Volume 8 • Issue 4 • Fall 2018 No Bones About It Critical Current Issues In This Issue: participate. I encourage all to • President’s Notes: try and make time to meet with Critical Current your fellow orthopedic surgeons from around the state. As a Issues reminder, the meeting will be • Your Practice Is April 26-28, 2019. About to Change... Also renewals for • 2019 Meeting: membership will go out in the Good Things next 60 days. We need your Coming President Stanley Tao, MD continued support to continue It is hard to believe the end our advocacy efforts at the • Disposing of of the year is approaching. The state and national levels. Please Unused year has gone quickly and my renew and support your state Prescriptions term is almost half way over! Orthopedic Society. For those • Endorsements I would like to report that who already have, thanks so Announced for the fall Orthopedic Society much! Nov. 6 Election meeting at The Greenbrier As many of you are aware, went very well. We were able election time is almost upon • 2018 Physicians to meet with and present us. I have taken the liberty of Foundation Survey issues to both Congressman presenting some information • WVOS Ortho Evan Jenkins and Senator Joe from Joe Prudhomme and Evidence Usage Manchin. We are running WESPAC on candidates • 7 Things to Know very well fiscally with Diane’s who would be beneficial for About Ortho EMR help and we had very good physicians in their respective feedback from the members positions. Please see the who attended the 2018 Spring information on page 5. Break Meeting at Stonewall I would like to comment Resort. We hope to take these on physician depression recommendations, and those and burnout. According to of this summer’s survey, to Medscape’s Physician Lifestyle make next year’s meeting & Happiness Report 2018, better than ever. As with most 32% of orthopedic surgeons meetings, the success of and rated themselves as very or benefits come from those who Issues More on page 10 1 By AAOS Councilor Joe Prud’homme, MD Your Practice Is About to Change...
And it’s about to change for first two of the open Supreme the worse! Court seats. It’s happening on West Virginia is on the cusp November 6. of something unsettling. It Do you want a seat at the is not a good thing.The West decision-making table? If Virginia Legislature has voted you are not at the table, then to impeach all five Justices of you are on the menu.Call me the Supreme Court of Appeals, at 304.282.9211 or email me The election for while the fifth resigned. Two at [email protected]. are facing criminal charges. All edu. I can teach you how to five justices may be replaced easily get involved and make a Supreme Court at the same time. Why should difference. Alternatively, send you care? a contribution to WESPAC and could decide If three of those new it will be put to good use to justices are plaintiff-oriented, or protect you. lean that way, they can quickly Editor’s update: Since your undo all of the hard-earned tort this was written on August reforms that make West Virginia 24, Justices Ketchum and a reasonable place to practice. Davis have resigned. Justice professional They will reverse the caps Ketchum has pleaded guilty to on liability suits. Currently, the charges and Justice Loughry future; maximum judgement in West has been indicted on 25 counts Virginia is limited to $750,000 in federal court, three of which for all damages (adjusted for have been dropped. Justice you MUST get inflation since 2004). Walker withstood the first The effects of no caps are impeachment trial and was involved! troubling. Michigan just has a censured. Governor Justice judgement involving one doctor appointed House Speaker Tim and one patient. It was an Armstead to fill the Ketchum orthopaedic surgeon performing vacancy, and Congressman a scoliosis surgery. The patient Evan Jenkins to fill the Davis was paralyzed by the operation. vacancy. Both must run for The amount awarded? $145 election on November 6. million! Your insurance can earily double or triple overnight. You could be sued potentially three to five times per year, instead of once every 10-15 years, based on experience of locales with no caps compared with the current situation. You must care about this; your future depends on it. You need to participate in the current special election for the 2 By CME Chairman Jack Steel, MD 2019 Meeting: Good Things Coming
