News to Use
15 Physicians Fired From Chicago-area Health System, Replaced by APRNs
At least 15 physicians were fired from suburban Chicago's Edward-Elmhurst Health to cut costs. They were replaced with APRNs in select Immediate Care locations. Hospital system CEO Mary Lou Mastro, MS, RN, and Chief Medical Officers Robert Payton, MD, and Daniel Sullivan, MD, in an Email to their medical staff, identified patient cost concerns as the reason for the move. "Patients have made it very clear that they want less costly care and convenient access for lower-acuity issues (sore throats, rashes, earaches), which are the vast majority of cases we treat in our Immediate Cares."
According to the Email, the action is part of the system's "vision of transforming the healthcare experience - safe, seamless and personal."
The story in MedPage Today may be found here.
Physicians in these 10 specialties are most likely to get sued
The DO. By ROSE RAYMOND Email, WEDNESDAY, DEC. 4, 2019
Nearly 6 in 10 physicians reported being sued at some point in their career, a recent Medscape report found. To prepare the report (login required), Medscape surveyed 4,300 physicians in over 29 specialties. Physicians who have been named in a malpractice lawsuit reported spending significant time preparing a defense—42% devoted more than 40 hours to defense-preparing tasks—and found the entire lawsuit process typically lasted one to two years.
What happened with these lawsuits? A third were settled before going to trial. In 11% of cases, the judge/jury ruled in favor of the physician, and the judge/jury ruled in favor of the patient in just 3% of cases. Nearly 20% of physicians said if they could do anything differently, they would have had better chart documentation of their patient encounters. Following a lawsuit, while nearly half of physicians said it didn’t affect the way they practiced medicine, one-quarter said their trust in patients had been eroded, which made them treat patients differently.
Overall, physicians in specialties are more likely to be sued than physicians in primary care—62% vs. 52%—and certain specialties see significantly more malpractice suits than others.
Top 10 specialties for lawsuits--Specialty Percentage of physicians who’ve been sued
- General surgery 85%
- Urology 84%
- Otolaryngology 83%
- OB-GYN and women’s health 83%
- Specialized surgery 80%
- Radiology 76%
- Emergency medicine 76%
- Cardiology 65%
- Gastroenterology 63%
- Anesthesiology 62%
The state where a physician practices will also influence the likelihood of lawsuits. Some states have more litigious cultures and lawsuit climates that are more favorable to plaintiffs, Medscape notes.
Just for Fun-- Top 10 Holiday Gifts for Doctors and Med Students This Year
Originally Appeared in The DO-- Edited.
1. The Body: A Guide for Occupants by Bill Bryson -- Widely acclaimed nonfiction author Bill Bryson turns his attention to the human body and its 37.2 trillion cells in his latest book.
2. Future Doctor Sweatshirt -- Show your Pride!
3. Nike Air Zoom Pulse Shoes -- For ultimate comfort on call and beyond.
4. A Self-watering planter -- Who has time for watering?
5. DO Coffee Mug -- "You can't spell DOCTOR without D.O."
6. Death Wish Coffee -- Double strength for when you need the extra caffeine boost.
7. Doctor Wars Hospital Card Game -- Peppered with inside jokes for those that work in medicine.
8. Inspired Art from PPrint -- Anatomy Prints for those that love the human form.
9. Homesick Candles-- Perfect for those residents training away from "home" or those docs in your life that may not remember what home smells like.
10. A coloring book designed by a DO!-- Jonathan Terry, DO recently designed and published a capybara-themed coloring book -- proceeds from sales will fund community mental health education, services and resources.
Bonus: MOA Swag! We have insulated lunch totes, Superman DO t-shirts, Beach bags, Hats, Water bottles and more to help you show your DO pride. Call the MOA office to order!
DO Day on Capitol Hill-- Date Change-- March 30th & 31st
The 2020 DO Day will take place on Monday, March 30th and Tuesday, March 31st. This is an exciting opportunity for DOs and osteopathic medical students to come to Washington, D.C. to educate Members of Congress and their staff about the osteopathic profession and the importance of osteopathic medicine. Participants will also engage with lawmakers and ask them to support legislation that is vital to the practice and principles of osteopathic medicine.
REGISTER FOR DO DAY!
