president’s farewell message In search of a definition for medical … · 2011-10-19 · ity covera ge? Contact our U at [email protected] y, ty protection – so you can focus

newsletter, 2011, Vol. 114, no. 4

print media reporting on this leg-islation.

The two words that appearedmost frequently were “quality,”more than 500 times, and“value,” a close second. Since“value” is defined as the worth orquality of something comparedto its price, we physicians mightwant to direct our attention to theconcept of “quality” and what itmeans to our society.

Like most physicians, I enjoychatting with people. In a previ-

ous column I recalled a conversation with a car-penter in Jo Daviess County, IL, who describedquality this way: “Quality is like buying oats,” heexplained. “If you want good clean oats you mustpay a fair price. However, if you are satisfied withoats that have been through the horse…well thoseare a little cheaper.”

This anecdote begs the question: what is “med-ical quality”? Can it be measured? Can it be de-fined precisely or is it an amorphous concept thatone can recognize upon observation? Is it based on

In search of a definition for “medical quality”

president’s farewell message

During the AMA Annual Meeting inJune, many of us attended a seminarconducted by Alice Gosfield, JD, on

“Leadership in Health Care Change: If notPhysicians, Then Who?” (Also see coverage,“Physicians hear about the need to be lead-ers,” on page 14.)

At the seminar’s opening, attorney Gos-field shared the result of her recent onlinesearch to determine the number of times cer-tain words appeared in the PPACA and in lay

(continues on page 2)

Inside

Illinois policies at AMA.........10

Threat to reimbursement.........18

OSHA training.........................20

Outgoing CMS President David A. Loiterman, MD, comments on aresolution during the recent AMA Annual Meeting in Chicago. SeeAMA coverage beginning on page 4.

how often hemoglobin A1c levels are measured intype 2 diabetics? Is it the fraction of a patient panelseen in primary care with a BMI at 25 or below? Isit the cost of supplies and materials used by an or-thopedic surgeon to replace a hip or a knee? Is itthe operative time of a surgical procedure or thelength of hospitalization after the procedure? Oris it the length of post-operative time before thepatient can return to normal activities of daily liv-ing?

One of my patients had a thoughtful notion thatstruck me as worth sharing.

He suggested that “medical quality” be definedand determined from the patient’s point of view.

Thus, if a person has a health problem, howlong does it take to communicate the problem withsomeone? Did the communication lead to resolu-tion of that problem? How long does that entireprocess take?

If the health problem is caused by a chronic con-dition, how effective is the therapeutic regimen inreturning the patient to his optimum level of dailyactivities? How long does it take to reach thatlevel?

As to surgical procedures, is a patient betterserved in systems with low-cost materials, briefoperating times, and short hospitalizations if post-operative recovery is prolonged? What about asystem with expensive materials, deliberate oper-

ating times with few complications, short hospital-izations, and immediate return to activities ofdaily living? What is the optimum balance amongthese parameters and who and how will we deter-mine where the most favorable balance lies?

What constitutes “community health”? Is thestandard the same for all communities and whatmeasures should be used in making the most ap-propriate determination?

What role should physicians have in answeringthese questions? Should these determinations bemade by the “free market,“ the “government,“ orsome balanced combination?

Answering these questions will require inputand participation from all of us.

This message will be my last as president of theChicago Medical Society. I’ve enjoyed represent-ing you and feel privileged to have served as aconduit of ideas between members.

I look forward to working with all of you andour next president, Dr. Thomas M. Anderson, asthis national dialogue continues.

Chicago Medicine, No. 4, 2011Page 2

David A. Loiterman, MD, fACSPresident,

Chicago Medical Society

news fOr CHiCagO pHYsiCians

515 N. Dearborn St.Chicago IL 60654

Liz Sidney, Co-Editor/EditorialScott Warner, Co-Editor/Production

Chicago Medicine (ISSN 0009-3637) ispublished monthly for $20 per yearfor members; $30 per year for non-members, by the Chicago MedicalSociety, 515 N. Dearborn St. Chicago,Ill. 60610. Periodicals postage paid atChicago, Ill. and additional mailingoffices. Postmaster: Send addresschanges to Chicago Medicine, 515 N.Dearborn St., Chicago, IL 60610. Tele-phone: (312) 670-2550. Copyright2011, Chicago Medicine. All rights re-served.

newsletter, april 2011, Vol. 114, no. 4

Chicago medical society

OffICerS Of THe SOCIeTy

David A. Loiterman, MDPresident

Thomas M. Anderson, MDPresident-elect

Kenneth G. Busch, MDSecretary

Philip B. Dray, MDTreasurer

Howard Axe, MDChairman of the Council

robert W. Panton, MDVice-chairman of the Council

William N. Werner, MD, MPH,Immediate Past President

farewell president’s message (continued from first page)

Kindred Healthcare understands that when people are discharged from a traditional hospital, they often need continued care in order to recover completely. That’s where we come in.

Kindred offers services including aggressive, medically complex care, intensive care and short-term rehabilitation.

Doctors, case managers, social workers and family members don’t stop caring simply because their loved one or patient has changed location.

Neither do we. To see how we care or to learn about a career with Kindred, please visit us at www.continuethecare.com.

Dedicated to Hope, Healing and Recovery

CONTINUE THE CARE

LONG-TERM ACUTE CARE HOSPITALS • NURSING AND REHABILITATION CENTERS • ASSISTED LIVING CENTERS

Recovery doesn’t always happen overnight.

addressing issues

LOCAL PHySICIANS WERE INfLuENTIAL INshaping the debate at the AMA Annual Meeting inChicago this June.

