User login
House passes IPAB repeal bill
WASHINGTON – House Republicans have made good on their promise to kill the Independent Payment Advisory Board with the passage on June 23 of H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015. The vote was 244-154 and fell mostly along party lines.
Many physician organizations, including the American Medical Association, have opposed the IPAB from the very beginnings of the Affordable Care Act. The panel has never been convened, and since Congress has never appropriated funds for the IPAB, the new legislation has no practical impact on practicing physicians.
According to Dr. Kavita Patel, health policy analyst at the Brookings Institution, the IPAB was designed as an objective, appointed commission to make direct recommendations that would become law if Medicare spending exceeded a certain target. Congress could overturn any IPAB legislation with a supermajority vote, Dr. Patel said in an interview.
Opponents of the IPAB, including House Ways and Means Committee Chairman Paul Ryan (R-Wis.), have criticized it as an approach to cost containment, since the panel’s decisions would not require ratification by Congress.
“This unelected panel exists only to take control away from patients and rations care – and it’s seniors who will suffer the consequences,” Rep. Ryan said in a statement.
In the Senate, the bill is known as S.141. It has been referred to the Finance Committee but no action had been taken at press time.
On Twitter @whitneymcknight
WASHINGTON – House Republicans have made good on their promise to kill the Independent Payment Advisory Board with the passage on June 23 of H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015. The vote was 244-154 and fell mostly along party lines.
Many physician organizations, including the American Medical Association, have opposed the IPAB from the very beginnings of the Affordable Care Act. The panel has never been convened, and since Congress has never appropriated funds for the IPAB, the new legislation has no practical impact on practicing physicians.
According to Dr. Kavita Patel, health policy analyst at the Brookings Institution, the IPAB was designed as an objective, appointed commission to make direct recommendations that would become law if Medicare spending exceeded a certain target. Congress could overturn any IPAB legislation with a supermajority vote, Dr. Patel said in an interview.
Opponents of the IPAB, including House Ways and Means Committee Chairman Paul Ryan (R-Wis.), have criticized it as an approach to cost containment, since the panel’s decisions would not require ratification by Congress.
“This unelected panel exists only to take control away from patients and rations care – and it’s seniors who will suffer the consequences,” Rep. Ryan said in a statement.
In the Senate, the bill is known as S.141. It has been referred to the Finance Committee but no action had been taken at press time.
On Twitter @whitneymcknight
WASHINGTON – House Republicans have made good on their promise to kill the Independent Payment Advisory Board with the passage on June 23 of H.R. 1190, the Protecting Seniors’ Access to Medicare Act of 2015. The vote was 244-154 and fell mostly along party lines.
Many physician organizations, including the American Medical Association, have opposed the IPAB from the very beginnings of the Affordable Care Act. The panel has never been convened, and since Congress has never appropriated funds for the IPAB, the new legislation has no practical impact on practicing physicians.
According to Dr. Kavita Patel, health policy analyst at the Brookings Institution, the IPAB was designed as an objective, appointed commission to make direct recommendations that would become law if Medicare spending exceeded a certain target. Congress could overturn any IPAB legislation with a supermajority vote, Dr. Patel said in an interview.
Opponents of the IPAB, including House Ways and Means Committee Chairman Paul Ryan (R-Wis.), have criticized it as an approach to cost containment, since the panel’s decisions would not require ratification by Congress.
“This unelected panel exists only to take control away from patients and rations care – and it’s seniors who will suffer the consequences,” Rep. Ryan said in a statement.
In the Senate, the bill is known as S.141. It has been referred to the Finance Committee but no action had been taken at press time.
On Twitter @whitneymcknight
Feds charge 243 in huge Medicare fraud bust
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people – including 46 medical providers – in the largest bust in strike force history.
The defendants are accused of various Medicare fraud schemes that involved $712 million in false billings to the Centers for Medicare & Medicaid Services, according to a joint announcement on June 18 by Health and Human Services Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch.
Among the allegations are that defendants submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other coconspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that physicians then could bill Medicare fraudulently, according to the announcement. The defendants include doctors, nurses, and other licensed professionals, along with lay individuals who participated in the alleged fraud. Several health professionals were also suspended from participating in federal government health care programs.
Accused defendants are from Los Angeles; Dallas, McAllen, and Houston, Tex.; Detroit; Brooklyn, N.Y.; Tampa and Miami; and New Orleans. Among the medical services involved in the alleged schemes are home health care, mental health services, pharmacy services, durable medical equipment, and physical and occupational therapy.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent and deter fraud and enforce antifraud laws. Since its inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants for allegedly falsely billing more than $7 billion to the Medicare program.
On Twitter @legal_med
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people – including 46 medical providers – in the largest bust in strike force history.
The defendants are accused of various Medicare fraud schemes that involved $712 million in false billings to the Centers for Medicare & Medicaid Services, according to a joint announcement on June 18 by Health and Human Services Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch.
Among the allegations are that defendants submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other coconspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that physicians then could bill Medicare fraudulently, according to the announcement. The defendants include doctors, nurses, and other licensed professionals, along with lay individuals who participated in the alleged fraud. Several health professionals were also suspended from participating in federal government health care programs.
Accused defendants are from Los Angeles; Dallas, McAllen, and Houston, Tex.; Detroit; Brooklyn, N.Y.; Tampa and Miami; and New Orleans. Among the medical services involved in the alleged schemes are home health care, mental health services, pharmacy services, durable medical equipment, and physical and occupational therapy.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent and deter fraud and enforce antifraud laws. Since its inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants for allegedly falsely billing more than $7 billion to the Medicare program.
On Twitter @legal_med
A nationwide investigation by the federal Medicare Fraud Strike Force has led to health fraud charges against 243 people – including 46 medical providers – in the largest bust in strike force history.
The defendants are accused of various Medicare fraud schemes that involved $712 million in false billings to the Centers for Medicare & Medicaid Services, according to a joint announcement on June 18 by Health and Human Services Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch.
Among the allegations are that defendants submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other coconspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that physicians then could bill Medicare fraudulently, according to the announcement. The defendants include doctors, nurses, and other licensed professionals, along with lay individuals who participated in the alleged fraud. Several health professionals were also suspended from participating in federal government health care programs.
Accused defendants are from Los Angeles; Dallas, McAllen, and Houston, Tex.; Detroit; Brooklyn, N.Y.; Tampa and Miami; and New Orleans. Among the medical services involved in the alleged schemes are home health care, mental health services, pharmacy services, durable medical equipment, and physical and occupational therapy.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to prevent and deter fraud and enforce antifraud laws. Since its inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants for allegedly falsely billing more than $7 billion to the Medicare program.
On Twitter @legal_med
VIDEO: How to avoid questionable physician compensation arrangements
CHICAGO – The U.S. Department of Health & Human Service’s Office of Inspector General (OIG) is warning doctors to be wary of improper physician arrangements that could violate the federal Anti-Kickback Statute.
The federal law prohibits doctors from receiving any form of payment in exchange for past or future patient referrals under the Medicare or Medicaid programs.
