Physicians iMonthly ovemer/Decemer 14 NHMS Welcomes 183 … · 2015-06-18 · Physicians iMonthly...

Physicians’ Bi-Monthly November/December 2014

New State Laws & Your PracticeImmunity for Reporting to DMV

New Hampshire does not have a requirement for physicians to report certain patients to the Division of Motor Vehicles; however, effective January 1, 2015, for physicians who be-lieve a patient cannot safely drive, there is a new law that provides immunity for such re-porting:

“Mature Minor”, cont. on page 10

Turn a New Leaf – A Healthy Dining Program that Can

Support Million Hearts By Maryanne Keating, Cheshire County HEAL Keene, N.H.

All physicians and healthcare in-stitutions will need to help their patients eat healthier if we are going to prevent 1 million heart attacks and strokes nationwide by 2017. Along with increased physical activity and smoking cessation, healthy eating is one of the most important behavioral in-fluences on overall health. Cur-

Million Hearts, cont. on page 9

New State Laws, cont. on page 11

By Todd Hathaway, Wadleigh, Starr & Peters, P.L.L.C. and The New Hampshire Homeless Teen Task Force

Can we treat an unaccompanied minor without parental consent? This is a question that many health-care practices face each day. Given the lack of clarity in the law, many practices say “no,” and the impacts on the care of those under 18 are significant.

It is estimated that more than 1,000 teens live in New Hamp-shire without a stable, permanent home. The real number is likely much higher. Many reports indi-cate that homeless, unaccompanied youth have difficulty accessing general medical and dental care, and homeless youth are at particu-larly high risk for untreated health problems. Even if a minor is in a

No Home + No Parent = No Health Care?

Applying the “Mature Minor” Rule

It is an honor and privilege to serve as the 183rd president of the New Hampshire Medical Society. I am extremely grateful to be in the com-pany of outgoing president Stuart Glassman and other immediate past presidents and colleagues: Dr. Travis Harker, Dr. Cindy Cooper, Dr. Charles Blitzer and others who preceded them, as well as with all the NHMS members. The year-long position will be a unique op-portunity in my career to become immersed in relevant issues that directly and indirectly impact the lives of New Hampshire residents through legislative and public health agendas as they relate to the practice of medicine in the state.

NHMS Welcomes 183rd President

183rd President, cont. on page 2

NHMS Inauguration, Nov. 8, 2014

By Lukas Kolm,

MD, MPH, MBA, FACEPIncoming NHMS president


2

New Hamphire Medical Society7 North State Street Concord, NH 03301 603 224 1909603 226 2432 [email protected] www.nhms.org Lukas R. Kolm, MD, FACEP ..... PresidentScott Colby ........................................ EVPMary West ....................................... Editor

Failure Is Not an Option.........................3Patient Communication:

Closing the Loop .................................4EVP Corner ............................................5Disability Income Insurance ...................62014 NHMS Council ..............................7The New Hampshire Medical Society

Corporate Affiliates .............................7Have You Registered for the N.H.

Prescription Drug Monitoring Program? .............................................8

NHMS Welcomes New Members ..........12

Mission: Our role as an organization in creating the world we envision.

The mission of the New Hampshire Medical Society is to bring together physicians to advocate for the well-being of our patients, for our profession and for the betterment of the public health.

Vision: The world we hope to create through our work together.

The New Hampshire Medical Society envisions a State in which personal and public health are high priorities, all people have access to quality healthcare, and physicians experience deep satisfaction in the practice of medicine.

Do you or a colleague need help?The New Hampshire Professionals’ Health Program (N.H. PHP) is here to help!

The N.H. PHP is a confidential resource that assists with identification, intervention, referral and case management of N.H. physicians, physician assistants, dentists, and dental hygienists who may be at risk for or affected by substance use disorders, behavioral/mental health conditions or other issues impacting their health and well-being. N.H. PHP provides recovery documentation, education, support and advocacy – from evaluation through treatment and recovery. For a confidential consultation, please call Dr. Sally Garhart @ (603) 491-5036 or email [email protected].

*Opinions expressed by authors may not always reflect official N.H. Medical Society positions. The Society reserves the right to edit contributed articles based on length and/or appropriateness of subject matter. Please send correspondence to “Newsletter Editor,” 7 N. State St., Concord, NH 03301.

2

I have a deep passion for practic-ing medicine and choosing emer-gency medicine as a specialty. When asked if I like what I do, my response is no, I don’t like what I do, I love what I do. Working my way into UNH as a part-time un-dergraduate stu-dent to eventually finding my pas-sion for medicine by volunteering for a local ambu-lance corps truly served as bedrock for so much of my personal jour-ney in becoming a physician. Re-turning to N.H. after residency to practice emergency medicine has allowed me to become more intimately aware of public health issues in N.H. This current op-portunity with the NHMS will be held with the same conviction and dedication I have as a clinician. A personal platform largely based on public health concerns and relevant issues will be my primary focus over the year.

There are opportunities to make progress in addressing both larg-er and smaller scale public health concerns and crises. There are accessible programs and low-cost services that may be pursued in collecting data to increase the sur-vivability for out-of-hospital car-diac arrests, as just one example. This is particularly germane for N.H. with its aging population. The out-of-hospital cardiac arrest (OHCA) survivor rate is extreme-ly poor. With better web-based information, N.H. can more ef-fectively allocate resources, train-ing and education to save lives.

