AMA - Oct. 30, 2009 - AMA eVoice®

Oct. 30, 2009 - AMA eVoice®

AMA eVoice is your regular update on the most important health care issues and recent AMA activities.

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From the President, J. James Rohack, MD

Health IT: helping to keep patient care at its premium

Aside from the AMA's quest to make health system reform a reality by the year's end, the association is in pursuit to convince the Department of Health and Human Services (HHS) to define "meaningful use" of health information technology (IT) in a way that's appropriate for all physicians before the calendar turns to Jan. 1.

Health IT may only be one piece of the larger debate about reform, but it's a topic that's gained much traction as of late. As part of the American Recovery and Reinvestment Act enacted in February, Congress invested $19.2 billion for physicians and hospitals that implement and use health IT in a meaningful way. Physicians who adopt a certified electronic health record (EHR) between 2011 and 2015 will be eligible for incentive payments. Those who don't will face reductions in their Medicare fee schedules starting in 2015 and even steeper financial penalties after that.

But what does "meaningful use" really mean? That's the question many have been asking-and it's the same question that the Centers for Medicare and Medicaid Services (CMS) and the HHS Office of the National Coordinator for Health Information Technology (ONC) have been working to answer. Together, they're developing a proposed rule that will define meaningful use; the administration expects to publish it by Dec. 31. CMS and the ONC have been receiving substantial input from two health IT federal advisory committees as well as many in the public, including the AMA.

Here's the issue: This isn't really a "one-size-fits-all" designation. Appropriate meaningful use criteria needs to ensure that all eligible physicians in all size practices and specialties are able to take advantage of the incentives. While health care providers should be preparing for implementing health IT into their practices-since the specific criteria that will dictate the rules under which physicians will qualify for these incentives are not yet final-many have been busy debating the rule since the meaningful use matrix was first introduced back in June by the Health IT Policy Committee advising CMS and the ONC.

The AMA, together with many state and medical specialty societies, has developed proposed recommendations for defining and demonstrating meaningful use for receipt of incentives. The Health IT Policy Committee drafted a set of criteria that, as mentioned above, will guide the rulemaking process and what will ultimately be required by the government. The AMA sent numerous letters over the past several months to the ONC and CMS, including a document that outlines our specific concerns with the policy committee's draft criteria.

We've continued to stress our concerns with the proposed matrix directly to the Obama administration, which include overly aggressive adoption time frames, the need to include clinically relevant measures for all specialties, and certain requirements that dilute the focus and make it more difficult to achieve widespread adoption.

Just last week, my colleague and AMA Trustee Steven Stack, MD, expressed medicine's support for adoption of health IT during a meeting with David Blumenthal, MD, director of the ONC. But Dr. Stack cautioned him that the final recommendations released last month by the Health IT Policy Committee for the definition of meaningful use that will determine whether physicians qualify for Medicare incentive payments were overly aggressive. He urged Blumenthal and the ONC staff to modify the criteria.

We'll have one final chance. When the ONC publishes the final rule in December, submit your comments for review. Because of the expedited timetable, the committee did in fact stress during the meeting last week its interest in suggestions and feedback that will be put forth during the comment period. This will be our opportunity to tell the ONC what meaningful use of health IT means and should be for physicians.

Ultimately the goal we're trying to achieve is widespread adoption of health IT. We want physicians to incorporate technology, such as EHRs, into their practices to improve quality of care delivery and enhance practice efficiencies that will lead to better overall health outcomes.

Gains from such technology can be as simple as sending electronic prescription requests to pharmacies so they're ready for pickup by the time the patient arrives or having patient access to medical information via portals thousands of miles away. They could even be as straightforward as reducing the risk that hard-to-read handwriting could lead to medical errors.

Look at the Michigan State University Internal Medicine Clinic, for example. After implementing an EHR system in 2002, the practice decreased its chart pulls by 99 percent after 24 months and recouped the cost of implementing an EHR system in less than 17 months.

Aside from the financial benefit, the practice's EHR system assisted with administrative efficiencies and work flow, and staff productivity improved. Other practices utilizing such systems have noticed benefits surrounding communication and patient records management, access to patient medication history information at the point of care, and capabilities to electronically refer patients and receive automated utilization reports.