Mark your calendars for the April 26-28, 2019, for the WVOS Annual Spring Break Meeting at Stonewall Jackson Resort. The WVU and Morgantown contingent will be in charge of the meeting content this year, with assistance from panhandle Theme: practitioners, and it will be enlightening. “The Future of Orthopaedics The Future of in a Changing Profession” will arthroplasty; and the role of be our theme and possible clinician scientists in academic Orthopaedics in talks include: system growth medicine. If you have topic or and development; employment speaker suggestions, please models – is private practice contact Dr. Sandy Emery. a Changing dying; physician-owned We have moved to a entities; myths and realities Saturday and Sunday format in Profession of the millennial generation; an effort to improve attendance what is preop-optimization and and facilitate recreation for is it relevant for us; payment families, as well as golfers. We reform- are bundled payments will keep you updated as the really the future; use of schedule develops. APP’s in your practice; is your As we’ve done for the past practice social media savvy; few years, we will be having a stem cells and PRP – hype or fundraiser for the Orthopaedic science; is 3-D printing a useful Research and Education technology or a fad; robotic Foundation (OREF) that, surgery – marketing tool vs according to this summer’s true advancement; grading survey, may be a contribution of physicians and outcomes; option. telemedicine; an opioid talk; infection control in joint
3 By WVOS/WVAOE Executive Director Diane Slaughter, CAE, APR, Fellow PRSA Disposing of Unused Prescriptions
Many people don’t know have this information on our how to dispose of unused web site and you can download medications, whether they the card shown below and just forget about an unfinished substitute your practice logo prescription, or whether they and address for the WV are cleaning out medications Orthopaedic Society information for a family member who currently shown. These can be must leave the home. Proper printed on Avery or other brand WVOS wants to disposal can avoid problems business cards that contain 10 with people using medications cards per page. not prescribed to them or the For patients, we have help you help theft of unfinished medications information on the card and by family, friends or strangers. on the web site that lets As members of the WV people know how to safely your patients Orthopaedic Society or the dispose of unused prescription WV Association of Orthopaedic medications. There are and their Executives, you know how options for home disposal or opioids and other pain pharmacy and law enforcement medications can impact your locations that accept unused families deal patients and their families. In medications. an effort to help you help your We have addresses for with unused patients and their families, we Walgreen’s pharmacies in have made some additions Charles Town, Charleston, to our web site. We have Martinsburg and Morgantown. prescriptions. added an “opioids” tab to the We are adding more chains navigation bar that has drop- and locations as they become down links to information for available. physicians and for patients. We have names, addresses As part of our effort to and hours of acceptance for address the opioid issue, we ten law enforcement agencies are making available to you across the state, in addition to information that you can share a link to the DEA program. with your patients at the time For just pennies a patient, prescriptions are written. We you can be part of the solution!
4 By WESPAC Chairman Joe Prud’homme, MD Endorsements Announced for Nov.
WESPAC is a voluntary, physician community into bi-partisan, unincorporated a powerful voice for quality organization composed of healthcare in West Virginia. physicians, residents medical They seek to preserve the vital students and their spouses relationship between you and and is a separate segregated your patients by educating fund established by the our legislators about issues West Virginia State Medical important to our members. Association (WVSMA). They WESPAC Chairman and Please study the work throughout the year with WVOS’ AAOS Councilor elected officials to make sure Joe Prud’homme, MD, has they understand the many announced the organization’s candidates and facets of our healthcare system. endorsements for the Nov. 6 Their goal is to organize the election: VOTE on Nov. 6! Supreme Court of Appeals District Recommendation Division Recommendation 24 Ralph Rodigherio 2 Evan Jenkins 27 Joe Ellington WV Senate 27 John Shott District Recommendation 30 Mick Bates 2 Charlie Clements 31 Rick Snuffer 4 Eric Tarr 32 Kayla Kessinger 7 Ron Stollings, MD 33 Roger Hanshaw 8 Ed Gaunch 35 Moore Capito 10 Stephen Baldwin 35 Charlotte Lane 11 Bill Hamilton 35 Eric Nelson 13 Mike Oliverio 42 Cindy Lavendar-Bowe 15 Charlie Trump 43 Bill Hartman 17 Tom Takubo, MD 48 Terry Waxman WV House of Delegates 48 Ben Queen District Recommendation 49 Amy Summers 1 Mark Zatezalo 51 Joe Statler 5 Dave Pethtel 52 Debbie Warner 6 Dave Kelly 58 Daryl Cowles 8 Bill Anderson 64 Eric Householder 10 Frank Deem 66 Paul Espinosa 11 Rick Atkinson 67 Riley Moore 12 Steve Westfall 13 Scott Cadle 14 Jim Butler 16 Matt Spurlock 17 Matt Rorhbach 18 Karen Nance 23 Rodney Miller 5 By Merritt Hawkins on behalf of The Physicians Foundation 2018 Physicians Foundation Survey