Additionally, the variability be-tween urban and rural areas with-in a reasonably small state popu-lation poses challenges for limited resources. It is now, more than ever, necessary to take advantage of readily available, cost-effective

programs used in other states to rationally and appropriately in-crease safety for as many residents as possible. Gen-erally, early inter-vention results in less comorbidity, with overall su-perior outcomes

and less cost. Reconsiderations for mandatory liability automo-bile insurance can be understood to have broad, far-reaching ben-efits for many while mitigating a recognized public health hazard compared to other states with mandatory liability insurance.

The end of the year will culminate with the NHMS Annual Confer-ence on November 6-8, 2015, at the Portsmouth Sheraton, with a focused agenda of “The Many Faces of Addiction.” This remains a public health crisis of epic pro-portion for many states and cer-tainly for New Hampshire. This should garner a lot of expert opin-ions and solutions to get a firmer and more sustainable handle on prescriptive practices and pat-terns of opiate and narcotic abuse amongst such diversity in demo-graphics. Overdose has become a leading cause of death, greater than motor vehicle crashes for those aged 25-64. Lastly, feed-back and inquires throughout the year will be greatly appreciated. �

183rd President, cont. from page 1

The end of the year will culminate with the NHMS

Annual Conference on November 6-8, 2015, at the Portsmouth Sheraton,

with a focused agenda of “The Many Faces of

Addiction.”


3

By Stuart J. Glassman, MD

In the fall of 1984, I received my first letter of acceptance to medical school. I was a senior in college, and I met up with my brother, who was in his third-year medi-cal school clinical rotations at that time, to celebrate. As we toasted to my good fortune, he said, “Here’s to the worst decision you will ever make.” Now, that statement seemed somewhat harsh, given that he wasn’t even a “real doctor” yet, but while I understood the differences between us, I chose to keep a positive but honest perspec-tive on the career path ahead. I have never looked back on my de-cision and would do it again in a heartbeat. Others in our profes-sion, however, have been question-ing the wisdom of their choice.1

Are we seeing the viewpoint of a single, frustrated physician in a large metropolitan teaching hos-pital, or is there a much larger problem? Who is monitoring the emotional health of those entrust-ed to caring for others?2 In 2012, the Archives of Internal Medicine

published findings that indicated nearly half of the physicians who responded had at least one symp-tom of work-related burnout3, and the medical profession was at higher risk than any other work population group for burnout.4 That same year, a study from the University of Michigan5 showed that job-related stress, combined with mental health issues, led to a higher rate of physician suicide. Although the access to proper care was available, these afflicted doctors were often undertreated. Major depression in female physi-cians was noted to be a major risk factor, while the cause of death is often firearm related.

Not enough time to spend with pa-tients. Too many insurance com-pany hoops to jump through just to get paid. An overall lack of in-spiration. Is the problem of career burnout6 affecting primarily mid-career physicians7 or are medical students and residents similarly at risk? A study published earlier this year showed that compared to the general population, medical students were at higher risk for developing depressive symptoms, and residents/fellows were more

likely to suffer from burnout than their age-related peers.8 Physi-cians who were in practice fewer than five years were less likely to suffer from fatigue, but still had higher rates of burnout.

So here we are in the fall of 2014. The ACO, EHR, PQRS and EVD/PPE discussions have seemed to take over the healthcare universe. Department of Health webinars get put on your schedule. A new CDC memo seems to be coming out every few days, changing ear-lier guidelines and recommenda-tions. Does this kind of stuff keep you up at night? One of the sad-dest issues early on in the West African Ebola crisis was that the fear of the townspeople where the disease was spreading led to at-tacks on doctors and health clinics because of the belief that health-care workers were spreading the disease.9 Juxtaposed with this is-sue is the fact that less than three months later, nurses at Texas Health Presbyterian Hospital in Dallas threatened to go on strike10 out of concern that their hospital did not have the proper safety protective equipment.11 What would Rambo do if he had a medi-cal degree? The only thing to stay sane — form a Pentagon “strike team” to eliminate the problem.12

What is the antidote for physi-cian burnout, you ask?13 I have heard everything from surfing in a nor’easter to growing organic eggplant in Tuscany. But, alas, it ultimately gets back to the culture of the hospital and the physician practice. Promote the importance of clinician health, both physical and psychological. Having coun-seling availability for physicians in a non-threatening atmosphere

Failure Is Not an Option

Failure, cont. on page 13

As doctors we may believe we are

superhuman, but we are all too human. Recognize the early

signs of burnout, find someone to talk to, and ask for help if

you need it.


4

By Denise Condron, Director of Loss Prevention, CMIC Group

Patients remember and under-stand as little as 50% of what is explained to them by the pro-vider1. Patients with low levels of health literacy are especially likely to have difficulty understanding and remembering medical infor-mation. These types of patients may have difficulty reading labels on prescription bottles, interpret-ing blood glucose values or un-derstanding educational materials or preoperative instructions.

Ensuring understanding and the ability to recall information should be addressed with patients at every visit. The Ask-Tell-Ask method2 is an excellent tool for as-sessing a patient’s ability to under-stand and recall information.

1. Ask/Anticipate Questions – Answering assumed ques-tions is important when communicating with pa-tients. In a self-study course on Cultural Competency, available on the CMIC Group’s website (www.cmic.biz), we discuss the Ask Me 3 method, which promotes three simple questions:

a. What is my main prob-lem?

b. What do I need to do?

c. Why is it important for me to do this?