The OIG recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements. The agency stated money paid to the doctors was improper because the payments took into account volume or value of referrals and did not reflect fair market value for services provided.
Physicians sometimes enter into questionable physicians arrangements, such as medical directorships, without fully understanding if they are proper, said attorney Adrienne Dresevic, who spoke at a recent conference held by the American Bar Association.
In a video interview during the conference, Ms. Dresevic discussed common physician compensation arrangements that come under government scrutiny and how well-intentioned doctors can fall prey to Anti-Kickback Statute allegations. Ms. Dresevic, who practices health law in Southfield, Mich., also spoke about how physicians can avoid risky physician compensation arrangements.
CHICAGO – The U.S. Department of Health & Human Service’s Office of Inspector General (OIG) is warning doctors to be wary of improper physician arrangements that could violate the federal Anti-Kickback Statute.
The federal law prohibits doctors from receiving any form of payment in exchange for past or future patient referrals under the Medicare or Medicaid programs.
The OIG recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements. The agency stated money paid to the doctors was improper because the payments took into account volume or value of referrals and did not reflect fair market value for services provided.
Physicians sometimes enter into questionable physicians arrangements, such as medical directorships, without fully understanding if they are proper, said attorney Adrienne Dresevic, who spoke at a recent conference held by the American Bar Association.
In a video interview during the conference, Ms. Dresevic discussed common physician compensation arrangements that come under government scrutiny and how well-intentioned doctors can fall prey to Anti-Kickback Statute allegations. Ms. Dresevic, who practices health law in Southfield, Mich., also spoke about how physicians can avoid risky physician compensation arrangements.
CHICAGO – The U.S. Department of Health & Human Service’s Office of Inspector General (OIG) is warning doctors to be wary of improper physician arrangements that could violate the federal Anti-Kickback Statute.
The federal law prohibits doctors from receiving any form of payment in exchange for past or future patient referrals under the Medicare or Medicaid programs.
The OIG recently reached settlements with 12 individual physicians who entered into questionable medical directorship and office staff arrangements. The agency stated money paid to the doctors was improper because the payments took into account volume or value of referrals and did not reflect fair market value for services provided.
Physicians sometimes enter into questionable physicians arrangements, such as medical directorships, without fully understanding if they are proper, said attorney Adrienne Dresevic, who spoke at a recent conference held by the American Bar Association.
In a video interview during the conference, Ms. Dresevic discussed common physician compensation arrangements that come under government scrutiny and how well-intentioned doctors can fall prey to Anti-Kickback Statute allegations. Ms. Dresevic, who practices health law in Southfield, Mich., also spoke about how physicians can avoid risky physician compensation arrangements.
EXPERT ANALYSIS FROM THE PHYSICIANS LEGAL ISSUES CONFERENCE
VIDEO: The most pressing health law risks for physicians
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, physicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Physicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for doctors and ways in which physicians can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, physicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Physicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for doctors and ways in which physicians can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
CHICAGO – From Stark law to HIPAA violations to whistle-blower claims, physicians face a litany of legal land mines in today’s practice landscape.
Not only that, but rules and regulations are constantly changing, and the government continues to increase its scope in some areas, said Michael E. Clark, chair of the American Bar Association Health Law Section.
Physicians should be mindful of the new – and old – laws that impact them and take steps to prevent legal scrutiny, Mr. Clark advised during a conference held by the American Bar Association.
In a video interview at the conference, Mr. Clark discussed the most pressing health law issues for doctors and ways in which physicians can avoid such risks. Mr. Clark, who practices health law in Houston, also shared his perspectives on what the future holds for upcoming legal dangers.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
EXPERT ANALYSIS FROM THE PHYSICIANS LEGAL ISSUES CONFERENCE
For doctors who take a break from practice, coming back can be tough
After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.
The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.
“I really thought it was not going to be that hard,” she said.
Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.
In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.
“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.
After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.
“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”
Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.
Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.
“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.
Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.
“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”
Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.
Setting standards and removing obstacles
Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.
The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.
The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.
After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.
In the end, she received two certificates – one from the program and one from the University of California, San Diego, for 180 hours of continuing medical education.
“I definitely felt more confident,” Dr. Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid family medicine fellowship at the University of Southern California, seeing patients under the oversight of other doctors.
Former medical school professor Dr. Leonard Glass created the San Diego program, called the Physician Retraining and Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care, as well as some restless retirees.
“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”
‘Expensive and time consuming’
Several retraining programs are run by hospitals, including Cedars-Sinai Medical Center in Los Angeles. There, participants spend between 6 weeks and 3 months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.
The Cedars-Sinai program costs $5,000 a month. Dr. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”
One Cedars-Sinai graduate, Dr. Maria DiMeglio decided she wanted to return to practice as an ob.gyn. after taking off almost 6 years to care for her children and her ill mother.
“I thought I was retiring, Dr. DiMeglio said, “but I kept my options open.” She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars-Sinai retraining program, she said, “wasn’t difficult, but it was expensive and time consuming. Not everyone can do that.”
Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than 2 years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said Dr. David Perrott, senior vice president and chief medical officer of the California Hospital Association.
Dr. Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.
“I was a double board–certified physician licensed in several states,” he said. “You would think I would be able to get a job.”
When he finally did get an offer at a medical center in New Jersey, he said both the position and the state medical license were contingent on him getting retrained. He completed a 2-month program at Drexel University in 2013, where he was surprised to discover many other doctors in a similar situation.
Dr. Petrozzino said he was grateful for the program – but given the hassles of reentry, he would advise doctors to plan carefully before taking a break from practice.
“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for reentry.”
Kaiser Health News (KHN) is a nonprofit national health policy news service. Blue Shield of California Foundation helps fund KHN coverage in California.
After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.
The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.
“I really thought it was not going to be that hard,” she said.
Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.
In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.
“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.
After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.
“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”
Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.
Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.
“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.
Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.
“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”
Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.
Setting standards and removing obstacles
Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.
The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.
The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.
After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.
In the end, she received two certificates – one from the program and one from the University of California, San Diego, for 180 hours of continuing medical education.
“I definitely felt more confident,” Dr. Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid family medicine fellowship at the University of Southern California, seeing patients under the oversight of other doctors.
Former medical school professor Dr. Leonard Glass created the San Diego program, called the Physician Retraining and Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care, as well as some restless retirees.
“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”
‘Expensive and time consuming’
Several retraining programs are run by hospitals, including Cedars-Sinai Medical Center in Los Angeles. There, participants spend between 6 weeks and 3 months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.
The Cedars-Sinai program costs $5,000 a month. Dr. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”
One Cedars-Sinai graduate, Dr. Maria DiMeglio decided she wanted to return to practice as an ob.gyn. after taking off almost 6 years to care for her children and her ill mother.
“I thought I was retiring, Dr. DiMeglio said, “but I kept my options open.” She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars-Sinai retraining program, she said, “wasn’t difficult, but it was expensive and time consuming. Not everyone can do that.”
Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than 2 years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said Dr. David Perrott, senior vice president and chief medical officer of the California Hospital Association.
Dr. Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.
“I was a double board–certified physician licensed in several states,” he said. “You would think I would be able to get a job.”
When he finally did get an offer at a medical center in New Jersey, he said both the position and the state medical license were contingent on him getting retrained. He completed a 2-month program at Drexel University in 2013, where he was surprised to discover many other doctors in a similar situation.
Dr. Petrozzino said he was grateful for the program – but given the hassles of reentry, he would advise doctors to plan carefully before taking a break from practice.
“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for reentry.”
Kaiser Health News (KHN) is a nonprofit national health policy news service. Blue Shield of California Foundation helps fund KHN coverage in California.
After taking a 10-year break from practicing medicine to raise four sons, Dr. Kate Gibson was ready to go back to work.
The family physician had been reading about a shortage of primary care doctors and knew she could help. But when Dr. Gibson, 51, applied to work at her former hospital near Los Angeles, she was turned away. She’d been out of clinical practice too long.
“I really thought it was not going to be that hard,” she said.
Like many professionals, physicians take time off to raise children, care for sick family members, or recover from their own illnesses. Some want to return from retirement or switch from nonclinical jobs back to seeing patients. But picking up where they left off is more difficult in medicine than in most careers.
In medicine, change occurs quickly. Drugs, devices, and surgical techniques that were standard a decade ago may now be obsolete. Or a returning doctor’s skills may simply be rusty.
“My hands feel like those of an intern,” said Dr. Molly Carey, 36, an Ivy League–educated doctor who recently enrolled in a Texas retraining program after 4 years away from patients.
After extended leaves, doctors must convince medical boards to reissue their licenses, hospitals to grant admitting privileges, and malpractice insurers to provide coverage. Only a handful of programs around the country are set up to help physicians brush up on their skills, and they can cost doctors thousands of dollars.
“Medical schools do a fantastic job graduating brand new medical students,” said Dr. Humayun J. Chaudhry, president of the Federation of State Medical Boards. “But what about people who have already graduated and need to get some retraining? There is clearly a dearth of those kind of training programs.”
Policy makers and professional organizations are pushing to make the process less burdensome and costly – in part because it may help ease shortages of primary care doctors.
Getting experienced doctors to dust off their white coats is cheaper than starting from scratch, said Dr. Robert Steele, director of KSTAR physician programs at Texas A&M Health Science Center, College Station. He oversees a miniresidency program at the University of Texas Medical Branch, Galveston, in which returning doctors divide their time between seeing patients and attending classes. The 3-month training includes the latest on medications, procedures, disease management, and treatment.
“[Returning doctors] just need polishing up to practice safely and competently,” Dr. Steele said.
Patient safety advocates argue that minimum standards should be set to ensure that doctors coming back after a hiatus are providing the best care possible. As it stands, no nationwide standards or requirements exist, and states have different requirements.
“Patients would like to think that any doctor who is seeing them or doing procedures on them is at the height of their career,” said Joe Kiani, founder of the Patient Safety Movement Foundation. “If a doctor has been out for a while, they are not.”
Dr. Carey had a great education, graduating from medical school at the University of Pennsylvania and completing a residency in 2011 in obstetrics and gynecology at Brown University and a Providence hospital. But after taking just 4 years off to care for a sick grandmother and another relative, she felt she needed to freshen her clinical skills. So she moved from Rhode Island to Texas to take part in the KSTAR program, hoping to gain more confidence as a surgeon and become more marketable.
Setting standards and removing obstacles
Reliable numbers of how many doctors suspend their practices aren’t available, but the American Medical Association estimated in 2011 that 10,000 doctors could reenter practice each year.
The Federation of State Medical Boards wants states to create a standard process for physicians to show they have the skills to return to medicine. It is asking licensing agencies to track whether doctors are still practicing and whether they are doing so in their area of training.
The American Academy of Pediatrics and the AMA also are trying to remove obstacles for doctors who want to return to work after taking time off. And Rep. John Sarbanes (D-Md.) has proposed legislation to help expand reentry programs for primary care doctors and help cover physicians’ costs if they agree to practice in high-need areas.
After hitting a wall with her former employer and others, Dr. Gibson enrolled in an online retraining program in San Diego, which cost her $7,000. She spent 4 months completing the courses last year and a week shadowing a family physician. Then she took a written exam and was evaluated during mock visits with “patients” played by actors.
In the end, she received two certificates – one from the program and one from the University of California, San Diego, for 180 hours of continuing medical education.
“I definitely felt more confident,” Dr. Gibson said. But she still wanted more hands-on clinical training. So she recently started a paid family medicine fellowship at the University of Southern California, seeing patients under the oversight of other doctors.
Former medical school professor Dr. Leonard Glass created the San Diego program, called the Physician Retraining and Reentry Program, in 2013. Besides retraining primary care doctors, the online program has attracted specialists who wanted to switch to primary care, as well as some restless retirees.
“Some are simply tired of being retired,” he said. “It’s sort of an itch to go back to taking care of people.”
‘Expensive and time consuming’
Several retraining programs are run by hospitals, including Cedars-Sinai Medical Center in Los Angeles. There, participants spend between 6 weeks and 3 months seeing patients under the supervision of other physicians, then discuss their cases in an exit interview to demonstrate what they learned. They leave with a letter that can be submitted to employers or hospitals.
The Cedars-Sinai program costs $5,000 a month. Dr. Leo A. Gordon, who runs it, said some doctors who call to inquire are angry about having to spend the time and money when they already have so much education and experience. But he said others are simply appreciative that “there is a way to get back in the game.”
One Cedars-Sinai graduate, Dr. Maria DiMeglio decided she wanted to return to practice as an ob.gyn. after taking off almost 6 years to care for her children and her ill mother.
“I thought I was retiring, Dr. DiMeglio said, “but I kept my options open.” She had retained her medical license and kept up with continuing education courses. But she needed to persuade her old hospital, Cedars-Sinai, to give her privileges so she could perform surgeries. The Cedars-Sinai retraining program, she said, “wasn’t difficult, but it was expensive and time consuming. Not everyone can do that.”
Hospitals set their own requirements for doctors to get credentials and privileges, but doctors who have been out of practice for more than 2 years generally must show that they are competent to see patients. Having a certificate from a reentry program helps, said Dr. David Perrott, senior vice president and chief medical officer of the California Hospital Association.
Dr. Jeff Petrozzino, a 50-year old doctor who trained in pediatrics and neonatology, knows all about that. He ran into difficulty returning to clinical practice after spending several years doing health economics research.
“I was a double board–certified physician licensed in several states,” he said. “You would think I would be able to get a job.”
When he finally did get an offer at a medical center in New Jersey, he said both the position and the state medical license were contingent on him getting retrained. He completed a 2-month program at Drexel University in 2013, where he was surprised to discover many other doctors in a similar situation.
Dr. Petrozzino said he was grateful for the program – but given the hassles of reentry, he would advise doctors to plan carefully before taking a break from practice.
