AMA eVoice Weekly Newsletter

Slowing a tsunami

In the discussion on health system reform that's occurring in the halls of Congress and the White House, the recognition of the challenges of increased spending for health care services has brought many to the table to discuss solutions. A key component to any successful and sustainable reform that will slow the rise in health care costs is our patients.

The reality is that a small number of patients account for a disproportionate share of health care costs. It is estimated that 1 percent of the population accounts for 22 percent of total health care spending, while 10 percent of the population accounts for more than 60 percent of total health care costs. Thus, the targeting of prevention of chronic diseases ideally would be on the 10 percent. Prevention costs for the whole population is good public health policy, but if resources are limited for prevention, then targeted outreach is where we as physicians must be engaged.

As many have noted, once a physician has made a diagnosis, then appropriate treatment follows.  In the prevention area, how can the AMA be of help to you and your patients?

It is recognized that more than half of the $1.1 trillion spent in health care each year is due to medical conditions that are preventable. Heart disease, diabetes mellitus, tobacco-related diseases as well as motor-vehicle trauma related to alcohol are the four most costly examples. To provide resources for physicians as well as patients to make lasting changes in behaviors to live a longer, healthier life, the AMA developed its Healthier Life Steps™ program. 

These resources address the four behaviors of nutrition, physical activity, tobacco use and risky use of alcohol, which, if patients make good choices, can help decrease the tsunami of health care costs coming within the next decade. You can obtain AMA PRA Category 1 Credit™ as you review these materials and put them to use. And your patients can obtain tools, such as personalized charts and reminders about proper nutrition, physical activity, stopping tobacco use and avoiding a risky use of alcohol. Working as partners with our patients to help them get healthy and stay healthy is a key component in making sure that health system reform is both achievable and sustainable.

We can redesign our medical delivery system to provide more efficient, effective, equitable, safe and timely medical care for our patients. But if the disease burden of preventable conditions is not successfully addressed, we will be overwhelmed with the tidal wave of health care costs that may drown our ability to provide patient-centered care.

How does one start to slow the tide? A simple conversation with each patient regarding their risks of preventable disease is the first step. Then use the tools the AMA has designed to help you help your patients. We need a breaker built to stem the tsunami of health care costs. You and your patients have the opportunity to use the tools to build that breaker. I hope you both use them well.

1) AMA stands with president during signing of historic tobacco regulation bill
In a victory for public health over Big Tobacco, President Barack Obama recently signed into law a bill that authorizes the Food and Drug Administration to regulate the manufacture, sale and distribution and marketing of tobacco products, with the primary goal of reducing youth and teen smoking. The signing drew applause from the AMA, a long-time advocate for strong regulation of the tobacco industry.

"This new law represents an important break from the past, as it signifies broad acceptance that nicotine is a drug that is harmful to people's health," said AMA President J. James Rohack, MD, who attended the June 22 bill signing at the White House.

Read more from Dr. Rohack.

View a fact sheet from the White House about the bill signing.

View a transcript of Obama's remarks during the bill-signing ceremony.

2) AMA president appears on ABC's "Primetime"
AMA President J. James Rohack was one of several audience members to ask questions to President Barack Obama on June 24 during a special edition of ABC's "Primetime" with Charles Gibson and Diane Sawyer. During the program, which was broadcast from the East Room of the White House, Obama fielded questions about health system reform from U.S. citizens selected by ABC News.

View Dr. Rohack's question to the president.

View Obama's answer.

3) Beware of scammers posing as Medicare carriers or contractors
The Centers for Medicare & Medicaid Services (CMS) has become aware of a scam in which perpetrators are sending faxes to physician offices posing as a Medicare carrier or Medicare Administrative Contractor. The fax instructs the office to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo or the contractor logo to enhance the appearance of authenticity.