By developing a protocol to ask these questions, you will soon find them as rou-tine as conducting a review of systems. Another im-portant part of the “Ask” is assessment. What does the patient already know? Ask-

ing a question such as “What do you know about sleep ap-nea?” allows the patient to explain to you what he/she knows and lets you fill in the gaps as you see fit.

2. Tell/Explain the Concept – In simple language explain to the patient three key points. If you are giving the patient unexpected or bad news, give the patient a forewarning such as “I have some difficult news to share with you about the results of the lab tests.”

3. Ask/Close the Loop – Say to the patient, “I have giv-en you a lot of information that is difficult for anyone to remember. I know your ________ will have questions, can we review what you un-derstand about today’s visit to make sure we are on the same page?” Having the pa-

tient repeat back to you the key points of the office visit is essential to assessing the patient’s understanding.

The patient encounter should be an interactive process of sharing information. This means that the information and plan should be explained to and understood by the patient. You will need to tailor the process for each patient in order to be most effective. Re-membering that patients only re-tain half of all the information given to them during an encoun-ter, it is very important to practice the methods above in order to in-crease patient understanding and retention of information.

Further Reading:

1. Bertakis KD, The Communica-tion of information from physician to patient: A method for increas-ing patient safety and satisfaction. J Fam Practice. 1977;5:217-222.

2. Partnership for Clear Health Communication www.npfs.org. �

About CMIC Group

CMIC Group includes both CMIC and its sponsored company, CMIC Risk Reten-tion Group (CMIC RRG).

CMIC Group is a leader in developing innovative insurance programs, services and solutions for physicians, doctors, healthcare providers, hospitals and facili-ties dating back to the origins of CMIC in 1984. Our products and services are tai-lored to meet the unique needs and chal-lenges our insureds face each day. For more information, visit CMIC Group’s website at www.cmic.biz.

Patient Communication: Closing the Loop

Ensuring understanding and the ability to recall information should be addressed with

patients at every visit. The Ask-Tell-Ask

method is an excellent tool for assessing a patient’s ability to

understand and recall information.


5

Email, texts, social media postings can oftentimes be emotional and reactionary rather than deliberate

Email and social media have be-come very powerful communica-tion tools in modern-day society. I personally receive more than 100 work emails in a typical day, most of which are updates or questions from NHMS members, colleagues and listserves; some of the latter could be considered junk.

Lately I am receiving more and more angry, “sharp” and emotion-ally charged emails. These come from a variety of sources: NHMS members, public officials, profes-sional colleagues and may or may not be directed at NHMS or me.

This trend is a bit concerning and, in my mind, indicative of the larg-er issue in our culture – we are too quick in pressing the send button. Please don’t feel at this point that I am looking for sympathy. Not at all. I have pretty thick skin (and perhaps a few of you are saying, “Maybe if he/NHMS did a bet-ter job, he wouldn’t receive such emails!”). But I think it’s an im-

portant topic for all – for me, for you, for our children.

Several years ago, a movement occurred in an effort to improve quality for patients undergoing surgery – the Surgical Time Out. According to The Joint Commis-sion [“TJC”] this time out is part of the process developed for “…pre-venting wrong site, wrong proce-dure and wrong person surgery.”

TJC explains the elements of the surgical time out in certain detail and begins with “conduct a time-out immediately before starting the invasive procedure or making the incision.” I am sure your sur-gical colleagues live this protocol. I can’t speak to its efficacy – I’m sure there is a study somewhere on whether this time out has con-tributed to the desired prevention cited above, but bringing it back to communication, certainly lessons can be learned.

Earlier in my career, as a young manager, I was given advice by my mentor when managing a very dif-ficult customer service team for a health insurance claims processing company. The advice my mentor gave me was: Act on situations; don’t react to them.

Easier said than done at certain times, and I don’t wish to pretend that I have nailed her advice 100% of the time. In fact, there have been occasional emails and voice mail messages that if I had the op-portunity to do over again, I would likely handle them in a different manner.

… Act on situations;

don’t react to them.

When we communicate, taking a page from TJC’s time out process may serve us quite well. It doesn’t matter whether the communica-tion is personal or professional. What matters is that we take the time to pause before pressing send. My mother used to say to me: “Scott, engage your brain before you engage your mouth.” Goodness, she was right!

In closing, if I have ever offended you, I apologize. If you have ever offended me, no worries. Let’s all commit to the surgical time out in our communication.

Let me know what you think: 603.224.1909 or [email protected]. �

EVP CornerTaking the Time to Pause Before Pressing Send… a Lesson to be Learned from the Surgical Time Out

Scott G. Colby


6

If you are unable to work due to a sickness or injury, disability in-come insurance can help you meet expenses and maintain your stan-dard of living until you can return to work. It can help you pay bills such as your mortgage, tuition and car payments, and help cover expenses for food, clothing and utilities.

Short-term disability insurance can replace a portion of your in-come during the initial weeks of a disabling illness or accident. Long-term disability insurance can replace a portion of your in-come after those initial weeks, for an extended period. You may have one or both of these through your employer. Many people also choose to purchase individual dis-ability insurance.

No one knows what the future holds, so it’s important for you to do your best to prepare for what life may bring. Based on our expe-rience, we have created these eight simple tips to provide guidance and answers to common questions about disability insurance. Every-one’s circumstances are different, but these will help you get started and make the best decision based on your specific needs.