“Careers are interrupted or derailed for various reasons,” he said. “The system does not readily allow for reentry.”
Kaiser Health News (KHN) is a nonprofit national health policy news service. Blue Shield of California Foundation helps fund KHN coverage in California.
Be aware of ‘gotcha’ clauses in managed care contracts
CHICAGO – Too often, physicians sign managed care contracts without negotiating or truly understanding all the terms. The complex clauses – or lack thereof – can come back to bite doctors in the form of delayed payments, sudden policy changes, and termination woes, health law attorney Mark S. Kopson warned at conference held by the American Bar Association.
To avoid these unwelcome surprises, prepare for contract discussions well before the conversation starts, Mr. Kopson advised.
“Don’t go into any negotiation unless you know two things. The first is what your starting position will be and, equally if not more important, is what is your ultimate line in the sand?” said Mr. Kopson, who practices in Bloomfield Hills, Mich. “If you go in there not knowing those answers, you’re liable to give away the store or not get what you really need.”
One major “gotcha” is an insurer that does not reveal upfront that it is not the actual payer, Mr. Kopson said. Some national companies that enter into contracts with doctors are basically network aggregators that negotiate price discounts but then sell the network to the health insurance marketplace, he explained. Physicians later realize their contract states that the company is not responsible for paying claims and that the doctor does not have a contract directly with the payer.
“This is a really big issue that I’ve been seeing more and more frequently,” Mr. Kopson said at the meeting. “If you don’t have a direct contract with the payer, you have the possibility of not being able to force payment obligations against the responsible party.”
Specify in your contract that the plan must require the payer to pay, he said. That way, if a payer fails to pay, the plan has breached its contract obligation.
Contract terms that involve medical necessity also can lead to frustration if not properly negotiated. In some cases, the fine print states that medical necessity will be determined by the plan’s medical director or otherwise will be ultimately decided by the payer. Instead, include language specifying that a treating physician’s professional opinion will be entitled to great deference if medical necessity comes into question, Mr. Kopson said.
The process surrounding clean claims is often overlooked by physicians during contract negotiations, he added. The “gotcha” occurs when a plan retains full control over how contested claims are handled.
“If you don’t adequately address this in the contract, you wind up with the payer taking multiple bites of the apple,” Mr. Kopson said.
Make sure to clarify parameters for how long insurers have to request additional information about a claim and whether they must pay a portion of the claim that is being contested, he advised. Include a firm time line of when payers must complete their review and address payment after the requested information is provided.
Another critical issue: changes to the contract. In some cases, doctors enter into a contract with a plan and then the plan decides some details aren’t working out and makes changes. The physician later learns that the contract language allowed the plan to make unilateral changes. In other instances, a plan institutes new products and doctors learn that they had only a certain timeframe to opt out.
To avoid these situations, specify during contract negotiations that policies in conflict with the contract are prohibited, that contract changes can only be made bilaterally, and that unless you directly opt-in to new products, you will not participate.
Mr. Kopson encouraged physicians to have a solid exit strategy in their contracts and to ensure terms regarding contract termination are clearly understood. Clearly defined criteria around “cause” for termination are imperative, he said. Additionally, if a plan alleges a termination breach, require it to send a written notice to a specific person/title and ensure that the notice also is provided to counsel.
The bottom line: To avoid trouble later, strongly negotiate at the start of a managed care contract, Mr. Kopson said.
“If you don’t ask, if you don’t negotiate it in there, you’re not going to have that weapon,” he said.
On Twitter @legal_med
CHICAGO – Too often, physicians sign managed care contracts without negotiating or truly understanding all the terms. The complex clauses – or lack thereof – can come back to bite doctors in the form of delayed payments, sudden policy changes, and termination woes, health law attorney Mark S. Kopson warned at conference held by the American Bar Association.
To avoid these unwelcome surprises, prepare for contract discussions well before the conversation starts, Mr. Kopson advised.
“Don’t go into any negotiation unless you know two things. The first is what your starting position will be and, equally if not more important, is what is your ultimate line in the sand?” said Mr. Kopson, who practices in Bloomfield Hills, Mich. “If you go in there not knowing those answers, you’re liable to give away the store or not get what you really need.”
One major “gotcha” is an insurer that does not reveal upfront that it is not the actual payer, Mr. Kopson said. Some national companies that enter into contracts with doctors are basically network aggregators that negotiate price discounts but then sell the network to the health insurance marketplace, he explained. Physicians later realize their contract states that the company is not responsible for paying claims and that the doctor does not have a contract directly with the payer.
“This is a really big issue that I’ve been seeing more and more frequently,” Mr. Kopson said at the meeting. “If you don’t have a direct contract with the payer, you have the possibility of not being able to force payment obligations against the responsible party.”
Specify in your contract that the plan must require the payer to pay, he said. That way, if a payer fails to pay, the plan has breached its contract obligation.
Contract terms that involve medical necessity also can lead to frustration if not properly negotiated. In some cases, the fine print states that medical necessity will be determined by the plan’s medical director or otherwise will be ultimately decided by the payer. Instead, include language specifying that a treating physician’s professional opinion will be entitled to great deference if medical necessity comes into question, Mr. Kopson said.
The process surrounding clean claims is often overlooked by physicians during contract negotiations, he added. The “gotcha” occurs when a plan retains full control over how contested claims are handled.
“If you don’t adequately address this in the contract, you wind up with the payer taking multiple bites of the apple,” Mr. Kopson said.
Make sure to clarify parameters for how long insurers have to request additional information about a claim and whether they must pay a portion of the claim that is being contested, he advised. Include a firm time line of when payers must complete their review and address payment after the requested information is provided.
Another critical issue: changes to the contract. In some cases, doctors enter into a contract with a plan and then the plan decides some details aren’t working out and makes changes. The physician later learns that the contract language allowed the plan to make unilateral changes. In other instances, a plan institutes new products and doctors learn that they had only a certain timeframe to opt out.
To avoid these situations, specify during contract negotiations that policies in conflict with the contract are prohibited, that contract changes can only be made bilaterally, and that unless you directly opt-in to new products, you will not participate.
Mr. Kopson encouraged physicians to have a solid exit strategy in their contracts and to ensure terms regarding contract termination are clearly understood. Clearly defined criteria around “cause” for termination are imperative, he said. Additionally, if a plan alleges a termination breach, require it to send a written notice to a specific person/title and ensure that the notice also is provided to counsel.
The bottom line: To avoid trouble later, strongly negotiate at the start of a managed care contract, Mr. Kopson said.
“If you don’t ask, if you don’t negotiate it in there, you’re not going to have that weapon,” he said.
On Twitter @legal_med
CHICAGO – Too often, physicians sign managed care contracts without negotiating or truly understanding all the terms. The complex clauses – or lack thereof – can come back to bite doctors in the form of delayed payments, sudden policy changes, and termination woes, health law attorney Mark S. Kopson warned at conference held by the American Bar Association.
To avoid these unwelcome surprises, prepare for contract discussions well before the conversation starts, Mr. Kopson advised.
