AMA - Oct. 9, 2009 - AMA eVoice®

Oct. 9, 2009 - AMA eVoice®

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From the President, J. James Rohack, MD

Two viruses, two vaccinations: You can never be too prepared

You may find yourself waiting in line for a vaccine twice this influenza season—and for good reason. While 5 to 20 percent of the population contract seasonal flu, resulting in about 200,000 hospitalizations and 36,000 deaths annually, the novel 2009 H1N1 influenza virus introduces new challenges and unpredictable circumstances to physicians, patients and public health.

I briefly touched on this topic in one of my August columns, and again in a September blog posting, but the H1N1 influenza virus is one subject that I can't possibly talk about enough. A recent story in American Medical News reports health officials saying that with two flu viruses, including the 2009 H1N1 influenza virus that has sparked a pandemic, this flu season is one of the most complicated in memory. And just as alarming, Centers for Disease Control and Prevention (CDC) Director Thomas Frieden, MD, said in the same story that there was as much flu in early September as there would normally be at the height of flu season.

That's why the AMA recommends that everyone—patients and physicians alike—receive their seasonal influenza vaccine and the 2009 H1N1 vaccine as soon as possible. We need both. While there is some data to suggest that people over age 65 may have some cross-reactive antibody protection against the 2009 H1N1 virus, the vast majority of the public has never been exposed to this virus and has no previous experience battling it. So while the uncertainty of what may or may not happen can be disturbing, being readily prepared for as many circumstances as possible and making sure our patients are too is all that we, as physicians, can do.

First, preparation includes vaccinating our patients. A pre-registration process has been established that allows physicians and health care providers who are authorized to administer vaccinations to pre-register for receipt of the 2009 H1N1 vaccine. And with physicians and health care providers expected to administer nearly 200 million doses of the H1N1 vaccine in the United States, the AMA expedited the publication of a new Current Procedural Terminology (CPT®) code specific to vaccine administration that will streamline the reporting and reimbursement procedure for physicians and revised existing code 90663 to include the H1N1 vaccine.

Secondly, physicians must receive their own vaccinations. Only about 46 percent of health care professionals are immunized for influenza each year, so we must work to help dispel myths about influenza immunization in our colleagues—myths such as the live attenuated vaccine cannot be given to health care workers and that the vaccine can give the flu. If we don't get vaccinated, then how can we promote the vaccine to our patients and expect them to listen? And if we contract the virus, how can we adequately take care of our patients without spreading it to them first?

The answer is we can't—which is why a vaccine exists. The U.S. Food and Drug Administration announced Sept. 15 that it has approved four vaccines against the H1N1 influenza virus. And health officials expect 45 to 100 million doses of the vaccine to be available by the middle of this month. While it's important that everyone receive the 2009 H1N1 vaccination in order to be protected, the CDC's Advisory Committee on Immunization Practices (ACIP) has established that certain groups be regarded as high priority for the vaccine. In particular, we need to focus on pregnant women. While pregnant women account for 1 percent of the U.S. population, they account for 7 percent of H1N1 hospitalizations and 8 percent of H1N1 deaths.

Another part of preparation is being aware of the antiviral guidelines that have recently been released by the CDC for treating influenza this season. It is important to remember that if antiviral treatment is indicated, it should be started empirically without waiting for laboratory confirmation of influenza.

The next part of preparation is patient education. My colleague AMA Immediate Past President Nancy H. Nielsen, MD, PhD, wrote in a Sept. 10 column on physician blog KevinMD.com that "this flu season will be challenging, but by educating our patients on the importance of getting vaccinated against seasonal influenza, and preparing our practices for the influx of patients and new H1N1 vaccine, we can successfully brave this storm."

I wholeheartedly agree and believe the AMA is doing its part to make sure we do. Last month, the AMA launched a new Web site, www.amaH1N1info.org, devoted solely to the 2009 H1N1 influenza virus, which includes clinical guidance, vaccination information, resources, patient information and the latest H1N1 news. The site also includes a short video, titled "2009 Influenza Vaccine Update," featuring L.J. Tan, the AMA's director of infectious diseases. He explains what makes this influenza season different than others and who should receive the vaccine.