1) If you or others depend on your income, you should consider purchasing disabil-ity insurance.

Many people may be sur-prised to learn that Social Security disability benefits are not available if you are expected to be out of work for less than a year. One year without income could deplete your savings and have a significant impact on your finances.

2) Disability insurance replaces a portion of your income when you can’t work.

If you were unable to work due to illness or injury, dis-ability insurance can help pay your most essential ex-penses.

3) Most long-term absences are due to illness, not accidents.

Only 10% of long-term dis-abilities are due to injury.i

4) You may need disability insurance even if you are young and healthy.

Almost 1 in 4 of today’s 20-year-olds may become disabled before reaching age 67.ii It may be easier and less expensive to get dis-ability insurance when you are young and healthy.

5) The risk of a disability dur-ing your working years may be greater than you think.

The average 20-year-old is twice as likely to become dis-abled as to pass away before age 67.iii Disability insurance helps you maintain a steady stream of income when you can’t work due to illness or injury.

6) A good rule of thumb is to protect 60%-80% of your after-tax income.

Approximately 72% of con-sumer expenditures are to cover essentials such as housing, food, transporta-tion, health care and educa-tion.iv

7) Some disability insurance is better than no disability in-surance.

When budgets are especially tight, it still may make sense to purchase sufficient dis-ability insurance to keep your family in their home should you become disabled.

8) Make sure you know how much disability insurance you get at work.

Look carefully at the cover-age, as group benefits alone may not be enough due to the amount of income being replaced, potential benefits limitations and types of in-come covered.

Many people recognize the need for disability insurance but don’t move forward because they don’t feel they have a reliable place to start. Your financial advisor can provide you with the information and knowledge you need to make an informed decision.

To discuss this topic or any other financial matter, please contact Rob Burns or Troy Zerveskes at 603-394-7880, Ext. 202, or [email protected]. �

______________________________i 2011 Long-Term Disability Claims Re-view, Council for Disability Awareness.ii Social Security Fact Sheet, April 2012.iii Social Security Fact Sheet, April 2012.iiv Consumer Expenditures (U.S. Depart-ment of Labor Statistics, October 2010).

Securities and investment advisory ser-vices offered through New England Securities (NES) (member FINRA/SIPC), a registered investment advi-sor. Baystate Financial is not affiliated with NES. Branch Office: 200 Claren-don St., 19th Floor, Boston, MA 02116. L0513325114[exp0715][All States][DC}

Disability Income Insurance


7

2015 NHMS Council President Lukas R. Kolm, MD

President-Elect John R. Butterly, MD

Immediate Past President Stuart J. Glassman, MD

Penultimate Past President P. Travis Harker, MD, MPH

Vice President Deborah A. Harrigan, MD

Secretary Seddon R. Savage, MD

Treasurer Paul F. Racicot, MD

Speaker Richard P. Lafleur, MD

Vice Speaker Tessa J. Lafortune-Greenberg, MD

AMA Delegate William J. Kassler, MD, MPH

AMA Alternate Delegate Cynthia S. Cooper, MD

Chair, Board of Trustees David C. Charlesworth, MD

Medical Student Vivienne Meljen

Physician Assistant Mark H. Rescino, PA-C

N.H. Osteopathic Assn. Rep. Robert G. Soucy, Jr., DO

Young Physician Rep. Vladimir Sinkov, MD

Young Physician Rep. Jeffrey C. Fetter, MD

Member-at-large Tina C. Foster, MD

Member-at-large Gregg Kaup, MD

Member-at-large John L. Klunk, MD

Member-at-large Edmund Schiavoni, Jr., MD

Member-at-large Anthony V. Mollano, MD

Physician Member of N.H. Board of Medicine Nicholas Perencevich, MD Sarah Blodgett, Esq.

Lay Person Martin Honigberg, Esq.

Physician Rep. of the N.H. Dept. Health Human Services Jose T. Montero, MD

Specialty Society Reps.:

· N.H. ACOG Oglesby H. Young, III, MD

· N.H. Academy of Family Physicians Gary A. Sobelson, MD

· N.H. Chapter of the American College of Physicians Richard P. Lafleur, MD

· N.H. Chapter of the American College of Cardiology Daniel Philbin, MD

· N.H. Chapter of Emergency Physicians Michelle S. Nathan, MD

· N.H. Orthopaedic Society Robert J. Heaps, MD

· N.H. Pediatric Society Tessa J. Lafortune-Greenberg, MD

· N.H. Psychiatric Society Leonard Korn, MD

· N.H. Society of Anesthesiologists Steven J. Hattamer, MD

· N.H. Society of Eye Physicians & Surgeons Sonalee M. Desai-Bartoli, MD

· N.H. Society of Pathologists Jeoffry B. Brennick, MD

Trustee David C. Charlesworth, MD

Trustee Charles M. Blitzer, MD

Trustee Cynthia S. Cooper, MD

Invited Guest: MGMA Rep. Dave Hutton

The New Hampshire

Medical Society Corporate Affiliates

Anthem BCBSAutoFairBaystate FinancialBridge & Byron Printers/Speedy

Printing & CopyingCGI Business SolutionsCMIC RRGCoverysCrown Healthcare Apparel ServiceFoundry Financial Group, Inc. Freedom Energy Logistics, LLCGeneral Linen Service Co., Inc.HUB Healthcare SolutionsI.C. SystemKilbride & Harris Insurance Ser-

vices, LLCMedical Mutual Insurance Com-

pany of MaineMinuteman Health, Inc.New Hampshire Medical Society

Insurance Services, L.L.C.Northeast Delta DentalNortheast Health Care Quality

FoundationProAssuranceRath, Young and PignatelliSage Payment SolutionsShaheen & Gordon, PASoftware AdviceSulloway & Hollis, P.L.L.C.Sunovion Pharmaceuticals, Inc.