With more than 200 resolutions on the agenda,top concerns included health system reform, theindividual mandate, physician reimbursement,and shifts in AMA membership.

The Illinois delegation brought a total of eightnew resolutions. This number included severalpublic health initiatives originally from CookCounty that won strong support from the 500-member voting body. The House also reportedback on several Cook County resolutions heldover from 2010.

urged on by members of the Illinois delegation, theHouse adopted ISMS policy calling upon the Associa-tion to vigorously work to change the Patient Protec-tion and Affordable Care Act (PPACA) to accuratelyrepresent AMA policy on health system reform.

In vowing to protect the primacy of the physi-cian-patient relationship, new AMA policy will ad-dress a number of issues in the PPACA: l Repeal of the Independent Payment AdvisoryBoard (IPAB).l Study of the Medicare cost/quality index.l Repeal of the non-physician provider non-dis-crimination provision.lEnactment of comprehensive medical liability re-form.

l Enactment of long-termMedicare physician paymentreform including permittingpatients to privately contractwith physicians not participat-ing in the Medicare program.lEnactment of antitrust reformto permit independently prac-ticing physicians to collectivelynegotiate with health insurancecompanies.l Expansion of health savingsaccounts as a means to providehealth insurance coverage.

* * *On the public health front,

the House adopted a resolutionoriginally from Cook County

that urged the AMA to address the growing obesi-ty epidemic. New AMA policy will now work todissuade corporations from using marketing in-centives on children that encourage them to makeunhealthy food choices. Responding to anotherCook County resolution, delegates called for na-tional legislation banning “bath salts,” a syntheticdrug containing methylenedioxypyrovalerone, orMDPV. The drug has been likened to cocaine andis used recreationally.

Reflecting the national political debate, theHouse wrestled with the individual mandate topurchase health insurance. The issue generatedheated testimony, with physicians on both sideslining up to testify. By a 2-1 ratio, delegates votedto reaffirm the AMA’s support for “individual re-sponsibility” to purchase health insurance, with taxcredits and subsidies for those who cannot affordinsurance. Existing policy “advocates that stategovernments be given the freedom to develop andtest different models for covering the uninsured.”

The individual mandate takes effect in 2014 aspart of the PPACA.

Delegates heard updates on AMA efforts to re-peal the SGR formula and replace it with a mecha-nism to pay for improving quality and coordinatingcare. The AMA is also urging Congress to approvelegislation that allows Medicare patients and theirdoctors to contract privately without penalty.

Shastri Swaminathan, MD, CMS/ISMS past president, raises concerns about aresolution during the AMA Annual Meeting in Chicago.


Illinois policies shape direction at AMA meeting


I am ISMIE.Service driven.

Innovative.

Dedicated.

©2011 ISMIE Mutual Insurance Company

Protecting the practice of medicine in Illinois

As a policyholder, I value ISMIE Mutual Insurance Company’s commitment to protecting Illinois physicians and our practices. ISMIE’s comprehensive risk management program is a benefit to policyholders and our patients. Founded, owned and managed by physician policyholders, ISMIE is focused on being our Physician-First Service Insurer.®

ISMIE Mutual has continuously insured all specialties throughout Illinois since 1976. Policyholders know they can depend on us to remain committed to them not only as their professional liability insurance company, but also as an advocate and partner.

Depend on ISMIE for your medical liability protection – so you can focus on the reason you became a physician: to provide the best patient care possible.

Not an ISMIE Mutual policyholder and interested in obtaining a comparison quote for your medical liability coverage? Contact our Underwriting Division at 800-782-4767, ext. 3350, or e-mail us at [email protected]. Visit our web site at www.ismie.com.

11-1

512-

P

,yholderAs a policIllinois physicians is a benefit to polic

ISMI yholders,polic

ISMIE Mutual has yholders knoolicP

their professional

I value ISMIE Mutual Insur s ISMIE’ and our practices.

tients.yholders and our pa c E is focused on being our Physician-F

continuously insured all specialties throughout Illinois since 1976.

liability insurance compan

s commitm y’ rance Compan comprehensive risk mana

wned and mana oounded, Fvice Insuirst Ser Physician-F

specialties throughout Illinois since 1976.

te but also as an advoca n

ment to protectinggement program aged by physician a

. urer ®

nois since 1976.

e and partner

their professional

Depend on ISMIE reason you becam

Not an ISMIE Mutu your medical liabili

or e-mail us 3350,

liability insurance compan

for your medical liabilit to provide me a physician:

yholder and inter ual policge? Contact our U ity covera

t [email protected] a

te but also as an advoca,y n

ty protection – so you can focus on the e the best patient care possible.

ested in obtaining a comp t 80 Underwriting Division at wwVisit our web site a om.

.e and partner

an focus on the ossible.

parison quote for ext. 00-782-4767,

.ismie.com. ww

©2011 ISMIE Mutual Insurance C

y ompan

Protecting the p

practice of medicine in Illinois

11-1

512-

P

addressing issues (continued)

Delegates welcome new leadership teamPeter W. Carmel, MD, a pediatric neurosurgeonpracticing in Newark, was inaugurated as AMApresident, and Jeremy A. Lazarus, MD, a Col-orado psychiatrist and speaker of the AMA Houseof Delegates, was named AMA president-elect. Anative of Chicago, Dr. Lazarus studied at North-western university before completing his residen-cy at the university of Illinois at Chicago.

Executive Vice President and CEO Michael D.Maves, MD, MBA, gave his final address to theHouse. (Dr. Maves stepped down from the posi-tion he had served in since 2001.) Delegates wel-comed new EVP/CEO James L. Madara, MD, theformer head of the university of Chicago MedicalCenter.

