systems</b></p> <p class="p3"> The AMA offers a number of resources to help physicians in their initial preparations for the coming payment policies, including:</p> <ul> <li class="p5"> <span class="s2"><a href="http://www.ama-assn.org/resources/doc/washington/macra-summary-05052016.pdf" target="_self">A summary of the proposed regulations</a></span></li> <li class="p6"> <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-alternative-payment-models.page" target="_self"><span class="s2">A guide to physician-focused payment models</span></a></li> <li class="p6"> <span class="s2"><a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-merit-based-incentive-program.page" target="_self">Key points of the Merit-based Incentive Payment System</a></span><span class="s4"> </span></li> <li class="p6"> <span class="s2"><a href="http://www.ama-assn.org/ama/pub/advocacy/topics/medicare-new-payment-systems.page" target="_self">What you can do now to prepare</a></span><span class="s4"> </span><span class="s5"> </span></li> <li class="p6"> The AMA’s <a href="https://www.stepsforward.org/%22%20%5Ct%20%22_blank" rel="nofollow" target="_blank"><span class="s6">STEPS Forward™ collection</span></a> of practice improvement strategies, which include advancing team-based care, implementing electronic health records, improving care and <span class="s7">practicing value-based care</span></li> </ul> <p class="p8" style="text-align:right;"> <i>By AMA Wire editor</i> <a href="https://twitter.com/amy_amawire%22%20%5Ct%20%22_blank" rel="nofollow" target="_blank"><span class="s6"><i>Amy Farouk</i></span></a></p> <p class="p9">  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:27901d44-9e1c-4857-ba0b-1d9da5f7818b What successful self-measured BP looks like in practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_successful-self-measured-bp-looks-like-practice Wed, 11 May 2016 22:26:00 GMT <p> When a patient is willing to partner with their physician in gaining control of high blood pressure, the results can be rewarding for both parties. That partnership is both important and surprisingly simple. A resident physician gives an inside look at how her medical center implemented self-measured blood pressure (SMBP) monitoring and is engaging patients in the advancement of their own health.</p> <p> At Family Health Center at Medstar Franklin Square in Baltimore, physicians incorporated SMBP monitoring in their practice in a way that has helped patients with high blood pressure take control of their health.</p> <p> The practice implemented SMBP monitoring when it collaborated with the AMA and Johns Hopkins Medicine as part of the <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/prevent-heart-disease.page" target="_self">M.A.P. program</a>—measure accurately, act rapidly and partner with patients, families and communities), said Crystal Peralta, MD, a third-year resident physician at Franklin Square.</p> <p> “Our project is a culmination of ideas that we brainstormed together as a team,” Dr. Peralta said. “It also incorporates ideas that we gathered from other family programs who were experiencing success with their own home blood pressure monitoring initiatives.”   </p> <p> Patient engagement was initially very high and has continued to grow at Franklin Square.</p> <p> <strong>How patients are identified for SMBP</strong></p> <p> The practice began incorporating SMBP into its regular routine as an effort to more accurately identify the true blood pressures of its patients. Studies show that patients’ pressures often are elevated when they are in the office and often are not a true reflection of their blood pressure in their daily environment, Dr. Peralta said. </p> <p> “By using our [electronic health records], we’ve identified the patients who have had continued elevated blood pressure” above goal, based on the clinical guidelines the practice follows, she said. “We’ve highlighted every one of those patients on each clinician’s  roster.” The clinicians are then responsible for contacting their patients and encouraging them to follow up in the office. At that point, the clinicians offer the patients an opportunity to participate in SMBP monitoring.  </p> <p> “We’ve included patients with hypertension, patients with white coat hypertension, patients with elevated blood pressure with a confirmed diagnosis, patients who have had a recent history of pre-eclampsia,” she said. “It’s basically open to everybody—and it’s a decision that the physician and the patient make together.”</p> <p> “So far the response has been wonderful,” she said. “We have seen that once patients are actively participating in their care by taking their pressures daily, they are eager and so motivated to improve their health.”</p> <p> It all begins when a patient comes into the office for an office visit. “Our medical assistants know that  when a patient has a blood pressure that is elevated above [goal], they automatically take out a laminated, neon orange card that says ‘140/90: Make a change; follow up in 2-4 weeks,’” Dr. Peralta said. “The card is left right on the keyboard in the room so that the physician sees the card when they sit down and start writing their notes. It’s a really good stop-and-pay-attention sign because it can’t be missed.”</p> <p> After addressing the elevated blood pressure, the physician gives the patient the opportunity to participate in SMBP monitoring. Any patient can participate if they meet three criteria:</p> <ul> <li> Two blood pressure readings above 140/90 during the office visit</li> <li> The patient’s arm circumference is within limits of the blood pressure cuff size</li> <li> The patient exhibits the motivation and willingness to improve their blood pressure</li> </ul> <p> <strong>Getting started</strong></p> <p> “We offer them the opportunity to take home a blood pressure cuff for approximately 14 days,” Dr. Peralta said. “We have 15 automated blood pressure machines at the moment. We started off with only five, but the program became so popular that we had to buy 10 more. Even with the 15 we have, they are always signed out, and there is often a waiting list for a monitor, so we are looking at hopefully buying a few more in the near future.”  </p> <p> The practice’s medical assistants are trained in the protocol and are key to the success of the project, she said. “It really is a team effort. Between the office staff, the medical assistants and clinicians, we all play a huge role.”</p> <p> “We have a package of handouts and other materials that the physicians along with the medical assistants review with the patient,” she said. “First, the physician educates the patient on what high blood pressure means, then discusses effective ways to improve their pressure through things like diet, exercise, medication compliance, etc. We review a handout about the DASH diet and spend a lot of time walking them through step-by-step instructions on how to take their blood pressure properly with the monitor we provide to them.”</p> <p> Before they leave the office, the patient has to demonstrate that they are able to take a proper blood pressure.</p> <p> “The patients are very appreciative when we offer them a monitor to take home,” Dr. Peralta said. “The truth is that many of our patients may not be able to afford a monitor. Some may not even truly understand the importance of having a monitor at home, and so this is a great way for us to educate our patients, increase their awareness, and provide them a resource that they may not have been able to otherwise access.”</p> <p> “Patients who have never taken their own blood pressure before tell me how pleasantly surprised they are at how easy it is to take their blood pressures properly,” she said. “The machines that we have are very user friendly.”</p> <p> Patients must schedule a follow-up visit for two weeks later before they leave the office and begin the 14-day measuring program.</p> <p> <strong>How it works</strong></p> <p> Patients are asked to take their blood pressure readings two times in the morning at least one minute apart and two times in the evening. To encourage active participation, the patient is responsible for recording their readings. There is also a column for comments, where they can list any factors that might have contributed to a high blood pressure reading, such as recent exercise, coffee or fast food consumption, or getting into an argument.</p> <p> “It helps them to be more aware of what they’re doing in a day that might be elevating their pressures,” Dr. Peralta said. “It makes them more aware of their diet. It makes them accountable and aware of what might be contributing to their high blood pressures.”</p> <p> “We advise that after a week they should check in with us. Either the physician will call the patient, or the patient calls us,” she said.</p> <p> “At the two-week visit, if their blood pressures have been within goal, the physician might decide that the patient has completed the program and continue to encourage the patient to stay the course and further improve upon the lifestyle changes they have made,” Dr. Peralta said. If the patient’s pressures continue to remain elevated above goal, then the patient and physician come up with a plan together. This plan may include medication adjustments, additional blood work or nutrition counseling. The patient also might continue on in the monitoring program for another 14 days to see how the changes affect the patient’s blood pressure.</p> <p> “Sometimes patients will come in, and if they haven’t had their blood pressure taken properly, they’ll tell the physician, ‘I was supposed to be sitting down with both feet flat on the ground, and I didn’t get it done that way this time.’ Some people tell us stories of how they are now able to teach other members of their family how to properly take a blood pressure,” she said. “It’s really great when you see your patients grow. They first present understanding very little about what hypertension even means and then transform into advocates for healthier living in their own families and communities.”</p> <p> <strong>Get started in your practice:</strong> Access the AMA-Johns Hopkins Medicine <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes/improving-blood-pressure-control.page" target="_self">M.A.P. resources</a> to implement SMBP monitoring in your practice. The resources cover everything from selecting an SMBP device to patient training on how to self-measure correctly to hypertension diagnosis and management.</p> <p> <strong>For more on SMBP:</strong></p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ways-promote-better-bp-may" target="_self">4 ways to promote better BP during National High Blood Pressure Education Month</a>.</li> <li> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/should-use-self-measured-blood-pressure-monitoring" target="_self">why you should use SMBP</a>.</li> <li> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/need-start-self-measured-bp-practice" target="_self">what you need to start SMBP in your practice.</a></li> <li> Examine <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-offer-insights-latest-bp-trials-guidelines" target="_self">expert insights</a> into the latest blood pressure trials and guidelines.</li> <li> Use the <a href="http://www.ama-assn.org/ama/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_self">one graphic you need for accurate blood pressure reading</a>.</li> </ul> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:7b39dccb-41d7-4d6c-9a82-1cc0195f7356 Virtual patients help create the med ed environment of the future http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_virtual-patients-create-med-ed-environment-of-future Wed, 11 May 2016 22:06:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/12/0ae5ecdd-3cb4-459d-acad-998dc4b601e7.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/12/0ae5ecdd-3cb4-459d-acad-998dc4b601e7.Large.jpg?1" style="margin:15px;float:right;" /></a>Medical students can expect virtual patients, those almost-real cases based in cyberspace, to play a larger role in learning and problem-solving as medical education evolves. Educators are looking at ways this technology can help address current issues in medical school education.</p> <p> <strong>A low-risk education tool </strong></p> <p> “Virtual patients allow students to learn without putting real patients at risk,” said Norm Berman, MD, professor of pediatrics at the Geisel School of Medicine at Dartmouth and the lead author of a <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/The_Role_for_Virtual_Patients_in_the_Future_of.98554.aspx" rel="nofollow" target="_blank">perspective piece</a> recently published by the journal <em>Academic Medicine</em>. “No actual patients are harmed in the process of learning from virtual patients.”</p> <p> The authors outlined the role of virtual patients in light of challenges and opportunities facing medical education, including the rapidly expanding body of medical knowledge, the ongoing issue of diagnostic and other cognitive errors, the ability to enhance education through learning preferences, and the need for better assessment.</p> <p> The authors argued that virtual patients have the potential to:</p> <ul> <li> <strong>Deepen learning</strong>. Virtual patients can be used for interactive learning activities that help students grasp expanding medical knowledge. One strategy is to assign virtual patients to students ahead of a seminar so they can practice a particular concept on their own and then attend a seminar or a problem-based learning or team-based learning session—the “flipped classroom” model. Virtual patients with embedded learning analytics can give the instructor insights into students’ preparation that would not otherwise be available.<br />  </li> <li> <strong>Promote clinical reasoning expertise</strong>. Virtual patients offer an opportunity to help students overcome the common difficulty of applying knowledge of foundational scientific and clinical concepts when they are solving or explaining clinical problems. Virtual patients can be integrated into earlier education and provide hands-on experience in clinical reasoning techniques, such as asking open-ended questions, supplying single-sentence summaries of patient problems, probing early for differential diagnoses and comparing diagnostic hypotheses based on real clinical data.<br />  </li> <li> <strong>Foster mastery and lifelong learning</strong>. Virtual patients can incorporate adaptive technologies, matching the cognitive demands of virtual patients with student capabilities. In this way, virtual patients can foster student mastery of the content, rather than simply meeting short-term goals, such as getting a good grade on a test.<br />  </li> <li> <strong>Reduce medical errors</strong>. As training in medical school and residency becomes increasingly focused on achieving competencies, virtual patients can be used to assess students’ competency and facilitate mastery of clinical skills needed for working with real patients.