Medicare fee-for-service providers, including physicians and nonphysician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should send information only to a Medicare contractor using the address found in the download section on the Medicare Learning Center Web page or the Medicare Provider-Supplier Enrollment page.

4) Don't write off that denied claim
Health insurers commonly deny claims with add-on codes. But thanks to the multi-district litigation (MDL) settlement agreements, physicians can hold health insurers accountable for payment of those services. Health insurers have already paid out more than $12.5 million to physicians who appealed claims that were previously denied utilizing the MDL settlement compliance dispute process.

Fight for accurate claims payments by reviewing your claims payments for accuracy and appealing any inappropriately underpaid or denied claims. Visit the AMA Web site to view provisions of the health insurer settlement agreements and learn how you can hold health insurers accountable for fair and accurate payment.

Access the AMA's Practice Management Center Web site, which contains a variety of materials on submitting accurate claims, reviewing and reconciling inappropriate payments, and other aspects of managing a physician practice. New resources are added frequently, so check back often for updates.

5) AMA members: Get special online-only rate for premier AMA medical journal
For the special discounted rate of just $50, AMA members can subscribe to the AMA Disaster Medicine and Public Health Preparedness journal online.

Disaster Medicine and Public Health Preparedness—the first comprehensive and authoritative journal of its kind—presents original research and high-quality critical analysis on epidemiologic and statistical studies; offers review articles on major topics in disaster preparedness; and introduces special topics, such as public ethics, legal issues, policy reviews and staffing and education requirements, to health care and public health professionals.

Learn more about the journal and view its table of contents or sign up for eAlerts.

To receive your discounted $50 online subscription today, visit the Lippincott Williams & Wilkins Web site and enter code W9Q564ZZ, or call (800) 638-3030 and mention code D9Q564ZZ.

6) CME online newsletter features prescribing for insomnia
State and national prescribing information for insomnia as well as evidence-based treatment guidelines are discussed in the latest edition of AMA Therapeutic Insights, a free online quarterly newsletter featuring a different disease in each issue. Aiming to enhance physician knowledge and practice—and, ultimately, improve the quality of patient care—each issue of the newsletter provides continuing medical education credit (CME).

Access this issue as well as previous issues featuring Parkinson disease, benign prostatic hyperplasia and overactive bladder.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

7) AMA's Virtual Mentor examines medicine and the environment
The June issue of Virtual Mentor, the AMA's online ethics journal, takes a closer look at the health and environment feedback loop and the duty of physicians to understand how humans and their environment can harm each other.

One article, "Climate Change and Human Health 101," deduces that climate change "may facilitate the emergence of infectious disease" and points to a 2004 outbreak in Alaska of Vibrio parahaemolyticus, the leading cause of seafood-associated gastroenteritis in the United States. This disease is typically associated with the consumption of raw oysters gathered from warm-water estuaries. In Alaska's case, the consumption of raw oysters was the only significant predictor of illness.

The article concludes by stating that a "basic understanding of climate change and its potential health impacts should be included in training and professional development courses for health care professionals to reduce current and projected injuries, illnesses and deaths due to climate-sensitive health outcomes."

8) Answers to your HIT questions: just one benefit of being an AMA member
What can technology do for your practice? Do you have enough advances in place? Or are you missing out on an efficient method that could be serving you well?

AMA members are encouraged to read the AMA members-only article "Information Technology solutions: Consider the potential savings," one of several members-only health information technology (HIT) resources offered by the AMA's Practice Management Center. This particular resource provides a breakdown of potential savings for a physician practice as well as a list of HIT solutions available for physicians and their practices.

Access the AMA Practice Management Center's HIT resources.

If you're an AMA member, don't lose access to valuable resources such as this. Renew your membership. If you're not a member, join the AMA today and begin receiving them.

9) In JAMA: Being overweight, obese during early adulthood associated with greater risk of pancreatic cancer
Young adults who are overweight or obese have an increased risk of pancreatic cancer, and being obese at an older age is associated with a lower overall survival rate for patients with pancreatic cancer, according to a study in the June 24 issue of the Journal of the American Medical Association (JAMA).

