Ronald M. Davis, MD
Rankings and report cards
Readers love rankings and report cards. Every week seems to bring us another list of the best or worst of whatever.
Michael Moore's new movie Sicko highlighted the World Health Organization's ranking of the best health care systems in the world. In my review of the movie in an earlier column, I cited a few compelling critiques of the WHO's ranking scheme.
On June 13, the Commonwealth Fund issued a ranking of health system performance in the 50 states, based on 32 indicators related to access, quality, avoidable hospital use and costs, equity, and healthy lives. Hawaii and Iowa ranked No. 1 and 2, respectively, whereas Mississippi and Oklahoma tied for last.
The United Health Foundation published a 2006 ranking of the health status of the 50 states, from the healthiest to the least healthy. It showed Minnesota and Vermont as the two healthiest states and Mississippi and Louisiana as the two unhealthiest.
States get grades for specific areas within health care, health policy, and public health. The National Alliance on Mental Illness has issued an analysis of states' mental health care systems; no states received an "A," five earned a "B," and eight got an "F." In January, the American Lung Association released its fifth annual report card on states' tobacco control policies; 15 states received an "A" but 23 got an "F." The AMA's medical liability crisis map shows 17 states in crisis, 25 states shaded yellow for caution, and eight states with a stable liability climate.
>>Read more
Please send comments, questions, and replies to amaprez@ama-assn.org.
eVoice®
July 26, 2007
AMA eVoice is your regular update on the most important health care issues and recent AMA activities.
The AMA is committed to communication. We encourage you to help us spread the word by forwarding AMA eVoice to your colleagues.
Your news interests
Sign up to receive customized AMA eVoice messages.
Faculty practice physician issues
1) In AMNews: Federal bill introduced to help physician shortage
2) More medical specialties needed in Iowa, task force finds
Gay, lesbian, bisexual, transgender physician issues
1) Psychologists to review stance on gays and lesbians
2) Save the date for AMA–GLBT event at the 2007 Interim Meeting
Group practice physician issues
1) AMA launches new journal on public health preparedness and disaster response
2) In AMNews: Minnesota law requires electronic claims filing by 2009
International medical graduate issues
1) AMA–IMG summary of actions available
Medical school news
1) Save the date: AMA–SMS November meeting
2) Study shows personality traits among incoming medical students
3) New Step 2 clinical knowledge examination features to be introduced
Medical student issues
1) Special travel and hotel rates offered for 2007 AMA–MSS Interim Meeting attendees
2) Mark your calendar: 2007 AMA–MSS Interim Meeting deadlines
3) Contact new AMA–MSS leadership
Minority health issues and professional concerns of minority physicians
1) Visit AMA booth at NMA convention
Organized medical staff issues
1) AMA representatives sought for Joint Commission PTACs
2) It's Hawaii—plan now to attend the 2007 AMA–OMSS Interim Assembly meeting
3) Pennsylvania to offer financial incentives to increase infection control in medical facilities
4) AHRQ offers atlas to locate hospitals, nursing homes in disaster management
5) In AMNews: First impressions and physician-patient communication
Resident and fellow issues
1) Reserve your hotel and flight to Hawaii for the 2007 AMA Interim Meeting
2) Latest "code blue" article highlights the uninsured
3) Mock oral exam may reveal program deficiencies
4) A mnemonic teaches safe patient handoff
Women physician and women's health issues
1) Nominate influential person for Physician Mentor Recognition Program
Young physician issues
1) Speak with your AMA–YPS leaders
2) Make reservations for 2007 AMA–YPS Interim Meeting, Nov. 9–10
3) A call for nominations for mentor recognition program
General AMA news:
1) Call your U.S representative in support of the CHAMP Act
2) AMA testifies against Nevada insurance mega–merger
3) Online fellowship covers physician ethics and professionalism
4) Anti–smoking measure in Illinois signed into law
5) Have you moved recently?
6) In JAMA: Implantable cardioverter-defibrillators help prevent sudden cardiac death
Your news interests
Sign up to receive customized AMA eVoice messages.