Public Health Updates
Some Mainers Could Lose SNAP Eligibility Under New Trump Administration Rule
NPR. By NORA FLAHERTY • DEC 4, 2019
The Trump Administration has finalized new rules that state officials say would make more than one-thousand Mainers ineligible for food assistance, starting next April. The new rule makes it more difficult for states to waive a requirement that able-bodied adults without children to work, take part in work training or volunteer for at least 20 hours a week — or else lose their benefits under the supplemental nutrition assistance program (SNAP).
Good Shepherd Food Bank president Kristen Miale says the rule won't put more people back to work: “There are significant barriers for many people, for them to successfully retain full employment,” Miale says. “And where we stand, taking away someone's ability to have access to food is not going to address those barriers and is not going to result in somebody securing full employment.”
Miale says that for many Mainers in rural areas, job opportunities, training or a qualifying volunteer opportunity are very far from home. “So for people who are living in rural parts of Maine they are going to be significantly challenged to meet these requirements,” she says.
The Maine Department of Health and Human Services shared a statement by email: "We are disappointed in this rule change, which threatens access to nutritious food for people who live in rural areas with economic and employment challenges. We estimate that 1,300 individuals in Maine could be affected, but the Department will continue providing their food supplement benefits through the end of this summer using existing federal resources. The Department will reapply for Maine’s waiver once the federal government determines which geographic areas may still qualify."
Congress previously considered making a similar change, but voted not to. During its public comment period, the new rule drew more than 100,000 responses.
“Congress already debated this in the last farm bill, and struck it down. Bipartisan, both said no this is not good policy,” Miale says. “So this is basically going around Congress, and changing the law that congress already passed.”
Read More on the Issue Here.
MaineCare Provider Enrollment Fees Increase to $595 for 2020
Effective January 1, 2020 in accordance with the Centers for Medicare and Medicaid Services’ (CMS) application fee requirements, MaineCare’s provider enrollment application fee will increase to $595 per enrollment application for new, reactivating, or revalidating providers, or when adding new service locations to an existing enrollment. You can pay the application fee by credit or debit card at the time of application submission.
You will not be required to pay the application fee to MaineCare if you have already paid the fee to another state Medicaid or Children’s Health Insurance Program (CHIP) or to Medicare (if you are enrolling with MaineCare in the same manner as you have with Medicare) within the past 12 months.
See the updated Application Fee Spreadsheet for more detail about provider types that will be required to pay an application fee for each service location.
Medicare Notice: MBI Transition Ends This Month: Will You Be Paid On January 1?
The 21 month transition period will end on December 31; use Medicare Beneficiary identifiers (MBIs) now.
- You are currently submitting 86% of claims with MBIs.
- Get MBIs from your patients and through the MAC portals (sign up) now and after the transition period. You can also find the MBI on the remittance advice.
- Protect your patients from identity theft - use MBIs.
Starting January 1, if you do not use the MBI (regardless of the date of service) for Medicare transactions
- We will reject your claims with a few exceptions
- We will reject all eligibility transactions
See the MLN Matters Article for more information on getting and using MBIs.
IMD Exclusion for SUD and SMI/SED 1115 Waiver Application
On November 26, 2019, MaineCare submitted a 1115 demonstration waiver application to CMS with the goal of improving the SUD service delivery system. If approved, this waiver would allow for additional federal funding for residential or inpatient SUD treatment for MaineCare-enrolled adults and would provide state flexibility to pilot four services focused on MaineCare-enrolled parents with SUD who are involved with or at-risk of involvement with Child Protective Services. The proposed pilots include community-based skill development, parenting interventions, and MaineCare eligibility changes intended to address coverage and service delivery gaps that impact the health and well-being of this target population and their families. For questions about the submitted waiver, please contact Olivia Alford at Olivia.Alford@maine.gov
Please note, the waiver application includes provisions related to SUD treatment and recovery only. Earlier this year, the Department proposed incorporating provisions related to SMI/SED residential and inpatient services as part of this submission; however in response to stakeholder feedback these two proposals have been separated. Delivery system improvements related to SMI/SED remain a priority and will be addressed after further system-wide capacity and needs assessment and informed by further stakeholder engagement.
1115 Waiver Submission Documents
To view documents related to and MaineCare 1115 waivers, including the most recent 1115 waiver submission to improve Maine’s substance use disorder service delivery system, please visit: https://www.maine.gov/dhhs/oms/rules/demonstration-waivers.shtml.