<br />  </li> <li> <strong>Improve learning outcomes</strong>. In addition to assessing individual students, virtual patients can help educators better understand educational outcomes more broadly. Learning data could be collected from virtual patients across a broad group of students and institutions, and analysis of this data can better inform education strategies and curriculum.</li> </ul> <p> <strong>Growing sophistication</strong></p> <p> The authors predicted that ever-more sophisticated virtual patients will play an increasing role in education and supplement case-based and patient-based learning.</p> <p> “Current virtual patients are largely one-size-fits-all,” said Marc Triola, MD, director of the Institute for Innovations in Medical Education, an associate professor at the NYU School of Medicine and one of the authors of the perspective piece. NYU School of Medicine is one of the founding members of the AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/accelerating-change-in-medical-education/schools.page" target="_self">Accelerating Change in Medical Education Consortium</a>.</p> <p> “Future virtual patients will be able to incorporate data from other systems, such as the electronic health record, to tailor the content and level of complexity of the cases to the needs of each specific learner,” Dr. Triola said.</p> <p> Dr. Berman agreed that virtual patients of the future will be vastly smarter. “Virtual patients with embedded learning analytics should be able to discern how much the student knows and how well the learner is able to think through a problem,” he said.</p> <p> <strong>For more information on the changing nature of medical education:</strong></p> <ul> <li> Learn now a <a href="http://www.ama-assn.org/ama/ama-wire/post/student-network-sparked-stronger-med-school-curriculum" target="_self">student network</a> sparked a stronger curriculum.</li> <li> Find out how real <a href="http://www.ama-assn.org/ama/ama-wire/post/real-clinical-data-gives-medical-students-new-perspectives" target="_self">clinical data</a> is driving new student perspectives.</li> <li> Discover how one school employed a <a href="http://www.ama-assn.org/ama/ama-wire/post/one-medical-school-created-student-gps" target="_self">student GPS</a> to track educational progress.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> <p>  </p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bbaa48fa-e85d-4604-883c-bfac7f90268d 5 financial planning tips every young physician should know http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_5-financial-planning-tips-young-physician-should Tue, 10 May 2016 22:19:00 GMT <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/6/500eda65-ab4e-4ca1-8632-7def69dd3f6b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/0/6/500eda65-ab4e-4ca1-8632-7def69dd3f6b.Large.jpg?1" style="margin:15px;float:right;" /></a>It’s never too early to start saving for your long-term needs, financial planners say. But if you’re still early in your career and training, how can you build a savings habit in the face of med school debt, day-to-day expenses and the complexity of financial planning?</p> <p> Despite the obstacles, it’s worth investing the time and money. Many put off financial planning for years and live to regret it, financial experts and older physicians say.</p> <p> “I didn’t really start figuring out finances until residency, and that put me years behind,” an established physician said. “Now I’m on the right track, but the catch-up was painful.”</p> <p> A recent study by <a href="https://www.amainsure.com/index.html" rel="nofollow" target="_blank">AMA Insurance</a> found that more than one-half of young physicians feel they don’t spend enough time on financial planning. Nearly 9 in 10 feel somewhat or not at all protected in the event that a disability would prevent them from practicing, according to the <a href="https://www.amainsure.com/reports/2015-young-physician-report/index.html?page=2" rel="nofollow" target="_blank">2015 Report on Young Physicians’ Financial Preparedness: Young Physicians Segment</a>.</p> <p> With those physicians in mind, AMA Insurance asked Jerry Moran, a senior wealth strategist with Millennium Brokerage Group, to offer five strategies for building a strong financial foundation.</p> <p> <strong>1. Pay yourself first. </strong></p> <p> Start saving from Day 1. Put 20 percent of your monthly salary into savings, knowing that just one unanticipated crisis can upend your finances.</p> <p> “Start thinking and planning about finances in residency,” one established physician suggested, “and carve out time on a regular basis thereafter to address it.”</p> <p> <strong>2. Develop a budget beyond debt repayment.</strong></p> <p> Don’t let loan repayment block saving for retirement. Build a realistic budget and adjust it as your income changes. Living with student loan debt—73 percent of physicians graduate with it—means keeping to a budget.<br /> <br /> “Live like a resident for the first three years of your practice,” one experienced physician advised.</p> <p> <strong>3. Understand the financial aspects of your employment contract.</strong></p> <p> Get educated on <a href="http://www.ama-assn.org/ama/ama-wire/post/need-negotiate-first-employment-contract" target="_self">contract negotiations</a>, and seek out older physicians for advice. Look beyond salary to things like office expenses, life and disability insurance, and employer-matching retirement funds.</p> <p> <strong>4. Prepare for the unexpected. </strong></p> <p> Protect your family. Only 24 percent of young physicians have an updated will and medical directives. About two-thirds of young physicians have less than $50,000 in emergency funds. “Make sure you have that financial cushion, because you can’t count on things going as planned,” a physician said.</p> <p> <strong>5. Engage a professional financial adviser.</strong></p> <p> Physicians with a financial adviser make smarter investments, have more savings and feel more confident they are making the right choices for their families. Physicians should rely on recommendations and interviews to shop for an adviser that is right for them. “Don’t assume financial matters will take care of themselves once you have an income,” an established physician said.</p> <p> If you’re a physician under 40, Moran said, you are probably weighing these issues. Young physicians tend to begin their savings years behind many other professionals because of a lengthy education. With the transition from austerity to earning a good living comes an obligation to be smart with money, Moran said.</p> <p> That calls for discipline and expert help to lay the foundation of life-long financial security, Moran said.</p> <p> <strong>Learn more about financial security for physicians:</strong></p> <ul> <li> Finding <a href="http://www.ama-assn.org/ama/ama-wire/post/5-ways-partner-physician-friendly-financial-advisor" target="_self">a financial adviser</a> that’s right for you.</li> <li> The basics of <a href="http://www.ama-assn.org/ama/ama-wire/post/should-student-loan-refinancing" target="_self">student loan refinancing</a>.</li> <li> The leading <a href="http://www.ama-assn.org/ama/ama-wire/post/6-top-financial-planning-mistakes-physicians" target="_self">financial planning mistakes</a> physicians make.</li> <li> Kicking your <a href="http://www.ama-assn.org/ama/ama-wire/post/kick-financial-plan-high-gear" target="_self">financial plan into high gear</a>.</li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/4-ira-questions-need-answers" target="_self">IRA questions</a> you need to answer.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:31835864-e78b-414f-91af-cb87c2034fd9 Finding a model of care for child immigrants http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_finding-model-of-care-child-immigrants Tue, 10 May 2016 22:13:00 GMT <p> A recent surge in minors crossing on their own from Mexico into the United States has brought renewed interest in their health and how physicians can best care for them.</p> <p> U.S. Customs and Border Protection <a href="http://www.cbp.gov/newsroom/stats/southwest-border-unaccompanied-children/fy-2016" target="_blank" rel="nofollow">reports</a> that 23,553 minors were apprehended while crossing the border from Oct. 1, 2015, to March 1, 2016, an increase of 89 percent from the same period a year earlier. Though far smaller than the high tide of crossings in 2014, the surge raises some of the same concerns that surfaced then.</p> <p> <strong>A special set of health needs</strong></p> <p> Unaccompanied alien children—“UACs” in the official jargon—have unique physical and mental health needs, according to a <a href="http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/04/14/unaccompanied-minors-the-state-and-local-story" target="_blank" rel="nofollow">report by the Pew Charitable Trusts</a> and the experience of physicians working with immigrant children.</p> <p> “Unaccompanied children have often faced trauma prior to, during and/or after arriving to the United States,” said Julie Linton MD, chairperson of the Immigrant Health Special Interest Group of the American Academy of Pediatrics. “Trauma-informed care is essential as they access health services.”</p> <p> Border crossings by unaccompanied minors, most of them from Central America, reached a peak in 2014, when 68,500 were apprehended at the border. The Centers for Disease Control and Prevention <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a4.htm?s_cid=mm6332a4_e" target="_blank" rel="nofollow">reported</a> clusters of pneumonia and influenza at the time in temporary shelters in the Southwest.</p> <p> <strong>Little public health hazard</strong></p> <p> Yet early warnings of a substantial health threat to the wider community seem to have been unfounded. Infectious diseases are no more common among unaccompanied children than they are among other immigrant children from low-resource nations, said Dr.Linton, who practices in Winston-Salem, N.C.</p> <p> The Office of Refugee Resettlement (ORR), part of the U.S. Department of Health and Human Services, reports that unaccompanied minors pose little health risk to the wider community.</p> <p> Still, meeting these children’s medical needs calls for heightened understanding of their particular experiences.</p> <p> The AMA House of Delegates has characterized unaccompanied minor immigration as “a humanitarian issue” and resolved that the organization would work to identify obstacles to mental and physical care in cooperation with other organizations.</p> <p> “Partnership with community-based organizations is essential when caring for unaccompanied children,” Dr. Linton said. To be effective, health care must work in tandem with the trauma, legal and institutional trust issues that child immigrants experience, she said.</p> <p> <strong>Finding a permanent place</strong></p> <p> While ORR pays for and provides services, including medical care for the children while they are at a shelter, once a child has been placed with a family member or sponsor, the care and well-being of the child becomes the responsibility of that sponsor.</p> <p> ORR has helped large numbers of unaccompanied minors move during the past two years from temporary shelters into long-term housing, arranging places with family members and other sponsors. Pew reports that 97 percent of children apprehended in late 2015 and early 2016 have been placed in housing around the U.S.</p> <p> Policies addressing health care for unaccompanied immigrant children vary by jurisdiction. Several states, including California, Illinois, Washington, Massachusetts and the District of Columbia, have sought a solution by providing child immigrants with Medicaid coverage.</p> <p> “Many of these children struggle to effectively integrate into communities,” Dr. Linton said. “However, having successfully reached a potentially safe new home, they also have tremendous potential to contribute immensely to our community.”</p> <p> <strong>Read more about populations facing barriers to health care:</strong></p> <ul> <li> Learn about <a href="http://www.ama-assn.org/ama/ama-wire/post/3-environmental-issues-disproportionately-affecting-patients" target="_self">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="_self">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="_self">reducing hypertension disparities</a>.</li> </ul> <p align="right" style="margin-left:.25in;"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e6ad82d0-f596-4ca4-aa32-55d345b398be 10 concepts that will help you thrive as an intern http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_10-concepts-will-thrive-intern Mon, 09 May 2016 21:58:00 GMT <p> The first year of residency can be one of the most physically and emotionally challenging years of your training. A chief resident offers tips for navigating this part of your education.</p> <p> In this second post of a <a href="http://www.ama-assn.org/ama/ama-wire/post/7-things-need-succeed-medical-intern" target="_self">two-part series</a>, Dr. Faton Bytyci, chief resident at Sacred Heart Hospital’s family medicine residency program in Allentown, Penn., provides insights to help you thrive throughout the challenges of your intern year.</p> <p> <strong>1. Say goodbye to being the best at everything you do.</strong></p> <p> When you start the first year, it’s important to recognize that there’s a lot you don’t know, Dr. Bytyci said. At the same time, don’t let that hold you back from learning everything you can. “It’s OK because you are being watched by every nurse, medical assistant, senior, attending, even the people who empty the trash,” he said.</p> <p> <strong>2. Know that you will make mistakes—and you will hear about them.</strong></p> <p> “You will be paged by a senior resident or attending physician to ask you why you did this thing or that,” Dr. Bytyci said. “Don’t argue. Just say you’re sorry, then cry in the corner for a moment and get over it. You are not a bad person because you made a mistake.”</p> <p> <strong>3. Ask for help.</strong></p> <p> “If you are completely over your head, admit it and ask for help,” he said. “Don’t pretend to be smart. Every residency is different and has specific regulations that you have to learn and follow. So focus on learning.”</p> <p> <strong>4. Be honest.</strong></p> <p> “It’s very important for your senior residents and attendings to trust you,” Dr. Bytyci said. “It’s OK to say ‘I don’t know’ or ‘I forgot.’ Don’t lie. Everything starts with trust and builds from there.”</p> <p> Learn the <a href="http://www.ama-assn.org/ama/ama-wire/post/6-key-factors-build-residents-trust-interns" target="_self">key factors</a> that build residents’ trust in interns.</p> <p> <strong>5. Don’t let fear stop you.