CMS Releases Sunshine Act Data: What Physicians Need to Know
Physicians' financial data under the Physician Payments Sunshine Act, also known as the "Open Payments" program, was released to the public last Tuesday. While many physicians won't find their data in the local news, chances are their patients or others they know will ask them about it.
Following are three questions physicians will most likely receive and sample talking points for giving a thoughtful response:
1. Why do physicians get money or items of value from the industry?
Physicians interact with the industry in many ways, including as consultants, speakers, researchers or recipients of "items of value." These interactions generally benefit patients. For instance, physicians often receive items of value, such as medical journal reprints or certain patient education materials.
2. Don't relationships with the industry influence physicians' decisions and recommendations?
The medical profession always is aware of the potential for conflicts of interest. But a relationship with the industry doesn't automatically mean that a physician's judgment has been influenced inappropriately. Industry support for research and development has been essential for developing new interventions and technologies to improve patient care and reduce health care costs.
3. How could individual physicians be justified in accepting large sums of money from the industry?
While there probably are some instances when physicians received money that, in retrospect, they should not have accepted, there are legitimate reasons that a physician could be listed as having accepted a large sum of money. For instance, many physicians receive funds to support clinical trials, an essential component of advancing medical knowledge around specific conditions and treatments.
Physicians can download more detailed talking points (log in) from the AMA website to help inform these conversations.
Data accuracy concerns
The Centers for Medicare & Medicaid Services (CMS) is withholding one-third of the data from the initial public release as a result of concerns about accuracy. Much of the remaining two-thirds of data that was released in the public database has yet to be verified by physicians and other covered recipients.
Physicians who weren't able to review their data by the September 11th deadline to flag any disputed information in the initial public data release should do so now. The deadline to file disputes for any inaccurate information that should be corrected in the next data release is December 31st. View instructions for doing so on the AMA's Sunshine Act Web page.
Want to know what the AMA has been doing about this issue? Read how the AMA has been advocating for an overhaul of how the Sunshine Act has been implemented.
In addition, the AMA issued a media guide ahead of the September 30th data release and is encouraging the media to make sure their reports about this data are presented in an accurate and informative way.
Doctors Advocate for SGR Repeal During Lame Duck Session
Members of Congress received house calls from physician leaders the week of September 15th as members of the AMA Board of Trustees and leaders of four national specialty organizations, the AMA Council on Legislation and attendees of the annual AMPAC Federation meeting conducted more than 100 meetings on Capitol Hill, urging their U.S. senators and representatives to make repealing Medicare's sustainable growth rate (SGR) formula a priority for the lame duck session.
Physicians asked Congress to pass H.R. 4015/S. 2000, the SGR Repeal and Medicare Provider Payment Modernization Act of 2014, which garnered bipartisan, bicameral support earlier this year. At the same time, the New Democrat Coalition held a briefing September 18th for its members and staff regarding the need for SGR repeal, during which the flaws of the formula and the negative impacts of perennial SGR patches were explained.
All physicians should contact their U.S. senators and representatives while Congress is on recess over the next several weeks to encourage them to repeal the SGR formula during the lame duck session. Visit the Fix Medicare Now website to access materials that can help these advocacy efforts. [return to top]
Newly Added November 7, First Friday Seminar: Efficient Use and Application of Health Information Technology
November 7, 2014 at the Maine Medical Association - Please register on-line at www.mainemed.com!
To promote the use of Health Information Technology (i.e. PMP, HIE & SBIRT) to assist health care providers throughout Maine in achieving easier access to comprehensive patient data to assist them in providing integrated, effective & efficient patient treatment.