A recent study shows that EHR systems can improve the quality of care in physician practices. The Oct. 6 issue of the Annals of Internal Medicine points out that routine use of EHRs may improve the quality of care provided in community-based primary care practices more so than other common strategies.

So what's been stopping some physicians from jumping on this health IT bandwagon? Cost is most certainly one thing—as well as time, work flow interruptions and concerns about privacy. And with the outlook of reform still in question, physicians may be a little leery of implementing such technology without knowing exactly what they will face come Jan. 1.

The AMA has done significant work to address barriers that keep physicians from implementing health IT into their practices and offers a number of resources to help doctors make the best technology decisions for themselves and their practices. These resources cover such topics as self-assessment and planning, understanding health IT applications, return on investment and sample patient communication models and exam room setup.

Among those resources is the AMA's ePrescribing Learning Center, which provides enhanced tools for electronic prescribing (ePrescribing), another form of health IT. The learning center features unbiased coverage of ePrescribing system vendor pricing, plus side-by-side comparisons of up to three ePrescribing vendors at one time. These tools also include the ability to read vendor feedback and ratings from other users and provide your own vendor feedback, automated contact-a-vendor capability for when a decision is reached, and readiness and planning resources to map out an implementation plan.

In addition, the AMA's Physician Spotlight is an online feature that provides an inside look at physicians around the country who are transitioning their practices from a paper-based system to one with EHRs. The AMA has loads of technology planning resources and will continue to unveil new resources and solutions for physicians to simplify the health IT decision-making and implementation processes.

Above all, it's important to remember who we're doing this for: our patients. They are the recipients of our care, and it is our job to make sure they receive the utmost quality. I believe health IT can help get us there. In the coming years, technology can play an important role in transforming health care by improving patient safety, enhancing care coordination and reducing administrative burdens.

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

General AMA news

1) AMA reviewing House health reform bills
The U.S. House of Representatives unveiled H.R. 3962, the Affordable Health Care for America Act, on Oct. 29. The bill represents the melding of the three House versions of health system reform legislation and includes a public option in which physician participation is voluntary and payments are based on negotiated rates and the private insurance market.

The House also unveiled H.R. 3961, the Medicare Physician Payment Reform Act. This bill would repeal Medicare’s sustainable growth rate, or SGR, formula and replace it with a payment system that provides for more predictable updates from Medicare.

The AMA’s advocacy staff is in the process of reviewing these bills, which together run more than 2,000 pages. The House is expected to take up both bills next week. House strategy on combining the bills or moving them separately has not yet been finalized.

2) Wall Street Journal ad helps AMA continue push to make health reform a reality
The AMA unveiled another piece of its campaign to make health system reform a reality with a full-page advertisement in the Oct. 27 issue of the Wall Street Journal. The ad ran in the Journal’s special report, “Fixing Healthcare.”

“This new ad reiterates the AMA’s role in the reform debate as an advocate for patients and physicians and shows that we will continue to be actively engaged until meaningful health reform is a reality,” AMA President J. James Rohack, MD, said.

Learn more in an AMA news release.

3) AMA hails New York’s attorney general for launching project to replace tainted Ingenix database
A new not-for-profit company, FAIR Health, Inc., and a research network headquartered at Syracuse University will develop an independent database for consumer reimbursement and a Web site where, for the first time, consumers will be able to compare prices before they choose their doctors, New York Attorney General Andrew Cuomo announced Oct. 27. The AMA commended Cuomo for the news, which is part of historic nationwide reform of the consumer reimbursement system for out-of-network health care charges.

At the heart of this reform movement was the closure of the insurer-controlled Ingenix database. Use of this flawed database by health insurers across the country corrupted the system for paying out-of-network medical bills, resulting in patients and physicians being cheated of proper reimbursements.

“The AMA had been fighting in court for almost a decade against the industry-wide insurer scheme to defraud patients and physicians of proper reimbursement,” AMA Trustee William A. Dolan, MD, said. “The cumulative impact of these achievements will bring national reforms that benefit tens of millions of Americans who receive care outside their insurer’s network of physicians.”