NHMS CAP is a paid membership program whose members meet criteria as posted at www.nhms.org


8

By David E. Strang, MDChairman, N.H. PDMP Advisory Council

As of Oct. 16, the N.H. Prescrip-tion Drug Monitoring Program (PDMP) is operational at the N.H. Board of Pharmacy. If the Board of Medicine has your email ad-dress, you should have received two emails informing you of your user name and temporary pass-word and asking you to go to the PDMP website to log in and es-tablish a permanent password. If you haven’t received these, please email the PDMP program manager ([email protected]) for information on how to register. Registration with the N.H. PDMP is mandatory for li-censed providers with a DEA number and dispensers/pharma-cists. You will not be able to re-

new your N.H. practitioner’s license if you have not registered. Although usage is not manda-tory, it is highly encour-aged for the benefit of your patients and to reduce the rate of duplicate controlled substance prescriptions in N.H.

Health Information Designs, LLC (HID) is the vendor that is coor-dinating the prescription data from N.H.’s pharmacies in order to make the PDMP work. It is also the vendor being used by our neighboring states of Vermont and Maine. If you have any prob-lems with accessing the PDMP website (http://newhampshirepd-mp.com), please call the HID help desk at 1.855.353.9903.

Prescription drug abuse and di-version are enormous problems in

our state and are closely linked to the current epidemic of heroin abuse and its associated overdose deaths. The PDMP will go a long way to assist our state’s provid-ers and dispensers in recognizing those patients with the problem of addiction. If you encounter any other problems with this pro-gram or have suggestions, please contact Michelle Ricco Jonas at 603.271.6980. �

Have You Registered for the N.H. Prescription Drug Monitoring Program?

Physician Receives Tom Fox Award for Excellence

Dr. Seddon Savage was recently awarded New Futures’ Tom Fox Award for Excellence, which recognizes more than a decade of sustained leadership and significant service to the field of alcohol and drug addiction, using best practices as an effective strategy, commitment to advocacy on alcohol and drug policy issues, and a willingness to take strategic, calculated risks to reduce the problems of addiction. Pictured, from left, are New Futures Executive Director Linda Saunders Paquette, Savage and New Futures Advocacy Director Tricia Lucas.


9

rent estimates suggest that one-third of the calories consumed by Americans and more than 40% of U.S. food expenditures occur out-side the home, primarily in res-taurants, fast-food establishments and as take-out meals. Not sur-prisingly, food available outside the home tends to be less heart healthy with higher caloric den-sity and having excessive amounts of salt, sugar and saturated fats.

In 2011, Cheshire County HEAL (an early affiliate of HEAL N.H.) developed Turn a New Leaf (TANL) – New Hampshire’s first county-wide healthy dining initia-tive. The program was developed to support the region’s Healthy Monadnock 2020 (formerly Vi-sion 2020) effort to become the nation’s healthiest community by 2020. TANL addresses both calo-rie counts and nutritional value by helping consumers identify healthier options through simple, logo-based menu labeling. TANL was initially launched with four Keene-area restaurants with sup-port from the Keene State Col-lege Dietetic Internship Program (KSC DI). Cheshire Medical Center/Dartmouth Hitchcock-Keene (CMC/DHK) was the first healthcare institution to pilot the program in its Center Court Cafe. Since then, other New Hampshire healthcare institutions, including Dartmouth Hitchcock-Lebanon, Dartmouth Hitchcock-Nashua and Littleton Regional Health-care, have joined the program while other communities in and outside the state are also looking at this model to provide guidance to their hospitals, worksite caf-eterias and dining establishments interested in providing healthier food choices.

Specifically, TANL uses a red heart and green leaf logo to aid consumers in identifying healthy menu options when dining away from home. It’s simple – one heart is healthy, two hearts are healthier and three hearts signify the health-iest selections. TANL is based on a nutrition science-supported ef-fort to promote whole grain, fruit, vegetable and bean consumption while limiting sodium, saturated fat, overall calories and eliminate trans-fat intake. In collaboration with the KSC DI program, the TANL initiative assesses recipes

and makes suggestions for feasible alterations that improve the health of the item, while maintaining its taste and appeal. The program also provides technical assistance and resources to the eating estab-lishments for environmental strat-egies such as point-of-sale pur-chases, pricing strategies and the substitution of similar yet healthier food options that support making the healthy choice the easy choice.

TANL is now implemented in more than 17 dining venues and has been particularly popular in healthcare cafeterias. The Medi-cine and Public Health Task Force believes the TANL program is a promising idea that should spread throughout New Hampshire and that medical professionals could accelerate the program’s growth. For more information about how your healthcare facility and/or community might implement the TANL program, please con-tact Maryanne Keating, Cheshire County HEAL coordinator, at [email protected] or 603-354-5454, Ext. 2369. �

Million Hearts, cont. from page 1

Wishing you a safe and happy holiday season from the

New Hampshire Medical Society.


10

stable living situation, many prac-titioners question whether care can be provided without parental consent, and those questions are frequently not resolved in the mi-nor’s favor.