</strong></p> <p> “Procedures can be scary,” Dr. Bytyci said. “If you understand from the beginning that fear is a normal response to new situations, you’ll expect it and be ready to move through it. You can’t learn without getting outside your comfort zone.”</p> <p> <strong>6. Be nice to everyone.</strong></p> <p> “Strive to be nice to staff, fellow residents, consultant services, patients, families, environmental assistants, clerks and everyone else,” he said. “It’s good for you, good for others and good for patient care.”</p> <p> <strong>7. Respect every team member.</strong></p> <p> “Most nurses are deeply dedicated to their patients,” Dr. Bytyci said. “Every nurse in the hospital has more clinical experience than you. Nurses are your best friends. They can make or break your experience.”</p> <p> <strong>8. Be careful how often you complain</strong>.</p> <p> Dr. Bytyci warns that residency is full of sacrifice. “You will be grumpy. You will be exhausted,” he said. “Complain only to your friends and family. Nobody wants to work with complainers.” In an environment where everyone works hard, others can find it annoying if you repeatedly tell people how hard you’re working, he said.</p> <p> <strong>9. Learn to say yes.</strong></p> <p> Dr. Bytyci recommends taking advantage of every learning opportunity. Say “yes” to participating in procedures and other clinical opportunities, conducting research, <a href="http://www.ama-assn.org/ama/ama-wire/post/master-publishing-process" target="_self">publishing</a> and attending conferences.</p> <p> <strong>10. Keep your eye on the goal: Residency will transform you.</strong></p> <p> “The most awesome thing about being an intern is that at the end of the year, everything that once seemed scary and difficult will become second nature,” Dr. Bytyci said. “You start out lost, scared, having no idea what to do, and in a short period of time, you turn into a well-informed, confident, professional physician.”</p> <p> <strong>Learn more about navigating residency:</strong></p> <ul> <li> Find out how to make it through residency <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-live-budget-during-training" target="_self">on a budget</a>.</li> <li> Read about the Mayo Clinic’s <a href="http://www.ama-assn.org/ama/ama-wire/post/preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_self">unique approach to preventing resident burnout</a>.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/ama-wire/post/4-building-blocks-successful-medical-marriage" target="_self">four building blocks</a> for a successful medical marriage.</li> <li> Learn about an initiative that could bring changes to <a href="http://www.ama-assn.org/ama/ama-wire/post/residency-training-environments-primed-transformation" target="_self">the residency environment</a>.</li> <li> Read up on whether more flexible hours can help improve the <a href="http://www.ama-assn.org/ama/ama-wire/post/flexible-duty-hours-positive-learning-experience" target="_self">residency experience</a>.</li> </ul> <p style="text-align:right;"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:8efec448-0c59-4291-b945-fb6c3567b6da Physicians team up to treat addiction in rural areas http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_physicians-team-up-treat-addiction-rural-areas Mon, 09 May 2016 21:50:00 GMT <p> Physicians in New Mexico have developed a distance learning model to address inadequate access to medical care in rural and traditionally underserved areas. Through a special focus on substance use and behavioral health disorders, the project has bolstered primary care physicians’ ability to care for patients with substance use disorders in the midst of the opioid overdose epidemic.</p> <p> Led by Professor of Medicine Sanjeev Arora, MD, <a href="http://echo.unm.edu/" rel="nofollow" target="_blank">Project ECHO</a> (Extension for Community Healthcare Outcomes) was created at the University of New Mexico Health Sciences Center in 2003. The project is a free-of-charge distance education model that connects primary care professionals with specialists through simultaneous video conferencing to help them develop and share knowledge in the care of a variety of complex health conditions they may not have felt prepared to treat.</p> <p> <strong>How Project ECHO works</strong></p> <p> The ECHO model connects local clinicians, or “spokes,” with specialist teams at academic medical centers, or “hubs,” in weekly teleconference clinics called teleECHO™ clinics. During these weekly two-hour sessions, participants present patient cases that raise challenging medical and other treatment issues to collect the input of their colleagues and the specialists on the call.</p> <p> TeleECHO clinic sessions typically begin with a brief didactic discussion on an aspect of substance use disorder or behavioral health. Then a participant gives an oral case presentation—cases are submitted by participants in advance of the session. Questions are solicited from other participants, including the specialists at the hub, and then the group has a discussion around the teaching points raised by the case. These recommendations are summarized and sent to participants as a reference.</p> <p> In light of the opioid overdose epidemic, Project ECHO has been ahead of the curve with two focus areas: effective treatment of substance use disorders and supporting medication-assisted treatment (MAT) with buprenorphine. Since 2005, specialists in treatment of substance use and behavioral health disorders at Project ECHO have offered the weekly Integrated Addictions and Psychiatry (IAP) teleECHO Clinic.</p> <p> Miriam Komaromy, MD, associate director of Project ECHO and an internal medicine specialist and addiction consultant, leads the IAP teleECHO Clinic sessions which have been used to recruit physicians to participate in buprenorphine waiver trainings. In 2006, only 36 physicians in New Mexico were buprenorphine-waivered. Since that time, 375 physicians in New Mexico have participated in buprenorphine waiver trainings offered by Project ECHO’s IAP teleECHO Clinic. New Mexico now has more buprenorphine-waivered physicians per capita than all but three other states.</p> <p> <strong>National expansion of the ECHO model</strong></p> <p> Several states, including Connecticut, Montana, Hawaii and upstate New York, have jumped on board and started their own substance use teleECHO clinic sessions in the last year. The ECHO Institute offers a rolling, monthly training that lasts up to three days and shows leaders how to establish the model in their state or region.</p> <p> In addition to individuals trying to connect and wanting to start programs in their own areas, Dr. Komaromy is involved in a national effort in collaboration with the American Society of Addiction Medicine (ASAM), with funding from the Center for Substance Abuse Treatment. “We’re doing a 16-week pilot we’re calling Fundamentals of Addiction Medicine teleECHO Clinic (FAME),” she said. “We recruited participants who had attended a one-day pre-course called “Fundamentals of addiction medicine” at the annual ASAM meeting.”</p> <p> “Every week people are coming into the clinic from all different corners and presenting cases,” she said. “A unique feature is that we’ve recruited a bench of addiction specialists from around the United States and Canada.” Dr. Komaromy facilitates the live conversation, but the guest specialists give didactic presentations and participate in the patient case discussion each week.</p> <p> “It’s been a rich opportunity for people at different levels of knowledge to interact and for the primary care physicians to develop mentorship relationships with the specialists,” she said.</p> <p> Participants ask questions and talk about patient cases to “promote the kind of dialogue that doesn’t happen enough between specialists and primary care physicians,” Dr. Komaromy said. “The specialists also learn from the primary care physicians, so it’s a really collaborative learning environment.”</p> <p> As a result of Project ECHO’s success, Sens. Brian Schatz, D-Hawaii, and Orrin Hatch, R-Utah, recently introduced the Expanding Capacity for Health Outcomes (ECHO) Act in an effort to expand the model to rural health networks throughout the country.</p> <p> <strong>How participants are responding</strong></p> <p> Dr. Komaromy has heard a lot of positive responses from physicians. One physician said he has started to see the Thursday morning clinic session as an anchor to his week. He saves up questions, and when he runs into a challenging case, he wants to bring it to the group for discussion.</p> <p> A nurse practitioner in Alaska said that she just doesn’t have many resources in her area for substance use treatment, and it’s helpful to have a network of people whom she can run cases by and gather advice.</p> <p> Another benefit of the ECHO sessions has been helping participants better understand the patient’s perspective as well as the power of language when talking about substance use and addiction.</p> <p> “We see people change over time,” Dr. Komaromy said. “Stigma is a big issue. It’s huge in the medical profession because it’s huge in society. Sometimes we’ll role play discussions … [and] model bringing compassion to the interaction—trying to understand this patient’s point of view, particularly focusing on trauma, which can help turn the conversation around.”</p> <p> “As physicians our tendency is to think the most helpful thing is to talk about the medication or the biology of the situation,” Dr. Komaromy said. But understanding the relationship component and how to talk with these patients is critical.</p> <p> “I think one of the most important components that we have is an excellent addiction counselor who is part of our faculty,” Dr. Komaromy said. To see medical professionals collaborating with the counselor and learning some very practical techniques for framing the issue with their patients “is very powerful to experience,” she said. “The multidisciplinary nature of the clinic is very helpful.”</p> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_self">five things physicians can do to prevent opioid abuse</a>, recommended by the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse/opioid-abuse-task-force.page?" target="_self">AMA Task Force to Reduce Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> Learn more about what physicians are doing to end the opioid epidemic:</p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/talk-substance-use-disorders-patients" target="_self">How to talk about substance use disorders with your patients</a></li> <li> Learn <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_self">how President Obama’s opioid initiatives align with the Task Force’s recommendations</a>.</li> <li> Read a <a href="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" target="_self">call to action for physicians to turn the tide of the opioid epidemic</a></li> <li> Find out what <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-saying-new-cdc-opioid-guidelines" target="_self">physicians are saying about the new Centers for Disease Control and Prevention opioid guidelines</a>.</li> </ul> <p align="right">  </p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:e4307885-0d6e-477f-9139-ed66ec2b3757 Burnout driving physicians to cut down work hours http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_burnout-tied-fewer-physician-work-hours Fri, 06 May 2016 21:40:00 GMT <p> A new study found that high levels of burnout and low professional satisfaction scores predict a reduction in work levels. Learn more about which physicians are reducing their work hours and what is being done to improve professional satisfaction.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/7/d54809cb-1817-4ad1-976d-b0c876138e4b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/5/7/d54809cb-1817-4ad1-976d-b0c876138e4b.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>Who is increasingly cutting hours</strong></p> <p> Full-time physicians who report worsening burnout or show declining job satisfaction are more likely to reduce the hours they work, according to <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(16)00101-4/abstract" rel="nofollow" target="_blank">study</a> published in April’s <em>Mayo Clinic Proceedings</em>.</p> <p> More than 1,800 Mayo Clinic physicians responded to a 2011 survey. For each one-point increase a physician had on a seven-point emotional exhaustion scale, there was a 43 percent higher likelihood that the physician would reduce his or her full-time employment over the next 24 months. Each one-point decrease in the five-point satisfaction score, meanwhile, led to a 34 percent higher likelihood a physician would reduce his or her hours, the study found.</p> <p> A longitudinal analysis at the physician level showed that full-time physicians who reported worsening burnout or declining satisfaction between 2011 and 2013 also were more likely to cut hours in the next 12 months.</p> <p> And it’s not the younger physicians who cut back hours.</p> <p> Between 2008 and 2014, there was a statistically significant increase in the proportion of men older than 55 who worked less than full time, a jump from 12.6 percent at the beginning of the study to 17.7 percent by the end of the study. The change was not statistically significant for men in other age groups, the study showed.</p> <p> Women overall were less likely to work full time than men, but their rate did not increase over the study period. In fact, the proportion of women 35 years old or younger who worked less than full time decreased from 29.2 percent to 11.8 percent during the study period.</p> <p> “These findings suggest that the trends in full-time employment we observed were not attributable to millennials oriented toward better work-life integration but rather reductions in work hours by their older colleagues,” study lead author Tait D. Shanafelt, MD, director of the Mayo Clinic Department of Medicine Program on Physician Well-being, and his colleagues wrote.</p> <p> “Although the reasons for this trend are unknown, several studies have suggested that the interval of 10 to 20 years after entering practice is a particularly stressful time for physicians, and it is possible that many physicians reduce their workload in response to the distress they experience during this period of their career,” Dr. Shanafelt and colleagues wrote.</p> <p> <strong>Could burnout exacerbate physician shortages?</strong></p> <p> The proportion of physicians working less than full time at the Mayo Clinic increased to 16 percent in 2014, up from 13.5 percent in 2008. While working fewer hours may help individual physicians cope with burnout, a better solution needs to be found so physician shortages are not even worse than projected, both the researchers and an <a href="http://www.mayoclinicproceedings.org/article/S0025-6196(16)00109-9/fulltext" rel="nofollow" target="_blank">editorial</a> accompanying the study said.