8:30 AM Registration
9:00 MaineCare and Opioids Dr. Kevin Flanigan
10:10 PMP/HIN Phil Profenno, PMP & Eriko Farnsworth
11:00 Panel session and Q&A
Philip Profenno, PMP, Director of Implementation and Client Services is Director of Implementation and Client Services at HealthInfoNet and responsible for connecting participants to the exchange, including data integration, clinical portal access, user training and education. He has been an IT Professional serving Maine healthcare organizations for over 20 years with extensive experience implementing practice management and electronic medical records systems. Phil holds a Bachelor of Arts in Mathematics from Bowdoin College and is certified as a Project Management Professional with the Project Management Institute.
Kevin Flanigan, MD is the medical director of MaineCare, the state’s Medicaid program for low-income and disabled adults and children. Among Dr. Flanigan’s goals are reducing the use of hospital emergency departments for nonemergency care and enhancing MaineCare’s statewide care management efforts. Dr. Flanigan is a graduate of the University of Richmond and the Medical College of Virginia in Richmond, Va. He completed an internship and residency at the University of Louisville Hospital in Kentucky, with concentrations in pediatrics and internal medicine. He continues to study at the University of Massachusetts at Amherst and serves in a leadership role with the Maine Medical Association. He first was licensed in Maine in 1997 and has worked in primary care, urgent care and hospital settings.
Eriko Farnsworth is managing the Prescription Monitoring Program’s integration and interoperability projects which include interstate PMP data exchange, integrating state’s health information exchange and other health networks with the PMP. She also oversees PMP data integrity and pharmacy compliance. She is currently involved with various in-state and nationwide committees and leadership groups helping to nationalize and standardize the PMP programs throughout the United States. Eriko’s background in law as well as in behavioral health gives her a unique perspective and insight into enhancing, promoting and increasing PMP utilization for efficient use of health information technology to improve patient care.
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Progress Report on Payment Reform
A recent Health Affairs blog by Suzanne Delbanco, Executive Director of Catalyst for Payment Reform (CPR), presents results of CPR’s 2014 National Scorecard on Payment Reform indicating that 40% of commercial sector payments are now based on value-oriented payment methods, up from just 11% in 2013.
The most common form of value-oriented payment is pay for performance. Newer value-oriented payment methods that entail risk sharing such as certain forms of accountable care organizations and bundled payments remain less common and may be key to realizing widespread cost reductions and quality improvements. Specialists also remain relatively at the periphery of changing payment methods with just 10% of their payments being value-oriented compared to 24% for primary care physicians.
This report and more is available on the MMA's Payment Reform Resources webpage.
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Consider the Hanley Center's Advanced Leadership Course
Physicians are urged to enroll in the Hanley Center's Advanced Leadership Course. Physicians who enroll this fall in the Hanley Center's 2015 Physician Executive Leadership Institute (Advanced Course) can lock in the 2014 tuition rate. The Advanced Course has been designed for existing physicians leaders who want to deepen their leadership and management knowledge and skills—and build a trusted network of colleagues across Maine. The course also is a good fit for physicians who are stepping up to roles of greater influence and authority. During the past three years, 87 physician leaders from across Maine, Vermont, and New Hampshire have enrolled in the course. Participating physicians are named "McAfee Fellows" in honor of Dr. Robert McAfee, the only Maine physician to have been elected president of the AMA. The fourth class of McAfee Fellows will convene next April at the Samoset in Rockport for the first of six two-day sessions led by faculty from Brandeis University and Maine-based physician leaders and other subject matter experts. The remaining five sessions will take place in Brunswick. Developed in cooperation with the Maine Medical Association, Maine Osteopathic Association, the Maine Hospital Association, Maine Quality Counts, and other groups, the McAfee Fellows program is a major element of a five year plan to build physician leadership capacity throughout Maine. Nearly 300 physician leaders have enrolled in the Advanced Program and year-long Foundational Programs that have been taken place at 11 sites across the state and New Hampshire over the past 34 months. Two more Foundational programs are scheduled to begin soon at York Hospital and Central Maine Medical Center.