Also last month, the AMA, the CDC and the Department of Health and Human Services (HHS) hosted a webinar that outlined the most accurate, current clinical guidelines for management of the 2009 H1N1 influenza virus. The webinar included information on basic epidemiology of the 2009 H1N1 virus, vaccine ordering and delivery, and recommendations for physicians from the CDC and the National Vaccine Program Office. If you weren't able to participate, you can watch it now or view slides from the presentation.

And the AMA, in conjunction with the HHS Office of the Public Health Emergency Medical Countermeasures Enterprise and the National Disaster Life Support Foundation Inc., will host the Third National Congress on Health System Readiness Dec. 1–3 in Washington, D.C. In addition to reviewing research related to recent public health emergencies worldwide and establishing elements of a comprehensive disaster response health system, "Disaster medicine and public health preparedness in the 21st century" will include a special session examining the 2009 H1N1 influenza pandemic. If you register before Oct. 31, you'll receive a discounted rate.

With so many mixed messages out there, physicians need to direct patients to the right sources. The AMA's H1N1 influenza Web site has a number of resources, including a guide on what patients should know about the 2009 H1N1 influenza virus, the most recent information about the diagnosis, treatment and infection control of the 2009 H1N1 influenza virus, frequently asked questions from the CDC covering the safety and availability of the 2009 H1N1 vaccine, and helpful information for patients targeted as a high-priority group for the H1N1 vaccine. You may also sign up to receive H1N1 updates by subscribing to receive AMA e-mails as news breaks.

While it's uncertain as to what the fall and winter months will bring, this much is clear: The AMA is committed to advancing the health of the public and the preparedness of the medical community and will continue to give physicians and patients timely and credible information and resources about seasonal flu and the 2009 H1N1 influenza.

This is only the beginning of the storm. Stay tuned and check the Web site often as new developments arise; we can brave it together.

E-mail comments, questions and replies to Dr. Rohack

General AMA news

1) Grassroots action needed to secure changes to Senate committee's health reform bill
The U.S. Senate Finance Committee health system reform proposal includes several provisions that concern physicians, and the AMA continues to advocate for improvements. The AMA is asking state and medical specialty societies to contact their senators on the following three issues:

Repealing the sustainable growth rate, or SGR, formula
Inequitable treatment of physician services under the proposed Independent Medicare Advisory Commission
Arbitrary Medicare payment reductions for physicians who are "outliers" in resource use

The AMA has developed talking points on each of these issues. View these talking points, which are listed under "Resources for physicians."

Visit the AMA Web site to send an e-mail to your senator or to join the AMA's Physicians' Grassroots Network. Also, call the AMA grassroots hotline at (800) 833-6354 to be connected directly to your senator's office.

Read about more health system reform news in the latest edition of the AMA's Health System Reform Bulletin.

2) Senate committee approves nomination of Regina Benjamin, MD, as surgeon general
The AMA applauded the Senate Health Committee's Oct. 7 approval of AMA member Regina Benjamin, MD, a family physician in Bayou La Batre, Ala., as the nation's next surgeon general. Her nomination now moves to the full Senate.

A former member of the AMA Board of Trustees (BOT), Dr. Benjamin was the first African-American woman to serve on the AMA-BOT and its first young physician member. She most recently served as chair of the AMA's Council on Ethical and Judicial Affairs. The AMA congratulated Dr. Benjamin and urged the full Senate to confirm her quickly so she can begin her work as an advocate for America's patients.

"As our country works for health reform that provides all Americans with affordable, high-quality health coverage, Dr. Benjamin brings the important perspective of a physician who has dedicated her life to caring for vulnerable patients to the surgeon general post," AMA President J. James Rohack, MD, said.

Gay, lesbian, bisexual, transgender physician issues

1) In the Miami Herald: Visitation rights case by dying patient’s lesbian partner dismissed
A federal court has thrown out the case of a lesbian who was not allowed to visit her dying partner at Florida’s Jackson Memorial Hospital, saying no law required the hospital to admit any visitors at all, the Miami Herald reports.