</p> <p> “There are many reasons why physicians may choose to decrease their work effort,” Rachel B. Levine, MD, an associate professor of medicine at Johns Hopkins School of Medicine wrote in the editorial. “However, [the study’s] findings provide further compelling evidence that now is the time to address physician burnout and diminished work satisfaction. We are currently facing projected workforce shortages, especially among primary care specialties, at the same time that our population is aging, and there is increased demand to care for newly insured patients.”</p> <p> Study authors said efforts to reduce burnout must recognize the problem is, in large part, a system issue, and efforts need to address the problems that drive burnout, including excessive workloads and inefficiencies in the practice environment.</p> <p> <strong>Improving professional satisfaction</strong></p> <p> The call for changing the practice environment echoes the findings of an AMA <a href="http://www.rand.org/content/dam/rand/pubs/research_reports/RR400/RR439/RAND_RR439.pdf" rel="nofollow" target="_blank">study</a> conducted with RAND as part of the AMA’s Professional Satisfaction and Practice Sustainability <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/steps-forward.page" target="_blank">initiative</a>. That study concluded that key drivers of physician satisfaction were providing high-quality care; having greater control over the pace and content of clinical work; holding similar values to the practice leadership; and working in an environment that fosters collegiality, fairness and respect.</p> <p> These areas are the ones policymakers and health delivery systems should work to change to improve professional satisfaction among physicians.</p> <p> “This may seem an obvious conclusion, but considering the typical tools used to influence physician behavior (regulations, payment rules, financial incentives, public reporting and the threat of legal action), refocusing attention on the targets identified in this study may actually represent a substantial change of orientation for many participants in the U.S. health care system,” the AMA-RAND study found.</p> <p> <strong>Resources to fight burnout </strong></p> <p> The AMA offers several online modules through its <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of practice improvement strategies to help physicians in practice and physicians in training recognize and address burnout. These modules cover <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">preventing resident and fellow burnout</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/improving-physician-resilience" rel="nofollow" target="_blank">improving physician resiliency</a>.</p> <p> The AMA also is helping physicians to create thriving practices, working with physicians to advance initiatives that enhance their practice through <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/physician-practices/physician-hospital-relationships.page" target="_blank">leadership principles and efforts.</a> The AMA is collaborating with hospitals, independent physician associations and others to cultivate successful physician leadership that improves the value of care for patients and fosters a more cohesive and integrative decision-making process within hospitals and health care systems.</p> <p> For those attending the <a href="http://www.ama-assn.org/sub/meeting/index.html" target="_blank">2016 AMA Annual Meeting</a>, Dr. Shanafelt will be the featured speaker for a continuing medical education activity at noon June 10, during which he’ll discuss physician burnout throughout medical education and practice.</p> <p> <strong>For more on physician burnout:</strong></p> <ul> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/physician-satisfaction-leadership-qualities-matter" target="_blank">Physician satisfaction: Why leadership qualities matter</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_blank">Preventing resident burnout: Mayo Clinic takes unique approach</a></li> <li> <a href="http://www.ama-assn.org/ama/ama-wire/post/role-of-personal-accomplishment-physician-burnout" target="_blank">The role of personal accomplishment in physician 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 you more than you think</a></li> </ul> <p align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:df6da955-e310-4d5d-9489-0ad341cc70ab 6 ways to free up time in your practice http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_6-ways-up-time-practice Fri, 06 May 2016 21:36:00 GMT <p> Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is healthy also can contribute to better outcomes and patient satisfaction. Learn six ways to streamline revenue-related processes to maximize the amount of time available for patient care.</p> <p> <strong>Speed up your processes electronically</strong><a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/4/9e3e8a86-098a-4548-84ad-1ad603aa2f2b.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/14/4/9e3e8a86-098a-4548-84ad-1ad603aa2f2b.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> A new <a href="https://www.stepsforward.org/modules/revenue-cycle-management" target="_blank" rel="nofollow">module</a> from the AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice streamline revenue cycle management processes. The module details several ways for your practice to become more efficient in these processes, which is critical for financial health and sustainability.</p> <p> It is important to have a practice management system (PMS) that works best for your staff and medical personnel before you implement new processes. Your PMS will determine your practice’s ability to take advantage of electronic processes. If you are choosing a new PMS, be sure to gather input from your staff and make a priority checklist to find the PMS that aligns with your needs and requirements—and make sure that system works with your electronic health record (EHR).</p> <p> Once you have a PMS in place that works for your practice, take advantage of these six ways to make your revenue cycle management processes more efficient:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Verify insurance eligibility electronically before visits.</strong><br /> Most health plans allow patient eligibility to be verified by phone or through a Web portal, but these methods are often inefficient and may not provide all the necessary information. Electronic eligibility verification can be a big time-saver.<br /> <br /> When a patient schedules an appointment, the scheduling or registration staff collects their insurance information and submits an electronic eligibility request by entering the patient’s data into the PMS. Federal regulations require health plans to respond within 20 seconds. Patients can then be made aware of any financial responsibility that will be requested at check-in.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Reduce prior authorization burdens through electronic transactions.</strong><br /> Newly available electronic pharmacy prior authorization transactions enable physicians to complete prior authorization requirements as part of the e-prescribing work flow. E-prescribing system vendors are in various stages of implementing the technology for these transactions, so find out your vendor’s timeframe and request this new technology for your practice.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Submit claims electronically to save time and money.</strong><br /> Submitting these health care claim submissions electronically can save time and speed up health plan adjudication and payment. After your PMS generates an electronic claim, your practice can either submit it directly to the health plan or indirectly through a clearinghouse or billing service, which may pre-audit or “scrub” claims prior to submission to check for missing or incorrect information.<br /> <br /> The built-in checks allow any potential issues to be addressed before the claim reaches the health plan’s adjudication system, reducing payment delays and denials.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Determine the status of a submitted claim.</strong><br /> Practices often don’t know if a claim has been received by the health plan until it is paid, pended or rejected. Use an electronic claim status inquiry to confirm receipt and determine status of submitted claims.<br /> <br /> Health plans are required to support real-time claim status processing. Practices can send “batch” transmissions to health plans to check the status of multiple claims at the same time. By law, health plans must respond by the next business morning. Rather than waiting two or more weeks before taking action, the electronic claim status request provides your practice with an immediate status report on the claim.</p> <p style="margin-left:40px;"> <strong>5.  </strong><strong>Use electronic remittance advice (ERA) to simplify processing of payment information.</strong><br /> An ERA is an electronic version of a paper explanation of benefits and holds all of the same details. The standardized ERA can reduce burdens, more quickly identify claims that require reworking and save time for staff to spend on higher-value activities.<br /> <br /> When implementing ERA in your practice, engage all involved trading partners, including health plans, your PMS vendor and any billing service that your practice uses. Determine the ERA capabilities of your PMS software. Taking full advantage of the ERA transaction may require an upgrade to the software. You can use the <a href="https://www.stepsforward.org/modules/revenue-cycle-management#downloadable" target="_blank" rel="nofollow">Critical conversations with trading partners about ERA tool</a> in the STEPS Forward module to make sure you cover all the bases.</p> <p style="margin-left:40px;"> <strong>6.  </strong><strong>Maximize collection of patient payment.</strong><br /> The growing prevalence of high-deductible health plans means many patients bear additional financial responsibility for their treatment. Collecting payments while the patient is still in your office is a vital first step in any effective patient collections strategy. It will increase cash flow, decrease accounts receivable, and reduce billing and back-end collection costs.<br /> <br /> To bill at the time of service, your staff will need to know the correct amount to charge. Completing an electronic eligibility check before the appointment will provide information about the patient cost. Use this information, along with the health plan’s current fee schedule, to calculate the amount the patient owes.<br /> <br /> For tips on point-of-care pricing, download the <a href="https://www.stepsforward.org/modules/revenue-cycle-management#downloadable" target="_blank" rel="nofollow">Managing patient payments: Calculating POC treatment price tool</a>.</p> <p> More than 25 modules are available in the AMA’s <a href="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:47fc57f7-559f-485c-8eb3-b8befcf6eb3c Tobacco products, e-cigarettes come under greater regulation http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_tobacco-products-e-cigarettes-come-under-greater-regulation Thu, 05 May 2016 21:01:00 GMT <p> The U.S. Food and Drug Administration (FDA) Thursday took an important step in the national regulation of tobacco products, issuing a new rule that prohibits the sale of a number of tobacco products, including e-cigarettes, to minors. But two provisions in a federal bill could significantly weaken this authority. Find out what the FDA rule says and how it could be already under threat.</p> <p> “Before today, there was no federal law prohibiting retailers from selling e-cigarettes, hookah tobacco or cigars to people under age 18,” the FDA said in a <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm499234.htm" rel="nofollow" target="_blank">news release</a>. “Today’s rule changes that with provisions aimed at restricting youth access.”</p> <p> <strong>What’s in the rule</strong></p> <p> The FDA <a href="https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-10685.pdf" rel="nofollow" target="_blank">rule</a> helps implement the Family Smoking Prevention and Tobacco Control Act of 2009 and allows the agency to improve public health through a variety of steps, including restricting the sale of all tobacco products to minors nationally.</p> <p> “The AMA supports the FDA’s new rule and its efforts to ensure the public—–especially young people—is aware of and protected from these harmful products,” said AMA President Steven J. Stack, MD, in a <a href="http://www.ama-assn.org/ama/pub/news/news/2016/2016-05-05-fda-new-rule-e-cigarettes.page" target="_blank">news release</a>. “We urge the FDA to issue further regulations addressing marketing of these products and banning flavored e-cigarettes, which are particularly enticing to minors.”</p> <p> “Patients suffer from many chronic and fatal diseases related to tobacco use, including cancer, heart disease and emphysema,” Dr. Stack said. “Smoking and tobacco use remain the No. 1 preventable cause of death in the United States.”</p> <p> The AMA has long called for e-cigarettes to be regulated in the same way the FDA regulates tobacco and nicotine products. The organization also has strongly advocated for the FDA to extend its tobacco regulations and oversight to include e-cigarettes, cigars and other tobacco products.</p> <p> The rule will go into effect in 90 days and establishes restrictions in the following ways:</p> <ul> <li> Not allowing products to be sold to persons under the age of 18 (both in person and online)</li> <li> Requiring age verification by photo ID</li> <li> Not allowing the selling of covered tobacco products in vending machines (unless in an adult-only facility)</li> <li> Not allowing the distribution of free samples</li> </ul> <p> The FDA also released a <a href="http://www.fda.gov/TobaccoProducts/NewsEvents/ucm499383.htm" rel="nofollow" target="_blank">fact sheet</a> further detailing the regulations.</p> <p> Also this week, California became the second state after Hawaii to <a href="http://www.ama-assn.org/ama/ama-wire/post/raising-tobacco-purchasing-age-matters" target="_blank">raise the tobacco purchasing age</a> when Gov. Jerry Brown signed bills that raise the tobacco and e-cigarette purchasing age from 18 to 21 years, among other measures.</p> <p> “As cigarette smoking among those under 18 has fallen, the use of other nicotine products, including e-cigarettes, has taken a drastic leap,” said U.S. Department of Health and Human Services Secretary Sylvia Burwell. “Today’s announcement is an important step in the fight for a tobacco-free generation.”</p> <p> <strong>A bill that stands in opposition to the FDA rule</strong></p> <p> Though this final rule is an important action for the health of the nation, two provisions in the House Agriculture Appropriations bill could weaken the FDA’s authority over these tobacco products.