“Don’t go into any negotiation unless you know two things. The first is what your starting position will be and, equally if not more important, is what is your ultimate line in the sand?” said Mr. Kopson, who practices in Bloomfield Hills, Mich. “If you go in there not knowing those answers, you’re liable to give away the store or not get what you really need.”
One major “gotcha” is an insurer that does not reveal upfront that it is not the actual payer, Mr. Kopson said. Some national companies that enter into contracts with doctors are basically network aggregators that negotiate price discounts but then sell the network to the health insurance marketplace, he explained. Physicians later realize their contract states that the company is not responsible for paying claims and that the doctor does not have a contract directly with the payer.
“This is a really big issue that I’ve been seeing more and more frequently,” Mr. Kopson said at the meeting. “If you don’t have a direct contract with the payer, you have the possibility of not being able to force payment obligations against the responsible party.”
Specify in your contract that the plan must require the payer to pay, he said. That way, if a payer fails to pay, the plan has breached its contract obligation.
Contract terms that involve medical necessity also can lead to frustration if not properly negotiated. In some cases, the fine print states that medical necessity will be determined by the plan’s medical director or otherwise will be ultimately decided by the payer. Instead, include language specifying that a treating physician’s professional opinion will be entitled to great deference if medical necessity comes into question, Mr. Kopson said.
The process surrounding clean claims is often overlooked by physicians during contract negotiations, he added. The “gotcha” occurs when a plan retains full control over how contested claims are handled.
“If you don’t adequately address this in the contract, you wind up with the payer taking multiple bites of the apple,” Mr. Kopson said.
Make sure to clarify parameters for how long insurers have to request additional information about a claim and whether they must pay a portion of the claim that is being contested, he advised. Include a firm time line of when payers must complete their review and address payment after the requested information is provided.
Another critical issue: changes to the contract. In some cases, doctors enter into a contract with a plan and then the plan decides some details aren’t working out and makes changes. The physician later learns that the contract language allowed the plan to make unilateral changes. In other instances, a plan institutes new products and doctors learn that they had only a certain timeframe to opt out.
To avoid these situations, specify during contract negotiations that policies in conflict with the contract are prohibited, that contract changes can only be made bilaterally, and that unless you directly opt-in to new products, you will not participate.
Mr. Kopson encouraged physicians to have a solid exit strategy in their contracts and to ensure terms regarding contract termination are clearly understood. Clearly defined criteria around “cause” for termination are imperative, he said. Additionally, if a plan alleges a termination breach, require it to send a written notice to a specific person/title and ensure that the notice also is provided to counsel.
The bottom line: To avoid trouble later, strongly negotiate at the start of a managed care contract, Mr. Kopson said.
“If you don’t ask, if you don’t negotiate it in there, you’re not going to have that weapon,” he said.
On Twitter @legal_med
EXPERT ANALYSIS FROM THE PHYSICIANS LEGAL ISSUES CONFERENCE
VIDEO: How should you respond to a possible privacy breach?
CHICAGO – Overreact, don’t underreact, when it comes to possible health care privacy breaches, attorney Clinton Mikel advised at a conference held by the American Bar Association.
The actions that physicians take immediately following a potential data exposure will significantly impact how the Health and Human Services Department’s Office for Civil Rights (OCR) responds to the incident and whether physicians face penalties, said Mr. Mikel, who specializes in the Health Insurance Portability and Accountability Act (HIPAA) and state privacy laws.
In an interview at the conference, Mr. Mikel, who practices law in Southfield, Mich., discussed common misconceptions that physicians have about privacy breaches and the best ways in which to respond internally to possible exposures. He also offered guidance on the top mistakes to avoid when confronted with possible security breaches and shared perspective on how the OCR might address such issues in the future.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO – Overreact, don’t underreact, when it comes to possible health care privacy breaches, attorney Clinton Mikel advised at a conference held by the American Bar Association.
The actions that physicians take immediately following a potential data exposure will significantly impact how the Health and Human Services Department’s Office for Civil Rights (OCR) responds to the incident and whether physicians face penalties, said Mr. Mikel, who specializes in the Health Insurance Portability and Accountability Act (HIPAA) and state privacy laws.
In an interview at the conference, Mr. Mikel, who practices law in Southfield, Mich., discussed common misconceptions that physicians have about privacy breaches and the best ways in which to respond internally to possible exposures. He also offered guidance on the top mistakes to avoid when confronted with possible security breaches and shared perspective on how the OCR might address such issues in the future.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO – Overreact, don’t underreact, when it comes to possible health care privacy breaches, attorney Clinton Mikel advised at a conference held by the American Bar Association.
The actions that physicians take immediately following a potential data exposure will significantly impact how the Health and Human Services Department’s Office for Civil Rights (OCR) responds to the incident and whether physicians face penalties, said Mr. Mikel, who specializes in the Health Insurance Portability and Accountability Act (HIPAA) and state privacy laws.
In an interview at the conference, Mr. Mikel, who practices law in Southfield, Mich., discussed common misconceptions that physicians have about privacy breaches and the best ways in which to respond internally to possible exposures. He also offered guidance on the top mistakes to avoid when confronted with possible security breaches and shared perspective on how the OCR might address such issues in the future.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
EXPERT ANALYSIS FROM THE PHYSICIANS LEGAL ISSUES CONFERENCE
AMA HOD: Preconception care, reducing opioid abuse are top issues
CHIGAGO – Primary care physicians need better training on preconception counseling, according to the American Medical Association House of Delegates.
At its annual meeting, the HOD passed without debate on June 9 a resolution that calls for the AMA to “support the training of all primary care physicians and relevant allied health professionals in the area of preconception counseling, including the recognition of long-acting reversible contraceptives as efficacious and economical forms of contraception.”
According to the reference committee report, the committee noted that “tremendously supportive testimony was heard for efforts to prevent teen pregnancy and for the use of long-acting reversible contraceptives (sic) methods to achieve such prevention and minimize barriers for the use of effective contraception.”
Delegates also called upon the AMA to work with federal stakeholders and pharmaceutical manufacturers to “intensify collaborative efforts involving a public health approach” to reduce harm from inappropriate use, misuse, and diversion of prescription controlled substances, increase awareness that substance use disorders are chronic diseases in need of treatment, and reduce the stigma associated with patients suffering from persistent pain and/or substance use disorders.
According to the report, limited testimony noted that it was “incumbent upon our AMA to continue to address these issues, and further intensify collaborative efforts in order to promote solutions to what are difficult and complex public health issues facing the American public, patients, and their families, and the health care professionals who are entrusted with their treatment.”
The reference committee tackled a number of other issues. Among them was a resolution targeting advocacy for hepatitis C virus education, prevention, screening and treatment. The resolution adopted without debate called for birth year–based HCV screening in alignment with recommendations of the Centers for Disease Control and Prevention; working with the CDC and others on education and prevention efforts; supporting screening, prevention, and treatment programs “targeted toward maximum health benefit”; supporting adequate funding and negotiation for affordable pricing for HCV treatments; and recognizing correctional physicians and other physicians in the public health sector as key stakeholders in the development of HCV treatment guidelines.