Your Illinois delegation at work—here

are your colleagues’ resolutions

Bisphenol A (BPA)Held over from 2010 for further study, two exist-

ing policies were reaffirmed. The House adopt-ed new policy that supports shifting to a more ro-bust, science-based, and transparent federal regu-latory framework for oversight of BPA. Amongother recommendations, the AMA will encourageongoing industry actions to stop producing BPA-containing baby bottles and infant feeding cups,support bans on the sale of such products, andurge the development and use of safe, non-harm-ful alternatives to BPA for the linings of infant for-mula cans and other food can linings. The AMArecognized BPA as an endocrine-disrupting agentand urged that BPA-containing products with thepotential to increase human exposure to BPA beclearly identified.

Invitations to Membership in OrganizedMedicineOriginally from Cook County, this resolution re-sulted in reaffirmation of current AMA policy G-625.010, AMA Mission and Vision.



Improve the vitals signson the full spectrum of medical delivery needs.

Warehousing. Distribution. Last mile. Our Faster, Better, Smarter approach, including experienced, professional couriers and state-of-the-art technology, ensures that your deliveries arrive on time, every time.

Contact our medical delivery specialist for a free trial. 888-IQCANDO or www.IQCanDo.comContact our medical deli

state-of-the-art techno Our Faster, Better, Sma Warehousing. Dis

888-I ivery specialist for a free trial.

ology, ensures that your deliveries arter approach, including experie

stribution. Last mile.

www.IQCanDo.com

Sor QCANDO

s arrive on time, every time. enced, professional couriers and

m


D E L I V E RY B E G IN S D E C EM B E R 2 011

The Ritz-Carlton Residences, Chicago, Magnificent Mile are not owned, developed or sold by The Ritz-Carlton Hotel Company, L.L.C. NM Project Company LLC uses The Ritz-Carlton marks under license from The Ritz-Carlton Hotel Company, L.L.C.

DEVELOPER NO. 1898487

Exclusively marketed by Prudential Rubloff

.......

Magnificent LivingMa nificent Living

SIMPLY



federal Medical Liability Tort reformThis resolution resulted in reaffirmation of cur-rent AMA policy supporting and promoting fed-eral medical liability reform, which in the resolu-tion cited the “Help Efficient, Accessible, Low-cost, Timely, Healthcare” (HEALTH) Act, current-ly before the Congress.

facilitate Certification of Open SourceeMr Software

This resolution advocated for increased finan-cial support from public and private payers forphysician adoption of EMRs that are interopera-ble. It resulted in reaffirmation of current AMApolicy.

e-Visit CriteriaThis resolution would establish criteria for an e-visit and pursue necessary discussions with third-party payers for recognition and reimbursementof electronic medical patient encounters/visits.While the sponsor extracted it for study, the reso-lution resulted in reaffirmation of existing poli-cies on payment for electronic communicationand reimbursement for telephonic and electroniccommunications.

Bath Salt BanOriginally from Cook County, this resolution pro-posed new policy that supports national legisla-tion banning the synthetic substances known as“bath salts” that include methylenedioxypy-rovalerone (MDPV) and related compounds. Theresolution was adopted by the House.

Patient Problem ListThis resolution asks the AMA, in consultationwith the ICD-10-CM consortium, to develop pa-tient problem list standards for use by physiciansthat will also meet core measure requirements ofEMR “meaningful use” initiatives. Delegatesnoted extensive and ongoing AMA advocacy onmeaningful use, and the requirement that everycertified EHR be able to maintain an up-to-dateproblem list of current and active diagnoses basedon ICD–9–CM or SNOMED CT® (according to theDHHS). The House voted against adoption.

Children’s Meals and Childhood ObesityTestimony was divided among those who felt cor-porations should assume some responsibility forpromoting healthy behavior and those whothought individuals and families should be re-sponsible for their own behavior. Thus, the Houseadopted a substitute resolution that encouragescorporate social responsibility through: 1) market-ing incentives that promote healthy childhood be-haviors; 2) competitive pricing between healthyand less healthy food in children’s meals; 3) collab-oration with appropriate agencies, organizations,and corporations to educate health professionalsand the public about healthy food choices in fastfood restaurants.

New AMA policies adopted during the

House of Delegates, June 18-22, 2011

l In response to concerns that EMR products aredifficult to navigate and use for retrieving impor-tant patient information, the AMA voted to advo-cate for the standardization of key elements ofEMR interface designlApproved a recommendation by the Council onMedical Service to prepare a report on the role ofpatient navigators, experts sometimes employed


CMS Past President William A. McDade, MD, listensto AMA proceedings with incoming CMS PresidentThomas M. Anderson, MD, (background).