View an editorial on this subject.

1) In the Chicago Sun-Times: Limited federal benefits will extend to same-sex partners
President Barack Obama announced last week that he was extending what federal benefits he could to same-sex partners of federal employees. Obama said that he had researched what was possible and found that he could unilaterally direct administrative agencies to extend family sick-leave policies to same-sex partners, but not health benefits.

A story published by the Chicago Sun-Times quotes Doug Ferguson, an attorney for a federal regulatory agency, for his reaction. “When I heard this was coming … I was hopeful the president had found a way to extend all the benefits I receive as a federal employee to my partner,” Ferguson said. "I was disappointed … when I learned that was not the case. I understand that a lot of President Obama’s promises require congressional action.”

View a statement from the White House.

2) News report states that 2010 U.S. Census will recognize same-sex marriages
According to a report by the Associated Press (AP), married same-sex couples will be counted as such in 2010, reversing a decision of the Bush administration. Same-sex couples could not be married in the United States during the last decennial count. But last year, after two states had approved same-sex marriages, the bureau said those legal marriages would go uncounted because the federal Defense of Marriage Act prevented the government from recognizing them, the AP reports.

View the story in the New York Times.

3) AMA video offers best practices when taking a sexual history
A patient’s sexual history oftentimes can reveal important details about the patient, such as his or her sexual orientation or gender identity. A free video developed by the AMA can help educate physicians on best practices when taking a patient’s sexual history. The video, “Patient Sexual Health History: What You Need to Know to Help,” offers recommendations and considerations when treating gay, lesbian, bisexual and transgender patients.

4) Survey shows possible crisis among Dallas-area LGBT youths
According to the Dallas Voice, a news publication serving North Texas’ lesbian, gay, bisexual and transgender (LGBT) population, a survey by a Dallas nonprofit organization suggests there may be a widespread mental health crisis among the city’s LGBT population.

Youth First Texas, which provides social services, education opportunities and recreational activities to that population through age 22, recently released the results of its first comprehensive survey of LGBT youth in the Dallas metropolitan area. The survey shows that 55 percent of Youth First Texas’ clients had attempted suicide in their lifetime, and more than 50 percent have considered it in the last year. In addition, one out of three had made plans to kill themselves in the past year.

Brought to you by the AMA Section on Medical Schools

1) View highlights from the Annual Meeting of the AMA House of Delegates
J. James Rohack, MD, a Bryan, Texas, cardiologist, was inaugurated as the 164th president of the AMA on June 16. View a news release about Dr. Rohack’s inauguration.

AMA Immediate Past President Nancy H. Nielsen, MD, PhD, closed out her term as AMA president with an inspirational speech during the meeting’s opening session.

Read the meeting highlights:

• June 14
• June 15
• June 16
• June 17
• AMA’s section and special group meetings

2) Study: Academic physicians avoid burnout by focusing on preferred tasks
According to a study in the May 25 edition of the Archives of Internal Medicine, many academic physicians reported that patient care was most rewarding, followed by research. Physicians at academic medical centers may be less likely to experience burnout if they spend at least one day a week on the aspect of work that is most meaningful to them.

In a related story published June 18 by the New York Times, researchers say many physicians risk burnout by not balancing the personal and professional aspects of their lives.

1) Apply to serve on an AMA-MSS standing committee
Each year the AMA-MSS Governing Council appoints AMA medical student members to serve one-year terms on its standing committees. Applications for 2009-10 standing committee positions are due June 28. Committee positions will be selected next month.

Visit the AMA-MSS Web site to learn more about these committees and to apply for a seat on one of them.