Gay, lesbian, bisexual, transgender physician issues

1) Senate passes hate crimes bill
A historic hate crimes bill that cleared through the Senate last week included new federal penalties for attacks on gay men and lesbians, according to a story by the Washington Post. The measure, which was attached to the conference report for the bill outlining the Pentagon’s budget, would extend the current definition of federal hate crimes—which covers attacks motivated by race, color, religion or national origin—to include those based on sex, sexual orientation, gender identity or disability, the Post reports.

2) HHS to create national resource center for older LGBT people
The Department of Health and Human Services announced plans last week to establish the nation’s first national resource center to assist communities across the country in their efforts to provide services and support for older lesbian, gay, bisexual and transgender (LGBT) people.

The new Resource Center for LGBT Elders will offer information, assistance and resources to help LGBT organizations and mainstream aging-service providers at the state and community levels provide culturally sensitive services. The center also will work to educate the LGBT community about the importance of planning ahead for future long-term care needs.

Medical school news

Brought to you by the AMA Section on Medical Schools

1) AMA-SMS meeting agenda book available online
As part of the AMA-SMS’s effort to be more environmentally friendly, the agenda book for the section’s Nov. 6 meeting is available to be downloaded from the section’s Web page. Meeting registrants were mailed the CD agenda book earlier in the week. No paper copies will be available.

2) Learn about the AMA’s efforts to transform medical education
If you’re attending the Association of American Medical Colleges (AAMC) Annual Meeting in Boston next month, then plan to attend an educational session covering the AMA’s initiatives to transform medical education, which will take place from 5:30 to 6:30 p.m. Nov. 8. The session will be held after the AMA-SMS’s Nov. 6 meeting, which will be held in conjunction with the AAMC meeting.

The session will highlight AMA efforts, including the AMA’s Initiative to Transform Medical Education, to improve the nation’s health through the reform of medical education in collaboration with other health profession stakeholders. Projects developed to address the 10 consensus recommendations—formed from partnerships with the American Academy of Pediatrics, the AAMC, the Federation of State Medical Boards and others—will be described.

Presenters will be Susan Skochelak, MD, the AMA’s vice president for medical education; M. Dewayne Andrews, MD, AMA-SMS immediate past chair; and Barbara Barzansky, director of the AMA Division of Undergraduate Medical Education.

3) AMA WorldScopes: helping doctors who need stethoscopes help patients
The AMA’s WorldScopes initiative, in collaboration with the AMA Foundation, collects and delivers stethoscopes to doctors, nurses and other health care professionals around the world who lack this most basic of medical instruments.

To date, WorldScopes has distributed nearly 6,500 stethoscopes—worth an estimated $100,000—to clinics and hospitals from Afghanistan to Zambia. Last year, WorldScopes provided stethoscopes for mobile medical teams that responded in the deadly aftermath of cyclones in Myanmar. Recently, stethoscopes were delivered to a maternity ward in the Philippines and to a pediatric hospital in the Dominican Republic.

WorldScopes donations are tax deductible. Learn more about how you can help make a difference.

Medical student issues

1) View the AMA-MSS meeting handbook
The AMA-MSS Interim Assembly Meeting Handbook is available online in advance of the meeting, which will be held November 5–7 at the Hilton Americas-Houston. Visit the AMA-MSS Web site to access the handbook and to view other meeting details. If you didn’t register for the meeting by the deadline, you can still do so on site.

2) Volunteer for national service project event at AMA-MSS meeting
The AMA-MSS will officially kick off its 2009–2011 national service project by hosting the “Fall into Healthier Life Styles Health Fair” at the upcoming AMA-MSS Interim Assembly Meeting.

Medical student volunteers will speak with Houston-area citizens about the four key health behaviors addressed by the AMA Healthier Life Steps™ Program: healthy eating, physical activity, reducing risky alcohol use and not smoking. Students also will provide various free services for adults, including blood pressure screenings, body mass index screenings, and healthy cooking and physical fitness demonstrations. Resources for the uninsured as well as CPR and stroke information also will be available.