Faculty practice physician issues
1) In AMNews: Federal bill introduced to help physician shortage
According to a July 9 article in American Medical News (AMNews), the Physician Workforce and Graduate Medical Education and Enhancement Act of 2007 was introduced to encourage younger doctors to consider practicing underserved areas on specialties of medicine. The bill would help establish scholarships, loan forgiveness plans, as well as tax incentives for doctors entering targeted specialties. Scholarships could total up to $30,000, and would be exempt from taxes. The federal government would also forgive up to $35,000 in debt for each year of service. The grants can be used for geriatric fellowship programs to train doctors practicing in targeted specialties.
2) More medical specialties needed in Iowa, task force finds
Iowa's number of physicians increased from 1980 to 2005, but the state still suffers shortages in several medical specialties, according to a new report on Iowa's physician work force. Currently, the task force shows 77 full– and part–time job openings for psychiatrists alone in Iowa, which mimics the shortage felt across the United States. The reason for the shortage is cited as low reimbursement from insurance companies as well as the federal government. Per an article in the Des Moines Register, the task force has made several recommendations to improve Iowa's physician work force. Included among these were increasing the class size of medical students trained at the University of Iowa, adding resident slots and lobbying the Iowa legislature to provide funding for some of its recommendations.
>>Return to your news interest contents
Gay, lesbian, bisexual, transgender physician issues
1) Psychologists to review stance on gays and lesbians
According to a recent USA Today article, the American Psychological Association is embarking on the first review of its 10–year–old policy on counseling gays and lesbians, a step that gay–rights activists hope will end with a denunciation of any attempt by therapists to change sexual orientation.
2) Save the date for AMA–GLBT event at 2007 Interim Meeting
The AMA Advisory Committee on GLBT Issues will host a reception at the 2007 AMA Interim Meeting in Honolulu. The event will be held Nov. 8 from 5:30 to 7 p.m. at a location to be determined. Take this time to relax with friends and colleagues while learning more about some of the top GLBT health concerns. The committee looks forward to seeing you there.
Send an e–mail for additional information.
>>Return to your news interest contents
Group practice physician issues
1) AMA launches new journal on public health preparedness and disaster response
In late June, the AMA launched the first comprehensive, peer–reviewed journal to emphasize public health preparedness and disaster response for all health care professionals. Disaster Medicine and Public Health Preparedness is a quarterly publication that will include best practices, guest commentaries from global leaders in disaster medicine, as well as advocacy, policy and education. The editor-in-chief, James J. James, MD, DrPH, MHA, notes that it is an academic field for all health and response personnel, saying "the evolution of this concept clearly brings us to the intersection of medicine, ... it also appreciates the necessary contributions of others from the commercial, academic, charitable and government sectors as well as community support organizations to ensure effective responses."
Register for a free trial subscription.
2) In AMNews: Minnesota law requires electronic claims filing by 2009
Under a new Minnesota law, all public and private group purchasers, along with physicians, will electronically exchange eligibility information, claims, payment and remittance advice in a standardized format, according to an article in the July 23/30 issue of American Medical News (AMNews). Physicians will not be charged for using the preset form. The law also requires that the companion guide used by health plans to explain payment guidelines be electronic and standardized. The move is intended to save the state millions of dollars in health care costs. While the federal Health Insurance Portability and Accountability Act provides uniformity with its standards, there are also optional fields on its forms, creating companion guides that vary from payer to payer. Minnesota's law will bring about one common form for use in that state.
>>Return to your news interest contents
International medical graduate issues
1) AMA–IMG summary of actions available
The AMA–IMG Section played an active role in the AMA's Annual Meeting in June, where more than 300 of its recommended policy items were considered by the AMA House of Delegates.
View the AMA-IMG Section summary of actions.
>>Return to your news interest content
Medical school news
(Brought to you by the AMA Section on Medical Schools)
1) Save the date: AMA-SMS November meeting
The next AMA–SMS meeting will be held Nov. 9–11 at the Hawaii Convention Center, Honolulu. This meeting will provide medical education colleagues an opportunity to network, help develop AMA policy and discuss issues affecting medical education.
Visit the Web site in mid–August or send an e–mail for meeting details.
2) Study shows personality traits among incoming medical students
Results of a nine–year multi–site study (PDF, 287KB, requires Adobe® Reader®) reveals distinct personality differences between male and female medical students. As increasing numbers of women are entering medical school, these findings may have implications for curriculum, teaching and assessment.