2) View policy highlights from the AMA-MSS meeting
The AMA-MSS held its 31st annual assembly meeting June 11–13 in Chicago, during which the assembly considered 26 items of business, including 20 resolutions and six reports. Issues considered were wide-ranging and included resident work hours, refugee health, price transparency in health care and a number internal AMA and AMA-MSS issues. Seventeen of these items were adopted, eight of which will be forwarded to the AMA House of Delegates (HOD) for consideration at the 2009 Interim Meeting of the AMA-HOD in November.

View highlights of the meeting.

3) AMA-MSS sets 2009-10 governing council
Last week the AMA-MSS Assembly elected the following governing council members for 2009-10:

• Vice chair—Kristina Maletz, Columbia University College of Physicians and Surgeons
• Delegate—Kevin Blaine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
• Alternate delegate—Keili Meyer, Wright State University Boonshoft School of Medicine
• At-large officer—Hayley Fischer, Brody School of Medicine at East Carolina University
• Speaker—Jennifer Paisley, University of Iowa Carver College of Medicine
• Vice speaker—Matthew Okazaki, John A. Burns School of Medicine at the University of Hawaii

At the conclusion of the meeting, Hans Arora, of the Northwestern University Feinberg School of Medicine, commenced his term as AMA-MSS chair, and Justin Mahida, of the Ohio State University College of Medicine, commenced his term as trustee. The section thanked Immediate Past Chair Michael Chapman for his outstanding service.

Access the Governing Council Action Form to relay any questions or concerns.

4) FREIDA Online: just one benefit of being an AMA member
Residency is just around the corner. Where are you going to go? Which institution has the right program for you?

As an AMA member, you have an outstanding resource at your fingertips—FREIDA Online^®. FREIDA is a database with more than 8,200 graduate medical education programs accredited by the Accreditation Council for Graduate Medical Education, as well as more than 200 combined specialty programs. AMA members-only functions for FRIEDA include being able to save the contents of your folder to view at a later date, and the ability to print program mailing address labels directly to your computer’s printer at no cost.

If you’re an AMA member, don’t lose valuable resources such as access to AMA member functions of FREIDA Online. Renew your membership. If you’re not a member, join the AMA and begin receiving them.

Brought to you by the AMA Minority Affairs Consortium

1) Report shows sizable health disparities in every state between women of different racial, ethnic groups
A decade after U.S. Surgeon General David Satcher, MD, called for the elimination of racial disparities in health, women of color in every state continue to fare worse than white women on a variety of measures of health, health care access and other social determinants of health, according to a new study by the Kaiser Family Foundation.

The report, “Putting Women’s Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level,” documents the persistence of disparities on 25 indicators between white women and women of color, including rates of diseases such as diabetes, heart disease, AIDS and cancer, as well as insurance coverage and health screenings. It also documents disparities in the factors that influence health and access to care, such as income and education. Women of color fared worse than white women on most measures, and in some cases, the disparities were stark.

1) AMA-OMSS holds annual assembly meeting
During the 53rd AMA-OMSS assembly meeting, held June 11–14 in Chicago, the section considered 35 items of business, including those on the need for principles for developing sustainable and successful hospitalist programs and standardization of health information technology user interfaces.

View highlights from the meeting.

2) AMA-OMSS reveals results of survey of primary care physicians and hospitalists
The AMA-OMSS and the Society of Hospitalist Medicine recently completed a nationwide survey of primary care physicians and hospitalists to examine each groups’ opinions of the growing hospitalist trend.

The survey, which follows a similar one from 2007, is designed to assess the effects of the hospitalist model on primary care physicians’ practices and to determine primary care physicians’ and hospitalists’ perceptions of this model on the care of their shared patients.