If you will be attending the AMA-MSS meeting and are interested in participating in the health fair, complete the online registration form by today, Oct. 30. Contact Hayley Fischer, the AMA-MSS’s at-large officer, at hayley.fischer@gmail.com with any questions.

3) Leadership development opportunities at AMA-MSS meeting
The AMA-MSS will host two education sessions focusing on leadership Nov. 5 in conjunction with the AMA-MSS meeting.

Albert Schumacher, MD, president of Schumacher Research and Leadership Group and former president of the Canadian Medical Association and the Ontario Medical Association, will lead a session covering such topics as grassroots organizing, maximizing meeting effectiveness, public speaking and effective advocacy to help you succeed as a leader.
A second session, facilitated by AMA-MSS leaders, will cover communication, networking, running an effective meeting and conflict resolution.

Limited spots are available for both of these sessions. To reserve a spot, send an e-mail to mss@ama-assn.org by today, Oct. 30, with your name and medical school and state if you’d like to attend either session or both.

4) Submit online AMA-MSS Reference Committee testimony
AMA-MSS members are encouraged to submit reference committee testimony online in advance of the traditional reference committee hearing at the AMA-MSS Interim Assembly Meeting. All testimony submitted online will be considered along with testimony heard in person as the AMA-MSS Reference Committee makes its recommendations to the assembly. Make your voice heard by submitting online reference committee testimony.

If you’re registered for the meeting, you already have access to the AMA-MSS Online Reference Committee blog on Central Desktop and should have received an e-mail Oct. 15 with log-in instructions.

If you’re not registered for the meeting but would still like to submit testimony, register for the AMA-MSS Discussion Forum to receive access to the AMA-MSS Online Reference Committee blog.

Send an e-mail to mss@ama-assn.org with any questions.

5) Want to be a theme issue editor for Virtual Mentor?
Virtual Mentor, the AMA’s online ethics journal, is looking for students and residents to serve as theme issue editors in conjunction with the journal’s staff editors. Theme issue editors are responsible for choosing themes, generating case narratives, working with other contributors and editing.

Each theme issue editor will receive a $1,000 stipend. Virtual Mentor aims to promote the ethical and professional development of tomorrow’s physicians; its primary audience is medical students, residents, physicians and medical educators.

Visit the Virtual Mentor Web site to learn more and apply. Applications are due by midnight CST Nov. 13.

6) Learn more about USMLE, COMLEX: just one benefit of AMA membership
The AMA members-only guide “Succeeding from Medical School to Practice” is jam-packed with helpful information on a variety of topics. Developed by AMA member physicians, this guide offers medical students and doctors the tools needed to succeed at every stage of their career.

Part 1 of the guide, which covers medical school and residency, offers a clear overview of both the United States Medical Licensing Examination (USMLE) and the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) and what to expect from those tests. It also includes steps to take toward entering a residency program. Parts 2 and 3 of the guide cover residency and practice.

AMA members can access the guide. Nonmembers can view the guide’s table of contents and view sample pages.

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.

Organized medical staff issues

1) AMA-OMSS meeting approaching fast
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 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. On-site registration will begin at noon Central time Nov. 5 in the George R. Brown Convention Center Grand Ballroom foyer. Late resolutions are due by 4 p.m. Central time Nov. 5.

View more information about the meeting, including the preliminary version of the AMA-OMSS Interim Meeting Handbook.

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.

2) New AMA resource helps you fight for accurate payment
If your practice submits claims electronically, a free resource from the AMA can help you secure accurate payment from health insurers for inappropriately denied claims.

Using the Claims Workflow Assistant, you can look up the reasons health insurers reported for denying claims on the electronic remittance advices, or ERAs, you receive. Then you can determine the best steps for your practice to reverse the denial. The Claims Workflow Assistant also helps you get started with recommended work flows for the top 80 percent of denials from the 2008 and 2009 National Health Insurer Report Card and provides numerous template appeal letters that AMA members can easily modify to use in their practices.

View the Claims Workflow Assistant on the AMA Practice Management Center Web site.