by a health system or an insurance company,whose job it is to assist sick patients to sortthrough treatment options and insurance cover-age.lApproved a resolution calling for the AMA to ad-vocate for elimination of health care disparitiesthat stem from health insurance status.lAgreed to avoid recommending a specific set of“essential benefits” to be included in plans sold instate health insurance exchanges after 2014. In-stead, they voted to reaffirm existing policy, whichstates that the federal Employees Health BenefitsProgram should be used as a reference when con-sidering if a given plan would provide meaningfulcoverage.lCalled on the Association to seek repeal of the In-dependent Payment Advisory Board and enact-ment of long-sought reforms to Medicare physi-cian payment, medical liability, and antitrust rulesthat bar physicians from bargaining collectively.l Adopted policy supporting a requirement that allfederal health care regulatory agencies demon-

strate “measurable improved patient outcomes”within three years of implementing a rule. Anyregulations that do not meet the test should be re-vised or rescinded, the AMA said.lReferred for further study a resolution proposedby the American Academy of Pediatrics directingthe AMA to “strongly oppose” block granting ofthe Medicaid program. The Republican-led u.S.House of Representatives this spring passed a billauthorizing block grants as a way to control enti-tlement spending.l Voted, without debate, in support of allowingpatients to use tax-exempt dollars to pay for over-the-counter medications. They were barred fromdoing so starting Jan. 1 under the health reformlaw.l Adopted policy that “recognizes that denyingcivil marriage based on sexual orientation is dis-criminatory and imposes harmful stigma on gayand lesbian individuals and couples and their fam-ilies.” The Association supported legislation enact-ed in December 2010 that ended the “don’t ask,


We hate lawsuits. We loathe litigation. We help doctors head o� claims at the pass. We track new treatments and analyze medical advances. We are the eyes in the back of your head. We make CME easy, free, and online. We do extra homework. We protect good medicine. We are your guardian angels. We are �e Doctors Company.

The Doctors Company is devoted to helping doctors avoid potential lawsuits. For us, this starts with patient safety. In fact, we have the largest Department of Patient Safety/Risk Management of any medical malpractice insurer. And, local physician advisory boards across the country. Why do we go this far? Because sometimes the best way to look out for the doctor is to start with the patient. To learn more about our medical professional liability program, call (800) 748-0465 or visit us at www.thedoctors.com.

www.thedoctors.com


(continues on page 12 )

��!��&'�� -�� !��&'�� -��

�� "��(��#!�'�(#�,#)&�� (��"')&�"��,#)��'�&*��(��'(��#!��"�(�#"�#��&��#!��#��"��$&��"�#,�(��&��#!�(#'��(��#�(#&��'$�� '(��"��#'$�(� �#��,#)&��#��+�(�#)(�&��&&� '�� "#+��#&�,#)&�$�&'#"� ��#"') (�(�#"��"��#!$�(�(�*��&�(��%)#(��

��'��+�# ,�#+"��')�'��&,�#��$#"'#&��,

�!�"�'(�&��,��"�(,��"')&�"��&*��'��"��

ILLI

NO

IS S

TATE MED ICAL S

OC

IETY

FOUNDED 1840

��#�� (�(��$ �"��#*�&��#$(�#"'��"��)�(�� '�(��(�!��(�,#)&�"��'��"��)��(�

don’t tell” policy barring gays from serving open-ly in the military.l Adopted five policies dealing with maintenance-of-licensure and maintenance-of-certification re-quirements. They include calling for the AMA toencourage medical boards to accept participationin maintenance of certification and osteopathiccontinuous certification as meeting maintenance-of-licensure requirements. At the same time, activemedical licenses shouldn’t be revoked on the basisof certification requirements, the policy says. lThe AMA also will study the effectiveness of pro-posed continued licensing requirements and rec-ommend to the American Board of Medical Spe-cialties that physicians be required to take onlyone specialty exam every 10 years.lAdopted policy aimed at ensuring due process inmedical licensure. Physicians under investigationshould have at least 30 days to respond to stateboard inquiries, the right to prompt board deci-sions in pending matters, and evaluation by an-other physician of the same specialty. l Referred proposals calling for further testing offull-body airport security scanners that use ioniz-ing radiation and for a panel of experts to studythe issue.l Referred a resolution calling for the study of theimpact of food containing genetically engineeredingredients.l The AMA said it will continue to look at alterna-tive membership models and possible changes tothe organizational structure of the Association.Delegates talked about several proposals to attractnew members. The Board is working to re-exam-

ine the AMA’s membership model. It identified ahybrid concept that would allow direct member-ship and society membership while maintainingthe Association’s tax-exempt status. The boardwill present a preliminary report and a proposal atthe Interim Meeting in November. Delegatesagreed not to raise dues in 2012.l Adopted policy that all AMA endorsements ofnominations of appointed officials for public officebe voted on by the Board before any public sup-port is given.lA task force examined whether individual votesof AMA trustees should be reported so delegateswould know how they voted on issues. But dele-gates said reporting such votes would be divisiveand decided against revealing individual votes. lReferred a proposal by the Washington state del-egation to overhaul the AMA’s organization andgovernance. The proposal called for replacing theHouse of Delegates with smaller policy-settingmechanisms that would address federal healthpolicy advocacy; public health, patient safety, edu-cation and quality; and practice support. underthe plan, state medical association and specialtysociety members of the medical federation wouldselect a representative for the three categories oforganizational focus. lApproved a resolution asking the Association tostudy issues related to patient data sent to andfrom health information exchanges. Specifically,the policy directs the AMA to develop model leg-islation dealing with data ownership, privacy, andaccess rights.l New policy says the AMA should “study issuesrelated to how best to protect the legitimate inter-ests of patients and physicians regarding clinicaldata that is sent to and received from a health in-formation exchange.” The model legislation wouldat a minimum ensure that “no payer would be al-lowed to obtain identifiable clinical data on indi-viduals who are not currently insured members ofa health plan belonging to that payer, with the ex-ception of informed consent.” The policy also saysthe model legislation would “define accountabilityfor clinical data use in an HIE and ensure that thosepolicies that are essential to protect patients andphysicians can be legally enforced.”l Adopted a resolution asking the AMA to com-municate with large insurance companies on the


Dr. Loiterman (left) confers with Dr. Swaminathanduring the AMA Annual Meeting.