Some key findings:

• More than 90 percent of hospitalists believe that hospitalist presence has improved the quality of hospital care, while less than half of primary care physicians feel the same way. However, since 2007, there is a significant trend toward an increase in primary care physicians believing that the hospitalist model does improve the quality of care in several domains. In fact, 46 percent of primary care physicians agree or strongly agree that hospitalists have improved the overall quality of hospital care, which is up from 40 percent just two years ago.
• Communication between hospitalists and primary care physicians throughout the hospital stay were recognized by both groups as being an area that needed improvement. Only 50 percent of hospitalists reported that they were effective at communicating with the primary care physicians during the hospital stay, and 70 percent felt they were effective with the communication at discharge. Not surprisingly, when asked those same questions, the rates of primary care physicians who felt hospitalists were effective was about half the rates as hospitalists (25 percent and 35 percent, respectively).
• Both primary care physicians and hospitalists want organizations such as the AMA-OMSS to provide resources to improve communication between hospitalists and primary care physicians as well as related resources and educational materials for both groups to more effectively care for patients.

3) Resources can help patients understand the nuances of Medicare Advantage
Two new resources can help AMA member physicians educate their patients and staff about the benefits and problems associated with participation in Medicare Advantage plans.

One resource, “Attention Medicare beneficiaries: What you need to know about Medicare Advantage,” provides basic information about the program, including what to expect in terms of benefits, enrollment and health insurer marketing of these plans. The other resource, “Attention Medicare beneficiaries: Which plan is right for you,” provides a brief overview of the different types of Medicare Advantage plans.

4) Webinar breaks down Patient Safety Act
Learn more about the Patient Safety and Quality Improvement Act of 2005—also known as the Patient Safety Act—by viewing “Physician Leadership In Patient Safety Organizations,” a free webinar offered through June 30 by the AMA-OMSS.

In the webinar, Michael Callahan, a partner in the firm Katten, Muchin, and Rosenman, explains the scope of the Patient Safety Act; describes the two entities—patient safety evaluation systems and patient safety organizations—created by the Patient Safety Act; offers insight on the reporting process; and explains the junctures between other mandatory reporting requirements and the Patient Safety Act’s voluntary reporting process.

View this and other webinars offered by the AMA-OMSS.

5) AMA-OMSS webcasts available
The AMA-OMSS offers several 90-minute educational webcasts, some for purchase and others free of charge. All programs for purchase provide AMA PRA Category 1 Credit™.

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

1) Apply for a seat on an AMA-RFS standing committee
The AMA-RFS is accepting applications for positions on its standing committees. Committee seats are appointed by the section’s governing council for a one-year term. Apply for a position on the

• Committee on long-range planning
• Committee on medical education
• Membership committee
• Legislative advocacy committee
• Poster symposium committee
• Public health committee

Visit the AMA-RFS Web site to learn more about these committees and to apply for a seat on one of them.

2) Final reference committee report available online
The AMA-RFS considered 18 items of business at its annual assembly meeting in Chicago last week, forwarding eight items immediately to the AMA House of Delegates. Some items covered resident duty hours, transfer of care, direct-to-consumer advertising, loan repayment, health insurance coverage of pre-existing conditions and the impact of specialty board-mandated residency completion dates on parental leave during residency training.

Download the reference committee report and read about the actions taken by the AMA-RFS Assembly on all items of business.

3) Apply for Fund for Better Health grant
The AMA Foundation is accepting applications for its Fund for Better Health grants. With support from the AMA Alliance, the foundation provides seed grants for grassroots public health projects that target healthy lifestyles. A maximum grant of $5,000 will be awarded to organizations that support healthy lifestyle programs that address such topics as nutrition and physical fitness; alcohol use; substance abuse and smoking prevention, including smoking cessation; and violence prevention, including domestic violence, Internet safety and bullying. Applications are due by July 15.

Visit the Web site to learn more about the Fund for Better Health and to download a grant application.

4) AMA physician profiles: just one benefit of being an AMA member
Whether your medical career is beginning tomorrow or it’s a few years away, you will need to get licensed. As an AMA member, this is a service that you won’t have to pay for, regardless of how many state licenses you need.