3) New Step 2 clinical knowledge examination features to be introduced
Beginning early August, the United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) Examination will have a small number of multiple-choice items with corresponding audio and/or video clips. These media items will be introduced in USMLE Step 1 and Step 3 examinations during 2008. A USMLE Step 2 CK tutorial is provided in the orientation materials.
>>Learn more
>>Return to your news interest contents
Medical student issues
1) Special travel and hotel rates offered for 2007 AMA–MSS Interim Meeting attendees
The 2007 AMA–MSS Interim Meeting will be held Nov. 8–10 in Honolulu. The AMA has reserved a block of rooms at a discounted rate for AMA-MSS Interim Meeting attendees at the Doubletree Alana Hotel Waikiki. A special room rate will be available until Oct. 7 or until the group block is sold out.
Visit the Web site to learn more and reserve your room. Rooms are sure to go fast.
The AMA also has teamed up with United Airlines to offer 2007 AMA–MSS Interim Meeting attendees a 10 percent discount (and an extra 5 percent discount if you make your reservation at least 30 days in advance).
Visit the Web site to learn more and make your reservation.
2) Mark your calendar: 2007 AMA–MSS Interim Meeting deadlines
The 2007 AMA–MSS Interim Meeting will be held Nov. 8–10 at the Hawaii Convention Center in Honolulu. Please join us for an exciting meeting, including policymaking sessions, educational sessions, a research poster session and more. The AMA–MSS is planning programs for this meeting and would like your ideas.
Obtain an online form and submit your ideas.
Please keep the following deadlines in mind:
- Sept. 7—Convention committee applications due.
- Sept. 21—Resolution submissions due.
- Sept. 21—AMA–MSS Research Poster Symposium abstracts due.
- Oct. 1—Meeting registration due.
- Oct. 1—Board of trustees/chair–elect applications due.
- Oct. 1—Regional delegate applications due.
Visit the Web site to learn more about the meeting and obtain applications.
3) Contact new AMA–MSS leadership
The first meeting of the 2007–08 AMA–MSS Governing Council will be held Aug. 3–5. During the meeting, the council will set its goals for the year—the AMA–MSS invites you to provide your input on these goals.
Obtain contact information for the newly elected governing council officers.
Share your ideas with the AMA-MSS via the governing council action form.
>>Return to your news interest contents
Minority health issues and professional concerns of minority physicians
(brought to you by the AMA Minority Affairs Consortium)
1) Visit AMA booth at NMA convention
The AMA will have an exhibitor booth (booth number 1117) at the National Medical Association (NMA) convention Aug. 5–7. Stop by and visit the booth to find out the latest news and information on AMA–MAC activities.
>>Return to your news interest contents
Organized medical staff issues
1) AMA representatives sought for Joint Commission PTACs
The AMA has representatives and alternate representatives on the Joint Commission's Ambulatory Care, Behavioral Health Care, Home Care, Hospital, and Long–Term Care Professional and Technical Advisory Committees (PTACs), and is now seeking nominations for the Ambulatory Health Care and the Home Care PTACs. To ensure consideration of your candidate(s), nominations must be received by Aug. 14. All nomination documents must be submitted electronically (not via fax) including all nomination forms, curricula vitae, letters of endorsement or other pertinent materials.
The nomination form must be signed. If an electronic signature is not possible, submit the form electronically and mail in a signed copy.
Send an e–mail with all information.
View (PDF, 28KB, requires Adobe® Reader®) Dr. Maves' memo regarding nominations.
Download (Word, 133KB) a nomination form for the Ambulatory Health Care PTAC.
Download (Word, 132KB)a nomination form for the Home Care PTAC.
View (PDF, 26KB) facts about the Joint Commission.
2) It's Hawaii–plan now to attend 2007 AMA–OMSS Interim Assembly meeting
It's not too early to make plans to attend the 50th AMA–OMSS Assembly meeting in Honolulu, Nov. 8–11. Mark your calendar and reserve a room at the Hilton Hawaiian Village, Honolulu.
Reserve a room.
Learn more about the development and submission of resolutions. The deadline for resolution submissions is Sept. 28.
Send an e–mail with all resolution submissions.