2) In the Boston Globe: Pentagon journal criticizes “don’t ask don’t tell” policy
An article in the Pentagon’s top scholarly journal argues that the military’s “don't ask, don't tell” policy essentially forces thousands of gay men and women to lead dishonest lives in an organization that emphasizes integrity as a fundamental tenet, the Boston Globe reports.

Medical school news

Brought to you by the AMA Section on Medical Schools

1) AMA-SMS November meeting registration deadline is next week
The next AMA-SMS meeting will be held from 2 to 5 p.m. Nov. 6 at the Marriott Copley Place in Boston. The deadline to register for the meeting is Oct. 12.

The meeting is being held in conjunction with the Association of American Medical Colleges (AAMC) Annual Meeting, which is taking place at the same time as the Interim Meeting of the AMA House of Delegates in Houston. Discounted rates for hotel reservations are available only when registering for the AAMC meeting.

If you will not be registering through the AAMC, those attending only the section meeting may visit the Marriott Web site to secure hotel accommodations.

Send an e-mail to jackie.drake@ama-assn.org or call the AMA-SMS at (312) 464-4655 if you have questions.

2) LCME to host public hearing on proposed revisions to standards
The Liaison Committee on Medical Education (LCME) will hold a hearing for public comment on a proposal to revise accreditation standards ED-11 and ED-15 on Nov. 10 during the Association of American Medical Colleges Annual Meeting. Written comments may be forwarded until Dec. 31 to LCME secretary Barbara Barzansky.

For more information, visit the LCME Web site or contact Barzansky at lcme@aamc.org or (312) 464-4690.

3) In JAMA: online posting of unprofessional content by medical students
A recent study published in the Sept. 23/30 issue of the Journal of the American Medical Association (JAMA) found that more medical students might be posting unprofessional content online than previously thought.

4) AMA Foundation spotlights senior physician volunteers improving access to care
The AMA Foundation is accepting nominations for the Jack B. McConnell, MD, Award for Excellence in Volunteerism, which recognizes a senior physician who provides treatment to U.S. patients who lack access to health care. The award is part of the AMA Foundation’s Excellence in Medicine Awards, which are presented in association with Pfizer, Inc.

The award will be presented at the Excellence in Medicine Awards banquet and special leadership program March 1, 2010, in Washington, D.C., during the AMA’s National Advocacy Conference. Nominations are due by Nov. 16.

View nomination materials.

Medical student issues

1) AMA-MSS meeting educational session to cover healthy lifestyle changes in poor communities
Join a discussion about the AMA’s community service theme, the AMA’s Healthier Life Steps™ Program, that will take place during the AMA-MSS Interim Assembly Meeting. The AMA-MSS Minority Issues Committee and the Committee on Global and Public Health will host the discussion, which will emphasize ways to support this theme in underserved populations.

The keynote speaker will be Lisa Armitige, MD, an assistant professor in the University of Texas Medical School at Houston’s internal medicine and pediatrics department who specializes in indigent care to patients with tuberculosis and HIV. Dr. Armitige will address challenges for patients with lower socioeconomic status in adhering to healthy lifestyle recommendations, potential creative solutions and current research efforts to address these challenges, and ideas on how the AMA, along with members of the AMA-MSS, can help promote changes in health care policy and other advocacy efforts on the local level.

The AMA-MSS Interim Assembly Meeting will take place Nov. 5–7 in Houston. If haven’t registered for the meeting, you still can do so there.

2) Reserve your hotel room for the AMA-MSS meeting
The AMA-MSS Interim Assembly Meeting will be held Nov. 5–7 in Houston, and the AMA has booked a block of rooms at the Hyatt Regency Houston for meeting attendees at a special rate of $190 per night. This discounted rate will be available until today, Oct. 9, or until the block of rooms is sold out.

Make a reservation.

If you’re looking for a roommate to share the cost of a hotel room at the meeting or have extra space in your hotel room, use the AMA-MSS Housing Exchange Forum to communicate with other meeting attendees.