</p> <p> In alliance with a large group of other national organizations, the AMA recently sent a letter to the Senate committee with jurisdiction over the bill, opposing the provisions.</p> <p> “One provision seeks to completely exempt certain cigars from FDA regulation,” the letter said. “The other exempts e-cigarettes, cigars and other currently unregulated tobacco products from an important product review requirement, taking away a powerful and efficient tool to protect children from the candy and fruit-flavored e-cigarettes and cigars that have flooded the market in recent years.”</p> <p> “We urge the Senate to reject any provisions [that] make it more difficult for FDA to address this public health problem,” the letter said. “The need for FDA oversight of these products could not be clearer.”</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a06a4df4-f2f9-474f-afe4-79c1c511ae53 The need for med ed fellowships and guidelines for success http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_need-med-ed-fellowships-guidelines-success Thu, 05 May 2016 21:00:00 GMT <p> As innovations in medical education continue to advance, training for faculty members often lags, with most training taking place on the job and with very little formal curriculum. A new study provides insights into what medical education fellowships should entail and explains why this training should take place before physicians assume the responsibilities of faculty appointments.</p> <p> Many medical schools offer formal development programs for existing faculty. But the lack of a standard model and curriculum for training academic physicians troubles directors of existing medical education programs, who believe standardization could improve teaching and scholarship.</p> <p> A <a href="http://journals.lww.com/academicmedicine/Abstract/publishahead/Creating_a_Cadre_of_Fellowship_Trained_Medical.98581.aspx" rel="nofollow">research report</a> in the journal <em>Academic Medicine</em> concludes that “medical education fellowships cultivate leaders and communities of trained educators.” The need for rigorous training is especially important amid innovations in teaching methods and training curriculum, researchers said.</p> <p> The report relied on interviews with eight directors of existing faculty education programs.</p> <p> <strong>Creating a core of faculty leaders</strong></p> <p> Directors noted that most faculty learn on the job while balancing competing demands of patient care and other clinical duties. The study also found that few programs are available to allow those who are interested in pursuing a career as an academic physician to undergo formal training in education before assuming faculty duties.</p> <p> Directors of existing programs told researchers they have ambitious hopes for graduates of education fellowship programs. They envision graduates:</p> <ul> <li> Assuming leadership roles</li> <li> Pursuing an academic career</li> <li> Producing scholarship</li> <li> Achieving national prominence in their fields</li> </ul> <p> “The whole idea is to change the culture one person at a time,” one program director told researchers.</p> <p> <strong>Fellows currently face competing demands</strong></p> <p> The most troubling drawback of existing education programs that train physicians who already are faculty members is participants being pulled away from faculty training to tackle other duties, directors said. This happens even when medical schools have promised to allow fellows the freedom to devote a certain amount of their time to their training in education.</p> <p> “People have committed to coming, but people are leaving because they get called back to cover an emergency patient or something has happened,” a director said. “I think that particularly for new faculty, their academic work takes a back seat to their patient care. I think there are times that they haven’t devoted their time and attention to the fellowship due to busy clinic schedules and various issues that come up in patient care activities.”</p> <p> These findings informed the researchers’ recommendation that medical education fellowship training should occur before initial faculty appointment.</p> <p> <strong>Establishing a new training program</strong></p> <p> Program directors promoted the idea of establishing new faculty training fellowships in medical schools that do not have them. After interviewing directors, the researchers identified four guidelines for success in creating new programs:</p> <ul> <li> Define the goals and objectives for the new program</li> <li> Evaluate best practices and choose those that fit local needs</li> <li> Enlist the support of institutional leaders</li> <li> Protect fellows’ time for training by releasing them from some of their clinical demands</li> </ul> <p> The consensus among the eight program directors was that expanded, improved and standardized faculty education could revolutionize teaching and create a generation of skilled, inspired scholars, educators and leaders.</p> <p> “Everybody says when they leave the program, they feel reinvigorated, reenergized and connected with people who love to teach,” the director of an existing program said. “It’s really an antidote to burnout.”</p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:bedd4f81-d691-44bb-b85e-c02aee6691da The resident depression endemic--and solutions underway http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_resident-depression-endemic-solutions-underway Wed, 04 May 2016 21:03:00 GMT <p> Researchers recently analyzed more than 50 years of peer-reviewed studies on depression and depressive symptoms in residents. The prevalence is high, and rates have risen with each calendar year. Learn how the medical community is working to increase wellness among physicians in training.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/11/12bcd8fc-890a-4bac-8b29-846757c7d710.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/11/12bcd8fc-890a-4bac-8b29-846757c7d710.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>It’s an endemic</strong></p> <p> Roughly one-third of residents suffer from depression or depressive symptoms according to an <a href="http://jama.jamanetwork.com/article.aspx?articleid=2474424" rel="nofollow" target="_blank">original investigation</a> recently published in the <em>Journal of the American Medical Association</em> (<em>JAMA</em>).</p> <p> The rate of physicians in training who screened positive for depression or depressive symptoms ranged from 20.9 percent to 43.2 percent, depending on the instrument used, the investigation showed. Researchers also found that depressive symptoms increased over time, a 0.5 percent increase per calendar year. The rates are at a level that an <a href="http://jama.jamanetwork.com/article.aspx?articleid=2474410" rel="nofollow" target="_blank">editorial</a> accompanying the <em>JAMA</em> study called “endemic.”</p> <p> The <em>JAMA</em> original investigation was a systematic review and meta-analysis of 31 cross-sectional studies and 23 longitudinal studies conducted between January 1963 and September 2015. More than 17,000 residents were involved in the studies analyzed.</p> <p> Study authors say depression is an important problem to address during residency because it has been linked to a higher chance of future depressive episodes and greater long-term morbidity, suggesting that the future health of residents may be impacted. Also, patient health may be affected because depression in physicians has been linked to lower quality of care.</p> <p> “The time is long overdue for a national conversation on the fundamental structure and function of the graduate medical education system, not unlike the discussion that reformed undergraduate medical education after the Flexner report,” Thomas L. Schwenk, MD, dean of the University of Nevada School of Medicine, wrote.</p> <p> <strong>Rethinking training with mental health in mind</strong></p> <p> <em>JAMA</em> study authors call for more studies to identify effective strategies for preventing and treating depression among physicians in training. Dr. Schwenk’s editorial suggests solutions can be classified into three categories:</p> <ul> <li style="margin-left:0.25in;"> Providing more and better mental health care to depressed physicians and those in training</li> <li style="margin-left:0.25in;"> Limiting trainees’ exposure to the training environment and system that are thought to contribute at least in part to poorer mental health and wellness</li> <li style="margin-left:0.25in;"> Considering the possibility that the medical training system needs more fundamental change</li> </ul> <p> “Relieving the burden of depression among physicians in training is an issue of professional performance in addition to one of human compassion,” he wrote.</p> <p> Dr. Schwenk also said the study’s findings are “significant” and an “important marker for deeper and more profound problems in the graduate medical education system that is in need of equally profound change.” He has more to say on solutions in this JAMA Network <a href="http://jama.jamanetwork.com/multimediaPlayer.aspx?mediaid=12083577" rel="nofollow" target="_blank">video</a>.</p> <p> <strong>Creative approaches emerging</strong></p> <p> A number of organizations are taking the lead in providing resources to help physicians in training who show signs of depression, and a number of residency programs are creating programs to try to ward off depression.</p> <p> The AMA offers several online modules through its <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward™ collection</a> of practice transformation strategies to help physicians in practice and physicians in training recognize and address burnout. Although burnout is different from depression, the two are closely related. These resources offer strategies for <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">preventing resident and fellow burnout</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/improving-physician-resilience" rel="nofollow" target="_blank">improving physician resiliency</a>.</p> <p> Included in these resources are <a href="http://www.ama-assn.org/ama/ama-wire/post/6-key-aspects-residents-need-well-being" target="_blank">six ways</a> that physicians in training can improve their personal wellness. The AMA also <a href="http://www.ama-assn.org/ama/ama-wire/post/stopping-burnout-top-priority-physicians-training" target="_blank">adopted policy</a> in November to support access to potentially life-saving mental health services for physicians in training.</p> <p> The Accreditation Council for Graduate Medical Education (ACGME), meanwhile, also is <a href="http://www.ama-assn.org/ama/ama-wire/post/acgme-seeks-transform-residency-foster-wellness" target="_blank">working toward</a> improving resident wellness across training programs. At its first <a href="http://www.acgme.org/What-We-Do/Initiatives/Physician-Well-Being" rel="nofollow" target="_blank">forum on physician well-being</a> in November, the ACGME identified six areas that could help improve well-being for residents: building awareness, maximizing levers of change (including competency milestones and program requirements), ongoing education and communication, collaboration across the continuum of education, research, and large-scale cultural change.</p> <p> Solutions taking place within residency programs include:</p> <ul> <li style="margin-left:27pt;"> Stanford University School of Medicine’s <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">Balance in Life</a> program gives residents access to mentors and a clinical psychologist, healthy food and social gatherings.<br />  </li> <li style="margin-left:27pt;"> The Mayo Clinic’s campus in Florida designates one <a href="http://www.ama-assn.org/ama/ama-wire/post/preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_blank">noon conference</a> every month as “Humanities Thursday.” The Fellows’ and Residents’ Health and Wellness Initiative (<a href="https://vimeo.com/130359798" rel="nofollow" target="_blank">FERHAWI</a>) humanities program includes discussions of artwork, guided visual imagery and art projects, such as watercolor painting, screen printing and origami.<br />  </li> <li style="margin-left:27pt;"> A physician created a one-act <a href="http://www.ama-assn.org/ama/ama-wire/post/residents-beating-burnout-theatre" target="_blank">play</a>, <em>Play What’s Not There</em>, to help residents tackle conversations about balancing family, personal identity and practice. Anyone interested in staging the play can <a href="http://changingaging.org/contact-us/" rel="nofollow" target="_blank">contact</a> the writer Bill Thomas, MD, and request a script.</li> </ul> <p> A wide variety of ideas will be shared at the <a href="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 align="right"> <em>By contributing writer Tanya Albert Henry</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:f71d00cd-8435-42c9-b2cc-17938f471452 Court case could lead to unlimited awards of punitive damages http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_court-case-could-lead-unlimited-awards-of-punitive-damages Wed, 04 May 2016 20:56:00 GMT <p> The Tennessee Supreme Court is weighing the state’s limit on punitive damages in medical and other liability cases. A ruling to lift the ceiling could mean unlimited awards against physicians and other defendants.</p> <p> <strong>From life insurance to medical liability</strong></p> <p> The case, <em>Lindenberg v. Jackson National Life Insurance Co.</em>, originated in a dispute between an insurance company and the beneficiary of a life insurance policy. The company withheld the proceeds of the policy from the ex-wife of the deceased policyholder based on concerns over competing claims.</p> <p> A jury in December 2014 found the insurance company had breached the terms of the policy contract and awarded the ex-wife $350,000 in actual damages, totaling the face amount of the policy. In addition, jurors awarded her $3 million in punitive damages. The insurance company asked a court to overturn the punitive damages award, citing a 2011 state law that caps punitive awards at $500,000 or twice the amount of actual damages, whichever is higher.</p> <p> A federal judge heard the plaintiff’s arguments that the cap violates her right to a jury trial and encroaches on the powers of the courts. The judge in November referred the question to the Tennessee Supreme Court.</p> <p> The case holds broader implications than for the scenario in question because lifting the cap on damages could leave physicians exposed to unlimited awards for punitive damages.</p> <p> <strong>What physicians are saying</strong></p> <p> The limit on awards ensures fairness and predictability in liability cases, the <a href="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>, the <a href="http://www.tnmed.org/" target="_blank" rel="nofollow">Tennessee Medical Association</a> and 20 other insurers and employers argued in an April 15 <a href="http://www.ama-assn.org/resources/doc/legal-issues/x-pub/lindenberg-v-jackson-nat-life-ins.pdf" target="_blank">friend-of-the-court brief</a> (log in).