Also addressed were issues related to drug labeling, with calls to the AMA to work with the Food and Drug Administration to ensure that drug labels are updated quicker as new evidence comes to market.
Delegates called on the AMA to support federal efforts to stimulate early research and development of rapid infectious disease diagnostic technologies through increased funding for the appropriate agencies, and to work with payers to overcome reimbursement barriers.
CHIGAGO – Primary care physicians need better training on preconception counseling, according to the American Medical Association House of Delegates.
At its annual meeting, the HOD passed without debate on June 9 a resolution that calls for the AMA to “support the training of all primary care physicians and relevant allied health professionals in the area of preconception counseling, including the recognition of long-acting reversible contraceptives as efficacious and economical forms of contraception.”
According to the reference committee report, the committee noted that “tremendously supportive testimony was heard for efforts to prevent teen pregnancy and for the use of long-acting reversible contraceptives (sic) methods to achieve such prevention and minimize barriers for the use of effective contraception.”
Delegates also called upon the AMA to work with federal stakeholders and pharmaceutical manufacturers to “intensify collaborative efforts involving a public health approach” to reduce harm from inappropriate use, misuse, and diversion of prescription controlled substances, increase awareness that substance use disorders are chronic diseases in need of treatment, and reduce the stigma associated with patients suffering from persistent pain and/or substance use disorders.
According to the report, limited testimony noted that it was “incumbent upon our AMA to continue to address these issues, and further intensify collaborative efforts in order to promote solutions to what are difficult and complex public health issues facing the American public, patients, and their families, and the health care professionals who are entrusted with their treatment.”
The reference committee tackled a number of other issues. Among them was a resolution targeting advocacy for hepatitis C virus education, prevention, screening and treatment. The resolution adopted without debate called for birth year–based HCV screening in alignment with recommendations of the Centers for Disease Control and Prevention; working with the CDC and others on education and prevention efforts; supporting screening, prevention, and treatment programs “targeted toward maximum health benefit”; supporting adequate funding and negotiation for affordable pricing for HCV treatments; and recognizing correctional physicians and other physicians in the public health sector as key stakeholders in the development of HCV treatment guidelines.
Also addressed were issues related to drug labeling, with calls to the AMA to work with the Food and Drug Administration to ensure that drug labels are updated quicker as new evidence comes to market.
Delegates called on the AMA to support federal efforts to stimulate early research and development of rapid infectious disease diagnostic technologies through increased funding for the appropriate agencies, and to work with payers to overcome reimbursement barriers.
CHIGAGO – Primary care physicians need better training on preconception counseling, according to the American Medical Association House of Delegates.
At its annual meeting, the HOD passed without debate on June 9 a resolution that calls for the AMA to “support the training of all primary care physicians and relevant allied health professionals in the area of preconception counseling, including the recognition of long-acting reversible contraceptives as efficacious and economical forms of contraception.”
According to the reference committee report, the committee noted that “tremendously supportive testimony was heard for efforts to prevent teen pregnancy and for the use of long-acting reversible contraceptives (sic) methods to achieve such prevention and minimize barriers for the use of effective contraception.”
Delegates also called upon the AMA to work with federal stakeholders and pharmaceutical manufacturers to “intensify collaborative efforts involving a public health approach” to reduce harm from inappropriate use, misuse, and diversion of prescription controlled substances, increase awareness that substance use disorders are chronic diseases in need of treatment, and reduce the stigma associated with patients suffering from persistent pain and/or substance use disorders.
According to the report, limited testimony noted that it was “incumbent upon our AMA to continue to address these issues, and further intensify collaborative efforts in order to promote solutions to what are difficult and complex public health issues facing the American public, patients, and their families, and the health care professionals who are entrusted with their treatment.”
The reference committee tackled a number of other issues. Among them was a resolution targeting advocacy for hepatitis C virus education, prevention, screening and treatment. The resolution adopted without debate called for birth year–based HCV screening in alignment with recommendations of the Centers for Disease Control and Prevention; working with the CDC and others on education and prevention efforts; supporting screening, prevention, and treatment programs “targeted toward maximum health benefit”; supporting adequate funding and negotiation for affordable pricing for HCV treatments; and recognizing correctional physicians and other physicians in the public health sector as key stakeholders in the development of HCV treatment guidelines.
Also addressed were issues related to drug labeling, with calls to the AMA to work with the Food and Drug Administration to ensure that drug labels are updated quicker as new evidence comes to market.
Delegates called on the AMA to support federal efforts to stimulate early research and development of rapid infectious disease diagnostic technologies through increased funding for the appropriate agencies, and to work with payers to overcome reimbursement barriers.
AT THE AMA HOD MEETING
ICOO: Massachusetts governor takes on opioid epidemic
BOSTON – A campaign promise to create viable strategies aimed at reducing the overuse of prescription opioids will be fulfilled, the governor of Massachusetts said during a keynote address at the International Conference on Opioids.
Without providing many specifics, Gov. Charles D. Baker (R) reported that the task force he created will soon release recommendations around three major components: 1. prevention and education; 2. addiction and intervention; and 3. the treatment of pain. He emphasized the importance of a comprehensive strategy.
“I am smart enough to know or humble enough to know that any one initiative in regard to this type of thing is unlikely to get us to where we need to go,” Gov. Baker said. Decriminalizing addiction will be part of the strategy aimed at reducing roadblocks to treatment, he said.
The opioid epidemic was not an initial part of Gov. Baker’s 2014 platform in his campaign for governor. Rather, he added a promise to address this problem in his inaugural address after voters expressed their concern repeatedly. He reported being “astonished” by how often he heard stories of addiction to prescription opioids.
“It didn’t matter where I was. It didn’t matter what part of the commonwealth I was in. It did not matter what kind of neighborhood I was in. It didn’t matter what the socioeconomic demographic makeup was of the group I was talking to,” Gov. Baker said. “It was literally everywhere.”
He said hard numbers tell the same story. In addition to the often repeated national statistics regarding the rapid increase in opioid prescriptions and its close correlation with opioid-related deaths, he said no area of Massachusetts has been left untouched. According to Gov. Baker, the largest hospital in the town of Plymouth, Mass., which has a population just under 60,000, is now averaging one opioid overdose per day.
“I am one of those people who thinks that you cannot solve this problem if you do not engage the health care community,” Gov. Baker said. One reason to focus on health care providers, the governor said, is that data from the Substance Abuse and Mental Health Services Administration show that a large percentage of patients addicted to heroin started on prescription pain medication.
The thrust of the coming initiatives is therefore likely to advocate pain medicine practice that reduces inappropriate prescriptions, Gov. Baker said. He noted that an initiative started 2 years ago by Blue Cross Blue Shield of Massachusetts resulted in a 25% reduction in opioid prescribing without restricting pain medications for those who need them.