MOA Medical Economic Committee Advocating for Maine DOs
The Maine Osteopathic Association's Medical Economics Committee (formerly known as the MOA Payor/Payee Committee) has been actively engaged here on the local level with several payors on recent audits of claims relating to billing E/M and OMT codes on the same date of service with modifier 25. The Committee is co-chaired by Dr. Stephanie Collins and Dr. Kiran Mangalam with key input and advice from multiple committee members including Dr. Boyd Buser, former AOA and MOA President and national expert.
The Committee has held multiple conference calls with Anthem representatives in Maine to learn more about their policy on modifier 25 after a Provider Communications notice was sent out this spring. We have shared pertinent documents including the National Government Services (NGS) Local Coverage Determination for OMT; the CMS 2011 Federal Register; and the AMA RUC database pre-, intra-, and post- service work descriptions to demonstrate that the RUC and CMS took into account any potential overlap between the E/M and OMT codes when they established their values. Our discussions have been informative and we have an additional meeting scheduled for December. We anticipate that we will have information to share with the membership on or before the MOA Mid Winter Conference in February 2020.
In addition, the MOA Medical Economics Committee has met several times with Aetna to discuss the volume of DO practices impacted by their denials of E/M and OMT claims. We have shared the relevant documents and continue to have meaningful dialogue about osteopathic manipulative treatment.
We have also reached out to Martin's Point to discuss the recent audits that many DOs have been impacted by which include a look back of up to two years of claims submitted related to modifier 25 when an E/M is billed on the same date of service with an OMT code. While these conversations are in the beginning stages, we do encourage DOs to appeal and to keep a detailed paper trail. If you are in need of template letters to assist you with your appeal, please contact the MOA office at 207-623-1101.
The MOA continues to advocate for appropriate reimbursement. If you have questions or need information, please do not hesitate to reach out. Feel complete the MOA Hassle Factor Form and/or call the MOA office at 207-623-1101 to share your experience. This information helps us to track trends and changes in payment policy.
More on the topic from the AOA: 5 Ways to get more of your modifier 25 claims approved. Click HERE to read the full article.
ICYMI: How the Medicare Physician Fee Schedule Final Rule for 2020 Could Impact Your Specialty
On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule Final Rule for calendar year (CY) 2020. The final rule updates payment rates and policy changes for services effective on or after Jan. 1, 2020. The final rule also includes updates for the Quality Payment Program (QPP). Collectively, these rules directly impact physician payment and practice.
For more on how it could impact YOU, click here.
Did you know that MOA offers online CME Programs?
Please find MOA on-demand CME programs at our new CE21 site:
308 Osteopathic CME Programs are now available via this site!
SAVE THE DATE FOR 2020 CME EVENTS:
MOA Midwinter Symposium
Holiday Inn by the Bay, Portland, ME
February 7-9th, 2020
109th Annual Convention
The Samoset Resort, Rockport, ME
June 5-7th, 2020
Opioid CME credit:
MICIS Academic Detailing Sessions (1 Hour Sessions)-- FREE, With CME Credit Offered
Academic detailing is peer-to-peer educational outreach which is designed to improve prescribing practices. It is useful for improving quality of care and identifying priorities for change.
Prescribers (MD, DO, PA, NP) and Medical Directors may request an individual Academic Detailing session at their practice location. This direct learning session will be lead by Elisabeth Fowlie Mock, MD, MPH, an experienced clinician, teacher and leader in the opioid crisis and an Academic Detailer with MICIS since 2011. There is no charge for this session.
This service is directed to two groups of prescribers: those who have complex patients with chronic pain on opioids and those who are considering providing buprenorphine treatment for opioid use disorder. Sessions can be scheduled for any time of day, cover one hour of content, and multiple sessions for providers in the same or nearby practices can be scheduled on the same day. Participants will be able to prioritize their learning needs and customize the learning session.
Contact MICIS to schedule an Academic Detailing session. More information can be found here.