</p> <p> The organizations underscored that the 2011 law should remain in place, citing laws in other states and previous court rulings as evidence that the cap does not violate the right to a jury trial or encroach on the powers of the courts.</p> <p> “Both sound legal and economic public policies support Tennessee’s reasonable limits on punitive damages,” the organizations said in their brief. They also made the case that the cap helps the state compete economically with other states and nations—physicians and others make decisions on where to set up business, in part, on the risk of excessive punitive awards.</p> <p> “If Tennessee’s legal climate is viewed as having excessive, unpredictable and disproportionate liability exposure,” the brief said, “then job-creators, physicians and others will have an incentive to go where they will receive fairer treatment.”</p> <p> The Tennessee law and others like it were enacted to combat a wave of punitive awards that had grown out of all proportion to actual damages, the brief said, and physicians face inflated penalties without the cap.</p> <p> <strong>Additional medical liability cases in which the AMA Litigation Center is involved:</strong></p> <ul> <li> Find out how the AMA is working to uphold a <a href="http://www.ama-assn.org/ama/ama-wire/post/court-case-could-extend-medical-liability" target="_blank">statute of limitations</a> on wrongful deaths.</li> <li> Read about 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><u>.</u></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><u>.</u></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><u>.</u></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><u>.</u></li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:91ae6452-1e5b-47ff-9759-86366882037c Ethics committees: Exploring the past, present and future http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_ethics-committees-exploring-past-present-future Tue, 03 May 2016 20:47:00 GMT <p> For complex ethical issues in medicine, ethics committees and consultations offer a solutions-oriented approach that is essential to modern health care. Learn about the historical development of these groups, their current roles in the medical community and how educators can prepare future physicians for ethical challenges they will face in practice.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/15/5a37a22a-d744-4006-9f8c-a8d58a7e2257.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/10/15/5a37a22a-d744-4006-9f8c-a8d58a7e2257.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> The <a href="http://journalofethics.ama-assn.org/site/current.html" target="_blank">May issue</a> of the <em>AMA Journal of Ethics®</em> explores the roles of ethics committees in the modern health care system. Articles featured in this issue include:</p> <ul> <li> “<a href="http://journalofethics.ama-assn.org/2016/05/ecas3-1605.html" target="_blank">Consequences for patients and their loved ones when physicians refuse to participate in ethics consultation processes</a>.” When a physician is unwilling to participate in the ethics deliberation process, how is the function and role of an ethics committee affected? Learn about the structural roles in ethics committees and the best approach to navigating these complicated situations.<br />  </li> <li> “<a href="http://journalofethics.ama-assn.org/2016/05/medu1-1605.html" target="_blank">Roles of student ethics committees in preparing future physicians</a>.” Medical students can experience ethical dilemmas and concerns about professional behavior during their training. Explore the roles of medical educators in preparing future physicians with the skills and knowledge to identify and respond to these challenges.<br />  </li> <li> “<a href="http://journalofethics.ama-assn.org/2016/05/mhst1-1605.html" target="_blank">Why did hospital ethics committees emerge in the U.S.?</a>” Ethics committees are the primary mechanism for dealing with ethical issues in hospitals today. But how did they come to be present in nearly all U.S. hospitals in just a few decades? Learn about the historical emergence of ethics committees and some of the landmark events that contributed to their integration into health care.<br />  </li> <li> “<a href="http://journalofethics.ama-assn.org/2016/05/stas2-1605.html" target="_blank">International access to clinical ethics consultation via telemedicine</a>.” Clinical ethics consultation is a service provided to enhance patient care by identifying, analyzing and resolving ethics dilemmas in clinical settings, but this service is often not available everywhere. Find out how telemedicine helps international and remote accessibility.</li> </ul> <p> In the journal’s <a href="http://journalofethics.ama-assn.org/podcast/ethics-talk-may-2016.mp3" target="_blank">May podcast</a>, Joseph J. Fins, MD, professor of medicine at Weill Cornell Medical College, discusses the work of ethics committees and consultants as they pursue professionalization and respond to changes in health care organization and practice.</p> <p> <strong>Take the ethics poll</strong></p> <p> <a href="http://journalofethics.ama-assn.org/site/poll.html" target="_blank">Give your answer</a> to this month’s poll: What is the most important role of ethics committees and consultation services in health care organizations in the United States?</p> <p> <strong>Submit an article</strong></p> <p> The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. <a href="https://amajournalofethics.msubmit.net/" 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:8dc510e7-3fd7-4909-8930-190f20cbe8eb Why the concept of invincibility causes harm http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_concept-of-invincibility-causes-harm Tue, 03 May 2016 20:44:00 GMT <p> In the taxing scramble of daily professional and personal demands, it’s easy to lose sight of the importance of a balanced life. But putting your own needs on the shelf can put you at risk of burnout and even suicide.</p> <p> That’s the message of Maria Lesetz in her article, “<a href="http://www.bluetoad.com/publication/?i=287407&pre=1#{%22issue_id%22:287407,%22page%22:14}" target="_blank" rel="nofollow">It’s OK not to be OK,”</a> published in the winter 2016 edition of <a href="http://www.bluetoad.com/publication/?i=287407&pre=1#{"issue_id":287407,"page":0}" target="_blank" rel="nofollow"><em>Physician Family</em></a>.</p> <p> Lesetz, a certified life coach, has spent 10 years exploring how burnout can transform into wellness for physicians and their families. Finding <a href="http://www.ama-assn.org/ama/ama-wire/post/4-physician-recommended-steps-work-home-life-balance" target="_blank">life balance</a> is difficult but crucial, she said.</p> <p> <strong>Shedding the idea of invincibility </strong></p> <p> Lesetz’s research into physician <a href="http://www.ama-assn.org/ama/ama-wire/post/stopping-burnout-top-priority-physicians-training" target="_blank">burnout and suicide</a> has convinced her of the need for open conversations free of stigma. She finds that some of the top contributors to suicide are:</p> <ul> <li> Isolation</li> <li> Lack of support</li> <li> Lack of autonomy</li> <li> Bureaucracy</li> <li> Fatigue</li> <li> Depression</li> </ul> <p> To deal with burnout in all its forms, physicians have to shed the idea that they have to be “invincible,” she said.</p> <p> “Physicians have told me that if they even addressed the topic of burnout, it was seen as a symptom of weakness,” Lesetz said. “Expressing your feelings is one of the most important action steps to take if you want to maintain great health, both physically and emotionally.”</p> <p> She said challenging the culture of invincibility would benefit physicians, their families and the profession as a whole.</p> <p> <strong>Three simple recommendations</strong></p> <p> Lesetz suggests several action items to begin building balance and wellness:</p> <ul> <li> Create a “best year yet” plan to set goals for the road ahead, both personally and professionally. Doing so can support balance and set the tone for your life.</li> </ul> <ul> <li> “Don’t medicate … meditate,” Lesetz said. Bringing mindfulness techniques to your daily routine will combat reliance on such things as prescription drugs and alcohol to deal with stress. A short break is all that is needed to practice meditation and mindfulness, she said.<br /> <br /> “If you build habits of presence into your daily routine, it will profoundly impact how you feel on the inside,” she said.</li> </ul> <ul> <li> For family members, she recommends offering their physician loved one the chance to make a stress-free transition from work to home each day by letting them unwind in their own way. Family members also can help reach out to a life coach if troubling signs, such a burnout or addiction, begin to appear, she said.</li> </ul> <p> “The bottom line is, it’s OK to not be OK,” Lesetz said. “It only takes one courageous action step to turn the course of your life around.”</p> <p> <strong>Ways the medical community is promoting wellness</strong></p> <p> The AMA has made physician wellness and doctors’ ability to thrive a top priority. Part of the AMA’s <a href="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, the AMA’s STEPS Forward™ collection of practice improvement strategies offers proven solutions for physicians by physicians.</p> <p> Three modules are specifically focused on physician wellness: One gives <a href="https://www.stepsforward.org/modules/physician-burnout" target="_blank" rel="nofollow">steps for preventing burnout</a>, another module outlines <a href="https://www.stepsforward.org/modules/improving-physician-resilience" target="_blank" rel="nofollow">solutions for enhancing joy in practice and mitigating stress</a>, and a third module focuses on <a href="https://www.stepsforward.org/modules/physician-wellness" target="_blank" rel="nofollow">ways to promote the well-being of physicians in training</a>.</p> <p> Other modules provide ways to improve elements of your practice environment that can be risk factors for burnout, such as improving work flow through <a href="https://www.stepsforward.org/modules/team-documentation" target="_blank" rel="nofollow">team documentation</a>, <a href="https://www.stepsforward.org/modules/patient-discharge-and-rooming" target="_blank" rel="nofollow">expanded rooming and discharge protocols</a>, <a href="https://www.stepsforward.org/modules/pre-visit-planning" target="_blank" rel="nofollow">pre-visit planning</a>, and <a href="https://www.stepsforward.org/modules/synchronized-prescription-renewal" target="_blank" rel="nofollow">synchronized prescription renewal</a>.</p> <p> 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> will take place Sept. 18-20 in Boston. This collaborative conference of the AMA, the Canadian Medical Association and the British Medical Association will explore the theme “Increasing Joy in Medicine.” The conference showcases research and perspectives into physicians’ health and offers practical, evidence-based skills and strategies to promote a healthier medical culture for physicians.</p> <p> <strong>Want more information on achieving and maintaining a healthy work-life balance?</strong></p> <ul> <li> Find out how <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" target="_blank">peer networks</a> can help cope with burnout.</li> <li> Hear from a <a href="http://www.ama-assn.org/ama/ama-wire/post/hospitalist-rapper-story-of-zdoggmd" target="_blank">physician and rapper</a> about his unique way of confronting burnout.</li> <li> Explore 6 tips for navigating the challenges of a <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-balancing-two-physician-family" target="_blank">two-physician family</a>.</li> <li> See how the <a href="http://www.ama-assn.org/ama/ama-wire/post/mayo-clinic-battling-burnout" target="_blank">Mayo Clinic</a> is creating a model for reducing burnout.</li> <li> Learn how accomplishments and <a href="http://www.ama-assn.org/ama/ama-wire/post/role-of-personal-accomplishment-physician-burnout" target="_blank">professional rewards</a> can reduce burnout and exhaustion</li> </ul> <p>  </p> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:b7730156-4efe-4b34-964a-17c47c40a447 How to talk about substance use disorders with your patients http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_talk-substance-use-disorders-patients Mon, 02 May 2016 21:53:00 GMT <p> Though it can be difficult, it’s essential for physicians to speak with their patients about substance use disorders, proper use of opioid medications and medication-assisted treatment—doing so can be a key component to both pain management and overdose prevention. Find out how one physician in San Francisco approaches the conversation around preventing and treating substance use disorder with his patients while avoiding stigma in the process.</p> <p> With 78 people dying from prescription opioid and heroin overdoses each day in the United States, having the conversation about the risk of substance use disorders and the need for treatment for those who have one is critical for patient safety.</p> <p> “It’s a challenging conversation to have,” said Phillip O. Coffin, MD, director of substance use research at the San Francisco Department of Public Health and an internal medicine and infectious disease specialist. “I struggle with it myself all the time.” But there are ways to approach the topic with your patients and partner with them in preventing misuse and overdose, or in getting treatment for a substance use disorder.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/14/ddfcc0ae-ecba-4ebb-bef4-af1277e01916.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/13/14/ddfcc0ae-ecba-4ebb-bef4-af1277e01916.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> <strong>3 core components to the conversation</strong></p> <p> Dr. Coffin’s expertise includes HIV management, viral hepatitis care, and substance use disorder treatment and research. Some of his patients have substance use disorders that involve prescription opioid medications or heroin, and he is working hard to make sure they are provided the best treatment possible.</p> <p> “There is no easy answer,” he said of his approach to the discussion of substance use disorders. “It’s really about exploring it with the individual patient.”</p> <p> Dr. Coffin offered these three elements that should be part of the conversation about substance use disorders to avoid the stigma that could be a roadblock to patients taking the appropriate steps for their health:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Honesty. </strong>“The most important piece of the story is to always be forthright and honest with your patients about the issues you’re addressing,” Dr. Coffin said. “It’s about patient-centered care, [and] it’s quite rare that patients are coming in looking to reduce their opioid dose.”