To learn more about the Advanced Course, click here or visit www.hanleyleadership.org, to see program dates, an overview of the curriculum and information about the faculty and tuition. Enrollments received by December 1, 2014 will lock in this year's tuition rate. No obligation informational conference calls/webinars will begin on October 29th. For more information, please contact the Hanley Center's Jim Harnar or Kathy Vezina. [return to top]
Maine GI DAY - October 29, 2014 - Dana Center, MMC
MAINE GI DAY - October 29, 2014
Maine Medical Center, Dana Center, Portland, Maine
Brian E. Lacy, MD, PhD, Section Chief, Gastroenterology and Hepatology Associate Professor of Medicine, Geisel School of Medicine
Anthony J. Lembo, MD, Associate Professor of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical Center
8:00 AM Irritable Bowel Syndrome - Auditorium
Anthony J. Lembo, MD
9:10 AM Achalasia and Esophageal Motility Disorder - Auditorium
Brian E. Lacy, MD, PhD
10:10 AM Break
10:30 AM Maine Gastroenterology Society Membership Meeting - Classroom 2
WHO SHOULD ATTEND?
Gastroenterologists, Gastroenterology Nurses and other interested health care professionals.
RSVP: Gail Begin, Maine Medical Association, firstname.lastname@example.org
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Sentinel Event Newsletter Discusses Pressure Ulcers, Safety Culture and Updates
The Division of Licensing and Regulatory Services’ second issue of the Sentinel Event Newsletter discusses pressure ulcers, culture of safety and provides updates from the sentinel event team.
Pressure ulcers were the most commonly reported sentinel event last year, according to the newsletter, which included tips on prevention and resources.
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Hydrocodone Reclassification Takes Effect Today
A new rule from the Drug Enforcement Administration (DEA) taking effect today reclassifies hydrocodone combination products as Schedule II controlled substances, establishing restrictions that will require considerable changes to prescribing practices.
The AMA offers several steps physicians need to take to ensure their patients who need these medications to alleviate pain don't have to go without them. Read more at AMA Wire®. [return to top]
Maine Rheumatology Association Meeting - November 13, 2014
MAINE RHEUMATOLOGY ASSOCIATION FALL MEETING
Thursday, November 13, 2014
HARRASEEKET INN, FREEPORT, MAINE
5:00 Social Hour
First Course: Maine Crab Cakes
Starter Selections: Lobster Stew or Chopped Salad
Entrée Selections: Seared Tenderloin of Beef or Roasted Wild Salmon
Desert: Creme Brûlée
Featuring Guest Lecturer:
Alvin Wells, MD, PhD, FACR
Director, Rheumatology and Immunotherapy Center; Adjunct Assistant Professor, Duke University Medical Center; Clinical Assistant Professor, Marquee University Franklin, Wisconsin
Management of Rheumatoid Arthritis, Anklyosing Spondylitis, and Psoriatic Arthritis: Early Detection to Ensure Appropriate Car
Who Should Attend?
Rheumatologists and Rheumatology Nurses and Staff
RSVP: Gail Begin, Maine Medical Association, email@example.com
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PTE Steering Committees Discusses Public Reporting Details
The Maine Health Management’s (MHMC) Pathways to Excellence (PTE) Steering Committees (physician and hospital/systems) met on September 25th at the Maine Medical Association.
PTE is the name of each of MHMC’s public reporting initiatives on physicians and hospitals at www.getbettermaine.org. The PTE Steering Systems Committee discussed how to report patient experience survey results for physician practices and how to “roll up” certain practice quality measures into an overall “effective” quality rating.
The PTE Steering Committees also endorsed a timeframe for publication of the Total Cost of Care Index (TCI) and Resource Use Index (RUI) for physician practices. There will be two TCI/RUI reports: one at the practice group level (e.g. Intermed), beginning in January 2015 and one at the practice site level (e.g. Intermed Family Medicine, Yarmouth, ME), beginning in April 2015. The heading for reporting these data will be “provides care at a reasonable cost” with scoring in alignment with the rest of the site as low, good, better or best.