In general, the address, which was heavily covered by the local news media, was well-received by those who attended the International Conference on Opioids. There was one area of disagreement. Many did not believe that most heroin addictions start with a prescription pain medication. Of those who challenged that assertion, Dr. Carol A. Warfield, the Lowenstein Distinguished Professor of Anesthesia at Harvard Medical School, Boston, clarified that those opioids might have been prescription drugs but were not prescribed to the user. Rather, the drugs were diverted, and this is a much more important focus of efforts to halt the epidemic than new restrictions on their use for pain control.
Similarly, Pamela J. Madej, a registered nurse affiliated with the Albany Center for Pain Management, New York, cautioned against overemphasizing the value of regulating opioids. She said plenty of regulations exist in New York but the problem persists. Many people are self-medicating for mental health disorders, she said, including the chronic brain disorder of addiction, for which coverage continues to be limited.
“Patients switch from hydrocodone to heroin, because heroin is cheaper,” Ms. Madej said. “We need expanded coverage for mental health to address the underlying problem.”
BOSTON – A campaign promise to create viable strategies aimed at reducing the overuse of prescription opioids will be fulfilled, the governor of Massachusetts said during a keynote address at the International Conference on Opioids.
Without providing many specifics, Gov. Charles D. Baker (R) reported that the task force he created will soon release recommendations around three major components: 1. prevention and education; 2. addiction and intervention; and 3. the treatment of pain. He emphasized the importance of a comprehensive strategy.
“I am smart enough to know or humble enough to know that any one initiative in regard to this type of thing is unlikely to get us to where we need to go,” Gov. Baker said. Decriminalizing addiction will be part of the strategy aimed at reducing roadblocks to treatment, he said.
The opioid epidemic was not an initial part of Gov. Baker’s 2014 platform in his campaign for governor. Rather, he added a promise to address this problem in his inaugural address after voters expressed their concern repeatedly. He reported being “astonished” by how often he heard stories of addiction to prescription opioids.
“It didn’t matter where I was. It didn’t matter what part of the commonwealth I was in. It did not matter what kind of neighborhood I was in. It didn’t matter what the socioeconomic demographic makeup was of the group I was talking to,” Gov. Baker said. “It was literally everywhere.”
He said hard numbers tell the same story. In addition to the often repeated national statistics regarding the rapid increase in opioid prescriptions and its close correlation with opioid-related deaths, he said no area of Massachusetts has been left untouched. According to Gov. Baker, the largest hospital in the town of Plymouth, Mass., which has a population just under 60,000, is now averaging one opioid overdose per day.
“I am one of those people who thinks that you cannot solve this problem if you do not engage the health care community,” Gov. Baker said. One reason to focus on health care providers, the governor said, is that data from the Substance Abuse and Mental Health Services Administration show that a large percentage of patients addicted to heroin started on prescription pain medication.
The thrust of the coming initiatives is therefore likely to advocate pain medicine practice that reduces inappropriate prescriptions, Gov. Baker said. He noted that an initiative started 2 years ago by Blue Cross Blue Shield of Massachusetts resulted in a 25% reduction in opioid prescribing without restricting pain medications for those who need them.
In general, the address, which was heavily covered by the local news media, was well-received by those who attended the International Conference on Opioids. There was one area of disagreement. Many did not believe that most heroin addictions start with a prescription pain medication. Of those who challenged that assertion, Dr. Carol A. Warfield, the Lowenstein Distinguished Professor of Anesthesia at Harvard Medical School, Boston, clarified that those opioids might have been prescription drugs but were not prescribed to the user. Rather, the drugs were diverted, and this is a much more important focus of efforts to halt the epidemic than new restrictions on their use for pain control.
Similarly, Pamela J. Madej, a registered nurse affiliated with the Albany Center for Pain Management, New York, cautioned against overemphasizing the value of regulating opioids. She said plenty of regulations exist in New York but the problem persists. Many people are self-medicating for mental health disorders, she said, including the chronic brain disorder of addiction, for which coverage continues to be limited.
“Patients switch from hydrocodone to heroin, because heroin is cheaper,” Ms. Madej said. “We need expanded coverage for mental health to address the underlying problem.”
BOSTON – A campaign promise to create viable strategies aimed at reducing the overuse of prescription opioids will be fulfilled, the governor of Massachusetts said during a keynote address at the International Conference on Opioids.
Without providing many specifics, Gov. Charles D. Baker (R) reported that the task force he created will soon release recommendations around three major components: 1. prevention and education; 2. addiction and intervention; and 3. the treatment of pain. He emphasized the importance of a comprehensive strategy.
“I am smart enough to know or humble enough to know that any one initiative in regard to this type of thing is unlikely to get us to where we need to go,” Gov. Baker said. Decriminalizing addiction will be part of the strategy aimed at reducing roadblocks to treatment, he said.
The opioid epidemic was not an initial part of Gov. Baker’s 2014 platform in his campaign for governor. Rather, he added a promise to address this problem in his inaugural address after voters expressed their concern repeatedly. He reported being “astonished” by how often he heard stories of addiction to prescription opioids.
“It didn’t matter where I was. It didn’t matter what part of the commonwealth I was in. It did not matter what kind of neighborhood I was in. It didn’t matter what the socioeconomic demographic makeup was of the group I was talking to,” Gov. Baker said. “It was literally everywhere.”
He said hard numbers tell the same story. In addition to the often repeated national statistics regarding the rapid increase in opioid prescriptions and its close correlation with opioid-related deaths, he said no area of Massachusetts has been left untouched. According to Gov. Baker, the largest hospital in the town of Plymouth, Mass., which has a population just under 60,000, is now averaging one opioid overdose per day.
“I am one of those people who thinks that you cannot solve this problem if you do not engage the health care community,” Gov. Baker said. One reason to focus on health care providers, the governor said, is that data from the Substance Abuse and Mental Health Services Administration show that a large percentage of patients addicted to heroin started on prescription pain medication.
The thrust of the coming initiatives is therefore likely to advocate pain medicine practice that reduces inappropriate prescriptions, Gov. Baker said. He noted that an initiative started 2 years ago by Blue Cross Blue Shield of Massachusetts resulted in a 25% reduction in opioid prescribing without restricting pain medications for those who need them.
In general, the address, which was heavily covered by the local news media, was well-received by those who attended the International Conference on Opioids. There was one area of disagreement. Many did not believe that most heroin addictions start with a prescription pain medication. Of those who challenged that assertion, Dr. Carol A. Warfield, the Lowenstein Distinguished Professor of Anesthesia at Harvard Medical School, Boston, clarified that those opioids might have been prescription drugs but were not prescribed to the user. Rather, the drugs were diverted, and this is a much more important focus of efforts to halt the epidemic than new restrictions on their use for pain control.
Similarly, Pamela J. Madej, a registered nurse affiliated with the Albany Center for Pain Management, New York, cautioned against overemphasizing the value of regulating opioids. She said plenty of regulations exist in New York but the problem persists. Many people are self-medicating for mental health disorders, she said, including the chronic brain disorder of addiction, for which coverage continues to be limited.