There are specific laws relating to the treatment of emancipated minors and laws concerning treat-ment for substance abuse (12 or older), STDs (14 or older), abor-tion, contraception and emergen-cies, but New Hampshire does not have an explicit rule concerning an unemancipated minor’s abil-ity to provide consent for general medical care.

However, there is a “mature mi-nor” standard that has been recog-nized in several contexts. N.H.’s Supreme Court decided in In re: Berg that a minor determined to be of sufficient maturity or “sound mind” could be capable of assert-ing a therapist-client privilege. Many N.H. statutes, such as the statute on treating minors for drug dependency, implicitly recognize that minors of sufficient maturity may consent to medical care.

A number of professional organi-zations have endorsed the “mature minor” concept in the context of treatment decisions, including the American Congress of Obstetri-cians and Gynecologists (ACOG) and American Medical Associa-tion (AMA). AMA Code of Medi-cal Ethics Opinion 5.055 indicates that physicians have an ethical duty to promote the autonomy of minor patients by involving them in the medical decision-making process to a degree commensu-rate with their abilities. When mi-nors request confidential servic-es, physicians should encourage patients to involve their parents, but should permit competent mi-nors to consent to medical care on

their own if the law does not re-quire otherwise.

The critical inquiry in determin-ing whether treatment without parental consent is appropriate is whether the minor is sufficient-ly mature to provide informed consent. N.H. law describes this as “sufficient maturity to under-stand the nature of such treat-ment and the consequences thereof.” In making this deter-mination, one may consider the following factors: (1) the child’s age, intelligence and maturity; (2) the intensity with which the child advances his or her preference; and (3) whether the preference is based on undesirable or improper influences. Some authorities also advocate for consideration of the minor’s prior experience with ill-ness, gravity of the illness and the risks of the therapy.

Generally, there is no specific “cut-off” age concerning matu-rity determinations, but an AMA report indicates that adolescents 14 and older are generally con-sidered mature enough to make informed decisions about their medical care. Nevertheless, com-petence should be evaluated on a case-by-case basis.

As always, documentation is im-portant. Issues related to a mi-nor’s informed consent should be documented, including the assess-ment of maturity level and specific factors that led to the determina-tion. One must keep in mind the potential impacts of non-parental consent on third-party payor is-sues and other potential legal pit-falls, such as shared custody ar-rangements and issues relating to disclosure of protected health information to guardians. Tak-ing the time to perform an assess-ment of sufficient maturity can help increase access to health care for this vulnerable population.

This information is not intended as legal advice or a guarantee re-garding the outcome of any partic-ular matter. It is a broad overview and does not include every aspect of the applicable law. A formal legal opinion should be sought re-garding any specific case. �

“Mature Minor”, cont. from page 1

It is estimated that more than

1,000 teens live in New Hampshire without a stable, permanent home.

The real number is likely much higher.

In Memoriam – The Silent Chapter

Alfred Bertagnoll, MD Goffstown

Carolyn Dixon, MD Greenland

Amir Khazei, MD Bedford

Claire Lonergan, DO Hopkinton

Robert Marchant, MD Stratham

James Pilliod, MD Belmont

Raymond Sobel, MD Lebanon

Joseph Wiegman, MD Auburn, Maine


11

N.H. RSA 263:6-d Reporting Medically Unfit Person; Im-munity. Any licensed health care provider who reasonably and in good faith believes a person cannot safely oper-ate a motor vehicle based on clinical evaluation appropri-ate to his or her practice and who reports such to the divi-sion of motor vehicles shall be immune from any civil or criminal liability that might otherwise result from making the report. All reports made and medical records reviewed and maintained by the divi-sion of motor vehicles pursu-ant to this section shall be con-sidered motor vehicle records under RSA 260:14.

Mandatory Registration of Med Techs

In response to the unfortunate in-cident of the drug-addicted medi-cal technician in Exeter, a new law was passed to require registra-tion for this otherwise unlicensed group of healthcare workers. Healthcare workers who are cur-rently practicing as medical tech-nicians as defined below, must apply for registration by January 1, 2015 (90 days after the law’s ef-fective date of October 1, 2014).

N.H. RSA 328-I:1 V. “Medical establishment” means a setting where health care services are provided to patients, includ-ing, but not limited to, the of-fice of a physician, dentist, na-turopath, advanced practice registered nurse, optometrist, podiatrist, or a clinic, labora-tory, or place not licensed un-der RSA 151.

VI. “Medical technician” means a health care worker

who is not licensed or regis-tered by a New Hampshire regulatory board and who assists licensed health care professionals in the diag-nosis, treatment, and pre-vention of disease. For the purposes of this chapter, medical technicians shall be limited to health care work-ers with access to controlled substances and with access to or contact with patients in a health care facility or in a medical establishment.

PAs to Authorize Handi-capped PlatesAs of August 10, 2014, physician assistants in your office have the authority under N.H. RSA 94:1, to certify eligible patients for walking disability license plates.

Health Decision Surrogates

For incapacitated patients without an advance directive, the law, as of January 1, 2015, allows certain adults to act as a health surrogate. Physicians are encouraged to seek guidance from the healthcare fa-cility on the process of identifying the surrogate.