unintended consequences of their providing in-centives to patients who use non-physician facili-ties, such as retail clinics. The policy says such in-centives can lead to decisions made on limited in-formation, duplication of testing and procedures,and ultimately higher health care costs and re-duced quality of care.l Adopted policy asking the AMA to urge third-party payers to include facility fee payments to ac-credited office-based surgical facilities in plans inwhich they pay facility fees for the same proce-dures performed in hospitals or accredited surgi-cal centers. lAdopted policy supporting the public reportingand notification of the professional status, includ-ing education, training and experience, of “prima-ry care clinicians” leading primary care medicalhomes.l Rejected proposed policy asking that the AMAstudy the ethics surrounding the use of “clonednotes“ in electronic medical records. l Adopted ethical guidelines for financial relation-ships with industry in continuing medical education. lAn AMA Council on Ethical and Judicial Affairsreport said CME providers and others with roles inCME should be transparent about financial rela-tionships that potentially could influence educa-tional activities. CME providers with financial in-terests in the educational subject matter should beallowed to participate in CME only when their roleis “central to the success of the educational activity,the activity meets a demonstrated need in the pro-fessional community, and the source, nature andmagnitude of the individual’s specific financial in-terest is disclosed,” the report said.)lAdopted policy that spells out ethical principlesto be used when developing medical practiceguidelines. The policy says such guidelines shouldbe developed independent of any direct financialsupport from entities that have an interest in therecommendations being developed.

Source: AMA Website. Reprinted with permission.

Physicians hear about

the need to be leadersA standing-room-only crowd of physicians and

medical students packed a symposium on “Lead-ership in Health Care Change: If Not Physicians,

Then Who?” held during the Annual Meeting ofthe AMA House of Delegates. The session broughttogether diverse perspectives from the AMAHouse, AMA sections, specialty societies and othergroups to illustrate how doctors can play leadingroles as the health care system continues to evolve.

“you have the broadest scope of authority ofanyone in health care,” said Alice Gosfield, JD, ahealth care lawyer from Philadelphia who was thesession’s keynote speaker. “At this ambiguous mo-ment, this is a phenomenal opportunity for physi-cians to step up.”

The three-hour session featured an encouragingtalk by Ms. Gosfield, who touched upon physi-cians’ personal qualities—such as their account-ability for patients’ well-being and their evidence-based, scientific decision-making—that makethem natural leaders. She also noted the impor-tance of physicians working together, with orwithout other organizations and professionals, toimprove their collective ability to deliver high-quality, safe and valued care to their patients andcommunities.

“That is the goal, the process, the foundationthat you need to be working on regardless of whatyour practice setting is,” Ms. Gosfield said.

Later, a panel of four physicians compared theirown experiences in leading change within their re-spective practice settings and communities.


There’s still time to install

an EHR systemPhysicians still have plenty of time to install an

EHR and qualify for meaningful use financial incen-tives, according to education session titled “Chal-lenges in the Adoption of Health IT for the SmallPractice,” held during the AMA Annual Meeting.

“Remember, there’s no rush,” said MichaelHodgkins, MD, the AMA’s chief medical informa-tion officer. “you can take the time to thinkthrough the decision and still earn full incentives.”

One of those key decisions includes whether touse a client server system or “software as a soft-ware” (SaaS), more commonly known as “cloudcomputing,” said Dr. Hodgkins. SaaS has manyadvantages over a client server, including:




l No server in your office.l Access via the Internet, outside your office, fromany device. l Lower cost of ownership.

A possible drawback is the need for reliable In-ternet service, so it may not work in a rural area.

One roadblock to more widespread adoption ofEHRs is confusion over meaningful use regula-tions. More than 50% of physicians are “somewhatconfused” about those rules, according to a recentsurvey. A separate session provided an overview ofperformance-based incentive programs.

Much of the emphasis in the media has beenabout installing a complete EHR, said Dr. Hodgkins,while not as much attention has been given to mod-ular bundles. Installing a complete EHR takes longer,causes greater practice disruption, and has the high-est cost. And it’s not necessary to install a completeEHR to qualify for incentives under meaningful useregulations, said Dr. Hodgkins.

Modular bundles are less disruptive to imple-ment and carry a lower cost, he added.

Dr. Hodgkins noted that the AMAGINE™physician portal is a sensible modular bundled so-lution for physician organizations and smallerphysician practices. Amagine Inc., a subsidiary ofthe AMA, recently announced that the health in-formation technology (IT) solutions platform isnow available to physicians nationwide.

Physicians are encouraged to visit the Amaginewebsite for a free practice assessment to help de-velop a health IT strategy.

The AMA website contains more informationon health IT, including archived webinars and anonline tutorial that provides step-by-step instruc-tions to help physicians choose, purchase and im-plement the best technology systems for theirpractices.




CMS AND ISMS STEADfASTLy OPPOSEDrecent changes to the Illinois workers’ compensa-tion system, warning that the proposed “reforms”will ultimately do more harm than good.

Indeed, the new legislation creates restrictivetreatment guidelines, while allowing employers toorganize networks and choose all medical, surgi-cal, and hospital services provided to injuredworkers.

While reform supporters project cost savings ofup to $750 million, the bulk of any savings willcome from slashing physician fees by 30%, addingto the already significant economic challenges ofpracticing medicine in Illinois.

When doctors decide they can no longer partic-ipate in the workers’ comp system, patients willencounter difficulties accessing highly trained spe-cialists.

“The legislation is really a plan to undercut

funding for injured workers’ medical care,” saidISMS President Wayne V. Polek, MD, in a statement.