The only change reviewed for the hospital reporting portion of the Web site was to move the SCIP measure from the “safety” category to the “effective” category, and then roll up the remaining “safety” measures (Leapfrog, Medication Spotlight survey and falls with injury) to an overall “safety score” with each element having equal weight.
The MHMC reported that they will work with Consumer Reports (CR) to have the physician practice site heart and diabetes data used for an early 2016 CR issue. CR would take the Maine data and present it in the CR format of red, clear, black circles and direct readers to the getbetterme Web site. The project will be funded by the Robert Wood Johnson Foundation to promote public reporting, and CR will pay the MHMC $20,000 per submission.
All PTE Steering Committee recommendations will be brought to the MHMC Foundation Board for a final decision.
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MHMC’s Healthcare Cost Workgroup Discusses Voluntary Growth Caps
The Maine Healthcare Management Coalition’s (MHMC) Healthcare Cost Workgroup discussed to which index voluntary growth caps should be pegged.
A majority of those at the meeting on September 24th supported a voluntary cap that would initially limit year-to-year growth to a Consumer Price Index (CPI) based on medical costs, rather than general inflation. Over a five-year period the cap would transition to one that is 25 percent above the general CPI. The group began an initial discussion on how to implement the voluntary cap, and those discussions will continue at the October 30th meeting.
Voluntary growth caps for risk-based contracts are a strategy participants had identified as a way to reduce health care costs. Under this strategy, risk-based contract participants would voluntarily agree to keep the increase in year-to-year costs below an agreed upon capped amount. The work group considered a range of possible voluntary caps, including caps based on CPI and gross domestic product.
Also at the September 24th meeting, the group heard a presentation on critical access hospitals (CAH) from Mayo Regional Hospital CEO Marie Vienneau and Maine Rural Health and Primary Care Program consultant Peggy Pinkham. They described the requirements for being a CAH, the services they offer, the financial challenges they face, and the high-quality care they provide.
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Family Physician - Potential income of $430,000.00 plus
We are recruiting for a full-time primary care physician with emergency/urgent care experience for a client in Nova Scotia, Canada.
The position is at a small community hospital near the town of Antigonish, Nova Scotia. Antigonish is a vibrant, welcoming community and home to one of Canada’s top undergraduate schools, St. Francis Xavier University.
The physician will be expected to maintain a primary care clinic at a community hospital and participate in after hours call for the level 1 ER at the facility. The emergency room sees approximately 30-40 patients per day.
This is an ideal position for a new physician with a sense of adventure, or an experienced physician looking for more work-life balance.
Income is from an Alternative Payment Plan (APP) and fee-for-service. Income of $236,000.00 for APP for daytime work, and $140/hour for out of hours emergency room coverage (expected 1400 hours of emergency room coverage, per physician, per year; 1 in 4 call.)
You will have access to a wide range of outdoor/indoor activities, including hiking, golf, boating, skating and, of course, hockey. (It’s Canada, after all.)
CanAm Physician Recruiting Inc.
Industrial Physician - Salaried Job Opportunity
- Provides routine and emergency medical services to BIW employees
- Performs physical examinations to support regulatory driven medical surveillance programs such as asbestos, lead, cadmium, respirator and hearing conservation
- Performs pre-placement and return-to-work examinations
- Performs patient examinations to support the company's Probable Cause policy
- Provides medical support for sea trials
- Determines work capacity and assigns work restrictions for new or chronic injuries and illnesses
- Interfaces with Workers' Compensation to assist case management
- Participates in quality assurance audits
- Provides consultation to management on ADA and job accommodations
- Participates in updating clinic protocols and standards of practice
- Allopathic/osteopathic physician with Maine license
- Board certified or board eligible in occupational medicine
- ACLS certified
Experience (type and number of years): Four years’ experience in ambulatory care preferred
Unique/Additional Requirements: DOT/CDL examiner certification desirable
Thank you for your interest in Bath Iron Works. For a link to this listing and other career opportunities, please visit our web site at: https://www.gdbiw.com/careers.