The 2018 Survey of do not consistently adhere America’s Physicians reveals to their treatment plans. an evolving medical profession • 26% of physicians favor a that continues to struggle with single payer health system, issues of burnout and low 35.5% favor single payer morale. Key findings include: with a private insurance • Only 31% of physicians option and 27% favor a identify as independent market-driven system. Key findings: practice owners/partners, • 22% of physicians do not down from 33% in 2016 and see Medicare patients or down from 48.5% in 2012. limit the number they see. Fewer indeen- • Physicians are working • 32% of physicians do not fewer hours and are seeing see Medicaid patients or dent physicians, fewer patients. limit the number they see. • Employed physicians work • 47% of physicians have more hours yet see fewer their compensation tied fewer drug patients than practice to quality/value, but only owners. 18% believe quality/value prescriptions, • 80% of physicians are payments will improve care at full capacity or are or reduce costs. overextended. • 49% would not recommend more quality • 62% are pessimistic about medicine as a career to their the future of medicine. children payments, • 69% are prescribing fewer • 88% of physicians indicate pain medications in light of that some, many or all the opioid crisis. of their patients have a telemedicine, • 55% describe their morale social situation (poverty, as somewhat or very unemployment, etc.) that the impact of negative, consistent with poses a serious impediment findings in previous years. to their health. Only 1% • 78% sometimes, often or of physicians indicate that poverty and always experience feelings none of their patients have of burnout. such a situation. struggles with • 23% of physician time • 46% of physicians indicate is spent on non-clinical relations between physicians paperwork. and hospitals are somewhat burnout and • 46% plan to change career or mostly negative. paths. • Physicians indicate morale. • 17% plan to retire (up from patient relationships are 14% in 2016) while 12% their greatest source of plan to find a non-clinical professional satisfaction, job or position. while electronic health • 18.5% now practice some records (EHR) are their form of telemedicine. greatest source of • 31% of physicians’ patients professional dissatisfaction. 6 By OrthoEvidence Managing Editor Christopher Smith, MSc OrthoEvidence Usage by WVOS
OrthoEvidence proving to be a popular WVOS member benefit.
7 By Jason Weisstein, MD, MPH, FACS, Director of Orthopaedics at Modernizing Medicine 7 Things to Know for Ortho EMR
You did it! You decided on lead and a lead physician. a new orthopedic electronic Your implementation lead will health record (EHR) system serve as the main contact with for your practice. So what’s the EHR vendor and monitor next? Whether you are making progress. A lead physician the transition from paper will have intimate experience charting to an orthopedic with the clinical applications EHR system for the first of your new EHR and can “So what’s next time or switching between provide unique insight on exam systems, implementation workflow. takes time, planning and 2. Get to know your EHR after you a strong relationship with vendor’s implementation your EHR vendor. Based on and orthopedic training select your my experience as both an team. orthopedic surgeon and on- Implementing a new staff physician at Modernizing orthopedic EHR system requires orthopaedic Medicine, I compiled some a team effort and support tips to help ensure a smooth from both the vendor and software transition as you implement stakeholders in your practice. your new orthopedic EHR. During the implementation 1. Work with your EHR process, the EHR vendor’s system?” vendor to create an implementation team should implementation plan. help you every step of the way. Your EHR vendor will help They will provide a wealth of assess your workflow within knowledge and should be your your practice to understand go-to source for any questions how to use your new to be answered. orthopedic EHR effectively. At Modernizing Medicine They should help you identify each new practice works with the functionality and features a team of software educators important for your practice and client advisors during and provide users the needed the implementation process. education. Together you’ll After initial implementation, set a feasible timeline for each orthopedic practice is implementation tasks and set transitioned to a dedicated goals to monitor progress and client services team to provide measure success. ongoing support and education Identify implementation to ensure you get the most champions, which we like to call out of your new orthopedic “superusers,” within the practice software. that will provide support and 3. Invest in EHR training encouragement during the and education. process. Depending on your Take advantage of the practice size you may want to training opportunities the have both an implementation Seven Things Cont. on pg. 9 8 Seven Things Continued from page 8 patients without turning your back and facing a desktop vendor offers. People learn in computer. different ways and a virtual You’ll want to understand training format may prove more the technical aspects of your useful for some, while an onsite new orthopedic EHR system training and practice session too. Server-based EHR may work better for others. systems can require expensive You’ll want to account for additional storage devices and travel and time away from