“We predict injured workers will wait longerfor care, thus triggering higher medical care costsand delays in their return to work,” he added.

The provisions also cap awards for carpal tun-nel syndrome and appoint new arbitrators tothree-year terms.

ISMS worked extensively with lawmakers,pushing hard to preserve an equitable workers’comp system for both patients and physicians.

“Everyone who voted against this law deservescredit for taking a stand for meaningful reform,”Dr. Polek concluded.

Governor Quinn signed the workers comp leg-islation on June 28. Some changes took effect im-mediately, while others will start on Sept. 1, ac-cording to the governor’s office.

basing reimbursement On mediCare paYment sYstem

Workers’ comp reform a blow to patients, quality health care

E-mail or fax your CV to:Scott Sansovich, [email protected]

or 248-662-9845

$160,000+ Full Benefits 401K Plan

“Specializing in the Care of Post-acute& Long-term Care Residents since 1983”

We are an independent practice hiring BC/BE internalmedicine and family physicians for the care of seniorsand adults with disabilities in the 6-county MetroChicago area.

Patients reside in nursing homes with SNFs, private,residential and group homes.


&


justifying the requested amounts, and knowingwhen the Act applies to them.

When deciding whether to participate in a net-work, doctors are encouraged to carefully weightheir options.

While ISMS-backed bills would have post-poned the Act’s effective date, the Illinois GeneralAssembly adjourned for the summer withoutpassing the bills.

ISMS continues to advocate for a remedy to thisunfair law.

A number of factors will determine the full ef-fect of the amendment. forthcoming DOI rulesand regulations, patient and physician feedbackon the arbitration experience, and the cost and af-fordability of arbitrating claims will shape thefinal outcome.

The Act took effect on June 1.

prOteCtiOn fOr HealtH insuranCe COmpanies

CMS AND ISMS ACTIVELy OPPOSED A RECENTamendment to the Illinois Insurance Code that al-lows insurers to drastically cut payment to hospi-tal-based physicians who provide out-of-networkservices at in-network facilities.

HB 5085, or Illinois Public Act 96-1523, appliesto services for radiology, anesthesiology, patholo-gy, emergency medicine, and neonatology.

under the Act, reimbursement levels will be setthrough negotiation and arbitration.

Physicians who wish to collect fair reimburse-ment will have to initiate costly and time-consum-ing arbitration proceedings.

The Act also prohibits physicians from balancebilling of patients and allows insurers to apply deeperdiscounts than would be offered on a contractual basis.

Among other provisions, physicians will be re-sponsible for monitoring their reimbursements,

Act gives insurers advantage in negotiating contracts

Eb

noitiddAanddAruoYotretneC

u osartluelbiomyegihhetscinilcd na

euneveRaln!ecitacrP

nypamocund ytiluaqqtsheg

undatnntepmquie

forpadd au oy

iffieneBpU - norffr

n- yeklanoitineinev.tPdna

getaattstse - f--of het - trrta

eW.srpheargnoosd neiartyhlgihdapruroyotecivresyrallincaelbatiffi

stistsoCtn

euneveR.tPr fot

secivreS

edivorPeWseidtuS

loffo.ncII,ngigamIIhocEaLkratSndaaeracideMlaehngidaelniatereW

niezilaicpesthaattsynenpamocruuO.secivres

poerllad natnntaiplomc.sdrndaaatsLEACI

yqgund osartlutp lhen ace

.ecitca

llaswol.senileduigwa

-rottaaterahctlyrallinca

AAPIIPHsiywolloffostrrt

oidracorAArditolUdirolanimolanimo

! woowNlalCuoytiffieneb

877:h.P -8bor:liamE

mragoryet

dnuosratletelpmCol

detimiLl

A.txxErewol/reV.txxErewol/re

dnuosratlUcivsratlUlanigavsn

edivorPeWseidtuS

! ,gngiaImohcEwohrnaeloT:taobRtcantoc,ecitcrapur

068 - 105.xtE1 911moc.gnigamiohceym@b

relppoDlariertArrelppoDsuoneV

dnuos

nac.cnI

ISMS WAS ACTIVE ON yOuR BEHALf INSpringfield throughout the spring legislative ses-sion. ISMS successfully opposed bills that wouldhave:l allowed advanced practice nurses to practice in-dependently.l licensed direct-entry midwives and allowedthem to deliver babies at home unsupervised.l given pharmacists prescriptive authority.l licensed naturopaths.

These attempted scope-of-practice intrusionscome up often, and are a constant reminder of theimportance of ISMS’ vigilant legislative advocacy.

ISMS supported bills strengthening advance di-rectives in Illinois and requiring license revocationfor health professionals convicted of sex crimes,both of which cleared the General Assembly. Wewere unsuccessful in our attempts to delay the ef-fective date of unfair out-of-network payment leg-islation and avoid a fee schedule reduction in Illi-nois’ workers’ compensation system. We continueto work hard to mitigate the impact of both issueson our members.

One important issue that remains unresolved isextension of the Illinois Medical Practice Act, whichis set to expire in November. This law governs thepractice of medicine in Illinois and must be re-newed, but lately, political games have overshad-owed the importance of quality patient care. for asummary of the Medical Practice Act and its impor-tance for all Illinois physicians and patients, visit

www.isms.org and click on the Illinois Medical PracticeAct--Why It’s Important to You.

for more details, visit our Legislative ActionHub, in the Governmental Affairs section ofwww.isms.org.