Family Nurse Practitioner
Sacopee Valley Health Center is recruiting a Family Nurse Practitioner to provide walk-in care on Fridays, Saturdays and Sundays. This 30 hour per week position involves no after-hours call with an excellent benefit package including health, disability and life insurance, 401k retirement plan, and a generous paid time off plan. Applicants must be a graduate of a Family Nurse Practitioner Program with current Maine licensure. Please submit resume to firstname.lastname@example.org or mail to: Human Resources Coordinator, Sacopee Valley Health Center, 70 Main Street, Porter, Maine 04068. Sacopee Valley Health Center is an Equal Opportunity Provider and Employer.
Family Practice Physicians
Katahdin Valley Health Center is recruiting dedicated Family Practice Physicians that are committed to providing quality health care services to the people in Central/Northern Maine. Join our practice in one of the newly expanded facilities. We are seeking physicians for our Millinocket, Ashland and Houlton locations. KVHC is a fully electronic medical record site and offers a competitive salary ($170,000 to $190,000 annual) and benefit package which includes: a 10% of first year salary sign on bonus, generous amounts of paid time off, $2500 annually toward CME as well as a completely outpatient site. The call schedule is 1 in 8 with additional coverage from the Open Access Clinic. Physicians who join KVHC are eligible to apply for NHSC Loan Repayment.
To learn more about KVHC and Practitioner Opportunities, please contact Michelle LeFay at email@example.com or visit our website at www.kvhc.org. KVHC is an equal opportunity employer.
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The Maine Public Health Association’s (MPHA)
30th Annual Fall Conference
October 7, 2014
Augusta Civic Center
Keynote speakers include: Erik N. Steele, D.O., FAAFP, Senior Vice President, Chief Medical Officer, Summa Health System and Paul Kuehnert, DNP, RN Team Director for the Bridging Health and Health Care Portfolio, Robert Wood Johnson Foundation
For more information or to register, click here.
Maine Health Management Coalition 2014 Annual Symposium:
"Finding Value: How to Lower Cost & Improve Health"
Wednesday, October 15th, 8 am to 2:45 pm
at the Abromson Center on the University of Southern Maine campus
MMA members are entitled to a special registration fee of $75 (instead of $100).
The Symposium is shaping up to be a truly enlivening event for all those engaged in the challenging work of improving health care delivery and controlling costs. Highlights of the day will include:
- Keynote speaker Ron Sims, Board Chair of Washington Healthplanfinder, Washington State’s insurance exchange. A community health innovator, Sims is well-known for the award-winning employee wellness program he instituted to reduce rising healthcare costs. Within the program’s first year, 75% of employees at moderate or high risk for developing a chronic disease eliminated at least one risk factor.
- Other outstanding speakers include Neel Shah, MD, MPP, Founder and Executive Director of CostofCare.org, a national nonprofit that helps caregivers engage in controlling medical costs, and Richard Wexler, MD, Chief Integration Officer of Healthwise, which merged with the Informed Medical Decisions Foundation in April 2014 and now uses expertise in shared medical decision making to help people make better health decisions.
A full agenda with links to all of the Symposium details is available at http://www.mehmc.org/news-events/2014-symposium/agenda/. To register, go to https://webapp.usm.maine.edu/DCPEOnline/addRegCONFPage1.do?offeringId=100075926.
Maine Concussion Management Initiative Training
October 21, 2014 in Portland in conjunction with the Maine Brain Injury Conference
7:30 a.m. - 12:00 p.m.
Includes An Introduction to Concussions and Concussion Management & Interpreting Neurocognitive Testing (including using ImPACT)
$100 for Health Care Professionals (CEUs/CME available); $40 for school personnel and all other attendees
For more information or to register, contact Jan Salis, firstname.lastname@example.org, (207) 577-2018
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