<br /> <br /> “I often speak about the limited role of opioids in management of many chronic pain indications, really focusing on management of their pain and how it affects their function,” he said. “It’s a talk about the first line, second line and third line options for pain management, which are rarely opioids.”<br /> <br /> “The goal of the conversation may be, for example, to get them toward a point where opioids are something they use intermittently … instead of on a daily basis,” Dr. Coffin said.</p> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Medication-assisted treatment</strong>. For patients with a substance use disorder, Dr. Coffin said he will “almost uniformly offer them buprenorphine and try to encourage them. There may be no interest initially, and it may take months or even years of speaking with patients to get them to consider and actually engage in a transition from full agonists or street opioids to buprenorphine.”<br /> <br /> “I have seen remarkable success with this approach, but it can take a long time of working with a patient,” he said. “For example, you may have, or have inherited, a patient on opioid medications for pain who is very high risk for overdose, who has multiple unprescribed opioids and stimulants in urine studies and has raised concerns about medication diversion,” he said. “If you discontinue opioids but are able to keep the patient engaged, you spend time really worrying about the welfare of the patient because they’ve resumed or increased heroin use, and their life is more chaotic.”<br /> <br /> “Every time you see them, you talk about buprenorphine, and each time they come back they have something positive to say about buprenorphine,” he said. “Sometimes what they come back with is what you told them six months ago, and other times what they’ve heard from talking to other people who have taken buprenorphine. Like with other therapies—such as insulin—over time you can eventually help them make a transition.<br /> <br /> “I can’t emphasize enough how transformative buprenorphine maintenance can be,” Dr. Coffin said. “It can be a remarkably powerful intervention, and it also happens to be quite good for pain management. Not to say you do the prescription and then the problem is no longer an issue at all. Insulin for a person with severe diabetes remains a good analogy; Buprenorphine requires ongoing management, but it solves so much of the core problem.”</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Treat substance use disorder as a disease.</strong> “You can [treat patients with] buprenorphine in the context of other substance use disorder treatment—behavioral or cognitive behavioral psychological therapy,” he said, “but it has also been shown to be highly effective when implemented in a regular medical setting with the counseling that you get from a primary provider.”<br /> <br /> “It is important that you talk with your patient about their substance use on a regular basis when you prescribe them buprenorphine,” Dr. Coffin said. “You don’t just have them come in, renew their prescription, talk to them about their other medical conditions and ignore their substance use. You have to sit down and talk about it.”<br /> <br /> “When I’ve started seeing patients already on opioids for pain who have multiple risks, opioid use disorder or concerning findings on urine toxicology, it’s really hard to do a 15-minute visit and actually address the issue,” he said. “The visits tend to be long and resource heavy, and hard to complete without a strong supportive team approach to care.”<br /> <br /> “When you bring buprenorphine into the picture,” he said, “substance use becomes one of the three or four issues that you talk about in a patient visit and that, frankly, makes it much more like other diseases that a primary care doctor manages.”<br /> <br /> “You want to ask them how they’re doing with their medication,” Dr. Coffin said. “Are they tolerating it, are they having any side effects, are they getting what they need out of the medication? Are they using any heroin? … And if the answer is ‘a little bit,’ then you ask them what you can do together to decrease how often that happens.”<br />  <br /> “Think of it a lot like talking to a patient with diabetes about their sugar intake per day,” he said. “What can we do to try to reduce that and help you keep your disease under control?”</p> <p> Reducing the stigma of substance use disorders and enhancing access to treatment for those who have a disorder is one of the <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_blank">five things physicians can do to prevent opioid abuse</a>, recommended by 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 Opioid Abuse</a>, which physicians convened to help the nation move closer to the goal of ending the opioid epidemic.</p> <p> For more on efforts to end the opioid epidemic:</p> <ul> <li> Learn <a href="http://www.ama-assn.org/ama/pub/advocacy/topics/preventing-opioid-abuse.page" target="_blank">how President Obama’s opioid initiatives align with the Task Force’s recommendations</a>.</li> <li> Read a <a href="http://www.ama-assn.org/ama/ama-wire/post/call-action-physicians-must-turn-tide-of-opioid-epidemic" target="_blank">call to action for physicians to turn the tide of the opioid epidemic</a></li> <li> Find out what <a href="http://www.ama-assn.org/ama/ama-wire/post/physicians-saying-new-cdc-opioid-guidelines" target="_blank">physicians are saying about the new Centers for Disease Control and Prevention opioid guidelines</a>.</li> </ul> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:33122ac3-7eb4-42e2-9b6c-7b42fc68e98e 7 things you need to know to succeed as a medical intern http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_7-things-need-succeed-medical-intern Mon, 02 May 2016 21:50:00 GMT <p> For graduating medical students preparing to begin their residency this summer, a chief resident offers tips for navigating one of the most challenging years of training.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/3/0271e3b9-d3bd-401b-935d-7a10eef93993.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/2/3/0271e3b9-d3bd-401b-935d-7a10eef93993.Large.jpg?1" style="float:right;margin:15px;" /></a></p> <p> In this first post of a<a href="http://www.ama-assn.org/ama/ama-wire/post/10-concepts-will-thrive-intern" target="_self"> two-part series</a>, Dr. Faton Bytyci, chief resident at Sacred Heart Hospital’s family medicine residency program in Allentown, Penn., suggests adopting these principles as you begin work in the clinical setting:</p> <p style="margin-left:40px;"> <strong>1. Get organized and get focused.</strong><br /> Dr. Bytyci says planning out your calendar and organizing your residency-related activities will be a big help in keeping you on track. You can start now by finding a place to live and getting to know the shortest way to the hospital, he said.<br /> <br /> Once you’re on site, make sure you know where all the units of the hospital are located, and get your tools of the trade ready. “Get your white coats, scrubs, stethoscopes, pocket books,” he said.<br /> <br /> Digital and old-fashioned methods of organizing your schedule are important. “Download apps on your smartphone,” Dr. Bytyci said. “Get a calendar and mark your important dates, such as presentations and the ITE exam.”</p> <p style="margin-left:40px;"> <strong>2. Ask for help from your support network.</strong><br /> As you go through this first year of residency, you may need to work with your family members or other members of your support network to help you with your personal responsibilities, Dr. Bytyci said.<br /> <br /> If you’re married, you may need to have a conversation with your spouse about how the two of you will manage household responsibilities. “It could mean that your spouse will take on a greater share or that you will need to hire a house cleaner or nanny,” he said. “It could mean ordering groceries online instead of making the trip to the market.”<br /> <br /> The <a href="http://www.ama-assn.org/ama/pub/about-ama/ama-alliance.page" target="_blank">AMA Alliance</a> offers networking and information to support medical families throughout training, practice and retirement.</p> <p style="margin-left:40px;"> <strong>3. Participate in outside activities that help keep you healthy and balanced.</strong><br /> “This is the most important part of your year,” Dr. Bytyci said. “Relaxing activities like games, exercising, hiking and yoga help combat chronic fatigue and burnout. Catch up with sleep, or take a weekend escape.”<br /> <br /> These kinds of activities are so important that several residency programs—including <a href="http://www.ama-assn.org/ama/ama-wire/post/one-program-achieved-resident-wellness-work-life-balance" target="_blank">Stanford University School of Medicine</a> and the <a href="http://www.ama-assn.org/ama/ama-wire/post/preventing-resident-burnout-mayo-clinic-takes-unique-approach" target="_blank">Mayo Clinic</a>—build them into special resident wellness programs.</p> <p style="margin-left:40px;"> <strong>4. Make time for friends.</strong><br /> “Studies show that people who socialize in general are happier,” Dr. Bytyci said. “This is especially true for residents after long hours and difficult cases. Meeting with old friends and new helps clear your mind from medicine for a while.”<br /> <br /> <a href="http://www.ama-assn.org/ama/ama-wire/post/ward-off-burnout-peer-network-may-impact-think" target="_blank">Learn why having a strong peer network</a> is a key to preventing burnout in residency.</p> <p style="margin-left:40px;"> <strong>5. Set realistic expectations.</strong><br /> If you go into your PGY-1 year with the expectation that it will be a singularly challenging year, you won’t be disappointed. “Be prepared to miss birthday parties, family holidays, weddings—that is just the reality of being a resident,” he said. “If you can accept that and move forward, you’ll do well.”</p> <p style="margin-left:40px;"> <strong>6. Get ready to show enthusiasm and take responsibility.</strong><br /> “This is what will get you through,” Dr. Bytyci said, “and what people really expect of you. In the beginning you may not have great clinical judgment and knowledge. But you can compensate for your shortcomings by preparing to show interest and by working hard.”</p> <p style="margin-left:40px;"> <strong>7. Don’t lose confidence.</strong><br /> “Don’t forget that the program interviewed hundreds of candidates and picked you,” he said. “They like you, and they have faith in you.”</p> <p> <strong>Learn more about navigating residency:</strong></p> <ul> <li> Find out how to make it through residency <a href="http://www.ama-assn.org/ama/ama-wire/post/6-tips-live-budget-during-training" target="_blank">on a budget</a>.</li> <li> Discover the <a href="http://www.ama-assn.org/ama/ama-wire/post/4-building-blocks-successful-medical-marriage" target="_blank">four building blocks</a> for a successful medical marriage.</li> <li> Learn about an initiative that could bring changes to <a href="http://www.ama-assn.org/ama/ama-wire/post/residency-training-environments-primed-transformation" target="_blank">the residency environment</a>.</li> <li> Read about how more flexible hours can influence the <a href="http://www.ama-assn.org/ama/ama-wire/post/flexible-duty-hours-positive-learning-experience" target="_blank">residency experience</a>.</li> </ul> <p align="right"> <em>By contributing writer Michael Winters</em></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:5e2b0501-92e3-4ce3-8e1c-9f23b95ef56d Why raising the tobacco purchasing age matters http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_raising-tobacco-purchasing-age-matters Mon, 02 May 2016 02:00:00 GMT <p> More than 140 localities in 10 states have raised the minimum purchasing age for tobacco from 18 years of age to 21—a movement that has been a long time coming. Find out why this is crucial to the health of the nation and which states and cities have such rules in place.<a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/13/8f474678-5b2c-4fa7-8d8d-60d94659643e.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/15/13/8f474678-5b2c-4fa7-8d8d-60d94659643e.Large.jpg?1" style="margin:15px;float:right;" /></a></p> <p> California became the second state to raise the tobacco purchasing age when Gov. Jerry Brown signed bills to reduce tobacco use by increasing the purchasing age for tobacco products from 18 years of age to 21, adding e-cigarettes to state tobacco regulations and adopting other measures.</p> <p> Hawaii was the first state to raise the minimum age for purchasing tobacco to 21 years old. Cities and counties in California, Illinois, Kansas, Massachusetts, Mississippi, Missouri, New Jersey, New York and Ohio also have enacted legislation bolstering the wave of support for this initiative.</p> <p> Chicago recently took it one step further, not only increasing the tobacco purchasing age to 21 but also eliminating smokeless tobacco use at sporting events, including its professional sports venues, such as Wrigley Field and U.S. Cellular Field.</p> <p> <strong>Keeping cigarettes away from minors</strong></p> <p> Tobacco use remains the No. 1 cause of preventable death in the United States. A <a href="http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf" rel="nofollow" target="_blank">report</a> from the U.S. Surgeon General shows that nearly 90 percent of adults who smoke on a daily basis had their first cigarette by age 18.</p> <p> The National Academy of Medicine, formerly the Institute of Medicine, last year concluded that raising the tobacco age would <a href="http://iom.nationalacademies.org/reports/2015/tobaccominimumagereport.aspx" rel="nofollow" target="_blank">significantly reduce smoking</a> among youth and young adults, decrease the number of smoking-caused deaths, and immediately improve the health of youth, young adults and young mothers who would be dissuaded from smoking as a result.</p> <p> The report also predicts that raising the minimum age will reduce the smoking rate over time by about 12 percent and smoking-related deaths by 10 percent. This reduction translates into 223,000 fewer premature deaths, 50,000 fewer deaths from lung cancer and 4.2 million fewer years of life lost.</p> <p> The AMA has long-standing <a href="http://www.ama-assn.org/ama/pub/news/news/2015/2015-06-09-ama-policy-protect-youth.page" target="_blank">policy</a> regarding increasing the age of tobacco purchase to 21. In January, the AMA submitted a <a href="https://download.ama-assn.org/resources/doc/arc/x-pub/ama-letter-supporting-new-jersey-ab3254-sb-602-raising-tobacco-age-14jan2016.pdf" target="_blank">letter</a> (log in) to N.J. Gov. Chris Christie, urging him to sign legislation that would raise the age for purchasing tobacco and electronic smoking devices as well as the age of a person to whom a vendor may sell, offer for sale, distribute, give or furnish such products in the state. Christie vetoed the legislation.