Although online registration is closed for the meeting, you still can register on site for free.

3) Celebrate diversity, unity this week
AMA-MSS Unity Week—an opportunity for medical students to celebrate the diversity in their student populations, communities and the nation—is being celebrated through tomorrow, Oct. 10. All AMA-MSS chapters are encouraged to participate in this initiative by coordinating an event during the week.

Any activity that celebrates diversity can be included in this effort, which is organized by the AMA-MSS Minority Issues Committee. Unity Week events might include community health fairs, brown-bag lunch presentations, ethnic lunches, food festivals and events coordinated with other school-diversity organizations. Don’t forget that you can also hold events throughout the year.

Visit the AMA-MSS Web site for more event ideas and to learn how to plan a successful event in your community.

4) Chapter of the Week: Washington University, St. Louis
Next month, medical students at Washington University in St. Louis will host “Healthier Life Steps Week”, a weeklong series of events promoting each of the four key health behaviors of the AMA Healthier Life Steps™ Program.

Activities will include a lecture about the obesity epidemic and how physicians can help, “mocktails” to promote responsible alcohol consumption, rotations through fitness stations, an outing to promote smoke-free environments and a hike to promote physical activity. Medical students are being asked to pledge to incorporate some aspect of healthy living into their lives, and those who keep their pledge will receive a seed packet of herbs to encourage healthy cooking and eating.

The AMA Healthier Life Steps™ Program is the focus of the AMA-MSS national service project. Learn more about the national service project and access resources, including project ideas, to help you and your chapter get involved.

Chapter Involvement Grants (CIGs) are available to help AMA-MSS chapters put student projects and recruitment events into action. Chapters are eligible for up to $1,000 per academic year. Apply for a CIG at least 30 days before your event.

5) AMA’s Ending Disparities e-Letter makes debut
The AMA recently launched the Ending Disparities e-Letter, a newsletter that contains periodic news, information and updates related to eliminating racial and ethnic disparities in health care, as well as details of the AMA’s activities related to ending health disparities.

Send an e-mail to commission.on.disparities@enews.ama-assn.org to sign up to receive this newsletter.

Learn more about the AMA’s effort to eliminate health disparities.

6) JAMA: just one benefit of AMA membership
Are you up to date on the issues and trends affecting medicine, health care and public health? The AMA brings that to its members’ front door.

AMA members can look in their mailbox for the Journal of the American Medical Association (JAMA), the most comprehensive resource for original research, reviews, commentaries, editorials, essays, medical news and correspondence. An international peer-reviewed general medical journal published 48 times annually, JAMA is the most widely circulated medical journal in the world. Since 1883, physicians and health care professionals around the world have turned to JAMA for groundbreaking research and insightful commentary from leaders across the broad spectrum of health care.

Check out the Sept. 23/30 issue, which is JAMA's annual medical education issue.

View the JAMA Web site.

If you’re an AMA member, don’t lose valuable benefits such as JAMA. Renew your membership. If you’re not a member, join the AMA today and begin receiving them.

Minority health issues and professional concerns of minority physicians

Brought to you by the AMA Minority Affairs Consortium

1) Chicago-based seminar to cover ways to reduce health disparities
The Chicagoland Clinical and Translational Science Awards for Community Engagement is sponsoring a seminar Oct. 28 in Chicago that will explore unique and effective ways to reduce health disparities in Chicago’s communities. The seminar will feature presentations by community, academic, government and industry groups that are actively engaged in creating more equitable and effective health care for communities.

The Chicagoland Clinical and Translational Science Awards for Community Engagement is a partnership of Northwestern University, the University of Illinois at Chicago and the University of Chicago.

2) Quality improvement resource aimed at reducing disparities in care
A guide developed by the National Committee for Quality Assurance, in collaboration with Lilly USA, LLC, serves as a resource for those interested in undertaking quality improvement initiatives to improve culturally and linguistically appropriate services and to reduce disparities in care.