3) AMA symposium to cover IMGs in the U.S. physician work force
Join the AMA for a symposium about international medical graduates in the U.S. physician work force from 6 to 7:30 p.m. Dec. 2 at AMA headquarters in Chicago. The event is open to all physicians, medical students and their guests who are interested in physician work force issues, particularly international medical graduates’ role in the nation’s physician work force.

Attendees will have an opportunity to network with colleagues and take an exclusive look at the 2009 edition of “International Medical Graduates in the U.S. Physician Workforce: A Discussion Paper,” which will be unveiled at the meeting prior to its online publication in January.

Visit the AMA-IMG Web site for more about the symposium and to register for it.

4) Joint Commission’s pre-publication standards available online
Pre-publication versions of the 2010 standards for all Joint Commission accredittion 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.

Resident and fellow issues

1) Video addresses ways to motivate patients
Inspiring patients to change their health behavior can be challenging. An online program by the AMA introduces physicians to motivational interviewing—a patient-centered, goal-oriented counseling strategy—and how it can help change or improve patient health behavior. Part of the AMA’s Educating Physicians on Controversies and Challenges in Health series, “Motivating Patients to Change Behavior” explains the basic principles of this strategy and can help physicians identify how motivational interviewing differs from traditional patient-physician interactions.

2) News story explains how scientists seek origins of obesity in the womb
Research is emerging that suggests an obese woman’s womb may program her fetus toward becoming a fat child and adult, according to a recent story by the Associated Press (AP). The idea has only recently become a topic of conversation between doctors and female patients, and scientists are scrambling to track down a biological explanation. That knowledge, in turn, may provide new ways to block obesity from crossing generations, the AP reports.

3) By the Associated Press: New York officials rescind mandatory H1N1 flu shot order
New York state health officials have suspended a ruling that would have forced health care workers across the state to get vaccinated against the 2009 H1N1 influenza virus by the end of November or risk losing their jobs, according to the Associated Press.

4) AMA-RFS meeting approaching fast
The AMA-RFS will hold its 33rd annual Interim Meeting Nov. 5–7 at the George R. Brown Convention Center in Houston.

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) AMA-SPG caucus planned for Interim Meeting
The AMA-SPG is sponsoring a caucus for senior physicians from 10 to 11:15 a.m. Central time Nov. 7 in room 330A 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 Todd Sagin, MD, of 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 that senior physicians can play in helping the uninsured. All are welcome; please plan to attend to network with new colleagues and old friends.

2) AMA WorldScopes: helping doctors who need stethoscopes help patients
The AMA’s WorldScopes initiative, in collaboration with the AMA Foundation, collects and delivers stethoscopes to doctors, nurses and other health care professionals around the world who lack this most basic of medical instruments.

WorldScopes donations are tax deductible. Learn more about how you can help make a difference.

3) Nominations for the Jack B. McConnell, MD, Award due by Nov. 16
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 on March 1, 2010, in Washington, D.C., during the AMA’s National Advocacy Conference. Nominations are due by Nov. 16.

View nomination materials. Contact Alice Reed at (312) 464-5523 or alice.reed@ama-assn.org if you have questions.

Young physician issues

1) AMA-YPS meeting approaching fast
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.

Visit the section's Web site to download the AMA-YPS Interim Assembly Meeting Handbook and to learn more about the meeting.

2) Register by tomorrow to participate in health reform session at Interim Meeting
Join the AMA’s sections and special groups for a candid discussion about the status of health system reform, where it is heading and what it means for physicians and patients from 11:30 a.m. to 1:30 p.m. Nov. 7 as part of the Interim Meeting of the AMA House of Delegates. Online registration will close today, Oct. 30, and space is limited.

The program will consist of AMA President J. James Rohack, MD; Richard Deem, the AMA’s senior vice president for advocacy; and congressional representatives, including U.S. Rep. Michael Burgess, MD, R-Texas, discussing the AMA’s involvement in the reform debate. Participants can earn 2.0 AMA PRA Category 1 Credits™.

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 2.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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) New AMA resource helps you fight for accurate payment
If your practice submits claims electronically, a free resource from the AMA can help you secure accurate payment from health insurers for inappropriately denied claims.