</p> <p> If California’s law is enacted, this may provide momentum to the numerous bills pending across the nation. Over the last two years, bills have been filed in more than 16 states, including: Connecticut, Iowa, Kentucky, Maryland, Minnesota, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington and West Virginia.</p> <p> The AMA also submitted a <a href="https://download.ama-assn.org/resources/doc/arc/x-pub/ama-letter-to-california-governor-supporting-sb2-7-raising-tobacco-age-15april2016.pdf" target="_blank">letter</a> (log in) to Calif. Gov. Jerry Brown, encouraging him to sign the bills, citing that the “legislation will protect California’s youth from the dangers of tobacco use and improve public health.”</p> <p align="right"> <em>By AMA staff writer</em> <a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:83823167-bfc7-46c5-a00a-ef1b441c9612 4 ways to promote better BP in May http://www.ama-assn.org/ama/pub/ama-wire/ama-wire.page_4-ways-promote-better-bp-may Fri, 29 Apr 2016 23:00:00 GMT <p> National High Blood Pressure Education Month starts today. Find out how you can participate, educate your patients and learn the latest techniques in self-measured blood pressure monitoring (SMBP) throughout the month of May.</p> <p> One in three U.S. adults has hypertension. With such a high prevalence rate, it is likely that your practice is treating patients with this condition. The AMA’s <a href="http://www.ama-assn.org/ama/pub/about-ama/strategic-focus/improving-health-outcomes.page" target="_blank">Improving Health Outcomes</a> initiative is taking steps to reduce the rate of uncontrolled hypertension.</p> <p> <a href="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/dc73a059-47f0-4f03-83f2-cf04b71c2614.Full.jpg?1" target="_blank"><img src="http://pluck.ama-assn.org/ver1.0/../static/images/store/12/3/dc73a059-47f0-4f03-83f2-cf04b71c2614.Full.jpg?1" style="width:365px;height:174px;margin:15px;float:right;" /></a></p> <p> Here are four ways you can partner with your patients to help get the upper hand on blood pressure control:</p> <p style="margin-left:40px;"> <strong>1.  </strong><strong>Learn how SMBP can work for your patients</strong><br /> According to the Centers for Disease Control and Prevention (CDC), the last decade saw a 66 percent increase in the number of hypertension-related deaths in the United States. SMBP is a great way to engage patients in managing high blood pressure. Learn more about SMBP, and get started in your practice with these resources:</p> <ul> <li style="margin-left:40px;"> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/should-use-self-measured-blood-pressure-monitoring" target="_blank">why you should use SMBP</a>.</li> <li style="margin-left:40px;"> Learn <a href="http://www.ama-assn.org/ama/ama-wire/post/need-start-self-measured-bp-practice" target="_blank">what you need to start SMBP in your practice.</a></li> <li style="margin-left:40px;"> Examine <a href="http://www.ama-assn.org/ama/ama-wire/post/experts-offer-insights-latest-bp-trials-guidelines" target="_blank">expert insights</a> into the latest blood pressure trials and guidelines.</li> <li style="margin-left:40px;"> Find out <a href="http://www.ama-assn.org/ama/ama-wire/post/one-practice-using-self-measured-bp-resources" target="_blank">how one practice is using SMBP with few resources</a>.</li> <li style="margin-left:40px;"> Check out the Improving Blood Pressure Control <a href="https://www.stepsforward.org/modules/hypertension-blood-pressure-control" rel="nofollow" target="_blank">module</a> in the AMA’s <a href="https://www.stepsforward.org/" rel="nofollow" target="_blank">STEPS Forward</a>™ collection of practice improvement strategies.</li> <li style="margin-left:40px;"> Use the <a href="http://www.ama-assn.org/ama/ama-wire/post/one-graphic-patients-need-accurate-blood-pressure-reading" target="_blank">one graphic you need for accurate blood pressure reading</a>.</li> </ul> <p style="margin-left:40px;"> <strong>2.  </strong><strong>Participate in Measure Up/Pressure Down National Day of Action May 5</strong><br /> Motivate your patients to “roll up their sleeves” and get a blood pressure reading May 5 for a special day of action as part of the Million Hearts® and American Medical Group Foundation’s <a href="http://www.measureuppressuredown.com/" rel="nofollow" target="_blank">Measure Up/Pressure Down initiative</a>.<br /> <br /> On May 5, physicians and others will be participating in at least one action to raise awareness of high blood pressure.</p> <p style="margin-left:40px;"> <strong>3.  </strong><strong>Take the World Hypertension Day and BP monitoring challenge</strong><br /> World Hypertension Day will be observed May 17. Supported by the American Heart Association (AHA) in collaboration with the World Hypertension League, this year’s theme is “know your numbers.”<br /> <br /> Throughout the month of May, encourage your patients to visit the AHA’s <a href="http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/High-Blood-Pressure_UCM_002020_SubHomePage.jsp" rel="nofollow" target="_blank">Target: BP</a> website and select the “I’ve Checked My Blood Pressure” button each time they get a blood pressure reading. All of the clicks will be counted by May 17 in an effort to reach 3 million blood pressure checks in one month. You can follow along with the action around this initiative on Twitter using the hashtags #BPcheck and #knowyournumbers.</p> <p style="margin-left:40px;"> <strong>4.  </strong><strong>Join the SMBP tweet chat for both physicians and patients May 26</strong><br /> Join #AHealthierNation tweet chat on SMBP hosted by the AMA at 3 p.m. Eastern time May 26. Experts from around the country will convene to discuss the benefits of SMBP and to answer questions from attendees.<br /> <br /> On the physician side, the conversation will focus on the benefits of and the steps to implement SMBP in your practice. Patients also are welcome to join and learn why monitoring their blood pressure can help them better manage their hypertension alongside other techniques for lowering blood pressure.<br /> <br /> Ahead of the chat, tweet any questions using #AHealthierNation to be answered throughout the chat on May 26. Watch the <a href="https://www.ama-assn.org/ama/pub/about-ama/strategic-focus/healthier-nation/build-a-healthier-nation.page" target="_blank">#AHealthierNation</a> Web page for more information coming soon.</p> <p> Follow <em>AMA Wire®</em> over the next four weeks for more on SMBP and how it is working for physicians and patients.</p> <p align="right"> <em>By AMA staff writer </em><a href="https://twitter.com/Troy_AMAWire" rel="nofollow" target="_blank"><em>Troy Parks</em></a></p> Blog:e38cf47a-fc5f-473b-9234-c9e714c1c8f0Post:a28ce186-da93-4b80-8f5d-f8e2ed0a1049 Better health, costs: One practice’s value-based care outcomes 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 the emphasis of U.S. health care shifts toward quality of care over quantity of services, physicians providing value-based care have been able to renew their focus on patients at the center of care. Find out how a practice in North Carolina successfully implemented and continued a value-based care model that both saved money and resulted in better health outcomes.<a href="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 heart failure care model team included a cardiologist, a nurse practitioner, an embedded behavioral health provider, pharmacy services, a health navigator and a nutritionist. The nurse practitioner and a health navigator worked closely with the patient’s cardiologist and other members of the health care team to create a treatment plan that was customized to the patient’s individual needs. They closely adjusted medications and taught patients other strategies to control their symptoms. The health navigator made calls between visits and monitored the patient’s progress.</p> <p> One of the challenges faced early was that physicians resisted referring patients to the clinic because they saw referrals as a sign of “giving up” on their patients.</p> <p> “They were so used to the old model, where they were responsible for everything, and everything was centered around them and the office visit with the patient that they initially had a hard time with it,” Dr. Terrell said.</p> <p> “Part of it was that physicians, by and large, want to see their patients with good outcomes,” she said. “As we were able to demonstrate that patients were having better outcomes, there became a cultural acceptance at Cornerstone, and a lot of the concerns went away.”</p> <p> “We’re all on one electronic health record,” Dr. Terrell said. “Having communication with the primary care physician so they can see what’s going on helped them see that they continued to be a part of story under the new model.”</p> <p> <strong>The results of the value-based care model</strong></p> <p> The new care model had a great impact on Cornerstone’s patient population and cost of care. In the three years since implementation, the care model has seen a per-patient cost-of-care savings of $5,500 and an overall cost-of-care savings of $1.7 million for the 321 patients enrolled in the program.</p> <p> Most of these savings are based on comparing the total cost of care for the patients before they entered the program and their total cost of care after enrolling in the program. A reduction in hospital admissions because of improved outpatient management was a critical factor in the overall cost savings.</p> <p> “Within the context of value-based payment,” Dr. Terrell said, “if you’re saving money and improving quality of care, and patients are having better outcomes, then some of the resources can be used to bring in these other things that have not been part of fee-for-service medicine: Clinically integrated networks, nurse navigators, community resources or social work.”</p> <p> “Those have not typically been in the actual fee-for-service bundle that a physician would get,” she said, “but by working together, you can have those resources.”</p> <p> “What is useful about thinking from a value-based care model point of view is that you look at it and ask, ‘What resources do we need to make sure that the patient has the best possible outcome at the best possible price for the best possible quality?’” Dr. Terrell said. “That’s a very different business model [than fee-for-service]. It means you have to collaborate. It means sometimes you spend time doing things that are, on the surface, more expensive, but that’s because it actually provides a better experience for the patient.”</p> <p> Cornerstone now has six specific care models to address their most vulnerable patient populations, and since implementation, they have seen positive outcomes resulting in an overall cost reduction of 12.7 percent and a 30 percent reduction in hospitalizations across all programs. They also have increased satisfaction among patients and health care professionals by 43 percent, and they have a quality score of 94 percent, ranking them sixth in the nation for quality in 2014 in the Medicare Shared Savings Program.</p> <p> “It’s a realignment of the whole system into a new value change,” Dr. Terrell said. “You have primary care practices, hospitals, specialists, home health care, community resources—and they are all really working together.”</p> <p> Dr. Terrell’s module on value-based care is one of eight new modules added this week to the AMA’s <a href="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" rel="nofollow" target="_blank">study</a> in <em>Academic Medicine</em>.</p> <p> Researchers asked more than 4,000 students from 28 medical schools to report the frequency of 17 aspects of the learning environment from the Medical School Learning Environment Survey (MSLES) on a scale from “never” to “very often” at the end of the first year of medical school. Among the items they ranked:</p> <ul> <li style="margin-left:0.25in;"> Students gather for informal activities.</li> <li style="margin-left:0.25in;"> Competition for grades is intense.</li> <li style="margin-left:0.25in;"> Students in school are distant from each other.</li> <li style="margin-left:0.25in;"> Faculty are reserved and distant with students.</li> <li style="margin-left:0.25in;"> Courses emphasize the interdependence of facts, concepts and principles.</li> </ul> <p> The students’ demographic characteristics accounted for very little of the total variance in student perceptions, according to the paper, which came out of the AMA’s <a href="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 20 will help to determine the finalists.</p> <p> In addition, members of the health care community can follow-up directly with the applicants if you have interest to mentor or advise, partner or pilot a solution in your health care setting.</p> <p align="right"> <em>By AMA staff writer </em><a href="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" rel="nofollow" target="_blank"><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" rel="nofollow" target="_blank">FERHAWI</a>) humanities program includes discussions of artwork, guided visual imagery and art projects, such as watercolor painting, screen printing and origami.</p> <p> The initiative has received rave reviews, leading Mayo Clinic to earmark funds for resident wellness programs on all three of their campuses, Dr. Odunukan said. The Mayo Fellows Association also began a quarterly Wellness Fair at the Florida campus, where residents and fellows have a three-hour period to come and go and participate in arts, chair massages, yoga and pilates, among other things. And physicians in training can visit vendors to gather information, such as healthy eating tips.</p> <p> “It is a strong message that we don’t just care for patients but we have to care for ourselves,” Dr. Odunukan said. “It is just very reassuring to see an institution placing value on the wellness and well-being of residents.”</p> <p> <strong>Improving residents’ well-being</strong></p> <p> The program, which won the <a href="https://www.acgme.org/Portals/0/PDFs/AwardRecipientsAnnouncement.pdf#page=4" rel="nofollow" target="_blank">David C. Leach Award</a> of the Accreditation Council for Graduate Medical Education in February, is one that could be replicated in resident programs nationwide. FERHAWI is featured in the AMA’s STEPS Forward™ collection of practice improvement strategies. The collection contains an <a href="https://www.stepsforward.org/modules/physician-wellness" rel="nofollow" target="_blank">online module</a> that explains what is needed to prevent burnout among physician trainees, based on lessons learned by successful residency wellness programs.</p> <p> Studies have shown there are six key factors in fostering residents’ <a href="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 y