3) Pennsylvania to offer financial incentives to increase infection control in medical facilities
Modern Healthcare reported that under a new Pennsylvania law, hospitals, nursing homes and ambulatory surgery centers will be offered financial incentives beginning in 2009 for increasing infection prevention and surveillance in an effort to curb infection rates. The law, signed by Pennsylvania Gov. Edward Rendell, requires providers to draft prevention and control plans for infections acquired in hospitals, nursing homes or surgery centers, and file plans with state health officials. For hospitals that already report infections to the state, they must now send data to the Centers for Disease Control and Prevention. Every hospital also will need to evaluate the cost and logistics of implementing an electronic infection–surveillance system and adopt such a system no later than Dec. 31, 2008. The law also has provisions for hospitals unable to comply with the 2008 deadline.
4) AHRQ offers atlas to locate hospitals, nursing homes in disaster management
The Agency for Healthcare Research and Quality (AHRQ) sponsored the development of an atlas to support local/regional planning and response efforts in the event of a bioterrorism or other public health emergency. The Emergency Preparedness Atlas includes maps of hospital and nursing home locations in each state and case studies for six states that show bed capacity and the emergency management and bioterrorism preparedness regions for each facility.
View a separate report discussing the role nursing homes could play in regional preparedness, based on nursing home focus groups.
5) In AMNews: First impressions and physician-patient communication
According to an article in the July 23/30 issue of American Medical News (AMNews), a recent study published in the Archives of Internal Medicine looked at the expectations of patients in their initial visit with their physician. A national phone survey of 415 patients from 2004 to 2005 revealed that 78 percent of patients preferred their physician shake hands, while 18 percent did not.
>>Return to your news interest contents
Resident and fellow issues
1) Reserve your hotel and flight to Hawaii for the 2007 AMA Interim Meeting
Make your travel plans for the 2007 AMA-RFS Interim Meeting in Hawaii. The meeting will be held Nov. 8–10 at the Hawaii Convention Center, Honolulu. A block of rooms have been reserved at a special rate at the Hilton Hawaiian Village, Honolulu, which is about a 15 minute walk from the convention center; shuttles will also be available for your convenience. United Airlines is offering a 10 percent discount on flights to Hawaii.
Book your hotel room online and learn more about flight discounts. The special room rates will be available until Oct. 17 or the room block is sold out.
2) Latest "code blue" article highlights the uninsured
The June edition of Resident and Staff Physician features a "code blue" article on the uninsured by AMA–RFS Governing Council Immediate Past Chair Sunny Ramchandani, MD. Dr. Ramchandani said, "the problem of health care for the uninsured dramatically affects our training programs (and hence our medical training) every day." He further states that residents and fellows can make a difference by making health care for the uninsured a priority of medical education, lobbying our leaders for reforms and integrating underserved health care into training programs.
View the article.
3) Mock oral exam may reveal program deficiencies
According to an article in the July 2007 Archives of Surgery, mock oral exams are seen as valuable not only to the surgery resident as a preparation tool for certifying exams but also to the residency program as a way to "critically evaluate its didactic curricula and the resident exposure to clinical disciplines." The article goes on to suggest that deficiencies may be due to the current work-hour restrictions which "have resulted in residents being pulled to subsidize manpower needs in the operating room," therefore, causing them to miss additional educational opportunities that would increase their competency.
4) A mnemonic teaches safe patient handoff
"With the advent of mandatory work–hour restrictions for residents and the development of hospitalist programs, patients are often cared for by several physicians during a 24–hour period," according to an article in the June edition of Resident and Staff Physician. Each handoff increases the risk for errors and may cause communication breakdowns. The HANDOFF mnemonics was found to minimize potential errors from multiple handoffs by providing a standard set of critical information and providing unambiguous instructions.
H—Hospital location: wing, room, number
A—Allergies/adverse reactions/medications
N—Name (age, gender)/number (medical record)
D—Do not attempt resuscitation/diet/deep-vein thrombosis prophylaxis
O—Ongoing medical/surgical problems
F—Facts about this hospitalization
F—Follow–up on…
S—Scenarios
View the article.