3) AMA-MAC Caucus set for Nov. 6
The AMA-MAC Caucus will take place from 5:30 to 7:30 p.m. Nov. 6 at the George R. Brown Convention Center in Houston preceding the Interim Meeting of the AMA House of Delegates (HOD). Stop by to network with colleagues, discuss a range of minority-related issues that the AMA-HOD will consider, and hear a presentation by Irby Jones, MD, the first female president of the National Medical Association.

Organized medical staff issues

1) Upcoming AMA webinar to cover patient safety improvement
Learn about patient safety evaluation systems, patient safety organizations and event reporting, and discover ways to optimize your participation in patient safety improvement by viewing a free AMA webinar from 8 to 9:30 p.m. EDT Oct. 27.

Presented by leading experts in the field, the webinar will help you

Understand the scope of patient safety evaluation systems and patient safety organizations
Participate effectively in hospital or group practice construction of patient safety evaluation systems and patient safety organizations
Understand safety event reporting
Recognize how the Patient Safety and Quality Improvement Act of 2005 could influence peer review and ongoing professional practice evaluation.

Speakers to be featured during the webinar include Susan M. Nedza, MD, the AMA’s vice president of clinical quality and patient safety strategy and medical director of clinical practice solutions; Janice Anderson, an attorney with Polsinelli Shughart PC; and William A. Conway, MD, senior vice president and chief quality officer with Henry Ford Health System and chief medical officer at Henry Ford Hospital.

2) Joint Commission’s pre-publication standards available online
Pre-publication versions of the 2010 standards for all Joint Commission accreditation programs can be viewed on the Joint Commission Web site. Please take the time to view this information with members of your organized medical staff and discuss it with your hospital leadership. These standards will be accessible online at least through Dec. 1.

3) AMA-OMSS meeting set for this fall
The next AMA-OMSS Assembly meeting will take place Nov. 5–7 at the George R. Brown Convention Center in Houston, preceding the Interim Meeting of the AMA House of Delegates. The assembly meeting will include unique education programs that provide insight and perspective on topics such as employment contracting, accountable care organizations, medical staff organization and leadership.

The final day to register online for the meeting is Oct. 26.

If you are not an AMA-OMSS representative and would like to become one, download a certification form and fax it to (312) 464-5845, e-mail it to omss@ama-assn.org or mail it to 515 N. State St., Chicago, IL 60654.

4) Feedback requested on working draft of Joint Commission medical staff standard
The AMA is soliciting feedback from its members concerning their level of support for proposed language of Joint Commission hospital accreditation standard MS.01.01.01. Feedback is due by Oct. 15.

A Joint Commission task force convened to implement medical staff standard MS.01.01.01, previously known as MS.1.20, reached consensus and unanimous agreement in March on a completely new “draft” standard that would replace the current standard. Consensus means that each member of the task force agreed to actively support adoption of the recommended new standard. The AMA supports the proposed language for standard MS.01.01.01.

AMA-OMSS representatives can review and provide comment on the working draft standard MS.01.01.01.

Resident and fellow issues

1) Find residency vacancies through the AMA-RFS
Are you looking for a residency or fellowship position? If so, the AMA-RFS can help. The AMA-RFS lists current job postings for vacant positions that are not traditionally filled through the National Resident Matching Program. This includes positions that are vacant after the Match process is completed and those that are recruiting residents who have completed a year or more of training. Listings include contact information and start dates for each position as well as a deadline by which to apply.

2) AMA’s Ending Disparities e-Letter makes debut
The AMA recently launched the Ending Disparities e-Letter, a newsletter that contains periodic news, information and updates related to eliminating racial and ethnic disparities in health care, as well as details of the AMA’s activities related to ending health disparities.

Send an e-mail to commission.on.disparities@enews.ama-assn.org to sign up to receive this newsletter.

Learn more about the AMA’s effort to eliminate health disparities.

3) Apply for a seat on the National Residency Match Program Board of Directors
The AMA is seeking candidates for two positions on the National Resident Matching Program (NRMP) Board of Directors.

Resident physician directors may serve a maximum of one two-year term. The NRMP Board of Directors has governance and oversight authority for the main residency Match and the Specialties Matching Service. It also ensures that all Match participants abide by the policies that govern those matches and informs the medical education community about trends in graduate medical education by conducting and sponsoring research using its Match outcome data.