N.H. RSA 137-J:2, XXII-a. “Surrogate decision-maker” or “surrogate” means an adult individual who has health care decision-making capacity, is available upon reasonable in-quiry, is willing to make health care decisions on behalf of a patient who lacks health care decision-making capacity, and is identified by the attend-ing physician or APRN in ac-cordance with the provisions of this chapter as the person who is to make those decisions in accordance with the provi-sions of this chapter.

Emergency Prescriptions

The new law allows a pharmacy to dispense a onetime emergency supply of a prescribed medication in certain circumstances, begin-ning January 1, 2015.

N.H. RSA 420-J:7-b, IX.(a) Every health benefit plan that provides prescription drug benefits shall allow its covered persons to obtain an emer-gency prescription for up to a 72-hour supply of covered prescription drugs on the cov-ered person’s health benefit plan formulary in the event a prescription requires prior authorization by an insur-ance carrier and the prior au-thorization has neither been approved nor denied and a pharmacist has determined the medication is essential as provided in RSA 318:47-i. �

New State Laws, cont. from page 1

Headquarters: Concord NHOffices in: Gorham NH and Portland ME

603.224.2341 | www.sulloway.com

Trusted Advisors for Changing Times

Thousands of families have put the creationof their trusts and the management of their

estates in our hands.


12

Pictured, from left, are Dr. Burt Dibble, MD, past president of NHMS, Sen. Nancy Stiles, and Steve Ahnen, NHHA president.

Senator Nancy Stiles was honored for her work on the N.H. Health Protection Program.

NHMS Welcomes New MembersMatthew V. Buck, MDCaleb R. Campbell, MDRobert A. Catania, MDStacey T. ChuMichael A. ConnerneyJan L. Cook, MDStefanie L. Diamond, PA-CLiliane R. ErnstAdam B. Fleit, MDAndrew P. HuangAnthony Ippolito, DOSamuel W. Joffe, MDJames H. Kelly, MDMichelle A. McPhersonNu R. NaAurora A. RobledoVanessa SoetantoRebecca I. SternMark D. Walrod, MD


13

may help address problems before they become unmanageable. The New Hampshire Professionals Health Program14 may be of val-ue for these types of discussions. Executive coaching opportunities, leadership retreats and colleague exchanges about a career in medi-cine can also be helpful. Abbre-viated mindfulness training?15 If

it helps me become a Jedi Master faster, I am all for it.

Are superheroes allowed to quit?16 Could you blame them for wanting to take a break from fighting the bad guys and take a mental health day? What if Atlas had shrugged, as Ayn Rand once theorized? As doctors we may be-

lieve we are superhuman, but we are all too human. Recognize the early signs of burnout, find some-one to talk to, and ask for help if you need it. Don’t let the batteries run down.17 �

Regards,

Stuart J. Glassman, MD

Failure, cont. from page 3

1 http://online.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-14093253612 http://jama.jamanetwork.com/article.aspx?articleid=11618493 http://www.psychologytoday.com/blog/high-octane-women/201311/the-tell-tale-signs-burnout-do-you-have-them4 http://archinte.jamanetwork.com/article.aspx?articleid=13513515 http://www.uofmhealth.org/news/archive/201211/job-stress-and-mental-health-problems-contribute-higher6 http://time.com/3004782/burnout-in-the-hospital-why-doctors-are-set-up-for-stress/7 http://well.blogs.nytimes.com/2012/08/23/the-widespread-problem-of-doctor-burnout/8 http://journals.lww.com/academicmedicine/Citation/2014/03000/Burnout_Among_U_S__Medical_Students,_Residents,.25.aspx9 http://www.nytimes.com/2014/07/28/world/africa/ebola-epidemic-west-africa-guinea.html?_r=010http://www.huffingtonpost.com/2014/10/14/ebola-nurses_n_5986468.html11 http://www.cnn.com/2014/10/20/health/ebola-outbreak-roundup/index.html12 http://wgntv.com/2014/10/19/pentagon-preps-ebola-strike-team-including-5-doctors-20-nurses/13 http://www.medscape.com/viewarticle/78251414 http://www.nhphp.org/15 http://www.ncbi.nlm.nih.gov/pubmed/2401927216 http://www.comicvine.com/articles/off-my-mind-should-superheroes-ever-quit/1100-144613/17 http://www.youtube.com/watch?v=OZuUwcl_wT8

Deadline

GPRO

Deadline

MOC

Deadline

Bridges toExcellence

Deadline

MU2Registry

PENALTY

TurboTax® is a registered trademark of Intuit, Inc.

ARE YOU READY?

nhms.pqrswizard.com 1-877-509-7774“ It’s like TurboTax for PQRS! ”


14

NHMS Annual Scientific Conference 2014

Thank You to Our Sponsors and

Exhibitors!

Baystate Financial

Boehringer Ingelheim

Bristol Meyers Squibb

CGI

CMIC RRG

CAN

Crown Healthcare Apparel Service

Janssen Pharmaceuticals

Medical Mutual Insurance Company of Maine

MHM Services

Minuteman Health, Inc.

N.H. Disability and Public Health Project (UNH)

NHMS Insurance Services, LLC

Nixon Peabody

Northeast Delta Dental

RBC Wealth Management

Sage Payment Solutions

Sulloway and Hollis, PLLC

Sunovion Pharmaceuticals, Inc.