“Patients switch from hydrocodone to heroin, because heroin is cheaper,” Ms. Madej said. “We need expanded coverage for mental health to address the underlying problem.”
AMA HOD: Delegates advocate medical service, health system reforms resolutions with little debate
CHICAGO – Other than a brief amendment related to the 3-day rule, the American Medical Association House of Delegates adopted via voice vote a series of reference committee recommendations related to medical service and health system reform.
The lone item that came up for discussion during the June 9 vote at the AMA HOD annual meeting was related to the 3-day rule. The reference committee had substituted language of two separate resolutions and combined it into one, with two provisions: that the AMA “continue to advocate that Congress eliminate the 3-day hospital inpatient requirement for Medicare coverage of posthospital skilled nursing facility services, and educate Congress on the impact of this requirement on patients,” and that the association continue to advocate for the start of the timing clock toward meeting the 3-day rule being when the person enters the hospital or the emergency department or when under an observational status.
During the full-house session, a third resolution was added that the AMA work with the Centers for Medicare & Medicaid Services to eliminate any regulations requiring inpatient hospitalization as a prerequisite for a Medicare patient’s being eligible for skilled nursing facility or long-term care placement, language resurrected from one of the two earlier resolutions.
Other adopted resolutions cover a wide range of topics, including the high price of generic drugs, vasectomy coverage, end-of-life counseling, and understanding the effects of Medicaid expansion.
Various separate resolutions related to the high cost of generic drugs were rolled into one final resolution that calls for a number of actions.
First, it calls on the AMA to work collaboratively with Food and Drug Administration, the Federal Trade Commission, the Generic Pharmaceutical Association, and other relevant stakeholders to promote policies that address the rising cost of generic drugs. The resolution calls on the AMA to seek a legislative solution to ensure fair generic drug pricing and to educate Congress on the adverse effects of high generic drug pricing.
On Medicaid expansion, the house instructed the AMA to understand the level of health care access due to expansion, the quality of health care delivered, the adequacy of provider payments, and the effects of Medicaid expansion as a whole.
Delegates also adopted a resolution asking the AMA to encourage all private and public payers to reimburse for advanced care planning.
On contraception, the AMA was directed to work with national state and medical specialty societies “to advocate for patient access to the full continuum of evidence-based contraceptive methods and sterilization procedures, including vasectomy and male contraceptive counseling, to promote gender equality in contraceptive services under the ACA.”
With the move to alternate payment models that pay for value and outcomes, the AMA received direction to help practicing physicians with guidance and other assistance to help in the transition.
CHICAGO – Other than a brief amendment related to the 3-day rule, the American Medical Association House of Delegates adopted via voice vote a series of reference committee recommendations related to medical service and health system reform.
The lone item that came up for discussion during the June 9 vote at the AMA HOD annual meeting was related to the 3-day rule. The reference committee had substituted language of two separate resolutions and combined it into one, with two provisions: that the AMA “continue to advocate that Congress eliminate the 3-day hospital inpatient requirement for Medicare coverage of posthospital skilled nursing facility services, and educate Congress on the impact of this requirement on patients,” and that the association continue to advocate for the start of the timing clock toward meeting the 3-day rule being when the person enters the hospital or the emergency department or when under an observational status.
During the full-house session, a third resolution was added that the AMA work with the Centers for Medicare & Medicaid Services to eliminate any regulations requiring inpatient hospitalization as a prerequisite for a Medicare patient’s being eligible for skilled nursing facility or long-term care placement, language resurrected from one of the two earlier resolutions.
Other adopted resolutions cover a wide range of topics, including the high price of generic drugs, vasectomy coverage, end-of-life counseling, and understanding the effects of Medicaid expansion.
Various separate resolutions related to the high cost of generic drugs were rolled into one final resolution that calls for a number of actions.
First, it calls on the AMA to work collaboratively with Food and Drug Administration, the Federal Trade Commission, the Generic Pharmaceutical Association, and other relevant stakeholders to promote policies that address the rising cost of generic drugs. The resolution calls on the AMA to seek a legislative solution to ensure fair generic drug pricing and to educate Congress on the adverse effects of high generic drug pricing.
On Medicaid expansion, the house instructed the AMA to understand the level of health care access due to expansion, the quality of health care delivered, the adequacy of provider payments, and the effects of Medicaid expansion as a whole.
Delegates also adopted a resolution asking the AMA to encourage all private and public payers to reimburse for advanced care planning.
On contraception, the AMA was directed to work with national state and medical specialty societies “to advocate for patient access to the full continuum of evidence-based contraceptive methods and sterilization procedures, including vasectomy and male contraceptive counseling, to promote gender equality in contraceptive services under the ACA.”
With the move to alternate payment models that pay for value and outcomes, the AMA received direction to help practicing physicians with guidance and other assistance to help in the transition.
CHICAGO – Other than a brief amendment related to the 3-day rule, the American Medical Association House of Delegates adopted via voice vote a series of reference committee recommendations related to medical service and health system reform.
The lone item that came up for discussion during the June 9 vote at the AMA HOD annual meeting was related to the 3-day rule. The reference committee had substituted language of two separate resolutions and combined it into one, with two provisions: that the AMA “continue to advocate that Congress eliminate the 3-day hospital inpatient requirement for Medicare coverage of posthospital skilled nursing facility services, and educate Congress on the impact of this requirement on patients,” and that the association continue to advocate for the start of the timing clock toward meeting the 3-day rule being when the person enters the hospital or the emergency department or when under an observational status.
During the full-house session, a third resolution was added that the AMA work with the Centers for Medicare & Medicaid Services to eliminate any regulations requiring inpatient hospitalization as a prerequisite for a Medicare patient’s being eligible for skilled nursing facility or long-term care placement, language resurrected from one of the two earlier resolutions.
Other adopted resolutions cover a wide range of topics, including the high price of generic drugs, vasectomy coverage, end-of-life counseling, and understanding the effects of Medicaid expansion.
Various separate resolutions related to the high cost of generic drugs were rolled into one final resolution that calls for a number of actions.
First, it calls on the AMA to work collaboratively with Food and Drug Administration, the Federal Trade Commission, the Generic Pharmaceutical Association, and other relevant stakeholders to promote policies that address the rising cost of generic drugs. The resolution calls on the AMA to seek a legislative solution to ensure fair generic drug pricing and to educate Congress on the adverse effects of high generic drug pricing.
On Medicaid expansion, the house instructed the AMA to understand the level of health care access due to expansion, the quality of health care delivered, the adequacy of provider payments, and the effects of Medicaid expansion as a whole.
Delegates also adopted a resolution asking the AMA to encourage all private and public payers to reimburse for advanced care planning.
On contraception, the AMA was directed to work with national state and medical specialty societies “to advocate for patient access to the full continuum of evidence-based contraceptive methods and sterilization procedures, including vasectomy and male contraceptive counseling, to promote gender equality in contraceptive services under the ACA.”
With the move to alternate payment models that pay for value and outcomes, the AMA received direction to help practicing physicians with guidance and other assistance to help in the transition.
AT THE AMA HOD MEETING