>>Return to your news interest contents
Women physician and women's health issues
(brought to you by the AMA Women Physicians Congress)
1) Nominate influential person for Physician Mentor Recognition Program
In the AMA–WPC's first annual Physician Mentor Recognition Program, it would like to recognize those who have made a difference in our professional lives. Tell the AMA–WPC about a professional colleague or teacher who had an influence on your work or career. The AMA–WPC will issue your nominee a special certificate, celebrate them during September's Women in Medicine Month and highlight their contributions through various AMA vehicles, such as AMA eVoice and the AMA Web site. In addition, the AMA–WPC will recognize your mentor through a special display at the AMA–WPC gala reception at the 2007 Interim Meeting of the AMA House of Delegates Nov. 9 at the Hilton Hawaiian Village, Honolulu.
Obtain a nomination form. Entries are due Sept. 1.
>>Return to your news interest contents
Young physician issues
1) Speak with your AMA–YPS leaders
The AMA–YPS Governing Council seeks to facilitate greater interaction and communication between the governing council and other AMA young physician members. To that end, there will be a conference call from noon to 1 p.m. (CDT) during its Aug. 4 meeting in Chicago. Young physicians are encouraged to call in and discuss their concerns, AMA priorities and AMA–YPS projects at that time.
Send an e–mail to R.S.V.P.
Members can visit the Web site to learn more.
2) Make reservations for 2007 AMA–YPS Interim Meeting, Nov. 9–10
This year's 2007 AMA–YPS Interim Meeting is scheduled Nov. 9–10 at the Hawaii Convention Center, Honolulu, and guests will stay at the Hilton Hawaiian Village, Honolulu. The meeting will offer AMA–YPS the opportunity to network with colleagues from across the country, attend educational sessions and determine AMA–YPS positions on AMA House of Delegates reports and resolutions. The AMA–YPS encourages all young physician members to participate in the meeting.
>>Learn more
3) A call for nominations for mentor recognition program
The first annual AMA Women Physicians Congress (WPC) Physician Mentor Recognition Program seeks to recognize those professional colleagues or teachers who have made a difference in women physicians' professional lives. The AMA–WPC will issue nominees a special certificate, celebrate them during September's Women in Medicine Month, and highlight their contributions through various AMA communication vehicles. In addition, the AMA will recognize mentors through a special display at the AMA–WPC gala reception at the 2007 Interim Meeting of the AMA House of Delegates Nov. 9 at the Hilton Hawaiian Village, Honolulu.
Obtain a nomination form. Entries are due Sept. 1.
>>Return to your news interest contents
General AMA news
1) Call your U.S representative in support of the CHAMP Act
Two committees in the U.S. House are considering recently introduced legislation that would advance medicine's agenda in two important ways—by renewing the successful State Children's Health Insurance Program (SCHIP) and replacing two years of cuts in Medicare payments to physicians with two years of positive updates. The AMA has mounted an aggressive campaign in support of this bill, as the measure could be considered by the full House next week.
The Children's Health and Medicare Protection (CHAMP) Act, H.R. 3162, would reauthorize SCHIP and provide increased funding for health coverage for children in low–income families. It would also replace the scheduled Medicare physician payment cuts of 15 percent over the next two years with two years of modest positive updates. To pay for the increased spending, the CHAMP Act would increase federal taxes on tobacco and eliminate overpayments to the private insurance companies that administer Medicare Advantage plans.
The bill includes many other provisions, some of which are not ideal. The AMA and its medical society partners will continue to work with members of Congress to improve the final legislative language.
The AMA and AARP recently launched a joint national TV ad in support of the CHAMP Act that will run in Washington, D.C., and across the country. The TV ad is just one piece of an advocacy campaign on this issue by the AMA that includes Internet ads, e–mails, letters, phone calls and direct mail outreach to generate support for this bill.
The voice of the medical community must be loud and clear in support of access to care for children and seniors. Contact your U.S. representative today by calling (800) 833-6354. Urge him or her to vote in favor of the CHAMP Act.
View the AMA/AARP television ad.
>>Return to your general news contents
2) AMA testifies against Nevada insurance mega–merger
In July 26 testimony to the Nevada Commission of Insurance, the AMA strongly opposed United HealthGroup's buyout of Sierra Health Services—a proposed merger that would result in one company having a stranglehold on the state's health insurance market. The proposed merger would allow UnitedHealth to control an estimated 95 percent of the health maintenance organization (HMO) market in Las Vegas.
AMA Immediate Past President William G. Plested III, MD, testified that unchecked consolidation and concentration in the Nevada health insurance market endangers the competitive process and threatens health care quality. Without competition, UnitedHealth would be free to dictate unreasonable terms that would hurt Nevada's quality of patient care.