Wentworth Douglass Hospital

Raffle Winners from the NHMS Annual Scientific Conference

Celtics/Pacers Tickets from Baystate Financial:

Melvin Prostkoff, MD

Richard Osborne, MD

Roberto Arquiza

Richard Lafleur, MD

Karl D’Silva, MD

Hilary Alvarez, MD and Alex Streeter

Last Man Standing (Saturday):

Richard Lafleur, MD

Last Man Standing (Sunday):

Richard Nelson, MD

Bingo card raffle:

Rieta Silang, MD ($100 gift card)

John Robinson, MD ($100 gift card – donated by CGI)

Ben Dewey (overnight stay at Mill Falls)

View of Lake Winnepesaukee

Dr. Albee Budnitz, left, and Nu Na

Dr. Richard and Pamela LafleurBen Dewey, left, and Luca Valle


15

Providing Protection and Support in a Complex Healthcare Environment For 30 years, our insureds have relied on us to develop innovative insurance programs and services for doctors, physicians, healthcare professionals, hospitals and facilities.

Our solutions are tailored to meet the unique needs and challenges you face each day.

Partner with an insurance provider that you can trust.

Learn more at www.cmic.biz or by calling: 800.228.0287.

We’re in this together.


16

NHMS works with CGI Business Solutions for your health, life and disability insurance needs.

CGI Business Solutions (CGI) is one of the region’s fastest growing, most innovative benefit brokerage and consulting firms. In addition to its dedication to customer service, CGI offers its clients a unique blend of planning and implementation services that will allow the NHMS to effectively deal with Healthcare Reform and the extremely challenging and changing benefits marketplace. Whether needs involve benefit design, compliance, or administration solutions, CGI has the resources to help NHMS and its members prepare for a quickly evolving marketplace.

CGI is proud to have been named the exclusive broker for the NHMS insurance products. Please contact our NHMS Dedicated Service Team at:

Contact: NHMS Dedicated Service TeamCGI Business Solutions171 Londonderry TurnpikeHooksett, NH 03106

Telephone: 888-383-0058 Facsimile: 603-232-9330 Email: [email protected]: www.cgibenefitsgroup.com/nh-medical-society

Dedicated

Business SolutionsBusiness Simplified


17

powered by Willis

What? Offering you the best products at the best prices with unsurpassed expertise and understanding

Why? In order to further public health initiatives for the benefit of New Hampshire’s citizens

Medical Professional Liability Commercial Property Hospital Professional Liability Directors & Officers Liability Facility Professional Liability Commercial Crime General Liability Fiduciary Workers Compensation Employment Practices Auto Liability and Physical Damage Kidnap & Ransom Umbrella Liability Personal Lines Regulatory Proceedings Coverage MCO E&O Coverage Network Security & Privacy Liability Environmental Liability Life Science Product & Prof. Liability Clinical Trial Liability Excess of Loss Reinsurance

P.O. Box 3772 Concord, NH 03302-3772

603.856.7558

www.nhmsinsurance.com


18

WOULDN’T YOU THINK THERE’D BE A SIMILAR SWING IN PREMIUM RATES OR DIVIDENDS?

THERE’S BEEN A DRASTIC REDUCTION IN MALPRACTICE CLAIMS OVER THE YEARS.

Medical Mutual NH Premium Relief from Rate and Dividend Actions

10

5

0

-5

-10

-15

-20

-25‘07 ‘08 ‘09 ‘10 ‘11 ‘12 ‘13 ‘14

Dividends

Rates

Medical Mutual has reduced rates in New Hampshire three times since 2008 and paid dividends in seven of the last eight years.

Not at most medical professional liability carriers in New Hampshire. But at Medical Mutual there has. In fact, Medical Mutual has lowered rates three times since 2008 and given money back to clients in the form of dividends in seven out of the past eight years. This year alone, the dividend and rate reduction together are providing premium relief of over 20%.

If your carrier hasn’t reduced rates or paid you dividends recently, it’s time to get a quote from Medical Mutual. For more information, or a list of authorized agents,

contact John Doyle, VP of Marketing and Corporate Communications at 800-942-2791, or via email at [email protected].


19

Treated Fairly

New Hampshire physicians now can choose medical professional liability insurance that over 60,000 physicians and healthcare entities rely on for fair treatment. Rated A+ (Superior) by A.M. Best, ProAssurance’s stability helps ensure the unparalleled defense and service that have been our hallmark for over 30 years.

With the uncertainty of today’s volatile healthcare environment, be sure you choose a strong partner whose resources can help you increase your control.

Go to ProAssurance.com to learn what our Treated Fairly pledge can mean for you. It’s about you and your profession. Take the first step today toward being treated fairly.

Professional Liability Insurance & Risk Management ServicesProAssurance Group is rated A+ (Superior) by A.M. Best. For individual company ratings, visit ProAssurance.com • 800.282.6242

7 North State Street Concord, NH 03301 603 224 1909603 226 2432 [email protected] www.nhms.org

ADDRESS SERVICE REQUESTED

Prsrt Std.U.S. Postage

PAIDConcord, NH

Permit No. 1584

Printed on recycled stock using soy-based inks.

There are more than 25,500 licensed commercial operators in N.H.

As of May 21, 2014, CMV drivers must have exams performed by a certified medical examiner listed on the National Registry.

Take the course at:

nhms.org/member-services/programs#CDLTraining

Physicians iMonthly ovemer/Decemer 14 NHMS Welcomes 183 … · 2015-06-18 · Physicians iMonthly...

Documents

Transcript of Physicians iMonthly ovemer/Decemer 14 NHMS Welcomes 183 … · 2015-06-18 · Physicians iMonthly...