Health Reform UniversityISMS and ISMIE Mutual are co-sponsoring

Health Reform university, a series of seminars de-signed to help physicians and staff prepare theirpractices for changes coming as a result of healthreform. Experienced health policy experts andveteran ISMS staff headline the half-day CME-eli-gible seminars, and ISMS members may attend ata significant discount. The first two sessions werevery well-received, and four more will be heldthroughout the state in September and October –including friday, Sept. 16, at ISMS HQ in Chicago,and Tuesday, Oct. 4, at the McDonald’s campus inOak Brook.

Visit www.isms.org to learn more and register today!

isms update

Dealing with scope of practice intrusions


2011 OSHA Training What Your Office Needs to Know

Spaces Fill Up Quickly!

TARGET AUDIENCE: Physicians, nurses, medical office staff, dentists, dental hygienists & dental office staff.

COURSE TOPICS: Health Care Worker Safety and Health, Common Hazards from Bloodborne Pathogens Associated with Medical & Dental Offices, Compliance with OSHA Regulations, Emerging Infectious Diseases and Q & A.

LEARNING OBJECTIVES: 1) Implement a training program for healthcare employees who may be exposed to blood-borne pathogens. 2) Identify appropriate personal protective equipment (PPE). 3) Develop an emergency response plan. 4) Create a written exposure control plan for healthcare workers assigned as first-aid providers. 5) Develop a strategy to prevent the spread of pandemic flu within a practice.

2011 WORKSHOPS:

Friday, Sept. 2: Hilton Oak Lawn Hotel (Oak Lawn, IL) 2 p.m. to 4 p.m.

Wednesday, Sept. 21: Embassy Suites (Downtown Chicago) 10 a.m. to 12N

Wednesday, Oct. 19: Advocate Christ Medical Center (Oak Lawn, IL) 2 p.m. to 4 p.m.

Friday, Oct. 21: Doubletree Hotel-Chicago (Oak Brook, IL) 9:30 a.m. to 11:30 a.m.

Friday, Nov. 4: Advocate Lutheran General Hospital (Park Ridge, IL) 2 p.m. to 4 p.m.

SPEAKER: Sukhvir Kaur, MPH, Compliance Assistance Specialist, OSHA-Chicago North Office. Ms. Kaur has disclosed that she has no relevant financial relationships with commercial interests. The following planning members of the Chicago Medical Society’s CME Subcommittee on Joint Sponsorship and staff have disclosed the following: Vickie Becker, MD, Chairman, Roger L. Rodrigues, MD, Planning Member, Bapu P. Arekapudi, MD, Planning Member, Marella L. Hanumadass, MD, Planning Member, Vijay Yeldandi, MD, Course Director, and Cecilia Merino, Director of Education, have no relevant financial relationships with commercial interests.

ACCREDITATION AND DESIGNATION STATEMENTS: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the

Accreditation Council for Continuing Medical Education (ACCME). The Chicago Medical Society is accredited by the ACCME to provide continuing medical education for physicians.

The Chicago Medical Society 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.

REGISTRATION: Register Online at www.cmsdocs.org or contact Elvia Medrano at (312) 670-2550, ext. 338, or [email protected]


CMS Student District Meeting10:00 a.m.-12:00 noonCMS Headquarters Building

CMS Mini-internship 8:00 a.m.-1:00 p.m.Ingalls Memorial HospitalRep. William Davis (30th Dist.)

CMS District 3 MeetingTime and Location TBA

Calendar Of eVents

august 20

september 1

One thing I am certain about is my malpractice protection.”

“As physicians, we have so many unknowns coming our way...

Professional Liability Insurance & Risk Management Services

ProAssurance Group is rated A (Excellent) by A.M. Best. www.ProAssurance.com.

Medicine is feeling the effects of regulatory and legislative changes, increasing risk, and profitability demands—all contributing to an atmosphere of uncertainty and lack of control.

What we do control as physicians: our choice of a liability partner.

I selected ProAssurance because they stand behind my good medicine. In spite of the maelstrom of change, I am protected, respected, and heard.

I believe in fair treatment—and I get it.

For more information, please call our staff at 312.670.2550.

september 19

Eb

noitiddAanddAruoYotretneC

u osartluelbiomyegihhetscinilcd na

euneveRaln!ecitacrP

nypamocund ytiluaqquatsheg

undatntepmquie

forpadd au oy

iffieneBpU - norffr

n- yeklanoitineinev.tPdna

getaattstse - f--of het - trrta

eW.srpheargnoosd neiartyhlgihdapruroyotecivresyrallincaelbatiffi

stistsoCtn

euneveR.tPr fot

secivreS

edivorPeWseidtuS

loffo.ncIInc,ngigamIImhocEaLkratSndaanderacideMlaehngidaelniatereW

niezilaicpesthaattsynenypamocrurO.secivres

poerllad natnntaiplomc.sdrndaaratsLEACI

yqgund osartlutp lhen ace

.ecitca

llaswol.senileduigwa

-rottaaterahctlyrallinca

AAPIIPHsiywolloffostrt

oidracorAArditolUdirolanimolanimo

! woowNlalCuoytiffieneb

877:h.P -8bor:liamE

mragoryet

dnuosratletelpmCol

detimiLl

A.txxtErewol/reV.txxtErewol/re

dnuosratlUcivsratlUlanigavsn

edivorPeWseidtuS

! ,gngiaImohcEwohrnaeloT:taobRtcantoc,ecitcrapur

068 - 105.xtE1 911moc.gnigamiohceym@b

relppoDlariertAArtrelppoDsuoneV

dnuos

nac.cnI


OSHA

Training

See Workshop dates on page 21 and RSVP!