AMA physician profiles are used extensively by licensing boards, hospitals, group practices and managed care organizations to verify physician credentials. Required by most states, the profiles cost $33 for each state and are free to AMA members.

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

1) Two named to AMA-SPG Governing Council
Bohn Allen, MD, of Arlington, Texas, and Richert Quinn Jr., MD, of Greeley, Colo., recently were appointed to the AMA-SPG Governing Council by the AMA Board of Trustees (BOT). The council consists of seven senior physicians who advise the AMA-BOT on senior physician-related issues.

View a full list of AMA-SPG Governing Council members.

2) Travel abroad with your fellow senior physicians
The AMA-SPG offers a number of educational and leisure travel opportunities through AHI Travel, a travel provider selected by the AMA for its members. Destinations for this year include South Africa, China and Egypt.

Contact Alice Reed at (312) 464-5845 or by e-mail to receive a brochure or more information.

Brought to you by the AMA Women Physicians Congress

1) Recognize your mentors
Nominations for the AMA-WPC Mentor Recognition Program are due July 1. This program is a unique way to acknowledge those individuals who have made a difference in your professional life. Download the flyer to learn more about this program and for a nomination form.

2) Deadline approaching to nominate for statistical sciences award
Nominations are due June 29 for the eighth annual Janet L. Norwood Award for Outstanding Achievement by a Woman in the Statistical Sciences, sponsored by the School of Public Health at The University of Alabama at Birmingham (UAB). Eligible individuals are women who have completed their degree, have made outstanding contributions to the statistical sciences, and, if selected, are willing to deliver a lecture at the award ceremony. The award recipient will receive $5,000, a plaque and an all-expenses-paid trip to the award ceremony.

3) Report shows sizable health disparities in every state between women of different racial, ethnic groups
A decade after U.S. Surgeon General David Satcher, MD, called for the elimination of racial disparities in health, women of color in every state continue to fare worse than white women on a variety of measures of health, health care access and other social determinants of health, according to a new study by the Kaiser Family Foundation.

The report, “Putting Women’s Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level,” documents the persistence of disparities on 25 indicators between white women and women of color, including rates of diseases such as diabetes, heart disease, AIDS and cancer, as well as insurance coverage and health screenings. It also documents disparities in the factors that influence health and access to care, such as income and education. Women of color fared worse than white women on most measures, and in some cases, the disparities were stark.

1) AMA-YPS action on student loan debt leads to new AMA policy
Two policies adopted last week by the AMA House of Delegates to help address the increasing student loan debt burden facing young physicians were resolutions initially approved by the AMA-YPS Assembly during its annual meeting.

Resolution 232 directs the AMA to draft legislation allowing 100 percent tax deductibility of student loan interest, and Resolution 323 asks the AMA to study the impact of the Higher Education Opportunity Act, which goes into effect July 1. A third resolution, which asked the AMA to try to expand the definition of public service under the federal Public Service Loan Forgiveness Program, was referred for further study.

View highlights from the AMA-YPS Assembly meeting.

2) AMA-YPS elects new governing council members
Last week during the AMA-YPS Assembly meeting, the section elected the following young physicians to its governing council:

• Ravi Goel, MD, an ophthalmologist from New Jersey, chair-elect
• Patricia Turner, MD, a surgeon from Maryland, speaker
• Steven Chen, MD, a surgical oncology specialist from California, alternate delegate
• Shilpen Patel, MD, a radiation oncology specialist from Washington, member at-large

At the close of the meeting, Dawn Buckingham, MD, an ophthalmologist from Texas, began her term as chair of the AMA-YPS Governing Council.

3) Reference committee report and AMA-HOD handbook review grids now online
The annotated report of the AMA-YPS Reference Committee is available for viewing on the AMA-YPS Web pages, along with AMA House of Delegates (HOD) handbook review grids outlining the section’s position on all items of business considered during the Annual Meeting of the AMA-HOD.

Send an e-mail if you have questions.