Osteopathic Cranial Academy CME Offerings
February 15-19, 2020 Midwinter Introductory Course in
Osteopathy in the Cranial Field
Course Director: Zina Pelkey DO FCA
Associate Director: Therese M. Scott DO
Hilton Norfolk The Main, Norfolk, Virginia
The Osteopathic Cranial Academy
3535 E. 96th Street, Suite 101 Indianapolis, IN 46240
(317) 581-0411 FAX: (317) 580-9299
Web site: www.cranialacademy.org
Congress of Medical Excellence 2.0-- American Osteopathic Society of Rheumatologic Diseases-- Integrative Healthcare Alliance
February 28-March 1st
The Pepper Mill Resort Inn, Reno, NV
Delivering world-class education focused on integrative health: from the most recently emerging clinical research, newly discovered therapies, future scientific advances, as well as basics in rheumatology, stem cell therapy, pain management, hormone replacement, and osteopathic manipulation.
onsidered to be the premier event in integrative medicine with osteopathic characteristics, this year's conference features a combination of unique programming, a diverse audience, and a collaborative learning environment. Our agenda is precisely engineered to maximize clinical education and sessions, coupled with dynamic exhibitors spotlighting the latest products, devices, and services in the field, the Congress of Medical Excellence 2.0 allows attendees to learn the newest, most innovative protocols & practices—all of which can immediately be immediately integrated into patient care.
For more information or to register, visit the conference website at www.aosrd.org Our email address is firstname.lastname@example.org.
Photo credit: D. Halbach
Location: DoubleTree by Hilton Portland - 363 Maine Mall Rd, So. Portland, ME 04106
28th Annual Family Medicine Update & Annual Meeting ~ April 1-4, 2020
- April 1st – 1-5pm - KSA Study Group
- April 2nd & 3rd – 8am – 5pm each day 28th Annual Family Medicine Update CME sessions
- Annual Business Meeting
- April 4th – (Tentative) Opioid Education Session – FREE to MAFP Members!
- (meets Maine Licensure CME requirements)
Full brochure & registration information available after January 15, 2020
Need a Change of Scenery? Find Osteopathic CME Live Programs All Over the US!
Download NOW! Android Users: Google Play Store Apple Users: Apple Store
Classified Ads & Job Postings
Maine DHHS Office of Child & Family Services (OCFS) Medical Director Opportunity: The Maine Office of Child & Family Services (OCFS) is looking to identify a new Medical Director and is eager to identify qualified physicians, nurse practitioners, or physician assistants who are interested in applying for the position.
The OCFS Medical Director is responsible for providing clinical leadership, strategic policy direction, technical assistance, and clinical support for OCFS program and staff, and supports OCFS goals and objectives established in coordination with the OCFS Director and the Commissioner’s Office of DHHS. The Medical Director supports development and implementation of policy that aims to improve health outcomes for Maine children and families by improving both their experience of care and population health outcomes. The Medical Director will provide consultation and technical assistance to OCFS staff and community-based providers; participate in relevant advisory groups; and when needed, interact with state legislature and legislative committees at the direction of OCFS leadership. The position is expected to be 0.8-1.0 FTE and is based in Augusta.
Qualified applicants are encouraged to contact Dr Lisa Letourneau at email@example.com with any questions, along with their resume.
MaineCare Medical Director Opportunity: The Office of MaineCare Services (OMS) is continuing its search for a new MaineCare Medical Director and is eager to identify qualified physicians, nurse practitioners, or physician assistants who are interested in applying for the position. More information & position qualifications are included in the attached position description, but in brief…
The Office of MaineCare Services is seeking qualified candidates for the position of MaineCare Medical Director. The Medical Director is responsible for providing clinical leadership and policy direction and oversight to the MaineCare program and staff and supports MaineCare goals and objectives established in coordination with the MaineCare Director and the Commissioner’s Office of Dept of Health & Human Services (DHHS). The Medical Director supports development and implementation of policy that aims to improve health outcomes for Medicaid beneficiaries by improving population health outcomes and member experience and promotes the cost-effective use of resources. The Medical Director directly communicates with healthcare providers in the state, participates in relevant advisory groups, and when needed, interacts with state legislature and legislative committees at the direction of MaineCare leadership. The position is expected to be 0.8-1.0 FTE and is based in Augusta.
Qualified applicants are encouraged to contact Dr Lisa Letourneau at firstname.lastname@example.org with any questions, along with their resume.
MOA Members--Save $$ On a Phillips HeartStart Defibrillator
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Maine Osteopathic Association, PO Box 315, Manchester, ME 04351
www.mainedo.org | P. 207.623.1101 | F. 207.623.4228