Classified adVertising

Personnel wanted PrIMAry CAre--MD AT HOMe IS LOOKINGto hire BE/BC primary care physicians to makehouse calls on the elderly homebound. ContactMatt Turman at (312) 243-2223 or email: [email protected].

PArT-TIMe PHySICIANS WANTeD fOrpeer-to-peer consultation services. CareCoreNational is a successful healthcare manage-ment company providing services to over 25major health plans nationwide. Physiciansholding a license or a retired license are need-ed to receive and handle incoming calls fromhealth plan physicians. your role will be to dis-cuss and determine medical necessity for spe-cific services against established and publishedclinical guidelines. Positions are part-time,working remotely from home, but require pre-determined hours for receiving calls. To apply,call (800) 918-8924; or email CV [email protected], with “Physi-cian Counselor” in the subject line.

IMMeDIATe OPeNING fOr AN INTerNISTin a busy practice in Chicago. Good benefitsincluded and partnership offered in two tothree years. Will sponsor H1 visa. Please faxCV to (708) 474-4574.

MOBILe DOCTOrS SeeKS A fuLL-TIMephysician for its Chicago office to make housecalls to the elderly and disabled. Nonight/weekend work. We perform the sched-uling, allowing you to focus on seeing patients.Malpractice insurance is provided and all ourphysicians travel with a certified medical assis-tant. To be considered, please forward yourCV to Nick at [email protected]; or call(312) 848-5319.

SeeKING BC/Be INTerNIST Or fAMILypractitioner to work with a group inChicagoland. Please call (773) 884-2782 for in-formation.

BC/Be IM/fP PHySICIAN—PArT-TIMe:fee-for-service compensation for disabilityevaluation/consultation for the Social SecurityDisability Program. Challenging, rewarding,and meaningful work. No malpractice re-quired. No pager or other hassles. See pathol-ogy you’ve only read about in textbooks. Pro-fessional Loop office with great supportivestaff. Set your own schedule. Two-threedays/week ideal. Long-term availability—sev-eral years—desired. Join our bright, fungroup. Contact Medical Director at: [email protected].

fAMILy PrACTICe CLINIC NeAr OAKPark looking for primary care physician. faxresume to (773) 379-9001; or call (773) 287-2200.

AMerICA’S DISABLeD—PHySICIAN HOMeVisits, a not-for-profit 501(c)3 organization, islooking for additional primary care physiciansto make house calls in the Chicagoland area.We are looking for full- and part-time physi-cians. Call Richard Ansfield (773) 774-7300.

PArT-TIMe PHySICIANS IN THe CHICA-goland area. Anesthesiology, ob-gyn, familypractice, gastroenterology (GI), and other spe-cialties. Please send resumes by fax to: (847)398-4585, or email to [email protected].

OB-GyN NeeDeD (PArT-TIMe Or fuLL-time) to perform pregnancy terminations for afamily planning clinic. Please send resumesby fax to (847) 398-4585, or email to [email protected].

Office/building for sale/rent/leasefOr reNT: LOCATeD IN THe GLeN INGlenview, this 1,962 sq.-ft. medical office wasbuilt five years ago and is in move-in condi-tion. Initial build-out cost was $275,000 andthe office contains four examination rooms, alaboratory with refrigerator, office, storageroom, lunchroom with refrigerator and mi-crowave and front desk area for four. Also in-cluded is a complete phone system and wait-ing room furniture for eight. This medical of-fice complex has three buildings, with ap-proximately 100 physicians. Across the hall isa Lake forest/Northwestern Imaging; nextdoor are Northwestern orthopedic surgeons,with Children’s Memorial pediatriciansacross the parking lot. There are 4.5 years lefton the lease. Contact David LeCavalier at(224) 436-3464.

Business servicesKM MeDICAL BILLING, INC. SINCe 1997.Visit us at KMMedicalBilling.com. Call (773)324-0119.

PHySICIANS’ ATTOrNey—exPerIeNCeDand affordable physicians’ legal services in-cluding practice purchases; sales and forma-tions; partnership and associate contracts; col-lections; licensing problems; credentialing; es-tate planning and real estate. Initial consulta-tion without charge. Representing practition-ers since 1980. Steven H. Jesser (847) 424-0200; (800) 424-0060; or (847) 212-5620 (mo-bile); 5250 Old Orchard Road, Suite 300, Skok-ie, IL 60077-4462; [email protected]; www.sjess-er.com.

F o r i n f o r m a t i o n o n p l a c i n g a c l a s s i f i e d a d , please go to w w w . c m s d o c s . o r g ( u n d e r “Advertise in

Chicago Medicine” o n h o m e p a g e ) o r c o n t a c t : S c o t t Wa r n e r a t [email protected] (312) 670-2 5 5 0 .

PPaaiidd UUpp && PPaaiidd OOffff!!

Stamp out unpaid bills!

The Chicago Medical Society has partnered with I.C. System to provide members

with individualized accounts receivable solutions.

CCaallll TTooddaayy!!

11--880000--227799--33551111

I. C. System, Inc. P.O. Box 64137

St. Paul, MN 55164-0137

www.icsystem.com

A


Tame the beast.

MORE MONEY MORE CONTROL

Running a practice is getting more complicated — and frustrating. And in your gut, you know traditional

software won’t make it simpler. Join the 27,000 providers who use our cloud-based practice management,

EHR, and patient communications services to tame the beast.

Put the power of the cloud to work. 800.981.5085 : athenahealth.com/ChicagoMed

Documents

president’s farewell message In search of a definition for medical … · 2011-10-19 · ity covera ge? Contact our U at [email protected] y, ty protection – so you can focus