All new members attend an orientation session in June. In addition, the board meets three times each year, usually in February, May and October. Board members also serve on one or more committees, which may entail additional travel if work cannot be accomplished by e-mail or telephone conference call.

Visit the NRMP Web site for more information about the Match program and NRMP policies.

Applications are due by Nov. 13. Access an application.

4) AMA-RFS meeting approaching
The AMA-RFS will hold its 33rd annual Interim Meeting Nov. 5–7 at the George Brown Convention Center in Houston. Visit the AMA-RFS Web site to register for the meeting.

Take a more active leadership role at the meeting by becoming a convention committee member. Convention committee activities range from helping formulate AMA-RFS policy to planning social and networking events.

View a letter from AMA-RFS Governing Council Chair Baligh Yehia, MD, and learn about important activities and deadlines associated with the meeting.

Senior Physicians issues

1) Early retirees choose locum tenens work
For physicians who are not ready to retire but who want to scale down their work hours, locum tenens work provides an excellent alternative to full-time practice. Physicians can enjoy more reasonable hours while combining work and travel time in a new location. The AMA-SPG Web pages provide volunteer opportunities as well as a link to the National Association of Locum Tenens Organizations.

2) AMA-SPG Caucus planned for Interim Meeting
The AMA-SPG is sponsoring a caucus for senior physicians from 10 to 11:15 a.m. Nov. 7 at the George R. Brown Convention Center in Houston preceding the Interim Meeting of the AMA House of Delegates.

The caucus will lead off with an educational program featuring a guest speaker from the Volunteers in Medicine Institute. The program will discuss the network of free clinics that exist today, which has grown to serve 4.5 million patients annually, and will focus on the role senior physicians can play in helping the uninsured. All are welcome; please plan to attend to network with new colleagues and old friends.

Young physician issues

1) AMA-YPS meeting set for this fall
Sign up to help represent the voice and vision of young physicians across the country at the AMA-YPS Interim Assembly Meeting, scheduled for Nov. 5–7 in Houston, preceding the Interim Meeting of the AMA House of Delegates (HOD). With health care on the minds of so many patients and physicians, now is a great time to participate in the AMA-YPS.

Registration is due by Oct. 25.

Join the AMA’s sections and special groups for a candid discussion about the status of health system reform from 11:30 a.m. to 1:30 p.m. Nov. 7.

Learn more about AMA-YPS committees and how to get involved.

Help the AMA-YPS host a productive meeting by volunteering to serve on the section’s reference committee or AMA House of Delegates handbook review committee. Learn more about AMA-YPS committees and how to get involved.

2) Be a volunteer judge for student, resident research poster symposium
Young physicians attending the AMA-YPS Interim Assembly Meeting are invited to serve as judges for the AMA Resident and Fellow Section and Medical Student Section (MSS) Research Poster Symposium.

Judging will take place from 5:30 to 6:45 p.m. Nov. 6 at the Hilton Americas Hotel, which is located next to the George R. Brown Convention Center, where the assembly meeting will be held. A reception will follow, and volunteer judges will receive a small token of appreciation.

Send an e-mail to Katherine Torres-Hertz of the AMA-MSS at katherine.torres-hertz@ama-assn.org if you’d like to volunteer.

3) AMA Foundation seeks everyday heroes in medicine
Recognizing the extraordinary efforts of leaders in the medical community, the AMA Foundation honors those who go beyond the call of duty to improve the health of our nation with the Excellence in Medicine Awards. Presented in association with Pfizer Inc., the awards recognize a select group of physicians and medical students who represent the highest standards of volunteerism, public service and leadership.

Nominations are due Nov. 16. Learn more about how you can nominate a colleague.

4) View archive of AMA’s H1N1 influenza webinar
An AMA webinar that provides the most accurate, current clinical guidelines for management of the 2009 H1N1 influenza virus, including information on vaccine ordering and delivery, is available for viewing on the AMA’s new H1N1 influenza Web site.

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