the IT maintenance. Cloud-based — practice and patients to fully or software as a service (SaaS) master your new EHR system. — EHRs require less onsite Investing upfront in training storage hardware, increase “Change can be and education for your practice mobility and accessibility and can pay off in the long run help decrease IT costs. with higher user satisfaction 5. Keep the lines of difficult, even and increased overall practice communication open. efficiency. Change can be difficult if it’s change in Cortney Hill, billing even if it’s a change in the right manager at Connecticut direction. Implementing a new Family Orthopedics, said, “We orthopedic EHR system doesn’t the right utilized the onsite training have to be scary, especially program Modernizing Medicine if it improves the clinical, direction.” provides and the transition was operational and financial seamless. We came prepared outcomes of your practice. By to learn, and the Modernizing fostering an environment of Medicine trainers were patient open dialogue and interaction, with us as we worked through you may be able to replace the learning curve together. uncertainty with optimism. Our providers were comfortable Regularly gather feedback with the system after the first from users to help address any training session because it’s challenges early on and identify that easy to use.” best practices to share with 4. Identify hardware colleagues. Share feedback with needs. the vendor’s implementation If you make the transition team to help uncover unmet from paper charts to an needs, identify training EHR, you’ll want to include opportunities or propose future an assessment of hardware product enhancements. to understand the necessary 6. Measure your EHR technological devices. Do you system success. need to purchase laptops, Throughout the desktops or more tablets? implementation process, Since EMA™ is a native iPad tracking goals is important to application, you’ll probably understand how well the new want to purchase more tablets. orthopedic EHR system works A mobile EHR can allow you to and can help identify areas freely move around the exam to improve. Some examples room and better engage with Seven Things Cont. on pg. 10 9 Seven Things were seeing 100 percent of our Continued from page 9 patients in EMA and we kept up of goals to help measure our usual pace.” the progress and success Another client, Patsy Smith, of your new EHR system the practice manager at South implementation may include: Palm Orthopedics noted, “The ● Less time spent implementation process went documenting exam notes smoothly, and the Modernizing ● Reduction in clicking and Medicine educators were typing during patient exams significant to our success, ● Reduction in documentation Initially, we lowered our patient errors schedule to accommodate the ● Fewer calls and faxes to labs small learning curve, but we “By working or physical therapy offices quickly ramped up to normal ● Reduction in manual volume one we got the hang of with a skilled processes for the office staff EMA.” ● Increase in patients seen in By working with a skilled a day implementation team, your implementation ● Increase in patient practice will hit the ground satisfaction scores running with your new team, your 7. Patience is a virtue. orthopedic EHR and you The amount of time needed may soon reap the clinical, to fully implement your new operational and financial practice will hit EHR will vary based on the size benefits of an even more of your practice, office workflow efficient practice. the ground and intuitive nature of the software. It is very beneficial Issues to have a superuser on site. Continued from page 1 running.” A user-friendly system and adaptive learning can equate to extremely happy at work, a shorter learning curve helping and 54% rated themselves your practice resume to full as very or extremely happy speed with minimal downtime. outside of work. Overall 30% Many of our orthopedic clients of physicians will acknowledge have experienced a smooth burnout. Traditionally implementation process. orthopedic surgeons are the Tara Salsman, office least likely of all specialties to manager at Illinois Valley seek professional treatment Community Hospital Medical for burnout, depression or Group, shared, “Our transition both. Emotional exhaustion to EMA went smoothly. We and depersonalization (two of participated in online and the three components of the onsite trainings provided by Maslach Burnout Inventory) Modernizing Medicine over a result from chronic mental ten-week period. We then did stress and emotional injury. a soft go live, seeing a couple The other is lack of personal of patients a day in EMA to achievement. Many of us familiarize ourselves with the deal with patients during very system. Within a few weeks, we Issues Continued on page 12 10 RESIDENT PAC PARTICIPATION what is the Ortho PAC? $3.5M
BENEFITS OF WHY WE NEED INVOLVEMENT RESIDENT INVOLVEMENT
WHY ADVOCACY IS IMPORTANT
HOW TO GET INVOVLED You can give MONEY: Text AAOS to 41444 You can give TIME: Email [email protected] for ways to get involved Or you can give BOTH!