"High-quality medical care is only possible if Nevada acts to protect a fully dynamic and competitive health care market," said Dr. Plested. "If this merger is not blocked, health care in Nevada will be controlled by a Minnesota-based company with a clear track record of placing profits over patient care, a lessened sensitivity to the local health care needs, and a selective sense of accountability to state and local regulators."
Dr. Plested shared the experiences of California's patients, physicians and employers after Anthem bought out WellPoint and its subsidiary, Blue Cross of California. In the first year, Blue Cross of California increased premiums faster than any other health insurer and reduced its spending on medical care to less than 79 percent of the premium dollar.
"Patients and employers are not the ones benefiting from the consolidation trend in the health insurance industry," said Dr. Plested. "Premiums have risen dramatically without any expansion of benefits, while many health insurers have posted record profits."
>>Return to your general news contents
3) Online fellowship covers physician ethics and professionalism
Now is the time to register for the Online Fellowship in Medical Ethics and Physician Professionalism—a program developed by the AMA's Institute for Ethics, in collaboration with the Medical College of Wisconsin's (MCW) Graduate Program in Bioethics.
As part of the one–of–a–kind fellowship, doctors study the history, role and practical applications of medical ethics and professionalism for personal interest or in preparation for leadership positions on ethics committees, privacy boards or institutional review boards.
The online program is current, comprehensive and convenient with courses taught by expert faculty from the AMA, MCW and special guest lecturers. All coursework and group discussions can be accessed from a personal computer using the Internet. While the coursework is intensive, the fellowship can be completed in one or two years and credits are applicable toward a graduate degree in bioethics from MCW or another accredited university.
Successful completion of the fellowship requires four online courses on topics such as the history of medical professionalism, current dilemmas in clinical ethics, conflicts of interest, research ethics and the relationship between ethics, philosophy and law. Also included will be a four-day seminar series in Chicago during the AMA's Annual Meeting in June. The seminar series provides an opportunity for physicians to meet leaders in bioethics and experience how the AMA establishes ethics policy and the Code of Medical Ethics, which sets the standard for physician professionalism.
Visit the Web site to register for the online fellowship this fall, or call (312) 464-5260 to learn more. The registration deadline is Aug. 15.
>>Return to your general news contents
4) Anti–smoking measure in Illinois signed into law
The AMA applauded Illinois for its comprehensive anti-smoking bill, which was signed into law this week. The new law will prohibit smoking in all public buildings and in most businesses and government vehicles starting Jan. 1, 2008. The law makes smoking illegal in bars and restaurants, as well as places ranging from student dormitories to private homes in which businesses open to the public are operated.
"The new law is a victory for all Illinois residents, workers and visitors, who will soon benefit from clean, smoke-free indoor environments that will protect them from the deadly dangers of secondhand smoke," said AMA President Ronald M. Davis, MD, calling it the strongest clean indoor air law in the country. Illinois is the 19th state to go smoke-free.
>>Return to your general news contents
5) Have you moved recently?
Continue to enjoy the benefits of AMA membership by letting us know about changes to your mailing address and phone number, and any updates about your specialty, board certification or office addresses.
Complete the AMA's secure data change form or call (800) 262-3211.
>>Return to your general news contents
6) In JAMA: Implantable cardioverter-defibrillators help prevent sudden cardiac death
High–risk patients with hypertrophic cardiomyopathy appear to have reduced risk of sudden cardiac death with an implantable cardioverter–defibrillator that terminates dangerous heart rhythm disorders, according to a study in the July 25 issue of the Journal of the American Medical Association (JAMA).
Preview an editorial on this topic.
>>Return to your general news contents
Feedback
If you have specific comments on this edition of AMA eVoice, simply reply to this message. For more general feedback on AMA eVoice, send an e–mail to evoice@ama-assn.org and alert the editor of your comments and concerns. Do you have general questions about the AMA? Call the AMA Unified Service Center at (800) 262-3211.
Read the AMA Privacy Statement
Thank you for your AMA membership! The AMA's strength comes from its numbers. That strength grows when our membership increases — please urge your fellow physicians and medical students to join our cause by calling (800) 262-3211 or visiting the AMA Web site.
Content provided by: Member Publications