11 Issues * Lobby against credentialing Continued from page 12 and licensing that requires reporting of private health trying times in their lives. It information for physicians. can be difficult to maintain our * Intervene. Be wiling to own mental and emotional have conversations, take health. Other factors can be next steps and assist a bullying, harassment and sleep colleague. deprivation. * Make it easier for your According to Medscape, colleagues to speak up the most frequent factors that and seek help earlier, as well contribute to burnout among as limit the repercussions to orthopedic surgeons are: their jobs or careers. There are 1. Too many bureaucratic tasks * Create organizational (58%) resources, set up links many current 2. Spending too many hours at or outsource assistance to work (34%) trusted people or groups. 3. Increasing computerization Lastly the next topic has non-medical of practice (29%) been hot in the media. It is also 4. Decreasing reimbursements pertinent to our profession. And issues of critical (25%) the topic is sexual harassment. 5. Lack of control/autonomy The #MeToo movement has (25%) gained forceful momentum as importance to 6. Insufficient compensation men in prominent positions in (22%) government, entertainment, our profession. 7. Government regulation and corporate industry were (20%) cslled upon to account for 8. Lack of respect from incidents of inappropriate administration , colleagues, behavior toward women. As staff (20%) a society, women continue 9. Lack of respect from to face barriers and threats patients (17%) to safety. In medicine, as in 10. Maintenance of certification other professions that long requirements (13%) were male-dominated, progress 11. Feeling like a cog in the toward fair and equal treatment wheel (13%) has been a slow but real 12. Emphasis on profits over process. In orthopedic surgery, patients (9%) women remain a decided How can we as orthopedic minority. Those of use who surgeons and as an work with female orthopedic organization address depression colleagues should always keep and burnout among ourselves this in mind. and our colleagues? Consider See you next year! doing one or more of the following: * Lessen the stigma. Encourage open discussion, participate in medical education and share stories.
12 I AM MODERNIZING ORTHOPEDICS
WITH A SMARTER EHR
It’s so advanced, it actually learns from you. Modernizing Medicine®’s all-in-one platform was designed by practicing orthopedists to streamline treatment and help improve workflow. From the moment you first log in, it begins learning how you practice, diagnose and treat patients, customizing itself to help give your practice greater efficiency.
So you can see more patients, while seeing more of your patients. It’s time to demand more from your EHR.
VIEW OUR 2-MINUTE DEMO MODMEDORTHO.COM TOGETHER, WE ARE MODERNIZING MEDICINE.
©2018 Modernizing Medicine, Inc.
For desktop and mobile devices 13 President Stanley Tao, MD Huntington, WV 304.525.6905 Vice President Felix Cheung, MD Huntington, WV Consider contributing to 304.691.1262 Secretary-Treasurer Shafic Sraj, MD Morgantown, WV Ortho PAC [email protected] Immediate Past President Brett Whitfield, MD Beckley, WV 304.253.1077 to help make your voice At-large Members Christopher Courtney, DO Bridgeport, WV 330.717.8094 Matthew Dietz, MD heard on issues of Morgantown, WV 304.285.7444 Charles (Ted) Shuff, MD Charleston, WV 304.344.3551 importance to Vivek Neginhal, MD Huntington, WV 304.525.6905 orthopaedic medicine and AAOS Councilor Joseph Prud’homme, MD Morgantown, WV 304.293.2779 your patients! Advocacy Chairman Joseph Prud’homme, MD Morgantown, WV 304.293.2779 Legislative Chairman Richard (Ret) Topping, MD Elkins, WV 304.637.4509 “No Bones About It” Membership Chairman Tony Majestro, MD is published four times a year by the Charleston, WV West Virginia Orthopaedic Society (WVOS). 304.343.4691 Stanley Tao, MD, President Program Chairman Jack Steel, MD Diane Slaughter CAE, APR, Executive Director Huntington, WV 304.525.6905 WVOS reserves the right to determine suitability of advertisements Ex Officio Members Sanford Emery, MD, MBA and content. Correspondence regarding subscriptions and changes of Morgantown, WV address should be sent to: 304.293.1170 Ali Oliashirazi, MD WVOS Huntington, WV PO Box 13604 304.697.7114 Charleston, WV 25360 Lunden Ryan, MD Morgantown, WV (304) 984-0308 304.293.1168 [email protected] • www.wvos.org Dana Lycans, MD Huntington, WV 304.631.1262 “No Bones About It” is a member service of the WVOS Executive Director and may not be reproduced without permission. Diane Slaughter, CAE, APR, Fellow PRSA PO Box 13604 WVOS © 2018. Charleston, WV 25360 304.345.7561 [email protected] 14